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U.S. Study Finds Black Patients to Receive the Highest Rates of Psychotic Disorder Diagnoses

November 1, 2023

Scientists assess inequalities in the incidence of psychotic disorders among different racial and ethnic groups.

Systemic racism is an ongoing issue within the U. S. and continues to place people of color at a disadvantage in the health care system. Previous studies have shown Black patients to be significantly more likely than White patients to be diagnosed with a psychotic disorder (e.g., schizophrenia). While there are a multitude of possible explanations for this, such as socioeconomic disadvantages, clinical bias, and a lack of access to proper mental health care, more research needs to be done to fully understand the patterns of psychosis diagnoses across different racial and ethnic groups within the U.S.

Winston Chung, MD, and his research team at the University of California San Francisco (UCSF) recently collaborated with the senior investigator and chief of the Genetic Epidemiology Research Branch of The National Institute of Mental Health (NIMH), Kathleen Merikangas, PhD, and the Child Mind Institute’s vice president and director of Research, Mike Milham, MD, PhD. Together, they conducted a retrospective cohort study investigating the trends in psychotic disorders among several racial and ethnic groups within the U.S.

“Our aims were to quantify the incidence of nonaffective and affective psychotic disorder diagnoses among different racial and ethnic groups over time; to estimate disparities in incidence by race/ethnicity; and to demonstrate the negative health burden associated with psychotic disorders generally, including psychiatric and medical comorbidities and causes of death,” explains Dr. Chung, first author, psychiatrist at the Kaiser Permanente Honolulu Medical Center.

Data was collected from the medical records of patients who received care within the Kaiser Permanente Northern California (KPNC) healthcare system between January 1, 2009, and December 31, 2019. Patients self-identified as African American or Black, American Indian or Alaskan Native (AIAN), Pacific Islander, Latino or Hispanic, non-Hispanic White, Asian American, or other were included in the study. Researchers were able to identify if patients had received diagnoses for either nonaffective psychotic disorders (schizophrenia spectrum disorders) or affective psychotic disorders (psychosis associated with depression or bipolar disorder) by using the ICD-9 and ICD-10 diagnostic codes recorded in the KPNC system. The data collected was used to assess the overall linear changes in annual incidence rates of psychosis disorder diagnoses over time during the 10-year study period. The association of receiving diagnoses for psychotic disorders with other psychiatric disorders like depression or bipolar disorder was also assessed. In addition, researchers looked at the association of psychotic disorder diagnoses and health issues such as diabetes, obesity, or even premature death.

Results found that Black patients had a notably higher incidence of overall psychosis diagnosis rates than any other racial/ethnic group. However, both Black and AIAN patients shared a higher risk of receiving a nonaffective psychosis diagnosis than their White counterparts. Asian patients consistently received the lowest rates of both nonaffective and affective psychosis diagnoses. Additionally, the study found that those who had been diagnosed with psychotic disorders were at a higher risk of also having health issues such as diabetes and were more likely to commit suicide or die prematurely. Patients who had both psychotic disorders and comorbid psychiatric disorders were at an even higher risk.

Researchers speculate that factors such as unequal distribution of resources, and differences in attitudes towards mental health care across racial/ethnic groups may have contributed to lower rates of clinical diagnosis among some groups. The results of this study may have also been affected by implicit bias, changing the way in which symptoms were perceived in patients from different racial/ethnic groups. Furthermore, it’s important to note that the consistent high rates of psychotic disorders among Black populations in the U.S. highlights the negative effects of systemic racism and its resulting societal disadvantages. More research must be done on this topic.

“Our findings on the stability of incident psychosis in a large registry, the pervasive comorbidity, and the negative health consequences ─ particularly suicide and premature death ─ highlight the urgency of preventive interventions for individuals presenting with psychosis in health settings,” Dr. Chung concludes.

In agreement with Dr. Chung’s sentiments, Dr. Milham adds, “I think this study underscores the importance of actively monitoring, understanding, and addressing inequalities in mental health and the provision of care. Inaction will allow disparities to persist or potentially worsen.”

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Tagged with: Concerns, Mental Health