Postgraduate Research Studies

There are currently three postgraduate research projects being undertaken alongside the CaFI study:

Ethnic differences in social network characteristics of people with severe mental health problems

African Caribbeans have the highest rates of psychosis, most difficult relationships with mental health services and greatest inequalities in access, experience and outcomes than any other ethnic group in the UK (Bhui et al., 2003a). Recent theories suggest that the fragmented structure of social networks and social isolation (within families and the community) contribute to higher incidence of psychosis and inferior outcomes (e.g. Pinto et al., 2008). Following the onset of psychosis, the social networks of African Caribbean people are likely to be more vulnerable to deterioration as a consequence of family burden and relationship breakdown associated with untreated illness, negative and coercive care pathways (often with families involved in calling the police), high rates of relapse and readmission, and lengthy stays in hospital (e.g. Bhui et al., 2003b; Keating, Robertson, McCulloch, Francis, 2002; The Sainsbury Centre for Mental Health, 2006).

This study will examine ethnic differences in the characteristics of social networks among people diagnosed with 'severe mental illness', such as 'schizophrenia' and the psychoses. The main aim will be to explore whether there is anything distinctive about the social networks of Black people (African Caribbean, Black African, Mixed Black and Black ‘other’) when compared to their White British counterparts. The study will be a secondary analysis of social network data conducted by the McPin Foundation  as part of a National Institute for Health Research (NIHR) Community Health Networks study, which involved mapping the social networks of 150 people with 'severe mental illness' in London communities.

Postgraduate researcher: Amy Degnan, Clinical Psychology PhD

Supervisors: Dawn Edge, Katherine Berry, Nick Crossley, Kathryn Abel

Social networks in African Caribbean & Black Africans who have experience of psychosis

Research studies show that African Caribbeans and Black Africans have the highest rates of psychosis when compared to other ethnic groups in the UK (Fearon et al., 2006). People with psychosis from AC or BA backgrounds are also less likely to seek help from or engage with services and, as a result, more likely to access mental health care through the police or forced admissions than other ethnic groups (Bhui et al., 2003; Morgan, Mallett, Hutchinson, & Leff, 2004). These negative experiences can lead to non-engagement with services and delay help-seeking when symptoms get worse, leading to more negative routes into care and poorer outcomes, such as longer hospital stays and higher rates of readmission (Keating, Robertson, McCulloch, & Francis, 2002).

This research therefore aims to understand factors that influence the help-seeking attitudes and engagement of AC and BA people with psychosis to improve their relationships with mental health services. This will be done through the examination of factors that are thought to influence help-seeking attitudes and engagement with services. 50 African Caribbean and Black African service users with experience of psychosis will be asked to meet with the researchers at two time points. First, we will conduct interviews and questionnaires to: 1) explore the relationships between attachment style, service engagement and working alliance with health professionals, and 2) examine the influence of social networks on engagement, and test whether these relationships are affected by perceived discrimination, illness beliefs and help-seeking attitudes. Second, we will carry out qualitative follow-up interviews to explore the influence of social networks, illness beliefs, and perceived stigma and discrimination on help-seeking and engagement from the service user perspective.

Postgraduate researchers: Amy Degnan, Clinical Psychology PhD; Lucy Shattock, Trainee Clinical Psychologist (ClinPsyD)

Supervisors: Dawn Ege, Katherine Berry, Nick Crossley, Kathryn Abel

Culturally-adapted Knowledge About Psychosis (CaKAP) questionnaire

African Caribbean people are more likely to experience psychosis than any other group in the UK (Fearon et al., 2006). Assessment tools need to be adapted for this group to increase engagement in therapy. The Knowledge About Schizophrenia Interview (KASI; Barrowclough & Tarrier, 1992) is an interview tool for people with psychosis and their families, to find out what they know about the mental health problem. KASI is used to inform the educational component of Family Interventions but is outdated and may not be suitable for African Caribbeans. This research aims to update the tool based on current evidence and feedback from expert researchers and clinicians to create a new Knowledge About Psychosis (KAP) questionnaire for the general public. The KAP will be culturally-adapted for African Caribbeans, creating the Culturally-adapted KAP (CaKAP) questionnaire.

The initial KAP and caKAP items will be developed using a secondary analysis of qualitative data from Phase 1 of the CaFI study and relevant literature. Focus groups will be carried out with the CaFI Research Advisory Group  and experts will be consulted to ensure the new questionnaires are acceptable, user-friendly and measure what they are supposed to measure. Following this, the KAP questionnaire will be given to 44 students and university staff and the culturally-appropriate KAP (caKAP) questionnaire will be given to 44 African Caribbean people. These participants will complete an online survey to see if their knowledge about psychosis (via KAP and caKAP) relates to their views about seeking help from mental health services and mental health stigma. The KAP and caKAP questionnaires will be used in therapy to help educate people about psychosis and in research studies investigating changes in knowledge following psychological therapy.

Postgraduate researcher: Susanna Jenkins, MSc Clinical and Health Psychology

Supervisors: Dawn Edge, Katherine Berry, Amy Degnan