Perceived racism, medication adherence, and hospital admission in African-Caribbean patients with psychosis in the United Kingdom

Background Differences in outcome between African- Caribbean and white British patients with psychosis may be due to perceived racism and a difficulty in trusting services seen as discriminatory. Method In 100 participants, racism was measured at baseline using the Perceived Racism Scale; with adherence, using the Drug Attitudes Inventory and Kemp Scale, and hospital admission data determined after 12 months. Results We found associations between total perceived racism for the previous year (b = -0.0074, P = 0.013), lifetime racism (b = -0.0068, P = 0.038), and everyday racism for the previous year (b = -0.051, P = 0.0046), with subsequent medication adherence. Shame felt about health system racism was associated with increased adherence (b = 0.20, P = 0.015), and powerlessness about it was associated with fewer subsequent hospital bed days (b = -14.49, P = 0.025). Finally, health system racism was associated with both the number of subsequent hospital bed days (b = 5.54, P = 0.010), and admission length (b = 4.92, P = 0.021). In addition, stratified analyses showed that both baseline adherence and 6-month estimated adherence appeared to mediate these effects. Conclusions In this cohort of African-Caribbean patients with psychosis, perceived racism is a determinant of adherence over 12 months. We propose a model whereby perceived racism contributes to an individual rejecting mental health services (manifested by the mediating effect of poor adherence) which leads to a poorer outcome, evidenced by a longer hospital stay. Secondly, powerlessness about perceived health-service racism may represent a sense of resignation about the ‘‘system’’, leading paradoxically to greater adherence and better outcome.