A 10-year longitudinal follow-up of 535 individuals with first-episode psychosis across three UK sites — London, Nottingham & Bristol — examining course, outcome, and ethnic disparities.
The AESOP study confirmed a genuine and marked excess of psychotic illness in African-Caribbean and Black African populations in the UK. Incidence was also modestly elevated in other minority ethnic groups compared with White British populations — consistent with a general increased risk for migrant and ethnic minority groups.
Incidence & AetiologyMedian DUP was 9 weeks (IQR 2–40 weeks), but heavily skewed — a minority presented years after onset. Four predictors of long DUP were identified: insidious onset, schizophrenia diagnosis, unemployment, and absence of family involvement in help-seeking. Each remained significant after controlling for confounders.
Key Predictor · DUPDespite challenging long-term trajectories, 77% of cases experienced at least one period of sustained remission. At 10-year follow-up, 46% were symptom-free for at least 2 years — challenging pessimistic views of psychosis as invariably chronic and deteriorating.
Clinical Outcomes · HopefulDespite remission rates, 72% of participants were employed for less than 25% of the follow-up period. The median number of hospital admissions was 2 (IQR 1–4), with 88% admitted at least once. Outcomes were worse for those with non-affective diagnoses and for men.
Social Function · EmploymentBaseline social disadvantage partially explained worse outcomes for Black Caribbean and Black African patients. The evidence suggested that disadvantage and psychosis are mutually reinforcing — disadvantage exacerbates symptoms, which in turn deepen social exclusion. For many patients from minority ethnic groups, the outcome was entrenched psychosis and long-term social isolation. Ethnic differences in employment persisted even after adjusting for clinical course, pointing to structural factors beyond symptom burden.
Social Determinants · Structural InequalityRelative median DUP in weeks — all remained significant after adjusting for age, sex, and study site.
Experienced at least one period of sustained remission over the decade
Were symptom-free for at least 2 consecutive years at follow-up
Employed for less than 25% of the entire follow-up period
Had died by the time of the 10-year follow-up assessment
Were hospitalised at least once during the follow-up period
Median hospital admissions — with a minority experiencing 10 or more
Compared to White British patients — with findings on clinical, social, and service use outcomes
The AESOP-10 study demonstrates that ethnic disparities in psychosis incidence extend to worse long-term outcomes for Black Caribbean and Black African patients. These disparities are partly explained by baseline social disadvantage — pointing to structural, not merely biological, determinants of outcome. Early intervention, reduction of DUP, family engagement, and tackling social inequalities are critical levers for improving outcomes across all ethnic groups. Almost half of all patients achieved meaningful recovery, underscoring the importance of sustained, equitable care.