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RESEARCH WEEKLY: September Research Roundup, Hispanic Heritage Month
By Hope Parker
(September 27, 2023) Research Roundup is a monthly public service of the Office of Research and Public Affairs. Each edition describes a striking new data point about severe mental illness and summarizes recently published research reports or developments.
This month’s roundup is in honor of Hispanic and Latino Heritage Month and highlights the experiences of Latino people whose lives are impacted by severe mental illness.
Datapoint of the month
Facilities offering mental health treatment in Spanish fell by 18% from 2014-2019
An article published in “Psychiatric Services” last May examined trends in the prevalence of mental health facilities that offered services in Spanish. Despite a growing Hispanic and Latino population in the United States, the proportion of facilities offering mental health treatment in Spanish fell from 40.5% to 33.3% in just five years.
A downward trend in access to treatment for Spanish-speaking Americans was observed in 44 U.S. states. The loss of facilities offering treatment in Spanish was most concentrated in the Southern and Southeastern United States. Maine, Ohio, Kentucky, Oklahoma, and North Dakota experienced a decrease in access to Spanish-speaking providers, despite a significant increase in their Hispanic population. There were, however, five states that had small increases to the number of facilities offering treatment in Spanish: Delaware, Maryland, Montana, Nebraska, and New Mexico.
Pro, G. et al. (May 2022). Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents. Psychiatric Services.
Research of the month
Marital status and knowing someone with a mental illness associated with stigma in Latino communities
A study published in “Community Mental Health Journal” in January investigated the stigma related to psychosis in the Latino community, as prior research often neglected this issue. Participants were asked to identify symptoms of psychosis using a vignette method and filled out scales about spirituality, acculturation, and stigma.
Only 42% of participants were partially correct in their identification of psychosis. Individuals who personally knew someone with a mental illness were more likely to believe that the vignette example with psychosis would have trouble developing into a successful person in the future. Participants who were married were less likely to have this belief. Believing that an individual was responsible for their mental health problem was related to higher stigma scores. Many participants in this study also associated symptoms of psychosis with dangerousness.
Gearing, R.E. et al. (January 2023). Public Stigma Toward Schizophrenia Withing Latino Communities in the United States. Community Mental Health Journal.
Hispanic Americans report higher rates of psychosis than non-Hispanic white Americans
Ethnic and racial minorities in the United States have higher rates of psychosis and schizophrenia spectrum disorders compared to the non-Hispanic white population. This disparity is not entirely explained by misdiagnosis or clinician bias. An extensive review of literature, published in “Annual Review of Clinical Psychology,” examines how racism and other social determinants of health may contribute to the development of psychosis in Black and Latino populations.
One study found that 85% of the racial difference in psychotic experiences could be accounted for if food insecurity, financial stress, and racial discrimination were considered. The physical environment an individual lives in may also contribute to the development of psychosis, with air pollution and stressful urban living playing a role. Police violence, unemployment, racial segregation in neighborhoods, and changes in ethnic density over time are additional community factors that may contribute to the development of psychosis.
Some studies theorize that exposure to racism may be associated with increased paranoia. These experiences change cognitive and emotional reactions in the brain, resulting in increased hyperarousal and vigilance. Racial discrimination may also be linked to higher resting-state activity in the amygdala, the brain’s fear center, as well as accelerated cellular-level aging and increased grey-brain matter density. Black and Latina mothers are also more likely to experience psychosis risk factors during pregnancy such as infections, inflammation, stress, and pre-term delivery.
To address these social determinants of health, physicians, psychologists, social workers, epidemiologists, and policy makers must work together to dismantle racism and discrimination at the structural level. This may include changing funding priorities, training mental health providers on assessing racial and historical trauma, increasing prevention efforts, using innovative research designs, and incorporating intersectionality into all healthcare.
Anglin, D.M. et al. (May 2023). Racism and Social Determinants of Psychosis. Annual Review of Clinical Psychology.
Evidence shows two prominent psychosis screening scales are valid in both English and Spanish
The Prodromal Questionnaire-Brief (PQ-B) and Youth Psychosis at Risk Questionnaire (YPARQ-B) are screening tools commonly used to identify cases of individuals with psychosis so they can be connected to appropriate care. Psychosis-risk screening tools have historically shown poorer correlation with psychosis risk in ethnic and racial minorities, so it is important to verify that these scales are valid when translated into other languages.
This study asked 1,191 participants to complete the PQ-B and YPARQ-B, along with scales to measure experiences of discrimination, ethnic identity, and acculturation. Participants were all either non-Hispanic white or Hispanic. Some Hispanic participants filled out the survey in English, while other Hispanic participants were asked to complete the survey in Spanish to determine if there is a difference between the results in Spanish and English.
The study found that the psychosis risk scales’ results did not vary when translated, meaning that score results do not show variance when participants took them in Spanish. The study also showed that Hispanic individuals had higher levels of psychosis on all measures in both English and Spanish compared to non-Hispanic white individuals, which is consistent with previous research. PQ-B and YPARQ-B scores were associated with discrimination, food insecurity, heritage, mainstream acculturation, and history of psychological treatment.
Bart, T.A. et al. (April 2023). Measurement Invariance of Commonly Used Psychosis Screening Scales in U.S. Spanish- and English-Speaking Hispanic Participants. Psychological Assessment.
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