Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.
Soc Psychiatry Psychiatr Epidemiol. 2023 Apr;58(4):569-579. doi: 10.1007/s00127-023-02428-w. Epub 2023 Jan 30.
Psychosis disproportionally affects ethnic minority groups in high-income countries, yet evidence of disparities in outcomes following intensive early intervention service (EIS) for First Episode Psychosis (FEP) is less conclusive. We investigated 5-year clinical and social outcomes of young people with FEP from different racial groups following EIS care.
Data were analysed from the UK-wide NIHR SUPEREDEN study. The sample at baseline (n = 978) included White (n = 750), Black (n = 71), and Asian (n = 157) individuals, assessed during the 3 years of EIS, and up to 2 years post-discharge (n = 296; Black [n = 23]; Asian [n = 52] and White [n = 221]). Outcome trajectories were modelled for psychosis symptoms (positive, negative, and general), functioning, and depression, using linear mixed effect models (with random intercept and slopes), whilst controlling for social deprivation. Discharge service was also explored across racial groups, 2 years following EIS.
Variation in linear growth over time was accounted for by racial group status for psychosis symptoms-positive (95% CI [0.679, 1.235]), negative (95% CI [0.315, 0.783]), and general (95% CI [1.961, 3.428])-as well as for functioning (95% CI [11.212, 17.677]) and depressive symptoms (95% CI [0.261, 0.648]). Social deprivation contributed to this variance. Black individuals experienced greater levels of deprivation (p < 0.001, 95% CI [0.187, 0.624]). Finally, there was a greater likelihood for Asian (OR = 3.04; 95% CI [2.050, 4.498]) and Black individuals (OR = 2.47; 95% CI [1.354, 4.520]) to remain in secondary care by follow-up.
Findings suggest variations in long-term clinical and social outcomes following EIS across racial groups; social deprivation contributed to this variance. Black and Asian individuals appear to make less improvement in long-term recovery and are less likely to be discharged from mental health services. Replication is needed in large, complete data, to fully understand disparities and blind spots to care.
精神分裂症在高收入国家的少数民族群体中不成比例地高发，但针对首发精神分裂症（FEP）强化早期干预服务（EIS）后结果存在差异的证据尚不明确。我们研究了 EIS 治疗后不同种族的 FEP 年轻人的 5 年临床和社会结局。
本研究的数据来自英国范围内的 NIHR SUPEREDEN 研究。基线时（n=978）的样本包括白人（n=750）、黑人（n=71）和亚洲人（n=157），在 EIS 的 3 年内进行评估，并在出院后 2 年内（n=296；黑人[n=23]；亚洲人[n=52]和白人[n=221]）进行评估。使用线性混合效应模型（具有随机截距和斜率）对精神病症状（阳性、阴性和一般）、功能和抑郁的轨迹进行建模，同时控制社会剥夺因素。还探讨了 EIS 后 2 年不同种族的出院服务情况。
精神病症状阳性（95%CI[0.679,1.235]）、阴性（95%CI[0.315,0.783]）和一般（95%CI[1.961,3.428]）以及功能（95%CI[11.212,17.677]）和抑郁症状（95%CI[0.261,0.648]）的线性增长随时间的变化差异可由种族群体状况解释。社会剥夺也导致了这种差异。黑人经历了更高程度的剥夺（p<0.001，95%CI[0.187,0.624]）。最后，亚洲人（OR=3.04；95%CI[2.050,4.498]）和黑人（OR=2.47；95%CI[1.354,4.520]）更有可能在随访时留在二级护理。
研究结果表明，EIS 后不同种族群体的长期临床和社会结局存在差异；社会剥夺是这种差异的原因之一。黑人及亚洲人在长期康复方面的改善似乎更少，也更不可能从精神卫生服务中出院。需要在更大、更完整的数据中进行复制，以充分了解护理方面的差异和盲点。
