1. The EMPIRIC study A collaboration between the National Centre for Social Research and Medical Schools in UCL, Imperial College, Queen Marys College and Bristol University Commissioned by the DoH Michael King 11 th July 2003

2. Raison dêtre Examining how mental illness varies with population and with time is important for: –understanding aetiology –developing policy

3. 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

4. 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

5. 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

6. 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

7. 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

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

9. 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.

10. 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)

11. 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

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.

13. 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

14. 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

15. Limitations Response rates Lack of data on substance misuse (alcohol and drugs) Some difficulties in understanding concepts in translated interviews – countered by qualitative study?

16. 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