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Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case−control study
- Supriya Misra, Bizu Gelaye, David R. Williams, Karestan C. Koenen, Christina P.C. Borba, Diego Quattrone, Marta Di Forti, Giada Tripoli, Caterina La Cascia, Daniele La Barbera, Laura Ferraro, Ilaria Tarricone, Domenico Berardi, Antonio Lasalvia, Sarah Tosato, Andrei Szöke, Pierre-Michel Llorca, Celso Arango, Andrea Tortelli, Lieuwe de Haan, Eva Velthorst, Julio Bobes, Miguel Bernardo, Julio Sanjuán, Jose Luis Santos, Manuel Arrojo, Cristina Marta Del-Ben, Paulo Rossi Menezes, Jean-Paul Selten, Peter B. Jones, Hannah E. Jongsma, James B. Kirkbride, Bart P.F. Rutten, Jim van Os, Robin M. Murray, Charlotte Gayer-Anderson, Craig Morgan
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- Journal:
- Psychological Medicine / Volume 52 / Issue 15 / November 2022
- Published online by Cambridge University Press:
- 02 March 2021, pp. 3668-3676
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Background
Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.
MethodsWe used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.
ResultsReporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).
ConclusionsPervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.
Social disadvantage, linguistic distance, ethnic minority status and first-episode psychosis: results from the EU-GEI case–control study
- Hannah E. Jongsma, Charlotte Gayer-Anderson, Ilaria Tarricone, Eva Velthorst, Els van der Ven, Diego Quattrone, Marta di Forti, EU-GEI WP2 Group, Paulo Rossi Menezes, Christina Marta Del-Ben, Celso Arango, Antonio Lasalvia, Domenico Berardi, Caterina La Cascia, Julio Bobes, Miguel Bernardo, Julio Sanjuán, Jose Luis Santos, Manuel Arrojo, Lieuwe de Haan, Andrea Tortelli, Andrei Szöke, Robin M. Murray, Bart P. Rutten, Jim van Os, Craig Morgan, Peter B. Jones, James B. Kirkbride
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- Journal:
- Psychological Medicine / Volume 51 / Issue 9 / July 2021
- Published online by Cambridge University Press:
- 03 March 2020, pp. 1536-1548
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Background
Ethnic minority groups in Western countries face an increased risk of psychotic disorders. Causes of this long-standing public health inequality remain poorly understood. We investigated whether social disadvantage, linguistic distance and discrimination contributed to these patterns.
MethodsWe used case–control data from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, carried out in 16 centres in six countries. We recruited 1130 cases and 1497 population-based controls. Our main outcome measure was first-episode ICD-10 psychotic disorder (F20–F33), and exposures were ethnicity (white majority, black, mixed, Asian, North-African, white minority and other), generational status, social disadvantage, linguistic distance and discrimination. Age, sex, paternal age, cannabis use, childhood trauma and parental history of psychosis were included as a priori confounders. Exposures and confounders were added sequentially to multivariable logistic models, following multiple imputation for missing data.
ResultsParticipants from any ethnic minority background had crude excess odds of psychosis [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.69–2.43], which remained after adjustment for confounders (OR 1.61, 95% CI 1.31–1.98). This was progressively attenuated following further adjustment for social disadvantage (OR 1.52, 95% CI 1.22–1.89) and linguistic distance (OR 1.22, 95% CI 0.95–1.57), a pattern mirrored in several specific ethnic groups. Linguistic distance and social disadvantage had stronger effects for first- and later-generation groups, respectively.
ConclusionSocial disadvantage and linguistic distance, two potential markers of sociocultural exclusion, were associated with increased odds of psychotic disorder, and adjusting for these led to equivocal risk between several ethnic minority groups and the white majority.