Abstract
Background
Despite increases in psychiatric treatment-seeking in the U.S., sociodemographic and racial inequalities in mental health service utilization and quality of care remain, particularly among Black/African-American populations. Factors including trauma and racial discrimination impact psychosis spectrum symptom severity, but little is known about how these factors uniquely impact treatment-seeking behaviors and attitudes among youth with psychosis-like experiences (PEs). The current study examined the associations between trauma, discrimination, self-reported PEs, race, and treatment-seeking among a racially diverse group of college-aged youth endorsing high levels of PEs.
Methods
Participants were college students between 18 - 25 years of age (N = 177). The sample included individuals with self-reported race of Asian, Black, or White who endorsed PEs at a “high-risk” cutoff level as per the Prime Screen or Prodromal Questionnaire (PQ), commonly used measures of PEs. Analyses included the PQ total score to measure PEs; trauma history was assessed with the Life Events Checklist (total number of lifetime traumatic experiences endorsed); discrimination was measured by the 9-item situation section of the Experiences of Discrimination questionnaire. Participants self-reported mental health service utilization in the past 2 months (current), before 3 months ago (past), as well as how strongly they were considering seeking mental health care (future).
Binary logistic regressions were used to analyze the associations between past and current help-seeking and race, trauma, discrimination, and PEs. A multiple linear regression analysis was performed to evaluate the associations between future treatment-seeking and race, PEs, trauma, and discrimination.
Results
Participants with higher PQ scores were more likely to endorse past (b = 0.04, SE = 0.15, χ2[1] = 8.03, p < .01, OR = 1.04), current (b = 0.05, SE =0.02, χ2[1] = 8.99, p < .01, OR = 1.05), and future treatment (b = 0.04, t(1) = 3.32, p < .01, f2 = 0.07). Asian and Black participants were significantly less likely than their White peers to have received past treatment (bAsian = -1.94, SEAsian = 0.47, χ2Asian[1] = 17.15, pAsian < .001, ORAsian = 0.14; bBlack = -1.53, SEBlack = 0.48, χ2Black[1] = 10.04, pBlack < .01, ORBlack = 0.22), current treatment (bAsian = -1.56, SEAsian = 0.51, χ2Asian[1] = 9.41, pAsian < .01, ORAsian = 0.21; bBlack = -1.06, SEBlack = 0.52, χ2Black[1] = 4.20, pBlack < .05, ORBlack = 0.35), and to be considering future treatment (bAsian = -0.51, tAsian (1) = -1.94, pAsian = .06, f2Asian = 0.02; bBlack = -0.58, tBlack (1) = -2.02, pBlack < .05, f2Black = 0.03). Experiences of trauma significantly predicted past treatment (b = 0.30 SE = 0.12, χ2[1] = 6.44, p < .05, OR = 1.35), but not current or future treatment (ps > .05). Experiences of discrimination did not significantly predict self-reported treatment variables across all analyses (all ps > .05).
Discussion
The current study examined the associations between race, trauma, PEs, discrimination, and psychiatric treatment-seeking in college students with high levels of psychosis-like experiences. Self-reported PE scores and race were significantly associated with all treatment-seeking variables, while experiences of discrimination were not significantly associated with help-seeking. Results suggest race-related disparities in help-seeking patterns among college-educated youth and young adults. These findings have implications for engaging racial and ethnic minorities in mental health treatment who are experiencing psychosis-like symptoms to alleviate these symptoms and any associated functional impairments or distress.
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