From Womb to Neighborhood: A Racial Analysis of Social Determinants of Psychosis in the United States in the American Journal of Psychiatry is a narrative review led by Dr. Deidre Anglin of the Department of Psychology.
The review is an investigation into how psychosis symptoms and schizophrenia can be linked to a social environment, focusing on systemic racism in the United States and how it fuels psychosis risk factors in racially and ethnically minoritized communities. Exploring this connection between psychosis symptoms and systemic racism is an area that has long been ignored by experts in the field of psychology.
“Of 85,000 papers published in JAMA and NEJM – both high impact and widely read journals – in the past 30 years, only 15 articles included the word ‘racism’ anywhere in the text, and so it’s really something that is not addressed to the level that it should be in terms of health.”
Dr. Anglin had been exploring this topic for several years, and she recently joined and now co-leads the Societal Context of Psychotic Experiences (SCOPE) workgroup—a conglomerate of doctors, scientists, and academic experts focused on studying the ties between psychosis risk and social determinants in the United States.
Part of the group’s motivation was the lack of attention on the issue in the United States when compared to European studies. Dr. Anglin took the lead on the project because she hoped to hone in on the relationship between psychosis risk and structural racism, primarily because racism is woven into America’s social environment and social risk factors.
“Much of the psychosis literature focuses on biological mechanistic factors that increase psychosis in the population,” Dr. Anglin said. “Very few studies, especially in the United States but even in Europe, look at the social environment.”
The team narrowed the scope of their research by focusing on three social risk factors commonly associated with schizophrenia – neighborhood environment, collective and individual cumulative trauma and stress, and prenatal and perinatal complications.
The research was built around two theoretical frameworks: Structural Racism: Fundamental Cause Theory, which deals with how structural racism can be a fundamental cause of illness, and Social Determinants of Mental Health Theory, which connects social determinants to mental health.
“Looking at these theoretical frameworks together, structural racism has an enduring association with health outcomes because it is maintained through multiple pathways by limiting access to flexible resources such as those connected to neighborhood segregation and individual freedom to control life circumstances. It allows this enduring association with health outcomes because of how structured it is into societal structures.”
A major conclusion is that the U.S. Black and Latinx community disproportionately suffer from psychosis risk factors augmented by structural racism deeply instilled in America’s institutions. From everyday discrimination to neighborhood disadvantages, these communities are exposed to the results of deeply rooted racism daily. This exposure can cause acute stress and trauma in members of these communities that could lead to increased risk of psychosis outcomes.
“In terms of the neighborhood, racism has historically structured U.S. neighborhoods in ways that generationally perpetuate disadvantage for racially minoritized communities through inequitable access to healthcare, healthy foods, education, and employment opportunities and more exposure to environmental toxins and stressors,” Dr. Anglin said. “U.S. studies show perceived neighborhood ethnic density and disruption and residential instability are associated with psychosis outcomes.”
Since the article’s publication, Dr. Anglin has received countless inquiries from researchers eager to build off of her findings and examine the neurobiological implications of racism and discrimination. The increase in awareness for this issue is a trend she hopes will continue so the environmental stressors that disproportionately afflict people of color can be properly addressed.
“The contribution of structural racism to psychosis risk is a neglected issue in the U.S. Our research indicates that we need to treat structural racism as it is: a critical public health threat,” Dr. Anglin said.
“To truly adopt an antiracist framework, it is necessary to walk in the opposite direction on the path that seeks to maintain the status quo. Meaning we can’t just stop doing the wrong things; we have to literally actively be working against this system, which has been so deeply structured into the systems in this country.”
Dr. Anglin hopes to continue collaborating with some of the experts in the SCOPE workgroup to dive deeper into the topic and expand her work to investigate how the collective traumas of police violence for groups minoritized by their race, gender, or sexual orientation is connected to mental health outcomes.
“People want to do anti-racism work, it requires continual effort,” noted Dr. Anglin.
Gabriel is a student at the Weissman School of Arts and Sciences at Baruch College, double majoring in journalism and political science. He is also the editor of the Science & Technology section of Baruch College’s independent, student-run newspaper, The Ticker.