AJP Review Examines How Racism Increases Risk of Psychosis

By Nick Zagorski

Neighborhood disadvantage, trauma history, and pregnancy complications are all established risk factors for psychosis. These social determinants of health are also more likely to impact minority groups in the United States, in part as a result of the racial discrimination these groups experience. A comprehensive review published in AJP in Advance today uses the above examples to show how structural racism helped lead to the disproportionate risk of psychosis facing minorities.

“That racism has historically structured U.S. societal systems means that the neighborhood and social context may hold a significant portion of the relative contribution of risk for psychosis. This may occur through individual-level discrimination as well as through collective trauma at the community level (e.g., police and gun violence),” wrote Deidre M. Anglin, Ph.D., an associate professor of clinical psychology at the City College of New York, and colleagues. Anglin presented the review at a virtual press session at APA’s online 2021 Annual Meeting.

Anglin and colleagues summarized multiple studies that show that common characteristics of many minority neighborhoods (including more densely populated areas and inequitable access to health care, healthy foods, clean air and water, green spaces, and employment) and exposure to trauma (including gun violence and police victimization) are associated with cumulative stress and increased risk of psychosis.

The authors presented data showing that Black women in the United States are at substantially increased risk for many obstetric complications and that obstetric complications are associated with psychotic disorders in offspring. For instance, studies show that Black women tend to have higher rates of preterm birth and infants born at low birth weights compared with other women in the United States. “Our review of obstetric complications suggests that discrimination among Black and Latina mothers may [also] contribute to … complications because of heightened responses to stress (e.g., inflammatory responses)—responses in offspring that are also caused by obstetric complications,” the authors wrote.

The review highlighted several studies demonstrating that discrimination is not just associated with psychological distress, but also adverse biological effects including advanced cellular aging and changes in neural connections.

“Overall, this research indicates that we need to acknowledge and treat structural racism as it is: A critical public health threat,” Anglin said during the virtual press session.

The authors offered several recommendations for addressing the ways that racism shapes social determinants of psychosis, such as establishing a federal program to provide reliable and up-to-date estimates of psychosis prevalence across different racial and ethnic groups and incorporating more discussion of discrimination and racial trauma in mental health training.

“This is [about] more than just attending a diversity workshop,” Anglin said. She said training efforts need to be continual and sustained so mental health professionals can develop structural competency.

“To truly adopt an anti-racist framework, it is necessary to walk in the opposite direction on the path that seeks to maintain the status quo,” the AJP article concluded. “Building a critical consciousness about the ways behaviors and symptoms are connected to the contexts in which we live, including in our training programs, among providers, and in our patients, can enhance practice effectiveness.” ■