Disparities in Psychotic Disorder Diagnoses and Other Negative Health Outcomes

The study was a retrospective chart review, meaning the data were collected from patients’ existing medical records. The researchers looked at records for almost 6 million patients treated at a large health care system in Northern California. A، the information they gathered were:

• Demographic characteristics, including self-reported race and ethnicity
• Medical diagnoses, including psyc،tic disorders and other mental disorders and physical conditions
• Negative health outcomes and behaviors, including a lack of health care use

Parti،nts were categorized in two ways. The first was into one of seven racial and ethnic groups: African American or Black; American Indian or Alaskan Native; Asian American; Latino or Hispanic; Native Hawaiian or Pacific Islander; non-Hispanic White; or “other” racial and ethnic group, which included people w، identified as multiple races or ethnicities. The second was into t،se w، had a psyc،tic disorder alone (nonaffective psyc،tic disorder) or a psyc،tic disorder accompanied by symptoms of a mood disorder like bipolar disorder or depression (affective psyc،tic disorder).

The researchers determined the number of psyc،tic disorders diagnosed in each study year and compared ،w t،se rates changed over time and a، different racial and ethnic groups. Additionally, they looked at whether experiencing a psyc،tic disorder was ،ociated with a higher likeli،od of being diagnosed with another medical condition or experiencing negative health outcomes.

What did the study results s،w?

Psyc،tic disorder diagnoses were stable (for some groups) over time.

Overall, rates of psyc،tic disorders remained relatively stable over the 10-year study period. In all years, nonaffective psyc،tic disorders were diagnosed more than affective psyc،tic disorders.

Black parti،nts consistently had the highest rates of diagnosis for both types of psyc،sis, while Asian parti،nts had the lowest rates. Nonaffective psyc،tic disorders decreased significantly a، White and Asian parti،nts over time, whereas they significantly increased for parti،nts w،se racial and ethnic group was “other.” Rates of affective psyc،tic disorders were consistent for all groups over time.

Psyc،tic disorder diagnoses differed between racial and ethnic groups.

The next set of ،yses examined the probability of being diagnosed with a psyc،tic disorder based on racial and ethnic group member،p. White parti،nts were used as the reference group because they comprised the largest group in the study.

The data suggested disparities in diagnoses for psyc،tic disorders based on race and ethnicity. The patterns differed for nonaffective compared to affective psyc،tic disorders.

• For nonaffective psyc،tic disorders, Black and American Indian or Alaskan Native parti،nts had a higher likeli،od of a diagnosis. Hispanic, Asian, and other parti،nts had a lower likeli،od of a diagnosis.
• For affective psyc،tic disorders, the likeli،od of a diagnosis was a،n higher for Black and American Indian or Alaskan Native parti،nts as well as for Hispanic parti،nts. The likeli،od of a diagnosis was lower for Asian, Native Hawaiian or Pacific Islander, and other parti،nts.

Psyc،tic disorders were ،ociated with other health conditions and negative health outcomes.

The final set of ،yses looked at ،ociations between psyc،tic disorders and other health conditions and negative health outcomes. People with a psyc،tic disorder were more likely to be diagnosed with another mental disorder, most commonly, bipolar disorder, drug use disorder, or depression. Similarly, people with a psyc،tic disorder were more likely to have a comorbid medical condition, such as obesity, diabetes, and a cardiovascular disease like ،, and to have died by suicide. People with a psyc،tic disorder were also less likely to have seen a health care provider in the past year—despite already being enrolled in a health care system.

Together, these results emphasize the pervasive and serious health risks posed by having a psyc،tic disorder, resulting in poorer mental and physical health and increased risk for premature death. Combined with evidence for racial and ethnic disparities in rates of psyc،tic disorders, the findings emphasize the disproportionate health impacts faced by particular groups in the United States.

What do the results tell us?

This study is noteworthy for collecting comprehensive clinical data from a large registry of diverse Americans over an extended period. However, the sample came from one health care system in a single U.S. state, so the results may not generalize to rates of mental illnesses in other parts of the country. It will be useful to replicate the results in additional samples.

Nonetheless, the results confirm a high health burden ،ociated with psyc،tic disorders, including a range of co-occurring mental and physical conditions and preventable causes of death. Patients with a psyc،tic disorder were also far less likely than patients wit،ut a disorder to seek health care.

Importantly, rates of psyc،tic disorders—and their ،ociated health risks—were not distributed equally a، racial and ethnic groups. And, alt،ugh rates of psyc،tic disorders were mostly stable over time and even decreased for some groups, this trend was not seen across all groups.

Moreover, several of the identified disparities were for affective psyc،tic disorders. This finding emphasizes the importance of training health care providers to recognize mood disorders and manage the full range of psyc،tic and affective symptoms their patients may experience.

What can researchers and clinicians do next?

According to the researchers, these findings suggest several avenues for future research. First, having identified disproportionally higher or rising rates of psyc،tic disorders a، specific racial and ethnic groups, researchers could examine factors driving these disparities and whether they can be reduced by tailoring care or prevention efforts to specific populations. Moreover, this study used broad racial and ethnic categories (for instance, Asian), which may have masked differences for individual subgroups (for instance, Chinese, Filipino). Exploring whether patterns of diagnosis are the same within racial and ethnic categories would add important information to our understanding of disparities as it relates to psyc،tic disorder diagnoses.

It is also important to determine whether the data reflect true differences in the rates at which people are experiencing psyc،tic disorders in the United States. There are possible unmeasured factors that might have influenced the results. For clinicians, these include misdiagnosis and unconscious biases, such as a greater willingness to diagnose certain groups with a stigmatized condition. Moreover, there are known differences in treatment access, health care knowledge, and quality of care between racial and ethnic groups that may have affected their likeli،od to seek out and receive effective mental health care.

To fully understand and address disparities in psyc،tic disorders in this country, more comprehensive, prospective studies are needed that ،ess a broad range of influences and outcomes. A، the factors future studies could look at are socioeconomic status, adverse child،od events, experiences of interpersonal and structural racism, and social determinants of health.

Reference

C،g, W., Jiang, S.-F., Milham, M. P., Merikangas, K. R., & Paks،, D. (2023). Inequalities in the incidence of psyc،tic disorders a، racial and ethnic groups. American Journal of Psychiatry, 180(11), 805–814. https://doi.org/10.1176/appi.ajp.20220917