Racism and psychosis: an umbrella review and qualitative analysis of the mental health consequences of racism

Abstract

Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the country of origin, and (2) analyzes interviews regarding the association of racism experiences with psychosis-related symptoms in racialized Black people and People of Color populations in Germany. We present an umbrella review of meta-analyses that report the incidence of positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., apathy and incoherent speech) of diagnosed schizophrenia, other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis among migrants by country of origin. We also report 20 interviews with first- and second-generation migrants racialized as Black and of Color in Germany to capture and classify their experiences of racism as well as racism-associated mental health challenges. In the umbrella review, psychosis risk was greatest when migration occurred from developing countries. Effect size estimates were even larger among Caribbean and African migrants. In the qualitative study, the application of the constant comparative method yielded four subordinate themes that form a subclinical psychosis symptomatology profile related to experiences of racism: (1) a sense of differentness, (2) negative self-awareness, (3) paranoid ideation regarding general persecution, and (4) self-questioning and self-esteem instability. We here provide converging evidence from a quantitative and qualitative analysis that the risk of poor mental health and psychotic experiences is related to racism associated with minority status and migration.

Linguistic findings in persons with schizophrenia—a review of the current literature

“…The hypothesis of reduced use of semantic context may also help to explain significantly higher rates of psychosis among migrants, refugees, and persons with minority status ( Brandt et al, 2019 ; Henssler et al, 2020 ; Selten et al, 2020 ; Varchmin et al, 2021 ). Here, unknown information regarding not only semantic but also pragmatic cultural contexts may increase prediction errors and facilitate stress-associated alterations that contribute to psychotic experiences, particularly when exposed to social exclusion, discrimination and racism ( Baker et al, 2021 ; Lazaridou et al, 2023 ).…”

“…In particular, schizophrenia can be accompanied by severe alterations of language functions. Idiosyncratic psychotic experiences can also lead to unusual verbal expressions that are often highly creative (Heinz, 2023). However, traditional accounts understand linguistic alterations in persons with schizophrenia as deficits directly caused by the psychotic disorder, and our review will also focus on this approach, while recognizing the need to also address the creative use of language in future studies.…”

‘Where do you feel it most?’ Using body mapping to explore the lived experiences of racism with 10‐ and 11‐year‐olds

“…There is a large and growing body of robust evidence demonstrating that experiencing racism is associated with mental health issues, including psychosis, depression and substance misuse (Berry et al., 2021; Bhui et al., 2018; Brondolo et al., 2016; Lazaridou et al., 2023; Mikrut et al., 2022; Paradies et al., 2015). In the United Kingdom, a recent government report (Commission on Race and Ethnic Disparities, 2021) indicated a relationship between racism and mental distress, suggesting that the fear of racism and racist attacks among people from ethnic minority groups can lead to chronic stress, and that when experienced by parents can affect the mental health of their children (Bhui et al., 2018).…”

Racism, early psychosis, and institutional contact: A qualitative study of Indigenous experiences

“…This includes: 1) systemic or institutional, which is the norms embedded in culture, society and organizational practices and policy, that privilege majority populations over others, 2) interpersonal, personally mediated racism that occurs at the individual level between people and 3) internalized, racism involving intrapersonal beliefs of inferiority related to race in oppressed groups ( Jones, 2000 ). In psychosis, racism has been identified as an important social risk factor ( Lazaridou et al, 2022 ; Nazroo et al, 2020 ). This includes at the interpersonal and internalized level with clear evidence of an association between experiences of racism and discrimination enhancing psychosis risk ( Anglin et al, 2014 ; Karlsen et al, 2005 ) and relevant to this, a relationship between ethnic density and discrimination ( Baker et al, 2021 ).…”

“…Despite many authors theorizing how racism impacts psychosis disparities ( Anglin et al, 2020 ; Nazroo et al, 2020 ), there has been limited qualitative exploration of the association between racism and psychosis. A perceived relationship between racism and psychological risk factors has been illustrated in recent qualitative research, for example, the impact of racism on identity and sense of self and experiences of racism related to persecution and subsequent paranoia ( Lazaridou et al, 2022 ). There is also more general qualitative literature that identifies racism impacts the level of trust people have in mental health service delivery ( Alang, 2019 ).…”