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Ethnoracially minoritized individuals with schizophrenia experience mental health disparities exacerbated by intensive mental health needs that often go unmet in the U.S. healthcare system. Consequently, they are left vulnerable to be under-resourced in housing, education, and employment. However, due to the underrepresentation of ethnoracially diverse groups in schizophrenia research, little is known about their functional outcomes, significantly limiting targeted interventions to groups impacted by structural racism (e.g., discrimination) in need of unique support. The current study investigated the following research questions: (1) What are the ethnoracial differences in functional outcomes for adult service users with schizophrenia? (2) Within Latinx adults, what are the racial differences in these functional outcomes?
Methods:
The study used secondary data from SAMHSA’s Mental Health Client-Level Data (MH-CLD), which contains demographic, clinical, and outcome data from a national sample of consumers receiving state-funded mental health services. Using a subset of adults with a schizophrenia spectrum primary diagnosis, we performed two sets of logistic regression models using R software. The first set of analyses (N=654,048) assessed ethnoracial differences in functional outcomes among Non-Latinx (NL) Black (32%), Latinx (14%), NL-Asian (3%), NL-American Indian or Alaskan Native (AIAN; 1%), and NL-other/multiple races (4%) compared to NL white respondents (47%). The second set (N = 79,606) investigated functional outcomes of Latinx adults by race, with white-Latinxs (40%) as the reference group. The binary (yes/no) outcome variables for all analyses were: (1) homelessness, (2) employment, (3) completion of high school or equivalent, (4) schooling past high school, and (5) substance use problem. Age, gender, marital status, number of mental health diagnoses, and census division were included as covariates.
Results
The first set of analyses revealed that NL-AIANs were less likely to be employed (OR=.73, 95% CI [.64, .83]), more likely to experience homelessness (OR=1.71, 95% CI [1.52, 1.91]), and two times more likely to have a substance use problem (OR=2.08, 95% CI [1.92, 2.24]). Latinxs were less likely to have completed high school (OR=.48, 95% CI [.47, .49]), while NL-Black individuals were more likely to experience homelessness (OR=1.47, 95% CI [1.42, 1.52]). In the second set of analyses, both AIAN-Latinxs and Black-Latinxs were more likely to experience homelessness (OR=1.76, 95% CI [1.29, 2.36]; OR=1.46, 95% CI [1.22, 1.73], respectively). All results were significant at p < .01.
Conclusions and Implications:
Ethnoracial minoritized groups, especially and consistently Black, Latinx, and AIAN groups, with schizophrenia experience disparities in functional outcomes, including homelessness and substance abuse issues. Structural racism in state-funded mental health may expose ethnoracial groups to ineffective and inequitable treatment (e.g., discrimination). To address these issues, social work scholars and professionals should improve the quantity and quality of research and services dedicated to addressing disparities, including sharing power with groups that have been historically excluded from reform efforts. Additional sociodemographic information (e.g. family and living situation, SES, health insurance and immigrant status) should be included in future research to account for anti-immigrant policies that may also negatively impact ethnoracial individuals with schizophrenia.