Racial and Ethnic Differences in the Prevalence of Psychotic Symptoms in the General Population

Abstract

OBJECTIVE This study determined the prevalence of psychotic symptoms among racial-ethnic groups in a representative sample of American adults and explored the relationship of these symptoms with race-ethnicity, psychological distress, and dysfunction. METHODS Data from the Collaborative Psychiatric Epidemiology Surveys were used, which combines three nationally representative surveys: the National Comorbidity Survey Replication, National Survey of American Life, and National Latino and Asian American Study. The sample comprised 16,423 respondents, and the analysis adjusted for design effects. RESULTS The adjusted lifetime and 12-month prevalence rates of psychotic symptoms were 11.6% and 1.4%, respectively. Latinos and blacks had higher lifetime rates (13.6% and 15.3%, respectively) than whites (9.7%) and Asians (9.6%). In logistic regression analysis, lifetime reports of psychotic symptoms were associated with Latino ethnicity, a lifetime diagnosis of a substance use disorder or posttraumatic stress disorder, lifetime psychological distress, and current dysfunction (limitations in daily activities). Prevalence rates of psychotic symptoms among respondents with and without lifetime distress, respectively, were as follows: Asian, 5.4% and 6.4%; Latino, 19.9% and 8.2%; black, 21.1% and 9.9%; and white, 13.1% and 5.1%. CONCLUSIONS Race-ethnicity was differentially associated with psychotic symptoms, with Latinos reporting more lifetime symptoms than other groups after the analysis controlled for other factors. Little evidence was found that psychotic symptoms are "idioms of distress"; respondents who reported lifetime psychotic symptoms were prone to a higher lifetime prevalence of distress, and this association was not specific to any racial-ethnic group. Although psychotic symptoms are often transient, their presence appears to signal a propensity to experience distress.

Distinctive Clinical Correlates of Psychotic Major Depression: The CRESCEND Study

“…Fourth, an influence of racial or ethnic factors on the prevalence of PMD cannot be excluded. In a study from the US, Asian subjects were found to have the lowest prevalence rates of psychotic symptoms compared to Hispanic, African American, and Caucasian subjects 33. Fifth, from the perspective of cultural psychiatry, Koreans with MDD usually present with somatic complaints rather than mental symptoms.…”

“…PMD subjects also tended to be more likely to have a history of suicidal attempt (41.7% vs. 22.1%), although the difference was not significant. Previous studies have found that PMD patients were 2 to 5 times more likely to have attempted suicide than those with NPMD 33,37. In a study of 183 PMD patients, Schaffer et al38 found that 21% of these patients had attempted suicide and that the lifetime risk of suicide attempts was negatively associated with advancing age.…”

Lack of Evidence for Regional Brain Volume or Cortical Thickness Abnormalities in Youths at Clinical High Risk for Psychosis: Findings From the Longitudinal Youth at Risk Study: Table 1.

“…56,57 Although these disparities seem more related to psychosocial inequalities than to ancestry differences, 58 it raised the idea that ethnical differences could be instructive regarding the pathogenesis of schizophrenia. 59 Accordingly, a structural MRI study reported an effect of ethnicity on gray-matter findings following a first episode of psychosis. 60 These neuroimaging findings should be interpreted with caution regarding the modest sample size and the abundance of possible confounds, nevertheless, they suggest that some neuroanatomical features of psychosis could be specific to the ethnic group under investigation.…”

Immigration and psychotic experiences in the United States: Another example of the epidemiological paradox?

“…Self-reported demographic variables (ethnicity, gender, age, marital status) that had potential to confound the analyses were included in the final adjusted models (Bresnahan et al, 2007;Cohen and Marino, 2013;McGrath et al 2015). Most studies conducted in Europe did not adequately account for socioeconomic status (SES), and so the present study controls for education, employment status, income-to-poverty ratio (0 ¼poor, 1-2 ¼near poor, 3 þ ¼non-poor).…”