Racism and Social Determinants of Psychosis

Abstract

The Centers for Disease Control and Prevention has identified racism as a serious threat to public health. Structural racism is a fundamental cause of inequity within interconnected institutions and the social environments in which we live and develop. This review illustrates how these ethnoracial inequities impact risk for the extended psychosis phenotype. Black and Latinx populations are more likely than White populations to report psychotic experiences in the United States due to social determining factors such as racial discrimination, food insecurity, and police violence. Unless we dismantle these discriminatory structures, the chronic stress and biological consequences of this race-based stress and trauma will impact the next generation's risk for psychosis directly, and indirectly through Black and Latina pregnant mothers. Multidisciplinary early psychosis interventions show promise in improving prognosis, but coordinated care and other treatments still need to be more accessible and address the racism-specific adversities many Black and Latinx people face in their neighborhoods and social environments. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 19 is May 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Prison or treatment? Gender, racial, and ethnic inequities in mental health care utilization and criminal justice history among incarcerated persons with borderline and antisocial personality disorders.

“…For example, research into disproportionate diagnosis of psychotic disorders among Black and Latinx individuals suggests likely systemic bias in clinical assessment (R. C. Schwartz & Blankenship, 2014;E. K. Schwartz et al, 2019) and increased exposure to psychosis risk factors associated with structural racism (Anglin, 2023;Shim, 2022). Within the current sample, nearly all participants received a lifetime diagnosis of BPD and ASPD, limiting statistical power to examine whether demographic groups were differentially likely to receive such diagnoses.…”

“…Various factors may contribute to differences in diagnostic rates and/or clinical presentation across social groups, including biases inherent in the definitions of disorder constructs (Metzl, 2010), bias on the part of diagnosticians (Garb, 2021; Shim & Vinson, 2021), or true differences in symptom manifestation that result from factors such as racism, minority stress, gender socialization, and culture (e.g., Anglin, 2023; DeVylder et al, 2023; Thomas et al, 2021). For example, research into disproportionate diagnosis of psychotic disorders among Black and Latinx individuals suggests likely systemic bias in clinical assessment (R. C. Schwartz & Blankenship, 2014; E. K. Schwartz et al, 2019) and increased exposure to psychosis risk factors associated with structural racism (Anglin, 2023; Shim, 2022). Within the current sample, nearly all participants received a lifetime diagnosis of BPD and ASPD, limiting statistical power to examine whether demographic groups were differentially likely to receive such diagnoses.…”

“…Various factors may contribute to differences in diagnostic rates and/or clinical presentation across social groups, including biases inherent in the definitions of disorder constructs (Metzl, 2010), bias on the part of diagnosticians (Garb, 2021;Shim & Vinson, 2021), or true differences in symptom manifestation that result from factors such as racism, minority stress, gender socialization, and culture (e.g., Anglin, 2023;DeVylder et al, 2023;Thomas et al, 2021). For example, research into disproportionate diagnosis of psychotic disorders among Black and Latinx individuals suggests likely systemic bias in clinical assessment (R. C. Schwartz & Blankenship, 2014;E.…”

Putting late-onset psychosis into context

“…Race is an important determinant of mental health and is not discussed in the Devanand and coauthors’ paper. Compared to Caucasians, Blacks in the United States and the UK are, respectively, 2.5 times and over 5 times more likely to be given a diagnosis of schizophrenia (Anglin, 2023; Halvorsrud et al ., 2019). Also, in the United States, Blacks have higher rates of psychotic symptoms in the general population.…”

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

“…Racial discrimination is positively associated with subthreshold psychotic experiences [17][18][19][20][21][22][23][24]. Findings from two epidemiological studies in the United States of America found that increased perceived racial discrimination was associated with higher auditory and visual hallucinations and delusional ideation [22].…”