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Social Psychiatry and Psychiatric Epidemiology

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01.10.2014 | Original Paper

Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults

verfasst von: Deidre M. Anglin, Quenesha Lighty, Michelle Greenspoon, Lauren M. Ellman

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 10/2014

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Abstract

Background

Racial discrimination is related to depression, anxiety, and severe psychological distress, and evidence drawn from studies emanating from the United Kingdom and The Netherlands suggest racial discrimination is also related to clinical psychosis and subthreshold psychotic symptoms in racial and ethnic minority (REM) populations. The present study sought to determine the association between racial discrimination experiences and attenuated positive psychotic symptoms (APPS) in a United States (US) urban, predominantly immigrant and REM young adult population.

Methods

A cohort of 650 young adults was administered a self-report inventory for psychosis risk [i.e., Prodromal Questionnaire (PQ)], and the Experiences of Discrimination Questionnaire. The PQ allowed the dimensional assessment of APPS, as well as the categorical assessment of a potentially “high risk” group (i.e., 8 or more APPS endorsed as distressing), the latter of which was based on previous validation studies using the structured interview for prodromal syndromes. The relations between self-reported racial discrimination and APPS, and racial discrimination and “high” distressing positive PQ endorsement were determined, while accounting for anxiety and depression symptoms.

Results

Racial discrimination was significantly associated with APPS and with significantly higher odds of endorsing eight or more distressing APPS, even after adjusting for anxiety and depression symptoms.

Conclusion

The present study provides preliminary evidence that racial discrimination among US ethnic minorities may be associated with APPS, as well as potentially higher risk for psychosis.

Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32(1):20–47. doi:10.1007/s10865-008-9185-0 PubMedCrossRefPubMedCentral

Williams DR, Neighbors HW, Jackson JS (2003) Racial/ethnic discrimination and health: findings from community studies. Am J Public Health 93(2):200–208PubMedCrossRefPubMedCentral

Brown TN, Williams DR, Jackson JS, Neighbors HW, Torres M, Sellers SL, Brown KT (2000) Being black and feeling blue: the mental health consequences of racial discrimination. Race Soc 2(2):117–131CrossRef

Feagin JR, Eckberg DL (1980) Discrimination–motivation, action, effects, and context. Annu Rev Sociol 6:1–20. doi:10.1146/annurev.so.06.080180.000245 CrossRef

Pascoe EA, Richman LS (2009) Perceived discrimination and health: a meta-analytic review. Psychol Bull 135(4):531–554. doi:10.1037/A0016059 PubMedCrossRefPubMedCentral

Sue DW, Lin AI, Torino GC, Capodilupo CM, Rivera DP (2009) Racial microaggressions and difficult dialogues on race in the classroom. Cult Divers Ethn Minor 15(2):183–190. doi:10.1037/A0014191 CrossRef

Richman LS, Pek J, Pascoe E, Bauer DJ (2010) The effects of perceived discrimination on ambulatory blood pressure and affective responses to interpersonal stress modeled over 24 hours. Health Psychol 29(4):403–411. doi:10.1037/A0019045 CrossRef

Coker TR, Elliott MN, Kanouse DE, Grunbaum JA, Schwebel DC, Gilliland MJ, Tortolero SR, Peskin MF, Schuster MA (2009) Perceived racial/ethnic discrimination among fifth-grade students and its association with mental health. Am J Public Health 99(5):878–884. doi:10.2105/Ajph.2008.144329 PubMedCrossRefPubMedCentral

Jackson JS, Torres M, Caldwell CH, Neighbors HW, Nesse RM, Taylor RJ, Trierweiler SJ, Williams DR (2004) The National Survey of American Life: a study of racial, ethnic and cultural influences on mental disorders and mental health. Int J Methods Psychiatr Res 13(4):196–207. doi:10.1002/Mpr.177 PubMedCrossRef

10.

Paradies Y (2006) A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 35(4):888–901. doi:10.1093/Ije/Dyl056 PubMedCrossRef

11.

Sellers SL, Bonham V, Neighbors HW, Amell JW (2009) Effects of racial discrimination and health behaviors on mental and physical health of middle-class African American men. Health Educ Behav 36(1):31–44. doi:10.1177/1090198106293526 PubMedCrossRef

12.

Ong AD, Fuller-Rowell T, Burrow AL (2009) Racial discrimination and the stress process. J Personal Soc Psychol 96(6):1259–1271. doi:10.1037/A0015335 CrossRef

13.

Hammond WP (2012) Taking it like a man: masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men. Am J Public Health 102:S232–S241. doi:10.2105/Ajph.2011.300485 PubMedCrossRefPubMedCentral

14.

Hudson DL, Neighbors HW, Geronimus AT, Jackson JS (2012) The relationship between socioeconomic position and depression among a US nationally representative sample of African Americans. Soc Psychiatry Psychiatr Epidemiol 47(3):373–381. doi:10.1007/s00127-011-0348-x PubMedCrossRefPubMedCentral

15.

Gaylord-Harden NK, Cunningham JA (2009) The impact of racial discrimination and coping strategies on internalizing symptoms in African American youth. J Youth Adolesc 38(4):532–543. doi:10.1007/s10964-008-9377-5 PubMedCrossRef

16.

Landrine H, Klonoff EA (1996) The schedule of racist events: a measure of racial discrimination and a study of its negative physical and mental health consequences. J Black Psychol 22(2):144–168. doi:10.1177/00957984960222002 CrossRef

17.

Soto JA, Dawson-Andoh NA, Belue R (2011) The relationship between perceived discrimination and generalized anxiety disorder among African Americans, Afro Caribbeans, and non-Hispanic Whites. J Anxiety Disord 25(2):258–265. doi:10.1016/j.janxdis.2010.09.011 PubMedCrossRefPubMedCentral

18.

Chae DH, Lincoln KD, Jackson JS (2011) Discrimination, attribution, and racial group identification: implications for psychological distress among Black Americans in the National Survey of American Life (2001–2003). Am J Orthopsychiatr 81(4):498–506. doi:10.1111/j.1939-0025.2011.01122.x CrossRef

19.

Krieger N, Kosheleva A, Waterman PD, Chen JT, Koenen K (2011) Racial discrimination, psychological distress, and self-rated health among US-born and foreign-born Black Americans. Am J Public Health 101(9):1704–1713. doi:10.2105/Ajph.2011.300168 PubMedCrossRefPubMedCentral

20.

Pieterse AL, Todd NR, Neville HA, Carter RT (2012) Perceived racism and mental health among Black American adults: a meta-analytic review. J Couns Psychol 59(1):1–9. doi:10.1037/A0026208 PubMedCrossRef

21.

Sellers RM, Caldwell CH, Schmeelk-Cone KH, Zimmerman MA (2003) Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults. J Health Soc Behav 44(3):302–317. doi:10.2307/1519781 PubMedCrossRef

22.

Saleem MM, Stowkowy J, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Addington J (2014) Perceived discrimination in those at clinical high risk for psychosis. Early Interv Psychiatry 8(1):77–81. doi:10.1111/eip.12058 PubMedCrossRef

23.

Cooper C, Morgan C, Byrne M, Dazzan P, Morgan K, Hutchinson G, Doody GA, Harrison G, Leff J, Jones P, Ismail K, Murray R, Bebbington PE, Fearon P (2008) Perceptions of disadvantage, ethnicity and psychosis. Br J Psychiatry 192(3):185–190. doi:10.1192/bjp.bp.107.042291 PubMedCrossRef

24.

Karlsen S, Nazroo JY, McKenzie K, Bhui K, Weich S (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychol Med 35(12):1795–1803. doi:10.1017/S0033291705005830 PubMedCrossRef

25.

Veling W (2013) Ethnic minority position and risk for psychotic disorders. Curr Opin Psychiatry 26(2):166–171. doi:10.1097/Yco.0b013e32835d9e43 PubMedCrossRef

26.

Veling W, Selten JP, Susser E, Laan W, Mackenbach JP, Hoek HW (2007) Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands. Int J Epidemiol 36(4):761–768. doi:10.1093/Ije/Dym085 PubMedCrossRef

27.

Berg CJ, Ling PM, Hayes RB, Berg E, Nollen N, Nehl E, Choi WS, Ahluwalia JS (2012) Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking. Health Educ Res 27(1):141–150. doi:10.1093/Her/Cyr106 PubMedCrossRefPubMedCentral

28.

Janssen I, Hanssen M, Bak M, Bijl RV, de Graaf R, Vollebergh W, McKenzie K, van Os J (2003) Discrimination and delusional ideation. Br J Psychiatry 182:71–76. doi:10.1192/Bjp.182.1.71 PubMedCrossRef

29.

Singh SP, Burns T (2006) Controversy: race and mental health: there is more to race than racism. Br Med J 333(7569):648–651. doi:10.1136/bmj.38930.501516.BE CrossRef

30.

Kuno E, Rothbard AB (2002) Racial disparities in antipsychotic prescription patterns for patients with schizophrenia. Am J Psychiatry 159(4):567–572. doi:10.1176/appi.ajp.159.4.567 PubMedCrossRef

31.

Nazroo JJJ, Karlsen S, Torres M (2007) The diaspora and health inequalities in the US and England: does where you go how you get there make a difference? Sociol Health Ill 29(6):811–830CrossRef

32.

Adebimpe VR (1981) Overview: white norms and psychiatric-diagnosis of black patients. Am J Psychiatry 138(3):279–285PubMed

33.

Neighbors HW, Jackson JS, Campbell L, Williams D (1989) The influence of racial factors on psychiatric-diagnosis—a review and suggestions for research. Community Ment Health J 25(4):301–311PubMedCrossRef

34.

Gara MA, Vega WA, Arndt S, Escamilla M, Fleck DE, Lawson WB, Lesser I, Neighbors HW, Wilson DR, Arnold LM, Strakowski SM (2012) Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry 69(6):593–600. doi:10.1001/archgenpsychiatry.2011.2040 PubMedCrossRef

35.

Gaerner SL, Dovidio JF (1986) The aversive form of racism. In: Dovidio JF, Gaerner SL (eds) Prejudice, discrimination, and racism. Academic Press, San Diego, pp 61–89

36.

Dovidio JF, Gaertner SL (1998) On the nature of contemporary prejudice: the causes, consequences, and challenges of aversive racism. In: Eberhardt JL, Fiske ST (eds) Confronting racism: The problem and the response. Sage Publications Inc., Thousand Oaks, pp 3–32

37.

Major B, Mendes WB, Dovidio JF (2013) Intergroup relations and health disparities: a social psychological perspective. Health Psychol 32(5):514–524. doi:10.1037/A0030358 PubMedCrossRefPubMedCentral

38.

Dovidio JF, Kawakami K, Gaertner SL (2002) Implicit and explicit prejudice and interracial interaction. J Personal Soc Psychol 82(1):62–68. doi:10.1037//0022-3514.82.1.62 CrossRef

39.

Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder AMB, Nadal KL, Esquilin M (2007) Racial microaggressions in everyday life—implications for clinical practice. Am Psychol 62(4):271–286. doi:10.1037/0003-066x.62.4.271 PubMedCrossRef

40.

Kendler KS, Gallagher TJ, Abelson JM, Kessler RC (1996) Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. Arch Gen Psychiatry 53(11):1022–1031PubMedCrossRef

41.

van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009) A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med 39(2):179–195. doi:10.1017/S0033291708003814 PubMedCrossRef

42.

Cannon TDCK, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R (2008) Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Arch Gen Psychiatry 65(1):28–37. doi:10.1001/archgenpsychiatry.2007.3 PubMedCrossRefPubMedCentral

43.

Poulton R, Caspi A, Moffitt TE, Cannon M, Murray R, Harrington H (2000) Children’s self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Arch Gen Psychiatry 57(11):1053–1058PubMedCrossRef

44.

van Os J, Linscott RJ (2012) Introduction: the extended psychosis phenotype–relationship with schizophrenia and with ultrahigh risk status for psychosis. Schizophr Bull 38(2):227–230. doi:10.1093/schbul/sbr188 PubMedCrossRefPubMedCentral

45.

Lewis-Fernandez R, Horvitz-Lennon M, Blanco C, Guarnaccia PJ, Cao Z, Alegria M (2009) Significance of endorsement of psychotic symptoms by US Latinos. J Nerv Ment Dis 197(5):337–347. doi:10.1097/NMD.0b013e3181a2087e PubMedCrossRefPubMedCentral

46.

Loewy RL, Bearden CE, Johnson JK, Raine A, Cannon TD (2005) The prodromal questionnaire (PQ): preliminary validation of a self-report screening measure for prodromal and psychotic syndromes. Schizophr Res 79(1):117–125. doi:10.1016/j.schres.2005.03.007 PubMedCrossRef

47.

Ising HK, Veling W, Loewy RL, Rietveld MW, Rietdijk J, Dragt S, Klaassen RM, Nieman DH, Wunderink L, Linszen DH, van der Gaag M (2012) The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population. Schizophr Bull 38(6):1288–1296. doi:10.1093/schbul/sbs068 PubMedCrossRefPubMedCentral

48.

Yung AR, Phillips LJ, Yuen HP, McGorry PD (2004) Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res 67(2–3):131–142. doi:10.1016/S0920-9964(03)00192-0 PubMedCrossRef

49.

Rosen JL, Miller TJ, D’Andrea JT, McGlashan TH, Woods SW (2006) Comorbid diagnoses in patients meeting criteria for the schizophrenia prodrome. Schizophr Res 85(1–3):124–131. doi:10.1016/j.schres.2006.03.034 PubMedCrossRef

50.

Myles-Worsley M, Weaver S, Blailes F (2007) Comorbid depressive symptoms in the developmental course of adolescent-onset psychosis. Early Interv Psychiatry 15(21):183–190. doi:10.1111/j.1751-7893.2007.00022.x CrossRef

51.

Wigman JTW, Van Nierop M, Vollebergh WAM, Lieb R, Beesdo-Baum K, Wittchen H-U, van Os J (2012) Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity—implications for diagnosis and ultra-high risk research. Schizophr Bull 38(2):247–257. doi:10.1093/schbul/sbr196 PubMedCrossRefPubMedCentral

52.

Anglin DM, Lee RLG, Yang L, Opler M (2010) Ethnicity and psychosis: examining the nature of the relationship. In: Fortier A, Turcotte S (eds) Health education: challenges, issues and impact. Nova Science Publishers, Hauppauge, pp 119–140

53.

Loewy RL, Johnson JK, Cannon TD (2007) Self-report of attenuated psychotic experiences in a college population. Schizophr Res 93(1–3):144–151PubMedCrossRefPubMedCentral

54.

Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, Woods SW (2002) Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry 159(5):863–865PubMedCrossRef

55.

Krieger N, Smith K, Naishadham D, Hartman C, Barbeau EM (2005) Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med 61(7):1576–1596PubMedCrossRef

56.

Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401. doi:10.1177/014662167700100306 CrossRef

57.

Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J (1993) Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health 5(2):179–193PubMedCrossRef

58.

Andresen EM, Malmgren JA, Carter WB, Patrick DL (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 10(2):77–84PubMed

59.

Roberts RE (1980) Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Res 2(2):125–134PubMedCrossRef

60.

Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the state–trait anxiety inventory. Consulting Psychologists Press, Palo Alto

61.

Bieling PJ, Antony MM, Swinson RP (1998) The State–Trait Anxiety Inventory, Trait version: structure and content re-examined. Behav Res Ther 36(7–8):777–788PubMedCrossRef

62.

Smeets G, Merckelbach H, Griez E (1997) Panic disorder and right-hemisphere reliance. Anxiety Stress Coping 10(3):245–255. doi:10.1080/10615809708249303 CrossRef

63.

Peterson RA, Reiss RL (1987) The anxiety sensitivity index: construct validity and factor analytic structure. J Anxiety Disord 1(2):265–277CrossRef

64.

Rule WR, Traver MD (1983) Test-retest reliabilities of state–trait anxiety inventory in a stressful social analog situation. J Personal Assess 47(3):276–277. doi:10.1207/s15327752jpa4703_8 CrossRef

65.

Terrell F, Terrell SL (1981) An inventory to measure cultural mistrust among Blacks. West J Black Stud 5(3):180–184

66.

Whaley AL (2002) Confluent paranoia in African American psychiatric patients: an empirical study of Ridley’s typology. J Abnorm Psychol 111(4):568–577PubMedCrossRef

67.

Selten JP, Cantor-Graae E (2005) Social defeat: risk factor for schizophrenia? Br J Psychiatry J Ment Sci 187:101–102. doi:10.1192/bjp.187.2.101 CrossRef

68.

Varghese D, Scott J, Welham J, Bor W, Najman J, O’Callaghan M, Williams G, McGrath J (2011) Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophr Bull 37(2):389–393PubMedCrossRefPubMedCentral

69.

Link BG, Struening EL, Rahav M, Phelan JC, Nuttbrock L (1997) On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. J Health Soc Behav 38(2):177–190PubMedCrossRef

70.

Yang LH, Anglin DM, Wonpat-Borja AJ, Opler MG, Greenspoon MI, Corcoran CM (2013) Public stigma associated with psychosis risk syndrome in a college population: implications for peer intervention. Psychiatr Serv 64(3):284–288. doi:10.1176/appi.ps.003782011 PubMedCrossRefPubMedCentral

71.

Anglin DM, Greenspoon MI, Lighty Q, Corcoran CM, Yang LH (2013) Spontaneous labelling and stigma associated with clinical characteristics of peers ‘at-risk’ for psychosis. Early Interv Psychiatry. doi:10.1111/eip.12047 PubMed

72.

Brusilovskiy E, Salzer MS (2012) Are environmental variables associated with the well-being of individuals already diagnosed with a serious mental illness? Soc Sci Med 74:1591–1601PubMedCrossRef

73.

Jones P, Rodgers B, Murray R, Marmot M (1994) Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344(8934):1398–1402PubMedCrossRef

74.

Cannon M, Caspi A, Moffitt TE, Harrington H, Taylor A, Murray RM, Poulton R (2002) Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: results from a longitudinal birth cohort. Arch Gen Psychiatry 59(5):449–456PubMedCrossRef

75.

Meyer SE, Bearden CE, Lux SR, Gordon JL, Johnson JK, O’Brien MP, Niendam TA, Loewy RL, Ventura J, Cannon TD (2005) The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. J Child Adolesc Psychopharmacol 15(3):434–451. doi:10.1089/cap.2005.15.434 PubMedCrossRef

76.

Office of Institutional Research at The City College of New York (2012) City facts fall 2012. http://www.ccny.cuny.edu/institutionalresearch/

77.

Cohen P, Cohen J (1984) The clinician’s illusion. Arch Gen Psychiatry 41(12):1178–1182PubMedCrossRef

78.

Kaymaz N, Drukker M, Lieb R, Wittchen HU, Werbeloff N, Weiser M, Lataster T, van Os J (2012) Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychol Med 42(11):2239–2253. doi:10.1017/S0033291711002911 PubMedCrossRef

Titel: Racial discrimination is associated with distressing subthreshold positive psychotic symptoms among US urban ethnic minority young adults
verfasst von: Deidre M. Anglin
Quenesha Lighty
Michelle Greenspoon
Lauren M. Ellman
Publikationsdatum: 01.10.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 10/2014
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-014-0870-8

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