Neighborhood Social Vulnerability and Racial Disparities in Schizophrenia Spectrum Disorder Prevalence
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 n...
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| Vydáno v: | The American journal of psychiatry Ročník 182; číslo 9; s. 850 |
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United States
01.09.2025
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| ISSN: | 1535-7228, 1535-7228 |
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| Abstract | 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. |
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| AbstractList | 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.OBJECTIVEThe 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.METHODSParticipants 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.RESULTSCompared 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.CONCLUSIONSThis 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. 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. |
| Author | Olfson, Mark Bareis, Natalie Oh, Hans Lewis-Fernández, Roberto Oluwoye, Oladunni Anglin, Deidre M van der Ven, Els DeVylder, Jordan Dixon, Lisa Stroup, T Scott Guyer, Heidi |
| Author_xml | – sequence: 1 givenname: Deidre M orcidid: 0000-0002-2717-3206 surname: Anglin fullname: Anglin, Deidre M organization: City University of New York Graduate Center, New York – sequence: 2 givenname: Mark orcidid: 0000-0002-3958-5662 surname: Olfson fullname: Olfson, Mark organization: New York State Psychiatric Institute, New York – sequence: 3 givenname: Els orcidid: 0000-0001-5103-7186 surname: van der Ven fullname: van der Ven, Els organization: Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam – sequence: 4 givenname: Hans surname: Oh fullname: Oh, Hans organization: School of Social Work, University of Southern California, Los Angeles – sequence: 5 givenname: Roberto orcidid: 0000-0003-1305-7471 surname: Lewis-Fernández fullname: Lewis-Fernández, Roberto organization: New York State Psychiatric Institute, New York – sequence: 6 givenname: Jordan orcidid: 0000-0001-5873-4582 surname: DeVylder fullname: DeVylder, Jordan organization: Silver School of Social Work, New York University, New York – sequence: 7 givenname: Oladunni surname: Oluwoye fullname: Oluwoye, Oladunni organization: Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane – sequence: 8 givenname: Lisa surname: Dixon fullname: Dixon, Lisa organization: Department of Psychiatry, Columbia University Medical Center, New York – sequence: 9 givenname: T Scott orcidid: 0000-0002-3123-0672 surname: Stroup fullname: Stroup, T Scott organization: Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York – sequence: 10 givenname: Heidi orcidid: 0000-0001-7621-2972 surname: Guyer fullname: Guyer, Heidi organization: RTI International, Research Triangle Park, NC – sequence: 11 givenname: Natalie orcidid: 0000-0002-9067-2075 surname: Bareis fullname: Bareis, Natalie organization: New York State Psychiatric Institute, New York |
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| SubjectTerms | Adult Black or African American - psychology Black or African American - statistics & numerical data Female Health Status Disparities Humans Male Middle Aged Neighborhood Characteristics - statistics & numerical data Prevalence Psychotic Disorders - epidemiology Psychotic Disorders - ethnology Schizophrenia - diagnosis Schizophrenia - epidemiology Schizophrenia - ethnology Social Vulnerability United States - epidemiology White - psychology White - statistics & numerical data Young Adult |
| Title | Neighborhood Social Vulnerability and Racial Disparities in Schizophrenia Spectrum Disorder Prevalence |
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