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Meta-Analysis
. 2024 May 1;81(5):447-455.
doi: 10.1001/jamapsychiatry.2023.5497.

Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis

Els van der Ven  1 , Thomas M Olino  2 , Katharina Diehl  1 , Stephanie M Nuñez  3 , Griffin Thayer  3 , Miranda A Bridgwater  4 , Sabrina Ereshefsky  5 , Christie Musket  6   7 , Sarah Hope Lincoln  8 , R Tyler Rogers  9 , Mallory J Klaunig  4 , Emily Soohoo  10 , Jordan E DeVylder  11 , Rebecca E Grattan  12 , Jason Schiffman  4 , Lauren M Ellman  2 , Tara A Niendam  5 , Deidre M Anglin  2   13
Affiliations
Meta-Analysis

Ethnoracial Risk Variation Across the Psychosis Continuum in the US: A Systematic Review and Meta-Analysis

Els van der Ven et al. JAMA Psychiatry. .

Abstract

Importance: Studies suggest a higher risk of schizophrenia diagnoses in Black vs White Americans, yet a systematic investigation of disparities that include other ethnoracial groups and multiple outcomes on the psychosis continuum is lacking.

Objective: To identify ethnoracial risk variation in the US across 3 psychosis continuum outcomes (ie, schizophrenia and other psychotic disorders, clinical high risk for psychosis [CHR-P], and psychotic symptoms [PSs] and psychotic experiences [PEs]).

Data sources: PubMed, PsycINFO and Embase were searched up to December 2022.

Study selection: Observational studies on ethnoracial differences in risk of 3 psychosis outcomes.

Data extraction and synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Using a random-effects model, estimates for ethnoracial differences in schizophrenia and PSs/PEs were pooled and moderation by sampling and setting was determined, along with the assessment of heterogeneity and risk of bias.

Main outcomes and measures: Risk of schizophrenia and other psychotic disorder, CHR-P, and conversion to psychosis among CHR-P and PSs/PEs.

Results: Of 64 studies in the systematic review, 47 were included in the meta-analysis comprising 54 929 people with schizophrenia and 223 097 with data on PSs/PEs. Compared with White individuals, Black individuals had increased risk of schizophrenia (pooled odds ratio [OR], 2.07; 95% CI, 1.64-2.61) and PSs/PEs (pooled standardized mean difference [SMD], 0.10; 95% CI, 0.03-0.16), Latinx individuals had higher risk of PSs/PEs (pooled SMD, 0.15; 95% CI, 0.08-0.22), and individuals classified as other ethnoracial group were at significantly higher risk of schizophrenia than White individuals (pooled OR, 1.81; 95% CI, 1.31-2.50). The results regarding CHR-P studies were mixed and inconsistent. Sensitivity analyses showed elevated odds of schizophrenia in Asian individuals in inpatient settings (pooled OR, 1.84; 95% CI, 1.19-2.84) and increased risk of PEs among Asian compared with White individuals, specifically in college samples (pooled SMD, 0.16; 95% CI, 0.02-0.29). Heterogeneity across studies was high, and there was substantial risk of bias in most studies.

Conclusions and relevance: Findings of this systematic review and meta-analysis revealed widespread ethnoracial risk variation across multiple psychosis outcomes. In addition to diagnostic, measurement, and hospital bias, systemic influences such as structural racism should be considered as drivers of ethnoracial disparities in outcomes across the psychosis continuum in the US.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Musket reported that this work was completed during Dr Musket's postdoctoral fellowship through the VA New England Mental Illness Research, Education, and Clinical Center. Dr Niendam reported being founder and shareholder in Safari Health Inc. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Forest Plot on Risk of Schizophrenia Among Black and White Individuals
The reference group is Black individuals in the US.
Figure 2.
Figure 2.. Forest Plot on Risk of Psychotic Symptoms and Experiences Among Black and White Individuals
The reference group is Black individuals in the US.
See this image and copyright information in PMC

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