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A pattern of racial disparities in the U.S. was linked with increased risk of psychosis, according to a literature review.

Individual and collective trauma, enhanced stress resulting from generations of prenatal and perinatal complications, and the neurodevelopmental and neurobiological effects of discrimination were associated with disproportionate rates of psychotic disorders among people of color and people from low socioeconomic backgrounds, reported Deidre Anglin, PhD, of the City College of New York, and colleagues.

Black and Latinx people had significantly more exposure to psychosis risk factors at the neighborhood and individual level due to structural racism, Anglin said in a press briefing at the American Psychiatric Association (APA) virtual meeting. The findings were published in the .

At the neighborhood level, ethnic density, displacement, and access to services were linked with an increased prevalence and severity of the extended psychosis phenotype, the authors wrote, noting that has shown that the fear of neighborhood disruption and growing gentrification was associated with significantly greater likelihoods of psychotic experiences in a large U.S. community sample.

When Anglin's group examined the relationship between trauma and psychosis, "a lot of studies reviewed showed that, among people experiencing psychosis, rates of trauma and adversity are significantly higher in marginalized racial groups compared to white people," she said. "And that cuts across various different kinds of trauma, from physical abuse to early childhood adversity, to discriminatory types of traumatic experiences."

Much of the the researchers analyzed determined that repeated experiences of victimization, trauma, and social stress contributed to an increased frequency and severity of psychosis symptoms, in accordance with a dose-response pattern.

Various obstetric complications have also been associated with higher risk of psychotic disorders in U.S. samples, the authors stated, but previous studies on this phenomenon did not adequately consider the racial and ethnic disparities in birth complications in their models.

Over the years, Black women in the U.S. have a risk of birth complications, ranging from preterm deliveries and reduced fetal growth to increased infection rates, the researchers noted.

Their review that Black women were more likely to have lower cortisol levels during their second trimester in comparison to other racial groups. Studies suggest that lower second-trimester cortisol levels have also been observed among women diagnosed with post-traumatic stress disorder.

"Not only is cortisol essential for fetal growth and development, but findings indicate that lower cortisol levels in later stages of pregnancy are associated with decreased fetal growth among those who develop schizophrenia," Anglin and colleagues wrote.

Other research reviewed by the authors found that Black women in mid-to-late pregnancy showed higher levels of stress biomarkers -- like C-reactive protein and adrenocorticotropic hormones -- than did white women of the same socioeconomic status. A showed that acts of discrimination experienced by pregnant women of color may also increase allostatic load, "wearing down the body's regulatory systems, causing biological and epigenetic changes in the infant as well as differences in birth outcomes," they explained.

In identifying the ways in which structural racism has led to increased psychosis risk, the authors make the case that there is an urgent need for future U.S. research to appropriately consider racial disparities and societal factors when studying rates of psychotic disorders. To date, the U.S. has not had a representative, population-based approach to study clinical psychosis that adjusts for race-based misdiagnosis and socioeconomic disadvantage, they stated.

"The disproportionate number of marginalized and disadvantaged Black people represented among individuals with psychosis in U.S. clinical settings may reflect how these traumas, discrimination, and neighborhood violence are influencing the ability to receive adequate treatment and avoid traumatic pathways to and through care," Anglin and colleagues concluded.

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