Ethnic identity, racial discrimination and attenuated psychotic symptoms in an urban population of emerging adults

Evidence for Environmental Risk Factors and Cumulative Stress Linking Racial/Ethnic Identity and Psychotic-Like Experiences in ABCD Study Data

OBJECTIVE

Previous work has found increased endorsement of psychotic-like experiences (PLEs) among marginalized racial and ethnic groups. According to social determinants frameworks, marginalized groups are at increased risk for exposure to socio-environmental risk factors, including systemic factors (eg, poverty and poor housing conditions) and social stressors (eg, discrimination). We examine the extent to which environmental risk factors and stress account for associations between racial/ethnic groups with PLEs.

METHOD

Analyses included 11,876 young adolescents 9 to 10 years of age from the Adolescent Brain Cognitive Development (ABCD) study. Mediation models assessed whether stress at 1-year follow-up indirectly linked baseline environmental risk to later distressing PLEs at 2-year follow-up. Serial mediation models examined whether environmental risk and stress indirectly accounted for variation among racial/ethnic groups in self-reported distressing PLEs.

RESULTS

Through principal component and mediation analyses, we found evidence that the link between environmental risk (eg, poverty and exposure to crime) and distressing PLEs was mediated by stress. There was also evidence that higher endorsement of distressing PLEs within the Black and Hispanic groups was serially mediated by greater environmental risk and greater stress.

CONCLUSION

The analyses provide evidence that the associations between marginalized racial and ethnic identities with the endorsement of PLEs partially reflects the sequelae of systemic socio-environmental factors. Findings suggest the potential for intervening upon environmental risk factors to target the reduction of cumulative stress over time, which may in turn buffer against the development of PLEs.

PLAIN LANGUAGE SUMMARY

Using longitudinal data from 11,876 young adolescents aged 9-10 from the Adolescent Brain Cognitive Development (ABCD) study, this study examined environmental (e.g., poverty) and stress-related factors (e.g., experiences of discrimination, childhood adversity) that are associated with psychotic-like experiences, and whether these factors explain racial/ethnic differences in psychotic-like experiences. The authors found evidence that the association between these environmental risk factors and psychotic-like experiences is partially explained by cumulative stress, and that differences in psychotic-like experiences across racial/ethnic groups were accounted for by both environmental risk factors and stress. Results highlight that systemic factors may explain higher levels of psychotic-like experiences among historically marginalized racial/ethnic groups. Findings suggest the potential for intervening upon modifiable risk factors to buffer against stress, and in turn, the development of psychotic-like experiences over time.

DIVERSITY INCLUSION STATEMENT

We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way.

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

OBJECTIVE

The NIH has mandated equal representation of Black, Indigenous, and people of color (BIPOC) individuals in clinical research, but it is unclear whether such inclusion has been achieved in multisite research studies of individuals at clinical high risk for psychosis or with first-episode psychosis (FEP). An assessment of inclusion rates is important for understanding the social determinants of psychosis and psychosis risk that specifically affect BIPOC individuals.

METHODS

The authors conducted a systematic review of the literature published between 1993 and 2022 of multisite research studies of clinical high risk for psychosis and FEP in North America to determine ethnoracial inclusion rates. Using an online systematic review tool, the authors checked 2,278 studies for eligibility. Twelve studies met all inclusion criteria. Data were extracted, and demographic characteristics, socioeconomic status, study design, and recruitment strategies used by each study were analyzed.

RESULTS

Most (62%) of the participants in studies of clinical high risk for psychosis were White. Compared with national data, the demographic characteristics of individuals with clinical high risk were representative across most ethnoracial groups. Black participants (43%) made up the largest ethnoracial group in FEP studies and were overrepresented compared with their representation in the U.S. population. FEP studies were more likely to recruit participants from community mental health centers than were the studies of clinical high risk.

CONCLUSIONS

Although these results suggest high representation of BIPOC individuals in psychosis research, opportunities exist for an improved focus on ethnoracial representation. The authors offer recommendations for practices that may increase ethnoracial diversity in future psychosis study samples.

Measurement invariance of the Revised-Green Paranoid Thought Scale across Black and White Americans

Given the culturally diverse landscape of mental healthcare and research, ensuring that our psychological constructs are measured equivalently across diverse populations is critical. One construct for which there is significant potential for inequitable assessment is paranoia, a prominent feature in psychotic disorders that can also be driven by culture and racial marginalization. This study examined measurement invariance-an analytic technique to rigorously investigate whether a given construct is being measured similarly across groups-of the Revised-Green Paranoid Thought Scale (R-GPTS; Freeman et al., 2021) across Black and White Americans in the general population. Racial group differences in self-reported paranoia were also examined. The analytic sample consisted of 480 non-Hispanic White and 459 non-Hispanic Black Americans. Analyses demonstrated full invariance (i.e., configural, metric, and scalar invariance) of the R-GPTS across groups, indicating that the R-GPTS appropriately captures self-reported paranoia between Black and White Americans. Accordingly, it is reasonable to compare group endorsement: Black participants endorsed significantly higher scores on both the ideas of reference and ideas of persecution subscales of the R-GPTS (Mean ± SD = 10.91 ± 7.12 versus 8.21 ± 7.17 and Mean ± SD = 10.18 ± 10.03 versus 6.35 ± 8.35, for these subscales respectively). Generalized linear modeling revealed that race remained a large and statistically significant predictor of R-GPTS total score (β = -0.38756, p < 0.001) after controlling for relevant demographic factors (e.g., sex, age). This study addresses a critical gap within the existing literature as it establishes that elevations in paranoia exhibited by Black Americans in the R-GPTS reflect actual differences between groups rather than measurement artifacts.

Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments

BACKGROUND AND AIMS

Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments.

STUDY DESIGN

PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review.

STUDY RESULTS

SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling.

CONCLUSIONS

Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.

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

BACKGROUND AND HYPOTHESIS

While individuals at clinical high-risk (CHR) for psychosis experience higher levels of discrimination than healthy controls, it is unclear how these experiences contribute to the etiology of attenuated positive symptoms. The present study examined the association of perceived discrimination with positive symptoms in a cohort from the North American Prodrome Longitudinal Study (NAPLS2). It predicted that CHR individuals will report higher levels of lifetime and past year perceived discrimination related to their race and ethnicity (ethnoracial discrimination) and that this form of discrimination will be significantly associated with baseline positive symptoms.

STUDY DESIGN

Participants included 686 CHR and 252 healthy controls. The present study examined data from the perceived discrimination (PD) scale, the Brief Core Schema Scale, and the Scale for the Psychosis-Risk Symptoms. Structural equation modeling was employed to examine whether negative schema of self and others mediated the relation of past year ethnoracial PD to baseline suspiciousness symptoms.

RESULTS

CHR individuals report higher levels of past year and lifetime PD compared to healthy controls. Lifetime ethnoracial PD was associated with suspiciousness and total positive symptoms. Negative schema of self and others scores partially mediated the relation of past year ethnoracial PD to suspiciousness, one of five positive symptom criteria for CHR.

CONCLUSIONS

For CHR individuals, past year ethnoracial discrimination was associated with negative beliefs about themselves and others, which was associated with suspiciousness. These findings contribute to an emerging literature characterizing the mechanisms by which discrimination contributes to the positive symptoms characterizing the CHR syndrome.

Ethnoracial Variation in Risk for Psychotic Experiences

BACKGROUND & HYPOTHESIS

Psychotic disorders are inequitably distributed by race in the United States, although it is not known whether this is due to assessment biases or inequitable distributions of risk factors. Psychotic experiences are subclinical hallucinations and delusions used to study the etiology of psychosis, which are based on self-report and therefore not subject to potential clinician biases. In this study, we test whether the prevalence of psychotic experiences (PE) varies by race and if this variance is explained by socioenvironmental risk factors.

STUDY DESIGN

Data on demographics, PE, and socioenvironmental risk factors were collected through the National Survey of Poly-victimization and Mental Health, a national probability sample of US young adults. Logistic regression analyses were used to determine whether PE prevalence varied by race/ethnicity and, if so, whether this was attenuated with inclusion of indicators of income, education, urban/rural living, discrimination, and trauma exposure.

STUDY RESULTS

Black and Hispanic respondents reported PE at significantly greater rates than White or "other" ethnoracial groups, with hallucinations more commonly reported by Hispanic respondents. PE were significantly associated with police violence exposure, discrimination, adverse childhood experiences, and educational attainment. These factors statistically explained ethnoracial differences in the likelihood of overall PE occurrence and of nearly all PE subtypes.

CONCLUSIONS

Previously observed racial differences in psychosis extend beyond clinical schizophrenia, and therefore, are unlikely to be explained entirely by clinician biases. Instead, racial disparities in PE appear to be driven by features of structural racism, trauma, and discrimination.

Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States

Background

Since its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature.

Results

Existing literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population.

Conclusions

Collectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field's prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR.

Discrimination, psychotic experiences, and racial identity among Black Americans: Findings from the National Survey of American Life

BACKGROUND

An emerging body of evidence suggests racial and ethnic identity may buffer the effects of discrimination on psychotic experiences, though the buffering effects have not been consistent across studies. More research is needed to clarify the conditions under which aspects of racial identity modify the effects of various forms of discrimination on psychotic experiences among Black Americans.

METHODS

We analyzed data from the National Survey of American Life (2001-2003). Using multivariable logistic regression, we examined the relations between various forms of discrimination and lifetime psychotic experiences, testing the interactive effects of two aspects of racial identity (racial group identification and racial private regard), adjusted for sociodemographic covariates.

RESULTS

The relation between everyday discrimination and psychotic experiences was stronger for African Americans who reported higher levels of racial group identification. Conversely, the relation between major discriminatory events and psychotic experiences was stronger for Caribbean Black Americans who reported lower levels of racial group identification. Higher racial private regard moderated the associations between everyday discrimination and psychotic experiences, and outgroup colorism and psychotic experiences among Caribbean Black Americans.

CONCLUSION

The role of racial identity is complex and appears to moderate the relation between some (but not all) forms of discrimination and lifetime psychotic experiences, depending on ethnicity.

Clinical and psychosocial outcomes of Black Americans in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study

PURPOSE

In the US, Black people diagnosed with schizophrenia experience worse psychosocial and clinical outcomes than their White counterparts. While racism-related factors contribute to these disparities, an additional understudied explanation may be that psychosocial treatments for psychotic disorders are less effective for Black than White individuals. The purpose of this study is to examine the extent to which best treatment practices for first-episode psychosis (FEP) are effective for Black and White participants.

METHODS

We conducted a secondary data analysis of the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP), a two-year multisite trial that compared a coordinated specialty care intervention for FEP (NAVIGATE) to community care as usual (CC) in 34 sites across the US. Specifically, we compared interviewer-rated quality of life and symptoms, as well as self-reported mental health and stigma, between 139 Non-Latinx Black and 172 Non-Latinx White participants with FEP in NAVIGATE and CC.

RESULTS

We found few differences between Black and White participants over two-year outcomes, either overall or in terms of benefit from NAVIGATE. Across both treatment conditions, Black participants improved less than White participants on positive symptoms, an effect driven primarily by suspiciousness/persecution. In NAVIGATE, self-reported mental health stigma decreased for both Black and White participants, while in CC stigma decreased for White participants but increased for Black participants. This effect was driven primarily by experienced stigma rather than self-stigma.

CONCLUSION

NAVIGATE benefits both Black and White individuals diagnosed with FEP. Mental health stigma and positive symptoms may be particularly important aspects of treatment for Black individuals diagnosed with FEP.

Online Dating and Mental Health among Young Sexual Minority Black Men: Is Ethnic Identity Protective in the Face of Sexual Racism?

Racialized Sexual Discrimination (RSD), also known as 'sexual racism,' is pervasive within online dating venues. RSD is associated with poor mental health outcomes among young sexual minority Black men (YSMBM), and there is limited research on factors that may mitigate this association. Ethnic identity has been identified as a potential protective factor for racial/ethnic minorities who encounter racialized stressors, though some evidence suggests that ethnic identity may also intensify the negative effects of racial discrimination. Using data from a cross-sectional web-survey of YSMBM (n = 690), a series of linear regression models were estimated to examine the moderating effect of ethnic identity search and ethnic identity commitment on the relationship between RSD and depressive symptoms/feeling of self-worth. Results indicated that having moderate-to-high scores on commitment attenuated the association between being physically objectified by White men and higher depressive symptoms. However, having high scores on commitment intensified the association between being rejected by Black men and lower feelings of self-worth. Stronger identity commitment may be protective against objectification from White men, though it may also exacerbate negative outcomes related to in-group discrimination. These findings may have important implications for the development of individual and group-level interventions addressing ethnic identity among YSMBM.

Psychosis and psychedelics: Historical entanglements and contemporary contrasts

Experiences of psychedelics and psychosis were deeply entangled in scientific practices in the mid-20th century, from uses of psychedelic drugs that could model psychosis, to detailed phenomenological comparisons of endogenous and drug-induced madness. After the moral panic of the 1960s shut down psychedelic research, however, these two phenomena became disentangled. In the decades following, the science of psychosis transformed, shedding the language of psychoanalysis, and adopting the new scientific veneer of psychiatry. Today, as psychedelic science re-emerges, the research programs surrounding psychosis and psychedelics now stand in stark contrast. Here, I look closely at how these research programs respond to questions related to what is worth measuring, what is worth investigating, and how we ought to respond to these experiences. This comparison reveals radically different assumptions and values that guide each research paradigm and shape clinical practice. While psychedelic research often includes scales that seek to capture experiences of mysticism, meaningfulness, and ego dissolution, research related to psychosis focuses on the measurement of pathological symptoms and functioning. Research into psychosis primarily seeks universal and reductionist causal explanations and interventions, while psychedelic research embraces the importance of set and setting in shaping unique experiences. Responses to psychedelic crisis involve warmth, compassion, and support, while responses to psychotic experiences often involve restraint, seclusion, and weapons. I argue that these differences contain important lessons for psychiatry. However, as psychedelic research struggles to meet regulatory requirements and fit within the paradigm of evidence-based medicine, these differences may quickly dissolve.

Understanding Associations Between Race/Ethnicity, Experiences of Discrimination, and Psychotic-like Experiences in Middle Childhood

OBJECTIVE

The present study aimed to examine factors that may account for race/ethnicity differences in psychotic-like experiences (PLEs) in a middle childhood sample, including evidence for experiences of discrimination as a psychosocial mediator of these differences.

METHOD

In a sample of 9- to 10-year-olds (N = 10,839) from the Adolescent Brain Cognitive Development Study, we compared PLEs across racial/ethnic groups. We also examined whether experiences of discrimination indirectly linked racial/ethnic identity and PLEs and whether social support moderated this indirect association.

RESULTS

Differences between racial/ethnic groups were found in the endorsement of PLEs, such that Black and Hispanic participants endorsed higher levels of PLEs compared with Asian, multiracial/multiethnic, and White participants. These differences were accounted for in part by experiences of discrimination, an indirect effect that was in turn attenuated by increased social support.

CONCLUSION

This is the first study to suggest that the experience of discrimination may indirectly link the association between racial/ethnic differences and endorsement of PLEs using the Prodromal Questionnaire-Brief Child Version and additionally that social support may act as a moderator of this mediation. Results provide evidence that social inequities such as racial discrimination may contribute to increases in PLEs. These findings shed further light on the links between structural racism and mental health inequities for people in minoritized groups.

From scary places to therapeutic landscapes: Voices from the community of people living with schizophrenia

This article discusses how people living with schizophrenia experience, understand, and respond to their urban environment. Our study relies on experiential photo-voice data gathered with a sample of six people diagnosed with schizophrenia and living in non-institutional settings in Montréal, Canada, to identify how individuals in this community perceive the urban landscape. We adopt a therapeutic landscapes' framework that explores the urban fabric at three levels: physical, social, and symbolic. Research participants identified both health-denying and health-enhancing places within ordinary urban landscapes. Landscapes identified as health-denying are characterized by environmental stressors and loss of control, with construction sites an example highlighted by participants. Healing and restorative landscapes, as identified by participants, were physically attractive or quiet, socially safe and welcoming, and symbolically affirmative of one's identity, all factors worthy of further study. The findings are also policy-relevant: they suggest that people living with schizophrenia and their clinicians can develop strategies to make health-enhancing uses of urban landscapes; and that urban policies and practices can foster urban environments conducive to enhanced health and well-being, both for the community of people living with schizophrenia and the wider population of urban dwellers.

Psychotic experiences, sexual minority status, and suicidal behavior among young adult college students in the United States

Psychotic experiences significantly predict suicidal behaviors; however, it is unknown whether these associations are conditional on sexual minority status. We analyzed cross-sectional data from the Healthy Minds Study (N = 109,975), which was collected between September 2020 and June 2021 from young adult (aged 18-34) students from across 140 colleges across the United States. Having psychotic experiences and sexual minority status were associated with significantly greater odds of reporting suicidal ideation, suicide plan, and suicide attempt, adjusting for sociodemographic characteristics. We found significant interactions between psychotic experiences and sexual minority status, such that the relations between psychotic experiences and suicidal behaviors were stronger among heterosexual students than among sexual minority students. However, the interactions disappeared for suicidal ideation and plans after adjusting for socio-behavioral risk factors. Future research can explore whether psychotic experiences predict suicide attempts among sexual minority status behavior socio-behavioral risk factors.

Structural Racism and Inequities in Incidence, Course of Illness, and Treatment of Psychotic Disorders Among Black Americans

Psychotic disorders (e.g., schizophrenia, schizoaffective disorder) are a leading cause of morbidity and premature mortality and an overlooked health inequity in the United States. European data indicate inequities in incidence, severity, and treatment of psychotic disorders, particularly for Black communities, that appear to be primarily attributable to social adversities. The dominant US narrative is that any observed differences are primarily a result of clinician bias and misdiagnosis. We propose that employing the framework of structural racism will prompt European and US research to converge and consider the multifaceted drivers of inequities in psychotic disorders among Black Americans. In particular, we describe how historical and contemporary practices of (1) racialized policing and incarceration, and (2) economic exploitation and disinvestment, which are already linked to other psychiatric disorders, likely contribute to risks and experiences of psychotic disorders among Black Americans. This framework can inform new strategies to (1) document the role of racism in the incidence, severity, and treatment of psychotic disorders; and (2) dismantle how racism operates in the United States, including defunding the police, abolishing carceral systems, and redirecting funds to invest in neighborhoods, housing, and community-based crisis response and mental health care. (Am J Public Health. 2022;112(4):624-632. https://doi.org/10.2105/AJPH.2021.306631).

The association of multidimensional schizotypy with symptoms and impairment across racial groups

The assessment of schizotypy and schizophrenia-spectrum psychopathology has historically been adversely impacted by multiple forms of measurement bias, including racial bias. The Multidimensional Schizotypy Scale (MSS) was developed using modern scale construction methods to minimize measurement bias in the assessment of schizotypic traits. However, studies have not examined the validity of the measurement across different racial groups. The present study examined whether the associations of MSS positive, negative, and disorganized schizotypy subscales with interview-assessed ratings of functioning, schizophrenia-spectrum personality traits, and depressive disorders were generally comparable across nonclinically ascertained samples of Black (n = 46), Asian (n = 87), and White (n = 116) young adults. Consistent with previous findings, all three schizotypy subscales were associated with impairment and schizotypal and paranoid traits. Negative schizotypy was associated with schizoid traits, and disorganized schizotypy was associated with depressive disorders. These associations were comparable across the racial groups, supporting the use of the MSS in these groups. Culturally and empirically valid assessments are essential for providing accurate assessments across racial/ethnic groups and reducing the risk of overpathologizing people of color. The present findings support the cross-cultural validity of the MSS; however, future studies should expand upon these findings by including more diverse samples and longitudinal designs.

Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors

Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.

The association between sleep quality and attenuated psychotic symptoms

AIM

To determine if poor sleep makes a unique contribution in predicting the likelihood of experiencing six or more attenuated psychotic symptoms and associated distress, after examining and controlling for sociodemographic factors, depression and drug/alcohol use.

METHOD

An online survey was conducted using Amazon's online crowdsourcing service Mechanical Turk (MTurk). The sample was 1013 adults (18 to 36 years) from the general population in the United States. The survey consisted of the Prodromal Questionnaire 16 (PQ-16), the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire 9, the Drug Abuse Screening Test 10 and the Alcohol Use Disorders Identification Test. Regression analyses were performed with the PQ-16 as the dependent variable, and sleep quality as the predictor variable, holding constant sociodemographic variables, depression, and alcohol/drug abuse.

RESULTS

37% of the sample endorsed six or more PQ-16 items, which may be suggestive of an at-risk mental state, with sleep disturbance significantly increasing the likelihood (Odds ratio 2.09 < .001) of endorsing six or more PQ-16 items. After controlling for sociodemographic variables, depression and drug/alcohol abuse, poor sleep quality made a unique contribution of 5.8% of the variance accounted for in level of distress experienced by attenuated psychotic symptoms.

CONCLUSION

Effective treatment of sleep disturbance may reduce the likelihood ofexperiencing attenuated psychotic symptoms and associated distress.

Understanding urbanicity: how interdisciplinary methods help to unravel the effects of the city on mental health

Twenty-first century urbanization poses increasing challenges for mental health. Epidemiological studies have shown that mental health problems often accumulate in urban areas, compared to rural areas, and suggested possible underlying causes associated with the social and physical urban environments. Emerging work indicates complex urban effects that depend on many individual and contextual factors at the neighbourhood and country level and novel experimental work is starting to dissect potential underlying mechanisms. This review summarizes findings from epidemiology and population-based studies, neuroscience, experimental and experience-based research and illustrates how a combined approach can move the field towards an increased understanding of the urbanicity-mental health nexus.

[Social defeat and schizophrenia: Hypotheses, arguments, mechanisms]

There is growing evidence for a main role of environment in the occurrence of mental disorders such as a psychosocial risk factor, for example, childhood trauma, discrimination linked to minority status, or migrant status. One hypothesis is that social adversity factors influence the risk of schizophrenia through a common pathway: social defeat which could be defined as the impotence of a subject in the face of a situation of social adversity, with a consequential experience of devaluation on the social scale. This review proposes to explain the animal model of social defeat which provides an overview of the neurobiological consequences of chronic stress. Then, we expose this topic in humans, the assessment methods, and its psychopathological field. Finally, we expose epidemiologic and neurobiological evidences, in particular the dopaminergic sensitization process, which provide evidence of a significant role of social defeat in schizophrenia risk due to exposure to psychosocial factors. This etiopathogenic hypothesis has several issues. First, a common pathway to several environmental risk factors could allow an ethiopathogenic model more parcimonious for schizophrenia. It could also allow the assessment and prevention of adversity factors involved in social defeat so as to finally improve the outcome of subjects who have an individual risk for schizophrenia.

Racial Discrimination, Racial Identity, and Obesity in Collegiate African American Women

OBJECTIVE

To investigate relationships among racial discrimination, explicit racial identity, and obesity in young collegiate African American (AA) women aged 18-25.

DESIGN

Researchers recruited 136 women who self-identified as AA from a large Midwestern university. Racial discrimination (RD) was measured using lifetime overt experiences of discrimination, recent microaggressions, and vicarious RD directed towards close others. Explicit racial identity included dimensions of private regard, public regard, and centrality. Generalized obesity (elevated body mass index) and abdominal obesity (increased fat distribution in the midsection) were measured biometrically using kg/m² and waist circumference, respectively. Hierarchical multiple regression was employed to explore main and interaction effects.

RESULTS

After controlling for adverse life events and income, overt RD, recent microaggressions, and private regard directly accounted for variance in both BMI and waist circumference. Public regard and centrality moderated relationships between RD variables and waist circumference.

CONCLUSIONS

RD and racial identity accounted for up to 13% of variance in BMI and waist circumference in main effects models among young collegiate AA women. While obesity is a multifactorial phenomenon, racial discrimination and racial identity may affect observed racial disparities in obesity rates among young women.

Post-secondary students with symptoms of psychosis: A mixed-methods systematic review

Post-secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed-methods systematic review of psychosis among post-secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self-esteem and self-concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.

Perceived ethnic discrimination as a risk factor for psychotic symptoms: a systematic review and meta-analysis

BACKGROUND

Previous studies have shown an elevated risk of psychotic symptoms (PS) and experiences (PEs) among ethnic minority groups, with significant variation between groups. This pattern may be partially attributable to the unfavorable socio-environmental conditions that surround ethnic minority groups. Perceived ethnic discrimination (PED) in particular has been a salient putative risk factor to explain the increased risk.

METHODS

We conducted a systematic literature review and meta-analysis to assess the impact of PED on reporting PS/PEs in ethnic minorities. This review abides by the guidelines set forth by Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The included studies were obtained from the databases: Medline, PsycINFO, and Web Of Science. Sub-group analyses were performed assessing the effect of PED in different subtypes of PS, the influence of ethnicity and moderating/mediating factors.

RESULTS

Seventeen studies met the inclusion criteria, and nine were used to conduct the meta-analysis. We found a positive association between PED and the occurrence of PS/PEs among ethnic minorities. The combined odds ratio were 1.77 (95% CI 1.26-2.49) for PS and 1.94 (95% CI 1.42-2.67) for PEs. We found that the association was similar across ethnic groups and did not depend on the ethnic origin of individuals. Weak evidence supported the buffering effects of ethnic identity, collective self-esteem and social support; and no evidence supported the moderating effect of ethnic density. Sensitivity to race-based rejection significantly but only slightly mediated the association.

CONCLUSION

These findings suggest that PED is involved in the increased risk of PS/PEs in ethnic minority populations.

Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review

BACKGROUND

Previous studies have provided initial evidence that people at risk for psychosis (PR) suffer from stigma and discrimination related to their condition. However, no study has systematically reviewed stigma and discrimination associated with being at PR and the potential underlying mechanisms.

METHODS

This work aimed to systematically review all studies addressing stigma and discrimination in PR people in order to assess: (1) the occurrence of this phenomenon and its different components (public, internalized, perceived, and labeling-related), (2) whether stigma affects outcomes of the PR state, and (3) whether other factors modulate stigma among PR individuals.

RESULTS

The reviewed studies (n = 38) widely differ in their design, methodological quality, and populations under investigation, thus limiting direct comparison of findings. However, converging evidence suggests that the general public endorses stigmatizing attitudes towards PR individuals, and that this is more frequent in people with a low educational level or with no direct experience of the PR state. PR individuals experience more internalized stigma and perceive more discrimination than healthy subjects or patients with non-psychotic disorders. Further, PR labeling is equally associated with both positive (e.g. validation and relief) and negative effects (e.g. status loss and discrimination). Moreover, stigma increases the likelihood of poor outcome, transition to full-psychosis, disengagement from services, and family stigma among PR individuals. Finally, very limited evidence awaiting replication supports the efficacy of cognitive therapies in mitigating the negative effects of stigma.

CONCLUSIONS

Evidence confirms previous concerns about stigma and its negative consequences for PR individuals, thus having important public health implications.

Perceived discrimination and psychosis: a systematic review of the literature

PURPOSE

Higher rates of psychosis have been reported in minority groups. Since individuals belonging to such groups are vulnerable to the experiences of discrimination, and in line with models proposing that social and life adversity may play a causal role in development and maintenance of psychotic experiences, it has been proposed that perceived discrimination may represent an important determinant of psychotic experiences. This paper reviews the literature examining the relationship between perceived discrimination and psychosis, examining whether discrimination is associated with an increased risk of psychosis, the severity of psychotic symptoms and whether there is an association with specific psychotic symptoms.

METHODS

A systematic database search of PsycINFO, Embase and PubMed was conducted to identify quantitative cross-sectional and prospective studies that examined the association between discrimination and psychosis.

RESULTS

Twenty-four studies met the inclusion criteria, four of which used prospective designs and twenty used cross-sectional designs. The main findings indicated that discrimination may be associated with an increased risk of psychosis (too few studies to determine whether discrimination is associated with severity). Some studies found associations between discrimination and positive psychotic experiences and/or specific psychotic experiences such as paranoia. A small number of studies found that greater exposure to discrimination was associated with a greater likelihood of reporting psychotic experiences, tentatively indicating a dose-response relationship.

CONCLUSIONS

This review indicates that discrimination plays an important role in the experience of psychosis; however, future research is required to clarify the nature of this relationship. Avenues for further research and clinical implications are proposed.

Moderating the association between discrimination and adjustment: A meta-analysis of ethnic/racial identity

The detrimental effects of discrimination are well documented; however, the influence of ethnic/racial identity (ERI) on this association is equivocal. There is theoretical and empirical support for both protective and detrimental effects of ERI. This meta-analysis includes 53 effect sizes from 51 studies and 18,545 participants spanning early adolescence to adulthood to synthesize the interaction of ERI and discrimination for adjustment outcomes. Consistent with existing meta-analyses, discrimination was associated with compromised adjustment; further, this effect was buffered by overall ERI particularly for academic and physical health outcomes. Different ERI dimensions and adjustment outcomes revealed important patterns. ERI exploration increased vulnerabilities associated with discrimination, particularly for negative mental health and risky health behaviors. The exacerbating influence of ERI exploration was strongest at age 24, and more recent publications reported weaker exacerbating effects. In contrast, ERI commitment conferred protection. A composite score of ERI exploration and commitment also conferred protection against discrimination. Sample demographics mattered. The buffering effect of ERI commitment was stronger for Latinx (compared with Asian heritage) individuals. The buffering effect of public regard was stronger for Asian heritage (compared with African heritage) individuals. For positive mental health outcomes, a composite score of ERI exploration and commitment had a stronger buffering effect for Latinx (compared with African heritage) individuals. For risky health behaviors, Latinx individuals reported a stronger buffering effect of ERI (compared with African heritage and Asian heritage) individuals. The current meta-analysis identifies gaps in the literature and offers suggestions for future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Ethnic minority position and migrant status as risk factors for psychotic symptoms in the general population: a meta-analysis

Psychotic symptoms (PS) are experienced by a substantial proportion of the general population. When not reaching a threshold of clinical relevance, these symptoms are defined as psychotic experiences (PEs) and may exist on a continuum with psychotic disorders. Unfavorable socio-environmental conditions, such as ethnic minority position (EMP) and migrant status (MS), may increase the risk of developing PS and PEs. We conducted an electronic systematic review and a meta-analysis assessing the role of EMP and MS for the development and persistence of PS in the general population. Sub-group analyses were performed investigating the influence of ethnic groups, host countries, age, types of PS, and scales. Twenty-four studies met our inclusion criteria. EMP was a relevant risk factor for reporting PS [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.22-1.70) and PEs (OR 1.36, 95% CI 1.16-1.60). The greatest risk was observed in people from the Maghreb and the Middle East ethnic groups in Europe (OR 3.30, 95% CI 2.09-5.21), in Hispanic in the USA (OR 1.98, 95% CI 1.43-2.73), and in the Black populations (OR 1.85, 95% CI 1.39-2.47). We found a significant association between MS and delusional symptoms (OR 1.47, 95% CI 1.33-1.62). We found no association between EMP and persistence of PEs.EMP was associated with increased risk of reporting PS and PEs, and the risk was higher in ethnic groups facing deprivation and discrimination. We found an association between MS and delusional symptoms. These results raise questions about the precise role of socio-environmental factors along the psychosis continuum.

Psychotic experiences among ethnic majority and minority adolescents and the role of discrimination and ethnic identity

PURPOSE

Research shows that the prevalence of psychiatric problems is higher in ethnic minority youth compared to native youth. This school-based screening study of early adolescents' mental health in the Netherlands examined differences in prevalence of psychotic experiences in ethnic minority youth compared to their Dutch peers. Moreover, we investigated the association between psychotic experiences, ethnic identity, and perceived discrimination.

METHODS

A cohort of 1194 ethnic majority and minority adolescents (mean age 13.72, SD 0.63) filled-out questionnaires on psychotic experiences (including delusional and hallucinatory experiences), perceived group and personal discrimination, and ethnic identity.

RESULTS

Apart from lower levels of hallucinatory experiences in Turkish-Dutch adolescents, prevalence of psychotic experiences did not differ between ethnic minority and majority adolescents. Perceived personal discrimination was associated with the presence of psychotic experiences (including delusional and hallucinatory experiences) (OR 2.30, 95% CI 1.22-4.34). This association was stronger for delusional experiences (OR 2.94, 95% CI 1.43-6.06) than for hallucinatory experiences (OR 1.65, 95% CI 0.73-3.72). No significant associations were found between perceived group discrimination and psychotic experiences. A weak ethnic identity was associated with higher risk for reporting psychotic experiences (OR 2.04, 95% CI 1.14-3.66), particularly hallucinatory experiences (OR 3.15, 95% CI 1.54-6.44). When looking at specific ethnic identity categories, marginalization, compared to separation, was associated with a threefold risk for reporting psychotic experiences (OR 3.26, 95% CI 1.33-8.03). Both marginalisation (OR 3.17, 95% CI 1.04-9.63) and assimilation (OR 3.25, 95% CI 1.30-8.13) were associated with a higher risk for hallucinatory experiences.

CONCLUSIONS

These results underline the protective effect of ethnic identity against mental health problems. Future research should focus on interventions that focus on strengthen social identity.

Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort

BACKGROUND

DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria.

METHOD

We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years.

RESULTS

The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis.

CONCLUSIONS

NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.