Schizophrenia in ethnic minority groups

Editor—To sociologists, Boydell et al's findings are counterintuitive.¹ One would expect economic deprivation (at neighbourhood level) to be a decisive factor for an increased incidence of mental illness. But it is surprising to learn that the lower the proportion of non-white ethnic minorities in a local area the higher the incidence of schizophrenia in those minorities (controlled for economic deprivation).

As an explanatory hypothesis the authors point to overt discrimination and institutionalised racism as sources of stress, which can be alleviated by people making use of social capital within the ethnic group. This hypothesis surely necessitates further testing and debate. It is a pity that non-white ethnic minority groups had to be considered as one homogeneous group on an aggregate level. The social networks and levels of social cohesion may be different for different ethnic groups, and follow up research should be able to distinguish these.

Boydell et al assume that all people with schizophrenia will come into contact with psychiatric services, but this requires closer attention. Members of an ethnic minority with a mental disorder who live in predominantly white neighbourhoods may be more likely to come into contact with psychiatric services. Probing for mental disorders might be more likely in predominantly white neighbourhoods than in non-white neighbourhoods. This is not necessarily ruled out by the fact that there is job mobility of clinical staff, since institutional cultures can both consciously and unconsciously shape and influence individual professional practice (and in fact necessitate individual adaptation).

Different processes of self selection in contacting health services or looking for particular types of treatment may operate in different areas. It might be that in mainly non-white neighbourhoods, which often are also the most economically deprived areas, mental health issues among non-white groups are considered to be “luxury” problems compared with other health or social problems. As a result, incidences might be underestimated. The risk of being diagnosed as mentally ill in white (and often better off) neighbourhoods might be higher because of cultural-institutional factors.

The findings of this study are interesting. Sociologists signal different levels of tolerance, or willingness to label someone as deviant (for example, as “ill” or “insane”), according to the social setting.²