Perceived discrimination and psychotic experiences across multiple ethnic groups in the United States
Introduction
Exposure to discrimination is a common experience for socially disadvantaged groups in the United States, and has been associated with increased probability of mental illness (Wamala et al., 2007, Pascoe and Smart Richman, 2009). Environmental stressors such as discrimination are associated with subordinate or outside status and contribute to a sense of “social defeat” (Selten and Cantor-Graae, 2005, Selten and Cantor-Graae, 2007), which may be particularly relevant to the onset and exacerbation of psychotic symptoms among vulnerable individuals (Corcoran et al., 2003). In accordance with the social defeat hypothesis, incidence of schizophrenia is high amongst certain immigrant and ethnic minority groups (Sharpley et al., 2001, Cantor-Graae and Selten, 2005, Fearon et al., 2006, Veling et al., 2006).
Population-based studies from Europe have found that perceived discrimination in general is associated with the increased likelihood of reporting psychosis (Veling et al., 2007, Cooper et al., 2008, Veling, 2013), with discriminatory verbal abuse increasing the odds of psychosis by as much as two to three fold, and discriminatory physical attacks increasing the odds of psychosis by three to five fold when compared with those who did not report experiences of discrimination (Karlsen and Nazroo, 2002, Karlsen et al., 2005). Veling et al. (2007) likewise found that the incidence rate for psychotic disorders was highest among ethnic groups that reported the most severe discrimination at the group level, although this was not replicated when examining individual-level perceived discrimination in a subsequent case–control study (Veling et al., 2008).
Psychotic disorders are stigmatized conditions, often characterized by experiences of persecution and mistreatment (Thornicroft et al., 2009). As such, perceived discrimination may be a consequence rather than a cause of psychotic disorders. It is therefore useful to examine the associations between discrimination and the sub-threshold range of the psychosis continuum (van Os et al., 2009), where the absence of a ‘psychosis’ label may make reverse causality less likely.
Janssen et al. (2003) examined the relationship between discrimination and psychotic experiences (PE) by analyzing data from The Netherlands Mental Health Survey and Incidence Study (NEMESIS)—a longitudinal random population sample of 7076 adult respondents, who were asked (yes/no) if they had experienced discrimination on the basis of their skin color/ethnicity, gender, age, appearance, disability, or sexual orientation within the past year. The authors found perceived discrimination to be associated with the onset of delusional ideation but not hallucinatory experiences, possibly reflecting the effects of chronic discrimination on cognitive attributions of daily events (Gilvarry et al., 1999, Sharpley and Peters, 1999, Bentall et al., 2001). However, endorsement of discrimination items was uncommon in their study and primarily consisted of age (6%) and gender (4%) discrimination. It is therefore unclear whether and to what extent these findings would generalize to individuals who experience more persistent forms of discrimination, which at severe levels can be traumatic (Carter, 2007, Carter and Forsyth, 2010) and thus possibly lead to hallucinations (Morrison and Petersen, 2003, Kilcommons and Morrison, 2005).
In this paper, we examine the relationship between perceived discrimination and psychotic symptoms in a racially- and ethnically-diverse population-level sample from the United States (US). To our knowledge, this is the first study to examine this relationship using a validated measure of perceived discrimination that captures the frequency and range of day-to-day discriminatory experiences in the general population. We expected to see associations between discrimination and delusions (Janssen et al., 2003), but given the greater overall prevalence and severity of perceived discrimination in our sample, we also expected to see associations between discrimination and hallucinations as well.
Section snippets
Sample and procedures
This paper analyzed data from the National Latino and Asian American Survey (NLAAS) (Alegria et al., 2004) and the National Survey of American Life (NSAL) (Jackson et al., 2004), which were conducted between the years 2001 and 2003 using the World Health Organization Composite International Diagnostic Interview (WHO CIDI; Kessler and Üstün, 2004). These two datasets were amalgamated for the purposes of this analysis. The study population included non-institutionalized adults over the age of 18
The sample
Approximately 87% of the total sample responded to both the perceived discrimination and psychotic experience items. The total analytic sample consisted of 8990 individuals, 9.39% of which reported a psychotic experience. Univariate Wald chi-square analyses revealed that those with PE were more likely to be poor, born in the U.S., African–American, have a substance use problem, have PTSD, and have impairment in social interactions. Those with PE were less likely to be Asian and less likely to
Discussion
To our knowledge, this is the first study to analyze discrimination and PE among several large racially/ethnically diverse population-level samples based in the United States, using validated measures of discrimination. We found that perceiving discrimination at moderate to high levels predicts PE in a linear dose–response fashion. This expands Janssen et al.'s (2003) study where endorsement of discrimination was minimal (approximately 12%), as opposed to our sample where discrimination was
Role of funding source
No funding source was used in the preparation of this manuscript.
Contributors
Hans Oh conducted the analyses and wrote the first draft of the manuscript. Lawrence Yang and Deidre Anglin provided consultation and assisted in revising the manuscript. Jordan DeVylder assisted in developing the hypotheses, planning the analysis, and revising the manuscript.
Conflict of interest
All authors report no conflicts of interest.
Acknowledgment
We thank the reviewers of Schizophrenia Research for taking the time to read our manuscript.
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