Ethnoracial discrimination and the development of suspiciousness symptoms in individuals at clinical high-risk for psychosis

Mechanisms mediating ethnoracial discrimination and suspiciousness in Asian, Black, and Hispanic United States college students

BACKGROUND

Despite the robust relationship between ethnoracial discrimination and positive psychotic-like experiences (PLEs) like subclinical suspiciousness in adulthood, the underlying mechanisms remain underexamined. Investigating the mechanisms previously implicated in trauma and positive PLEs - including negative-self schemas, negative-other schemas, perceived stress, dissociative experiences, and external locus of control - may inform whether ethnoracial discrimination has similar or distinct effects from other social stressors.

METHOD

We examined the indirect effects of experiences of discrimination (EOD) to suspicious PLEs and total positive PLEs through negative-self schemas, negative-other schemas, perceived stress, dissociative experiences, and external locus of control in Asian (nAsian = 268), Black (nBlack = 301), and Hispanic (nHispanic = 129) United States college students.

RESULTS

Among Asian participants, results indicated a significant indirect effect of EOD to suspicious PLEs and EOD to positive PLEs via perceived stress, and EOD to positive PLEs via negative-self schemas. Among Hispanic participants, results indicated a significant indirect effect of EOD to suspicious PLEs and EOD to positive PLEs via dissociative experiences. No mechanisms appeared significant in Black participants nor were any significant direct effects observed across models, despite them reporting significantly greater experiences of ethnoracial discrimination.

CONCLUSIONS

Our findings suggest some shared but potentially distinct mechanisms contribute to increased suspicious PLEs and positive PLEs in Asian, Black, and Hispanic college students, with results differing by group, compared to the mechanisms underlying trauma and positive PLEs, with implications for the treatment of PLEs in college students exposed to ethnoracial discrimination.

Racial Disparities Among Clinical High-Risk and First-Episode Psychosis Multisite Research Participants: A Systematic Review

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.