Ethnic disparities in psychotic experiences explained by area-level syndemic effects
<p><strong><span class="bold">Background:</span></strong> Ethnic inequalities in health outcomes are often explained by socioeconomic status and concentrated poverty. However, ethnic disparities in psychotic experiences are not completely attenuated b...
| Main Authors: | , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Cambridge University Press
2019
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| _version_ | 1826293746802622464 |
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| author | Coid, J Gonzalez Rodriguez, R Kallis, C ZhanG, Y Bhui, K De Stavola, B Bebbington, P Ullrich, S |
| author_facet | Coid, J Gonzalez Rodriguez, R Kallis, C ZhanG, Y Bhui, K De Stavola, B Bebbington, P Ullrich, S |
| author_sort | Coid, J |
| collection | OXFORD |
| description | <p><strong><span class="bold">Background:</span></strong> Ethnic inequalities in health outcomes are often explained by socioeconomic status and concentrated poverty. However, ethnic disparities in psychotic experiences are not completely attenuated by these factors.</p>
<p><strong><span class="bold">Aims:</span></strong> We investigated whether disparities are better explained by interactions between individual risk factors and place-based clustering of disadvantage, termed a syndemic.</p>
<p><strong><span class="bold">Method:</span></strong> We performed a cross-sectional survey of 3750 UK men, aged 18–34 years, oversampling Black and minority ethnic (BME) men nationally, together with men residing in London Borough of Hackney. Participants completed questionnaires covering psychiatric symptoms, substance misuse, crime and violence, and risky sexual health behaviours. We included five psychotic experiences and a categorical measure of psychosis based on the Psychosis Screening Questionnaire.</p>
<p><strong><span class="bold">Results:</span></strong> At national level, more Black men reported psychotic experiences but disparities disappeared following statistical adjustment for social position. However, large disparities for psychotic experiences in Hackney were not attenuated by adjustment for social factors in Black men (adjusted odds ratio, 3.24; 95% CI 2.14–4.91; <span class="italic">P</span> < 0.002), but were for South Asian men. A syndemic model of joint effects, adducing a four-component latent variable (psychotic experiences and anxiety, substance dependence, high-risk sexual behaviour and violence and criminality) showed synergy between components and explained persistent disparities in psychotic experiences. A further interaction confirmed area-level effects (Black ethnicity × Hackney residence, 0.834; <span class="italic">P</span> < 0.001).</p>
<p><strong><span class="bold">Conclusions:</span></strong> Syndemic effects result in higher rates of non-affective psychosis among BME persons in certain inner-urban settings. Further research should investigate how syndemics raise levels of psychotic experiences and related health conditions in Black men in specific places with multiple deprivations.</p> |
| first_indexed | 2024-03-07T03:34:55Z |
| format | Journal article |
| id | oxford-uuid:bbf43a04-e8a9-43d5-9b3f-8826f55f1eef |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:34:55Z |
| publishDate | 2019 |
| publisher | Cambridge University Press |
| record_format | dspace |
| spelling | oxford-uuid:bbf43a04-e8a9-43d5-9b3f-8826f55f1eef2022-03-27T05:20:53ZEthnic disparities in psychotic experiences explained by area-level syndemic effectsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:bbf43a04-e8a9-43d5-9b3f-8826f55f1eefEnglishSymplectic ElementsCambridge University Press2019Coid, JGonzalez Rodriguez, RKallis, CZhanG, YBhui, KDe Stavola, BBebbington, PUllrich, S<p><strong><span class="bold">Background:</span></strong> Ethnic inequalities in health outcomes are often explained by socioeconomic status and concentrated poverty. However, ethnic disparities in psychotic experiences are not completely attenuated by these factors.</p> <p><strong><span class="bold">Aims:</span></strong> We investigated whether disparities are better explained by interactions between individual risk factors and place-based clustering of disadvantage, termed a syndemic.</p> <p><strong><span class="bold">Method:</span></strong> We performed a cross-sectional survey of 3750 UK men, aged 18–34 years, oversampling Black and minority ethnic (BME) men nationally, together with men residing in London Borough of Hackney. Participants completed questionnaires covering psychiatric symptoms, substance misuse, crime and violence, and risky sexual health behaviours. We included five psychotic experiences and a categorical measure of psychosis based on the Psychosis Screening Questionnaire.</p> <p><strong><span class="bold">Results:</span></strong> At national level, more Black men reported psychotic experiences but disparities disappeared following statistical adjustment for social position. However, large disparities for psychotic experiences in Hackney were not attenuated by adjustment for social factors in Black men (adjusted odds ratio, 3.24; 95% CI 2.14–4.91; <span class="italic">P</span> < 0.002), but were for South Asian men. A syndemic model of joint effects, adducing a four-component latent variable (psychotic experiences and anxiety, substance dependence, high-risk sexual behaviour and violence and criminality) showed synergy between components and explained persistent disparities in psychotic experiences. A further interaction confirmed area-level effects (Black ethnicity × Hackney residence, 0.834; <span class="italic">P</span> < 0.001).</p> <p><strong><span class="bold">Conclusions:</span></strong> Syndemic effects result in higher rates of non-affective psychosis among BME persons in certain inner-urban settings. Further research should investigate how syndemics raise levels of psychotic experiences and related health conditions in Black men in specific places with multiple deprivations.</p> |
| spellingShingle | Coid, J Gonzalez Rodriguez, R Kallis, C ZhanG, Y Bhui, K De Stavola, B Bebbington, P Ullrich, S Ethnic disparities in psychotic experiences explained by area-level syndemic effects |
| title | Ethnic disparities in psychotic experiences explained by area-level syndemic effects |
| title_full | Ethnic disparities in psychotic experiences explained by area-level syndemic effects |
| title_fullStr | Ethnic disparities in psychotic experiences explained by area-level syndemic effects |
| title_full_unstemmed | Ethnic disparities in psychotic experiences explained by area-level syndemic effects |
| title_short | Ethnic disparities in psychotic experiences explained by area-level syndemic effects |
| title_sort | ethnic disparities in psychotic experiences explained by area level syndemic effects |
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