title: Ethnicity and pathways to care during first episode psychosis: the role of cultural illness attributions.
abstract: BACKGROUND
  Studies demonstrate ethnic variations in pathways to care during first episode psychosis (FEP). There are no extant studies, however, that have statistically examined the influence of culturally mediated illness attributions on these variations.
  
  
  METHODS
  We conducted an observational study of 123 (45 White; 35 Black; 43 Asian) patients recruited over a two-year period from an Early Intervention Service (EIS) in Birmingham, UK. Sociodemographic factors (age; sex; education; country of birth; religious practice; marital status; living alone), duration of untreated psychosis (DUP), service contacts (general practitioner; emergency services; faith-based; compulsory detention; criminal justice) and illness attributions ("individual;" "natural;" "social;" "supernatural;" "no attribution") were assessed.
  
  
  RESULTS
  Ethnic groups did not differ in DUP (p = 0.86). Asian patients were more likely to report supernatural illness attributions in comparison to White (Odds Ratio: 4.02; 95 % Confidence Intervals: 1.52, 10.62) and Black (OR: 3.48; 95 % CI: 1.25, 9.67) patients. In logistic regressions controlling for confounders and illness attributions, Black (OR: 14.00; 95 % CI: 1.30, 151.11) and Asian (OR: 13.29; 95 % CI: 1.26, 140.47) patients were more likely to consult faith-based institutions than White patients. Black patients were more likely to be compulsorily detained than White patients (OR: 4.56; 95 % CI: 1.40, 14.85).
  
  
  CONCLUSIONS
  Illness attributions and sociodemographic confounders do not fully explain the ethnic tendency to seek out faith-based institutions. While Asian and Black patients are more likely to seek help from faith-based organisations, this does not appear to lead to a delay in contact with mental health services.
authors.affiliation: Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. S.P.Singh@warwick.ac.uk.
authors.forename: Swaran P
authors.initials: SP
authors.lastname: Singh
authors.affiliation: Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. brown.like.j@gmail.com.
authors.forename: Luke
authors.initials: L
authors.lastname: Brown
authors.affiliation: Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. catherine.winsper@warwick.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: Winsper
authors.affiliation: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. Ruchika.Gajwani@glasgow.ac.uk.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Gajwani
authors.affiliation: LOROS, Hospice Care for Leicester, Leicestershire and Rutland, Leicester, UK. ZoebiaIslam@loros.co.uk.|De Montfort University, Leicester, UK. ZoebiaIslam@loros.co.uk.
authors.forename: Zoebia
authors.initials: Z
authors.lastname: Islam
authors.affiliation: HCRI, University of Manchester, Manchester, UK. rubina.jasani@manchester.ac.uk.
authors.forename: Rubina
authors.initials: R
authors.lastname: Jasani
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK. H.Parsons@warwick.ac.uk.
authors.forename: Helen
authors.initials: H
authors.lastname: Parsons
authors.affiliation: Faculty of Health, Education & Life Sciences, Birmingham City University, Birmingham, UK. Fatemeh.Rabiee@bcu.ac.uk.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Rabbie-Khan
authors.affiliation: Mental Health and Well Being, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. M.J.Birchwood@warwick.ac.uk.
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
mesh_terms: D044466:Asian People / Q000208:ethnology; D044383:Black People / Q000208:ethnology; D019091:Critical Pathways; D003469:Culture; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012938:Social Perception; D044465:White People / Q000208:ethnology; D055815:Young Adult