Racial Differences in First-Episode Psychosis Treatment Access & Outcomes

Kelsey A. Johnson, MPH

Beth Israel Deaconess Medical Center
Racial Differences in First-Episode Psychosis Treatment Access & Outcomes

Scientific Abstract

Background: Notable racial and ethnic disparities persist in treatment for psychotic disorders. Across the US, Black Americans are five times more likely than their white counterparts to receive a diagnosis of schizophrenia, and are more likely to be misdiagnosed with schizophrenia. Black and Hispanic patients diagnosed with psychotic disorders are less likely to receive, adhere to, and benefit clinically from outpatient treatment, and have higher rates of involuntary hospitalizations. Using clinical data collected in first-episode psychosis (FEP) clinics across Massachusetts, this study sought to understand how local clinics compare to national trends and identify targets for interventions to enhance racial equity in state- wide FEP treatment.

Methods: Ten FEP clinics reported routine demographic and clinical assessment data from a total of 299 adolescents and young adults receiving treatment at their program, with assessments completed at patient intake and at six-month intervals following intake. Data collection was organized by the Massachusetts Psychosis Network for Early Treatment (MAPNET). Chi-square analyses examined differences by race in diagnosis and treatment engagement at baseline. A logistic regression was conducted to demonstrate the effect of race on symptom severity over time.

Results: We report results across race and ethnic groups on diagnosis, treatment engagement, and symptom severity over time. There was a significant relationship between race and diagnosis at baseline, with Black patients being 1.7 times more likely than others and 2.0 times more likely than white patients to receive a diagnosis of schizophrenia (χ2= 16.2, p= 0.02). No relationship was found between race and overall treatment engagement at baseline (χ2= 37.2, p= 0.91).

Conclusions: FEP treatment programs in MA appear to follow national trends associating race with diagnosis of schizophrenia. However, national disparities in treatment engagement were not observed in this sample. These analyses demonstrate the importance of applying a learning healthcare model to assess and address racial disparities in populations receiving care for severe mental illness.

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research Areas


Kelsey A. Johnson, MPH, Alyssa Williamson, BA, Beshaun Davis, PhD, Emily Kline, PhD, Matcheri Keshavan, MD

Principal Investigator

Matcheri Keshavan, MD

Affiliated Website