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Desmarais SL, Morrissey B, Lowder EM, Zottola SA. Patterns of Self-Reported Mental Health Symptoms and Treatment among People Booked into a Large Metropolitan County Jail. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01398-8. [PMID: 39014285 DOI: 10.1007/s10488-024-01398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
The Brief Jail Mental Health Screen (BJMHS) is one of the most well-known and frequently used tools to conduct routine mental health screening at jail intake. In prior research, the BJMHS results typically have been evaluated overall (i.e., yes/no positive screen). However, there is heterogeneity in symptom presentation and treatment histories among people with serious mental illness, and there are potential consequences of this heterogeneity for mental health administration and policy in jails. We conducted a latent class analysis of BJMHS item-level results using administrative data for 37,998 people booked into a southeastern, metropolitan, U.S. county jail over a 3.5-year period. A 4-class solution provided the best fitting and most interpretable model. The largest class (89.5%) comprised people unlikely to report symptoms or treatment histories (limited symptoms). The next class comprised people who were unlikely to report ongoing symptoms but reported medication and hospitalization (managed symptoms). The third class (2.5%) included people likely to report feeling useless/sinful, prior hospitalization, and current psychiatric medication (depressive symptoms). The fourth class (1.0%) comprised people likely to report thought control, paranoia, feeling useless/sinful, medication, and hospitalization (psychotic symptoms). Controlling for sociodemographic and booking characteristics, people in the managed, depressive, and psychotic symptoms classes had significantly longer jail stays compared to those in the limited symptoms class. People in the managed and depressive symptoms classes were at heightened risk of re-arrest compared to the limited symptoms class. Findings can inform case prioritization and the allocation of resources to support efficient and effective jail-based mental health services.
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Affiliation(s)
| | - Brandon Morrissey
- Policy Research Associates, Inc, Troy, 12180, NY, US
- North Carolina State University, Raleigh, NC, 27695, US
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Paquin V, Guay E, Moderie C, Paradis C, Nahiddi N, Philippe FL, Geoffroy MC. Psychotic-like experiences and associated factors in resident physicians: A Canadian cross-sectional study. Early Interv Psychiatry 2024. [PMID: 38767000 DOI: 10.1111/eip.13564] [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: 01/10/2024] [Revised: 05/05/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
AIM Medical residency training is associated with a range of sociodemographic, lifestyle and mental health factors that may confer higher risk for psychotic-like experiences (PLEs) in residents, yet little research has examined this question. Thus, we aimed to document the prevalence and associated factors of PLEs among resident physicians. METHODS Physicians enrolled in residency programmes in the Province of Québec, Canada (four universities) were recruited in Fall 2022 via their programme coordinators and social media. They completed an online questionnaire assessing PLEs in the past 3 months (the 15-item Community Assessment of Psychic Experiences), as well as sociodemographic characteristics, lifestyle and mental health. Analyses included survey weights and gamma regressions. RESULTS The sample included 502 residents (mean age, 27.6 years; 65.9% women). Only 1.3% (95% CI: 0.5%, 4.0%) of residents met the screening cut-off for psychotic disorder. Factors associated with higher scores for PLEs included racialised minority status (relative difference: +7.5%; 95% CI: +2.2%, +13.2%) and English versus French as preferred language (relative difference: +7.9% 95% CI: +3.1%, +12.9%), as well as each additional point on scales of depression (relative difference: +0.8%; 95% CI: +0.3%, +1.3%) and anxiety (relative difference: +1.3%; 95% CI: +0.8%, +1.7%). In secondary analyses, racialised minority status was associated with persecutory items, but not with other PLEs. Gender, residency programmes and lifestyle variables were not associated with PLEs. CONCLUSIONS This study found low reports of PLEs in a sample of resident physicians. Associations of PLEs with minoritised status may reflect experiences of discrimination.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
| | - Emilie Guay
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Christophe Moderie
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Camille Paradis
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Nima Nahiddi
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Frederick L Philippe
- Department of Psychology, University of Québec in Montréal, Montréal, Quebec, Canada
| | - Marie-Claude Geoffroy
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
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Michaels TI, Simon-Pearson L, Kane JM, Cornblatt B. Racial Disparities Among Clinical High-Risk and First-Episode Psychosis Multisite Research Participants: A Systematic Review. Psychiatr Serv 2024; 75:451-460. [PMID: 38204372 DOI: 10.1176/appi.ps.20230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The NIH has mandated equal representation of Black, Indigenous, and people of color (BIPOC) individuals in clinical research, but it is unclear whether such inclusion has been achieved in multisite research studies of individuals at clinical high risk for psychosis or with first-episode psychosis (FEP). An assessment of inclusion rates is important for understanding the social determinants of psychosis and psychosis risk that specifically affect BIPOC individuals. METHODS The authors conducted a systematic review of the literature published between 1993 and 2022 of multisite research studies of clinical high risk for psychosis and FEP in North America to determine ethnoracial inclusion rates. Using an online systematic review tool, the authors checked 2,278 studies for eligibility. Twelve studies met all inclusion criteria. Data were extracted, and demographic characteristics, socioeconomic status, study design, and recruitment strategies used by each study were analyzed. RESULTS Most (62%) of the participants in studies of clinical high risk for psychosis were White. Compared with national data, the demographic characteristics of individuals with clinical high risk were representative across most ethnoracial groups. Black participants (43%) made up the largest ethnoracial group in FEP studies and were overrepresented compared with their representation in the U.S. population. FEP studies were more likely to recruit participants from community mental health centers than were the studies of clinical high risk. CONCLUSIONS Although these results suggest high representation of BIPOC individuals in psychosis research, opportunities exist for an improved focus on ethnoracial representation. The authors offer recommendations for practices that may increase ethnoracial diversity in future psychosis study samples.
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Affiliation(s)
- Timothy I Michaels
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Laura Simon-Pearson
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - John M Kane
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
| | - Barbara Cornblatt
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Michaels, Simon-Pearson, Cornblatt); Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York (Michaels, Kane); Department of Psychology, Hofstra University, Hempstead, New York (Simon-Pearson); Institute of Behavioral Science (Kane) and Center for Psychiatric Neuroscience (Cornblatt), Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York
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Monette MA, Russell MT, Abel DB, Lewis JT, Mickens JL, Myers EJ, Hricovec MM, Cicero DC, Wolny J, Hetrick WP, Masucci MD, Cohen AS, Burgin CJ, Kwapil TR, Minor KS. Differential Risk: Gender and Racial Differences in the Relationship between Trauma, Discrimination, and Schizotypy. Behav Sci (Basel) 2024; 14:363. [PMID: 38785854 PMCID: PMC11117737 DOI: 10.3390/bs14050363] [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: 01/29/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Traumatic experiences are associated with increased experiences of positive schizotypy. This may be especially important for People of Color, who experience higher rates of trauma and racial discrimination. No study to date has examined how racial disparities in traumatic experiences may impact schizotypy. Furthermore, of the studies that have examined the relationship between trauma and schizotypy, none have examined racial discrimination as a potential moderator. The present study examined if racial discrimination moderates the relationship between trauma and multidimensional (positive, negative, and disorganized) schizotypy. In a sample of 770 college students, we conducted chi-squared analyses, analyses of variance, and stepwise regressions. We found that Black students experienced significantly higher racial discrimination and trauma than Latinx and Asian students. Furthermore, Black and Latinx students experienced significantly more multidimensional schizotypy items than Asian students. Trauma and racial discrimination explained 8 to 23% of the variance in each dimension of schizotypy. Racial discrimination did not moderate the relationships between trauma and multidimensional schizotypy. Our findings suggest that we need to examine risk factors that may prevent recovery from psychotic disorders. Additionally, disorganized schizotypy showed the most robust associations and may be a critical site of intervention.
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Affiliation(s)
- Mahogany A. Monette
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN 46202, USA; (M.T.R.); (J.L.M.); (E.J.M.); (K.S.M.)
| | - Madisen T. Russell
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN 46202, USA; (M.T.R.); (J.L.M.); (E.J.M.); (K.S.M.)
| | - Danielle B. Abel
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN 46202, USA; (M.T.R.); (J.L.M.); (E.J.M.); (K.S.M.)
| | - Jarrett T. Lewis
- Department of Educational Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
| | - Jessica L. Mickens
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN 46202, USA; (M.T.R.); (J.L.M.); (E.J.M.); (K.S.M.)
| | - Evan J. Myers
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN 46202, USA; (M.T.R.); (J.L.M.); (E.J.M.); (K.S.M.)
| | - Megan M. Hricovec
- Department of Psychology, University of North Texas, Denton, TX 76201, USA (D.C.C.)
| | - David C. Cicero
- Department of Psychology, University of North Texas, Denton, TX 76201, USA (D.C.C.)
| | - J. Wolny
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA; (J.W.)
| | - William P. Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405, USA; (J.W.)
| | - Michael D. Masucci
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Christopher J. Burgin
- Department of Psychology, Tennessee Technological University, Cookeville, TN 38505, USA;
| | - Thomas R. Kwapil
- Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL 61820, USA;
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC 27412, USA
| | - Kyle S. Minor
- Department of Psychology, Indiana University Indianapolis, Indianapolis, IN 46202, USA; (M.T.R.); (J.L.M.); (E.J.M.); (K.S.M.)
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Gamba R, Toosi N, Wood L, Correia A, Medina N, Pritchard M, Venerable J, Lee M, Santillan JKA. Racial discrimination is associated with food insecurity, stress, and worse physical health among college students. BMC Public Health 2024; 24:883. [PMID: 38519967 PMCID: PMC10958967 DOI: 10.1186/s12889-024-18240-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Students of color disproportionately experience racial discrimination and food insecurity, which both lead to poor academic and health outcomes. This study explores the extent to which the location of racial discrimination experienced is associated with food insecurity, stress, physical health and grade point average among college students METHODS: A cross sectional study design was implemented to survey 143 students from a racially diverse public university. Logistic regression models assessed if discrimination at various locations was associated with food insecurity and linear models assessed how racial discrimination was associated with physical health, stress and grade point average RESULTS: Student's experiencing food security had an average discrimination score of 2.3 (1.23, 3.37), while those experiencing food insecurity had a statistically significant (P < 0.001) higher average discrimination score 7.3 (5.4, 9.21). Experiencing any racial discrimination was associated with increased odds of experiencing food insecurity when experienced from the police (OR 11.76, 95% CI: 1.41, 97.86), in the housing process (OR 7.9, 95% CI: 1.93, 32.34) and in the hiring process (OR 6.81, 95% CI: 1.98, 23.48) compared to those experiencing no racial discrimination after adjusting for race, gender, age and income. CONCLUSION The location in which a student experienced racial discrimination impacted the extent to which the racial discrimination was associated with food security status. Further research is needed to explore potential mechanisms for how racial discrimination may lead to food insecurity.
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Affiliation(s)
- Ryan Gamba
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA.
| | - Negin Toosi
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Lana Wood
- University Libraries, California State University, East Bay, 94542, Hayward, CA, USA
| | - Alexandra Correia
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Nomar Medina
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Maria Pritchard
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Jhamon Venerable
- Department of Psychology, California State University, East Bay. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Mikayla Lee
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
| | - Joshua Kier Adrian Santillan
- Department of Public Health, California State University, East Bay. SF 102. 25800 Carlos Bee Boulevard, 94542, Hayward, CA, USA
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Saxena A, Liu S, Handley ED, Dodell-Feder D. Social victimization, default mode network connectivity, and psychotic-like experiences in adolescents. Schizophr Res 2024; 264:462-470. [PMID: 38266514 DOI: 10.1016/j.schres.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
Social victimization (SV) and altered neural connectivity have been associated with each other and psychotic-like experiences (PLE). However, research has not directly examined the associations between these variables, which may speak to mechanisms of psychosis-risk. Here, we utilized two-year follow-up data from the Adolescent Brain Cognitive Development study to test whether SV increases PLE through two neural networks mediating socio-affective processes: the default mode (DMN) and salience networks (SAN). We find that a latent SV factor was significantly associated with PLE outcomes. Simultaneous mediation analyses indicated that the DMN partially mediated the SV-PLE association while the SAN did not. Further, multigroup testing found that while Black and Hispanic adolescents experienced SV differently than their White peers, the DMN similarly partially mediated the effect of SV on PLE for these racial groups. These cross-sectional results highlight the importance of SV and its potential impact on social cognitive neural networks for psychosis risk.
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Affiliation(s)
| | - Shangzan Liu
- University of Pennsylvania, United States of America
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7
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Anglin DM, Espinosa A, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Stone W, Tsuang M, Woods SW, Walker E, Bearden CE, Ku BS. Association of Childhood Area-Level Ethnic Density and Psychosis Risk Among Ethnoracial Minoritized Individuals in the US. JAMA Psychiatry 2023; 80:1226-1234. [PMID: 37585191 PMCID: PMC10433142 DOI: 10.1001/jamapsychiatry.2023.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/13/2023] [Indexed: 08/17/2023]
Abstract
Importance The protective ethnic density effect hypothesis, which suggests that minoritized individuals who grow up in neighborhoods with a high proportion of ethnoracial minoritized groups are protected from the effects of perceived discrimination, has not been examined among individuals at clinical high risk of psychosis (CHR-P). This level of examination may help identify intervention targets for preventing psychosis among high-risk individuals. Objective To examine the association between area-level ethnic density during childhood, perceived discrimination, and psychosis risk outcomes among ethnoracial minoritized individuals with CHR-P. Design, Setting, and Participants Data were collected as part of the North American Prodrome Longitudinal Study-2 (NAPLS 2) between November 2008 and March 2013. Participants included ethnoracial minoritized youth with CHR-P. Area-level ethnoracial minoritized density pertained to the percent of ethnoracial minoritized individuals within the participant's county during childhood. Generalized mixed-effects models with random intercepts for participants, NAPLS 2 site, and county estimated the associations between area-level ethnic density and the risk of psychosis risk outcomes. Self-reported experience of discrimination was assessed. Mediation analyses computed the indirect association of perceived discrimination in the prospective correlation between ethnic density and psychosis risk outcomes. Analyses took place between December 2021 and June 2023. Main Outcomes and Measures Psychosis risk outcomes included remission, symptomatic, progression, and conversion to psychosis and were assessed throughout 24-month follow-up. Results Of 193 individuals, the mean (SD) age was 17.5 (3.4) years and 113 males (58.5%) were included. Participants self-identified as Asian (29 [15.0%]), Black (57 [29.0%]), Hispanic (any race; 87 [45.0%]), or other (First Nations, Middle Eastern, and interracial individuals; 20 [10.4%]). Greater area-level minoritized density was associated with a lower likelihood of remaining symptomatic (relative risk [RR], 0.54 [95% CI, 0.33-0.89]) and having progressively worsening symptoms (RR, 0.52 [95% CI, 0.32-0.86]) compared with being in remission. More perceived discrimination was associated with a higher risk of staying symptomatic (RR, 1.43 [95% CI, 1.09-1.88]) and progressively worsening (RR, 1.34 [95% CI, 1.02-1.78]) compared with being in remission. Perceived discrimination significantly mediated 21.7% (95% CI, 4.1%-67.0%; P = .02) of the association between area-level minoritized density and the likelihood of being in remission. Conclusions and Relevance This study found that among ethnoracial minority youth with CHR-P, growing up in communities with a greater proportion of ethnically minoritized individuals was associated with remission of psychosis risk symptoms partly through lower levels of perceived discrimination. Understanding how the social environment impacts early psychosis risk may help develop effective interventions to prevent psychosis, especially for vulnerable minoritized youth.
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Affiliation(s)
- Deidre M. Anglin
- Department of Psychology, The City College of New York, City University of New York, New York
- The Graduate Center, City University of New York, New York
| | - Adriana Espinosa
- Department of Psychology, The City College of New York, City University of New York, New York
- The Graduate Center, City University of New York, New York
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Tyrone D. Cannon
- Department of Psychiatry, Yale University, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Barbara A. Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California, and San Francisco Veterans Affairs Medical Center, San Francisco
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ming Tsuang
- Department of Psychiatry, University of California, San Diego
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, Connecticut
| | - Elaine Walker
- Department of Psychology, Emory University, Atlanta, Georgia
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California
- Department of Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California
| | - Benson S. Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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Li K, Richards E, Goes FS. Racial differences in the major clinical symptom domains of bipolar disorder. Int J Bipolar Disord 2023; 11:17. [PMID: 37166695 PMCID: PMC10175527 DOI: 10.1186/s40345-023-00299-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Across clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes. In the current report, we have combined data from two large multi-ethnic studies of bipolar disorder with comparable semi-structured interviews to investigate differences in symptoms presentation across the major clinical symptom domains of bipolar disorder. RESULTS In the combined meta-analysis, there were 4423 patients diagnosed with bipolar disorder type I, including 775 of self-reported as Black race. When symptom presentations were compared in Black versus White individuals, differences were found across all the major clinical symptom domains of bipolar disorder. Psychotic symptoms, particularly persecutory hallucinations and both persecutory and mood-incongruent delusions, were more prevalent in Black individuals with bipolar disorder type I (ORs = 1.26 to 2.45). In contrast, Black individuals endorsed fewer prototypical manic symptoms, with a notably decreased likelihood of endorsing abnormally elevated mood (OR = 0.44). Within depression associated symptoms, we found similar rates of mood or cognitive related mood symptoms but higher rates of decreased appetite (OR = 1.32) and weight loss (OR = 1.40), as well as increased endorsement of initial, middle, and early-morning insomnia (ORs = 1.73 to 1.82). Concurrently, we found that black individuals with BP-1 were much less likely to be treated with mood stabilizers, such as lithium (OR = 0.45), carbamazepine (OR = 0.37) and lamotrigine (OR = 0.34), and moderately more likely to be on antipsychotic medications (OR = 1.25). CONCLUSIONS In two large studies spanning over a decade, we found highly consistent and enduring differences in symptoms across the major clinical symptom domains of bipolar disorder. These differences were marked by a greater burden of mood-incongruent psychotic symptoms, insomnia and irritability, and fewer prototypical symptoms of mania. While such symptoms warrant better recognition to reduce diagnostic disparities, they may also represent potential targets of treatment that can be addressed to mitigate persistent disparities in outcome.
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Affiliation(s)
- Kevin Li
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Erica Richards
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, 550 N. Broadway, Suite 204, Baltimore, MD, 21205, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Michaels TI, Carrión RE, Addington J, Bearden CE, Cadenhead KS, Cannon TD, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone WS, Tsuang MT, Walker EF, Woods SW, Cornblatt BA. Ethnoracial discrimination and the development of suspiciousness symptoms in individuals at clinical high-risk for psychosis. Schizophr Res 2023; 254:125-132. [PMID: 36857950 PMCID: PMC10106391 DOI: 10.1016/j.schres.2023.02.021] [Citation(s) in RCA: 1] [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: 10/07/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND AND HYPOTHESIS While individuals at clinical high-risk (CHR) for psychosis experience higher levels of discrimination than healthy controls, it is unclear how these experiences contribute to the etiology of attenuated positive symptoms. The present study examined the association of perceived discrimination with positive symptoms in a cohort from the North American Prodrome Longitudinal Study (NAPLS2). It predicted that CHR individuals will report higher levels of lifetime and past year perceived discrimination related to their race and ethnicity (ethnoracial discrimination) and that this form of discrimination will be significantly associated with baseline positive symptoms. STUDY DESIGN Participants included 686 CHR and 252 healthy controls. The present study examined data from the perceived discrimination (PD) scale, the Brief Core Schema Scale, and the Scale for the Psychosis-Risk Symptoms. Structural equation modeling was employed to examine whether negative schema of self and others mediated the relation of past year ethnoracial PD to baseline suspiciousness symptoms. RESULTS CHR individuals report higher levels of past year and lifetime PD compared to healthy controls. Lifetime ethnoracial PD was associated with suspiciousness and total positive symptoms. Negative schema of self and others scores partially mediated the relation of past year ethnoracial PD to suspiciousness, one of five positive symptom criteria for CHR. CONCLUSIONS For CHR individuals, past year ethnoracial discrimination was associated with negative beliefs about themselves and others, which was associated with suspiciousness. These findings contribute to an emerging literature characterizing the mechanisms by which discrimination contributes to the positive symptoms characterizing the CHR syndrome.
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Affiliation(s)
- Timothy I Michaels
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Ricardo E Carrión
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Tyrone D Cannon
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA; Department of Psychology, Yale University, School of Medicine, New Haven, CT, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - Daniel H Mathalon
- VA San Francisco Healthcare System, San Francisco, CA, USA; Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA
| | - William S Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA
| | - Barbara A Cornblatt
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA; Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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10
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DeVylder J, Anglin D, Munson MR, Nishida A, Oh H, Marsh J, Narita Z, Bareis N, Fedina L. Ethnoracial Variation in Risk for Psychotic Experiences. Schizophr Bull 2023; 49:385-396. [PMID: 36398917 PMCID: PMC10016402 DOI: 10.1093/schbul/sbac171] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND & HYPOTHESIS Psychotic disorders are inequitably distributed by race in the United States, although it is not known whether this is due to assessment biases or inequitable distributions of risk factors. Psychotic experiences are subclinical hallucinations and delusions used to study the etiology of psychosis, which are based on self-report and therefore not subject to potential clinician biases. In this study, we test whether the prevalence of psychotic experiences (PE) varies by race and if this variance is explained by socioenvironmental risk factors. STUDY DESIGN Data on demographics, PE, and socioenvironmental risk factors were collected through the National Survey of Poly-victimization and Mental Health, a national probability sample of US young adults. Logistic regression analyses were used to determine whether PE prevalence varied by race/ethnicity and, if so, whether this was attenuated with inclusion of indicators of income, education, urban/rural living, discrimination, and trauma exposure. STUDY RESULTS Black and Hispanic respondents reported PE at significantly greater rates than White or "other" ethnoracial groups, with hallucinations more commonly reported by Hispanic respondents. PE were significantly associated with police violence exposure, discrimination, adverse childhood experiences, and educational attainment. These factors statistically explained ethnoracial differences in the likelihood of overall PE occurrence and of nearly all PE subtypes. CONCLUSIONS Previously observed racial differences in psychosis extend beyond clinical schizophrenia, and therefore, are unlikely to be explained entirely by clinician biases. Instead, racial disparities in PE appear to be driven by features of structural racism, trauma, and discrimination.
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Affiliation(s)
- Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, USA
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Deidre Anglin
- Department of Psychology, The City College of New York, New York, USA
| | | | - Atsushi Nishida
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| | - Jonathan Marsh
- Graduate School of Social Service, Fordham University, New York, USA
| | - Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Natalie Bareis
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
| | - Lisa Fedina
- University of Michigan School of Social Work, Ann Arbor, MI, USA
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11
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Magee C, Oberle E, Guhn M, Gadermann A, Puyat JH. Risk of Diagnosed Adolescent-Onset Non-Affective Psychotic Disorder by Migration Background in British Columbia: A Retrospective Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:33-42. [PMID: 35698751 PMCID: PMC9720480 DOI: 10.1177/07067437221100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We recently found that the risk of diagnosed non-affective psychotic disorder between the ages of 13 and 19 was lower for immigrant adolescents compared to those without a personal or parental migration history in British Columbia (BC), Canada. In the current study, we further examined the risk for migrants compared to non-migrants by region of origin and immigrant generation (first vs. second), adjusting for several demographic factors and migration class. METHODS Administrative data were used to construct a cohort of individuals born 1990-98 and residing in South-Western BC (N = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits with a primary diagnosis of a non-affective psychotic disorder. Poisson regression was used to estimate incidence rate ratios (IRR) of a diagnosed non-affective psychotic disorder by region of origin among first- and second-generation migrants compared to non-migrants, adjusting for sex, birth year, neighbourhood income and low family income. RESULTS Risk of diagnosed non-affective psychotic disorder was lower among first-generation migrants from East Asia (IRR = 0.34[95% CI: 0.25-0.46]), South-Asia (IRR = 0.47[95% CI: 0.25-0.89]) and South-East Asia (IRR = 0.55[95% CI: 0.32-0.93]) and second-generation migrants from East Asia (IRR = 0.49[95% CI: 0.35-0.69]) and South Asia (IRR = 0.52[95% CI: 0.37-0.73]), compared to non-migrants. Adjusting for migration class attenuated but did not fully explain variation in risk by region among first-generation migrants. No groups exhibited a significantly elevated risk of the diagnosed non-affective psychotic disorder compared to non-migrants. CONCLUSION Findings from this study underline the complexity of the association between migration and psychotic disorders. Future research should investigate why certain groups of migrants are less likely to be diagnosed and whether there are specific sub-groups that face an elevated risk.
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Affiliation(s)
- Carly Magee
- School of Population and Public Health (SPPH), 8166University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership (HELP), 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Eva Oberle
- School of Population and Public Health (SPPH), 8166University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership (HELP), 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- School of Population and Public Health (SPPH), 8166University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership (HELP), 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Gadermann
- School of Population and Public Health (SPPH), 8166University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Joseph H Puyat
- School of Population and Public Health (SPPH), 8166University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), St. Paul's Hospital, Vancouver, British Columbia, Canada
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12
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Oh H, Susser E, Volpe VV, Lui F, Besecker M, Zhou S, Anglin DM. Psychotic experiences among Black college students in the United States: The role of socioeconomic factors and discrimination. Schizophr Res 2022; 248:198-205. [PMID: 36088750 PMCID: PMC10227771 DOI: 10.1016/j.schres.2022.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/27/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psychosis is more prevalent among Black individuals compared with White individuals. However, it is unknown whether this disparity exists among college populations in the United States, and if so, what factors contribute to the disparity. METHODS We analyzed data from Black and White young adult students using the Health Minds Study (2020-2021), which is a survey administered at 140 colleges in the U.S. Using mediation analysis, we examined the extent to which the relation between race and psychotic experiences was mediated by socioeconomic factors (past and current financial distress, food insecurity, parental education) and discrimination. RESULTS Approximately 38 % of Black students and 30 % of White students reported lifetime psychotic experiences. Including all socioeconomic factors together in the same model accounted for just over half (50.2 %) the association between race and psychotic experiences. We then conducted additional analyses examining discrimination, all the socioeconomic factors plus discrimination accounted for 81.5 % of the association between race and psychotic experiences. When disentangling the mediators, food insecurity and discrimination accounted for the largest percentages of the association. The effects of past financial distress and parental education were modified by race. CONCLUSION Black college students were more likely to report lifetime psychotic experiences than their White counterparts. Moreover, socioeconomic factors and discrimination made significant contributions to this racial difference.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America.
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, United States of America
| | - Vanessa V Volpe
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695
| | - Florence Lui
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Megan Besecker
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America
| | - Sasha Zhou
- Department of Public Health, Wayne State University, United States of America
| | - 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, United States of America; The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, United States of America
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13
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Capizzi R, Pierce KM, Olino TM, Ellman LM. Item-level endorsement on the Prodromal Questionnaire in a large non-clinical sample. Schizophr Res 2022; 248:309-319. [PMID: 36155304 PMCID: PMC10131285 DOI: 10.1016/j.schres.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 07/30/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brief questionnaires, such as the Prodromal Questionnaire (PQ) positive scale, have been used to pre-screen individuals who may be at clinical high-risk (CHR) for psychosis. Despite the apparent utility of the PQ, few studies have examined response styles in non-clinical settings, which this study aimed to assess. METHODS Response frequencies were examined for PQ positive subscale items in 3584 students (ages 18-35) from a nationally representative, semi-public undergraduate institution. Highly endorsed items were evaluated further in conjunction with established cutoffs and associated symptom ratings from the Structured Interview for Psychosis-risk Syndromes (SIPS) in a smaller subset of participants (n = 162). Positive subscale and distressing item responses were also evaluated by gender, race, and ethnicity using measurement invariance analyses and by comparing the relative proportion of individuals above established cutoffs. RESULTS Fifteen symptoms were endorsed by over 20 % of the sample with as high as 71 % of respondents endorsing them. Responses to 12 of these items were not associated with ratings on the SIPS. The PQ functioned similarly across demographic characteristics with strong evidence found for gender and race invariance across items and strong ethnicity invariance and partial invariance for positive subscale items and distressing items, respectively. CONCLUSIONS These findings suggest that a commonly used psychosis-risk questionnaire may not be appropriate for non-clinical samples, with the possibility of high false positive rates of those at CHR for psychosis. Future large-scale epidemiological studies should evaluate if psychosis-risk screeners can be improved to identify CHR individuals in community settings.
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Affiliation(s)
- Riley Capizzi
- Temple University, Department of Psychology & Neuroscience, United States of America
| | - Katherine M Pierce
- Temple University, Department of Psychology & Neuroscience, United States of America
| | - Thomas M Olino
- Temple University, Department of Psychology & Neuroscience, United States of America
| | - Lauren M Ellman
- Temple University, Department of Psychology & Neuroscience, United States of America.
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