Changes in perceived neighborhood ethnic density among racial and ethnic minorities over time and psychotic-like experiences

Anglin, Deidre M.; Lui, Florence; Schneider, Mark; Ellman, Lauren M.

doi:10.1016/j.schres.2019.11.034

Cited by 18 publications

(34 citation statements)

References 58 publications

(62 reference statements)

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“…The remaining study found that Black, Latino, and Asian individuals in the USA who recounted growing up in neighbourhoods with higher proportions of out-group ethnic minority groups reported more psychotic-like symptoms than those who grew up in ethnically concordant or predominantly White neighbourhoods 51 . Further, Black individuals who perceived a change in the ethnic density of their neighbourhood during childhood reported more psychotic experiences than those who did not 51 .…”

Section: Virtual Reality Symptomatology and Perceived Ethnic Densitmentioning

confidence: 92%

“…All of these studies were conducted in a neighbourhood context with the exception of one which considered a school setting 46 . The other five studies examined Virtual Reality [VR] environments 43,44 , perceived ethnic density 51 , and symptomatology 37,38 and remission 38 .…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Around half of the studies (n=15, 48%) examined first incident cases 9,[25][26][27]31,35,36,39,41,42,[45][46][47]49,50 and six (19%) used measures of subclinical psychosis 11,[28][29][30]33,51 . The others assessed symptomatic outcomes 37,38,43,44 , mortality rates 32 , inpatient days following admission 34 , compulsory admission 48 , individuals meeting ultra-high risk [UHR] criteria 53 , dispensed antipsychotic medication 40 , lifetime prevalence of psychosis 52 , psychophysiological outcomes 43 , and social distance 43,44 .…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Five studies used different methods: two used VR 43,44 , two looked at symptom profiles 37,38 and remission 38 , and one examined perceived ethnic density 51 . VR studies simulated high and low group density environments by manipulating the ethnicity of avatars 43,44 .…”

Section: Virtual Reality Symptomatology and Perceived Ethnic Densitmentioning

confidence: 99%

“…Ten studies were eligible for meta-analysis 11,[26][27][28][29]40,46,47,49,52 . Of the twenty-one studies excluded, five did not adjust for the specified individual and area-level confounds 25,26,35,36,41 , five used non-eligible outcomes 32,34,37,38,48 , four used non-eligible exposures (VR simulation 43,44 , perceived ethnic density 51 , and ethnic enclaves 45 ), four studies used overlapping 11,30,49,50 or potentially overlapping datasets 27,31,39,40 , two only examined between-group density effects 9,42 , and one did not use multilevel modelling 33 .…”

Section: Meta-analysismentioning

confidence: 99%

See 4 more Smart Citations

A comprehensive systematic review and multilevel meta-analysis of the ethnic density effect in psychosis

Baker¹,

Jackson²,

Jongsma³

et al. 2020

Preprint

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BackgroundA group density effect in psychosis has been observed, whereby minority groups living in areas where there is a high proportion of their own group are at a lower risk of psychosis than minorities residing in neighbourhoods where their group is less represented. However, there is conflicting evidence over whether the group density effect differs by minority group, and limited investigation into other potential moderators.AimsTo conduct a comprehensive systematic review and meta-analysis of the group density effect in psychosis, examine moderating factors, and discuss possible mechanisms driving the effect.MethodFour electronic databases were systematically searched for studies reporting on the group density effect in psychosis. Evidence was qualitatively synthesised, and a three-level ‘multilevel’ meta-analysis was conducted on eligible studies. We assessed whether the pooled effect was moderated by broadly and specifically defined minority groups. Country, time, geographic unit, and outcome were also tested as moderators. We drew upon a wider evidence-base to explore potential mechanisms.ResultsThe search yielded 2652 unique articles, twenty-eight studies were included in the qualitative synthesis, and fourteen of these were eligible for meta-analysis. A ten percentage-point decrease in own-group density was associated with a 36% increase in psychosis risk [OR=1.36 (95% CI 1.11-1.65), p=0.003]. In line with the qualitative synthesis, the pooled effect was moderated by broadly defined minority groups [F6, 74=3.58, p=0.004] and when more specific minority groups were considered, a stronger moderating effect was observed [F21, 59=4.93, p<0.0001]. Other moderator tests were non-significant.ConclusionsThis is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density environments is not uniform across minority groups. This may reflect experiences of disempowerment which may arise differently in particular groups. This is explored further, along with implications of findings and avenues for future research.

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Section: Virtual Reality Symptomatology and Perceived Ethnic Densitmentioning

confidence: 92%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Virtual Reality Symptomatology and Perceived Ethnic Densitmentioning

confidence: 99%

Section: Meta-analysismentioning

confidence: 99%

See 3 more Smart Citations

A comprehensive systematic review and multilevel meta-analysis of the ethnic density effect in psychosis

Baker¹,

Jackson²,

Jongsma³

et al. 2020

Preprint

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Association of Childhood Area-Level Ethnic Density and Psychosis Risk Among Ethnoracial Minoritized Individuals in the US

et al. 2023

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ImportanceThe protective ethnic density effect hypothesis, which suggests that minoritized individuals who grow up in neighborhoods with a high proportion of ethnoracial minoritized groups are protected from the effects of perceived discrimination, has not been examined among individuals at clinical high risk of psychosis (CHR-P). This level of examination may help identify intervention targets for preventing psychosis among high-risk individuals.ObjectiveTo examine the association between area-level ethnic density during childhood, perceived discrimination, and psychosis risk outcomes among ethnoracial minoritized individuals with CHR-P.Design, Setting, and ParticipantsData were collected as part of the North American Prodrome Longitudinal Study-2 (NAPLS 2) between November 2008 and March 2013. Participants included ethnoracial minoritized youth with CHR-P. Area-level ethnoracial minoritized density pertained to the percent of ethnoracial minoritized individuals within the participant’s county during childhood. Generalized mixed-effects models with random intercepts for participants, NAPLS 2 site, and county estimated the associations between area-level ethnic density and the risk of psychosis risk outcomes. Self-reported experience of discrimination was assessed. Mediation analyses computed the indirect association of perceived discrimination in the prospective correlation between ethnic density and psychosis risk outcomes. Analyses took place between December 2021 and June 2023.Main Outcomes and MeasuresPsychosis risk outcomes included remission, symptomatic, progression, and conversion to psychosis and were assessed throughout 24-month follow-up.ResultsOf 193 individuals, the mean (SD) age was 17.5 (3.4) years and 113 males (58.5%) were included. Participants self-identified as Asian (29 [15.0%]), Black (57 [29.0%]), Hispanic (any race; 87 [45.0%]), or other (First Nations, Middle Eastern, and interracial individuals; 20 [10.4%]). Greater area-level minoritized density was associated with a lower likelihood of remaining symptomatic (relative risk [RR], 0.54 [95% CI, 0.33-0.89]) and having progressively worsening symptoms (RR, 0.52 [95% CI, 0.32-0.86]) compared with being in remission. More perceived discrimination was associated with a higher risk of staying symptomatic (RR, 1.43 [95% CI, 1.09-1.88]) and progressively worsening (RR, 1.34 [95% CI, 1.02-1.78]) compared with being in remission. Perceived discrimination significantly mediated 21.7% (95% CI, 4.1%-67.0%; P = .02) of the association between area-level minoritized density and the likelihood of being in remission.Conclusions and RelevanceThis study found that among ethnoracial minority youth with CHR-P, growing up in communities with a greater proportion of ethnically minoritized individuals was associated with remission of psychosis risk symptoms partly through lower levels of perceived discrimination. Understanding how the social environment impacts early psychosis risk may help develop effective interventions to prevent psychosis, especially for vulnerable minoritized youth.

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Ethnoracial Risk Variation Across the Psychosis Continuum in the US

van der Ven,

Olino,

Diehl

et al. 2024

JAMA Psychiatry

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ImportanceStudies 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.ObjectiveTo 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 SourcesPubMed, PsycINFO and Embase were searched up to December 2022.Study SelectionObservational studies on ethnoracial differences in risk of 3 psychosis outcomes.Data Extraction and SynthesisPreferred 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 MeasuresRisk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs.ResultsOf 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 RelevanceFindings 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.

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Changes in perceived neighborhood ethnic density among racial and ethnic minorities over time and psychotic-like experiences

Cited by 18 publications

References 58 publications

A comprehensive systematic review and multilevel meta-analysis of the ethnic density effect in psychosis

A comprehensive systematic review and multilevel meta-analysis of the ethnic density effect in psychosis

Association of Childhood Area-Level Ethnic Density and Psychosis Risk Among Ethnoracial Minoritized Individuals in the US

Ethnoracial Risk Variation Across the Psychosis Continuum in the US

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