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Does Schizophrenia Affect A Certain Ethnic Group

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Box 3no Effect Or No Evidence

No significant effect does not equal evidence of no effect. To determine that there is a 95% likelihood that two groups are the same requires around five times as many cases as would be needed to demonstrate a 95% likelihood that two groups are different. For example, if we wish to determine whether a bag of chocolate-coated peanuts is not pure, but also contains raisins, we only need to find one raisin. However, if we wish to be certain that it is pure peanuts, we would need to check all of them.

Current studies have difficulty getting enough cases to demonstrate differences; we are clearly some way off demonstrating the significant absence of an effect.

Other illnesses, both pre- and perinatally, have also been implicated. A wide range of viruses that can be considered neurotrophic have been associated with central nervous system problems including learning disability, epilepsy and psychosis . An ecological study from Finland found an association with polio, and a single-cohort study with robust documentation of rubella status showed an effect size for later affective psychosis of over 5, much greater than that found for maternal influenza . Again, there is no evidence that allows us to establish whether these are specific effects of the infection, or effects of pyrexia, medications or the maternal immune response.

In The Late 1960s Schizophrenia’s Profile As A Disease Changed Dramatically

First, some preliminaries about your fascinating book, . How did you come to unearth such a trove of important documents at Ionia State Hospital in northeastern Michigan?

Ionia State Hospital for the Criminally Insane was, for much of the 20th century, one of the nation’s more notorious mental asylums, occupying an incredible 529 acres, and its annual census hovered above 2,000 patients. But, like many American asylums, Ionia suffered a rapid fall from grace in the late 1960s and early 70s, during the so-called era of deinstitutionalization. By 1974, the census was a paltry 300, and in 1975 the facility closed, then quickly reopenedas a prison.

That rapid transformation fascinated me. What had happened to the patients? What had changed? Why did the hospital become a prison? I spent a long time searching for the records, and ultimately discovered that much of the hospital’s institutional memorynearly a century of patient charts, reports, photographs, ledgers, and other artifactshad been placed randomly in storage in the State Archive of Michigan, in Lansing. I spent another year gaining clearance from various review boards since of course the archive contains highly personal and confidential information, then spent the next four years reviewing the charts of over 800 patients.

When did you first suspect that diagnostic patterns with schizophrenia had become heavily racialized?

Latest Mental Health News

In the 1990’s, new antipsychotic medications were developed. These new medications are called second generation, or “atypical” antipsychotics.

One of these medications, clozapine is an effective medication that treats psychotic symptoms, hallucinations, and breaks with reality. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. People who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. But clozapine is potentially helpful for people who do not respond to other antipsychotic medications.

Other atypical antipsychotics were also developed. None cause agranulocytosis. Examples include:

Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol. A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication.

Typical antipsychotic medications can cause side effects related to physical movement, such as:

How are antipsychotics taken and how do people respond to them?

How do antipsychotics interact with other medications?

Psychosocial treatments

Theme 1: Accumulation Of Stressors

Were dealing with things like poverty, isolation, a lot of people are coming from other countries, asylum seekers They have stress where they are, theyve got stress when they come over here.

The ethnic minority experience is not the same as the native experience. Maybe weve had more struggles in life, and especially inner city and stuff like that, and basically the struggles that we have in life could turn us in a different direction.

It’s a stress related illness for instance if you go to get a job and you get turned down that could be stress related so that could build up eventually.

Those root causes of disillusionment, going for jobs, applying for jobs, you know, and it makes you question why such things still go on cos youre being told there’s nothing like racism.


going for jobs and getting knocked downyou get knocked down. You get knocked down when you go for house you get the worst kind of housing. Sometimes, even when you are going to a shop, you get knocked down by your neighbours. You get knocked down when you go into the post office. When you have this thing happen to you repeatedly, you understand, after a while you do get psychotic,

On a daily basis your self-esteem, your self-respect , your way of, you can no longer think positively, you understand, youre always under stress, flight or fight, yeah the chemicals for flying are always building up in you, theyre never going down, your pulse rate always going up

Reactions To Mental Disorders

Cognitive Ability & Your Genes

Socio-cultural reactions to mental disorders, which are generally spontaneous or unplanned, can have profound consequences for sufferers. Labelling, stigma, discrimination and the adoption of the sick role may negatively affect the patients life.17

While the majority of those with mental disorders want to work, their employment rate is usually very low.18,19,20,21 Despite European Union and International Labour Organisation policies to reduce unemployment, social stigmatizing is multidimensional and requires a multifaceted approach to overcome.

Socio-cultural reactions can differentially impact prognosis. A WHO collaborative study showed that while newly-diagnosed patients from different cultural backgrounds were similar in their symptom profile, the course of the disease over two years was more favourable in those from developing rather than developed countries.1 

How Common Is Schizophrenia Globally

The World Health Organization estimates that about 20 million people worldwide are currently living with schizophrenia. Schizophrenia statistics worldwide indicate, as mentioned, that the condition affects about one percent of a given population. While about half of people with schizophrenia in the U.S. receive no treatment, that statistic is worse in other nations where nearly 70 percent of the schizophrenia population receives no treatment to manage the condition.

There have been some studies that point to the prevalence of the condition being higher/lower in certain areas of the world. For instance, The Netherlands has a higher prevalence of schizophrenia diagnoses than other European nations. North Africa, Sub-Saharan Africa, and the Middle East have a slightly lower prevalence of the condition than other global regions. However, these statistics do not take into account the disparities in medical care. In short, many people in developing countries may simply not access medical care, so remain undiagnosed.

How It Affects Thoughts

People with schizophrenia may have trouble organizing their thoughts or making logical connections. They may feel like their mind is jumping from one unrelated thought to another. Sometimes they have “thought withdrawal,” a feeling that thoughts are removed from their head, or “thought blocking,” when someone’s flow of thinking suddenly gets interrupted. 

How To Avoid Ethnic Bias When Diagnosing Schizophrenia

Current Psychiatry

Stephen M. Strakowski, MDProfessor of psychiatry, psychology, neuroscience and biomedical engineering Department of psychiatry University of Cincinnati College of Medicine Cincinnati, OH

Is your practice bias-free? Examining the misdiagnosis of African-Americans yields insights into how to avoid cultural misunderstandings.

Place Of Birth: Urbanisation

An increased risk of developing schizophrenia in urban compared with rural areas has been reported by many researchers since Faris & Dunham’s original 1939 study of inner-city Chicago, although initial reports suggested that this was due to increased migration of putatively prodromal individuals into these areas . More recent data suggest that the social drift hypothesis might not be the whole story. Reports that greatest risk is associated with urban birth rather than later urban living suggest that, whatever effect an urban environment may be having, it is acting early. It should be noted that studies looking at this in terms of deprivation have come up with some of the largest effect sizes in the literature , but on the other hand there is a clear suggestion that the effects may not be restricted to schizophrenia, as rates of many other mental disorders are increased as well . Thus, the effect may be mediated through a general increase in stress, making individuals more likely to express whatever illnesses they are predisposed to.

What About Substance Abuse

Some people who abuse drugs show symptoms similar to those of schizophrenia. Therefore, people with schizophrenia may be mistaken for people who are affected by drugs. Most researchers do not believe that substance abuse causes schizophrenia. However, people who have schizophrenia are much more likely to have a substance or alcohol abuse problem than the general population.

Substance abuse can make treatment for schizophrenia less effective. Some drugs, like marijuana and stimulants such as amphetamines or cocaine, may make symptoms worse. In fact, research has found increasing evidence of a link between marijuana and schizophrenia symptoms. In addition, people who abuse drugs are less likely to follow their treatment plan.

Schizophrenia and smoking

Addiction to nicotine is the most common form of substance abuse in people with schizophrenia. They are addicted to nicotine at three times the rate of the general population .

The relationship between smoking and schizophrenia is complex. People with schizophrenia seem to be driven to smoke, and researchers are exploring whether there is a biological basis for this need. In addition to its known health hazards, several studies have found that smoking may make antipsychotic drugs less effective.

Research Weekly: How Race And Ethnicity Affect Psychiatric Outcomes

Race and ethnicity significantly influence the likelihood of being diagnosed and treated for psychiatric disease, but the reasons why remain to be determined.

Karen J. Coleman and colleagues searched for patterns by analyzing rates of diagnoses, medication prescription and psychotherapy sessions for 7.5 million adult patients enrolled in private, not-for-profit health care organizations in 11 states. The analysis is the first to examine racial-ethnic differences based on service utilization instead of patient self-reports, which are not considered entirely accurate. The Coleman analysis used de-identified medical and pharmacy record data instead.

Differences in Diagnoses

Of the 7.5 million health system patients in the analysis, 15.6% were diagnosed with one or more of nine psychiatric conditions: bipolar disorder, schizophrenia, other psychoses, depression, anxiety, substance use disorders, attention-deficit disorders, autism spectrum disorders and dementia.

Among the findings:

Treatment Differences

In the study population, 73% of the patients received a psychotropic medication in the study year; 34% received formal psychotherapy.

The Meaning in the Differences

“Our study does not provide answers to why racial-ethnic differences in the diagnosis and treatment of psychiatric conditions persist, especially for non-Hispanic black patients,” the authors concluded. “There are many patient- and provider-level factors that could contribute….”

Doris A. Fuller

Data Extraction And Quality Assessment

A data extraction form was piloted and iteratively amended to improve relevant data capture. One reviewer extracted data for meta-analyses , checked by another reviewer . When there was significant suspected overlap in samples across papers, we selected the paper with the most comprehensive analysis in terms of the specificity or number of ethnic categories, or if similar ethnic categories were applied we chose relevant data from the largest sample size.

Quality assessments were completed by two independent reviewers reaching consensus, with differences reconciled by a third reviewer . The AMSTAR checklist was used to assess quality of previous reviews . For primary studies included in our refined meta-analyses, we adapted a verified and recently adapted 5-item quality assessment tool and added an item to assess the specificity or clarity of the use of ethnic/national categories in the studies analyses taken from another verified and replicated tool .

Public Opinion / Perception Of Schizophrenia

Cognitive Ability & Your Genes

Worldwide, people diagnosed with schizophrenia face stigma and discrimination. The stigma associated with schizophrenia can delay a diagnosis as many people may hesitate to discuss their symptoms even with a healthcare provider. Although this stigma has been challenged in the U.S., it still exists in much of the rest of the world. Families may attempt to keep the diagnosis of a loved ones schizophrenia secret. In developed nations like the U.S., however, a clearer understanding of the illness and its symptoms has reduced the stigma. Given the rate of homelessness among this population, however, more support must be allocated to this segment of the population.

Review Of International Research On Race And Diagnosis Of Psychotic Disorders

The vast majority of empirical literature related to race and diagnosis of psychotic disorders has included consumer samples and clinicians from the United States. Nevertheless, could the same diagnostic patterns be found internationally? Alexandre et al reviewed medical records of 977 patients in Portugal, where 82% of the immigrants were from African Portuguese-speaking countries and only 3.3% from Eastern Europe countries. The term Black is widely used in Portugal and refers to patients of African origin while not suggesting any racial prejudice, according to Alexandre et al. Their results showed that Black inpatients where significantly more frequently diagnosed with Schizophrenia and acute and transient psychosis. By contrast, in the Netherlands, Vinkers et al examined 21857 pre-trial psychiatric reports comparing Dutch natives with what they termed Black and minority ethnic groups , and Whites from other Western countries . These researchers found that mandated psychiatric hospital admissions were more frequently recommended for BME persons and Whites from other Western countries compared to Dutch natives .

According to Vinkers et al these findings show how immigrants may encounter an increased risk of psychotic disorders diagnoses and hospital admissions, perhaps related to misunderstanding of or biases about symptomatology.

Black And Minority Ethnic Group And Mental Health


Literature Review

The UK is highly culturally diverse, with 4.6 million people living in the UK being from an ethnic minority background, making up 7.9% of the population . However, over the last few decades, an increasing body of empirical research, survey evidence and user testimonies have highlighted the difficulties facing individuals of the black and ethnic minority communities in their experiences of mental health services. Moreover, high-profile incidents such as the death of David Bennett , a 38-year-old African Caribbean man who died after being forcibly restrained by nurses in a medium secure unit, have re-ignited the discussion on the prevalence of institutional racism and the inequality experienced by members of BME communities .

The grey literature on access to mental health services in ethnic minorities warrants further investigation. In so doing, this literature review will outline and critically analyse the barriers commonly faced by members of the BME community, such as cultural bias, negative attitudes, discrimination and lack of sensitivity awareness among personnel and lack of funding Recent community development programmes and ongoing government-funded initiatives aimed at successfully removing these barriers shall also be interwoven in the review.

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Mental Health in the BME community

Discrimination and Racism

Cultural Bias

What Are The Symptoms Of Schizophrenia

The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms

Positive symptoms

Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often “lose touch” with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:

Hallucinations are things a person sees, hears, smells, tastes, or feels that no one else can see, hear, smell, taste, or feel. “Voices” are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia may hear voices for a long time before family and friends notice the problem.

Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near. Hearing voices is the most common type of hallucination in schizophrenia.

Negative symptoms

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

What Is The Outlook For The Future

The outlook for people with schizophrenia continues to improve. Although there is no cure, treatments that work well are available. Many people with schizophrenia improve enough to lead independent, satisfying lives.

Continued research and understanding in genetics, neuroscience, and behavioral science will help scientists and health professionals understand the causes of the disorder and how it may be predicted and prevented. This work will help experts develop better treatments to help people with schizophrenia achieve their full potential. Families and individuals who are living with schizophrenia are encouraged to participate in clinical research.

Resources For People With Schizophrenia

While that work continues, here are some resources for Black Americans living with schizophrenia and their caregivers, too.

  • Nagendra suggests the Oregon-based Early Assessment Support Alliance. The group has a national directory that can be used to find early intervention services all over the country.
  • The Lieber Clinic offers telehealth. Herlands also suggests OnTrackNY, a resource for adolescents and young adults experiencing psychosis.
  • Dr. Strakowski encourages patients and family members to join the National Alliance on Mental Illness , a grassroots education and support group. Take advantage of anything available, he says. And if youre unhappy with your care providers, find different ones. He recommends starting with a university psychiatry department because they tend to be plugged into a well-established mental health center that is connected to different specialists, able to get the information they need and just keep advocating for care.

Finally, its important to remember that connecting people who are struggling to treatment early is key to thriving with any mental illness.


  • Olbert CM, Nagendra A, Buck B. Meta-analysis of Black vs. White racial disparity in schizophrenia diagnosis in the United States: Do structured assessments attenuate racial disparities? J Abnorm Psychol. 2018 Jan;127:104-115. doi: 10.1037/abn0000309. Epub 2017 Nov 2. PMID: 29094963.
  • Deaths Related To Schizophrenia

    Research indicates that people with schizophrenia are 3.5 times more likely to die than similarly aged individuals in the general population in a single year. In general, people who have schizophrenia are likely to die 25 years earlier than people in the general population. The large majority of deaths in schizophrenia patients is from natural causes other health conditions and infectious diseases. Even so, people with schizophrenia suffer elevated rates of suicide and fatal accidents. Some of these schizophrenia-related deaths are medically understandable; for instance, a majority of Americans with schizophrenia smoke. Smoking, of course, is related to a heightened risk for lung and other cancers as well as cardiovascular disease.

    Beyond Immigrant And Refugee

    We hear about immigrants and refugees all the time, and it can be easy to think of them as one group. But there may be big differences between immigrants and refugees, including different mental health risks.

    Immigrants are people who come to live in a new country. According to the healthy immigrant effect, immigrants are healthier when they arrive in Canada than the Canadian-born population. Then, over time, their health declines until the difference disappears. Many researchers suggest this happens because you need to be healthy to immigrate to Canada. But there are many cultural factors that affect how you think about health in the first place. For example, a person may not identify a mental health problem as a health concern.

    Refugees are people who are forced to leave their home because they will be harmed if they stay. They may have witnessed conflict like war or political unrest. They may have lost their families, friends, home, status and income.  As a result, refugees may have a higher risk of mental health problems as they cope with the stresses of coming to Canada, adapting to their new community and making an income. Some of the challenges they might face include post-traumatic stress, unemployment and poverty, racism and feelings of worthlessness.

    National Statistics On The Prevalence Of Schizophrenia


    Schizophrenia stats suggest that in a given year, roughly 100,000 people will be diagnosed with this disorder in the U.S. To date, there are as many as 3.5 million schizophrenia diagnoses. To put these schizo statistics in context, that means that in a city of three million, about 21,000 people are living with schizophrenia. These stats dont take into account the thousands who are undiagnosed. In certain stages of the disease, it can be difficult to diagnose and many individuals may be unaware that they are suffering from any type of disorder as schizophrenia affects a persons perceptions of themselves and the world around them.

    Schizophrenia Statistics In The United States

    • The prevalence of schizophrenia among U.S adults is estimated to be 1.5 million people per year.
    • Schizophrenia is often diagnosed in young people during their late teens to early 30s with symptoms commonly presenting earlier in males than in females.
    • The average life lost for individuals with schizophrenia in the U.S. is 28.5 years.

    Are Rates Of Mental Ill Health Different For People From A Bame Background

    Rates of mental health problems can be higher for some BAME groups than for White people. For example:

    • Black men are more likely to have experienced a psychotic disorder in the last year than White men
    • Black people are four times more likely to be detained under the Mental Health Act than White people
    • older South Asian women are an at-risk group for suicide
    • refugees and asylum seekers are more likely to experience mental health problems than the general population, including higher rates of depression, anxiety and PTSD
    • Irish people living in the UK, while not included as a BAME group, have much higher hospital admission rates for mental health problems than other ethnic groups. They have higher rates of depression and alcohol problems and are at greater risk of suicide.

    Some groups have better mental health. For example:

    • people of Indian, Pakistani and African-Caribbean origin showed higher levels of mental wellbeing than other ethnic groups
    • suicidal thoughts and self-harm were less common in Asian people than White people.
    • mental ill-health is lower among Chinese people than White people.

    With all these statistics, its important to note that they might not reflect the true extent of mental health problems among BAME groups. This is because not much data is available, and also because BAME people may be less likely to report mental health problems.

    Alcohol Drugs Are A Risk

    People with schizophrenia are much more likely than other people to abuse alcohol or illicit drugs. Some substances, including marijuana and cocaine, can make symptoms worse. Drug abuse also interferes with treatments for schizophrenia. If you know someone whoâs dealing with that, look for substance abuse programs designed for people with schizophrenia.

    Racial Ethnic Differences Found In Psychiatric Diagnoses Treatment According To Researchers

    Georgia State University
    Non-Hispanic blacks are almost twice as likely as non-Hispanic whites to be diagnosed with schizophrenia, but they’re significantly less likely to receive medication for treatment, according to researchers.

    Non-Hispanic blacks are almost twice as likely as non-Hispanic whites to be diagnosed with schizophrenia, but they’re significantly less likely to receive medication for treatment, according to researchers.

    These are some of the findings of a recent study published in the journal Psychiatric Services, which reported significant racial-ethnic differences in diagnosis and treatment of psychiatric conditions across 11 private, not-for-profit U.S. healthcare delivery systems. The organizations were part of the Mental Health Research Network, a consortium of research centers based in large not-for-profit health care systems that have a mission to improve the management of mental health conditions.

    “It’s concerning that we saw a higher rate of diagnosis of schizophrenia and seemingly an undertreatment in terms of pharmacotherapy for that group,” said Ashli A. Owen-Smith, co-author of the study and assistant professor of health management and policy in the School of Public Health at Georgia State University. “In general, pharmacotherapy is an important part of the treatment plan. That’s a finding that warrants some additional research.”

    Additional results from the study include:

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