Factors in the onset of schizophrenia: a comparison between London and Trinidad samples

Objective: Sociodemographic factors play an important role in the genesis of mental disorders. High rates of unemployment and other social factors have been reported previously among African-Caribbeans with schizophrenia in London. The aim of the present study was to compare these factors in Trinidad with London African-Caribbeans. METHOD: Using internationally-defined criteria, patients with first-onset schizophrenia were recruited in both countries, and information on the onset of symptoms, help-seeking, pathways into care, premorbid personality and educational and employment status were collected. These two samples are compared on a number of these factors. A total of 56 cases of first-onset of psychosis coming into contact with psychiatric services in Trinidad were studied. Of these, 46 cases were diagnosed as having schizophrenia using the CATEGO program. Over a period of 2 years, 38 African-Caribbean patients with schizophrenia were recruited in London. RESULTS: African-Caribbean patients with schizophrenia in London were more likely to be admitted for perceived threat to others and to have shown loss of interest and serious neglect and to have assaulted others. A lower proportion were admitted via a psychiatrist and a higher proportion by the police. The unemployment rate among the London sample of African-Caribbeans was much higher than in the general population, whereas this was not the case for the Trinidad patients. CONCLUSION: These findings are discussed in the context of culture and aetiology of schizophrenia, and suggestions with regard to future research are made. (AU)

Suicide rate in Jamaica in 1998 and the prevalence of mental disordes and stressful life events in suicide victims in Kingston, St Andrew and St. Catherine in 1998

The suicide rate of Jamaica was reviewed using available police records. The prevalence of mental disorders and stressful life events in 1998 suicide victims in two parishes in Jamaica was investigated. A psychological autopsy interview method was used to interview relatives and acquaintances of 32 suicide victims over a 4 month period. Hospital records and telephone interviews supplemented information. The DSM IV criteria and a stressful life event categorisation was used to diagnose mental disorders and assess year long exposure to stressful events. It was confirmed that Jamaica's suicide rate (2.8 per 100,000) had increased but remained one of the lowest in the Caribbean. Young men and older men were most at risk. At least 90 percent of the victims were diagnosed as having a mental disorder at the time of suicide. The most common diagnosis was depression, followed by schizophrenia, alcoholism and personality disorder. There was significant comorbidity with substance abuse disorders - marijuana and alcohol abuse. There was a significant level of stressful life events in the suicide victims. The category of interpersonal losses and problems was the most common, followed by health related injuries and living conditions. The category of financial, job related and legal issues was least prominent. The author recognises limitations in time, methodology and analysis. The findings of the prevalence of mental disorders were similar to other psychological autopsy findings. Case controlled studies and regression analysis could give further insight on the role that mental disorders and stressful events play in suicide. Recommendations are made for prevention and control of suicide in Jamaica.(AU)

Adolescents' self-image: A cross-cultural perspective

The aim of the study was to examine the self-image of Jamaican adolescents using an instrument which employs the multidimensional construct of the self-image. Past research using global measures has reported poor adjustment among these youths. The Offer Self-Image Questionnaire for Adolescents which measures 11 aspects of adjustment, was administered to 233 Jamaican secondary school students representing a cross-section of localities in Jamaia. Jamaican adolescents expressed satisfaction with their adjustment in seven areas, impulse control, emotional tone, body image, social relationships, sexual attitudes, mastery of the external world, and superior adjustment, while expressing dissatisfaction on the other four dimensions: morals, vocational and educational goals, family relationships, and emotional health. The findings support the multifaceted nature of the self. The discussion on the cultural and circumstantial fators affecting Jamaican youth.(AU)

Psychiatric hospital admission rates in Jamaica, 1971 and 1988

The overall psychiatric hospital admission rates in Jamaica were 136 per 100,000 in 1971 and 69 per 100,000 in 1988. The admission rate for schizophrenia was 69 per 100,000 in 1971 and 35 per 100,000 in 1988. The 49 percent reduction in admission rates over these 17 years is attributed to the introduction of an island-wide community mental health service with psychiatric admission to general parish hospitals in 1972. This admission rate for schizophrenia is five to six times lower than the rate reported for Afro-Caribbeans in the UK by a number of studies, and is more in keeping with the admission rate for schizophrenia reported for the general population in England. (AU)

A study of mental illness in Asians West Indians and Africans living in Manchester

First admission rates have been determined for immigrants living in Manchester. They show that immigrants as a whole had about twice the rate of British-born subjects, but that various sub groups had still higher, including those aged 35-44 and Asian women. According to hospital diagnoses the psychiatric conditions responsible for these increased rates are schizophrenia (in all groups) and neuroses and personality disorders (in the Asians). A case note of the psychopathology showed, however, that the most characteristic symptoms of schizophrenia were not common in the immigrants. It is concluded that most of the immigrants are suffering from paranoid psychoses, not schizophrenia. (Summary)