1
|
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.
Collapse
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
| |
Collapse
|
2
|
Bazargan-Hejazi S, Shirazi A, Hampton D, Pan D, Askharinam D, Shaheen M, Ebrahim G, Shervington D. Examining racial disparity in psychotic disorders related ambulatory care visits: an observational study using national ambulatory medical care survey 2010-2015. BMC Psychiatry 2023; 23:601. [PMID: 37592201 PMCID: PMC10436449 DOI: 10.1186/s12888-023-05095-y] [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: 06/01/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND One of the most consistent research findings related to race and mental health diseases is the disproportionately high rate of psychotic disorder diagnoses among people of color, specifically people of African descent. It is important to examine if a similar pattern exists among specific psychotic disorders. We aimed to examine the racial/ethnic differences in ambulatory care visits diagnosed with schizophrenia-spectrum disorders (SSDs). METHODS We analyzed data from the National Ambulatory Medical Care Survey (NAMCS) 2010-2015. The study sample included physician office-based visits by individuals diagnosed with SSDs, including schizophrenia, schizoaffective, and unspecified psychotic disorder (n = 1155). We used descriptive and bivariate analysis by race/ethnicity and three multinomial logistic regression models to test the association between the SSDs and race/ethnicity, adjusting for age, gender, insurance, disposition, medication Rx, and co-morbidity, considering the design and weight. RESULT Of the 1155 visits for SSDs, 44.8% had schizophrenia, 37.4% had schizoaffective disorder diagnosis, and 19.0% had unspecified psychosis disorder. We found significant racial disparities in the diagnosis of SSDs. Black patients were overrepresented in all three categories: schizophrenia (24%), schizoaffective disorder (17%), and unspecified psychosis disorder (26%). Also, a notable percentage of Black patients (20%) were referred to another physician in cases of schizophrenia compared to other ethnoracial groups (p < 0.0001). Moreover, we found a significant disparity in insurance coverage for schizoaffective disorder, with a higher percentage of Black patients (48%) having Medicaid insurance compared to patients from other ethnoracial groups (p < 0.0001). Black patients had nearly twice the odds of receiving a diagnosis of schizophrenia compared to White patients [AOR = 1.94; 95% CI: 1.28-2.95; P = 0.001]. However, they had significantly lower odds of being diagnosed with schizoaffective disorder [AOR = 0.42, 95% CI: 0.26-0.68; P = 0.003]. Race/ethnicity was not associated with receiving an unspecified psychosis disorder. CONCLUSIONS Our results show that SSDs, more specifically schizophrenia, continue to burden the mental health of Black individuals. Validation of our findings requires rigorous research at the population level that reveals the epidemiological difference of SSDs diagnoses in different race/ethnicity groups. Also, advancing our understanding of the nature of disparity in SSDs diagnoses among the Black population requires disentangling etiologic and systemic factors in play. This could include psychological stress, the pathway to care, services use, provider diagnostic practice, and experiencing discrimination and institutional and structural racism.
Collapse
Affiliation(s)
- Shahrzad Bazargan-Hejazi
- Department of Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science and UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Anaheed Shirazi
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - David Hampton
- Department of Family Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Deyu Pan
- Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | | | - Magda Shaheen
- College of Medicine, Charles R. Drew University of Medicine and Science, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Gul Ebrahim
- Kedren Community Care Clinic and Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Denese Shervington
- Department Psychiatry, College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Daley TC, George P, Goldman HH, Krenzke T, Zhu X, Ren W, Giangrande M, Ghose S, Rosenblatt A. Client Racial Composition in First-Episode Psychosis Programs Compared With Compositions in Program Service Areas. Psychiatr Serv 2022; 73:1373-1379. [PMID: 35652193 DOI: 10.1176/appi.ps.202100587] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the extent to which clients served by first-episode psychosis programs reflected the racial composition of the surrounding service area and, to the extent that they did not, explored possible explanatory factors. METHODS As part of a national study of coordinated specialty care (CSC) sites in the United States, 35 programs documented race for 772 clients. Programs identified a geographic service area for their clients. Using Census data, the authors identified the proportion of clients in this service area who were Black and then examined the extent of disproportionality, calculated as a risk ratio and as a relative difference in racial composition between CSC programs and their service areas. RESULTS Overall, 71% of CSC programs had a disproportionately greater proportion of Black clients than Black residents within the service area. This disproportionality was still evident after conducting sensitivity analyses that included adjusting for sampling error in the service area population estimates; however, smaller study sites displayed greater fluctuations in disproportionality in the sensitivity analyses. CONCLUSIONS Using data from diverse CSC programs, the authors illustrate that the odds of Blacks receiving services through a CSC program are much higher than would be expected on the basis of the population living in the area being served by the program. Multiple reasons may explain this finding, but in the absence of clear explanatory factors, this result may be ripe for discussion and further investigation.
Collapse
Affiliation(s)
- Tamara C Daley
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Preethy George
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Howard H Goldman
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Tom Krenzke
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Xiaoshu Zhu
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Weijia Ren
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Michael Giangrande
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Shoma Ghose
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| | - Abram Rosenblatt
- Abt Associates, Durham, North Carolina (Daley); Westat, Rockville, Maryland (George, Goldman, Krenzke, Zhu, Ren, Giangrande, Ghose, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, College Park (Goldman)
| |
Collapse
|
5
|
Sex and gender differences in symptoms of early psychosis: a systematic review and meta-analysis. Arch Womens Ment Health 2022; 25:679-691. [PMID: 35748930 DOI: 10.1007/s00737-022-01247-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/12/2022] [Indexed: 11/02/2022]
Abstract
First-episode psychosis (FEP) can be quite variable in clinical presentation, and both sex and gender may account for some of this variability. Prior literature on sex or gender differences in symptoms of psychosis have been inconclusive, and a comprehensive summary of evidence on the early course of illness is lacking. The objective of this study was to conduct a systematic review and meta-analysis of the literature to summarize prior evidence on the sex and gender differences in the symptoms of early psychosis. We conducted an electronic database search (MEDLINE, Scopus, PsycINFO, and CINAHL) from 1990 to present to identify quantitative studies focused on sex or gender differences in the symptoms of early psychosis. We used random effects models to compute pooled standardized mean differences (SMD) and risk ratios (RR), with 95% confidence intervals (CI), for a range of symptoms. Thirty-five studies met the inclusion criteria for the systematic review, and 30 studies were included in the meta-analysis. All studies examined sex differences. Men experienced more severe negative symptoms (SMD = - 0.15, 95%CI = - 0.21, - 0.09), whereas women experienced more severe depressive symptoms (SMD = 0.21, 95%CI = 0.14, 0.27) and had higher functioning (SMD = 0.16, 95%CI = 0.10, 0.23). Women also had a lower prevalence of substance use issues (RR = 0.65, 95%CI = 0.61, 0.69). Symptoms of early psychosis varied between men and women; however, we were limited in our ability to differentiate between biological sex and gender factors. These findings may help to inform early detection and intervention efforts to better account for sex and gender differences in early psychosis presentation.
Collapse
|
6
|
Cunningham R, Stanley J, Haitana T, Pitama S, Crowe M, Mulder R, Porter R, Lacey C. The physical health of Māori with bipolar disorder. Aust N Z J Psychiatry 2020; 54:1107-1114. [PMID: 32929981 DOI: 10.1177/0004867420954290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS There is very little empirical evidence about the relationship between severe mental illness and the physical health of Indigenous peoples. This paper aims to compare the physical health of Māori and non-Māori with a diagnosis of bipolar disorder in contact with NZ mental health services. METHODS A cohort of Māori and non-Māori with a current bipolar disorder diagnosis at 1 January 2010 were identified from routine mental health services data and followed up for non-psychiatric hospital admissions and deaths over the subsequent 5 years. RESULTS Māori with bipolar disorder had a higher level of morbidity and a higher risk of death from natural causes compared to non-Māori with the same diagnosis, indicating higher levels of physical health need. The rate of medical and surgical hospitalisation was not higher among Māori compared to non-Māori (as might be expected given increased health needs) which suggests under-treatment of physical health conditions in this group may be a factor in the observed higher risk of mortality from natural causes for Māori. CONCLUSION This study provides the first indication that systemic factors which cause health inequities between Māori and non-Māori are compounded for Māori living with severe mental illness. Further exploration of other diagnostic groups and subgroups is needed to understand the best approach to reducing these inequalities.
Collapse
Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tracy Haitana
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Suzanne Pitama
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Department of the Dean, Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand
| |
Collapse
|
7
|
Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care. J Psychiatr Pract 2020; 26:294-304. [PMID: 32692126 DOI: 10.1097/pra.0000000000000485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although previous research has suggested that racial disparities exist in the administration of forced medication (FM) in psychiatric inpatients, data remain scarce regarding other contributing variables. Therefore, this study examined sociodemographic and clinical variables associated with FM administration in psychiatric inpatients. METHODS Electronic medical records from 57,615 patients admitted to an academic psychiatric hospital between 2010 and 2018 were reviewed to identify patients who received FM. These records indicated that FM petitions were requested and approved for ∼6200 patients. Patients were excluded from the analysis if they met the following exclusion criteria: under 18 years of age, presence of intellectual/developmental disability, dementia, or other neurological condition, or primary diagnosis of a nonpsychiatric medical condition or a substance-induced mood or psychotic disorder. After data on those patients were excluded, the final sample included records from 2569 patients (4.5% of the total records) in which the administration of FM was petitioned for and approved. The FM group was compared with a control group of 2569 patients matched in terms of age, sex, and admission date (no-forced medication group; NFM) via propensity scoring matching. Group comparisons (FM vs. NFM group) examined sociodemographic factors (race, age, sex, living situation), clinical features (diagnosis, substance abuse, history of abuse), and outcomes (length of stay, readmission rate). Regression analyses examined the association between FM and sociodemographic, clinical, and outcome variables. RESULTS Compared with the NFM group, the FM group contained significantly more African Americans (P<0.001), homeless individuals (P<0.001), and individuals with histories of abuse (P<0.001). Having received FM was a significant predictor of a longer length of stay (P<0.001) and higher readmission rates (P<0.001). DISCUSSION These results suggest that FM is more likely to be instituted in psychiatric inpatients who are of a minority race (African American), are in a homeless living situation, and/or have a history of abuse. Moreover, FM may be associated with poorer clinical outcomes at least as measured by the length of stay and higher readmission rates. We discuss possible reasons for these results and the importance of culturally competent and trauma-focused care.
Collapse
|
8
|
Lång U, Mittal VA, Schiffman J, Therman S. Measurement Invariance of Psychotic-Like Symptoms as Measured With the Prodromal Questionnaire, Brief Version (PQ-B) in Adolescent and Adult Population Samples. Front Psychiatry 2020; 11:593355. [PMID: 33584365 PMCID: PMC7873944 DOI: 10.3389/fpsyt.2020.593355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
Valid measurement of group differences in self-reported psychotic-like experiences (PLEs) requires knowing any group-specific measurement properties of the instruments. We investigated the measurement invariance of the 21-item Prodromal Questionnaire-Brief (PQ-B) questionnaire across gender, ethnic minority/majority status, and presence of depressive symptoms in two different US non-clinical undergraduate samples (N = 1,099). For each item, endorsement of the experience and the associated distress were combined for analysis. A unidimensional model of the PQ-B fit the data well. Across genders, the PQ-B showed configural and metric, but not full scalar invariance; there were statistically significant differences in eight thresholds of six items, most being higher endorsement thresholds for self-identified females. Partial scalar invariance was also found for ethnic status, with five thresholds of three items being higher for the minority participants. For depressive symptomatology, defined as the top quintile by the Beck Depression Inventory-II, partial scalar invariance required dropping one item, after which there were statistically significant differences only in two response thresholds. Overall, a wide range of PLE questionnaire items were found to be robust to gender and ethnicity effects, strengthening confidence in found group differences in PLEs. Although full scalar invariance could not be ascertained for any of the group comparisons, the few found scalar differences across groups were small, with minimal impact on group PLE estimates. However, since PLEs are easily conceptually entangled with depression symptoms, similar items should be considered for exclusion if separable constructs are the target of investigation.
Collapse
Affiliation(s)
- Ulla Lång
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Vijay Anand Mittal
- Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, United States.,Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Sebastian Therman
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
9
|
Quattrone D, Di Forti M, Gayer-Anderson C, Ferraro L, Jongsma HE, Tripoli G, La Cascia C, La Barbera D, Tarricone I, Berardi D, Szöke A, Arango C, Lasalvia A, Tortelli A, Llorca PM, de Haan L, Velthorst E, Bobes J, Bernardo M, Sanjuán J, Santos JL, Arrojo M, Del-Ben CM, Menezes PR, Selten JP, Jones PB, Kirkbride JB, Richards AL, O'Donovan MC, Sham PC, Vassos E, Rutten BPF, van Os J, Morgan C, Lewis CM, Murray RM, Reininghaus U. Transdiagnostic dimensions of psychopathology at first episode psychosis: findings from the multinational EU-GEI study. Psychol Med 2019; 49:1378-1391. [PMID: 30282569 PMCID: PMC6518388 DOI: 10.1017/s0033291718002131] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 07/01/2018] [Accepted: 07/24/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The value of the nosological distinction between non-affective and affective psychosis has frequently been challenged. We aimed to investigate the transdiagnostic dimensional structure and associated characteristics of psychopathology at First Episode Psychosis (FEP). Regardless of diagnostic categories, we expected that positive symptoms occurred more frequently in ethnic minority groups and in more densely populated environments, and that negative symptoms were associated with indices of neurodevelopmental impairment. METHOD This study included 2182 FEP individuals recruited across six countries, as part of the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study. Symptom ratings were analysed using multidimensional item response modelling in Mplus to estimate five theory-based models of psychosis. We used multiple regression models to examine demographic and context factors associated with symptom dimensions. RESULTS A bifactor model, composed of one general factor and five specific dimensions of positive, negative, disorganization, manic and depressive symptoms, best-represented associations among ratings of psychotic symptoms. Positive symptoms were more common in ethnic minority groups. Urbanicity was associated with a higher score on the general factor. Men presented with more negative and less depressive symptoms than women. Early age-at-first-contact with psychiatric services was associated with higher scores on negative, disorganized, and manic symptom dimensions. CONCLUSIONS Our results suggest that the bifactor model of psychopathology holds across diagnostic categories of non-affective and affective psychosis at FEP, and demographic and context determinants map onto general and specific symptom dimensions. These findings have implications for tailoring symptom-specific treatments and inform research into the mood-psychosis spectrum.
Collapse
Affiliation(s)
- Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Hannah E Jongsma
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
| | - Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Daniele La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129 Palermo, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
| | - Domenico Berardi
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126 Bologna, Italy
| | - Andrei Szöke
- INSERM, U955, Equipe 15, 51 Avenue de Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM (CIBERSAM), C/Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Antonio Lasalvia
- Section of Psychiatry, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris 75020, France
| | | | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Academic Medical Centre, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/Julián Clavería s/n, 33006 Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital clinic, Department of Medicine, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/Avda. Blasco Ibáñez 15, 46010 Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz”, C/Hermandad de Donantes de Sangre, 16002 Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- Department of Preventative Medicine, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain & Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
- CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Alexander L Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK
| | - Michael C O'Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK
| | - Pak C Sham
- Department of Psychiatry, the University of Hong Kong, Hong Kong, China
- Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Bart PF Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Craig Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Robin M Murray
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Ulrich Reininghaus
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
10
|
Heuvelman H, Nazroo J, Rai D. Investigating ethnic variations in reporting of psychotic symptoms: a multiple-group confirmatory factor analysis of the Psychosis Screening Questionnaire. Psychol Med 2018; 48:2757-2765. [PMID: 29526172 DOI: 10.1017/s0033291718000399] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Epidemiological evidence suggests risk for psychosis varies with ethnicity in Western countries. However, there is little evidence to date on the cross-cultural validity of screening instruments used for such comparisons. METHODS Combining two existing UK population-based cohorts, we examined risk for reporting psychotic symptoms across White British (n = 3467), White Irish (n = 851), Caribbean (n = 1899), Indian (n = 2590), Pakistani (n = 1956) and Bangladeshi groups (n = 1248). We assessed the psychometric properties of the Psychosis Screening Questionnaire (PSQ) with a multiple-group confirmatory factor analysis, assessing the equivalence of factor loadings, response thresholds and residual variances in an analysis of measurement non-invariance. RESULTS Compared with prevalence among British Whites (5.4%), the prevalence of self-reported psychotic symptoms was greater in the Caribbean group (12.7%, adjusted OR = 2.38 [95% CI 1.84-3.07]). Prevalence was also increased among Pakistani individuals (8.3%, adjusted OR = 1.36 [1.01-1.84]) although this difference was driven by a greater likelihood of reporting paranoid symptoms. PSQ items for thought interference, strange experience and hallucination were measured in equivalent ways across ethnic groups. However, our measurement models suggested that paranoid symptoms were measured less reliably among ethnic minorities than among British Whites and appeared to exaggerate latent differences between Pakistani and White British groups when measurement non-invariance was not accounted for. CONCLUSIONS Notwithstanding evidence for measurement non-invariance, the greater risk for reporting psychotic symptoms among Caribbean individuals is unlikely to be an artefact of measurement. Greater residual variance in the recording of paranoid symptoms among ethnic minority respondents warrants caution in using this item to investigate ethnic variation in psychosis risk.
Collapse
Affiliation(s)
- Hein Heuvelman
- Centre for Academic Mental Health,Population Health Sciences,Bristol Medical School,University of Bristol,Oakfield House,Oakfield Grove,BS8 2BN Bristol,UK
| | - James Nazroo
- The Cathie Marsh Institute for Social Research (CMIST),School of Social Sciences,University of Manchester,Humanities Bridgeford Street Building,M13 9PL Manchester,UK
| | - Dheeraj Rai
- Centre for Academic Mental Health,Population Health Sciences,Bristol Medical School,University of Bristol,Oakfield House,Oakfield Grove,BS8 2BN Bristol,UK
| |
Collapse
|
11
|
Nagendra A, Schooler NR, Kane JM, Robinson DG, Mueser KT, Estroff SE, Addington J, Marcy P, Penn DL. Demographic, psychosocial, clinical, and neurocognitive baseline characteristics of Black Americans in the RAISE-ETP study. Schizophr Res 2018; 193:64-68. [PMID: 28709773 DOI: 10.1016/j.schres.2017.06.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 11/20/2022]
Abstract
This study compared baseline characteristics of Black Americans and Caucasians with first-episode psychosis in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP). Black American (N=152) and Caucasian (N=218) participants were compared on demographic, psychosocial, clinical, and neurocognitive measures. Results indicated several notable racial differences in baseline characteristics: a greater proportion of Black Americans than Caucasians were female, and Black Americans reported less personal and parental education than Caucasians. Black Americans were also less likely to have private insurance, more likely to be homeless or transient, had significantly poorer quality of life, more severe disorganized symptoms, worse neurocognition, and were less likely to abuse alcohol than Caucasians. The implications of these findings are discussed, and suggestions are provided for future avenues of treatment and research on racial disparities in first-episode psychosis.
Collapse
Affiliation(s)
- Arundati Nagendra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Nina R Schooler
- SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA; The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
| | - John M Kane
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | - Delbert G Robinson
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychology, & Psychiatry, Boston University, Boston, MA, USA
| | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Patricia Marcy
- The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
12
|
Some Thoughts About Racial Disparities. J Clin Psychopharmacol 2017; 37:641-645. [PMID: 29049079 DOI: 10.1097/jcp.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Maraj A, Anderson KK, Flora N, Ferrari M, Archie S, McKenzie KJ. Symptom profiles and explanatory models of first-episode psychosis in African-, Caribbean- and European-origin groups in Ontario. Early Interv Psychiatry 2017; 11:165-170. [PMID: 26353924 DOI: 10.1111/eip.12272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/06/2015] [Accepted: 08/17/2015] [Indexed: 11/30/2022]
Abstract
AIM To assess variability in symptom presentation and explanatory models of psychosis for people from different ethnic groups. METHODS Clients with first-episode psychosis (n = 171) who identified as black African, black Caribbean or white European were recruited from early intervention programmes in Toronto and Hamilton. We compared results by ethnic group for symptom profiles and explanatory models of illness. RESULTS Clients of black Caribbean origin had a lower odds of reporting that they were speaking incomprehensibly (OR = 0.36; 95% CI: 0.14-0.90) and black African clients had a greater odds of reporting persistent aches or pains (OR = 2.92; 95% CI: 1.32-6.50). Black African clients had a lower odds of attributing the cause of psychosis to hereditary factors (OR = 0.41; 95% CI: 0.19-0.89) or to substance abuse (OR = 0.29; 95% CI: 0.13-0.67) and had a lower odds of assigning responsibility for their illness to themselves (OR = 0.41; 95% CI: 0.19-0.89). CONCLUSIONS Understanding the differences in illness models for ethnic minority groups may help improve the cultural competence of mental health services.
Collapse
Affiliation(s)
- Anika Maraj
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kelly K Anderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Nina Flora
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Manuela Ferrari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Kwame J McKenzie
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
14
|
Medlock M, Weissman A, Wong SS, Carlo A, Zeng M, Borba C, Curry M, Shtasel D. Racism as a Unique Social Determinant of Mental Health: Development of a Didactic Curriculum for Psychiatry Residents. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10618. [PMID: 29387786 PMCID: PMC5788030 DOI: 10.15766/mep_2374-8265.10618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/26/2017] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Mental health disparities based on minority racial status are well characterized, including inequities in access, symptom severity, diagnosis, and treatment. For African Americans, racism may affect mental health through factors such as poverty and segregation, which have operated since slavery. While the need to address racism in medical training has been recognized, there are few examples of formal didactic curricula in the psychiatric literature. Antiracism didactics during psychiatry residency provide a unique opportunity to equip physicians to address bias and racism in mental health care. METHODS With advocacy by residents in the Massachusetts General Hospital/McLean Psychiatry residency program, the Division of Public and Community Psychiatry developed a curriculum addressing racial inequities in mental health, particularly those experienced by African Americans. Four 50-minute interactive didactic lectures were integrated into the required didactic curriculum (one lecture per postgraduate training class) during the 2015-2016 academic year. RESULTS Of residents who attended lectures and provided anonymous feedback, 97% agreed that discussing racism in formal didactics was at least "somewhat" positive, and 92% agreed that it should "probably" or "definitely" remain in the curriculum. Qualitative feedback centered on a need for more time to discuss racism as well as a desire to learn more about minority mental health advocacy in general. DISCUSSION Teaching about racism as part of required training conveys the explicit message that this is core curricular material and critical knowledge for all physicians. These lectures can serve as a springboard for dissemination and provide scaffolding for similar curriculum development in medical residency programs.
Collapse
Affiliation(s)
- Morgan Medlock
- Fourth-year Psychiatry Resident, Massachusetts General Hospital
| | - Anna Weissman
- Fourth-year Psychiatry Resident, Massachusetts General Hospital
| | | | - Andrew Carlo
- Fourth-year Psychiatry Resident, Massachusetts General Hospital
| | - Mary Zeng
- Fourth-year Psychiatry Resident, Massachusetts General Hospital
| | - Christina Borba
- Director of Research, Department of Psychiatry, Boston University School of Medicine
| | - Michael Curry
- Director of Legislative Affairs, Massachusetts League of Community Health Centers
- Board Member, National Association for the Advancement of Colored People (NAACP)
| | - Derri Shtasel
- Director, Division of Public and Community Psychiatry, Massachusetts General Hospital
| |
Collapse
|
15
|
Perlman G, Kotov R, Fu J, Bromet EJ, Fochtmann LJ, Medeiros H, Pato MT, Pato CN. Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort. Am J Med Genet B Neuropsychiatr Genet 2016; 171:546-55. [PMID: 26663585 DOI: 10.1002/ajmg.b.32409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/25/2015] [Indexed: 11/10/2022]
Abstract
Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Greg Perlman
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Jinmiao Fu
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Helena Medeiros
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Michele T Pato
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Carlos N Pato
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, California
| |
Collapse
|
16
|
Zandi T, Havenaar JM, Laan W, Kahn RS, Brink WVD. Effects of a culturally sensitive assessment on symptom profiles in native Dutch and Moroccan patients with a first psychosis referral. Transcult Psychiatry 2016; 53:45-59. [PMID: 25851336 DOI: 10.1177/1363461515577288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have reported a higher incidence of psychosis in Moroccan immigrants in the Netherlands than among native-born residents. However, this disparity was substantially attenuated when cultural differences in symptom presentation were taken into account. To better understand the impact of different diagnostic procedures on incidence rates, we examined the effects of the use of a culturally sensitive diagnostic interview, compared to a standard semi-structured diagnostic interview, on symptom profiles among Moroccan immigrant and native Dutch patients in the Netherlands. A total of 26 Dutch and 26 Moroccan patients referred with a possible first psychosis diagnosis were interviewed twice: once with the standard version and once with a culturally adapted version of the Comprehensive Assessment of Symptoms and History questionnaire (CASH and CASH-CS, respectively). Among native Dutch patients, symptoms profiles based on CASH and CASH-CS interviews were very similar. By contrast, among Moroccan immigrant patients, symptom profiles based on CASH and CASH-CS interviews differed substantially, with more mania symptoms (+30%; p < .05) and fewer delusions (-31%; p < .05) reported when using the CASH-CS. These results suggest that the over-diagnosis of schizophrenia in Moroccan immigrants with a first psychosis referral may be related to a tendency to under-detect mood symptoms and over-detect positive psychotic symptoms when a standard diagnostic procedure is used. This bias may be corrected, at least in part, by the use of a culturally sensitive interview instrument such as the CASH- CS.
Collapse
|
17
|
Abstract
INTRODUCTION Knowledge of the factors affecting the adoption of new medications can enhance mental health care and guide quality improvement and policy development. Food and Drug Administration indications for treating bipolar disorder with several second-generation antipsychotics (SGAs) in the 2000s represent an opportunity to identify factors that impact the spread of a then-innovative treatment through a new population. METHODS Analysis of Department of Veterans Affairs administrative data identified the population of 170,811 veterans diagnosed with bipolar disorder from 2003 to 2010. We analyzed time trends and predictors of antimanic choice (SGA vs other) among the 40,512 outpatients with bipolar disorder who initiated their first VA outpatient antimanic prescription, using multinomial logistic regression in month-by-month analyses. We conducted classwise analyses and investigated prespecified predictors among specific agents. RESULTS In classwise analyses, SGAs supplanted lithium, valproate, and carbamazepine/oxcarbazepine as the most commonly initiated antimanics by 2007. Psychosis, but not other indices of severity, predicted SGA initiation. Demographic analyses did not identify substantial disparities in initiation of SGAs. Drug-specific analyses revealed some consideration of medical comorbidities in choosing among specific antimanic agents, although effect sizes were small. Most patients initiating an antimanic had received an antidepressant in the previous year. DISCUSSION Second-generation antipsychotics quickly became the frontline antimanic treatment for bipolar disorder, although antidepressants most commonly predated antimanic prescriptions. Second-generation antipsychotics were used for a broad range of patients rather than being restricted to a severely ill subpopulation. The modest association of antimanic choice with relevant medical comorbidities suggests that continued attention to quality prescribing practices is warranted.
Collapse
|
18
|
Sabbag S, Prestia D, Robertson B, Ruiz P, Durand D, Strassnig M, Harvey PD. Absence of bias in clinician ratings of everyday functioning among African American, Hispanic and Caucasian patients with schizophrenia. Psychiatry Res 2015; 229:347-52. [PMID: 26160197 PMCID: PMC4546870 DOI: 10.1016/j.psychres.2015.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/20/2015] [Accepted: 06/30/2015] [Indexed: 11/30/2022]
Abstract
A substantial research literature implicates potential racial/ethnic bias in the diagnosis of schizophrenia and in clinical ratings of psychosis. There is no similar information regarding bias effects on ratings of everyday functioning. Our aims were to determine if Caucasian raters vary in their ratings of the everyday functioning of schizophrenia patients of different ethnicities, to find out which factors determine accurate self-report of everyday functioning in different ethnic groups, and to know if depression has similar effects on the way people of different ethnicities self-report their current functionality. We analyzed data on 295 patients with schizophrenia who provided their self-report of their everyday functioning and also had a Caucasian clinician rating their functionality. Three racial/ethnic groups (African American (AA), Hispanic and Caucasian) were studied and analyzed on the basis of neurocognition, functional capacity, depression and real-world functional outcomes. No differences based on racial/ethnic status in clinician assessments of patients' functionality were found. Differences between racial groups were found in personal and maternal levels of education. Severity of depression was significantly correlated with accuracy of self-assessment of functioning in Caucasians, but not in AAs. Higher scores on neurocognition and functional capacity scales correlated with reduced overestimation of functioning in AAs, but not in Hispanics. This data might indicate that measurement of everyday functionality is less subject to rater bias than measurement of symptoms of schizophrenia.
Collapse
Affiliation(s)
- Samir Sabbag
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA
| | - Davide Prestia
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA
| | - Belinda Robertson
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA
| | - Pedro Ruiz
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA
| | - Dante Durand
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA
| | - Martin Strassnig
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA
| | - Philip D. Harvey
- Deparcmenr of Psydtiarry and Behavioral Sciences, Universiry of Miami Miller School of Medicine, Miami, FL, USA, Research Service, Bruce W Career VAMedical Cenrer, Miami, FL, USA, Corresponding author at: University of Miami Miller School of Medicine. Department of Psychiatiy and Behavioral Sciences. 1120 NW 14th Street. Suite 1450, Miami. FL 33136, USA. fax: +1 305 243 1619. (P.D. Harvey)
| |
Collapse
|
19
|
Berg AO, Aas M, Larsson S, Nerhus M, Hauff E, Andreassen OA, Melle I. Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder. Psychol Med 2015; 45:133-142. [PMID: 25065296 DOI: 10.1017/s0033291714001135] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations. METHOD In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version. RESULTS Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations. CONCLUSIONS More childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.
Collapse
Affiliation(s)
- A O Berg
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - M Aas
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - S Larsson
- Department of Research and Development, Division of Mental Health and Addiction,Oslo University Hospital,Oslo,Norway
| | - M Nerhus
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - E Hauff
- Department of Research and Development, Division of Mental Health and Addiction,Oslo University Hospital,Oslo,Norway
| | - O A Andreassen
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| | - I Melle
- NORMENT; K. G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Institute of Clinical Medicine,University of Oslo,and Oslo University Hospital, Oslo,Norway
| |
Collapse
|
20
|
Schwartz RC, Blankenship DM. Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World J Psychiatry 2014; 4:133-140. [PMID: 25540728 PMCID: PMC4274585 DOI: 10.5498/wjp.v4.i4.133] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/03/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
Psychotic disorder diagnoses are common in the United States and internationally. However, racial disparities in rates of psychotic disorder diagnoses have been reported across time and mental health professions. This literature review provides an updated and comprehensive summary of empirical research on race and diagnosis of psychotic disorders spanning a 24-year period. Findings reveal a clear and pervasive pattern wherein African American/Black consumers show a rate of on average three to four higher than Euro-American/White consumers. Latino American/Hispanic consumers were also disproportionately diagnosed with psychotic disorders on average approximately three times higher compared to Euro-American/White consumers. In addition, a trend among international studies suggests that immigrant racial minority consumers receiving mental health services may be assigned a psychotic disorder diagnosis more frequently than native consumers sharing a majority racial background. Potential explanations for this phenomenon are discussed, including possible clinical bias and sociological causes such as differential access to healthcare and willingness to participate in mental health services. Directions for future research should include the exploration of disproportionate diagnoses according to race through qualitative interviewing as well as empirical investigation.
Collapse
|
21
|
The impact of immigration and visible minority status on psychosis symptom profile. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1747-57. [PMID: 24927946 DOI: 10.1007/s00127-014-0897-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Immigrants have heightened risks of psychotic disorders, and it is proposed that migration influences symptom profiles. The purpose of this study was to investigate if either migration experience and/or visible minority status affected symptom profiles, using a cross-culturally validated five-factor model of the Positive and Negative Syndrome Scale (PANSS), in patients with broadly defined psychotic disorders. METHODS PANSS was assessed in a large catchment area based sample of patients with psychotic disorders verified with the Structured Clinical Interview for DSM-IV (n = 1,081). Symptom profiles based on Wallwork et al. five-factor model were compared for Norwegians (73 %), white immigrants (10.5 %), and visible minority groups (16.5 %). RESULTS Visible minorities were significantly younger, had less education, more often a schizophrenia diagnosis and higher PANSS positive, negative and disorganized/concrete factor scores than Norwegians and white immigrants. After controlling for confounders only the items "Delusions" and "Difficulty in abstract thinking" differed between groups. Multivariate analyses indicated that these items were not associated with immigration per se, but rather belonging to a visible minority. CONCLUSION We found mostly similarities in psychotic symptoms between immigrants and Norwegians when using a cross-culturally validated five-factor model of the PANSS. Immigration did not directly influence psychotic symptom profiles but visible minority groups had higher levels of "Delusions" and "Difficulty in abstract thinking", both symptoms that are partially context dependent.
Collapse
|
22
|
Affiliation(s)
- Jacquelyn H Flaskerud
- University of California-Los Angeles, School of Nursing, Los Angeles, California, USA
| |
Collapse
|
23
|
Ojelade II, McCray K, Meyers J, Ashby J. Use of Indigenous African Healing Practices as a Mental Health Intervention. JOURNAL OF BLACK PSYCHOLOGY 2014. [DOI: 10.1177/0095798414533345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current study used a qualitative design informed by indigenous research methodologies to describe how indigenous African healers and their clients address Western-defined mental health problems. Healers for this study included Orìsà priests initiated within the Yorùbá-based system of Ifá. Two research questions guided this inquiry: (1) How do Orìsà priests and their clients conceptualize issues and concerns associated with mental health problems in Western psychology (2) What methods and techniques do Orìsà priests and their clients use to address issues and concerns associated with mental health problems in Western psychology? Data were collected during semistructured individual interviews with Orìsà priests in a three-phase model. The study also included focus groups with informants who sought the services of Orìsà priests. A combined total of 18 interviews were conducted that included 22 separate respondents residing within the southeastern United States. The following steps were employed to enhance methodological rigor: (1) bracketing of assumptions by the research team members, (2) use of a reflexive journal, (3) member checking, and (4) an audit trail. Data analysis consisted of a recursive process divided into multiple steps including codebook development, code application, and data analysis. Three major themes emerged from the data: (1) Conceptualization of Mental Health Problems as Spiritual Matters, (2) Origins of Mental Health Problems, and (3) Addressing Mental Health Problems. Results of this study indicate that respondents primarily conceptualize mental health problems as spiritual matters and seek to address these concerns with an Orìsà priest first. Practice and research implications for psychologists are discussed.
Collapse
Affiliation(s)
| | - Kenja McCray
- Atlanta Metropolitan and State College, Atlanta, GA, USA
| | | | | |
Collapse
|
24
|
Earl T, Fortuna LR, Gao S, Williams DR, Neighbors HW, Takeuchi D, Alegría M. An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life. ETHNICITY & HEALTH 2014; 20:273-92. [PMID: 24920148 PMCID: PMC4930554 DOI: 10.1080/13557858.2014.921888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE . To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA. DESIGN Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n > 100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms. RESULTS African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p < .001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p < .05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p < .05; 6.3% and 2.7%, p < .05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms. CONCLUSION Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.
Collapse
Affiliation(s)
- Tara Earl
- Health Education and Social Programs, Division of Public Health and Survey Research, ICF International, Inc., Atlanta, GA
| | - Lisa R. Fortuna
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA
| | - Shan Gao
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - David R. Williams
- Harvard School of Public Health, Department of Society, Human Development and Health, Boston, MA
| | | | - David Takeuchi
- Graduate School of Social Work, Boston College, Chestnut Hill, MA
| | - Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA
| |
Collapse
|
25
|
Race and psychiatric diagnostic patterns: understanding the influence of hospital characteristics in the National Hospital Discharge Survey. J Natl Med Assoc 2013; 104:505-9. [PMID: 23560352 DOI: 10.1016/s0027-9684(15)30216-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Historically, blacks have been more frequently diagnosed with schizophrenia and less frequently diagnosed with mood disorders than whites. Our understanding of why these disparities exist has primarily focused on patient and clinician characteristics and failed to examine the influence of social contextual factors such as hospital characteristics on diagnostic patterns. We analyzed data from the 2007 National Hospital Discharge Survey, a large national database of hospital inpatient stays. The paper examines whether race influences inpatient diagnoses before and after adjustment for select patient and hospital characteristics. Results indicate that blacks were 3-fold more likely to be diagnosed with schizophrenia (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.96-4.57) or a psychotic disorder (OR, 3.39; 95% CI, 2.90-3.96) than whites. However, blacks were less likely than whites to be diagnosed with bipolar disorder (OR, 0.60; 95% CI, 0.50-0.72) or mood disorder (OR, 0.50; 95% CI, 0.43-0.58). These same diagnostic patterns persisted after adjustment for selected patient and hospital characteristics. These results provide confirmation of trends observed in earlier studies of single hospitals with smaller sample sizes. Further research is necessary to determine whether the hospital characteristics selected for these analyses are appropriate proxy measures of factors that influence diagnostic judgment in inpatient settings.
Collapse
|
26
|
Cognitive deficits and ethnicity: a cohort study of early psychosis patients in The Netherlands. Soc Psychiatry Psychiatr Epidemiol 2013; 48:37-47. [PMID: 22696073 DOI: 10.1007/s00127-012-0521-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Incidence rates of psychotic disorders are higher in immigrant groups compared to native populations. This increased risk may partly be explained by misdiagnosis. Neurocognitive deficits are a core feature of psychotic disorders, but little is known about the relationship between migration and cognition in psychotic disorders. We examined whether immigrant patients have cognitive deficits similar to non-immigrant patients, in order to investigate the plausibility of misdiagnosis as explanation for increased incidence rates. METHODS Patients who made first contact for non-affective psychotic disorder were assessed in the cognitive domains sustained attention, immediate recall and delayed recall. Immigrant patients were compared to Dutch patients on cognitive performance. RESULTS 407 Patients diagnosed with a non-affective psychotic disorder completed cognitive assessment (157 Dutch, 250 immigrants). Both Dutch and immigrant patients showed large cognitive deficits. Between-subgroup comparisons revealed large cognitive deficits for immigrants compared to Dutch, especially for immigrants from Morocco, Turkey and other non-Western countries. CONCLUSIONS These results indicate that immigrant status is associated with poorer cognitive functioning in early psychosis. The findings argue against diagnostic bias as an explanation for the increased incidence of psychotic disorders in immigrants.
Collapse
|
27
|
Shim RS, Baltrus P, Bradford LD, Holden KB, Fresh E, Fuller LE. Characterizing depression and comorbid medical conditions in African American women in a primary care setting. J Natl Med Assoc 2013; 105:183-91. [PMID: 24079219 PMCID: PMC4039195 DOI: 10.1016/s0027-9684(15)30106-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND African American women are more likely to seek treatment for depression in primary care settings; however, few women receive guideline-concordant depression treatment in these settings. This investigation focused on the impact of depression on overall functioning in African American women in a primary care setting. METHODS Data was collected from a sample of 507 African American women in the waiting room of an urban primary care setting. The majority of women were well-educated, insured, and employed. The CESD-R was used to screen for depression, and participants completed the 36-Item Short-Form Survey to determine functional status. RESULTS Among the participants with depression, there was greater functional impairment for role-physical (z = -0.88, 95% CI = -1.13, -0.64) when compared to individuals with diabetes and hypertension. Individuals with depression also had greater role-emotional impairment (z = -1.12, 95% CI = -1.37, -0.87) than individuals with diabetes and hypertension. African American women with comorbid hypertension and depression had greater functional impairment in role-physical when compared to African American women with hypertension and no depression (t(124) = -4.22, p < 0.01). CONCLUSION African American women with depression are more likely to present with greater functional impairment in role function when compared to African American women with diabetes or hypertension. Because African American women often present to primary care settings for treatment of mental illness, primary care providers need to have a clear understanding of the population, as well as the most effective and appropriate interventions.
Collapse
Affiliation(s)
- Ruth S Shim
- National Center for Primary Care, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA.
| | | | | | | | | | | |
Collapse
|
28
|
Todder D, Avissar S, Schreiber G. Non-Linear Dynamic Analysis of Inter-Word Time Intervals in Psychotic Speech. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2013; 1:2200107. [PMID: 27170852 PMCID: PMC4819231 DOI: 10.1109/jtehm.2013.2268850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/27/2013] [Accepted: 06/07/2013] [Indexed: 11/23/2022]
Abstract
“Language is a form and not a substance”
— Ferdinand de Saussure Objective: Analyses of speech processes in schizophrenia are invariably focused on words as vocal signals. The results of such analyses are, however, strongly related to content, and may be language- and culture-dependent. Little attention has been paid to a pure measure of the form of speech, unrelated to its content: inter-words time intervals. Method: 15 patients with schizophrenia and 15 healthy volunteers are recorded spontaneously speaking for 10–15 min. Recordings are analyzed for inter-words time intervals using the following non-linear dynamical methods: unstable periodic orbits, correlation dimension, bi-spectral analysis, and symbolic dynamics. Results: The series of inter-word time intervals in normal speech have the characteristics of a low-dimensional chaotic attractor with a correlation dimension of \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{upgreek}
\usepackage{mathrsfs}
\setlength{\oddsidemargin}{-69pt}
\begin{document}
}{}$3.2\pm 1.1$\end{document}. Deconstruction of the attractor appears in psychosis with re-establishment after anti-psychotic treatment. Shannon entropy, a measure of the complexity in the time series, calculated from symbolic dynamics, is higher for psychotic speech, which is also characterized by higher levels of phase coupling: higher bicoherence, obtained using bi-spectral analysis. Conclusion: Non-linear dynamical methods applied to ITIs thus enable a content-independent, pure measure of the form of normal thought, its distortion in psychosis, and its restoration under treatment.
Collapse
Affiliation(s)
- Doron Todder
- Ben Gurion University of the Negev Psychiatry Department Beer Sheva Israel 84105
| | - Sofia Avissar
- Ben Gurion University of the Negev Clinical Pharmacology Department Beer Sheva Israel 84105
| | - Gabriel Schreiber
- Ben Gurion University of the Negev Faculty of Health Sciences Beer Sheva Israel 84105
| |
Collapse
|
29
|
Abstract
Three broad areas related to changes in DSM-5 are addressed in this article, and their implications for mental health nursing (MHN) education are discussed. The first area is the changes in structure and in the classification and description of mental disorders; knowledge of these is necessary so that nurse educators can teach students about the new faces of pathology in DSM-5 and what these changes mean for their future practice. Second, nurse educators must prepare advanced practice nurses to deal with the realities of the issues, criticisms, and concerns surrounding use of the DSM, including the influence of market forces on diagnosis, the validity and reliability of diagnosis, and cultural bias in diagnosis. Finally, there are additional concerns in preparing primary care nurses (nurse practitioners [NPs]) for the changes to DSM-5. It is not only psychiatric mental health (PMH) advanced practice nurses who must be aware of DSM changes and issues. The majority of mental health care in the United States is given in primary care settings and NPs must be prepared to assess and diagnose psychiatric disorders. The challenge to PMH nursing education is twofold: upholding the clinical role of advanced practice nurses in delivering mental health care, and maintaining the humanism and emphasis on quality care that has long characterized PMH nursing practice.
Collapse
Affiliation(s)
- Jacquelyn H Flaskerud
- University of California-Los Angeles, School of Nursing, Los Angeles, California 90095-1702, USA.
| |
Collapse
|
30
|
van der Ven E, Bourque F, Joober R, Selten JP, Malla AK. Comparing the clinical presentation of first-episode psychosis across different migrant and ethnic minority groups in Montreal, Quebec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2012; 57:300-8. [PMID: 22546062 DOI: 10.1177/070674371205700505] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore differences in severity and nature of symptoms of first-episode psychosis (FEP) according to ethnic group and migrant status. METHOD We administered rating scales to assess positive and negative symptoms, as well as general psychopathology, to 301 consecutive patients presenting with an FEP within a defined catchment area in Montreal, Quebec, classified according to ethnicity and migrant status. Symptom scores of Euro-Canadian patients without a recent history of migration, that is, the reference group (n = 145), were compared with those of African and Afro-Caribbean (n = 39), Asian (n = 27), Central and South American (n = 15), Middle Eastern and North African (n = 24), and European and North American (n = 39) patients. RESULTS Except for referral source, there were no significant differences between ethnic groups on any demographic variables. The African and Afro-Caribbean group had a higher level of negative symptoms (especially alogia) and general psychopathology scores on the Positive and Negative Syndrome Scale (especially, uncooperativeness, preoccupation, and poor attention), compared with the reference group. Ethnic groups did not differ on the Scale for the Assessment of Positive Symptoms scores. CONCLUSIONS A comparison of FEP patients from different ethnic groups and native-born Euro-Canadians revealed no significant differences in the nature of positive symptoms at first presentation or in age at onset, suggesting that there was no evidence for the hypothesis that ethnic minorities are misdiagnosed as psychotic. Increased severity of negative symptoms and general psychopathology, specifically among the black ethnic minority group, may have implications for the role of ethnicity for the treatment and outcome of the initial episode of psychotic disorders.
Collapse
Affiliation(s)
- Elsje van der Ven
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | | | | | | |
Collapse
|
31
|
Velthorst E, Nieman DH, Veling W, Klaassen RM, Dragt S, Rietdijk J, Ising H, Wunderink L, Linszen DH, de Haan L, van der Gaag M. Ethnicity and baseline symptomatology in patients with an At Risk Mental State for psychosis. Psychol Med 2012; 42:247-256. [PMID: 21835093 DOI: 10.1017/s0033291711001486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ethnicity has been associated with different incidence rates and different symptom profiles in young patients with psychotic-like disorders. No studies so far have examined the effect of ethnicity on symptoms in people with an At Risk Mental State (ARMS). METHOD In this cross-sectional study, we analysed the relationship between ethnicity and baseline data on the severity of psychopathology scores in 201 help-seeking patients who met the ARMS criteria and agreed to participate in the Dutch Early Detection and Intervention (EDIE-NL) trial. Eighty-seven of these patients had a non-Dutch ethnicity. We explored the possible mediating role of ethnic identity. RESULTS Higher rates of negative symptoms, and of anhedonia in particular, were found in the ethnic minority group. This result could be attributed mainly to the Moroccan-Dutch and Turkish-Dutch subgroups, who also presented with more depression symptoms when the groups were examined separately. The ethnic minority group displayed a lower level of ethnic group identity compared to the immigrants of the International Comparative Study of Ethnocultural Youth (ICSEY). Ethnic identity was inversely related to symptoms in the Moroccan-Dutch patient group. CONCLUSIONS The prevalence of more severe negative symptoms and depression symptoms in ethnic minority groups deserves more attention, as the experience of attenuated positive symptoms when accompanied by negative symptoms or distress has proven to be predictive for transition to a first psychotic episode.
Collapse
Affiliation(s)
- E Velthorst
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - D H Nieman
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - W Veling
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - S Dragt
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Rietdijk
- VU University and EMGO Institute, Amsterdam, The Netherlands
| | - H Ising
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - D H Linszen
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - L de Haan
- Department of Early Psychosis, Academic Medical Centre, Amsterdam, The Netherlands
| | - M van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| |
Collapse
|
32
|
Zandi T, Havenaar JM, Laan W, Kahn RS, van den Brink W. Predictive validity of a culturally informed diagnosis of schizophrenia: a 30 month follow-up study with first episode psychosis. Schizophr Res 2011; 133:29-35. [PMID: 22019074 DOI: 10.1016/j.schres.2011.09.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/14/2011] [Accepted: 09/18/2011] [Indexed: 11/29/2022]
Abstract
UNLABELLED Previous research has shown discrepancies between a standard diagnostic interview for schizophrenia (CASH) and a culture sensitive version of this instrument (CASH-CS) in Moroccan patients. More specifically we showed that among Moroccan immigrants the CASH-CS resulted in fewer patients with a diagnosis of schizophrenia compared with diagnoses based on the CASH, whereas for Native Dutch patients there was no difference between the CASH and the CASH-CS. The aim of the current study was to compare the predictive validity of a diagnosis of schizophrenia according to the CASH and CASH-CS. METHOD Thirty months after referral, 26 Moroccan and 26 native Dutch patients with a suspected first psychotic episode were compared with regard to 30-month diagnostic stability, symptom development, psychosocial functioning, medication use and hospitalization using baseline diagnoses based on the two versions of the CASH. RESULTS Moroccan patients who were diagnosed with schizophrenia using the standard CASH at baseline had a significantly better 30-month prognosis than native Dutch patients with the same CASH diagnosis. Prognosis of schizophrenia according to the CASH-CS was similar for Moroccans and native Dutch patients. Diagnostic stability according to the CASH was high for native Dutch (92%), but low for Moroccan patients (27%), whereas diagnostic stability according to the CASH-CS was high for both groups (85% and 81%, respectively). CONCLUSION These data raise questions regarding the validity of the standard CASH in Moroccan immigrants in The Netherlands and support the validity of the CASH-CS. As a consequence, there are serious doubts about the validity of previous studies showing an increased incidence of schizophrenia in immigrants using standard diagnostic procedures.
Collapse
Affiliation(s)
- Tekleh Zandi
- Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
33
|
Li H, Eack SM, Montrose DM, Miewald JM, Keshavan M. Longitudinal treatment outcome of African American and Caucasian patients with first episode psychosis. Asian J Psychiatr 2011; 4:266-71. [PMID: 23051160 PMCID: PMC4184183 DOI: 10.1016/j.ajp.2011.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 08/10/2011] [Accepted: 08/19/2011] [Indexed: 01/08/2023]
Abstract
The purpose of our analyses to examine the outcome differences between African American and Caucasian first-episode psychotic patients over the course of one year, to explore the interactive effects of gender, diagnosis, and race on treatment outcome. A consecutive series of patients (N=199) were recruited into our study from the inpatient and outpatient services at a psychiatric clinic. Global functioning, positive, negative, affective, and depression symptoms and treatment adherence were assessed at baseline prior to treatment and during follow-up up to one year. African American patients (N=62) were found to experience significantly less improvement in symptoms, bizarre behavior, avolition, anhedonia, and functional performance, and affective symptoms than their Caucasian counterparts (N=137). In addition, African American female patients experienced less improvement in affective flattening. While both groups of patients have experienced significant improvement during the one-year treatment, that of the African American patients was less optimal.
Collapse
Affiliation(s)
- Huijun Li
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School
| | | | - Debra M. Montrose
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Jean M. Miewald
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 401 Park Drive, Landmark Center, 2 East, Boston, MA 02215, Phone: 617-998-0078, Fax: 617-990-5007
| |
Collapse
|
34
|
Haeri S, Williams J, Kopeykina I, Johnson J, Newmark A, Cohen L, Galynker I. Disparities in diagnosis of bipolar disorder in individuals of African and European descent: a review. J Psychiatr Pract 2011; 17:394-403. [PMID: 22108396 DOI: 10.1097/01.pra.0000407962.49851.ef] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Over the past 3 decades, a wide range of studies in the United States and the United Kingdom has reported that white individuals are more likely to be diagnosed with bipolar and affective disorders, whereas black individuals appear to be at higher risk for schizophrenia spectrum diagnoses. Despite the pressing need for strategies aimed at eliminating racial and cultural disparities in diagnosis and treatment of bipolar disorder, no systematic review of the existing literature in this area has been done. This study draws together the disparate strands of information in a comprehensive overview of the research base in this area. METHODS An electronic literature search of the Medline and PsychINFO databases was conducted in October 2009, supplemented by a review of references in the identified articles, for a total of 51 articles included in this qualitative review. RESULTS Black patients have consistently been found to be more likely than white patients to be diagnosed with schizophrenia rather than bipolar disorder. Four factors were identified as potential contributors to racial disparities in diagnostic rates: clinical presentation and expression of symptoms, access to care, help-seeking behaviors, and clinician judgment. CONCLUSION Despite efforts to curtail the phenomenon, racial disparities in diagnosis of bipolar disorder persist. Racial and cultural elements may affect how patients manifest behaviors and symptoms and how these are interpreted and attributed by clinicians in the diagnostic process. As an appropriate diagnosis determines treatment options and is central to quality of care, incorrect diagnosis can potentially have a negative impact on treatment effectiveness and accuracy of prognosis.
Collapse
|
35
|
Lim CS, Subramaniam M, Poon LY, Chong SA, Verma S. Cross-ethnic differences in severity of symptomatology of individuals with first-episode schizophrenia spectrum disorder. Early Interv Psychiatry 2011; 5:242-8. [PMID: 21449991 DOI: 10.1111/j.1751-7893.2011.00260.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS The aims of this study were to describe the relationship between ethnicity and severity of baseline symptomatology in a sample of Asian individuals with first-episode schizophrenia spectrum disorder, and to determine if ethnicity predicts severity of symptomatology independent of gender, duration of untreated illness, premorbid functioning, and age of illness onset. METHODS This descriptive study included all Chinese, Malay and Indian individuals consecutively admitted into an early intervention programme for treatment of first-episode schizophrenia spectrum disorder. Comparisons of mean scores among the three ethnic groups were performed using analysis of variance, while chi-squared tests were used to compare proportions. Subsequent pair-wise comparisons were performed with Bonferroni corrected statistic to examine specific ethnic group differences. Multivariate regression analyses were conducted to identify factors significantly associated with the severity of different clinical dimensions of schizophrenia measured using the Positive and Negative Syndrome Scale (PANSS). RESULTS The analyses involved 503 individuals. The mean PANSS scores were significantly different between the ethnic groups across the PANSS subscales. A post-hoc analysis showed that Malays scored significantly higher than Chinese did across the PANSS subscales. Malays also scored significantly higher than Indians did on the negative scale and the general psychopathology scale. Being Malay compared with Chinese consistently predicted more severe positive, negative and general psychopathology symptoms. DISCUSSION The results indicated that the severity of baseline symptomatology of individuals with first-episode schizophrenia spectrum disorders differed by ethnicity. Premorbid functioning appears to act as a potential mediator of the effects of ethnicity on the severity of psychotic symptoms.
Collapse
Affiliation(s)
- Caroline S Lim
- School of Social Work, University of Southern California, Los Angeles, California 90089, USA.
| | | | | | | | | |
Collapse
|
36
|
Daniel D, Alphs L, Cazorla P, Bartko J, Panagides J. Training for Assessment of Negative Symptoms of Schizophrenia across Languages and Cultures: Comparison of the NSA-16 with the PANSS Negative Subscale and Negative Symptom Factor. ACTA ACUST UNITED AC 2011; 5:87-94. [DOI: 10.3371/csrp.5.2.5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
37
|
Abstract
The incidence of psychotic disorders is extremely high in several immigrant groups in Europe. This article describes the epidemiological evidence for increased incidence rates among immigrants compared with nonimmigrant populations and explores possible explanations for this excess risk. Potential causes not only involve factors acting at the level of the individual, but encompass the broader social context of neighborhoods and ethnic groups. Growing up and living in a disadvantaged ethnic minority position, characterized by a low social status, high degree of discrimination against the group and low neighborhood ethnic density, may lead to an increased risk of psychotic disorders, especially when individuals reject their minority status and when their social resources are insufficient to buffer the impact of adverse social experiences. Future research should refine measures of the social context, adopt a life-course perspective and should integrate social and neurobiological pathways.
Collapse
Affiliation(s)
- Wim Veling
- Center for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | |
Collapse
|
38
|
Chang N, Newman J, D'Antonio E, McKelvey J, Serper M. Ethnicity and symptom expression in patients with acute schizophrenia. Psychiatry Res 2011; 185:453-5. [PMID: 20705345 DOI: 10.1016/j.psychres.2010.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 07/15/2010] [Accepted: 07/20/2010] [Indexed: 11/30/2022]
Abstract
Chinese patients have been largely ignored in the literature examining ethnic differences in schizophrenia. This study examined demographics and symptom profiles of Euro-, African-, Chinese-American, and Latino inpatients with schizophrenia. Chinese-American patients had fewer symptoms, hospitalizations, and least amount of education compared to other groups. Cultural and clinical implications are discussed.
Collapse
Affiliation(s)
- Nadine Chang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- Jacquelyn H Flaskerud
- University of California—Los Angeles, School of Nursing, Los Angeles, California 90095–1702, USA.
| |
Collapse
|
40
|
First rank symptoms in first episode psychosis and their relationship to the duration of untreated illness. J Nerv Ment Dis 2010; 198:820-3. [PMID: 21048473 DOI: 10.1097/nmd.0b013e3181f97c29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most studies of First Rank Symptoms (FRS) are based on cross-sectional inpatient samples of people with schizophrenia at various stages of illness. We sought to examine the prevalence of FRS in a representative sample of first episode psychosis patients and compare those with and without FRS clinically and in terms of duration of untreated illness. Information was gathered from 158 consecutive cases of first episode psychosis presenting in a defined geographical region through semi-structured interview tools. Of this sample, 40.5% of cases received a diagnosis of schizophrenia. The prevalence of FRS among the entire group was 52.5%. After controlling for multiple testing, no FRS contributed significantly to predicting a diagnosis of schizophrenia. There was no significant relationship between the duration of untreated illness and FRS.
Collapse
|
41
|
Affiliation(s)
- Jacquelyn H Flaskerud
- University of California-Los Angeles, School of Nursing, Los Angeles, California 90095-1702, USA.
| |
Collapse
|
42
|
Archie S, Akhtar-Danesh N, Norman R, Malla A, Roy P, Zipursky RB. Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophr Bull 2010; 36:688-701. [PMID: 18987101 PMCID: PMC2894595 DOI: 10.1093/schbul/sbn137] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine ethnic variations in the pathways to care for persons accessing early intervention (EI) services in Ontario. METHOD The pathways to care and the duration of untreated psychosis were assessed for first-episode psychosis patients who entered specialized EI services in Ontario. The sample was assigned to the following ethnic classifications: the White (Caucasian), Black (African descent), and Asian (ancestry from the continent) groups, plus all the "other ethnicities" group. RESULTS There were 200 participants: 78% were male; 61% from the White, 15% Black, 13% Asian, and 11% were from the other ethnicities group. At the first point of contact, more participants used nonmedical contacts (12%), such as clergy and naturopathic healers, than psychologists (8%) or psychiatrists (7%). There were no ethnic differences for duration of untreated psychosis (median 22 weeks) or for initiation of help seeking by family/friends (53%), police (15%), or self (33%). After adjusting for relevant clinical and demographic factors, the Asian and other ethnicities groups were 4 and 3 times (respectively) more likely than the White or Black groups (P = .017) to use emergency room services as the first point of contact in the pathways to care. Participants from the Asian group experienced less involuntary hospitalizations (P = .023) than all the other groups. Yet overall, there were many more similarities than significant differences in the pathways to care. CONCLUSION EI services should monitor the pathways to care for young people of diverse ethnic backgrounds to address any disparities in accessing care.
Collapse
Affiliation(s)
- S. Archie
- McMaster University, Hamilton, Ontario,St. Joseph's Healthcare Hamilton
| | | | - R. Norman
- University of Western Ontario, London, Ontario,London Health Sciences Centre, Ontario
| | - A. Malla
- McGill University, Montreal, Quebec,Douglas Hospital, Montreal, Quebec
| | - P. Roy
- University of Ottawa, Ontario,The Ottawa Hospital
| | - R. B. Zipursky
- McMaster University, Hamilton, Ontario,St. Joseph's Healthcare Hamilton
| |
Collapse
|
43
|
Zandi T, Havenaar JM, Smits M, Limburg-Okken AG, van Es H, Cahn W, Algra A, Kahn RS, van den Brink W. First contact incidence of psychotic disorders among native Dutch and Moroccan immigrants in the Netherlands: influence of diagnostic bias. Schizophr Res 2010; 119:27-33. [PMID: 20332065 DOI: 10.1016/j.schres.2010.02.1059] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/20/2010] [Accepted: 02/19/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several studies have reported increased incidence rates of psychotic disorders among immigrant groups. Surprisingly, the cross-cultural validity of the diagnostic instruments that were used was never tested. AIMS To examine whether the incidence rates of psychotic disorders including schizophrenia among Moroccan immigrants to the Netherlands remain increased when a cultural sensitive diagnostic interview is used. METHOD We compared first contact incidence with a standard and a cultural sensitive version of a diagnostic interview. RESULTS Age and gender adjusted relative risk for psychotic disorders and schizophrenia among Moroccans compared to native Dutch was 7.9 (95% CI 4.7-13.5) and 7.8 (95% CI 4.0-15.2) respectively based on the standard diagnostic interview and 4.2 (95% CI 2.3-7.9) and 1.5 (0.5-4.3) respectively based on the cultural sensitive version the diagnostic interview. CONCLUSION First contact incidence of schizophrenia among Moroccans was no longer significantly higher than among ethnic Dutch people when a cultural sensitive diagnostic procedure was applied.
Collapse
Affiliation(s)
- T Zandi
- Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
|
45
|
Zayas LH, Torres LR, Cabassa LJ. Diagnostic, symptom, and functional assessments of Hispanic outpatients in community mental health practice. Community Ment Health J 2009; 45:97-105. [PMID: 18648933 DOI: 10.1007/s10597-008-9156-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
With increased US Hispanic diversity come diagnostic challenges associated with culture, language, and expression of mental disorders. In a community-based clinic, we compared diagnostic agreement between Hispanic and non-Hispanic clinicians, and a structured diagnostic instrument, in live and videotaped interviews with Hispanic adults. Percentage agreement and kappas show low diagnostic reliability between clinicians, and between clinicians and instrument. Significant differences appeared in rates of various diagnoses. Non-Hispanic clinicians rated patients' functional capacity and symptom-severity as significantly worse than Hispanic clinicians. Findings match past research with Hispanic patients and raise questions about diagnostic reliability in multi-cultural community mental health practice.
Collapse
Affiliation(s)
- Luis H Zayas
- Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA.
| | | | | |
Collapse
|
46
|
|
47
|
|
48
|
Compton M, Leiner A, Bergner E, Chien V, Franz L, Goulding S, Trotman H. Prevalence, Factorial Structure, and Clinical Correlates of First Rank Symptoms in Urban, African-American Patients with First-Episode Nonaffective Psychosis. ACTA ACUST UNITED AC 2008. [DOI: 10.3371/csrp.2.1.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Zandi T, Havenaar JM, Limburg-Okken AG, van Es H, Sidali S, Kadri N, van den Brink W, Kahn RS. The need for culture sensitive diagnostic procedures: a study among psychotic patients in Morocco. Soc Psychiatry Psychiatr Epidemiol 2008; 43:244-50. [PMID: 18060339 DOI: 10.1007/s00127-007-0290-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 11/05/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examine the procedural validity of a standardized instrument for the diagnosis of psychotic disorders in Morocco. METHOD Twenty-nine patients from Casablanca, Morocco, with a psychotic or mood disorder were examined using the Comprehensive Assessment of Symptoms and History (CASH) an adapted version using cultural formulation to make the instrument more culturally sensitive (CASH-CS). Chance corrected agreement was calculated between diagnoses based on these two versions of CASH and independent clinical diagnoses according to local psychiatrists. RESULTS Agreement for traditional CASH versus clinical diagnosis and for CASH versus CASH-CS was low (kappa = -0.19; SD 0.16 and kappa = 0.21; SD 0.16, respectively). De CASH-CS, showed good agreement with clinical diagnosis (kappa = 0.79; SD 0.11). CONCLUSION Standardized instruments for the assessment of psychosis such as the CASH may be liable to cultural misinterpretations. This may be relevant to the interpretation of the high incidence rates of schizophrenia among immigrants. SIGNIFICANT OUTCOMES Agreement between a culturally naïve version of a standardized diagnostic instrument for the assessment of psychosis and clinical diagnosis by Moroccan psychiatrists is poor. Adding additional probes and decision rules based on cultural formulation improves agreement with clinical diagnosis significantly. LIMITATIONS The study was conducted in a small sample. Both versions of CASH were administered by the same interviewer in a single interview session.
Collapse
Affiliation(s)
- Tekleh Zandi
- Altrecht, Institute for Mental Health Care, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Youngstrom EA, Birmaher B, Findling RL. Pediatric bipolar disorder: validity, phenomenology, and recommendations for diagnosis. Bipolar Disord 2008; 10:194-214. [PMID: 18199237 PMCID: PMC3600605 DOI: 10.1111/j.1399-5618.2007.00563.x] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To find, review, and critically evaluate evidence pertaining to the phenomenology of pediatric bipolar disorder and its validity as a diagnosis. METHODS The present qualitative review summarizes and synthesizes available evidence about the phenomenology of bipolar disorder (BD) in youths, including description of the diagnostic sensitivity and specificity of symptoms, clarification about rates of cycling and mixed states, and discussion about chronic versus episodic presentations of mood dysregulation. The validity of the diagnosis of BD in youths is also evaluated based on traditional criteria including associated demographic characteristics, family environmental features, genetic bases, longitudinal studies of youths at risk of developing BD as well as youths already manifesting symptoms on the bipolar spectrum, treatment studies and pharmacologic dissection, neurobiological findings (including morphological and functional data), and other related laboratory findings. Additional sections review impairment and quality of life, personality and temperamental correlates, the clinical utility of a bipolar diagnosis in youths, and the dimensional versus categorical distinction as it applies to mood disorder in youths. RESULTS A schema for diagnosis of BD in youths is developed, including a review of different operational definitions of 'bipolar not otherwise specified.' Principal areas of disagreement appear to include the relative role of elated versus irritable mood in assessment, and also the limits of the extent of the bipolar spectrum--when do definitions become so broad that they are no longer describing 'bipolar' cases? CONCLUSIONS In spite of these areas of disagreement, considerable evidence has amassed supporting the validity of the bipolar diagnosis in children and adolescents.
Collapse
Affiliation(s)
- Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA.
| | - Boris Birmaher
- Child and Adolescent Mood Disorders, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert L Findling
- Child and Adolescent Psychiatry, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, OH, USA
| |
Collapse
|