Systematic review of pathways to care in the U.S. for Black individuals with early psychosis

The pathway to receiving specialty care for first episode psychosis (FEP) among Black youth in the US has received little attention despite documented challenges that negatively impact engagement in care and clinical outcomes. We conducted a systematic review of US-based research, reporting findings related to the pathway experiences of Black individuals with FEP and their family members. A systematic search of PubMed, PsycInfo, and Embase/Medline was performed with no date restrictions up to April 2021. Included studies had samples with at least 75% Black individuals and/or their family members or explicitly examined racial differences. Of the 80 abstracts screened, 28 peer-reviewed articles met the inclusion criteria. Studies were categorized into three categories: premordid and prodromal phase, help-seeking experiences, and the duration of untreated psychosis (DUP). Compounding factors such as trauma, substance use, and structural barriers that occur during the premorbid and prodromal contribute to delays in treatment initiation and highlight the limited use of services for traumatic childhood experiences (e.g., sexual abuse). Studies focused on help-seeking experiences demonstrated the limited use of mental health services and the potentially traumatic entry to services (e.g., law enforcement), which is associated with a longer DUP. Although the majority of studies focused on help-seeking experiences and predictors of DUP, findings suggests that for Black populations, there is a link between trauma and substance use in the pathway to care that impacts the severity of symptoms, initiation of treatment, and DUP. The present review also identifies the need for more representative studies of Black individuals with FEP

Association of Exposure to Police Violence With Prevalence of Mental HealthSymptoms Among Urban Residents in the United States

Importance Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. Objective To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. Design, Setting, and Participants This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. Exposures Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). Main Outcomes and Measures Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. Results Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). Conclusions and Relevance Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence

The predictive effects of racial socialization, racial identity, and African self -consciousness on African American college adjustment and psychological defenses

The purpose of this study was to add to the literature on psychosocial functioning in African American college students. Specifically, the interrelationships among racial socialization, racial identity, and African self-consciousness, and their predictive influence on college adjustment were examined in Black college students. Psychological defenses were also examined as an indicator of psychosocial functioning. Previous research on racial identity has used the Racial Identity Attitude Scale (RIAS), which has been criticized for its psychometric limitations. This study used Cross\u27s new measure of Racial Identity (CRIS). Few empirical studies have directly examined the theoretical link between racial socialization and racial identity. Even fewer studies have examined racial socialization in college populations. One hundred forty five Black college students from Fordham University and City College of New York were administered self-report questionnaires assessing racial identity, racial socialization, African self-consciousness, college adjustment, and psychological defenses. It was hypothesized that students who experienced racial socialization would tend to have internalized racial identities and higher levels of African self-consciousness. Further, it was expected that these racial variables would predict better college adjustment and be related to mature psychological defenses. Internalized racial identity was also expected to mediate and/or moderate the relationship between more racial socialization experiences and better college adjustment. Bivariate correlation and multiple regression analyses were conducted on data from 141 participants. The results showed that students who were racially socialized tended to possess more internalized racial identities and African self-consciousness. Students with Internalized-Multicultural racial identity tended to be better adjusted in college, but students with Internalized Afrocentric racial identity were less adjusted. Pre-encounter Miseducation racial identity significantly predicted poorer adjustment in college. Racial identity and African self-consciousness were not significantly related to mature psychological defenses. The mediation and moderation hypotheses were not supported. These findings support the importance of racially socializing Black youth and debunking negative stereotypes during racial identity development. This information is valuable to college counselors and college preparation programs who are involved with improving student adjustment to college

The predictive effects of racial socialization, racial identity, and African self -consciousness on African American college adjustment and psychological defenses

The purpose of this study was to add to the literature on psychosocial functioning in African American college students. Specifically, the interrelationships among racial socialization, racial identity, and African self-consciousness, and their predictive influence on college adjustment were examined in Black college students. Psychological defenses were also examined as an indicator of psychosocial functioning. Previous research on racial identity has used the Racial Identity Attitude Scale (RIAS), which has been criticized for its psychometric limitations. This study used Cross\u27s new measure of Racial Identity (CRIS). Few empirical studies have directly examined the theoretical link between racial socialization and racial identity. Even fewer studies have examined racial socialization in college populations. One hundred forty five Black college students from Fordham University and City College of New York were administered self-report questionnaires assessing racial identity, racial socialization, African self-consciousness, college adjustment, and psychological defenses. It was hypothesized that students who experienced racial socialization would tend to have internalized racial identities and higher levels of African self-consciousness. Further, it was expected that these racial variables would predict better college adjustment and be related to mature psychological defenses. Internalized racial identity was also expected to mediate and/or moderate the relationship between more racial socialization experiences and better college adjustment. Bivariate correlation and multiple regression analyses were conducted on data from 141 participants. The results showed that students who were racially socialized tended to possess more internalized racial identities and African self-consciousness. Students with Internalized-Multicultural racial identity tended to be better adjusted in college, but students with Internalized Afrocentric racial identity were less adjusted. Pre-encounter Miseducation racial identity significantly predicted poorer adjustment in college. Racial identity and African self-consciousness were not significantly related to mature psychological defenses. The mediation and moderation hypotheses were not supported. These findings support the importance of racially socializing Black youth and debunking negative stereotypes during racial identity development. This information is valuable to college counselors and college preparation programs who are involved with improving student adjustment to college

Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States

The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to ‘recovery.’ In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches

Comparing the Role of Aberrant Salience and Dissociation in the Relation between Cumulative Traumatic Life Events and Psychotic-Like Experiences in a Multi-Ethnic Sample

Exposure to traumatic life events (TLE) is a risk factor for psychosis. Yet, a dearth of studies examines factors linking TLE to psychosis, while considering differences in TLE frequency. This study investigated dissociation and aberrant salience as mediators and moderators of the relation between three TLE groups (none, 1–3 TLE and 4+ TLE) and psychotic-like experiences (PLE) in a multi-ethnic sample of 816 emerging adults. The participants completed self-report inventories of PLE (Prodromal Questionnaire), TLE (Life Events Checklist), dissociative experiences (Dissociative Symptoms Scale), and aberrant salience (Aberrant Salience Inventory). As expected, groups with higher TLE frequency endorsed higher PLE. Parallel mediation models indicated that, while aberrant salience mediated the relation between both levels of cumulative traumatic experiences (1–3 TLE and 4+ TLE) and PLE, dissociation only mediated the relation between exposure to at least four different traumatic experiences and PLE. The moderation results showed that risk of PLE was highest among individuals with 1–3 TLE who endorsed dissociation. Our results suggest that, while aberrant salience processing explains why TLE may relate to higher psychosis risk, dissociation’s role in this relation is dependent on the number of different TLE exposures

Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis

Abstract Background Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. Methods The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. Discussion Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity