The association between racism and psychosis: An umbrella review

Elevated rates of psychosis are consistently identified in people from racialised backgrounds, with growing evidence from the systematic review literature that suggests a role for racial/ethnic discrimination. We synthesised current systematic review evidence on the association between racial/ethnic discrimination and psychosis. We conducted an umbrella review, systematically searching Medline, Embase, PsycINFO, ProQuest Central and Google Scholar (up to 19 July 2024) for systematic reviews and meta-analyses published in peer-reviewed journals exploring the effect of racial/ethnic discrimination on psychosis. 2898 citations were de-duplicated and screened, included reviews were assessed for risk of bias using AMSTAR-2 and extracted data analysed narratively following a pre-registered protocol (CRD42023400656). Seven reviews (reporting 23 primary studies representing 40,300 participants) met inclusion criteria, five of which explicitly reported on the association between racial/ethnic discrimination and psychosis. All observed evidence of a positive relationship between the two, including meta-analyses for psychotic symptoms (adjusted OR=1.77, 95%CI 1.26, 2.49) and psychotic experiences (pooled OR=1.94, 95%CI 1.42, 2.67). We observed more robust evidence for psychotic outcomes in non-clinical populations. Despite this, results were driven by cross-sectional studies (87%) and were hindered by high heterogeneity and low (n = 2) or critically low (n = 5) AMSTAR-2 review quality scores. The available systematic review evidence supports a role for racial/ethnic discrimination in developing psychosis, but high-quality studies are needed to determine the temporal and mechanistic causal pathways through which this occurs. The current findings add to knowledge on the widespread presence and deleterious impacts of racism on health and inform potential public health interventions that reduce exposure to, and the impact of, racial/ethnic discrimination.