A new piece published in Psychiatry Research finds that people with multiple minoritized identities experiencing early psychosis report more severe mental health symptoms. The current work, led by Megan Puzia of Washington State University, also finds that Black people experiencing psychosis reported more race-based discrimination compared to other minorities.
The authors of the current work sought to understand how these discriminatory experiences intersect for people with psychosis. They also observed the intersection of these factors independently and in combination with each other. Further, they evaluated how this impacts the severity of their psychological distress while emphasizing the importance of studying how, due to intersectionality, discriminatory experiences are often compounded. They write:
“Among individuals in CSC services for FEP, increased exposure to discrimination was associated with more severe mental health symptoms (psychotic, depressive, and anxiety symptoms), especially when tied to race or multiple identities. Ethnoracial discrimination was the most commonly reported type of discrimination, with Black participants reporting more frequent experiences than other ethnoracial groups. Our findings potentially capture the breadth of perceived discrimination across multiple facets of identity, thereby offering insight into how intersectional exposure may shape mental health risk.”
Mental health providers, along with the public, often hold prejudiced views and attitudes towards individuals experiencing mental health issues, especially psychosis. All too often, this translates into discrimination towards people dealing with psychological stress and those that have received mental health diagnoses. This widely recognized damaging experience takes a cumulative toll on individuals dealing with mental health problems, which is further compounded when combined with racism, misogyny, transphobia, homophobia, etc.
The findings in the current work suggest that severity of poor mental health is related to experiencing discrimination. In other words, minorities, especially those having multiple minority identities (such as being black, gay, and female) face a significant mental health burden.
The authors of the current study recruited participants from an early psychosis intervention program. In total 157 people participated in the study. Most participants identified as Latinx (40%), while around one quarter identified as multiracial (25.6%), and the remaining identified as Black, Asian, American Indian, and Pacific Islander. The sample was composed of 42.3% cisgender women, 39.7% cisgender men, 17.9% transgender or nonbinary, with 52.6% identifying as LGBQ+.
They completed various self-report measures screening for symptoms related to depression, anxiety, psychosis, and discrimination.
Discrimination and Intersectionality
Experiences of discrimination were common among participants:
- 52% reported racial/ethnic discrimination
- 30% gender identity discrimination
- 30% sexual orientation discrimination
Participants reporting racial and sexual orientation discrimination had worse self-harm scores. Previous research has found that sexually minoritized and gender diverse people are often pathologized with borderline personality disorder. One of the criteria for this diagnosis is engaging in socially unacceptable forms of self-harm, but the diagnosis doesn’t consider the causal effect of discrimination.
Black people who were in the early stages of psychosis reported experiencing more racism and race-based discrimination than Hispanic people who were also in the early stages of psychosis. Among ethnoracially minoritized people experiencing early psychosis, those who faced more day-to-day discrimination, including people with multiple minoritized identities, showed more severe mental health symptoms when they first entered care. The study’s findings highlight how costly and harmful discrimination can be, especially for people who hold multiple minoritized identities, and how it may worsen mental health symptoms even before someone receives early intervention services for psychosis. The authors write:
“Our findings, combined with existing literature suggest that it may not only be the frequency of discrimination that impacts mental health, but also the range of identity dimensions to which individuals attribute these experiences—highlighting the potential cumulative and compounding effects of intersectional discrimination (e.g., racism and ableism) particularly among individuals with FEP.”
Additionally, studies such as this one highlight the need to not only focus on clinical symptoms but to address structural and interpersonal discrimination as well. Moreover, the study helps shed light on how therapeutic settings, often unintentionally, can become spaces where additional and compounding harm may occur. These findings highlight the need to address institutional racism, medical gatekeeping, and cis-heteronormative bias in psychiatric practice.
Limitations
The current work has several limitations. The length of untreated psychosis was not accounted for, which could be a factor in observed symptoms. The design of the study means the authors can only speak to links between discrimination and mental health symptoms. In other words, this data can only say discrimination is linked to worse symptoms, not that it causes worse symptoms. The participants were all residing in Washington State and attending New Journeys programs for early psychosis. This limits generalizability to other populations.
A History of Discrimination
This study adds to a growing body of findings determining that contextual and societal factors, and not individual pathology or biological factors, are directly influencing psychological distress. A recent national study found that discrimination was a main factor of psychological distress among LGBTQA+ individuals. Moreover, research from the United Kingdom and the United States has found that ethoracially minoritized people presenting with psychological distress are at higher risk of being restrained and for longer periods of time.
Ethnoracially majoritized youth are less likely to be labeled with highly stigmatizing diagnoses versus their minoritized counterparts, regardless of whether they are experiencing similar forms of distress. Like ethnoracially minoritized adults, Black children are more likely to be restrained in pediatric emergency departments, especially if they are autistic. Women experiencing psychosis are not taken seriously by providers when reporting being subjected to gender-based violence.
Clinicians have argued that treatment interventions require a starting point of solidarity towards the other, dismantling the hierarchical paradigms currently in place, especially when it comes to those experiencing psychosis. Individuals experiencing psychosis face multiple discrimination-based barriers when trying to access care. One of these is medical gaslighting due to diagnostic overshadowing when trying to get medical care.
****
Puzia, M. E., Mendenhall, A. N., Posada, C., Siantz, E., Ali, M., Matias, C., Ramos, E., & Glynn, S. (2026). Intersectional discrimination and mental health symptom severity among individuals from racially minoritized groups receiving coordinated specialty care for first episode psychosis in Washington State. Psychiatry Research, 330 (Link)
This is completely consistent with my experience. Back in the 1980s, I realized that a very large percentage of the inpatients were “gender rebels.” Another chunk were domestic violence survivors (often, outrageously, committed by their abusive spouse.) I also noticed that I was surrounded by passive people, completely beaten down by a variety of forces. The medical professionals were often most cruel to the most vulnerable among us. One man, clearly struggling with severe altered states, could best communicate with music and his guitar. So, the staff took away his guitar unless he consented to ECT treatments which he did not want. It is one of the cruelest things I have ever seen — I was terrified seeing someone so nonviolent and helpless being punished like that.
Report comment