Assessing Intersecting Risk Factors for Psychotic Experiences Using an Expanded Social Defeat Hypothesis

Background: The social defeat hypothesis postulates experiences of chronic exclusion from the majority group as a risk factor for Schizophrenia. It attempts to explain the association between various well-known psychosocial risk factors of psychosis, such as trauma and substance use, among others, with the neurobiological consequences of being regarded as being in a subordinate position or as an outsider. Although the hypothesis has helped consider the impact of being part of marginalized groups, the factors it posits are rarely examined in conjunction with each other and overarching power structures. Additionally, it does not include important factors that may coincide with the experiences of disempowerment among members of marginalized groups, such as police violence. In the present study, we test the association between the conjunction of socially defeating factors and psychotic experiences.

Methods: Data from the National Survey of Poly-victimization and Mental Health (NSPMH), a cross-sectional study using a quota sample of young adults ages 18-29 (N = 1,584) in the United States, was used to test associations between indicators of social defeat and psychotic experiences (PEs). PEs were assessed using self-reported items from the WHO Composite International Diagnostic Interview psychosis screener, specifically the items assessing paranoia, thought control, and hallucinations. A social defeat score was computed by summing the binary indicators of social defeat factors, including police violence, discrimination, ethnoracial identity, and other previously tested demographic variables. A logistic regression was used to test for cumulative associations between social defeat factors and PEs.

Results: The final sample (n = 1,555), mean age(SD) = 22.99(3.52) was diverse with primarily BIPOC (Black Indigenous People of Color) (60.45%), 6.56% transgender or genderqueer participants, and at least 25.79% with LGBQ+ sexual orientations. In independent analyses, several indicators of social defeat were associated with increased odds of PEs, namely BIPOC identity, high incidence of childhood abuse and bullying, high frequency of substance use, discrimination, and police violence. As hypothesized, we found significant differences between the number of socially defeating characteristics and having PEs. Increases in the number of socially defeating factors were linearly associated with increased odds of PEs (OR 1.64; 95% CI 1.53 to 1.75; p =.00).

Conclusion and Implications: This study reinforces the social defeat hypothesis by demonstrating an association between a range of psychosocial risk factors and increased odds of PEs among young adults in the United States. The findings support the cumulative effect of these factors on the likelihood of endorsing PEs. This emphasizes the importance of considering intersectionality as a lens for mental health research and highlights the need for researchers, clinicians, and policymakers to consider the diverse, overlapping experiences of marginalized individuals. Furthermore, these results suggest the necessity of a broadened understanding of contributors to mental health concerns to include those that are structural and systemic (i.e., police violence). Future research should continue exploring the complex relationships between these factors to inform targeted prevention and intervention strategies for those at higher risk of developing psychotic disorders.