Ethno-Racial Variation in Psychotic Experiences in the United States: Findings from the Collaborative Psychiatric Epidemiology Surveys and Healthy Minds Survey

BACKGROUND AND PURPOSE: The prevalence of psychosis varies widely across racial and ethnic groups in the United States (US). While ethno-racial differences are documented, less is known regarding whether they extend to sub-threshold psychotic experiences, and whether there is significant variation within ethno-racial categories by ethnic subgroup. Extant literature frequently categorize racial identity as monoliths, often masking the variation across ethnic subgroups, with some groups exhibiting better or worse health status depending on their migration histories and their experiences residing in the US. Ethno-racial inequalities in schizophrenia spectrum disorders may also be evident at the sub-clinical range of the psychosis continuum, given that positive symptomatology (i.e., hallucinations and delusions) often occurs in the general population but do not rise to levels of clinical significance. In light of these gaps, we conducted two studies to explore ethno-racial variation on psychotic experiences among adults in the US.

METHODS: Two related studies were conducted. In Study 1, we analyzed data from the National Latino and Asian American Survey (NLAAS) and the National Survey of American Life (NSAL) to explore whether ethnic subgroup variation exists within ethno-racial categories in representative samples of the general adult population obtained through lay interviewers and probability sampling. Using multivariable logistic regression, we examined the association between race/ethnicity and lifetime psychotic experiences among Latinx, Asian, and Black adults in the general population. In Study 2, we analyzed data from the Healthy Minds Study (HMS), which consists of data collected through non-probability sampling among a sample of adult students in higher education. We replicated the analyses from Study 1 using more ethno-racial categories.

RESULTS: In the NLAAS, among Latinx Americans, Puerto Ricans, Cubans, and other Hispanics had greater odds of lifetime psychotic experiences when compared with Mexicans. Among Asian Americans, Filipinx and other Asians had greater odds of lifetime psychotic experiences when compared with Chinese. In the NSAL, among Black Americans, there were no significant ethnic subgroup differences. In the HMS, Black, Hispanic/Latinx, multiracial, and American Indian/Alaska Native students had greater odds of 12-month psychotic experiences when compared with White students. There was significant variation within ethno-racial categories by ethnic subgroup.

CONCLUSIONS AND IMPLICATIONS: Taking both studies together, we found significant differences across, and variation within, ethno-racial categories. This study strengthened the generalizability of ethno-racial differences across the psychosis continuum, highlighting the racial disparities impacting Black and Latinx/Hispanic groups, while raising the possibility that other ethno-racial groups may also exhibit disparities, pending future research. We found it is imperative to engage in further research to explore psychosis as a potential disparity impacting Native American/Alaska Native, Native Hawaiian/Pacific Islander, Middle Eastern, and multiracial populations in the US. This study also found nuanced risk profiles, such that there was significant ethnic subgroup variation within larger ethno-racial categories. Differences in risk profiles across ethnic subgroups may be attributable to varying experiences living in the US, underscoring the critical need for more targeted preventive intervention efforts to specific communities.