title: Cultural and social influences of negative illness appraisals in first-episode psychosis.
abstract: BACKGROUND
  In the UK, there has been growing concern about the incidence and prognosis of psychosis in minority ethnic groups for a number of years. Negative self-appraisals after first-episode psychosis (FEP) are associated with post-psychotic depression, poor functioning and suicidality. In carers, appraisals of loss and decreased control are linked with high expressed emotion and relapse; however, as yet there has been no investigation as to how ethnicity and culture relate to these negative appraisals in FEP.
  
  
  OBJECTIVE
  The study aims to investigate the occurrence of negative illness appraisals, for example, loss and shame, in FEP within different ethnic and social-cultural groups. In addition, it aims to explore influence of insight, recovery style and carers' appraisals in the development of negative appraisals.
  
  
  METHODS
  There were 67 patients and 46 carers who completed reliable and valid measures on beliefs about illness, insight and recovery style. Data on ethnicity and deprivation were also collected.
  
  
  RESULTS
  Black patients experienced significantly less loss, lack of control and entrapment than White, Asian and mixed ethnicity patients, yet these were not explained by lower levels of insight or recovery style. Patient's and carer's appraisals were highly correlated.
  
  
  CONCLUSIONS
  Black patients, in spite of higher incidence and poorer outcome in FEP, experienced less loss and shame. Possible explanations, including a protective aspect of alternative health belief models, are explored. This area provides much scope for further investigation. Strong relationships between patient and carer appraisals indicate that family interventions are essential to improved clinical outcomes.
authors.affiliation: South Birmingham Early Intervention Services, Birmingham and Solihull Mental Health NHS Foundation Trust.
authors.forename: Rachel
authors.initials: R
authors.lastname: Upthegrove
authors.forename: Onyekachi
authors.initials: O
authors.lastname: Atulomah
authors.forename: Kat
authors.initials: K
authors.lastname: Brunet
authors.forename: Rajan
authors.initials: R
authors.lastname: Chawla
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003863:Depression / Q000150:complications / Q000523:psychology; D005006:Ethnicity / Q000523:psychology; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D012647:Self-Assessment; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult