An Intersectional Approach to Ethnoracial Disparities in Pathways to Care Among Individuals With Psychosis in Coordinated Specialty Care

Ven, Els van der; Jones, Nev; Bareis, Natalie; Scodes, Jennifer; Dambreville, Renald; Ngo, Hong; Mathai, Chackupurackal M; Bello, Iruma; Martínez-Alés, Gonzalo; Mascayano, Franco; Lee, Rufina J.; Veling, Wim; Anglin, Deidre M.; Lewis‐Fernández, Roberto; Süsser, Ezra; Compton, Michael T.; Dixon, Lisa B.; Wall, Melanie M.

doi:10.1001/jamapsychiatry.2022.1640

Cited by 7 publications

(4 citation statements)

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“…We found that patients who identified as Black or other racial and ethnic groups were more likely to be referred from the ED or bridging clinic and inpatient units compared with White patients. Our findings add to the EPI evidence highlighting racial disparities in service access and use, with numerous studies documenting that Black patients are at higher risk of coercive referral and intervention, involuntary admissions, and emergency service use, relative to other racial and ethnic groups . In past research, these disparities have been explained by delays in help-seeking due to stigma or cultural and/or religious beliefs, mistrust in the medical system because of past negative experiences, racial bias leading to police involvement and coercive intervention, and other structural barriers including poverty and residential instability .…”

Section: Discussionsupporting

confidence: 52%

“…Our findings add to the EPI evidence highlighting racial disparities in service access and use, with numerous studies documenting that Black patients are at higher risk of coercive referral and intervention, involuntary admissions, and emergency service use, relative to other racial and ethnic groups. 27 In past research, these disparities have been explained by delays in help-seeking due to stigma or cultural and/or religious beliefs, mistrust in the medical system because of past negative experiences, racial bias leading to police involvement and coercive intervention, and other structural barriers including poverty and residential instability. 5 , 12 , 14 , 28 , 29 These factors may also pose barriers to accessing care for other patients with minoritized race and ethnicity as they were also more likely to be referred from the ED or bridging clinic compared with White patients.…”

Section: Discussionmentioning

confidence: 99%

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Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Polillo,

Foussias,

Wang

et al. 2023

JAMA Netw Open

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ImportanceBroad efforts to improve access to early psychosis intervention (EPI) services may not address health disparities in pathways to care and initial engagement in treatment.ObjectiveTo understand factors associated with referral from acute hospital-based settings and initial engagement in EPI services.Design, Setting, and ParticipantsThis retrospective cohort study used electronic medical record data from all patients aged 16 to 29 years who were referred to a large EPI program between January 2018 and December 2019. Statistical analysis was performed from March 2022 to February 2023.ExposuresPatients self-reported demographic information in a structured questionnaire. The main outcome for the first research question (referral source) was an exposure for the second research question (initial attendance).Main Outcomes and MeasuresRate of EPI referral from acute pathways compared with other referral sources, and rate of attendance at the consultation appointment.ResultsThe final study population included 999 unique patient referrals. At referral, patients were a mean (SD) age of 22.5 (3.5) years; 654 (65.5%) identified as male, 323 (32.3%) female, and 22 (2.2%) transgender, 2-spirit, nonbinary, do not know, or prefer not to answer; 199 (19.9%) identified as Asian, 176 (17.6%) Black, 384 (38.4%) White, and 167 (16.7%) other racial or ethnic groups, do not know, or prefer not to answer. Participants more likely to be referred to EPI services from inpatient units included those who were older (relative risk ratio [RRR], 1.10; 95% CI, 1.05-1.15) and those who identified as Black (RRR, 2.11; 95% CI, 1.38-3.22) or belonging to other minoritized racial or ethnic groups (RRR, 1.79; 95% CI, 1.14-2.79) compared with White participants. Older patients (RRR, 1.16; 95% CI, 1.11-1.22) and those who identified as Black (RRR, 1.67; 95% CI, 1.04-2.70) or belonging to other minoritized racial or ethnic groups (RRR, 2.11; 95% CI, 1.33-3.36) were more likely to be referred from the emergency department (ED) compared with White participants, whereas participants who identified as female (RRR, 0.51 95% CI, 0.34-.74) had a lower risk of ED referral compared with male participants. Being older (odds ratio [OR], 0.95; 95% CI, 0.90-1.00) and referred from the ED (OR, 0.40; 95% CI, 0.27-0.58) were associated with decreased odds of attendance at the consultation appointment.Conclusions and relevanceIn this cohort study of patients referred to EPI services, disparities existed in referral pathways and initial engagement in services. Improving entry into EPI services may help facilitate a key step on the path to recovery among youths and young adults with psychosis.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Polillo,

Foussias,

Wang

et al. 2023

JAMA Netw Open

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“…Furthermore, examining related concepts, such as an individual’s ethnoracial identity, may improve our understanding of underlying mediating mechanisms. A promising avenue for further inquiry also includes the role of various intersecting characteristics that defines a person’s social position, thereby impacting psychosis liability.…”

Section: Discussionmentioning

confidence: 99%

“…Even though disadvantaged groups, especially Black communities, were more likely to present with psychosis, research shows they are less likely to reach high-quality mental health services, such as coordinated specialty care. 83 Future studies should improve the measurement of race and ethnicity by using more fine-grained measures, especially for the group labeled as other. Furthermore, examining related concepts, such as an individual's ethnoracial identity, may improve our understanding of underlying mediating mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Ethnoracial Risk Variation Across the Psychosis Continuum in the US

van der Ven,

Olino,

Diehl

et al. 2024

JAMA Psychiatry

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ImportanceStudies 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.ObjectiveTo 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 SourcesPubMed, PsycINFO and Embase were searched up to December 2022.Study SelectionObservational studies on ethnoracial differences in risk of 3 psychosis outcomes.Data Extraction and SynthesisPreferred 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 MeasuresRisk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs.ResultsOf 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 RelevanceFindings 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.

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Targeting Internalized Stigma in First-Episode Psychosis Services: Treatment Strategies from an Intersectional Perspective

Yanos

2023

J Health Serv Psychol

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An Intersectional Approach to Ethnoracial Disparities in Pathways to Care Among Individuals With Psychosis in Coordinated Specialty Care

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Cited by 7 publications

References 34 publications

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Care Pathways and Initial Engagement in Early Psychosis Intervention Services Among Youths and Young Adults

Ethnoracial Risk Variation Across the Psychosis Continuum in the US

Targeting Internalized Stigma in First-Episode Psychosis Services: Treatment Strategies from an Intersectional Perspective

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