Mental hospital admission rates of immigrants to England: A comparison of 1971 and 1981

Summary The present study compares admissions to mental hospitals in England in 1981 with comparable figures obtained for 1971. Patients were classified by place of birth and the two data sets reveal interesting similarities a decade apart. With schizophrenia the trend in 1981, as in 1971, is for the foreign born to have higher rates of admission in comparison to the native born; and as in 1971 the groups with the highest rate of admission are the Irish born and those born in the Caribbean and Poland. Overall rates of admission in 1981 for immigrants from India, Pakistan, Germany and Italy (like 1971) are lower than the native born rates. As in 1971 the Irish and Scots have extremely high rates of alcohol and drug related disorders, and although they also have high rates of personality disorders they are not as high as the 1971 rates. Those born in the Caribbean continue to show relatively low rates of admission for alcohol, drug and personality disorders. For Indian born males the 1981 figure for alcohol related admissions is twice that of 1971. There is an apparent increase in the rates of depression in 1981 compared to 1971 across all the groups which is affected by changes in recording procedures. There are other findings which are peculiar to only one sub-group, such as the very low re-admission rates for Pakistani women compared to the other groups. This paper provides some possible explanations to account for these variations in rates of admission.     

The use of inpatient psychiatric care by immigrants in a London Borough

The prevalence of admission to psychiatric inpatient care in the major immigrant groups in the London Borough of Newham in 1982 is surveyed and results discussed with reference to relevant published literature. High admission rates were found among young West Indian men and older West Indian women, Pakistani men, older Indian women, Irish women and women from the West African new commonwealth. Women from the East African new commonwealth had a low admission rate. The diagnostic mixture found in patients from the various groups is discussed.     

Mental illness in immigrants to England and Wales: An analysis of mental hospital admissions, 1971

Summary A study has been made of all admissions to mental hospitals in England and Wales in 1971 by place of birth. After age/sex standardization of rates and reallocating those patients for whom place of birth was not recorded to appropriate categories, several surprising findings emerged. Compared to the native born, those born in Ireland and Scotland had very high rates of mental hospital admission. Poles also had high rates but West Indians and those born in the U. S. A. had rates comparable to the native born. Rates of mental hospital admission for immigrants from India, Pakistan, Germany and Italy were much lower than native born rates. All immigrant groups studied had higher rates of admission for schizophrenia than natives but much of this discrepancy can be explained by the age structures of the populations being compared. The Irish and Scots had extremely high rates of alcohol and drug related disorders and personality and behaviour disorders but West Indians were underrepresented in these diagnostic categories. Various explanations for these and other results are considered and it is concluded that the most tenable hypothesis is one of differential selection for migration — where migration is relatively easy the less stable members of a population self select for migration but where migration is relatively difficult only the most stable individuals can achieve migration.     

Age at immigration to England of Asian and Caribbean immigrants and the risk of developing multiple sclerosis

OBJECTIVES—Previous studies have shown thatmultiple sclerosis is very uncommon among Indian and Pakistaniimmigrants to England but that their children born in the UnitedKingdom, in the age groups available for study, have a similar risk ofdeveloping the disease as occurs in the general British population. Thepresent study was to ascertain if these immigrants who enter England aschildren below the age of 15, have a higher risk of developing multiple sclerosis than those that enter after this age.
METHODS—A search was made in Greater London, theWest Midlands, Leicester, Bradford, Halifax, and Huddersfield to findethnic Indian, Pakistani, and Bangladeshi immigrants to England withmultiple sclerosis. During the course of the study some immigrants from the Caribbean with multiple sclerosis were also found. The population at risk by ethnic group and age at entry was not available from the1991 Census but was available in the annual Labour Force Surveys.
RESULTS—Indian and Pakistani immigrants whoentered England younger than 15 had a higher risk of developingmultiple sclerosis than those that entered after this age. Caribbeanimmigrants, who have a higher multiple sclerosis prevalence than Asianimmigrants, did not show this difference.
CONCLUSION—This study confirms previous studieswhich show that the environment during childhood is a major factor indetermining the risk of developing multiple sclerosis.

     

Rates and risk factors by ethnic group for suicides within a year of contact with mental health services in England and Wales

OBJECTIVE: This study compared suicide rates, clinical symptoms, and perceived preventability of suicide among persons in four ethnic groups who completed suicide within 12 months of contact with mental health services. METHODS: The rates and standardized mortality ratios (SMRs) of suicide following contact with mental health services were calculated by using national suicide data from 1996 to 2001 for the four largest ethnic groups in England and Wales: black Caribbean, black African, South Asian (Indian, Pakistani, and Bangladeshi), and white. The study also investigated whether clinical indices of risk show ethnic variations. RESULTS: A total of 8,029 suicides in the four ethnic groups were investigated. Overall, compared with the SMRs for their white counterparts, low SMRs were found for South-Asian men and women (SMR=.5, 95% confidence interval [CI]=.4-.6 for South-Asian men and SMR=.7, CI=.5-.9 for South-Asian women). High SMRs were found for black Caribbean and black African men aged 13-24 (SMR=2.9, CI=1.4-5.3 for black Caribbean men and SMR=2.5, CI=1.1-4.8 for black African men). High SMRs were found for young women aged 25-39 of South-Asian origin (SMR=2.8, CI=1.9-3.9), black Caribbean origin (SMR=2.7, CI=1.3-4.8), and black African origin (SMR=3.2, CI=1.6-5.7). Some widely accepted suicide risk indicators were less common in the ethnic minority groups than in the white group. There were more symptoms of active psychosis for people from ethnic minority groups who later committed suicide, and perceived preventability was highest among black Caribbean people. CONCLUSIONS: Rates and SMRs varied across ethnic groups. Specific preventive actions must take account of the ethnic variations of clinical indices of risk and include more effective treatment of psychosis.     

Psychiatric disorders in selected immigrant groups in Camberwell

Summary This paper reports on psychiatric disorder amongst West Indians and Irish-born residents of Camberwell in South London. National figures suggest high rates of severe functional disorders in West Indians with relatively few minor disorders. Among the Irish, however, mania is rare, schizophrenia shows high rates in women but not in men and the milder affective disorders are more common than in the native born (Cochrane 1977). The current study uses both hospital-based data from the Camberwell registrar and data from a community survey and essentially substantiates these findings. It is suggested that these persistent opposing patterns in these two groups of immigrants could be in large part explained by culturally determined patterns of response to adversity.     

The pattern of psychiatric admissions of Caribbean-born immigrants in London

Summary Data from the mental health enquiry and the 1981 census are used to describe the age/sex specific pattern of first and total admissions of West Indian born patients to psychiatric hospitals in two Thames Regions. By contrast to native Britons, more young men, but not young women, appear to be admitted but the readmission rate for young patients of both sexes is high. Older West Indians of both sexes have a similar first admission rate to the native British. Older men but not older women have a low overall admission rate. Time trends suggest that there is a cohort of young men of whom the oldest are now in their early thirties who are at particular risk.     

Ethnicity,primary care and non-psychotic disorders

Compared to the wealth of literature on the relationships between ethnicity, the psychoses and their management, relatively little is known about the primary care presentation, management and outcome of non-psychotic disorders such as anxiety and depression among patients from ethnic minorities. In the 16-65 age group, the ethnic groups most likely to attend the GP are men and women of Pakistani origin. Male Asians including those born in Britain and those originating from the Indian subcontinent and East Africa are more likely to consult the GP than the general population. Men of Afro-Caribbean origin also consult more than their white counterparts. Women of Afro-Caribbean and Asian origin do not appear to consult more than white women of British origin. When it comes to consultation rates for psychosocial problems, the picture is almost reversed: the group most likely to be diagnosed by the GP as having a non-psychotic mental illness are white women of British origin. The groups least likely to be diagnosed as having non-psychotic disorders are women of Asian and Afro-Caribbean origin. Possible explanations for these findings are discussed.     

Admission of British Caribbeans to mental hospitals: is it a cohort effect?

Work in the 1980s has shown that the high incidence of schizophrenia in British Caribbean men is restricted to those born after 1950. Data from a study of admissions in three London health districts suggested that the greater part of this excess risk may be confined to those born before 1966. This suggests that the group of British Caribbean men experiencing a high frequency of schizophrenia could be a tightly delineated birth cohort. If confirmed in wider studies, this could have important implications for the elucidation of the causes of one type of schizophrenia.     

Mental illness in England,in Scotland and in Scots living in England

Summary Beginning from the observation that Scots living in England have much higher rates of mental hospital admission than do the English, several hypotheses are proposed to account for this. Much of the excess in rates of mental illness is accounted for by those diagnosed as having alcohol-related disorders and behaviour and personality problems. The results of an examination of offical statistics in the two countries enabled some explanations to be offered. It was found that rates of admissions to mental hospitals are higher in Scotland than in England but not as high as those found among Scots migrants who have a much higher rate of readmission to hospitals than either of the other groups. In fact, if first admissions only are considered the rates of admission in Scotland are not only higher than rates for English natives but also higher than for Scottish migrants. It seems that Scots living in England are somewhat less likely to become mental patients than Scots in Scotland but that once they do achieve this status they are very much more likely to be readmitted on subsequent occasions. It was concluded that there might be two fairly distinct groups of migrants from Scotland to England who have different backgrounds, different reasons for migrating and different psychological characteristics. On the one hand there are stable, economically motivated migrants who move south for definite employment related reasons and who show few psychological symptoms. While on the other hand there is a group of migrants who perhaps have psychological problems and who move more in hope than expectation without definite prospects and who account for the high rates of mental hospital admission found in Scottish migrants.     

Psychological and social adjustment of Asian immigrants to Britain: A community survey

Summary A community survey of 50 Indian and 50 Pakistani born residents of Birmingham and 100 matched native controls has been completed. Asians were selected so that the sample corresponded to the known demographic characteristics of the immigrant population and were interviewed in their native languages in their own homes. Measures of psychological disturbance, social adjustment, family relationships, housing and employment history as well as attitudinal measures were employed to test some hypotheses concerning the relationship between migration and adjustment. Analysis revealed that on most indices (psychological symptoms, life events, employment, housing, satisfaction) Asian immigrants were better adjusted than their British neighbours. There were strong indications, however, that the British control groups employed were not representative of the British population at large because of their residence in high immigrant concentration areas. The British groups interviewed may have been less well adjusted than a representative British group would have been and so have exaggerated the difference between British and Asian groups. Within the immigrant groups psychological adjustment was related to age and social class among Pakistani males; experiencing disruptive life events was most important for Pakistani females and British controls, crowding correlated with symptoms for Indian and Pakistani females but not for males, and length of residence in Britain was negatively related to symptom levels for Indian males.     

Gender specificity of geographical variation in morbid risk for schizophrenia in rural Ireland

The morbid risk for schizophrenia was determined separately for men and women within each of 36 contiguous district electoral divisions of a rural Irish county in which all cases of schizophrenia satisfying DSM-III-R criteria had been sought. The distribution of morbid risk values for men (0.0-19.2 per 1000) was in accordance with a statistical model for random occurrences in space, while for women (0.0-38.3 per 1000) it deviated markedly from such a model; thus, morbid risk for schizophrenia showed very prominent geographical variations in women, but not in men. These findings may have a basis in factors that can show both spatial inhomogeneity and gender specificity in their consequences for schizophrenia.     

Searching for the causes of schizophrenia: the role of migrant studies

There have been consistent reports in the literature of increased rates of hospital admissions for schizophrenia among Afro-Caribbean (West Indian) migrants to England. Recent evidence for even higher rates in the British-born second generation is reviewed, together with the methodological limitations of such studies. It is concluded that there is probably an epidemic of schizophrenia and related psychoses in this group of migrants although further prospective and longitudinal studies are required. The findings point to the potentially important role of migrant studies in determining environmental risk factors for schizophrenia.     

The prevalence of depot neuroleptic treatment among West Indians and Asians in the London borough of Newham

Summary The frequency of treatment with injectable depot neuroleptics in U.K. born, West Indian born and Asian born residents of the London borough of Newham was compared by means of a prevalence survey. By comparison with the U.K. born, West Indians had a high prevalence for young men and women of all age groups. For Asians a high prevalence was seen in older women only. Prevalence data cannot, however determine whether this means that more of the migrant groups receive such treatment or that those who receive it do so for longer.     

Motor neuron disease and multiple sclerosis among immigrants to England from the Indian subcontinent, the Caribbean, and east and west Africa.

The mortality from motor neuron disease (MND) and multiple sclerosis (MS) was studied among immigrants to England and Wales from the Indian subcontinent, the Caribbean, and East and West Africa during the 10 years 1979-88. The MND mortality among ethnic Asian males was only half and for females one fifth of that expected at English rates. MND mortality in Caribbean immigrants was somewhat lower than expected. White immigrants from the Indian subcontinent had the expected MND mortality. MS mortality was low among Asian, West Indian, and African immigrants. This study is evidence that MND mortality is not the same in all ethnic groups.     

Sex differences, season of birth and platelet 5-HT levels in schizophrenic patients

Summary. Similar occurrence of schizophrenia was observed in men and women independent of their season of birth. Platelet 5-HT concentration was determined in 116 healthy control subjects (61 male and 55 female) and 152 patients with schizophrenia (96 male and 56 female). Platelet 5-HT concentration was significantly higher in male than in female healthy persons and schizophrenic patients. Male and female healthy subjects born in different seasons had similar platelet 5-HT concentrations, whereas schizophrenic patients with different birth-seasons had significantly different platelet 5-HT concentrations. The highest platelet 5-HT levels were observed in both male and female schizophrenic patients born in winter when compared to matched healthy controls. Male schizophrenic patients born in winter had higher platelet 5-HT levels than schizophrenic men born in spring and summer. Female schizophrenic patients born in winter had higher platelet 5-HT than schizophrenic women born in all other seasons. These results indicated sex differences in platelet 5-HT levels in healthy persons and schizophrenic patients. The relationship between season of the birth and platelet 5-HT concentration observed only in schizophrenic patients added further support to the presumption that schizophrenia is connected with a disturbance in the central serotoninergic system. Received January 26, 1998; accepted September 18, 1998     

Cancer in schizophrenia: is the risk higher or lower?

Studies exploring the relationship between schizophrenia and cancer have shown conflicting results. Our study explores this association in three Jewish-Israeli population groups defined by their continent/place of birth (Israel, Europe-America, and Africa-Asia). The identification of the patients was made through the linkage of the nationwide psychiatric and cancer registries. The incidence of cancer in patients diagnosed with schizophrenia was compared with the incidence in the general population. The results showed that the cancer standardized incidence ratios (SIRs) for all sites were significantly lower among men and women with schizophrenia, 0.86 [95% confidence interval (CI) 0.80-0.93] and 0.91 (95% CI 0.85-0.97), respectively. This reduced overall risk was clearest for those born in Europe-America, both men (SIR 0.85, 95% CI 0.74-0.97) and women (SIR 0.86, 95% CI 0.77-0.94). Among women diagnosed with schizophrenia, the SIR was statistically higher for cancer in the breast among those born in Asia-Africa (1.37, 95% CI 1.12-1.63) and in the corpus uteri among the Israel-born (2.75, 95% CI 1.69-3.81) than among their counterparts in the general population. Lung cancer was significantly higher in men born in Asia-Africa diagnosed with schizophrenia than in the respective comparison population group (1.58, 95% CI 1.13-2.2). Our findings, and those of the literature, justify conducting a multinational study that includes identification of cancer-related risk factors among patients with schizophrenia and their families, and information on the use of psychotropic medications. This effort may clarify an epidemiological puzzle that remains outstanding.     

Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context

OBJECTIVE: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) provided estimates of the prevalence of DSM-III-R disorders and utilization of services for help with those disorders in American Indian populations. Completed between 1997 and 1999, the AI-SUPERPFP was designed to allow comparison of findings with the results of the baseline National Comorbidity Survey (NCS), conducted in 1990-1992, which reflected the general United States population. METHOD: A total of 3,084 tribal members (1,446 in a Southwest tribe and 1,638 in a Northern Plains tribe) age 15-54 years living on or near their home reservations were interviewed with an adaptation of the University of Michigan Composite International Diagnostic Interview. The lifetime and 12-month prevalences of nine DSM-III-R disorders were estimated, and patterns of help-seeking for symptoms of mental disorders were examined. RESULTS: The most common lifetime diagnoses in the American Indian populations were alcohol dependence, posttraumatic stress disorder (PTSD), and major depressive episode. Compared with NCS results, lifetime PTSD rates were higher in all American Indian samples, lifetime alcohol dependence rates were higher for all but Southwest women, and lifetime major depressive episode rates were lower for Northern Plains men and women. Fewer disparities for 12-month rates emerged. After differences in demographic variables were accounted for, both American Indian samples were at heightened risk for PTSD and alcohol dependence but at lower risk for major depressive episode, compared with the NCS sample. American Indian men were more likely than those in NCS to seek help for substance use problems from specialty providers; American Indian women were less likely to talk to nonspecialty providers about emotional problems. Help-seeking from traditional healers was common in both American Indian populations and was especially common in the Southwest. CONCLUSIONS: The results suggest that these American Indian populations had comparable, and in some cases greater, mental health service needs, compared with the general population of the United States.     

Reproductive rates in schizophrenic outpatients

We investigated the marriage rates, the reproductive rates and the marital reproductivity of schizophrenic outpatients in Japan. A total of 553 patients with DSM-III-R-diagnosed schizophrenia at the Teikyo University Hospital, Tokyo, Japan were compared with age- and sex-matched outpatients at surgical clinics of the same hospital. Our findings indicate that the reproductivity of schizophrenics is reduced, even though the sample consists of outpatient population and modern operational diagnostic criteria have been used. The marriage rate and reproductive rate of the schizophrenics were reduced, especially in men. The number of married men was significantly less than that of married women and the reduced marital reproductivity was found in women but not men. These findings indicate that the reduced reproductivity of men is accounted for largely by a reduced rate of marriage, and that in women is accounted for partly by lower rate of reproductivity within marriage.     

Increasing rates of hospital admission for men with major mental illnesses: data from Scottish mental health units, 1980-1995.

OBJECTIVE: We studied first admission rates for major mental illness in order to explore links with an increase in psychiatric morbidity and mortality in men. METHOD: Patient discharge data from Scottish Mental Health Units during 1980-1995 were analysed. RESULTS: Admission rates for schizophrenia remained constant in men and decreased in women. Affective disorders remained constant in men and decreased in women. Paranoid states increased in men and remained constant in women. Non-organic psychoses increased in both men and women. CONCLUSION: Further evidence is provided for an increase in the proportion of men, particularly younger age groups, admitted with major mental illness. Possible reasons include (i) comorbidity, (ii) biological variables, (iii) responses to and change in health-seeking behaviour in men and (iv) an increased prevalence of major mental illness in men.