Structural racism and social defeat may drive psychosis in marginalized youth

Prevailing theories about why young people experience psychotic breaks at a young age rely on individual factors like exposure to child abuse, school bullying, or drugs.

But a new study from the NYU Silver School of Social Work suggests that broader social factors, such as racial inequality and experience with police violence, might contribute to the proportionately higher rates of psychosis seen among low-income young adults of color.

The study, "Social Defeat and Psychosis in the United States," was published today by Schizophrenia Bulletin and authored by NYU Silver associate professor Jordan DeVylder and doctoral students Jacqueline Cosse and Brianna Amos.

The researchers culled the National Survey of Poly-Victimization and Mental Health to explore individual-level and societal, or structural, impacts on early psychosis risk. The sample included 1,584 U.S. participants aged 18-29.

Among the respondents, Blacks, Latinos, multiracial, and Indigenous respondents had 60% higher odds of reporting having experienced one or more psychotic episodes in the prior year compared to white respondents, the study determined.

Furthermore, those who cited an experience involving police violence in had 52% higher odds of reporting one or more delusional or hallucinatory episode in the prior year.

The most widely recognized risk factors for psychosis are spelled out in the "Social Defeat Hypothesis," an influential theoretical framework used by psychiatrists to treat young adults with psychosis. While the social defeat hypothesis frames risk factors around the impact on the individual, the study shifts the focus to take in account social systems and structural factors.

In the study's analysis of the U.S. survey, an individual's sense of "social defeat" can indeed result in psychotic symptoms and can arise from a high frequency of substance use or exposure to bullying, as the theory holds. But the persistence of racial inequality, and related experiences such as exposure to police violence, could also be relevant factors, according to the study. It calls for research into the impact of societal factors that are more prominent in low-income and marginalized communities.

Developed in Northern Europe, the "Social Defeat Hypothesis" has been used by U.S. psychiatrists for over two decades to understand the development of psychosis, a condition that could show a young adult to be at higher risk of suicidal thinking or even schizophrenia.

Under the hypothesis, social defeats, like feeling humiliated, contribute to long-term neurobiological shifts in the brain and dopamine system especially, and are part of what may bring on instances in which an individual loses touch with reality. 

In conducting the study, DeVylder, Cosse, and Amos collaborated extensively with fellow social work scholar Lisa Fedina of the University of Michigan, as well as additional NYU Silver doctoral students.

Commenting on findings' significance, DeVylder said that structural factors may exert a "substantial" influence on an individual risk for psychosis, and could potentially help explain ethno-racial disparities in psychosis in the U.S.

This potentially means that reducing exposure to systemic factors, like societal racism, may provide mental health benefits similar to individual-focused interventions, like psychotherapy."

Jordan DeVylder, NYU Silver associate professor