Pearson, Jules; (2002) Black and white patients' experience of their first psychiatric admission: Is there a relationship between negative experiences of psychiatric care and 'poor insight' in schizophrenia? Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Black patients with schizophrenia are currently over-represented in psychiatric and forensic mental health settings. It has been shown that psychiatrists view Black patients as having less insight than their White counterparts. No studies have yet explored the potential relationship between negative experiences of psychiatric care at first admission and insight, or have empirically investigated potential consultant bias in ratings of insight in Black patients. 22 Black and 22 White patients with paranoid schizophrenia were recruited from two medium secure units in London. Black and White groups were compared on their experiences and perception of their first psychiatric admission, and current views of psychiatric care. Participants were interviewed on measures of: psychiatric care at first admission, the impact of these experiences on symptoms of trauma, patient satisfaction, reasons for current medication compliance, and insight. Consultants were also asked to rate insight in their Black and White patients. Consultant ratings were compared between the groups and with standardised measures of insight. There were no differences between the groups in negative experiences or feelings about the first admission, current trauma, reasons for current medication compliance, or insight. However, Black patients were less satisfied with the care they received at first admission, which was associated with being younger at first admission. Consultants did not rate Black patients as having less insight than White patients. However, consultants' ratings for White patients were significantly correlated with the standardized measure of insight, but not for Black patients. The difference between these correlations between the groups was significant (p<0.05). Insight across the sample was unaffected by negative experiences or perceptions of psychiatric care, trauma, satisfaction, IQ, psychological therapy, and depression. Only severity of psychosis predicted levels of insight. Suggestions were made for future research and clinical practice in the areas of understanding of Black patients, improving their satisfaction with psychiatric care, and enhancing congruence between Black patients and clinicians, particularly in the area of assessment.

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