Psychosis-risk among Black American youth: The role of stressful experiences and cognitive schemas Open Access
Novacek, Derek (Summer 2019)
Abstract
Black Americans are diagnosed with psychotic disorders at a rate three times higher than their White American counterparts and endorse more severe psychotic symptoms. Elevated rates remain even when accounting for indices of socioeconomic status. These findings raise important questions about the determinants and treatment implications of racial disparities, both of which remain major public health issues. Early theories focused on diagnostic bias to explain these differences, but more recent research suggests that this bias does not likely fully account for higher rates of psychosis and differing symptom presentations. Contemporary theoretical conceptualizations postulate that greater exposure to discrimination, social disadvantage, social defeat, and other forms of adversity contribute to elevated rates of psychosis among racial/ethnic minorities. In addition, cognitive models of psychosis posit that early adversity can lead to enduring cognitive vulnerabilities characterized by negative cognitive schemas, which ultimately can increase susceptibility to the development of psychotic symptoms. No prior studies have sought to characterize the clinical presentation of Black American youth prior to the onset of psychosis or elucidate mechanisms of heightened risk. The clinical high-risk (CHR), or prodromal phase, is characterized by a period of functional decline and the emergence of attenuated psychotic symptoms that often precedes the first psychotic episode. Data from the North American Prodrome Longitudinal Study (NAPLS-2) were used to examine potential differences in attenuated psychotic symptoms, stress exposure, and cognitive schemas between Black and White American youth meeting CHR criteria. Controlling for group differences in age, analyses revealed that Black youth had more severe suspiciousness/persecutory ideas and grandiosity. Black youth also reported more perceived discrimination and daily stress. In addition, Black youth endorsed more negative schemas about others as well as more positive schemas about the self. Negative schemas mediated the effects of stress exposure on attenuated psychotic symptoms. However, race was not a significant moderator. Longitudinal studies are warranted to determine what sociocultural and clinical factors predict conversion among Black CHR youth and whether they have higher conversion rates compared to other racial/ethnic groups. Stress exposure, perceived discrimination, and negative schemas represent potential targets for culturally-adapted preventative interventions.
Table of Contents
Table of Contents
Introduction............................................................................................................1
Method...................................................................................................................15
Results....................................................................................................................20
Discussion..............................................................................................................26
References..............................................................................................................39
Appendix................................................................................................................48
Tables 1-2
Figures 1-16
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