Centre for Implementation Science, Department of Health Service and Population Research, Institute for Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.
National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK.
BMC Public Health. 2024 Oct 5;24(1):2718. doi: 10.1186/s12889-024-20107-6.
COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI.
This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions.
We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically.
Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews.
These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.
COVID-19 精神健康和多重合并症中的族裔不平等（COVEIMM）是一项混合方法研究，旨在探索 COVID-19 是否加剧了有严重精神和身体健康状况的成年人中族裔健康不平等现象。我们分析了英格兰电子健康记录的数据，并在伯明翰和索利赫尔、曼彻斯特和伦敦南部进行了访谈。选择这些地点是因为它们是英格兰国民保健署推出的患者和护理人员种族平等框架的试点地点，旨在解决精神健康方面的种族不平等问题。大流行之前，英格兰患有严重精神疾病（SMI）的人预期寿命缩短了 11-17 年，这主要是由于可预防的长期身体疾病。在大流行期间，患有 SMI 的人的死亡人数明显增加。
本定性访谈研究旨在了解在 COVID-19 大流行期间，生活在英格兰的有严重多重长期精神和身体健康状况的黑人非洲、黑人加勒比、印度、巴基斯坦和孟加拉背景的成年服务使用者和照顾者的死亡和服务使用方面存在族裔不平等现象的根本原因。
我们采用了参与式行动研究方法，由专家和大学研究人员进行定性访谈。参与者是根据种族、诊断和合并症在英格兰三个地理位置不同的地点进行有针对性抽样的。对转录本进行了归纳和演绎编码，并进行了主题分析。
研究结果表明，在精神和身体健康的主要和次要健康途径上存在多个潜在因素，这些因素有可能加剧 SMIs 患者中存在的黑人及亚洲人死亡不公平差距。从访谈中得出的重要主题包括及时获得护理（面对面和远程）、以同情、尊严和尊重的方式得到治疗、能够在不遭受不必要的武力、种族主义或其他形式的交叉歧视的情况下使用服务。
这些不良体验给患有 SMI 的少数族裔群体带来了系统性和持久的医疗保健伤害，需要加以解决。我们的研究结果表明，不仅需要在精神卫生服务提供者中解决这些问题，还需要在整个卫生保健系统中解决这些问题，并需要确保与经常被排斥在外的少数族裔背景的服务使用者、照顾者和社区建立更公平的医疗保健伙伴关系。
