title: Ethnic inequalities in the use of secondary and tertiary mental health services among patients with obsessive-compulsive disorder.
abstract: Obsessive-compulsive disorder (OCD) has similar prevalence rates across ethnic groups. However, ethnic minorities are underrepresented in clinical trials of OCD. It is unclear whether this is also the case in clinical services.
  
  
  
  To explore whether ethnic minorities with OCD are underrepresented in secondary and tertiary mental health services in the South London and Maudsley (SLaM) NHS Foundation Trust.
  
  
  
  The ethnic distribution of patients with OCD seen between 1999 and 2013 in SLaM (n = 1528) was compared with that of the general population in the catchment area using census data. A cohort of patients with depression (n = 22 716) was used for comparative purposes.
  
  
  
  Ethnic minorities with OCD were severely underrepresented across services (-57%, 95% CI -62% to -52%). The magnitude of the observed inequalities was significantly more pronounced than in depression (-29%, 95% CI -31% to -27%).
  
  
  
  There is a clear need to understand the reasons behind such ethnic inequalities and implement measures to reduce them.
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Lorena
authors.initials: L
authors.lastname: Fernández de la Cruz
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Marta
authors.initials: M
authors.lastname: Llorens
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Amita
authors.initials: A
authors.lastname: Jassi
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Georgina
authors.initials: G
authors.lastname: Krebs
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Pablo
authors.initials: P
authors.lastname: Vidal-Ribas
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Joaquim
authors.initials: J
authors.lastname: Radua
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Stephani L
authors.initials: SL
authors.lastname: Hatch
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bhugra
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Isobel
authors.initials: I
authors.lastname: Heyman
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: Bruce
authors.initials: B
authors.lastname: Clark
authors.affiliation: Lorena Fernández de la Cruz, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Marta Llorens, MD, King's College London, Institute of Psychiatry, London, UK; Amita Jassi, DClinPsy, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Georgina Krebs, DClinPsy, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London and National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; Pablo Vidal-Ribas, MSc, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Joaquim Radua, MD, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, Fundació per a la Investigació i la Docència Maria Angustias Giménez Research Unit, Germanes Hospitalàries, Barcelona and Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Stephani L. Hatch, PhD, Dinesh Bhugra, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK; Isobel Heyman, MBBS, PhD, FRCPsych, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London and Great Ormond Street Hospital for Children, London, UK; Bruce Clark, MD, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; David Mataix-Cols, PhD, King's College London, Institute of Psychiatry, Psychology, and Neuroscience, London, National and Specialist OCD Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK and Department of Clinical Neu
authors.forename: David
authors.initials: D
authors.lastname: Mataix-Cols
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003866:Depressive Disorder / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005006:Ethnicity / Q000523:psychology*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008131:London / Q000208:ethnology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000208:ethnology*; D012042:Registries; D063728:Secondary Care Centers; D062606:Tertiary Care Centers