Xavier Salomé M, Both Adrianne, van der Ven Els, Ferrari Manuela, Abdel-Baki Amal, van den Bogerd Nicole, Lemmers-Jansen Imke, Iyer Srividya N
Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Douglas Mental Health University Institute, Montréal, QC, Canada.
Department of Psychiatry, McGill University, Montreal, QC, Canada.
Front Psychiatry. 2025 Oct 7;16:1602468. doi: 10.3389/fpsyt.2025.1602468. eCollection 2025.
Previous research, predominantly quantitative, has attributed the excess risk for psychosis among immigrants and ethnic minorities to social adversity, discrimination and structural inequities. Although calls have acknowledged their potential for yielding nuanced insights, qualitative methods focused on first-person narratives have not been used in research into the social determinants of the development of psychosis.
We explored the experiences and socio-environmental contexts of individuals with psychosis from diverse ethno-racial and immigrant backgrounds. We also gathered their perspectives on the causality of psychosis. We conducted in-depth interviews with 24 participants at early intervention services for psychosis in Montreal, Canada.
Through thematic analysis, we identified five themes: "Spaces and societies of oppression"; "Nothing to hold on to"; "Mistreated, invisible or seen in the wrong light"; "Places of freedom, connection and safety"; and "Healing and well-being". Spaces described as oppressive fomented experiences of precarity, isolation and mistreatment. Spaces of freedom, connection and inclusivity enabled healing and well-being. Experiences of precarity, mistreatment and exclusion were more frequent for minoritized individuals. Participants attributed psychosis to multiple factors, many pertaining to social contexts.
Our findings shed light on the processes through which social contexts shape the lives and illness development of individuals from diverse backgrounds. By framing them within particular life stories and places, we gain a fuller, more fine-grained understanding of the social-structural determinants that have been identified in quantitative studies. Our work highlights the need to attend closely to patients' social contexts and narratives and advocate for inclusivity, equity, and connection at the societal level.
先前的研究主要是定量研究，将移民和少数族裔中患精神病的额外风险归因于社会逆境、歧视和结构不平等。尽管有人呼吁承认定性研究在产生细微见解方面的潜力，但专注于第一人称叙述的定性方法尚未用于精神病发展的社会决定因素研究。
我们探讨了来自不同种族和移民背景的精神病患者的经历和社会环境背景。我们还收集了他们对精神病病因的看法。我们在加拿大蒙特利尔的精神病早期干预服务机构对24名参与者进行了深入访谈。
通过主题分析，我们确定了五个主题：“压迫的空间和社会”；“无所依靠”；“受虐待、被忽视或被误解”；“自由、联系和安全的场所”；以及“治愈与幸福”。被描述为压迫性的空间引发了不稳定、孤立和受虐待的经历。自由、联系和包容的空间促进了治愈和幸福。少数族裔个体经历不稳定、受虐待和被排斥的情况更为频繁。参与者将精神病归因于多种因素，其中许多与社会背景有关。
我们的研究结果揭示了社会背景塑造不同背景个体的生活和疾病发展的过程。通过将这些过程置于特定的生活故事和场所中，我们对定量研究中确定的社会结构决定因素有了更全面、更细致的理解。我们的工作强调需要密切关注患者的社会背景和叙述，并在社会层面倡导包容、公平和联系。
