Psychotic experiences among Black college students in the United States: The role of socioeconomic factors and discrimination

Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis

Importance

Studies 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.

Objective

To 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 Sources

PubMed, PsycINFO and Embase were searched up to December 2022.

Study Selection

Observational studies on ethnoracial differences in risk of 3 psychosis outcomes.

Data Extraction and Synthesis

Preferred 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 Measures

Risk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs.

Results

Of 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 Relevance

Findings 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.

Racial discrimination is associated with food insecurity, stress, and worse physical health among college students

BACKGROUND

Students of color disproportionately experience racial discrimination and food insecurity, which both lead to poor academic and health outcomes. This study explores the extent to which the location of racial discrimination experienced is associated with food insecurity, stress, physical health and grade point average among college students METHODS: A cross sectional study design was implemented to survey 143 students from a racially diverse public university. Logistic regression models assessed if discrimination at various locations was associated with food insecurity and linear models assessed how racial discrimination was associated with physical health, stress and grade point average RESULTS: Student's experiencing food security had an average discrimination score of 2.3 (1.23, 3.37), while those experiencing food insecurity had a statistically significant (P < 0.001) higher average discrimination score 7.3 (5.4, 9.21). Experiencing any racial discrimination was associated with increased odds of experiencing food insecurity when experienced from the police (OR 11.76, 95% CI: 1.41, 97.86), in the housing process (OR 7.9, 95% CI: 1.93, 32.34) and in the hiring process (OR 6.81, 95% CI: 1.98, 23.48) compared to those experiencing no racial discrimination after adjusting for race, gender, age and income.

CONCLUSION

The location in which a student experienced racial discrimination impacted the extent to which the racial discrimination was associated with food security status. Further research is needed to explore potential mechanisms for how racial discrimination may lead to food insecurity.

Mental health outcomes of multiracial individuals: A systematic review between the years 2016 and 2022

BACKGROUND

Emerging evidence suggests that multiracial individuals are at high risk for mental health problems. Systematic and ongoing synthesis of literature is necessary to understand mental health among multiracial individuals.

METHODS

We conducted a systematic review of scholarly articles published during the years 2016-2022. Studies must have focused explicitly on mental health outcomes of biracial/multiracial individuals using quantitative methods. A total of 22 articles met criteria for this review.

RESULTS

Studies were mainly from the United States, with one study from the United Kingdom and one from the Netherlands. Sample sizes ranged from 57 to 393,681. Findings revealed a complicated picture between multiracial identity and mental health, which may be a function of how multiracial identity is defined and empirically examined. Among studies comparing multiracial individuals with monoracial groups, multiracial individuals tended to have worse mental health, with notable exceptions depending on the multiracial subgroup, the mental health outcome, and the reference group. Among studies that only examined multiracial individuals, discrimination and ethno-racial identity emerged as complex explanatory factors that can shape mental health, though each of these constructs can be explored more deeply across social milieu.

LIMITATIONS

The review focused on studies explicitly examining multiracial mental health, published during a limited time frame.

CONCLUSION

Multiracial individuals tended to have worse mental health outcomes compared to their monoracial counterparts, with variations depending on the outcomes, populations/subgroups, contexts, and reference groups. Racial discrimination and ethno-racial identity may shape mental health trajectories of multiracial people, calling for more research to inform targeted interventions.

Social victimization, default mode network connectivity, and psychotic-like experiences in adolescents

Social victimization (SV) and altered neural connectivity have been associated with each other and psychotic-like experiences (PLE). However, research has not directly examined the associations between these variables, which may speak to mechanisms of psychosis-risk. Here, we utilized two-year follow-up data from the Adolescent Brain Cognitive Development study to test whether SV increases PLE through two neural networks mediating socio-affective processes: the default mode (DMN) and salience networks (SAN). We find that a latent SV factor was significantly associated with PLE outcomes. Simultaneous mediation analyses indicated that the DMN partially mediated the SV-PLE association while the SAN did not. Further, multigroup testing found that while Black and Hispanic adolescents experienced SV differently than their White peers, the DMN similarly partially mediated the effect of SV on PLE for these racial groups. These cross-sectional results highlight the importance of SV and its potential impact on social cognitive neural networks for psychosis risk.

Moderating effect of alexithymia between problem gambling and psychotic experiences in university students

BACKGROUND

Most of the young individuals with problem gambling (PG) or psychotic experiences (PEs) are less prone to seek medical help. Therefore, community-based studies investigating the relationship between these entities in non-clinical young people across a continuum of severity are warranted. To this end, the present study proposes to advance knowledge on the mechanisms that potentially underlie the association between PG and PEs, by examining the role of a potential moderator, i.e. alexithymia, in this relationship.

METHODS

A total of 399 participants enrolled in this study (mean age = 21.58 ± 3.20 years) participated in an online cross-sectional survey. The South Oaks Gambling Screen (SOGS), the Prodromal Questionnaire-Brief (PQ-B), and the Toronto alexithymia scale (TAS-20) were used.

RESULTS

Thirty-three (8.3%) participants had problem-gambling, whereas 13 (3.3%) were probable pathological gamblers. Moderation analysis results adjusted over confounders (age, household crowding index, marital status, personal history of mental disorder, other illegal drug use) showed that the interaction PG by alexithymia (p = .018) was significantly associated with PEs scores. At moderate (Beta = 1.93) and high (Beta = 3.38) levels of alexithymia, more PG was significantly associated with more PEs scores.

CONCLUSION

Findings suggest that GP may have a different impact on PEs depending on the individual's level of alexithymia. As such, both alexithymia and gambling behavior should be considered in the clinical assessment of young people who present with PEs, which can help in implementing more tailored and individualized treatment plans.

Examining delusional ideation: Relationships with race and socioeconomic status

Race and socioeconomic status (SES) are commonly cited as risk factors for psychosis and psychotic-like experiences (PLEs). However, few studies have investigated the relationships between race and SES with specific domains of PLEs. Specifically, little work has examined the relationships between race and SES with delusional ideation, severity (preoccupation, conviction, distress), and delusional themes. Using cross-sectional, general population data (N = 727) from the Nathan Kline Institute-Rockland (NKI-Rockland) database, we investigated racial differences in delusional ideation and severity between Black and White participants, including differences in delusional themes. Then, we investigated SES's relationship with delusional thinking and the interaction between race and SES on delusional thinking. Black American participants endorsed higher delusional ideation with stronger severity than White Americans. A significant interaction between race and delusional theme revealed that Black Americans endorse significantly more delusional ideation in themes of grandiosity, religiosity, and referential-guilt. Black Americans endorse greater delusional severity in grandiose and religious ideations. Black Americans endorse stronger preoccupation and conviction - but not distress-in their referential-guilt ideation. SES was not significantly associated with delusional thinking, nor did SES moderate the significant relationships between race and delusional ideation. These results illuminate the clear racial disparity that exist in delusional ideation within a general population, which did not extend to SES in this dataset. Future work should investigate deeper into the contributory factors to these racial disparities, particularly whether they are based in psychological and/or cultural differences or are the result of assessment/measurement bias.