Introduction
Method
Inclusion and exclusion criteria
Search strategy
Quality assessment
Results
Discrimination type | Author, date, country of recruitment | Design | Sample ethnicity (%)/immigration status (%) | Sample information | Sample size (N) | Mean age | N (F:M)h | Measures | |
---|---|---|---|---|---|---|---|---|---|
Psychosis | Perceived discrimination | ||||||||
Clinical | |||||||||
Racial | Berg et al. (2011), Norway [35] | Cross-sectional | Europe = 26.7%, Africa = 21.1%, Asia = 46.7%, American = 2.2% | Immigrant first- and second-generation clinical participants with psychotic diagnoses (DSM-IV) recruited from inpatient and outpatient services | 90 | 30.16g | 40 F:50 M | 1. SCI-PANSS | 1. Self-report questionnaire developed by Berry et al. [71] |
Gilvarry et al. (1999), UK [36] | Prospective (12- and 24-month follow-ups) | White British = 23.1%, African Caribbean = 53.1%, others = 23.8% | Clinical multi-ethnic participants discharged from the hospital or receiving outpatient care for psychotic disorders (schizophrenia or affective psychosis) | 147 | 36.67g | 69 F:77 M | 1. OCCPI | 1. RALES | |
Veling et al. (2008), The Netherlands [9] | Cross-sectional | Moroccan = 29%, Turkish = 19%, Surinamese = 32%, other Non-Western = 20% | Schizophrenia spectrum disorder participants | 100 | 26.60 | 26 F:74 M | 1. CIDI | 1. Self-report questionnaire developed by Berry et al. [71] | |
Moroccan = 30, Turkish = 20%, Surinamese = 34%, other Non-Western = 17% | Control group 1 (general hospital) | 100 | 27.20 | 28 F:72 M | |||||
Moroccan = 32%, Turkish = 19%, Surinamese = 33%, other Non-Western = 16% | Control group 2 (sibling to clinical sample) | 63 | 26.50 | 34 F:29 M | |||||
Racial, religious, cultural or social class | Cooper et al. (2008), UK [37] | Cross-sectional | White British = 59.9%, Black = 40.1% | AESOP study sample including first-episode psychosis sample | 224 | 32.10 | 122 F:102 M | 1. SCAN | 1. CANDID-2 |
White British = 87.6%, Black = 12.4% | AESOP study sample including healthy controls | 293 | 38.70 | 171 F:122 M | |||||
Non-clinical | |||||||||
Racial | Anglin et al. (2014), USAa [38] | Cross-sectional | Black = 32.8%, Asian = 27.5%, Hispanic = 24.2%, other = 15.6% | Undergraduate student sample compromising of Black/African American, Asian, Hispanic or other | 644 | 19.90 | 426 F:215 M | 1. PQ | 1. EOD |
Anglin et al. (2014), USAa [11] | Cross-sectional | Black = 32.8%, Asian = 27.5%, Hispanic = 24.2%, other = 15.6% | Undergraduate student sample compromising of Black/African American, Asian, Hispanic or other. | 644 | 19.90 | 426 F:215 M | 1. PQ | 1. EOD | |
Anglin et al. (2016), USAa [39] | Cross-sectional | Black = 32.8%, Asian = 27.5%, Hispanic = 24.2%, other = 15.6% | Undergraduate student sample compromising of Black/African American, Asian, Hispanic or other. | 644 | 19.90 | 426 F:215 M | 1. PQ | 1. EOD | |
Becares et al. (2009), UKb [55] | Cross-sectional | White = 41%, Caribbean = 17%, Indian = 18% Bangladeshi = 8%, Pakistani n = 16% | Epidemiological sample (Fourth National Survey of Ethnic Minorities) | 7257 | 44.0 | 3834 F:3423 M | 1. PSQ | 1. Author measure of interpersonal racism | |
Combs et al. (2006), USA [40] | Cross-sectional | African American = 100% | African American college students recruited from three universities | 128 | 20.50 | 96 F:32 M | 1. PS 2. PAI—persecutory ideation subscale | 1. PRS | |
Das-Munshi et al. (2012), UKc [56] | Cross-sectional | White = 20%, Irish = 17%, Black Caribbean = 16%, Bangladeshi = 15%, Indian = 15%, Pakistani n = 17% | Epidemiological sample (EMPIRIC; Ethnic Minority Psychiatric Illness Rates in the Community dataset) | 4281 | 2340 F:1941 M | 1. PSQ | 1. Author measure of work-related discrimination 2. Author measure of interpersonal racism | ||
Kong (2016), USA [41] | Prospective (baseline and 1-month follow-up) | Study 1: Asian American employees recruited from ‘StudyResponse’ a nonprofit organisation which recruits participants for academic research | 116 | 34.33 | 57 F:59 M | 1. BSI—paranoia items | 1. Items from Triana and Garcia’s perceived ethnic discrimination measure [72] | ||
Prospective (baseline and 3-week follow-up) | Study 2: Latino/Hispanic employees recruited from ‘StudyResponse’ | 76 | 37.08 | 18 F:58 M | 1. Adapted Stephan et al. scale [73] | ||||
Oh et al. (2016), USAd [42] | Cross-sectional | African American = 93.13%, Afro-Caribbean American = 6.87% | Epidemiological sample (NSAL; National Survey of American Life) | 4384 | 1. WHO—CIDI 3.0—psychosis section | 1. Adapted Lifetime Discrimination subscale [74] | |||
Shaikh et al. (2016), UK [43] | Cross-sectional | Black = 30%, White British = 36%, White other = 17%, other = 17% | UHR participants recruited from specialist services for young people at risk of psychosis. | 64 | 22.55 | 26 F:38 M | 1. SSPS 2. PQ—paranoia | 1. PEDQ-CV | |
Cross-sectional | Black = 23%, White British = 37%, White other = 16%, other = 23% | Matched (demographics) control sample recruited by advertisements | 43 | 24.02 | 23 F:20 M | ||||
Gender orientation | Thoroughgood et al. (2017), USA [44] | Cross-sectional | White = 75%, African American = 9%, Hispanic = 2%, Asian = 2%, Pacific Islander = 1%, other = 5% | Full time or part-time transgender participants recruited from a health conference and snowball sampling | 160 | 41.20 | 66 M-to-F:68 F-to-M:26 other | 1. PS 2. Author Paranoid cognition measure | 1. Perceived gender discrimination |
Sexual orientation | Gevonden et al. (2014), The Netherlandse [45] | Cross-sectional | Epidemiological sample NEMISIS-1 (NEMESIS; Netherlands Mental Health Survey and Incidence Studies), participants categorised as heterosexual (N = 5812) or LGB (N = 115) | 5927 | 40.57g | 3096 F:2831 M | 1. CIDI—psychosis section 2. SCID | 1. Items developed by authors | |
Epidemiological sample NEMISIS-2, participants categorised as heterosexual (N = 5816) or LGB (N = 114) | 5300 | 43.47g | 2877 F:2423 M | ||||||
Religious | Rippy and Newman (2006), USA [46] | Cross-sectional | Immigrant Muslims = 56.8%, second-generation Muslim = 13.8%, Adult Muslim convert = 29.1% | Sample of Muslim participants recruited from the community in Oklahoma. | 152 | 33.94g | 60 F:92 M | 1. PS | 1. PRDS |
Racial or religious | Chakraborty et al. (2010), UKc [47] | Cross-sectional | White = 20%, Irish = 17%, Black Caribbean = 16%, Bangladeshi = 15%, Indian = 15%, Pakistani = 17% | Epidemiological sample (EMPIRIC) with greater proportion of ethnic minority groups: Black Caribbean, Indian, Pakistani, Bangladeshi and Irish | 4281 | 2340 F:1941 M | 1. PSQ | 1. Questions taken from the self-report Fourth National Survey [75] | |
Karlsen and Nazroo (2002), UKb [48] | Cross-sectional | Caribbean = 23%, Indian = 39%, Pakistani and Bangladeshi = 34%, Chinese = 4% | Epidemiological sample (Fourth National Survey of Ethnic Minorities) | 2507 | 1. CIS 2. PSQ | 1. Questionnaire from Smith and Prior (1997) [76] | |||
Karlsen et al. (2005), UKc [49] | Cross-sectional | Irish n = 21%, Caribbean = 20%, Bangladeshi = 19%, Indian = 19%, Pakistani = 21% | Epidemiological sample (EMPIRIC dataset) | 3446 | 37.36g | 1. PSQ | 1. Questionnaire from Smith and Prior (1997) [76] | ||
General (appearance, age, skin colour, ethnicity, sex, religion, disability, sexual orientation | Oh et al. (2014), USAd [50] | Cross-sectional | Asian = 15.98%, Hispanic = 44.06%, African American = 37.6%, African Caribbean = 2.35% | Epidemiological sample (NLASS; National Latino and Asian American Survey and NSAL; National Survey of American Life dataset) | 8990 | 4660 F:4330 M | 1. WHO—CIDI 3.0—psychosis section | 1. EDS | |
Janssen et al. (2003), The Netherlandse [51] | Prospective (baseline and 3-year follow-up) | Epidemiological sample (NEMESIS) of people who had no history of experiencing psychosis | 4076 | 41.40 | 2144 F:1923 M | 1. CIDI 2. BPRS | 1. Questionnaire developed by authors | ||
Saleem et al. (2014), USAf [52] | Cross-sectional | Epidemiological sample recruited as part of NAPLS 2 (North American Prodrome Longitudinal Study 2) and categorised as CHR | 360 | 18.99 | 149 F:211 M | 1. SIPS-SOPS | 1. Adapted self-report measure of perceived discrimination [51] | ||
Epidemiological sample recruited as part of NAPLS 2 and categorised as healthy controls | 180 | 19.54 | 93 F:93 M | ||||||
Stowkowy et al. (2016), USAf [53] | Prospective (baseline and 2-year follow-up) | Caucasian = 57.3%, other = 42.7% | CHR sample recruited as part of an epidemiological study (NAPLS 2) | 764 | 18.50 | 328 F:436 M | 1. SIPS-SOPS | 1. Adapted self-report measure of perceived discrimination [51] | |
Caucasian = 54.3%, other = 45.7% | Health control participants recruited as part of an epidemiological study (NAPLS 2) | 280 | 19.73 | 139 F:141 M | |||||
van de Beek et al. (2017), The Netherlands [54] | Cross-sectional | First-generation immigrants = 19%, second-generation immigrants = 81% | Epidemiological dataset (MEDINA) of the Moroccan Dutch population | 267 | 24.50 | 231 F:36 M | 1. PQ-16 | 1. EDS |
Sample and design characteristics of eligible studies
Quality assessment
Name of study | Selection bias | Study design | Confounders | Blinding | Data collection | Withdrawals and dropouts |
---|---|---|---|---|---|---|
Anglin et al. [38] | Weak | Weak | Moderate | Moderate | Strong | NA |
Anglin et al. [11] | Weak | Weak | Weak | Moderate | Strong | NA |
Anglin et al. [39] | Weak | Weak | Weak | Moderate | Strong | NA |
Becares et al. [55] | Moderate | Weak | Strong | Moderate | Moderate | NA |
Berg et al. [35] | Moderate | Weak | Weak | Moderate | Strong | NA |
Chakraborty et al. [47] | Moderate | Weak | Strong | Moderate | Moderate | NA |
Combs et al. [40] | Weak | Weak | Weak | Moderate | Strong | NA |
Cooper et al. [37] | Moderate | Moderate | Moderate | Moderate | Strong | NA |
Das-Munshi et al. [56] | Moderate | Weak | Strong | Moderate | Moderate | NA |
Gevonden et al. [45] | Moderate | Weak | Strong | Moderate | Moderate | NA |
Gilvarry et al. [36] | Weak | Moderate | Weak | Moderate | Moderate | Strong |
Janssen et al. [51] | Strong | Moderate | Strong | Moderate | Moderate | Moderate |
Karlsen and Nazroo [48] | Moderate | Weak | Weak | Moderate | Moderate | NA |
Karlsen et al. [49] | Moderate | Weak | Moderate | Moderate | Moderate | NA |
Kong [41] | Weak | Moderate | Weak | Moderate | Strong | Strong |
Oh et al. [50] | Strong | Weak | Strong | Moderate | Strong | NA |
Oh et al. [42] | Moderate | Weak | Strong | Moderate | Strong | NA |
Rippy and Newman [46] | Weak | Weak | Weak | Moderate | Strong | NA |
Shaikh et al. [43] | Weak | Weak | Moderate | Moderate | Strong | NA |
Saleem et al. [52] | Moderate | Moderate | Weak | Moderate | Moderate | NA |
Stowkowy et al. [53] | Moderate | Moderate | Weak | Moderate | Moderate | Weak |
Thoroughgood et al. [44] | Weak | Weak | Weak | Moderate | Strong | NA |
van de Beek et al. [54] | Weak | Weak | Strong | Moderate | Strong | NA |
Veling et al. [9] | Moderate | Moderate | Strong | Moderate | Strong | NA |
Do people experiencing psychosis report more discrimination?
Discrimination type | Author, date, country of recruitment | Results |
---|---|---|
Clinical | ||
Racial | Berg et al. (2011), Norway [35] | Positive correlations were found between perceived discrimination and positive psychotic symptoms (r = 0.26, p < 0.050). No associations were found between perceived discrimination and negative psychotic symptoms African Americans reported the most severe ‘positive symptoms’ and higher rates of perceived discrimination (t = 2.472, df = 88, p < 0.015). Multiple linear regression demonstrated that the relationship between African immigrant status and severity of symptoms reduced when perceived discrimination was added into the model (Model 1 without covariate: B = 3.096, SE 1.103, p = 0.006; Model 2 controlling for perceived discrimination: B = 2.535, SE 1.123, p = 0.270), indicating that it partially mediated the relationship |
Gilvarry et al. (1999), UK [36] | Logistic regression indicated that Black and ethnic minority individuals were more likely to report life events (financial, health, assault) as being related to discrimination than White British individuals (but not housing life events) Perceptions of racial discrimination were not associated with diagnosis (schizophrenia vs affective psychosis) or course of illness (episodic vs continuous) | |
Veling et al. (2008), The Netherlands [9] | Cases reported slightly higher levels of perceived discrimination (52%) than both control groups (42%), but the relationship was not statistically significant. However, cases significantly reported more personal experiences of discrimination than group 1 controls [OR 1.08, 95% CI (1.01, 1.17)]. However, after controlling for employment, education, marital status, cultural distance, mastery, ethnic identity, self-esteem, social support and cannabis use, no statistically significant differences in perceived discrimination was found between cases and group 1 controls. Additionally, perceived discrimination was reported more by males than females (50% vs 37%, x2 = 3.38, df = 1, p = 0.046) in the total sample | |
Racial, religious, cultural or social class | Cooper et al. (2008), UK [37] | People experiencing psychosis were more likely to experience racial perceived disadvantage [OR 1.2, 95% CI (1.1, 1.4)], p < 0.009) than the control group. However, when higher perceived disadvantage scores by Black people were controlled for, people experiencing psychosis were less likely to attribute disadvantage to skin colour [OR 0.82, 95% CI (0.68, 0.98), p < 0.027]. Additionally, greater perceptions of disadvantage were not significantly associated with persecutory delusions, delusions of reference or hallucinations Psychosis cases were more likely to be from Black ethnic group, and were also more likely to believe they were at a greater disadvantage compared to White people [OR 1.3, 95% CI (1.1, 1.5), p < 0.001]. Additionally, Black ethnic groups were four times more likely to experience psychosis [OR 4.7, 95% CI (3.1, 7.2), p < 0.001] than White people, after controlling for age and gender. This association reduced when perceived disadvantage was added in to the model, indicating that it partially mediated the relationship [OR 4.1, 95% CI (2.5, 6.8), p < 0.001] between case status (controls or psychosis) and Black ethnicity |
Non-clinical | ||
Racial | Anglin et al. (2014), USAa [38] | Positive correlations were found between number of racial discrimination domains (getting housing, credit or medical care, at work, getting hired, in police or courts, getting a service, at school and on the street or in public) and ‘attenuated psychotic symptoms’ (APPS) (r = .242, p < .001), as well as, the frequency of discrimination and APPS (r = .249, p < .001). Discrimination domains were significantly (p < .001) associated with an increased risk of all psychotic domains: cognitive disorganisation (r = .229), unusual thinking (r = .197), perceptual abnormalities (r = .199) and paranoia (r = .204). Additionally, discrimination frequency was significantly (p < .001) associated with an increased risk of all psychotic domains: cognitive disorganisation (r = .234), unusual thinking (r = .204), perceptual abnormalities (r = .196) and paranoia (r = .210) Racial discrimination was associated with an increased risk of being in the high than low APPS-distress category OR = 1.41 (95% CI [1.23, 1.60]). The association remained when race/ethnicity, gender, age and income had been adjusted for OR = 1.29 (95% CI [1.10, 1.51]). Therefore, racial discrimination was found to increase the risk of higher levels of distress associated with psychosis |
Anglin et al. (2016), USAa [11] | Black people were significantly more likely to report racial discrimination compared to ‘other’ racial groups (p < .001), but not significantly more likely than Asian and Hispanic ethnic/racial groups. Also, there were no racial differences in the number of APPS-distress endorsed Racial discrimination was associated with APPS-distress and remained significant after adjusting for age (β = .105, p < .001). Bootstrapping analyses suggested that the relationship between racial discrimination and APPS-distress was partially mediated by RS-scores (Rejection Sensitivity Questionnaire-Race; participants concerns and expectations of rejection based on their race) | |
Anglin et al. (2016), USAa [39] | At least 70% of the student sample experienced one type of perceived discrimination, and a positive significant relationship between perceived discrimination and positive psychotic symptoms (r = 0.211, p < 0.001) Additionally, the relationship between discrimination and positive psychotic symptoms differed based on participant’s commitment and exploration of their ethnicity, i.e., ethnic identity (e.g., low ethnic identity, moderate ethnic identity and high ethnic identity). For example, the effect of perceived racial discrimination on positive psychotic symptoms was higher for participants with low ethnic identity [F(4, 165) = 19.71, p < 0.001, R2= 0.30, adjusted β = 0.76] than higher (moderate and high ethnic identity combined) ethnic identity participants [F(4, 457) = 51.14, p < 0.001, R2 = 0.30, adjusted β = 0.23] | |
Becares et al. (2009), UKb [55] | Racial abuse was associated with an increased likelihood of reporting psychotic experiences in the combined ethnic minority group (adjusted OR 3.13, p < 0.001), with Indians (adjusted OR 4.15, p < 0.001) and Caribbean people (adjusted OR 3.47, p < 0.001) demonstrating the strongest likelihood of psychotic experiences An interaction was found between racial abuse and ethnic density on psychotic symptoms (not significant), with the association between racism and psychotic experiences smaller in areas of high ethnic density | |
Combs et al. (2006), USA [40] | Perceived discrimination was associated with non-clinical (r = 0.40, p < 0.001) and clinical (r = 0.24, p = 0.008) levels of paranoia. Males had higher levels of clinical paranoia (t = 2.7, df = 124, p = 0.007) Multiple regression model was overall significant (R = 0.69, Adj R2 = 0.38, F (15, 81) = 5.0, p < 0.001) showing that perceived discrimination was a significant predictor of non-clinical paranoia, but not a significant predictor of clinical paranoia | |
Das-Munshi et al. (2012), UKc [56] | In the combined ethnic minority sample (after adjusting for confounding variables), interpersonal racism [OR 2.26, 95% CI (1.62, 3.14), p < 0.001] and work-related discrimination [OR 1.46, 95% CI (1.06, 2.00), p = 0.020] were associated with psychotic experiences When own-group density decreased by 10%, individuals were more likely to report psychotic experiences in all ethnic groups (except for White British). This relationship achieved significance only in the combined (OR 1.03, p = 0.030) and Indian (OR 1.38, p = 0.030) samples (not Black Caribbean, Irish, Bangladeshi, and Pakistani samples). Additionally, ethnic minority groups were more likely to report discriminatory experiences and less social support when living in areas of low own-group density | |
Kong (2016), USA [41] | Study 1: Path analysis found that perceived ethnic discrimination was significantly related to paranoia [β = 0.48, p < 0.001, bootstrap 95% CI (0.33, 0.61)] Study 2: Similar to study 1, path analysis found that perceived ethnic discrimination was significantly related to paranoia [β = 0.21, p < 0.05, bootstrap 95% CI (0.04, 0.39)]. Additionally, collective self-esteem was found to moderate the relationship between perceived ethnic discrimination and paranoia, because when collective self-esteem was low, discrimination was positively related to paranoia (β = 0.10, SE 0.03, t = 2.99, p < 0.01). However, when collective self-esteem was high, the relationship was not significant (β = − 0.06, SE 0.05, t = − 1.14, p = 0.26) | |
Oh et al. (2016), USAd [42] | Logistic regression demonstrated that police abuse [adjusted OR 1.69, 95% CI (1.20, 2.39), p < 0.01], being denied a promotion (adjusted [OR 1.44, 95% CI (1.07, 1.95), p < 0.05] or a loan [adjusted OR 1.93, 95% (1.16, 3.26), p < 0.05] was associated with increased lifetime psychotic experiences (these discriminatory experiences were attributed to race, skin colour or ancestry). Also, those who reported one or two discriminatory experiences were 63% more likely to report psychotic experiences (compared to those reporting none), and those who reported three or more, were twice as likely Additionally, after controlling for confounders, being denied a promotion (adjusted OR 1.53, p < 0.01) or a loan (OR 2.02, p < 0.05), police abuse (adjusted OR 1.82, p < 0.01), and being discouraged from education (adjusted OR 2.02, p < 0.01) was associated with an increased risk of visual hallucinations. Whilst, not being hired (adjusted OR 2.60, p < 0.05), or excluded from the neighbourhood (adjusted OR 2.81, p < 0.05), or discouraged from education (adjusted OR 2.99, p < 0.01), was associated with an increased risk of delusional ideation. No discriminatory experience was associated with auditory hallucinations | |
Shaikh et al. (2016), UK [43] | Perceived ethnic discrimination was significantly higher in the UHR group compared to health controls, t = 3.63, p < 0.001 Positive correlation between perceived ethnic discrimination and persecutory paranoia in virtual reality for the whole sample (r = 0.25, p = 0.009), but not in individuals at UHR risk (r = 0.119, p = 0.360), or healthy controls (r = 0.212, p = 0.180). Logistic regression found that perceived discrimination was not a significant predictor of paranoid ideation in virtual reality for the whole sample (p = 0.25) or the UHR group (p = 0.95). However, it was a significant predictor in healthy controls (OR 0.046, p = 0.049) Positive correlations between perceived discrimination and prodromal psychotic symptoms in the whole sample (r = 0.42, p < 0.001) and UHR group (r = 0.33, p = 0.009) no significant correlation in healthy controls (r = 0.09, p = 0.560) | |
Gender orientation | Thoroughgood et al. (2017), USA [44] | Perceived transgender discrimination was significantly associated with trait paranoia (r = 0.40, p < 0.01) and paranoid cognition at work (r = 0.61, p < 0.001). After controlling for trait paranoia and negative affect, perceived discrimination was related to paranoid cognition at work (β = 0.45, p < 0.001) |
Sexual orientation | Gevonden et al. (2014), The Netherlandse [45] | Psychosis incidence was significantly elevated in the LGB group compared to the heterosexual group [NEMESIS-1: adjusted OR 2.56, 95% CI (1.71, 3.84); NEMESIS-2: adjusted OR 2.30, 95% CI (1.42, 3.71)]. Discrimination in the past year mediated 34% of the total effect of sexual minority status (e.g., homosexual behaviour) on occurrence of psychotic symptoms (z = 3.52, p < 0.001) in NEMESIS-1 |
Religious | Rippy and Newman (2006), USA [46] | Between group analysis demonstrated there were significant differences (p < 0.020) between the immigrant, second-generation immigrant, or convert Muslims living in the US in level of perceived discrimination, with second-generation Muslims reporting greater amounts of perceived discrimination than convert (p < 0.050) and immigrant Muslims A positive correlation was found between perceived discrimination and non-clinical paranoia in male but not female Muslims (r = 0.42, p < 0.010) |
Racial or religious | Chakraborty et al. (2010), UKc [47] | Racial verbal insults were associated with being categorised as experiencing psychosis (PSQ positive) in Black Caribbean [OR 3.35, 95% CI (1.79, 6.26)], Bangladeshi [OR 5.46, 95% CI (1.79, 6.26)] and Pakistani groups [OR 2.65, 95% CI (1.26, 5.55)]. Also, job refusal was associated with being PSQ positive in the Pakistani origin group [OR 2.26, 95% CI (1.08, 4.75)]. There were no significant associations found between racial discrimination and psychosis in the Indian origin group. (All odds ratios were adjusted for age, gender, social class, number of close persons, and distance of closest person) |
Karlsen and Nazroo (2002), UKb [48] | Logistic regression analysis revealed that the perception of racial discrimination increased the risk of psychosis [OR 1.57, 95% CI (1.02, 2.42)] Experiencing verbal racial abuse [OR 2.86, 95% CI (1.69, 4.83)] and physical racial attacks [OR 4.77, 95% CI (2.32, 9.80)] were significantly associated with experiencing psychosis | |
Karlsen et al. (2005), UKc [49] | In the combined sample risk of psychosis was associated with experienced racial verbal abuse [OR 2.18, 95% CI (1.31, 3.63)], and physical racial attack [OR 2.94, 95% CI (1.14, 7.57)], similar results were found for males and females. The Bangladeshi group showed the greatest risk [OR 7.83, 95% CI (2.00, 30.61)] followed by Caribbean [OR 3.45, 95% CI (1.73, 6.90)] and Pakistani participants [OR 3.36, 95% (1.58, 7.18)] Perceived work-related discrimination (attributed to race, religion or ethnic background) was not significantly related to an increased risk of psychosis in the combined sample. However, Caribbean people who perceived employers to be racist had an increased risk of psychosis [OR 2.34, 95% CI (1.28, 4.28)] | |
General (appearance, age, skin colour, ethnicity, sex, religion, disability, sexual orientation | Oh et al. (2014), USAd [50] | Discriminatory experiences were mostly attributed to race (64.87%, SE 1.9), followed by other reasons (23.1%, SE 0.97), height or weight (2.35%, SE 0.20), gender (3.7%, SE 0.29) and age (5.99%, SE 0.57) Participants experiencing psychosis were more likely to be African American and less likely to be Asian Multiple logistic regression models demonstrated that participants who reported the highest levels of perceived discrimination (compared to those who experienced no discrimination) were more likely to report experiences of psychosis (moderate levels OR 2.432, high levels OR 3.262). Lower levels of perceived discrimination did not significantly predict psychosis (low levels OR 1.497 and mild levels OR 1.24). The overall likelihood of psychotic experiences increased with greater exposure to discrimination (z = 12.22, p < 0.001) indicating a dose–response relationship Also, higher levels of perceived discrimination were associated with an increased risk of delusions OR 4.278, auditory hallucinations OR 3.843, and visual hallucinations OR 2.971 after controlling for covariates (e.g., age, gender, income, education, immigration status, race, substance abuse, PTSD, region, social interaction and complex survey design) |
Janssen et al. (2003), The Netherlandse [51] | Rates of baseline perceived discrimination were: ethnicity/skin colour (n = 75, 2%), age (n = 261, 6%), disability (n = 77, 2%), gender (n = 182, 4%), appearance (n = 80, 2%), and sexual orientation (n = 13, 0.3%) Perceived discrimination predicted the onset of delusional ideation in a dose–response fashion [OR 2.1, 95% CI (1.2, 3.8), p = 0.027], as rate of delusion ideation was 0.5% in participants reporting one discriminatory, and 2.7% in those who reported more than one domain. The relationship remained significant after controlling for confounding variables [OR 2.3, 95% CI 95% (1.2, 4.2)]. No association was found between baseline discrimination and hallucinations | |
Saleem et al. (2014), USAf [52] | CHR participants had significantly higher frequencies of total perceived discrimination (z = − 6.04, p < 0.001) and individual experiences (perceived discrimination based on appearance, age, skin colour, religion, disability, sexual orientation, and other, not ethnicity or gender) than the healthy comparison group CHR had higher levels of negative schemas about self (U = 196.23, p < 0.0001), and about others (U = 136.04, p < 0.0001) than the comparison group Perceived discrimination was not associated with total ‘positive symptoms’ and specific experiences (unusual thoughts, suspiciousness, grandiose ideas, perceptual abnormalities, disorganised communication) in either the CHR or the comparison group Perceived discrimination was significantly associated with negative schemas | |
Stowkowy et al. (2016), USAf [53] | Perceived discrimination was significantly associated with being in an ethnic minority group in both CHR (r = − 0.15, p < 0.0001) and healthy control groups (r = − 0.21, p < 0.01). However, CHR participants reported more perceived discrimination compared to controls (z = − 6.44, p < 0.0001) In the CHR group, perceived discrimination was positively associated with the following psychotic symptoms: grandiose ideas (r = 0.09, p < 0.05), disorganized communication (r = 0.15, p < 0.003 after Bonferroni correction), and suspiciousness (r = 0.16, p < 0.003 after Bonferroni correction) Additionally, individuals at a clinical high risk of psychosis who reported significantly more perceived discrimination were more likely to experience later conversion to psychosis, compared to CHR individuals who reported less perceived discrimination. For example, for one discrimination experience endorsed, an individual had a 52.4% chance of conversion to psychosis [HR 1.101, 95% CI (1.002, 1.209), p = 0.0449] | |
van de Beek et al. (2017), The Netherlands [54] | Regression analyses found that perceived discrimination was associated with greater psychotic experiences (β = 0.257, p < 0.001), the relationship remained significant after adjusting for age, gender, education, immigration status and social support (β = 0.197, p < 0.01), and the regression models explained variance increased after adjusting for the above-mentioned variables (adjusted R2 = 0.179 vs unadjusted R2 = 0.062) |