Demographic, psychosocial, clinical, and neurocognitive baseline characteristics of Black Americans in the RAISE-ETP study (original) (raw)
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Journal of Ethnic & Cultural Diversity in Social Work, 2019
Objective: To determine the generalizability of the Schizophrenia Patient Outcomes Research Team (PORT) 2009 treatment recommendations to African Americans. Methods: We examined inclusion of African Americans with schizophrenia spectrum disorders in 58 studies across seven interventions. Results: Evidence varied by intervention. Representation of African Americans ranged from 0% to 83%. The strongest evidence was found for assertive community treatment, supported employment, substance use disorder interventions, skills training, and weight management interventions. Conclusions: Future research should recruit samples that are representative of African Americans. We offer practice recommendations as well as recommendations for social work research to advance generalization of findings to African Americans.
Frontiers in Psychiatry, 2023
There is a notable disparity between the observed prevalence of schizophreniaspectrum disorders in racialized persons in the United States and Canada and White individuals in these same countries, with Black people being diagnosed at higher rates than other groups. The consequences thereof bring a progression of lifelong punitive societal implications, including reduced opportunities, substandard care, increased contact with the legal system, and criminalization. Other psychological conditions do not show such a wide racial gap as a schizophrenia-spectrum disorder diagnosis. New data show that the di erences are not likely to be genetic, but rather societal in origin. Using real-life examples, we discuss how overdiagnoses are largely rooted in the racial biases of clinicians and compounded by higher rates of traumatizing stressors among Black people due to racism. The forgotten history of psychosis in psychology is highlighted to help explain disparities in light of the relevant historical context. We demonstrate how misunderstanding race confounds attempts to diagnose and treat schizophrenia-spectrum disorders in Black individuals. A lack of culturally informed clinicians exacerbates problems, and implicit biases prevent Black patients from receiving proper treatment from mainly White mental healthcare professionals, which can be observed as a lack of empathy. Finally, we consider the role of law enforcement as stereotypes combined with psychotic symptoms may put these patients in danger of police violence and premature mortality. Improving treatment outcomes requires an understanding of the role of psychology in perpetuating racism in healthcare and pathological stereotypes. Increased awareness and training can improve the plight of Black people with severe mental health disorders. Essential steps necessary at multiple levels to address these issues are discussed.
Psychiatry Research, 2015
A substantial research literature implicates potential racial/ethnic bias in the diagnosis of schizophrenia and in clinical ratings of psychosis. There is no similar information regarding bias effects on ratings of everyday functioning. Our aims were to determine if Caucasian raters vary in their ratings of the everyday functioning of schizophrenia patients of different ethnicities, to find out which factors determine accurate self-report of everyday functioning in different ethnic groups, and to know if depression has similar effects on the way people of different ethnicities self-report their current functionality. We analyzed data on 295 patients with schizophrenia who provided their self-report of their everyday functioning and also had a Caucasian clinician rating their functionality. Three racial/ethnic groups (African American (AA), Hispanic and Caucasian) were studied and analyzed on the basis of neurocognition, functional capacity, depression and real-world functional outcomes. No differences based on racial/ethnic status in clinician assessments of patients' functionality were found. Differences between racial groups were found in personal and maternal levels of education. Severity of depression was significantly correlated with accuracy of self-assessment of functioning in Caucasians, but not in AAs. Higher scores on neurocognition and functional capacity scales correlated with reduced overestimation of functioning in AAs, but not in Hispanics. This data might indicate that measurement of everyday functionality is less subject to rater bias than measurement of symptoms of schizophrenia.
Schizophrenia Research, 2007
The Project among African-Americans to Explore Risks for Schizophrenia (PAARTNERS) is a multi-site, NIMH-funded study that seeks to identify genetic polymorphisms that confer susceptibility to schizophrenia among African-Americans by linkage mapping and targeted association analyses. Because deficits in certain dimensions of cognitive ability are thought to underlie liability to schizophrenia, the project also examines cognitive abilities in individuals affected by schizophrenia and their extended family members. This article describes PAARTNERS study design, ascertainment methods and preliminary sample characteristics. We aim to recruit a sample of 1260 African-American families, all of whom have at least one proband with schizophrenia or schizoaffective disorder. The data collection protocol includes a structured Diagnostic Interview for Genetic Studies, Family Interview for Genetic Studies, focused neurocognitive assessment, medical records review, and the collection of blood or buccal cells for genetic analyses. We have currently completed study procedures for 106 affected sib-pair, 457 case-parent trio and 23 multiplex families. A total of 289 probands have completed the best estimate final diagnosis process and 1153 probands and family members have been administered the computerized neuropsychological battery. This project lays the foundation for future analysis of cognitive and behavioral endophenotypes. This novel integration of diagnostic, neurocognitive and genetic data will also generate valuable information for future phenotypic and genetic studies of schizophrenia.
American Journal of Psychiatry, 2010
The Project among African-Americans to Explore Risks for Schizophrenia (PAARTNERS) is a multi-site, NIMH-funded study that seeks to identify genetic polymorphisms that confer susceptibility to schizophrenia among African-Americans by linkage mapping and targeted association analyses. Because deficits in certain dimensions of cognitive ability are thought to underlie liability to schizophrenia, the project also examines cognitive abilities in individuals affected by schizophrenia and their extended family members. This article describes PAARTNERS study design, ascertainment methods and preliminary sample characteristics. We aim to recruit a sample of 1260 African-American families, all of whom have at least one proband with schizophrenia or schizoaffective disorder. The data collection protocol includes a structured Diagnostic Interview for Genetic Studies, Family Interview for Genetic Studies, focused neurocognitive assessment, medical records review, and the collection of blood or buccal cells for genetic analyses. We have currently completed study procedures for 106 affected sib-pair, 457 case-parent trio and 23 multiplex families. A total of 289 probands have completed the best estimate final diagnosis process and 1153 probands and family members have been administered the computerized neuropsychological battery. This project lays the foundation for future analysis of cognitive and behavioral endophenotypes. This novel integration of diagnostic, neurocognitive and genetic data will also generate valuable information for future phenotypic and genetic studies of schizophrenia.
Schizophrenia Research, 2004
The duration of untreated psychosis (DUP) is a concept of importance in schizophrenia research from the perspective of secondary prevention. Although findings to date are mixed, several studies have demonstrated an inverse association between the duration of treatment delay and a variety of clinical and psychosocial outcomes. Research is needed to better understand the multifactorial determinants of the DUP and family-level influences on the DUP may prove to be important predictors. The authors present basic descriptive statistics and case histories of 10 parents/siblings of 6 African American first-episode patients. The mean DUP reported by the family members (five mothers, two fathers, one stepfather and two siblings) was 59.5 weeks (range 2-234). Family members' levels of knowledge of schizophrenia may not necessarily have a major impact upon the length of treatment delays. Among this small sample of relatives, early psychotic symptoms were often attributed to depression, lack of motivation or relational stressors. Family members' decisions to seek help often were solidified only after the emergence of unbearable psychotic symptoms or socially disruptive behaviors. Low concordance among family members' reports of the DUP and perceived barriers to accessing psychiatric services were unexpected findings. These preliminary observations may serve to generate hypotheses for further research that aims to elucidate the determinants of treatment delays in the early course of schizophrenia, especially among African American populations.
Changing psychiatric perception of African Americans with psychosis
European Journal of American Culture, 2008
In the years before the American Civil War, medical observers deemed psychosis to be rare in slaves, but common in free blacks of the North. After 1865, the prevailing psychiatric perception of African Americans was that psychosis was increasing at an alarming rate. Reasons for the increasing rates were initially ascribed to the effects of emancipation, but as researchers reported rates of psychosis to be on the rise through the first half of the 20th century, the stress of internal migration and social adversity were increasingly invoked as explanatory factors. After 1970, however, attitudes influencing the psychiatric assessment of African Americans changed profoundly. Psychiatrists no longer reported differential rates of psychosis by ethno-racial category. Observed racial differences were attributed, instead, to misdiagnosis with clinician bias emerging as the principal cause. Hence, in the new way of thinking, African Americans were over-diagnosed with psychosis, thereby creating a false impression of high rates. These changes in attitude and perception have taken place in the context of historical trends that have increasingly viewed African Americans as equal to rather than inferior to whites. Links from past to present will uncover racial stereotypes that continue to influence the psychiatric diagnosis and treatment of African Americans today.
Racial and Ethnic Disparities in the Treatment of a Medicaid Population with Schizophrenia
Health Services Research, 2009
Objective. To assess health care disparities among black and Latino adults with schizophrenia receiving services during the period July 1994–June 2006, and to evaluate trends in observed disparities.Data Sources. Administrative claims data from the Florida Medicaid program. Data sources included membership files (demographic information), medical claims (diagnostic, service, and expenditure information), and pharmacy claims (prescriptions used and expenditures).Study Design. We identified adults with at least two schizophrenia claims during a fiscal year. We used generalized estimating equation models to estimate disparities in spending on psychotropic drugs, psychiatric inpatient services, all mental health services, and all health services.Principal Findings. Spending on psychotropic drugs, mental health, and all health was 0.9–70 percent lower for blacks and Latinos than for whites. With the exception of blacks with substance use disorder comorbidity, minorities were less likely than whites to use psychiatric inpatient services. Psychiatric inpatient spending among users did not differ by race/ethnicity. With the exception of psychiatric inpatient utilization/spending, trend analyses showed no change or modest reductions in disparities.Conclusions. Black and Latino Medicaid recipients diagnosed with schizophrenia experience health care disparities. Some but not all disparities narrowed modestly over the study period.
Schizophrenia Research, 2009
Background-Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain.