Racial/ethnic discrimination might be a factor in disparities in psychosis risk

(Press-News.org) Racial/ethnic discrimination is associated with an increased risk of psychosis, a mental state where someone loses touch with reality, experiencing symptoms such as hallucinations, delusions, confused thinking, and disorganized behavior, according to a new study published September 24, 2025, in the open-access journal PLOS Mental Health by India Francis-Crossley from University College London, U.K., and colleagues. 

Psychosis is a severe mental health condition that has detrimental impacts on people’s lives, and longstanding ethnic disparities in psychosis risk are well-documented. Recently, various social determinants of health have been implicated in our understanding of racial/ethnic disparities in psychosis risk. These factors include exposure to lower socioeconomic positions, adverse neighborhood conditions, and experience of traumatic events such as racism. There is emerging evidence for a role of racial/ethnic discrimination as a potential factor behind ethnic disparities in psychosis risk. Nonetheless, several recent systematic reviews on the topic present a disparate picture of the literature. 

To synthesize the current evidence on the association between racial/ethnic discrimination and psychosis, Francis-Crossley and colleagues sought systematic reviews and meta-analyses published in peer-reviewed journals. The authors identified seven relevant reviews that reported 23 primary studies representing 40,300 participants. Five of the reviews explicitly reported on the association between racial/ethnic discrimination and psychosis.

 These five reviews provided evidence of a positive relationship between the two, for both clinical and non-clinical populations. The largest effect sizes were observed in non-clinical settings, in people who did not have a psychotic disorder but were experiencing psychotic experiences and symptoms (or schizotypy) linked to racial/ethnic discrimination they were experiencing.

 However, the authors noted several limitations. For example, there was variability in the methods and in review quality and some studies had small sample sizes. In addition, the reviews focused on interpersonal racism rather than structural and institutional racism, and the studies were all conducted in the U.S. or Europe. The authors state that high-quality, long-term research could help to understand and even prevent excess psychosis risk arising from pervasive exposure to multiple, ongoing forms of racism in society.

First author India Francis-Crossley summarizes: “This review is an important addition to the existing body of evidence on the real and serious impact of racial/ethnic discrimination on people’s mental health…[t]hese findings are important in aiding better understanding of the serious health inequities in the development of psychosis, both through highlighting the relationship between racial/ethnic discrimination and psychosis and by providing an evidence base upon which targeted policy and practise changes can be built.”

Senior author James Kirkbride (University College London) adds: “While our review finds that experiences of racism are linked to greater psychosis risk, too little is being done in public health and policy to tackle this societal scourge, resulting in both the breakdown of civic trust and perpetuation of intergenerational disparities in mental health and illness between different ethnic groups.”

Senior author Juliana Onwumere (Reader in Clinical Psychology at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London) concludes: “Racism is a global threat to society. This review shines a spotlight on the threat it poses to our mental health. This review offers different messages, including ideas for further studies. However, a message that should not be overlooked is that racism is neither inevitable nor a disease but if left unchecked its human costs are substantial.”

 

In your coverage please use this URL to provide access to the freely available article in PLOS Mental Health: https://plos.io/4n6t33b

Citation: Francis-Crossley I, Hudson G, Harris L, Onwumere J, Kirkbride JB (2025) The association between racism and psychosis: An umbrella review. PLOS Ment Health 2(9): e0000401. https://doi.org/10.1371/journal.pmen.0000401

Author Countries: United Kingdom

Funding: This project was funded by the UCL-Windsor Fellowship Research Opportunities scholarship (https://www.windsor-fellowship.org/; https://www.ucl.ac.uk/) (to IFC), a Wellcome Trust PhD Fellowship in Mental Health Science (218497/Z/19/Z) (https://wellcome.org/) (to GH), the Mental Health Mission Early Psychosis Workstream (NIHR203316) (www.nihr.ac.uk) (to JBK) and by UK Research and Innovation (UKRI) funding for the Population Mental Health Consortium (Grant no MR/Y030788/1) which is part of Population Health Improvement UK (PHI-UK) (https://www.phiuk.org/), a national research network which works to transform health and reduce inequalities through change at the population level (to JBK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. JO is part supported by Wellcome [308556/Z/23/Z] and the National Institute for Health Research's (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. This paper represents independent research funded by the Wellcome Trust [308556/Z/23/Z]. The funders had no involvement in study design, data collection, analysis, interpretation or the decision to submit for publication. The views expressed are those of the author(s) and not necessarily those of the funders.

 

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