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Child Psychiatrist /Adult Psychiatrist

Racial and Ethnic Disparities in Schizophrenia, Psychosis Risk

Keypoint: There are significant racial disparities in the risk for psychotic continuum outcomes.


Psychosis Risk

The risk for schizophrenia, psychotic symptoms (PSs), and psychotic experiences (PEs) are higher among Black and Latinx patients compared with White patients, according to study results published in JAMA Psychiatry.


Although previous research has indicated that Black individuals are at higher risk for psychotic disorder diagnoses, relatively little is known about how risk varies across ethnoracial groups for other psychosis continuum outcomes — namely PSs, PEs, and clinical high risk for psychotic disorder [CHR-P]). To this aim, investigators conducted a systematic review and meta-analysis to assess the risk variation for these psychosis continuum outcomes across multiple racial and ethnic groups.


The investigators searched publication databases from inception to December 2022 for observational studies conducted in the United States that evaluated psychotic disorder diagnoses, CHR-P, or PSs/PEs as outcomes among at least 2 ethnoracial groups. The primary outcome of the meta-analysis was schizophrenia spectrum diagnoses, while secondary analyses evaluated the risk for CHR-P and PSs/PEs.


Overall, a total of 47 studies were included in the meta-analysis for a pooled total of 54,929 patients with schizophrenia (Asian: 4653; Black: 15,146; Latinx: 14,516; White: 19,744; Other: 870) and 223,097 patients with PSs/PEs (Asian: 16,951; Black: 25,528; Latinx: 17,683; White: 156,627; Other: 6308). Of the included studies, 32 evaluated a psychotic disorder, 29 assessed PSs/PEs, and 3 investigated CHR-P.


Relative to White individuals, the investigators observed higher odds of a schizophrenia spectrum diagnosis among Black patients (odds ratio [OR], 2.07; 95% CI, 1.64-2.61; P <.01) and individuals who identified as Other (OR, 1.81; 95% CI, 1.31-2.50; P <.01). The investigators also found that the risk for PSs/PEs was higher among Black (pooled standardized mean difference [SMD]; 0.10; 95% CI, 0.03-0.16) and Latinx individuals (pooled SMD, 0.15; 95% CI, 0.08- 0.22) compared with White participants.


The investigators also conducted sensitivity analyses based on treatment setting, diagnosis, and sampling characteristics. When compared with White individuals, the investigators found that Asian individuals displayed greater odds of a schizophrenia spectrum diagnosis when treated in inpatient settings (OR, 1.84; 95% CI, 1.19-2.84; P <.05) and when participants were sampled in a college setting (Cohen d, 0.16; 95% CI, 0.02-0.29; P <.05).


The investigators did note a high level of heterogeneity across the included studies.

Researchers concluded, “Ethnoracial risk variation in the US is present across multiple psychosis-related outcomes, suggesting that factors other than diagnostic bias alone underlie these disparities.”


These results may be limited, given the risk for bias due to the included studies’ insufficient controlling of confound variables, the low representativeness of sample populations, high heterogeneity, and poorly assessed and defined ethnoracial groups.


Note: This article originally appeared on Psychiatry Advisor

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