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Ethnic inequalities and pathways to care in psychosis in England: a systematic review and meta-analysis

期刊

BMC MEDICINE
卷 16, 期 -, 页码 -

出版社

BMC
DOI: 10.1186/s12916-018-1201-9

关键词

Pathways to care; Psychosis; Severe mental illness; Ethnicity; Systematic review; Meta-analysis

资金

  1. Lankelly Chase Foundation

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BackgroundAs part of a national programme to tackle ethnic inequalities, we conducted a systematic review and meta-analysis of research on ethnic inequalities in pathways to care for adults with psychosis living in England and/or Wales.MethodsNine databases were searched from inception to 03.07.17 for previous systematic reviews, including forward and backward citation tracking and a PROSPERO search to identify ongoing reviews. We then carried forward relevant primary studies from included reviews (with the latest meta-analyses reporting on research up to 2012), supplemented by a search on 18.10.17 in MEDLINE, Embase, PsycINFO and CINAHL for primary studies between 2012 and 2017 that had not been covered by previous meta-analyses.ResultsForty studies, all conducted in England, were included for our updated meta-analyses on pathways to care. Relative to the White reference group, elevated rates of civil detentions were found for Black Caribbean (OR=3.43, 95% CI=2.68 to 4.40, n=18), Black African (OR=3.11, 95% CI=2.40 to 4.02, n=6), and South Asian patients (OR=1.50, 95% CI 1.07 to 2.12, n=10). Analyses of each Mental Health Act section revealed significantly higher rates for Black people under (civil) Section 2 (OR=1.53, 95% CI=1.11 to 2.11, n=3). Rates in repeat admissions were significantly higher than in first admission for South Asian patients (between-group difference p<0.01). Some ethnic groups had more police contact (Black African OR=3.60, 95% CI=2.15 to 6.05, n=2; Black Caribbean OR=2.64, 95% CI=1.88 to 3.72, n=8) and criminal justice system involvement (Black Caribbean OR=2.76, 95% CI=2.02 to 3.78, n=5; Black African OR=1.92, 95% CI=1.32 to 2.78, n=3). The White Other patients also showed greater police and criminal justice system involvement than White British patients (OR=1.49, 95% CI=1.03 to 2.15, n=4). General practitioner involvement was less likely for Black than the White reference group. No significant variations over time were found across all the main outcomes.ConclusionsOur updated meta-analyses reveal persisting but not significantly worsening patterns of ethnic inequalities in pathways to psychiatric care, particularly affecting Black groups. This provides a comprehensive evidence base from which to inform policy and practice amidst a prospective Mental Health Act reform.Trial registrationCRD42017071663

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