| Summary: | Research shows that UK Caribbean patients with psychosis have more aversive pathways in psychiatric care compared with the white British population. This may indicate "cultural mistrust" of services which is attributed by Caribbean patients to racism, explaining their poorer adherence and engagement with services. Mistrust may reflect a mismatch in the attribution of illness between patient and psychiatrist: whereby the patient perceives both his predicament and services as racist and oppressive, whilst the psychiatrist over-estimates the "dangerousness" of the patient. No study to-date has examined the association between the perception that society and services are racist and adherence with psychiatric treatment in Caribbean patients with psychosis. This is a London-based prospective cohort study of 100 Caribbean patients with psychosis. It uses the Perceived Racism Scale (PRS - a multi-dimensional measure of self-reported racism), the Drug Attitudes Inventory (DAI) and the Kemp seven-point scale (a commonly used self-report and multi-sourced measure of adherence, respectively). Perceived racism was measured at baseline using the PRS, with adherence and hospital admission data determined after 12 months, using the DAI and Kemp Scale. The study found small but independent and significant associations between measures of total perceived racism for the previous year, over a lifetime, and everyday racism for the previous year, with medication adherence one year later. It also found that feeling ashamed and powerless about any racism that was personally experienced within the health system were associated with increased adherence and fewer hospital bed-days in the subsequent year. Finally, the strongest positive association was between perceived racism within the system and both the number of subsequent hospital bed-days and length of hospital admission over the next year. This implies that in this group of UK Caribbean patients with psychosis, perceived racism is a determinant of adherence with psychotropic medication over a twelve-month period.
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