一项六国病例对照研究中感知到的主要歧视经历、种族群体与精神病风险

Perceived major experiences of discrimination, ethnic group, and risk of psychosis in a six-country case-control study.

作者信息

Misra Supriya, Gelaye Bizu, Williams David R, Koenen Karestan C, Borba Christina P C, Quattrone Diego, Di Forti Marta, Tripoli Giada, La Cascia Caterina, La Barbera Daniele, Ferraro Laura, Tarricone Ilaria, Berardi Domenico, Lasalvia Antonio, Tosato Sarah, Szöke Andrei, Llorca Pierre-Michel, Arango Celso, Tortelli Andrea, de Haan Lieuwe, Velthorst Eva, Bobes Julio, Bernardo Miguel, Sanjuán Julio, Santos Jose Luis, Arrojo Manuel, Del-Ben Cristina Marta, Menezes Paulo Rossi, Selten Jean-Paul, Jones Peter B, Jongsma Hannah E, Kirkbride James B, Rutten Bart P F, van Os Jim, Murray Robin M, Gayer-Anderson Charlotte, Morgan Craig

机构信息

Department of Public Health, San Francisco State University, San Francisco, CA94132, USA.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA02115, USA.

出版信息

Psychol Med. 2021 Mar 2:1-9. doi: 10.1017/S0033291721000453.

DOI:10.1017/S0033291721000453

PMID:33648622

Abstract

BACKGROUND

Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.

METHODS

We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case-control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.

RESULTS

Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91-1.59) for any discrimination and 1.79 (95% CI 1.19-1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12-2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65-3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).

CONCLUSIONS

Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.

摘要

背景

感知到的歧视与较差的心理健康状况相关。很少有研究评估感知到的歧视（i）是否与精神障碍风险相关，以及（ii）相对于多数族裔而言，是否会导致少数族裔的风险增加。

方法

我们使用了欧洲国家精神分裂症网络研究基因-环境相互作用工作包2的数据，这是一项基于人群的病例对照研究，涉及六个国家17个集水区的新发精神障碍病例。我们使用混合效应逻辑回归模型计算感知到的歧视与精神病之间关联的优势比（OR）和95%置信区间（95%CI）。我们使用分层分析和中介分析来探讨少数族裔的差异。

结果

报告有任何重大歧视经历（如受到警察不公平对待、未被录用）的病例高于对照组（41.8%对34.2%）。普遍存在的歧视经历（≥3种类型）在病例中也高于对照组（11.3%对5.5%）。在完全调整模型中，与无歧视相比，任何歧视导致精神病的优势比为1.20（95%CI 0.91-1.59），普遍存在的歧视导致精神病的优势比为1.79（95%CI 1.19-1.59）。在分层分析中，少数族裔普遍存在的歧视经历的关联强度（OR = 1.73，95%CI 1.12-2.68）似乎比多数族裔（OR = 1.42，95%CI 0.65-3.10）更强。在探索性中介分析中，普遍存在的歧视对少数族裔中额外风险的解释作用最小（5.1%）。