8 - Schizophrenia in African–Caribbeans: contributing factors

Summary

Summary Studies over the past half-century using various methods and assessment tools have consistently reported higher than expected rates of schizophrenia among people of African–Caribbean descent compared with other minority ethnic groups and White British. These rates have varied from twofold to sixteenfold. The reasons for such a discrepancy are not clear, although various hypotheses have been put forward. There are undoubtedly methodological problems in determining accurate rates. Both biological and social factors have been proposed as potential aetiological factors. In this chapter we give an overview of the evidence and make suggestions for improved assessment and management.

The epidemiology and management of schizophrenia have been well studied over the past few decades. In the UK, key findings that have emerged time and again are the excess prevalence and incidence rates of schizophrenia among people of African–Caribbean origin. The reasons for this excess and its implications are many. The findings may reflect a true excess or a methodological artefact related to errors in the estimation of numerator and denominator data. The findings have been increasingly accepted as better-designed studies have emerged, but these still do not fully address concerns about the nature of schizophrenia in other cultural groups and in societies in which industrialisation and the economic productivity of the individual are not considered to be as crucial to an individual's sense of belonging in a community. Implications include individual and family distress related to the loss of hopes and expectations and being seen as belonging to a group at high risk for a condition that carries stigma. In addition, there is economic burden on the individual, family and society if unemployment and disability diminish financial security. There are also significant implications for service providers and planners, who are required to meet the health and social care needs of patient, family and community in order to maximise the chances of a functional recovery at each of these levels.