Mental health care utilization in individuals with high levels of psychosis-like experiences: Associations with race and potentially traumatic events.

Abstract

Objective: Racial inequities in mental health care utilization (MHCU) are well documented. Marginalized racial groups are more likely to report psychosis-like experiences (PLEs) and are at elevated risk for racial discrimination and trauma, impacting PLE severity. Little is known about how factors associated with race impact treatment seeking among individuals reporting PLEs. The present study examined associations between race, trauma, discrimination, PLEs, and MHCU among people endorsing high levels of PLEs. Method: Participants were Asian/Asian American, Black/African American, or White/European American college students ages 18–25 years meeting PLE self-report measure cutoff scores (N = 177). Binary logistic and multiple linear regressions were used to examine associations between past, current, and prospective MHCU and race, potentially traumatic events, discrimination, and PLEs. Results: Participants endorsing more PLEs were more likely to report past and current treatment and to be considering future services. Asian/Asian American and Black/African American participants were less likely to endorse past, current, and prospective future mental health care. Potentially traumatic events predicted increased utilization of past treatment. Conclusions: Results suggest service differences among participants, such that Black/African American and Asian/Asian American young adults reporting PLEs were less likely than White/European American counterparts to seek treatment even when accounting for traumatic events and discrimination. These findings highlight the need to further elucidate MHCU among marginalized racial groups experiencing psychosis-like symptoms.

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

“…These differences were explained by socio-environmental factors, including exposure to discrimination and police violence. Differences in mental health care utilization across racialized groups among individuals reporting high levels of PLEs have also been observed such that college students who self-identified as Asian, Asian American, Black, or African American were significantly less likely to have received past or current mental health care and were considering seeking future services significantly less than those who self-identified as White or European American ( 19 ).…”

“…Attempts to understand the impact of sociodemographic, environmental, and contextual factors on the CHR phase have led to several conceptual and theoretical models worldwide that reflect the relevance of such factors in assessment, symptom severity, and mental health care utilization along the psychosis spectrum [e.g., ( 2 , 19 , 20 )]. For example, the psychosis proneness–persistence–impairment model highlights the role that “environmental risk” plays in the development of more severe, persistent, and clinically relevant psychotic symptomatology ( 2 ).…”

“…For example, the psychosis proneness–persistence–impairment model highlights the role that “environmental risk” plays in the development of more severe, persistent, and clinically relevant psychotic symptomatology ( 2 ). Similarly, Petti et al highlight the role of sociocultural and contextual factors across ecological systems levels in service use for individuals experiencing psychosis-spectrum symptoms ( 19 ). Additionally, recent work, such as a review by Anglin et al ( 10 ) of neighborhood factors, trauma, and perinatal factors, has laid important groundwork for examining the links between structural racism, social determinants, and CHR.…”

Differential Risk: Gender and Racial Differences in the Relationship between Trauma, Discrimination, and Schizotypy

“…Despite these challenges, several factors predict or modify the course of schizophrenia and individuals' recovery outcomes, including not only clinical and treatment features (e.g., symptom severity, substance abuse, and duration of illness), but also demographic characteristics (e.g., age at onset and sex) and socioeconomic variables [4]. However, systematic barriers such as provider bias and racism persist and impede marginalized racial groups' trust in the healthcare system, access to quality care, and recovery [5][6][7]. Moreover, although marginalized racial and ethnic groups experience higher rates of trauma than their White counterparts, they are also more likely to report unmet mental healthcare needs, especially following traumatic life events [8][9][10].…”