An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life

Abstract

Objective To examine racial/ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African Americans, Asians, Caribbean Blacks, and Latinos living in the United States. Design Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n>100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms. Results African Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p<.001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p<.05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African Americans (11% and 4.7%, p<.05; 6.3% and 2.7%, p<.05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms. Conclusion Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Racial/ethnic differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.

Sentiment Measured in Hospital Discharge Notes Is Associated with Readmission and Mortality Risk: An Electronic Health Record Study

“…Alternatively, a growing literature suggests important cultural differences in symptom expression. In one recent study, the nature and understanding of psychotic-like symptoms in Latino patients differed from comparison groups[ 24 ]. Differences in symptoms appear to be substantial enough to impact validity of diagnostic criteria in psychiatry, as an investigation in adolescents suggested[ 25 ].…”

The association between psychosis and severe pain in community-dwelling adults: Findings from 44 low- and middle-income countries

“…For example, reporting of psychotic symptoms may have been affected by social desirability (DeVylder and Hilimire, 2015). Also, the perception of conditions such as psychotic symptoms and pain may have differed by culture and region (Earl et al, 2015;McGrath, 1994). Next, we did not have information on all types of psychotic symptoms or the duration of symptoms, number of episodes, and severity.…”

“…This study has several limitations. First, all information was selfreported, and thus, reporting bias may have existed (Earl et al, 2015). For example, reporting of psychotic symptoms may have been affected by social desirability (DeVylder and Hilimire, 2015).…”

Racial-ethnic disparities in empirically-derived subtypes of subclinical psychosis among a U.S. sample of youths

“…Cultural differences between groups may also have influenced our results despite assessment for measurement invariance. For example, cultural variation in the normative expression of spirituality or ways of coping with death or trauma could lead to differential rates of endorsement of experiences such as auditory perceptions (Earl et al, 2015). We lacked information on nativity that would allow for differentiation between racial-ethnic minority status and immigration status (Breslau and Chang, 2006).…”