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Sankoh M, Clifford J, Peterson RE, Prom-Wormley E. Racial and ethnic differences in comorbid psychosis: a population-based study. Front Psychiatry 2024; 15:1280253. [PMID: 39140109 PMCID: PMC11320602 DOI: 10.3389/fpsyt.2024.1280253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 06/27/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Differences in the prevalence of psychiatric conditions such as psychosis as well as patterns of comorbidity for psychosis have been reported between racial and ethnic groups. It is unclear whether those differences are consistent for comorbid psychosis. Methods Self-reported diagnostic data from American adults ages 18-99 participating in the Collaborative Psychiatric Epidemiology Surveys (CPES) (N ~ 11,844) were used to test the association between four racial and ethnic group categories (White, Asian, Hispanic, Black) and comorbid psychosis. Comorbid psychosis was measured as a 4-level categorical variable (No mental illness nor psychosis, Mental Illness, Psychosis only, comorbid psychosis (i.e., Psychosis + Mental Illness). Chi-square tests were used to determine significant differences in the prevalence of comorbid psychosis by race and ethnicity. A multinomial logistic regression was used to test the association between racial and ethnic classifications and comorbid psychosis after adjusting for common demographic characteristics (i.e., education, sex, income, and age). Results Relative to White participants, Hispanic and Asian participants were less likely to be affected with comorbid psychosis. (Adjusted Odds Ratio, AORAsian = 0.32, CI = 0.22 - 0.47, p <0.0001, AORHispanic = 0.66, CI = 0.48 - 0.92, p = 0.012). Relative to White participants there was not significant association for comorbid psychosis in Black participants (AORBlack = 0.91, CI = 0.70 - 1.20, p = 0.52) In contrast Hispanic and Black participants were more likely to report psychosis alone (AORHispanic = 1.94, CI = 1.27-2.98, p = 0.002, AORBlack = 1.86, 1.24-2.82, p = 0.003) compared to White participants. Conclusion There were different patterns of associations by race and ethnicity for psychosis and comorbid psychosis. The lower prevalence of comorbid psychosis in non-White groups may be due to underdiagnosis or underreporting of other mental disorders.
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Affiliation(s)
- Mariam Sankoh
- Department of Integrative Life Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - James Clifford
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Roseann E. Peterson
- Department of Psychiatry and Behavioral Sciences, Institute for Genomics in Health, Downstate Health Sciences University, State University of Brooklyn, New York, NY, United States
| | - Elizabeth Prom-Wormley
- Department of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States
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Oh H, Karcher NR, Li Verdugo J, Botello R, DeVylder JE, Anglin D. Ethno-racial disparities in psychosis-like experiences among students in higher education: Findings from the Healthy Minds Study 2020-2021. Psychiatry Res 2024; 337:115959. [PMID: 38749075 PMCID: PMC11246701 DOI: 10.1016/j.psychres.2024.115959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Ethno-racial variations of psychosis-like experiences exist in the general population; however, it is unknown whether this variation exists among emerging adults in higher education, and whether there are differences across ethnic groups within racial categories. METHODS Using the Health Minds Study data from 2020 to 2021, we used multivariable logistic regression models to examine race/ethnicity and psychosis-like experiences, adjusting for socio-demographic characteristics (age, gender, international student status). We then adjusted for food insecurity, parental education, and social belonging. RESULTS Black, Hispanic/Latinx, multiracial, and American Indian/Alaska Native students had greater odds of 12-month psychosis-like experiences when compared with White students. These associations attenuated and were no longer statistically significant for Black and Hispanic/Latinx students after adjusting for food insecurity and parental education. Multiracial and American Indian/Alaska Native students still had greater odds of psychosis-like experiences after further adjusting for sense of belonging. When looking at ethnic subgroups, Filipinx and multi-ethnic Asian students had significantly greater odds than East Asian students, and multi-ethnic Black students had greater odds than African Americans. CONCLUSION Odds of psychosis-like experiences vary across and within ethno-racial categories among emerging adults in higher education. Future research may explore psychosis as a disparity impacting Native American/Alaska Native and multiracial/multi-ethnic populations.
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Affiliation(s)
- Hans Oh
- University of Southern California, United States.
| | - Nicole R Karcher
- Washington University in St. Louis School of Medicine, United States
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van der Ven E, Olino TM, Diehl K, Nuñez SM, Thayer G, Bridgwater MA, Ereshefsky S, Musket C, Lincoln SH, Rogers RT, Klaunig MJ, Soohoo E, DeVylder JE, Grattan RE, Schiffman J, Ellman LM, Niendam TA, Anglin DM. Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:447-455. [PMID: 38381422 PMCID: PMC10882506 DOI: 10.1001/jamapsychiatry.2023.5497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/26/2023] [Indexed: 02/22/2024]
Abstract
Importance Studies suggest a higher risk of schizophrenia diagnoses in Black vs White Americans, yet a systematic investigation of disparities that include other ethnoracial groups and multiple outcomes on the psychosis continuum is lacking. Objective To identify ethnoracial risk variation in the US across 3 psychosis continuum outcomes (ie, schizophrenia and other psychotic disorders, clinical high risk for psychosis [CHR-P], and psychotic symptoms [PSs] and psychotic experiences [PEs]). Data Sources PubMed, PsycINFO and Embase were searched up to December 2022. Study Selection Observational studies on ethnoracial differences in risk of 3 psychosis outcomes. Data Extraction and Synthesis Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Using a random-effects model, estimates for ethnoracial differences in schizophrenia and PSs/PEs were pooled and moderation by sampling and setting was determined, along with the assessment of heterogeneity and risk of bias. Main Outcomes and Measures Risk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs. Results Of 64 studies in the systematic review, 47 were included in the meta-analysis comprising 54 929 people with schizophrenia and 223 097 with data on PSs/PEs. Compared with White individuals, Black individuals had increased risk of schizophrenia (pooled odds ratio [OR], 2.07; 95% CI, 1.64-2.61) and PSs/PEs (pooled standardized mean difference [SMD], 0.10; 95% CI, 0.03-0.16), Latinx individuals had higher risk of PSs/PEs (pooled SMD, 0.15; 95% CI, 0.08-0.22), and individuals classified as other ethnoracial group were at significantly higher risk of schizophrenia than White individuals (pooled OR, 1.81; 95% CI, 1.31-2.50). The results regarding CHR-P studies were mixed and inconsistent. Sensitivity analyses showed elevated odds of schizophrenia in Asian individuals in inpatient settings (pooled OR, 1.84; 95% CI, 1.19-2.84) and increased risk of PEs among Asian compared with White individuals, specifically in college samples (pooled SMD, 0.16; 95% CI, 0.02-0.29). Heterogeneity across studies was high, and there was substantial risk of bias in most studies. Conclusions and Relevance Findings of this systematic review and meta-analysis revealed widespread ethnoracial risk variation across multiple psychosis outcomes. In addition to diagnostic, measurement, and hospital bias, systemic influences such as structural racism should be considered as drivers of ethnoracial disparities in outcomes across the psychosis continuum in the US.
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Affiliation(s)
- Els van der Ven
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Thomas M. Olino
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Katharina Diehl
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Stephanie M. Nuñez
- Department of Psychology, The City College of New York, City University of New York, New York
| | - Griffin Thayer
- Department of Psychology, The City College of New York, City University of New York, New York
| | | | - Sabrina Ereshefsky
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Christie Musket
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Sarah Hope Lincoln
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - R. Tyler Rogers
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
| | - Mallory J. Klaunig
- Department of Psychological Science, University of California, Irvine, Irvine
| | - Emily Soohoo
- Department of Biological Sciences, San Jose State University, San Jose, California
| | | | - Rebecca E. Grattan
- School of Psychology, Victoria University of Wellington–Te Herenga Waka, Wellington, New Zealand
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine
| | - Lauren M. Ellman
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento
| | - Deidre M. Anglin
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
- The Graduate Center, City University of New York, New York
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Oh H, Verdugo JL, Karcher NR, van der Ven E, Koyanagi A, Smith L, DeVylder JE. Ethno-racial variation in psychotic experiences in the United States: Findings from the National Latino and Asian American Survey and the National Survey of American Life. Schizophr Res 2023; 262:55-59. [PMID: 37925751 DOI: 10.1016/j.schres.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/26/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Ethno-racial differences in psychosis risk are documented; however, there is less research on whether these differences extend to sub-threshold psychotic experiences, and whether there is significant variation within ethno-racial categories. METHODS We analyzed data from the National Latino and Asian American Survey (NLAAS) and the National Survey of American Life (NSAL). Using multivariable logistic regression, we examined the association between race/ethnicity and lifetime psychotic experiences among Latino, Asian, and Black adults in the general population, adjusting for gender, age, nativity, education level, income level, employment status, and everyday discrimination. RESULTS Puerto Ricans, Cubans, and other Hispanics had greater odds of lifetime psychotic experiences when compared with Mexicans, though differences diminished when adjusting for covariates. Filipino and other Asians had greater odds of lifetime psychotic experiences when compared with Chinese, though again, differences diminished when adjusting for covariates. Among Black Americans, there were no significant ethnic subgroup differences. CONCLUSION Ethno-racial differences extend across the psychosis continuum. There are nuanced health profiles across and within ethno-racial categories. Differences may be attributable to differences in experiences living in the US, underscoring the need for community-specific interventions.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, United States.
| | | | - Nicole R Karcher
- Washington University in St. Louis School of Medicine, Department of Psychiatry, United States
| | - Els van der Ven
- Dept of Clinical, Neuro- & Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Jordan E DeVylder
- Silver School of Social Work, New York University, New York, United States
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Espinosa A, Ruglass LM, Conway FN. The relative contribution of ethnic identity and ethnic discrimination on alcohol, tobacco, and other drug use disorders among Hispanic/Latin American individuals. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 153:208963. [PMID: 37654011 DOI: 10.1016/j.josat.2023.208963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 01/17/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Racial/ethnic discrimination and ethnic identity, the affiliation and connection to one's ethnic group, are important for understanding alcohol, tobacco, and drug use disorders (AUD, TUD, DUD, respectively) among Hispanic/Latin American individuals. Although discrimination is a well-recognized risk factor, the role of ethnic identity is less understood. Moreover, no study has examined which of these factors is more important for informing AUD, TUD, and DUD. This information is necessary for creating effective prevention and treatment programs tailored for Hispanic/Latin American people. Herein we examined the role and relative importance of racial/ethnic discrimination and Hispanic ethnic identity on past year AUD, TUD, and DUD. METHODS Hispanic/Latin American participants of the National Epidemiologic Survey on Alcohol and Related Conditions-III constituted the sample for this cross-sectional secondary data analysis. Participants (N = 7037) were 39.93 years old on average (SD = 15.32). More than half were female (56.1 %) and had family incomes below the median household income in the United States (58.7 %). Most had national origins in North America (79.3 %), including US dependent territories and Mexico. Confirmatory factor analysis (CFA) verified the psychometric properties of the discrimination and Hispanic ethnic identity measures. Logistic regressions, supplemented with dominance analysis, estimated the role and relative contribution of discrimination and Hispanic ethnic identity on the probability of past year AUD, TUD, and DUD. RESULTS The CFAs yielded adequate convergent validity and reliability for each construct. More racial/ethnic discrimination and a higher Hispanic ethnic identity related to a higher and lower probability of AUD, TUD, and DUD, respectively. The magnitude of the association between Hispanic ethnic identity and the probability of TUD exceeded that of racial/ethnic discrimination, but the converse was the case for AUD and DUD. CONCLUSIONS Prevention and treatment programs for TUD that highlight the value of having a strong sense of self as a member of a Hispanic ethnic group, and that encourage the individual to explore their Hispanic ancestry may prove effective among Hispanic/Latin American individuals, particularly those who have experienced racial/ethnic discrimination. Programs for AUD and DUD tailored for Hispanic Latin/American adults should also incorporate coping strategies to address experiences with racial/ethnic discrimination.
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Affiliation(s)
- Adriana Espinosa
- Department of Psychology, The City College of New York, CUNY, United States of America; Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, NJ, United States of America.
| | - Lesia M Ruglass
- Department of Psychology, The City College of New York, CUNY, United States of America; Center of Alcohol & Substance Use Studies, Rutgers University, New Brunswick, NJ, United States of America
| | - Fiona N Conway
- Steve Hicks School of Social Work, The University of Texas at Austin, United States of America
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Oh H, Koyanagi A. Immigrant status and psychotic experiences in the United States: revisiting an immigrant paradox. Psychol Med 2023; 53:301-303. [PMID: 33536106 DOI: 10.1017/s0033291720005462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hans Oh
- University of Southern California, Suzanne Dworak Peck School of Social Work, 1149 South Hill Street Suite #1422, Los Angeles, CA 90015, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
- ICREA, Barcelona, Spain
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7
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Karcher NR, Klaunig MJ, Elsayed NM, Taylor RL, Jay SY, Schiffman J. Understanding Associations Between Race/Ethnicity, Experiences of Discrimination, and Psychotic-like Experiences in Middle Childhood. J Am Acad Child Adolesc Psychiatry 2022; 61:1262-1272. [PMID: 35378237 PMCID: PMC9525459 DOI: 10.1016/j.jaac.2022.03.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/06/2022] [Accepted: 03/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The present study aimed to examine factors that may account for race/ethnicity differences in psychotic-like experiences (PLEs) in a middle childhood sample, including evidence for experiences of discrimination as a psychosocial mediator of these differences. METHOD In a sample of 9- to 10-year-olds (N = 10,839) from the Adolescent Brain Cognitive Development Study, we compared PLEs across racial/ethnic groups. We also examined whether experiences of discrimination indirectly linked racial/ethnic identity and PLEs and whether social support moderated this indirect association. RESULTS Differences between racial/ethnic groups were found in the endorsement of PLEs, such that Black and Hispanic participants endorsed higher levels of PLEs compared with Asian, multiracial/multiethnic, and White participants. These differences were accounted for in part by experiences of discrimination, an indirect effect that was in turn attenuated by increased social support. CONCLUSION This is the first study to suggest that the experience of discrimination may indirectly link the association between racial/ethnic differences and endorsement of PLEs using the Prodromal Questionnaire-Brief Child Version and additionally that social support may act as a moderator of this mediation. Results provide evidence that social inequities such as racial discrimination may contribute to increases in PLEs. These findings shed further light on the links between structural racism and mental health inequities for people in minoritized groups.
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Affiliation(s)
| | - Mallory J Klaunig
- University of Maryland, Baltimore County; University of California, Irvine
| | | | | | | | - Jason Schiffman
- University of Maryland, Baltimore County; University of California, Irvine
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DeVylder J, Endo K, Yamasaki S, Ando S, Hiraiwa-Hasegawa M, Kasai K, Nishida A. Migration and Psychotic Experiences in the Tokyo Teen Cohort. J Migr Health 2022; 5:100078. [PMID: 35118436 PMCID: PMC8800099 DOI: 10.1016/j.jmh.2022.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/30/2022] Open
Abstract
Associations between migration, ethnicity, and psychosis risk have not previously been researched in Japan. Children of migrants to Japan are at an elevated risk for psychotic experiences. The association between migration and psychosis does not appear to be present for children with an above-average IQ. Future studies should explore social exclusion as a potential mechanisms for the associations found in this study.
Background Immigration has been shown to be associated with an increased risk for psychotic experiences, with similar effect sizes for first-generation and second-generation migration (i.e., children whose parents had migrated). However, this association varies by country, and by ethnic group at the within-country level, such that risk is greatest among migrants facing substantial social exclusion and disadvantage. This is the first study to our knowledge to examine migration as a potential risk factor for psychotic experiences in Japan. Method Using data from the Tokyo Teen Cohort (N=3052), we tested whether migrant status was associated with the lifetime prevalence of psychotic experiences at age 10. Results Only 2.2% of the sample (n=68) had at least one migrant parent. Psychotic experiences were more common among children with at least one migrant parent, odds ratio (95% CI) = 2.06(1.26–3.35). This association appeared to be driven primarily by visual hallucinations and thought broadcasting, and specific to children with lower IQ at age 10. Discussion The findings suggest that migrant status is associated with increased likelihood of psychotic experiences at age 10 in Tokyo, Japan. Future prospective research should explore social exclusion as a potential underlying mechanism and can further clarify the protective role of IQ and related factors.
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Affiliation(s)
- Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, United States
- Corresponding author.
| | - Kaori Endo
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN), University of Tokyo Institutes of Advanced Study (UTIAS), Tokyo, Japan
| | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Understanding the Healthy Immigrant Effect in the Context of Mental Health Challenges: A Systematic Critical Review. J Immigr Minor Health 2021; 24:1564-1579. [PMID: 34807354 PMCID: PMC8606270 DOI: 10.1007/s10903-021-01313-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/10/2023]
Abstract
The "Healthy Immigrant Effect" (HIE) suggests that immigrants have a health advantage over the domestic-born which vanishes with increased length of residency. Most HIE research focuses on physical health, with less attention given to mental health (MH). This systematic review of 58 MH studies examines whether there is a MH advantage among immigrants and explores changes in immigrants' MH, besides critically assessing the use of HIE theory. Inconsistent evidence was detected regarding the presence of MH advantage, whereas consistent, convincing evidence was revealed for a decline in immigrants' MH over years. Although the HIE theory can help reveal MH disparities, this theory alone does not explain the reasons for these disparities nor inform about potential avenues to improve immigrants' MH. A paradigm shift is needed to incorporate other potential theoretical concepts/frameworks, including the "Health Inequalities Action" framework, for a broader understanding of MH issues and to inform effective, culturally-sensitive interventions.
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Burkhard C, Cicek S, Barzilay R, Radhakrishnan R, Guloksuz S. Need for Ethnic and Population Diversity in Psychosis Research. Schizophr Bull 2021; 47:889-895. [PMID: 33948664 PMCID: PMC8266627 DOI: 10.1093/schbul/sbab048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article aims to evaluate "racial", ethnic, and population diversity-or lack thereof-in psychosis research, with a particular focus on socio-environmental studies. Samples of psychosis research remain heavily biased toward Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Furthermore, we often fail to acknowledge the lack of diversity, thereby implying that our findings can be generalized to all populations regardless of their social, ethnic, and cultural background. This has major consequences. Clinical trials generate findings that are not generalizable across ethnicity. The genomic-based prediction models are far from being applicable to the "Majority World." Socio-environmental theories of psychosis are solely based on findings of the empirical studies conducted in WEIRD populations. If and how these socio-environmental factors affect individuals in entirely different geographic locations, gene pools, social structures and norms, cultures, and potentially protective counter-factors remain unclear. How socio-environmental factors are assessed and studied is another major shortcoming. By embracing the complexity of environment, the exposome paradigm may facilitate the evaluation of interdependent exposures, which could explain how variations in socio-environmental factors across different social and geographical settings could contribute to divergent paths to psychosis. Testing these divergent paths to psychosis will however require increasing the diversity of study populations that could be achieved by establishing true partnerships between WEIRD societies and the Majority World with the support of funding agencies aspired to foster replicable research across diverse populations. The time has come to make diversity in psychosis research more than a buzzword.
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Affiliation(s)
- Carla Burkhard
- Research Master Student in Cognitive and Clinical Neuroscience Psychopathology Program, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Saba Cicek
- Department of Psychiatry, Gazi University Medical School, Ankara, Turkey
| | - Ran Barzilay
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children’s Hospital of Philadelphia (CHOP), Philadelphia, PA,Lifespan Brain Institute of CHOP and Penn Medicine, Philadelphia, PA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Sinan Guloksuz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands,To whom correspondence should be addressed; Maastricht University Medical Center, Vijverdalseweg 1, PO Box 616, 6200 MD Maastricht, the Netherlands; tel: +31-433-88-40-71, fax: +31-433-88-4122, e-mail:
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11
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Bilal PI, Chan CKY, Somerset SM. Acculturation and Perceived Ethnic Discrimination Predict Elevated Blood Glucose Level in Sub-Saharan African Immigrants in Australia. J Immigr Minor Health 2021; 22:771-777. [PMID: 31845072 DOI: 10.1007/s10903-019-00958-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sub-Saharan African migrants experience significant sociocultural challenges, including those related to acculturation and perceived ethnic discrimination (PED), in addition to increased risk of non-communicable diseases, such as type 2 diabetes mellitus (T2DM). Although acculturation and PED are each established risk factors for elevated blood glucose level (EGBL) and T2DM, they have not been studied in relation to EBGL risk in a single model. This study aimed to investigate associations between acculturation, PED and EBGL in a sub-Saharan African migrant population in Australia. Face to face survey using a purposive sampling method was used to collect data from 170 adults, aged 18-72 years. A large proportion (41.8%) of the study group was in the integration mode of acculturation, which strongly correlated positively with EBGL/T2DM, although traditional mode correlated inversely with EBGL/T2DM. PED correlated positively with EBG/LT2DM. Immigrants manifesting the integration mode were 4.2 times more likely to have EBGL/T2DM than other acculturation modes. Multiple linear regression showed that the association between integration mode and EBGL/T2DM was mediated by PED. The apparent interaction between PED and acculturation in relation to EBGL/T2DM risk suggests that interventions to lower T2DM risk in this population may benefit from incorporating strategies to address these two important health determinants.
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Affiliation(s)
- P I Bilal
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Brisbane, Australia.
| | - C K Y Chan
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - S M Somerset
- Faculty of Health, University of Canberra, Bruce, Australia
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12
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Sadness and the continuum from well-being to depressive disorder: Findings from a representative US population sample. J Psychiatr Res 2021; 132:50-54. [PMID: 33038566 DOI: 10.1016/j.jpsychires.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Sadness is a common symptom in the general population. We tested the hypothesis that sadness is an intermediate state on a continuum from well-being to major depressive disorder (MDD). METHODS Using data from The National Epidemiologic Study of Alcohol and Related Conditions III (NESARC-III), a large and representative US population sample, we assessed the prevalence of sadness, its sociodemographic and clinical correlates, using three non-overlapping groups: (i) non-depressed sad participants, (ii) non-sad non-depressed participants and (iii) depressed participants. We estimated sensitivity and specificity of sadness. RESULTS Sadness was frequent in the general population 34.3%), and present in almost all participants with MDD (99.6%). Sad (N = 4593) and MDD participants (N = 4593) and 7889 respectively) shared common sociodemographic characteristics. Compared to controls, sad and MDD participants presented more psychiatric disorders, including anxiety, substance use, psychotic, eating and personality disorders. Sadness was an intermediate state, sad individuals reporting more psychiatric disorders than controls, but less than participants with MDD. Sadness demonstrated a very high sensitivity (99.6%), with a good specificity (83.8%) for MDD. LIMITATIONS The NESARC assessed sadness over lifetime, which may involve memorization bias. CONCLUSION Our study confirms the existence of a depressive continuum. Sadness is frequent in general population, and shares correlates with MDD. We have also shown a continuum where sadness is an intermediate state between well-being and psychiatric disorders. With high sensitivity and specificity, sadness appears as a clear MDD prodrome and at-risk state, and may be a symptom of a transdiagnostic distress process.
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Le Strat Y, Melchior M, Gorwood P, Tebeka S, Dubertret C. The role of comorbidity in the association of obesity with unemployment and disability. Ann Epidemiol 2020; 45:61-68. [PMID: 32336657 DOI: 10.1016/j.annepidem.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The association of obesity with a large range of physical conditions and numerous psychiatric disorders has been extensively studied. Our study sought the extent to which physical conditions or psychiatric disorders associated with obesity mediate the association of obesity with unemployment or disability. METHODS Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III, 2012-2013), we estimated the prevalence of unemployment as a function of obesity taking into account these comorbidities. Data on self-reported height and weight were available for 35,725 respondents. Clinician-diagnosed physical conditions were self-reported and lifetime psychiatric disorders were assessed with a semistructured interview. RESULTS The adjusted prevalence of obesity was 30.4%. Participants with obesity were more likely than participants without obesity to report at least one of the 31 assessed physical conditions (64.46% vs. 46.87%; P < .001). Participants with obesity were more likely to report at least one of the 24 assessed psychiatric diagnoses than respondents without obesity (60.57 vs. 56.75%; P < .001). The rates of unemployment were higher in participants with obesity than in those without obesity (15.75% vs. 11.26%; P < .001). Similarly, participants with obesity reported higher rates of disability than those without obesity. Although the number of physical conditions and psychiatric disorders partly explains this association, obesity remained significantly associated with unemployment and greater disability when controlling for the number of physical conditions and psychiatric disorders. CONCLUSIONS Obesity is associated with high rates of unemployment and with high disability. This is not explained solely by the high rate of physical conditions and psychiatric disorders associated with obesity.
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Affiliation(s)
- Yann Le Strat
- Université de Paris, INSERM U1266, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Maria Melchior
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Philip Gorwood
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France; CMME, Sainte Anne Hospital, AP-HP, Colombes, France
| | - Sarah Tebeka
- Université de Paris, INSERM U1266, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France.
| | - Caroline Dubertret
- Université de Paris, INSERM U1266, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
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Anglin DM, Lui F, Schneider M, Ellman LM. Changes in perceived neighborhood ethnic density among racial and ethnic minorities over time and psychotic-like experiences. Schizophr Res 2020; 216:330-338. [PMID: 31822432 PMCID: PMC7374710 DOI: 10.1016/j.schres.2019.11.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/02/2019] [Accepted: 11/22/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Research primarily conducted in Europe find high neighborhood ethnic density (i.e., proportion of own ethnic group) lessens risk of psychotic symptoms among racial and ethnic minorities; however, most studies measure ethnic density through crude demarcations in geographic data only at illness onset which may miss meaningful variation from the perspective of residents. The present study is the first in the U.S. to examine whether changes in perceived ethnic density from childhood are associated with psychotic-like experiences (PLE). METHODS A Northeastern U.S. urban undergraduate sample of 1330 racial and ethnic minorities completed a self-report inventory of PLE, the Prodromal Questionnaire, and indicated their racial and ethnic neighborhood composition before and after age 12. One way analyses of covariance (ANCOVA) adjusted for age, family poverty, racial and ethnic group, immigrant status, and lifetime cannabis use, compared PLE across ethnic density categories and change. RESULTS Racial and ethnic minorities who grew up in a neighborhood (before age 12) predominantly inhabited by a different group of color (e.g., being Black in a predominantly Asian neighborhood) endorsed significantly more PLE than those who grew up in racially concordant, mixed, or predominantly White neighborhoods. In addition, those reporting a change in perceived neighborhood ethnic density after age 12 endorsed significantly more PLE than those reporting no change. CONCLUSION Racial dynamics among people of color in urban neighborhood U.S. contexts may create psychological challenges in the social environment. The developmental timing of demographic changes in neighborhoods may influence stress processes that enhance risk for PLE.
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Affiliation(s)
- Deidre M. Anglin
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, North Academic Center, New York, NY 10031,The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016
| | - Florence Lui
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, North Academic Center, New York, NY 10031,The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016
| | - Matthew Schneider
- Department of Psychology, The City College of New York, City University of New York, 160 Convent Avenue, North Academic Center, New York, NY 10031,The Graduate Center, City University of New York, 365 5th Avenue, New York, NY, 10016
| | - Lauren M. Ellman
- Department of Psychology, Temple University, 1801 N. Broad Street, Philadelphia, PA 19122
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Leaune E, Dealberto MJ, Luck D, Grot S, Zeroug-Vial H, Poulet E, Brunelin J. Ethnic minority position and migrant status as risk factors for psychotic symptoms in the general population: a meta-analysis. Psychol Med 2019; 49:545-558. [PMID: 30178719 DOI: 10.1017/s0033291718002271] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Psychotic symptoms (PS) are experienced by a substantial proportion of the general population. When not reaching a threshold of clinical relevance, these symptoms are defined as psychotic experiences (PEs) and may exist on a continuum with psychotic disorders. Unfavorable socio-environmental conditions, such as ethnic minority position (EMP) and migrant status (MS), may increase the risk of developing PS and PEs. We conducted an electronic systematic review and a meta-analysis assessing the role of EMP and MS for the development and persistence of PS in the general population. Sub-group analyses were performed investigating the influence of ethnic groups, host countries, age, types of PS, and scales. Twenty-four studies met our inclusion criteria. EMP was a relevant risk factor for reporting PS [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.22-1.70) and PEs (OR 1.36, 95% CI 1.16-1.60). The greatest risk was observed in people from the Maghreb and the Middle East ethnic groups in Europe (OR 3.30, 95% CI 2.09-5.21), in Hispanic in the USA (OR 1.98, 95% CI 1.43-2.73), and in the Black populations (OR 1.85, 95% CI 1.39-2.47). We found a significant association between MS and delusional symptoms (OR 1.47, 95% CI 1.33-1.62). We found no association between EMP and persistence of PEs.EMP was associated with increased risk of reporting PS and PEs, and the risk was higher in ethnic groups facing deprivation and discrimination. We found an association between MS and delusional symptoms. These results raise questions about the precise role of socio-environmental factors along the psychosis continuum.
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Affiliation(s)
| | | | - David Luck
- Centre de recherche, Institut Universitaire en Santé Mentale de Montréal,Canada
| | - Stéphanie Grot
- Centre de recherche, Institut Universitaire en Santé Mentale de Montréal,Canada
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Tortelli A, Nakamura A, Suprani F, Schürhoff F, Van der Waerden J, Szöke A, Tarricone I, Pignon B. Subclinical psychosis in adult migrants and ethnic minorities: systematic review and meta-analysis. BJPsych Open 2018; 4:510-518. [PMID: 30564447 PMCID: PMC6293451 DOI: 10.1192/bjo.2018.68] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is well established that migration and ethnic minority status are risk factors for psychotic disorders. Recent studies have aimed to determine if they are also associated with subclinical psychosis (psychotic-like experiences and schizotypal traits). AIMS We aimed to determine to what extent migrant and ethnic minority groups are associated with higher risk of subclinical psychosis. METHOD We conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and examined findings by ethnicity, migrant status, outcomes of subclinical psychosis and host country. A meta-analysis was carried out with robust variance estimation where possible, to handle statistically dependent effect size estimates. RESULTS We included 28 studies (19 studies on psychotic-like experiences and 9 studies on schizotypal traits) and found that ethnicity, but not migrant status, was associated with current and lifetime psychotic-like experiences. In the narrative analysis, we observed the effect of psychosocial risk factors on this association: Black ethnicity groups showed consistent increased prevalence of current and lifetime psychotic-like experiences compared with the reference population across countries. CONCLUSIONS More generalisable and standardised cohort studies of psychotic-like experiences and schizotypal traits in relation to migration/ethnicity are necessary to examine the effects of exposures and outcomes in different contexts, and to understand the underlying mechanisms of the association between subclinical psychosis and migrant and ethnic minority status. DECLARATION OF INTEREST None.
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Affiliation(s)
- Andrea Tortelli
- U955-15, INSERM, Créteil and Pôle GHT Psychiatrie Précarité, Paris, France
| | - Aurélie Nakamura
- UMR_S 1136, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, France
| | - Federico Suprani
- Department of Medical and Surgical Sciences, Bologna University, Italy
| | - Franck Schürhoff
- U955-15, INSERM and Pôle de Psychiatrie et d'Addictologie, DHU PePSY, Hôpitaux universitaires Henri-Mondor, AP-HP and Fondation FondaMental Scientific Cooperation Foundation, F-94010 Creteil and Faculté de médecine, University Paris-Est Créteil, France
| | - Judith Van der Waerden
- UMR_S 1136, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, l'université Pierre et Marie Curie, France
| | - Andrei Szöke
- U955-15, INSERM and Pôle de Psychiatrie et d'Addictologie, DHU PePSY, Hôpitaux universitaires Henri-Mondor, AP-HP and Fondation FondaMental, France
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna University, Italy
| | - Baptiste Pignon
- U955-15, INSERM and Pôle de Psychiatrie et d'Addictologie, DHU PePSY, Hôpitaux universitaires Henri-Mondor, AP-HP and Fondation FondaMental and Faculté de médecine, University Paris-Est Créteil, France
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Psychotic experiences and disability: Findings from the Collaborative Psychiatric Epidemiology Surveys. Schizophr Res 2018; 193:343-347. [PMID: 28797526 PMCID: PMC5912340 DOI: 10.1016/j.schres.2017.07.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022]
Abstract
Psychotic experiences are associated with a number of poor clinical outcomes, including multimorbid psychopathology, suicidal behavior, and poor treatment response. We wished to investigate the relationship between psychotic experiences and disability, including the following domains: cognition, mobility, self-care, social interaction, role functioning, and days out of role. We used three nationally representative and racially/ethnically diverse samples of the general US adult population: the National Comorbidity Survey Replication (NCS-R), the National Latino and Asian American Survey (NLAAS), and the National Survey of American Life (NSAL). Multi-variable logistic regression analyses were used to assess the associations between lifetime psychotic experiences (visual and auditory hallucinatory experiences and delusional ideation; WHO Composite International Diagnostic Interview psychosis screen) and 30-day impairments in functioning across disability domains (using the WHO Disability Assessment Schedule II). In all three samples, models were adjusted for socio-demographics and co-occurring psychiatric disorders. In the NCS-R, models were also adjusted for chronic health conditions. Across all three studies, our adjusted models showed that people with disability had anywhere from about 1.5 to over 3 times the odds of reporting lifetime psychotic experiences, depending on the domain. This was true for each disability domain, except self-care in the NLAAS and in the NSAL. Psychotic experiences are markers of risk for disability across a wide range of domains. This may explain the elevated rates of service utilization among individuals who report psychotic experiences and supports the need to assess for and respond to psychotic experiences even in the absence of psychotic disorder.
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Termorshuizen F, Selten JP, Heerdink ER. Dispensing of psychotropic medication among 400,000 immigrants in The Netherlands. Soc Psychiatry Psychiatr Epidemiol 2017; 52:963-977. [PMID: 28616632 PMCID: PMC5534199 DOI: 10.1007/s00127-017-1405-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/03/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Previously, a high prevalence of certain psychiatric disorders was shown among non-Western immigrants. This study explores whether this results in more prescriptions for psychotropic medication. METHODS Data on dispensing of medication among adults living in the four largest Dutch cities in 2013 were linked to demographic data from Statistics Netherlands. Incident (i.e., following no dispensing in 2010-2012) and prevalent dispensing among immigrants was compared to that among native Dutch (N = 1,043,732) and analyzed using multivariable Poisson and logistic regression. RESULTS High adjusted Odds Ratios (ORadj) of prevalent and high Incidence Rate Ratios (IRRadj) of incident dispensing of antipsychotics were found among Moroccan (N = 115,455) and Turkish individuals (N = 105,460), especially among young Moroccan males (ORadj = 3.22 [2.99-3.47]). Among Surinamese (N = 147,123) and Antillean individuals (N = 41,430), slightly higher rates of dispensed antipsychotics were found and the estimates decreased after adjustment. The estimates for antipsychotic dispensing among the Moroccan and Turkish increased, following adjustment for household composition. Rates for antidepressant dispensing among Turkish and Moroccan subjects were high (Moroccans: ORadj = 1.74 [1.70-1.78]). Among Surinamese and Antillean subjects, the rates for antidepressant dispensing were low and the ORadj lagged behind the IRRadj (Surinamese: 0.69 [0.67-0.71] vs. 1.06 [1.00-1.13]). Similar results were found for anxiolytics. For ADHD medication, lower dispensing rates were found among all migrant groups. CONCLUSIONS The findings agree with earlier reports of more mental health problems among Moroccan and Turkish individuals. Surinamese/Antillean individuals did not use psychotropic drugs at excess and discontinued antidepressants and anxiolytics earlier. The data strongly suggest under-treatment for ADHD in all ethnic minority groups.
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Affiliation(s)
- Fabian Termorshuizen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands. .,Rivierduinen, Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ, Leiden, The Netherlands.
| | - Jean-Paul Selten
- Rivierduinen, Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands ,0000 0001 0481 6099grid.5012.6Department of Psychiatry and Psychology, School for Mental Health and Neuroscience MHeNS, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Eibert R. Heerdink
- 0000000120346234grid.5477.1Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, P.O. Box 80082, 3508 TB Utrecht, The Netherlands ,0000000090126352grid.7692.aDepartment of Clinical Pharmacy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Paksarian D, Merikangas KR, Calkins ME, Gur RE. Racial-ethnic disparities in empirically-derived subtypes of subclinical psychosis among a U.S. sample of youths. Schizophr Res 2016; 170:205-10. [PMID: 26711527 PMCID: PMC4790463 DOI: 10.1016/j.schres.2015.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Racial-ethnic minority status is a consistent risk factor for schizophrenia, with associations extending to bipolar disorder and subthreshold psychotic experiences. However, few epidemiologic studies have been conducted in the U.S., and evidence is inconsistent. Furthermore, no U.S. studies of youths have directly investigated the phenomenological overlap between schizophrenia and bipolar disorder. We aimed to do so at the subthreshold level in the Philadelphia Neurodevelopmental Cohort. METHODS Participants included 6533 individuals, age 11-21years, from a community healthcare network. Latent class analysis was used to form subtypes of sub-psychosis based on 12 attenuated positive items and 7 mania items without duration criteria. Associations between race-ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, "other") and sub-psychosis subtype were estimated using latent class regression. RESULTS Four classes were identified: Sub-positive Only (13.4%), Mania Only (15.5%), Both (9.1%), and Neither (62.0%). Minority participants were generally more likely than non-Hispanic whites to belong to one of the three sub-psychosis classes compared to the Neither class. Associations for Hispanics and non-Hispanic blacks remained after adjustment for age, sex, and maternal education, and restriction to participants without significant physical health conditions. Racial-ethnic disparities were greater in magnitude for the two classes characterized by sub-positive symptoms, Sub-positive Only and Both, than for the Mania Only class. This pattern was statistically significant among non-Hispanic blacks. CONCLUSIONS We found evidence for racial-ethnic disparities in empirically-derived subtypes of subthreshold psychosis, broadly defined, among U.S. youths. Further research is needed to determine whether these disparities persist to the clinical disorder level in adulthood.
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Affiliation(s)
- Diana Paksarian
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35A Convent Drive, MSC#3720, Bethesda, MD 20892, USA.
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, 35A Convent Drive, MSC#3720, Bethesda, MD 20892, USA
| | - Monica E Calkins
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 10(th) Floor, Gates Bldg., Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 10(th) Floor, Gates Bldg., Philadelphia, PA 19104, USA
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