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Kingston JL, Schlier B, Lincoln T, So SH, Gaudiano BA, Morris EMJ, Phiri P, Ellett L. Paranoid Thinking as a Function of Minority Group Status and Intersectionality: An International Examination of the Role of Negative Beliefs. Schizophr Bull 2023; 49:1078-1087. [PMID: 36940411 PMCID: PMC10318883 DOI: 10.1093/schbul/sbad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
BACKGROUND Paranoia is higher in minority group individuals, especially those reporting intersecting aspects of difference. High negative and low positive self and other beliefs, and low social rank, are predictive of paranoia overtime; however, data are typically from majority group participants. This study examined whether social defeat or healthy cultural mistrust best characterizes paranoia in minority groups. STUDY DESIGN Using cross-sectional, survey design, with a large (n = 2510) international sample, moderation analyses (PROCESS) examined whether self and other beliefs, and perceived social rank, operate similarly or differently in minority vs majority group participants. Specifically, we tested whether beliefs moderated the influence of minority group, and intersecting aspects of difference, on paranoia. STUDY RESULTS Paranoia was consistently higher in participants from minority vs majority groups and level of paranoid thinking was significantly higher at each level of the intersectionality index. Negative self/other beliefs were associated with elevated paranoia in all participants. However, in support of the notion of healthy cultural mistrust, low social rank, and low positive self/other beliefs were significantly associated with paranoia in majority group participants but unrelated to paranoia in respective minority group members. CONCLUSIONS Although mixed, our findings signal the need to consider healthy cultural mistrust when examining paranoia in minority groups and bring into question whether "paranoia" accurately describes the experiences of marginalized individuals, at least at low levels of severity. Further research on paranoia in minority groups is crucial to developing culturally appropriate ways of understanding people's experiences in the context of victimization, discrimination, and difference.
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Affiliation(s)
- J L Kingston
- Department of Psychology, Royal Holloway, University of London, Bowyer, UK
| | - B Schlier
- University of Hamburg, Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - T Lincoln
- University of Hamburg, Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - S H So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - B A Gaudiano
- Department of Psychiatry & Human Behavior, Brown University and Butler Hospital, Providence, RI, USA
| | - E M J Morris
- School of Psychology & Public Health, La Trobe University, Bundoora, Melbourne, Australia
| | - P Phiri
- Southern Health NHS Foundation Trust, Botley Rd, West End, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - L Ellett
- School of Psychology, University of Southampton, Southampton, UK
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Bridgwater MA, Petti E, Giljen M, Akouri-Shan L, DeLuca JS, Rakhshan Rouhakhtar P, Millar C, Karcher NR, Martin EA, DeVylder J, Anglin D, Williams R, Ellman LM, Mittal VA, Schiffman J. Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States. Front Psychiatry 2023; 14:1117022. [PMID: 36993932 PMCID: PMC10040591 DOI: 10.3389/fpsyt.2023.1117022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundSince its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature.ResultsExisting literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population.ConclusionsCollectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field's prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR.
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Affiliation(s)
- Miranda A. Bridgwater
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Emily Petti
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Maksim Giljen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - LeeAnn Akouri-Shan
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Joseph S. DeLuca
- Department of Psychological and Brain Sciences, Fairfield University, Fairfield, CT, United States
| | | | - Caroline Millar
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Nicole R. Karcher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Elizabeth A. Martin
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, United States
| | - Deidre Anglin
- Department of Psychology, The City College of New York, New York, NY, United States
| | | | - Lauren M. Ellman
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
- *Correspondence: Jason Schiffman
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Rakhshan Rouhakhtar P, Roemer C, Reeves G, Schiffman J. The associations between attenuated psychosis symptoms and functioning in Black and White youth at clinical high-risk for psychosis. Schizophr Res 2023; 253:40-47. [PMID: 34922800 DOI: 10.1016/j.schres.2021.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/22/2022]
Abstract
Extensive research has demonstrated racial disparities, particularly among Black individuals, in both presentation and course of psychosis spectrum disorders. Few studies, however, have examined racial differences in the clinical high-risk (CHR) phase of illness. It is unclear if functional deficits seen in association with CHR symptoms generalize to marginalized racial groups, or whether race may play a role in the link between symptoms and functioning. In a sample of youth at CHR (N = 46), the present study examined the effect of race (Black and White represented in this sample) on the relation between CHR symptoms and social/role functioning. Race had a moderating effect on the relation between CHR symptoms and social functioning for total positive symptom score (p < .04, f2 = 0.10). Although positive symptoms were associated with worse social functioning for White participants, no association was found for Black participants. Follow up analyses indicated suspiciousness was a statistically significant predictor of social functioning for White participants but was unrelated to functioning for Black participants. Results may be indicative of phenomenon experienced by individuals within racial minority groups (e.g., "healthy suspiciousness") or potential measurement validity concerns. Findings further the understanding of racial differences in the CHR phase of illness among White and Black youth and highlight limitations of the existing CHR literature and assessment tools for diverse youth.
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Affiliation(s)
- Pamela Rakhshan Rouhakhtar
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States of America; University of Maryland School of Medicine, Division of Child & Adolescent Psychiatry, 701 W. Pratt Street, Baltimore, MD 21201, United States of America.
| | - Caroline Roemer
- University of Maryland, Baltimore County, Department of Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States of America
| | - Gloria Reeves
- University of Maryland School of Medicine, Division of Child & Adolescent Psychiatry, 701 W. Pratt Street, Baltimore, MD 21201, United States of America
| | - Jason Schiffman
- University of California, Irvine, Department of Psychological Science, 4201 Social & Behavioral Sciences Gateway, Irvine, CA 92697, United States of America
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Misra S, Etkins OS, Yang LH, Williams DR. Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans. Am J Public Health 2022; 112:624-632. [PMID: 35319958 PMCID: PMC8961835 DOI: 10.2105/ajph.2021.306631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Abstract
Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).
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Affiliation(s)
- Supriya Misra
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Onisha S Etkins
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - Lawrence H Yang
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
| | - David R Williams
- Supriya Misra is with the Department of Public Health, San Francisco State University, San Francisco, CA. Onisha S. Etkins and David R. Williams are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA. Lawrence H. Yang is with the Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY
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Wittmann L, Dorner R, Heuer I, Bock T, Mahlke C. Effectiveness of a contact-based anti-stigma intervention for police officers. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 76:101697. [PMID: 33836436 DOI: 10.1016/j.ijlp.2021.101697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Police force interaction rates with individuals with mental health conditions are on the rise. International research reveals that the presence of a mental health condition increases the risk for detention and use of force by police officers. Stigmatization of individuals with mental health conditions as dangerous and unpredictable is assumed to have an impact on the likelihood of police use of force. The following study examines a trialogical intervention to reduce stigmatization of individuals with a diagnosis of schizophrenia in a police officer sample. METHOD 1318 police officers participated in a trialogical contact-based intervention with the aim to reduce stigmatizing attitudes and beliefs. Emotional reactions, stereotypes and social distance were assessed prior to and after the intervention in a one-group design. RESULTS Negative stereotypes were positively associated with social distance in individuals with a diagnosis of schizophrenia and were positively associated with anxiety. Dependent sample t-test revealed reduced anxiety towards individuals with a diagnosis of schizophrenia, less negative stereotypes, and less social distance post intervention. All results were significant, and all effect sizes showed a small to moderate effect. CONCLUSIONS Trialogical contact-based, short-term anti-stigma interventions appear to reduce stigmatizing attitudes towards individuals with mental health conditions in a large police force sample. A missing control group is a key study limitation. Further research is needed to examine the effectiveness of the intervention in a randomized-controlled trial. However, the results clearly suggest that anti-stigma interventions could be beneficially introduced into police training.
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Affiliation(s)
- Linus Wittmann
- Department of Health Psychology and Health Education, University of Flensburg, Germany.
| | - Robert Dorner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Imke Heuer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Germany
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Xuan W, Song D, Yan Y, Yang M, Sun Y. Police Violence among Adults Diagnosed with Mental Disorders. HEALTH & SOCIAL WORK 2020; 45:81-89. [PMID: 32393967 PMCID: PMC7683147 DOI: 10.1093/hsw/hlaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 06/11/2023]
Abstract
Police violence is reportedly common among those diagnosed with mental disorders characterized by the presence of psychotic symptoms or pronounced emotional lability. Despite the perception that people with mental illness are disproportionately mistreated by the police, there is relatively little empirical research on this topic. A cross-sectional general population survey was administered online in 2017 to 1,000 adults in two eastern U.S. cities to examine the relationship between police violence exposure, mental disorders, and crime involvement. Results from hierarchical logistic regression and mediation analyses revealed that a range of mental health conditions are broadly associated with elevated risk for police violence exposure. Individuals with severe mental illness are more likely than the general population to be physically victimized by police, regardless of their involvement in criminal activities. Most of the excess risk of police violence exposure related to common psychiatric diagnoses was explained by confounding factors including crime involvement. However, crime involvement may necessitate more police contact, but does not necessarily justify victimization or excessive force (particularly sexual and psychological violence). Findings support the need for adequate training for police officers on how to safely interact with people with mental health conditions, particularly severe mental illness.
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Affiliation(s)
- Wei Xuan
- Department of Hepatopancreaticobiliary Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Dandan Song
- Department of Clinical Laboratory, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun 130041, China
- State Key Laboratory of Inorganic Synthesis and Preparative Chemistry, College of Chemistry, Jilin University, Changchun 130012, China
| | - Youyou Yan
- Department of Cardiology, Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun 130041, China
| | - Ming Yang
- Department of Molecular Biology, College of Basic Medical Sciences, No. 126 Xinmin Street, Changchun 130041, China
| | - Yan Sun
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun 130033, China
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Smith ME, Sharpe TL, Richardson J, Pahwa R, Smith D, DeVylder J. The impact of exposure to gun violence fatality on mental health outcomes in four urban U.S. settings. Soc Sci Med 2020; 246:112587. [DOI: 10.1016/j.socscimed.2019.112587] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 08/13/2019] [Accepted: 10/03/2019] [Indexed: 11/26/2022]
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DeVylder JE, Jun HJ, Fedina L, Coleman D, Anglin D, Cogburn C, Link B, Barth RP. Association of Exposure to Police Violence With Prevalence of Mental Health Symptoms Among Urban Residents in the United States. JAMA Netw Open 2018; 1:e184945. [PMID: 30646377 PMCID: PMC6324385 DOI: 10.1001/jamanetworkopen.2018.4945] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. OBJECTIVE To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. EXPOSURES Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). MAIN OUTCOMES AND MEASURES Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. RESULTS Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). CONCLUSIONS AND RELEVANCE Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence.
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Affiliation(s)
- Jordan E. DeVylder
- Graduate School of Social Service, Fordham University, New York, New York
| | - Hyun-Jin Jun
- School of Social Work, University of Maryland, Baltimore
| | - Lisa Fedina
- School of Social Work, University of Maryland, Baltimore
- School of Social Work, University of Michigan, Ann Arbor
| | - Daniel Coleman
- Graduate School of Social Service, Fordham University, New York, New York
| | | | | | - Bruce Link
- School of Public Policy, University of California Riverside, Riverside
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