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Clinical and psychosocial outcomes of Black Americans in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study

Abstract

Purpose

In the US, Black people diagnosed with schizophrenia experience worse psychosocial and clinical outcomes than their White counterparts. While racism-related factors contribute to these disparities, an additional understudied explanation may be that psychosocial treatments for psychotic disorders are less effective for Black than White individuals. The purpose of this study is to examine the extent to which best treatment practices for first-episode psychosis (FEP) are effective for Black and White participants.

Methods

We conducted a secondary data analysis of the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP), a two-year multisite trial that compared a coordinated specialty care intervention for FEP (NAVIGATE) to community care as usual (CC) in 34 sites across the US. Specifically, we compared interviewer-rated quality of life and symptoms, as well as self-reported mental health and stigma, between 139 Non-Latinx Black and 172 Non-Latinx White participants with FEP in NAVIGATE and CC.

Results

We found few differences between Black and White participants over two-year outcomes, either overall or in terms of benefit from NAVIGATE. Across both treatment conditions, Black participants improved less than White participants on positive symptoms, an effect driven primarily by suspiciousness/persecution. In NAVIGATE, self-reported mental health stigma decreased for both Black and White participants, while in CC stigma decreased for White participants but increased for Black participants. This effect was driven primarily by experienced stigma rather than self-stigma.

Conclusion

NAVIGATE benefits both Black and White individuals diagnosed with FEP. Mental health stigma and positive symptoms may be particularly important aspects of treatment for Black individuals diagnosed with FEP.

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Fig. 1

Availability of data and material (data transparency)

The RAISE-ETP dataset is publicly available through the National Institutes of Mental Health.

Code availability

N/A.

Notes

  1. The reasons why Black participants were more likely to receive first- rather than second-generation antipsychotic medications was not addressed by the cited paper. Other extant literature suggests that there are several possible reasons: (a) Receipt of poorer quality care for African Americans; (b) Cost restrictions (e.g., due to poorer insurance quality); and (c) concerns about certain side effects (e.g., hypertension) that might be higher in African Americans. Puyat et al. [41] has published a meta-analysis on this topic.

  2. A previous paper that examined baseline demographic differences between Black and White participants in the RAISE-ETP study found that a greater proportion of White participants than Black participant were male [40]. The same pattern was observed in this study but did not reach statistical significance (p = 0.09). The difference in findings emerged because Nagendra et al. [40] included Latinx participants while this study considered Latinx individuals a separate racial/ethnic group.

  3. Notably, our findings are similar but not identical to findings from Oluwoye et al. [42] using the same data. Specifically, Oluwoye et al. [42] reported that in CC, Black participants showed less improvement in positive symptoms than White participants but in NAVIGATE, there were no differences between the two groups. While our models did not detect a significant three-way interaction, an examination of graphed interactions suggested that the lower rate of improvement for Black participants was driven more strongly by CC than NAVIGATE. The slight discrepancy between our study and that of Oluwoye et al. [42] may have emerged due to differences between the two studies in the statistical models, covariates, and PANSS factor models used.

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Funding

This secondary data analysis used data from the RAISE-Early Treatment program study, which was supported in whole or in part with funds from the American Recovery and Reinvestment Act and the National Institute of Mental Health (HHSN-271-2009-00019C). Additional support was provided by the National Institute of Mental Health Advanced Centers for Intervention and/or Services Research award (P30MH090590) to Dr. John Kane.

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AN conceptualized and wrote the first draft of the paper. DMW conducted statistical analyses. The other authors provided substantive feedback, edits, and revisions to the manuscript.

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Correspondence to Arundati Nagendra.

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Nagendra, A., Weiss, D.M., Merritt, C. et al. Clinical and psychosocial outcomes of Black Americans in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) study. Soc Psychiatry Psychiatr Epidemiol (2022). https://doi.org/10.1007/s00127-022-02297-9

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Keywords

  • Schizophrenia
  • First-episode psychosis
  • Racial disparities
  • Black mental health
  • Treatment outcomes