TITLE: Do GPs prescribe antidepressants differently for South Asian patients?
AUTHOR: Cornwell J, Hull S
AFFILIATION: Department of General Practice and Primary Care, St Bartholomew's and The Royal London School of Medicine and Dentistry at Queen Mary and Westfield College Medical Sciences Building, London, UK.
SOURCE: Fam Pract 1998 Apr;15 Suppl 1:S16-8 Published erratum appears in Fam Pract 1998 Jun;15(3):288
ABSTRACT: BACKGROUND: In spite of evidence from controlled trials and published guidelines, general practitioners prescribe antidepressants in lower doses and for shorter courses than are recommended . However, these studies have not examined the effect of ethnicity on antidepressant prescribing by general practitioners. OBJECTIVES: To compare the antidepressant treatment of South Asian patients with White patients. METHODS: Patients, between 16 and 65 years prescribed an antidepressant between November 1993-1995, were selected from an east London training practice by searching the practice computer system EMIS. From a total of 438 patients identified, 40 cases were selected on the basis of their surname  as South Asian, and 50 cases formed the White comparison group. Data was collected retrospectively from the computer and paper records and analysed using Stata. The main outcome measures were presenting symptoms, maximum dose of antidepressant prescribed, duration of treatment and continuity of care. RESULTS: Women formed 2/3 of each group, the mean age in both groups being similar. Psychological symptoms were noted in the majority of both groups, but South Asians presented more physical complaints than the White group (67.5% compared to 22%, Chi squared=18.86, P=0.00001). The South Asian group were significantly more likely to be prescribed amitriptyline at doses of 75 mg or less than the White group (Fisher exact 2 tailed test, P=0.008), had significantly shorter median durations of antidepressant treatment (60 days, compared with 160 days for the White group, Mann Whitney test P=0.005). No differences were found between the groups in their continuity of care. CONCLUSION: The results suggest that successful drug treatment of depressed South Asian patients may be less likely than in White patients. Publication Types:
TITLE: Ethnicity and sex as correlates of depression symptoms in a Canadian university sample.
AUTHOR: Dion KL, Giordano C
AFFILIATION: Department of Psychology, University of Toronto, Ontario, Canada.
SOURCE: Int J Soc Psychiatry 1990 Spring;36(1):30-41
ABSTRACT: Differences in the extent of depression symptoms were explored in a sample of Canadian university students representing Anglo-Celtic, South European, North European, East European, South Asian, and East Asian ethnocultural backgrounds in Toronto, one of the world's most ethnically diverse cities. Consistent with expectations, sex and ethnic differences in the self-reported strength of depression symptoms, as measured by the Beck Depression Inventory (BDI), were found. Women scored higher overall on total BDI scores and were proportionally more apt to be classified as mildly depressed (by having scored 10 or more on the BDI) than men. Similarly, as regards ethnicity, students from South Asian and South European ethnic backgrounds scored higher on the BDI and were also more likely to be classifiable as mildly depressed than those from either East European or Anglo-Celtic backgrounds. An explanation emphasizing the role of societal discrimination in producing feelings of learned helplessness and subsequent depression is proposed to account for the sex and ethnic differences in depression symptoms we and others have observed.
TITLE: Common mental disorders, explanatory models and consultation behaviour among Indian women living in the UK.
AUTHOR: Jacob KS, Bhugra D, Lloyd KR, Mann AH
AFFILIATION: Institute of Psychiatry, Denmark Hill, London, UK.
SOURCE: J R Soc Med 1998 Feb;91(2):66-71
ABSTRACT: Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care. The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as 'cases', the others as 'controls'. Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P = 0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression. Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.
TITLE: Suicide patterns and trends in people of Indian subcontinent and Caribbean origin in England and Wales.
AUTHOR: Raleigh VS
AFFILIATION: Institute of Public Health, University of Surrey, Guildford, UK.
SOURCE: Ethn Health 1996 Mar;1(1):55-63
ABSTRACT: OBJECTIVES: To examine suicide rates and trends in people of Indian subcontinent, east African and Caribbean origin using the latest mortality data available for England and Wales. To compare suicide rates in these groups with the baseline and target rates for suicide in the Health of the Nation strategy. METHODS: Suicide data for England and Wales for 1988-1992, classified by the country of birth of the deceased, and population denominators from the 1991 Census were used for the analysis. Standardised mortality ratios (SMRs) for ages 15-64 and age-specific ratios were computed, using the age-sex specific rates for England and Wales as the standard. Trends over the preceding decade and suicide by burning were also analysed. Directly age-standardised suicide rates were derived to facilitate comparison with Health of the Nation baseline and target rates. RESULTS: Suicide ratios were significantly low (SMRs 32, 52 and 55 respectively) in Bangladeshi, Sri Lankan and Pakistani born men at all ages, but raised in young Indian and east African men. Ratios were significantly high in Indian and east African women (143 and 154), with a 2-3 fold excess at ages 15-34 years. Ratios were low in Pakistani and Bangladeshi women overall, but elevated at 15-24 years. For the Caribbean-born, ratios were low overall but raised at ages 25-34. 20% of Asian female suicides were by burning. Indians are a high risk group in terms of the Health of the Nation suicide targets. Suicide trends in the minority ethnic groups reflect national trends. CONCLUSIONS: This study confirms previous findings of high suicide rates in young Asian women. A new finding is the raised suicide rate in young Caribbeans. High suicide risks among young people from some ethnic minority communities are significant in the context of both the Health of the Nation strategy and recent governmental concern about the need to tackle health variations in the UK. Such deaths are indicative of larger numbers of young ethnic minority adults at risk of mental distress and self harm.
TITLE: Stress and psychiatric disorder in rural Punjab. A community survey.
AUTHOR: Mumford DB, Saeed K, Ahmad I, Latif S, Mubbashar MH
AFFILIATION: Department of Mental Health, University of Bristol.
SOURCE: Br J Psychiatry 1997 May;170:473-8
ABSTRACT: BACKGROUND: The prevalence of psychiatric disorders in rural Punjab is unknown. Previous studies in rural areas elsewhere in the Indian subcontinent have yielded widely differing estimates. METHOD: First-stage screening of a village near Gujar Khan used the Bradford Somatic Inventory and Self Reporting Questionnaire. Psychiatric interviews were conducted with stratified samples using the ICD-10 Diagnostic Criteria for Research. RESULTS: It is estimated that 66% of women and 25% of men suffered from anxiety and depressive disorders. Levels of emotional distress increased with age in both genders. Women living in unitary households reported more distress than those living in extended or joint families. With younger men and women, lower levels of education were associated with greater risk of psychiatric disorders. Social disadvantage was associated with more emotional distress. CONCLUSIONS: This study in rural Punjab confirms that findings of a previous study in Chitral, northern Pakistan, of high levels of emotional distress and psychiatric morbidity among women in rural areas of Pakistan.
TITLE: Psychological distress among British South Asians: the contribution of stressful situations and subcultural differences in the West of Scotland Twenty-07 Study.
AUTHOR: Williams R, Hunt K
AFFILIATION: MRC Medical Sociology Unit, University of Glasgow.
SOURCE: Psychol Med 1997 Sep;27(5):1173-81
ABSTRACT: BACKGROUND: This paper seeks to explain an excess of psychological distress previously found among groups of British South Asians (with ancestry from the Indian subcontinent) living in Glasgow, compared with the general population. The excess was found on a psychosomatic measure and a measure of self-assessed distress but not on a clinically validated measure (the General Health Questionnaire or GHQ). The paper investigates whether South Asians are subject to stressful situations to which the GHQ is less sensitive than the other two measures. METHODS: Random samples of 159 South Asians aged 30-40, mean age 35, and 319 from the general population, all aged 35, were interviewed in Glasgow, using the 12-item General Health Questionnaire (GHQ-12), a psychosomatic symptom scale (PSS) and a self-assessment of distress. Subcultural groupings were differentiated by South Asian origin, English fluency, religion, and gender. Stressful situations assessed were experience of assault, stress/dissatisfaction with work, overcrowding, low standard of living, absence of family and absence of confidants. RESULTS: The GHQ-12 was less sensitive to certain stressful situations than the other two measures. The PSS and/or self-assessed distress were more sensitive to low standard of living, self-rated stress in work around the house and possibly experience of assault. In a combined analysis, the relation between distress on the PSS or self-assessed measure and subcultural groupings became nonsignificant, while the relation between distress and key stressful situations remained significant. CONCLUSIONS: The greater distress of women, Muslims and limited English speakers is largely explained by the stressful situations they experience. The GHQ-12 under-estimates distress related to situations experienced particularly by ethnic minorities and by women.
TITLE: Suicide among immigrants from the Indian subcontinent: a review.
AUTHOR: Patel SP, Gaw AC
AFFILIATION: Department of Psychiatry, Boston University Medical Center Hospital, Massachusetts, USA.
SOURCE: Psychiatr Serv 1996 May;47(5):517-21
ABSTRACT: OBJECTIVE: Studies of suicide among immigrants from the Indian subcontinent (India, Pakistan, Bangladesh, and Sri Lanka) were examined to increase awareness of suicide risk and to better understand social and psychological factors contributing to suicide in this group. METHODS: An online search was conducted of MEDLINE for the years 1966 to 1994 and Psychological Abstracts for the years 1974 to 1994, and all references on completed suicides in the target population were selected for review. RESULTS: Suicide rates of young women immigrants from the Indian subcontinent are consistently higher than those of their male counterparts and of young women in the indigenous populations of the countries to which they immigrate. Suicide rates among older men in this immigrant group have been reported to be low, although reports are less consistent. Use of violent methods such as hanging, burning, and poisoning is common among both men and women. A disproportionately higher number of immigrant Hindus commit suicide. Family conflict appears to be a precipitating factor in many suicides, whereas mental illness is rarely cited as a cause. Depression, anxiety, and domestic violence may contribute to the high rates. Affective disorders may be underdiagnosed in this population. CONCLUSIONS: More research is needed on the epidemiology of psychiatric illnesses and their contribution to suicide in this group.