The EMPIRIC study

A collaboration between the National Centre for Social Research and Medical Schools in UCL,

Imperial College, Queen Mary’s College and Bristol University

Commissioned by the DoH

Michael King 11th July 2003

Raison d’être

• Examining how mental illness varies with population and with time is important for:– understanding aetiology– developing policy

Background

• Research: – high rates of psychosis in African-Caribbean– low rates of mental illness in South Asian populations– mixed evidence on effects of migration

• But– Evidence is variable– Little of it comes from population studies– Cultural variation in ways people experience and

express mental illness

AIMS

• To assess across a range of ethnic minority populations– prevalence and risk factors for mental illness– levels of service use

In the context of the idiom of mental distress

Two parts

• Quantitative survey– FU of 5 ethnic minority groups (Black-Caribbean,

Irish, Indian, Bangladeshi, and Pakistani) interviewed in the 1999 HSE

– Whites from 1998 HSE– Survey questionnaires were translated into five

languages, Hindi, Gujarati, Punjabi, Urdu and Bengali.

• Qualitative survey – to examine models of and explanations for psychiatric symptoms

Instruments

• Clinical Interview Schedule for psychiatric symptoms

• Psychosis Screening Questionnaire• Quality of life (SF12)• Brief Social Function questionnaire• Close Persons Questionnaire (social support)• Religious and Spiritual Beliefs scale• Access to services

Analyses

• Weightings from the HSE 99 were retained, and in addition, weights were applied to adjust for the non-response to the EMPIRIC survey

• Ongoing evaluations:– Prevalence and predictors of common of mental

disorder– Prevalence and predictors of psychosis– Racism and mental illness– Use of services– Spirituality and mental illness.– Qualitative study

Numbers

• 4281 adults were interviewed, constituting 68.2% of those eligible – White 837– Irish 733– Black Caribbean 694– Bangladeshi 650– Indian 643– Pakistani 724

Common mental disorder

• No overall differences in rates between groups

• But complex picture:– Higher prevalence (compared to whites) in

Irish and Pakistani men aged 35-54, and Indian and Pakistani women aged 55-74.

– Lower prevalence in Bangladeshi women than in White or other South Asian women, across the age span.

Psychosis

• Scoring on PSQ highest in B-C

• Estimated prevalence of psychosis– 6/1000 in Bangladeshis to 16/1000 in B-C. – Highest rates in B-C and Pakistanis– Adjustment for demography, social support

and social function - only the B-C group outstanding c.f. whites (OR 1.86 CI 1.12, 3.10)

Use of services

• Higher overall service use associated with:– Women– Increasing age– South Asian ethnicity– Economic inactivity– CMD

• Bangladeshis most likely to consult GPs 6/12• Whites, Irish and BC most likely to have

consulted psychologists or counsellors 6/12

Religion and spirituality

• Religious affiliation not associated with CMD

• Spiritual beliefs in absence of religious affiliation predicts CMD (OR 1.5 to 2.0)

• Correlation of religion with ethnicity and role of migration still to be examined.

Qualitative study - issues

• No language or ethnic specificity in discussion of problems

• Family/marital problems common to all groups• Divorce and separation in whites and BC• Arranged marriages in South Asians• Experiences of racism in non-whites• Religion important to non-white groups – making

sense of problems, coping and increasing faith

Qualitative study - issues

• Idioms for mental distress broadly similar across all groups

• Idioms for physical distress also similar but “richer” in South Asian groups (esp in migrants

and non-English speakers)

• Thus, little evidence for major cross-ethnic difference or “misunderstandings”

Limitations

• Response rates

• Lack of data on substance misuse (alcohol and drugs)

• Some difficulties in understanding concepts in translated interviews – countered by qualitative study?

Conclusions

• Data on mental illness and its predictors across ethnic groups that are not subject to selection biases.

• Much more to be explored – e.g.– role of personality difficulties– social support– examination of specific groups such as the

Irish