Mental illness, including psychosis, is a very poorly understood and negatively stereotyped field. A group of researchers conducted the Social Epidemiology of Psychoses in East Anglia, or SEPEA study, to better characterize the incidence of psychoses.
Mental illness is a topic that makes a lot of people uneasy and uncertain. This is largely due to a lack of understanding and awareness regarding the topic itself. Researchers and health care providers themselves have not fully grasped the severity of mental illness and how significant of a problem it poses. In part, this is because “mental illness” is an umbrella term encompassing many conditions with varying diagnoses, symptoms, and therapeutic approaches. This lack of understanding translates to an undereducated and uncertain public, who are incapable of appropriately interacting with the patients themselves and often their families. Properly defining mental illness, identifying the specific conditions it encompasses, and developing diagnostic and therapeutic techniques is just the beginning of the fight against impaired mental health. Rigorous efforts are needed to understand the epidemiology of mental illness to then understand their causes and those at risk. However, educating the public regarding the conditions, and how to go about treating those affected with respect and utmost empathy is equally important.
Psychosis is defined as a mental disorder whereby thought and emotions are severely impaired. The patient loses contact with external reality and adopts a wide range of bizarre behaviors, some of which can be quite scary for an unaware individual. The current gold standard for treatment for psychosis is early intervention, which incorporates a combination of pharmacological and psychological interventions, family and social support, supported employment, and physical care exams. Studies prior to the development of these early psychotic interventions have demonstrated that psychotic disorders vary in incidence and risk depending on the person’s individual characteristics and their environment. To update the previous literature regarding the epidemiology of psychoses, a group of researchers conducted a naturalistic cohort study called the Social Epidemiology of Psychoses in East Anglia (SEPEA).
The SEPEA study included 687 participants from England, aged 16-35, whom fulfilled the study criteria, and were diagnosed clinically and with a research-based approach for a psychotic disorder. Baseline sociodemographic data were collected including patient’s birth date, sex, ethnicity, marital status, birth country, postcode (where they lived), employment status, current/last occupation, as well as their parents’ occupations. Each patient was followed up for three years of care or until they were discharged. The research revealed that when considering all clinically relevant psychotic disorders, the psychoses rates were higher in ethnic minority participants when compared with white British participants. Moreover, the risk of psychoses significantly increased with lower socioeconomic status, and densely populated and deprived neighborhoods.
The SEPEA study also demonstrated that the median referral age was not significantly different between men (22.5 years) and women (23.4). However, the study demonstrated that suspected substance-induced psychotic cases were more likely to be younger men from an ethnic minority background, to be single, unemployed and of lower socioeconomic status, and from a more deprived and densely-populated neighborhood. A similar trend was true for nonaffective psychoses, where emotions and mood are not altered. In contrast, the incidence of affective psychoses, where mood and emotions are altered, were similar between men and women of all ages.
In one of the largest epidemiological studies investigating the epidemiology of psychoses, researchers revealed that incidence rates of clinically relevant psychotic disorders are higher in young people, and in urban and deprived communities. The researchers were unable to establish causation directly between sociodemographic factors and psychotic disorders. It did, however, highlight that deprived communities and younger individuals are more commonly affected, and thus early intervention services should put more focus on these populations.
Written By: Haisam Shah, BSc