Racial and ethnic differences in the prevalence of psychotic symptoms in the general population

OBJECTIVE This study determined the prevalence of psychotic symptoms among racial-ethnic groups in a representative sample of American adults and explored the relationship of these symptoms with race-ethnicity, psychological distress, and dysfunction. METHODS Data from the Collaborative Psychiatric Epidemiology Surveys were used, which combines three nationally representative surveys: the National Comorbidity Survey Replication, National Survey of American Life, and National Latino and Asian American Study. The sample comprised 16,423 respondents, and the analysis adjusted for design effects. RESULTS The adjusted lifetime and 12-month prevalence rates of psychotic symptoms were 11.6% and 1.4%, respectively. Latinos and blacks had higher lifetime rates (13.6% and 15.3%, respectively) than whites (9.7%) and Asians (9.6%). In logistic regression analysis, lifetime reports of psychotic symptoms were associated with Latino ethnicity, a lifetime diagnosis of a substance use disorder or posttraumatic stress disorder, lifetime psychological distress, and current dysfunction (limitations in daily activities). Prevalence rates of psychotic symptoms among respondents with and without lifetime distress, respectively, were as follows: Asian, 5.4% and 6.4%; Latino, 19.9% and 8.2%; black, 21.1% and 9.9%; and white, 13.1% and 5.1%. CONCLUSIONS Race-ethnicity was differentially associated with psychotic symptoms, with Latinos reporting more lifetime symptoms than other groups after the analysis controlled for other factors. Little evidence was found that psychotic symptoms are "idioms of distress"; respondents who reported lifetime psychotic symptoms were prone to a higher lifetime prevalence of distress, and this association was not specific to any racial-ethnic group. Although psychotic symptoms are often transient, their presence appears to signal a propensity to experience distress.