Nagendra Arundati, Weiss David M, Merritt Carrington, Cather Corinne, Sosoo Effua E, Mueser Kim T, Penn David L
Center of Excellence in Psychosocial and Systemic Research, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Soc Psychiatry Psychiatr Epidemiol. 2023 Jan;58(1):77-89. doi: 10.1007/s00127-022-02297-9. Epub 2022 Aug 6.
In the US, Black people diagnosed with schizophrenia experience worse psychosocial and clinical outcomes than their White counterparts. While racism-related factors contribute to these disparities, an additional understudied explanation may be that psychosocial treatments for psychotic disorders are less effective for Black than White individuals. The purpose of this study is to examine the extent to which best treatment practices for first-episode psychosis (FEP) are effective for Black and White participants.
We conducted a secondary data analysis of the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP), a two-year multisite trial that compared a coordinated specialty care intervention for FEP (NAVIGATE) to community care as usual (CC) in 34 sites across the US. Specifically, we compared interviewer-rated quality of life and symptoms, as well as self-reported mental health and stigma, between 139 Non-Latinx Black and 172 Non-Latinx White participants with FEP in NAVIGATE and CC.
We found few differences between Black and White participants over two-year outcomes, either overall or in terms of benefit from NAVIGATE. Across both treatment conditions, Black participants improved less than White participants on positive symptoms, an effect driven primarily by suspiciousness/persecution. In NAVIGATE, self-reported mental health stigma decreased for both Black and White participants, while in CC stigma decreased for White participants but increased for Black participants. This effect was driven primarily by experienced stigma rather than self-stigma.
NAVIGATE benefits both Black and White individuals diagnosed with FEP. Mental health stigma and positive symptoms may be particularly important aspects of treatment for Black individuals diagnosed with FEP.
在美国，被诊断患有精神分裂症的黑人在心理社会和临床方面的预后比白人更差。虽然与种族主义相关的因素导致了这些差异，但另一个研究较少的解释可能是，针对精神障碍的心理社会治疗对黑人的效果不如对白人的效果。本研究的目的是检验首发性精神病（FEP）的最佳治疗方法对黑人和白人参与者的有效程度。
我们对精神分裂症首次发作早期治疗项目后的康复（RAISE - ETP）进行了二次数据分析，这是一项为期两年的多地点试验，在美国34个地点比较了针对FEP的协调专科护理干预（NAVIGATE）与常规社区护理（CC）。具体而言，我们比较了NAVIGATE和CC中139名非拉丁裔黑人FEP参与者与172名非拉丁裔白人FEP参与者之间，由访谈者评定的生活质量和症状，以及自我报告的心理健康和耻辱感。
我们发现，在两年的结果方面，黑人和白人参与者总体上或在从NAVIGATE中获益方面几乎没有差异。在两种治疗条件下，黑人参与者在阳性症状方面的改善都不如白人参与者，这种影响主要由猜疑/迫害观念驱动。在NAVIGATE中，黑人和白人参与者自我报告的心理健康耻辱感都有所下降，而在CC中，白人参与者的耻辱感下降，黑人参与者的耻辱感增加。这种影响主要由经历的耻辱感而非自我耻辱感驱动。
NAVIGATE对被诊断患有FEP的黑人和白人都有益。心理健康耻辱感和阳性症状可能是被诊断患有FEP的黑人治疗中特别重要的方面。
