Investigating ethnic variations in reporting of psychotic symptoms: a multiple-group confirmatory factor analysis of the Psychosis Screening Questionnaire

Abstract

BackgroundEpidemiological 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.MethodsCombining 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.ResultsCompared 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.ConclusionsNotwithstanding 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.

Cultural differences in positive psychotic experiences assessed with the Community Assessment of Psychic Experiences-42 (CAPE-42): a comparison of student populations in the Netherlands, Nigeria and Norway

“…Similar findings have been reported with regard to the prevalence of positive symptom clusters across different ethnic groups within certain countries: disparity in symptom prevalence between ethnic groups exceeds disparity in prevalence of psychotic disorder [37–39]. This seems to be especially true for perceptual anomalies and paranoia [40–42]. Moreover, discrepancies between positive symptom prevalence and prevalence of a diagnosis of psychosis have been shown to be more pronounced in some ethnic groups than in others [10, 37, 39, 43], pointing towards a complex interplay of cultural and social factors (e.g.…”

Children’s Hope in South Africa: A Population-Based Study

“…Improvement of model fit was achieved by the consideration of modification indices, standardized residual covariances, and the expected parameter change (Savahl et al, 2019). Measurement invariance was used to compare the results across provincial regions and was tested using multi-group confirmatory factor analysis (MGCFA) to ensure meaningful, reliable, and unambiguous group comparisons (Meredith, 1993;Millsap and Olivera-Aguilar, 2012). This process comprised three sequential steps wherein restrictive constraints were incrementally applied.…”

Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism

“…And, although not extensive, what evidence there is suggests that diagnostic categories are valid across ethnic, cultural and language groups (Heuvelman et al . , Nazroo ). Of course, problems remain.…”