Anglin Deidre M, Olfson Mark, van der Ven Els, Oh Hans, Lewis-Fernández Roberto, DeVylder Jordan, Oluwoye Oladunni, Dixon Lisa, Stroup T Scott, Guyer Heidi, Bareis Natalie
Department of Psychology, City College of New York, New York.
City University of New York Graduate Center, New York.
Am J Psychiatry. 2025 Sep 1;182(9):850-860. doi: 10.1176/appi.ajp.20240906.
The study aim was to identify ethnoracial disparities in the prevalence of schizophrenia spectrum disorders (SSDs) and positive psychotic symptoms in the United States and examine the role of social neighborhood inequities.
Participants in the Mental and Substance Use Disorders Prevalence Study, a national household sample of nonelderly adults (N=4,764), were assessed by clinicians with the Structured Clinical Interview for DSM-5 (SCID-5) for SSDs (past year and lifetime), including schizophrenia, schizoaffective disorder, and schizophreniform disorder, and for psychotic symptoms. Weighted logistic regression models estimated ethnoracial differences in the prevalence of SSDs and psychotic symptoms in unadjusted models, age- and sex-adjusted models, and models further adjusted for a neighborhood Social Vulnerability Metric (SVM) score, a composite index of five social determinants of health domains.
Compared to non-Hispanic White individuals, non-Hispanic Black individuals had a significantly higher prevalence of SSDs (4.1% vs. 1.2%; adjusted odds ratio=3.49, 95% CI=1.37, 8.91) and psychotic symptoms (9.3% vs. 4.9%; adjusted odds ratio=2.04, 95% CI=1.15, 3.63), and non-Hispanic multiracial individuals had a significantly higher prevalence of SSDs (5.6%; adjusted odds ratio=4.59, 95% CI=1.53, 13.76). Further adjustment for SVM score lowered the Black-White group difference for SSDs (adjusted odds ratio=2.49, 95% CI=0.63, 9.90) and psychotic symptoms (adjusted odds ratio=1.69, 95% CI=0.83, 3.44), and the associations were no longer statistically significant. The difference in SSDs between the non-Hispanic multiracial and White groups was attenuated after SVM score adjustment (adjusted odds ratio=3.95, 95% CI=1.30, 12.00) but remained significant.
This national U.S. household study found ethnoracial differences in the prevalence of clinician-assessed SCID-based schizophrenia spectrum disorders and positive psychotic symptoms. The higher prevalence among minoritized groups, particularly Black individuals, was connected to social inequities and community-level vulnerabilities embedded in neighborhoods and associated with structural racism.
本研究旨在确定美国精神分裂症谱系障碍（SSDs）患病率及阳性精神病性症状方面的种族差异，并探讨社区社会不平等因素所起的作用。
精神与物质使用障碍患病率研究选取了一个全国性的非老年成年人家庭样本（N = 4764），临床医生使用《精神疾病诊断与统计手册》第5版结构化临床访谈（SCID - 5）对其进行评估，以确定SSDs（过去一年和终生），包括精神分裂症、分裂情感性障碍和精神分裂症样障碍，以及精神病性症状。加权逻辑回归模型在未调整模型、年龄和性别调整模型以及进一步根据社区社会脆弱性指标（SVM）得分进行调整的模型中估计了SSDs患病率和精神病性症状方面的种族差异，SVM得分是健康领域五个社会决定因素的综合指数。
与非西班牙裔白人个体相比，非西班牙裔黑人个体的SSDs患病率（4.1%对1.2%；调整后的优势比 = 3.49，95%置信区间 = 1.37，8.91）和精神病性症状患病率（9.3%对4.9%；调整后的优势比 = 2.04，95%置信区间 = 1.15，3.63）显著更高，非西班牙裔多种族个体的SSDs患病率也显著更高（5.6%；调整后的优势比 = 4.59，95%置信区间 = 1.53，13.76）。对SVM得分进行进一步调整后，黑人和白人组在SSDs方面的差异降低（调整后的优势比 = 2.49，95%置信区间 = 0.63，9.90），在精神病性症状方面的差异也降低（调整后的优势比 = 1.69，95%置信区间 = 0.83，3.44），且这些关联不再具有统计学意义。非西班牙裔多种族和白人组在SSDs方面的差异在SVM得分调整后有所减弱（调整后的优势比 = 3.95，95%置信区间 = 1.30，12.00），但仍具有显著性。
这项美国全国家庭研究发现，在基于临床医生评估的、以SCID为基础的精神分裂症谱系障碍患病率和阳性精神病性症状方面存在种族差异。少数群体，特别是黑人个体中较高的患病率与社区中存在的社会不平等和社区层面的脆弱性有关，并与结构性种族主义相关。
