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Merritt CC, Halverson TF, Elliott T, Jarskog LF, Pedersen CA, Penn DL. Racial disparities and predictors of functioning in schizophrenia. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:177-187. [PMID: 36931838 PMCID: PMC10175100 DOI: 10.1037/ort0000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Black Americans are diagnosed with schizophrenia spectrum disorders at more than twice the rate of White individuals and experience significantly worse outcomes following diagnosis. Little research has examined specific factors that may contribute to worse functional outcomes among Black Americans diagnosed with schizophrenia. One approach to understanding why racial disparities emerge is to examine established predictors of functioning in this population: neurocognition, social cognition, and symptom severity. The present study aims to broaden existing literature on racial differences within these domains by (a) examining racial differences in functioning and these established predictors of functioning (i.e., neurocognition, social, and symptom severity) and (b) investigating whether cognition and symptom domains similarly predict functioning between Black and White Americans with schizophrenia. Sixty-six participants' baseline neurocognition, social cognition, symptom severity, and functioning were assessed. Black participants demonstrated lower neurocognition scores and higher levels of disorganized symptoms relative to White participants. No racial differences in functioning or social cognition were observed. Further, race did not moderate the relationship between any of these established predictors and functioning outcomes. The largely nonsignificant differences in known predictors of functioning highlight the need to explore further domains that may be more relevant for understanding racial disparities in schizophrenia. Considering that psychosocial treatments for schizophrenia spectrum disorders often focus on cognition, these results underscore the importance of identifying whether these domains or other treatment targets may be better in addressing racial disparities in functioning. Possible areas of exploration for future work (e.g., structural factors, racism-related stress) are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Carrington C. Merritt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Tate F. Halverson
- Durham Veterans Affairs Health Care System
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Cort A. Pedersen
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
- School of Behavioural and Health Sciences, Australian Catholic University
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Faith LA, Howie JH, Blanco E, Jarvis SP, Rempfer MV. Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis. Psychol Psychother 2022; 95:958-969. [PMID: 35810321 DOI: 10.1111/papt.12412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 06/12/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Therapeutic alliance is an important element of evidence-based treatments for people diagnosed with a serious mental illness. Cognitive enhancement therapy (CET) is an efficacious cognitive rehabilitation programme that emphasizes coach-participant relationships. The purpose of this study was to examine experiences of therapeutic alliance among CET participants. DESIGN We used an exploratory qualitative approach. METHODS Semi-structured interviews were conducted with 24 participants diagnosed with a serious mental illness. Interview transcripts were analysed by three independent coders using thematic analysis. RESULTS Four themes related to therapeutic alliance emerged: (1) positive regard; (2) collaboration; (3) authenticity; (4) negative alliance. CONCLUSIONS Findings suggest that therapeutic alliance is an important component of CET that bolsters the learning environment and ensures a positive group experience. Our qualitative analyses contribute greater understanding of how strong therapeutic relationships impact people with serious mental illnesses participating in evidence-based treatments beyond psychotherapy context.
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Affiliation(s)
- Laura A Faith
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
| | - J Hunter Howie
- Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
| | - Emily Blanco
- Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
| | - Stephen P Jarvis
- University Health Behavioral Health, Kansas City, Missouri, USA.,University of Missouri School of Medicine, Kansas City, Missouri, USA
| | - Melisa V Rempfer
- Department of Psychology, The University of Missouri, Kansas City, Missouri, USA
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Nagendra A, Halverson TF, Pinkham AE, Harvey PD, Jarskog LF, Weisman de Mamani A, Penn DL. Neighborhood socioeconomic status and racial disparities in schizophrenia: An exploration of domains of functioning. Schizophr Res 2020; 224:95-101. [PMID: 33190787 DOI: 10.1016/j.schres.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/19/2020] [Accepted: 09/24/2020] [Indexed: 01/20/2023]
Abstract
Black Americans are disproportionately diagnosed with schizophrenia and experience worse objective functional outcomes (e.g., hospitalizations) than their White counterparts. However, we have a limited understanding of the psychological pathways through which Black Americans with schizophrenia reach worse outcomes. This study assessed race and domains of functioning (e.g., neurocognition, functional capacity) known to be associated with objective outcomes in a sample of 108 non-Hispanic Black and 61 non-Hispanic White individuals with schizophrenia-spectrum disorders from the Social Cognition Psychometric Evaluation (SCOPE) study. Three primary findings emerged: First, Black participants showed lower scores than White participants on measures of neurocognition(NC), social cognition(SC), and everyday living skills, but not social skills or community functioning. Second, neighborhood socioeconomic status (SES) explained 21% of the relationship between race and NC but did not mediate the relationship between race and SC or everyday living skills. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals with schizophrenia. In our sample, after controlling for neighborhood SES, race did not moderate the relationships of NC, SC, social skills, or everyday living skills to community functioning. This indicates that relationships between these domains are comparably strong across Black and White Americans. Taken together, these findings show that NC, SC, and everyday living skills may be important areas to explore in regards to racial disparities in schizophrenia. More research, especially incorporating nuanced race- and SES-related variables, is needed to understand how to best intervene and improve real-world outcomes for Black Americans with schizophrenia.
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Affiliation(s)
- Arundati Nagendra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA; Center for Psychosocial and Systemic Research / Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Tate F Halverson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA; Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia
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Beebe L, Smith KD, Oppizzi LM. Telephone Intervention-Problem Solving (TIPS) for Schizophrenia Spectrum Disorders: Responses of Stable Outpatients Over Nine Months. Issues Ment Health Nurs 2018; 39:561-567. [PMID: 29465273 DOI: 10.1080/01612840.2018.1431824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Medication adherence and community living problems were assessed by a telephone intervention for stable outpatients with schizophrenia spectrum disorders. A majority were white males who lived with family members. We conducted a descriptive analysis of data gathered during weekly calls to 87 participants receiving weekly TIPS for nine months. Analysis included traditional atheoretical content analysis, Pearson correlations, and Chi squares. The following themes emerged: mood disturbances and related symptoms, psychotic symptoms, coping problems, medication adherence, and substance cravings. The most frequently reported problems were mood disturbances: depression and anxiety. Forty two percent of Caucasians versus 72.1% of African Americans were prescribed intramuscular (IM) antipsychotic delivery (Chi square = 8.24, df 2, p = 0.016). Our findings regarding racial differences in antipsychotic delivery method warrant further investigation.
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Affiliation(s)
- Lora Beebe
- a University of Tennessee, College of Nursing , Knoxville , Tennessee , United States
| | - Kathlene D Smith
- b TN Wesleyan College, Department of Nursing , Knoxville , Tennessee , United States
| | - Lauren Michelle Oppizzi
- c University of Tennessee Knoxville College of Nursing, Nursing , Knoxville , Tennessee , United States
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