The association between perceived racial discrimination and subclinical symptoms of psychosis.

BACKGROUND: Schizophrenia is one of the most disabling disorders with the poorest outcomes. Cross-cultural research indicates an association between perceived racial discrimination and depression, anxiety, general psychological distress, and psychotic-spectrum disorders. Studies also find that coping moderates the relationship between discrimination and depression. Assessing subclinical symptoms may be useful in prevention efforts. AIMS: The study aims to (1) assess if perceived racial discrimination is associated with psychosis subclinical symptoms among a non-clinical sample and (2) examine the role of maladaptive coping and depression, anxiety, and stress. METHODS: The sample consisted of 261 ethnic minority undergraduate students. A structural equation model using a subclinical psychosis latent variable within a moderated mediation model assessed relationships between racial discrimination, maladaptive coping, depression, anxiety, and stress, and subclinical psychosis. RESULTS: Perceived racial discrimination was associated with greater subclinical symptoms of psychosis through increased depression, anxiety, and stress at greater levels of maladaptive coping. CONCLUSIONS: Knowing risk factors that can be targeted, such as perceived discrimination and maladaptive coping, may have implications for vulnerable populations.

Risk and Resiliency Factors Related to Dementia Caregiver Mental Health.

Prevalence rates for dementia are expected to rise exponentially as the elderly population rises. With this comes a corresponding increase in the number of family members who will become dementia caregivers. Caregivers of people with dementia often experience a deterioration in mental health. Identifying factors that relate to caregiver mental health is necessary to develop appropriate interventions. The current study explored how family functioning (measured with a latent variable that includes family cohesion, family balance, and family communication), caregiver expressed emotion (EE), and patient symptom severity related to caregiver mental health (measured with a latent variable that includes depression, anxiety, and stress). Participants included 107 dementia caregivers. The following specific hypotheses were tested: lower levels of both (1) EE and (2) patient symptom severity, and (3) higher levels of family functioning would be related to better caregiver mental health. Results produced a well-fitting model: X2 (18) = 14.858, p = .672; CFI = 1.00; RMSEA = .00; SRMR = .037. Moreover, results indicated that better family functioning (Ɣ = -3.54, SE = 1.34, p = .008), lower levels of caregiver EE (ß = .36, SE = 0.07, p < .01), and higher patient symptom severity (ß = -3.03, SE = 0.88, p = .001) were related to better caregiver mental health. Results from this study suggest that efforts to bolster family functioning (i.e., enhance communication, promote cohesion, encourage flexibility) could help improve caregiver mental health.

Se espera que los índices de prevalencia de la demencia aumenten exponencialmente a medida que se incremente la población de personas mayores. Esto trae aparejado un aumento correspondiente del número de familiares que se convertirán en cuidadores de personas con demencia. Los cuidadores de personas con demencia frecuentemente sufren un deterioro de la salud mental. Por eso, es necesario identificar los factores relacionados con la salud mental de los cuidadores para desarrollar intervenciones adecuadas. El presente estudio analizó cómo el funcionamiento familiar (medido con una variable latente que incluye cohesión familiar, equilibrio familiar y comunicación familiar), la emoción expresada por los cuidadores y la gravedad de los síntomas de los pacientes se relacionaron con la salud mental de los cuidadores (medida con una variable latente que incluye depresión, ansiedad y estrés). Los participantes fueron 107 cuidadores de personas con demencia. Se evaluaron las siguientes hipótesis específicas: los niveles bajos de 1) emoción expresada y 2) gravedad de los síntomas de los pacientes, y 3) los niveles más altos de funcionamiento familiar estarían relacionados con una mejor salud mental de los cuidadores. Los resultados generaron un modelo con buen ajuste: X2 (18) = 14.858, p = .672; CFI = 1.00; RMSEA = .00; SRMR = .037. Además, los resultados indicaron que un mejor funcionamiento familiar (Ɣ = -3.54, SE = .1.34, p = .008), niveles más bajos de emoción expresada por los cuidadores (ß = .36, SE = .07, p<.01) y una mayor gravedad de los síntomas de los pacientes (ß = -3.03, SE = .88, p = .001) estuvieron relacionados con una mejor salud mental de los cuidadores. Los resultados de este estudio sugieren que los esfuerzos para reafirmar el funcionamiento familiar (p. ej.: mejorar la comunicación, promover la cohesión, estimular la flexibilidad) podrían contribuir a mejorar la salud mental de los cuidadores.

Stigma, Expressed Emotion, and Quality of Life in Caregivers of Individuals with Dementia.

Expressed emotion (EE) is a measure of a caregiver's critical and emotionally overinvolved (EOI; e.g., intrusive, self-sacrificing) attitudes and behaviors toward a person with a mental illness. Mounting evidence indicates that high levels of these critical and EOI attitudes and behaviors (collectively termed high EE) in family members are associated with a poorer course of illness for people with a range of disorders, including dementia (Nomura et al., 2005). However, less is known about factors that might trigger high EE and how high EE might impact dementia caregivers' own mental health. In this study we propose that caregivers who perceive stigma from their relative's illness may be more likely to be critical or intrusive (high EOI) toward their relative in an attempt to control symptomatic behaviors. We further hypothesized that high EE would partially mediate the link between stigma and quality of life (QoL) as there is some evidence that high EE is associated with poorer mental health in caregivers themselves (Safavi et al., 2015). In line with study hypotheses and using a sample of 106 dementia caregivers, we found that greater caregiver stigma was associated with both high EE (for criticism and EOI) and with poorer QoL. Mediational analyses further confirmed that high EE accounts for much of the association between stigma and poorer QoL. Study results suggest that addressing caregiver stigma in therapy could reduce levels of high EE and indirectly therefore improve caregiver QoL. Intervening directly to reduce high EE could also improve caregiver QoL.

Caregiver Expressed Emotion and Psychiatric Symptoms in African-Americans with Schizophrenia: An Attempt to Understand the Paradoxical Relationship.

Expressed emotion (EE) is a family environmental construct that assesses how much criticism, hostility, and/or emotional over-involvement a family member expresses about a patient (Hooley, Annual Review of Clinical Psychology, 2007, 3, 329). Having high levels of EE within the family environment has generally been associated with poorer patient outcomes for schizophrenia and a range of other disorders. Paradoxically, for African-American patients, high-EE may be associated with a better symptom course (Rosenfarb, Bellack, & Aziz, Journal of Abnormal Psychology, 2006, 115, 112). However, this finding is in need of additional support and, if confirmed, clarification. In line with previous research, using a sample of 30 patients with schizophrenia and their primary caregivers, we hypothesized that having a caregiver classified as low-EE would be associated with greater patient symptom severity. We also aimed to better understand why this pattern may exist by examining the content of interviews taken from the Five-Minute Speech Sample. Results supported study hypotheses. In line with Rosenfarb et al. (2006), having a low-EE caregiver was associated with greater symptom severity in African-American patients. A content analysis uncovered some interesting patterns that may help elucidate this finding. Results of this study suggest that attempts to lower high-EE in African Americans may, in fact, be counterproductive.

Integrity of Literature on Expressed Emotion and Relapse in Patients with Schizophrenia Verified by a p-Curve Analysis.

There is growing concern that much published research may have questionable validity due to phenomena such as publication bias and p-hacking. Within the psychiatric literature, the construct of expressed emotion (EE) is widely assumed to be a reliable predictor of relapse across a range of mental illnesses. EE is an index of the family climate, measuring how critical, hostile, and overinvolved a family member is toward a mentally ill patient. No study to date has examined the evidential value of this body of research as a whole. That is to say, although many studies have shown a link between EE and symptom relapse, the integrity of the literature from which this claim is derived has not been tested. In an effort to confirm the integrity of the literature of EE predicting psychiatric relapse in patients with schizophrenia, we conducted a p-curve analysis on all known studies examining EE (using the Camberwell Family Interview) to predict psychiatric relapse over a 9- to 12-month follow-up period. Results suggest that the body of literature on EE is unbiased and has integrity, as there was a significant right skew of p-values, a nonsignificant left skew of p-values, and a nonsignificant test of flatness. We conclude that EE is a robust and valuable predictor of symptom relapse in schizophrenia.

Mental Health Disparities, Treatment Engagement, and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review.

Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.

Risk and Protective Factors, Perceptions of Family Environment, Ethnicity, and Schizophrenia Symptoms.

The family environment can play either a detrimental or a protective role in symptom severity for people with schizophrenia. The current study examined both patient and caregiver perspectives of the family environment in an ethnically diverse sample of 221 patients with schizophrenia. We hypothesized that environments characterized by high levels of perceived caregiver criticism, low perceived caregiver warmth, and low family cohesion (from both the patient and caregiver perspective) would predict greater symptom severity. As expected, results demonstrated that lower patient ratings of family cohesion and caregiver warmth were associated with greater symptom severity. However, once put into a hierarchical regression analysis, only patient ratings of family cohesion remained significant. Ethnic patterns were also examined and revealed that family cohesion may be particularly protective for ethnic minorities. Study implications are discussed.

Burden, interdependence, ethnicity, and mental health in caregivers of patients with schizophrenia.

Caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health. Using a sample of 176 caregivers of patients with schizophrenia, the present study examined how two components of burden (objective and subjective) interacted with interdependence and ethnicity to influence relatives' overall mental health. In line with study hypotheses, and with the stress-appraisal-coping model developed by Lazurus and Folkman (1984), we found that subjective burden mediated the relationship between objective burden and mental health. In other words, subjective appraisals of caregiving appeared to partially underlie the association between the concrete costs of caregiving and psychological outcomes in schizophrenia caregivers. Also as hypothesized, we found that interdependence, or the perceived interconnectedness of individuals within a group, moderated the relationship between objective burden and subjective burden. In other words, when levels of interdependence were high, the objective components of burden appeared to have a weaker relationship with subjective burden. When interdependence was low, on the other hand, objective burden was more likely to be associated with subjective burden. This finding suggests that helping caregivers to value harmony and connection with others over individual self-interests may reduce the likelihood that objective stressors (which are often inevitable in schizophrenia) will result in subjective distress. On the basis of prior research, we also tested several hypotheses regarding the role of ethnicity and its association with burden, interdependence, and mental health. However, contrary to expectations, no ethnic patterns were observed.

Associations between cognitive biases and domains of schizotypy in a non-clinical sample.

Schizotypy is a non-clinical manifestation of the same underlying biological factors that give rise to psychotic disorders (Claridge and Beech, 1995). Research on normative populations scoring high on schizotypy is valuable because it may help elucidate the predisposition to schizophrenia (Jahshan and Sergi, 2007) and because performance is not confounded by issues present in schizophrenia samples. In the current study, a Confirmatory Factor Analysis was conducted using several comprehensive measures of schizotypy. As expected and replicating prior research, a four-factor model of schizotypy emerged including a positive, a negative, a cognitive disorganization, and an impulsive nonconformity factor. We also evaluated how each factor related to distinct cognitive biases. In support of hypotheses, increased self-certainty, decreased theory of mind, and decreased source memory were associated with higher scores on the positive factor; decreased theory of mind was associated with higher scores on the negative factor; and increased self-certainty was associated with greater impulsive nonconformity. Unexpectedly, decreased self-certainty and increased theory of mind were associated with greater cognitive disorganization, and decreased source memory was associated with greater impulsive nonconformity. These findings offer new insights by highlighting cognitive biases that may be risk factors for psychosis.

Neurocognition and cognitive biases in schizophrenia.

Individuals with schizophrenia have been found to exhibit a number of information processing biases that may play a role in the development and exacerbation of symptoms and may impair overall functioning. However, little is known about the factors that are associated with these cognitive biases. Recently, researchers have begun to consider whether neurocognitive deficits, common in schizophrenia, may be risk factors for the development of cognitive biases. In the present study, we assessed neurocognition (verbal learning, delayed verbal recall memory, and verbal recognition memory) and cognitive biases (knowledge corruption and impaired cognitive insight) in 72 individuals with schizophrenia or schizoaffective disorder. As hypothesized, poorer delayed verbal recall memory was associated with increased knowledge corruption. Contrary to expectations, verbal learning and verbal memory were not associated with cognitive insight. These findings suggest that an inadequate recall memory system may put patients with schizophrenia at greater risk for cognitive distortions.

Enculturation and acculturation's relationship to suicidal ideation in Hispanic/Latinx individuals with psychotic spectrum disorders.

Suicide is a leading cause of premature death in people with schizophrenia (Inoue et al., 2020). Hispanic/Latinx (H/L) individuals, the largest ethnic minority group in the U.S., face potential hurdles (e.g., discrimination, language barriers) when trying to receive care for psychotic spectrum disorders, which may increase their risk for suicidal ideation. Drawing from prior literature, we tested the hypotheses that greater acculturation and lower enculturation would be associated with increased suicidal ideation in a sample of 45 H/L individuals with psychotic spectrum disorders using a linear regression analysis controlling for gender and education. As hypothesized, greater acculturation and lower enculturation were associated with greater suicidal ideation. In line with prior research, results of this study suggest that maintaining beliefs and traditions from one's home culture may be beneficial to H/Ls with psychotic spectrum disorders and may reduce suicidal ideation whereas there may be detrimental aspects of mainstream United States culture on one's desire to live. Thus, encouraging H/L patients with psychotic spectrum disorders to maintain a sense of ethnic pride and stay engaged with practices and values from their culture of origin may help reduce suicidal ideation in this vulnerable population.

A mixed-methods approach to psychological help-seeking in Muslims: Islamophobia, self-stigma, and therapeutic preferences.

OBJECTIVE: Muslims living in the United States (MLUS) report high mental health stigma. They also underutilize professional psychological help, despite experiencing rising Islamophobia and comparatively poorer mental health. In line with double stigma, we examined whether MLUS who perceived greater Islamophobia also experienced greater self-stigma of seeking help, and whether this was related to negative help-seeking attitudes. We also assessed therapist demographic and treatment modality preferences and explored how they related to risk factors for low help-seeking. METHOD: Utilizing a representative sample of 350 MLUS (50% women, 33% immigrants) acquired via a Qualtrics panel aggregate, we assessed a path model of help-seeking attitudes to determine the direct and indirect effects of perceived Islamophobia via self-stigma and psychological distress. Therapist and treatment preferences were examined via multiple regression models and analysis of variance (ANOVAs). Open-ended responses were coded through content analysis. RESULTS: Perceived Islamophobia was associated with greater psychological distress and also indirectly related to negative help-seeking attitudes via greater self-stigma. Therapists of a similar background, therapy in a mosque-setting, group therapy, and imam collaboration were more appealing to MLUS who were at risk for low help-seeking. CONCLUSIONS: Among MLUS, perceived Islamophobia may present a dual risk-simultaneously increasing psychological distress and indirectly leading to negative attitudes toward help-seeking via higher self-stigma. Conversely, for MLUS at risk for low help-seeking, accessible community-based treatments and treatment with a Muslim or race/ethnicity-matched therapist may facilitate help-seeking behaviors. Future work may determine whether addressing double stigma within Muslim communities (e.g., Islamophobia and self-stigma) may improve psychological help-seeking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Neighborhood socioeconomic status and racial disparities in schizophrenia: An exploration of domains of functioning.

Black Americans are disproportionately diagnosed with schizophrenia and experience worse objective functional outcomes (e.g., hospitalizations) than their White counterparts. However, we have a limited understanding of the psychological pathways through which Black Americans with schizophrenia reach worse outcomes. This study assessed race and domains of functioning (e.g., neurocognition, functional capacity) known to be associated with objective outcomes in a sample of 108 non-Hispanic Black and 61 non-Hispanic White individuals with schizophrenia-spectrum disorders from the Social Cognition Psychometric Evaluation (SCOPE) study. Three primary findings emerged: First, Black participants showed lower scores than White participants on measures of neurocognition(NC), social cognition(SC), and everyday living skills, but not social skills or community functioning. Second, neighborhood socioeconomic status (SES) explained 21% of the relationship between race and NC but did not mediate the relationship between race and SC or everyday living skills. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals with schizophrenia. In our sample, after controlling for neighborhood SES, race did not moderate the relationships of NC, SC, social skills, or everyday living skills to community functioning. This indicates that relationships between these domains are comparably strong across Black and White Americans. Taken together, these findings show that NC, SC, and everyday living skills may be important areas to explore in regards to racial disparities in schizophrenia. More research, especially incorporating nuanced race- and SES-related variables, is needed to understand how to best intervene and improve real-world outcomes for Black Americans with schizophrenia.

Affective and physiological reactivity to emotional comments in individuals at elevated risk for psychosis.

BACKGROUND: Individuals with schizophrenia are at increased risk of relapse when they live in highly critical (i.e., high expressed emotion; EE) family environments. It remains less clear, however, how individuals at elevated risk for a psychotic disorder react to the social stress of EE. Here we examined whether individuals at elevated risk for developing schizophrenia report greater subjective changes in affect and have increased physiological reactivity after hearing critical, praising and neutral comments. METHOD: Measures of heart rate, heart rate variability, skin conductance, and self-reported affective ratings were used to assess differential responses to EE-type stimuli in 38 individuals at elevated-risk for psychosis and 38 low-risk controls. RESULTS: The elevated-risk group and low-risk controls, did not differ in their initial affective and physiological reactivity to criticism. However, during the recovery period following the criticism, the elevated-risk group demonstrated greater heart rate activation. They also showed more sensitivity to praise. Although elevated-risk participants initially had higher baseline levels of negative affect and heart rate, following praise, these levels reduced and became indistinguishable from the levels of low-risk controls. CONCLUSIONS: These findings suggest that at-risk individuals may have more difficulty recovering from criticism than their self-report data might suggest. They may also derive physiological and affective benefits from praise. Important clinical implications of these findings are discussed.

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature.

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs.

The mediating effect of family cohesion in reducing patient symptoms and family distress in a culturally informed family therapy for schizophrenia: A parallel-process latent-growth model.

OBJECTIVE: Although both patients with schizophrenia and their caregivers report elevated levels of depression, anxiety, and stress (DASS), affective symptoms in patients and family members seldom constitute a primary treatment focus. The present study tested whether a culturally informed family therapy for schizophrenia (CIT-S) outperformed standard family psychoeducation (PSY-ED) not only in decreasing patient schizophrenia symptoms, but also in decreasing individual DASS. Because CIT-S fostered family cohesion throughout treatment, we predicted that increases in family cohesion would mediate treatment effects. METHOD: Participants included 266 patients and family members nested within 115 families, randomized to the CIT-S or PSY-ED conditions. We specified a series of multilevel latent growth and latent change models to examine direct effects of CIT-S on patient schizophrenia symptoms, individual DASS, and family cohesion over time. Next, we used parallel-process growth models to test the indirect effect of CIT-S on decreasing patient and caregiver psychopathology over time via changes in family cohesion. RESULTS: The CIT-S treatment significantly reduced patient schizophrenia symptoms from baseline to follow-up (γ = -1.72, 95% confidence interval [CI] [-2.83, -0.60]), as well as individual DASS (γ = -4.39, 95% CI [-6.44, -2.34]) from baseline to termination. In line with treatment goals, CIT-S increased family cohesion from baseline to midpoint (γ = 0.93, 95% CI [0.06, 1.80]). The CIT-S-related change in cohesion mediated changes in DASS (γ = -0.87, 95% CI [-1.47, -0.27]), but not patient symptoms. CONCLUSION: By integrating the family's cultural context into treatment, clinicians may foster family dynamics that enhance treatment outcomes and promote broad improvements in mental health. (PsycINFO Database Record

The feasibility of a culturally informed group therapy for patients with schizophrenia and their family members.

Research suggests that group-based psychosocial treatments for schizophrenia provide benefits to patients and family members alike. However, few existing treatments consider cultural factors that may enhance their efficacy with diverse populations. The current study examined the feasibility of a culturally informed group therapy for schizophrenia (CIGT-S), which incorporates collectivistic principles and spiritual coping into the treatment protocol. The feasibility of the group protocol was tested by examining differences in patient symptom severity and patient and family member depression, anxiety, and stress after completion of the group program. Within-groups analyses were conducted comparing baseline data to group termination data from 12 patients and 11 family members. Additionally, between-groups analyses were conducted comparing waitlist termination data from 20 patients and 13 family members to group termination data from 12 patients and 11 family members. Finally, we examined participant satisfaction with the group protocol, including qualitative reports on components of the protocol that participants deemed most valuable. Results indicated that patients demonstrated lower levels of symptom severity upon completion of the CIGT-S program; however, no other significant effects were found. Results examining overall patient and family member satisfaction with the treatment protocol indicated that patients and family members both reported being highly satisfied by the treatment program. This was also represented in participant's open-ended responses to our satisfaction questionnaire. These findings indicate that CIGT-S may represent a feasible, cost-effective approach that can be flexibly used with patients and family members of diverse racial and ethnic backgrounds. (PsycINFO Database Record

Expressed emotion and interdependence in White and Latino/Hispanic family members of patients with schizophrenia.

This study examined associations among ethnicity, expressed emotion (EE) and interdependence in a sample of 41 Latino/Hispanic and White family members of patients with schizophrenia. EE was assessed using both the Camberwell Family Interview (CFI) and the Five Minute Speech Sample (FMSS). These measures were found to be highly concordant for rating EE. However, the CFI appears to identify high EE more often than does the FMSS. Whites were designated as high EE significantly more often than were Latinos/Hispanics, regardless of assessment method. Using the interdependence subscale of the Self-Construal Scale, we found a strong trend for Latino/Hispanics to report a more interdependent self-construal than did Whites. However, contrary to expectations, interdependence was not found to mediate the relationship between ethnicity and EE. EE and interdependence may both play a role in the better course of illness observed for patients from traditional cultures. However, these two constructs may relate to patient functioning through different mechanisms.

Does religiosity predict attrition from a culturally-informed family treatment for schizophrenia that targets religious coping?

OBJECTIVE: People dealing with serious mental illness frequently report turning to religion to help cope with the disorder. However, little is known about how religion impacts commitment to psychotherapy programs for people with schizophrenia and their caregivers. METHOD: In a sample of 64 families enrolled in a culturally informed family treatment for schizophrenia that targets religiosity, we hypothesized that patients and caregivers who use high levels of adaptive religious coping and low levels of maladaptive religious coping, would be less likely to drop out of treatment than their counterparts. RESULTS: In line with hypotheses, results demonstrated that greater maladaptive religious coping was associated with fewer family therapy sessions attended. Contrary to expectations, greater adaptive religious coping was also associated with attending fewer family therapy sessions. CONCLUSION: Results suggest that any type of religious coping may be associated with higher levels of attrition from family therapy. Perhaps spiritual/religious people are already getting support and guidance from their beliefs and practices that aid them in coping with mental illness. Results may also suggest that there is a "religiosity gap" in which religious individuals perceive a disconnect between their beliefs and the beliefs of their mental health providers. It is important to point out that in this study, of those who dropped out prematurely, nearly all did so before the religiosity segment of treatment even began. Modifying how family treatments are introduced early on in therapy to ensure they appear congruent with the beliefs and values of religious families may help to reduce attrition. (PsycINFO Database Record

Acculturation styles and their associations with psychiatric symptoms and quality of life in ethnic minorities with schizophrenia.

This study examined whether Berry's model of acculturative stress would predict psychiatric symptom severity and quality of life (QoL) in ethnic minorities with schizophrenia. Tested extensively in non-psychiatric populations, Berry's framework generally suggests that integration, or engagement with both the host and minority culture, is most adaptive. Using the Abbreviated Multidimensional Acculturation Scale (AMAS), we tested the hypothesis that individuals with schizophrenia who employed an integrative acculturation strategy would have the highest QoL and lowest symptom severity, followed by the assimilation and enculturation groups, then the marginalized group. Psychiatric symptoms and QoL were regressed on AMAS assimilation scores, enculturation scores, and the interaction term in a sample of 128 Hispanic and Blacks with schizophrenia (M age = 41.28; 70% male). Acculturation strategy was not found to relate to psychiatric symptoms (measured from the Brief Psychiatric Rating Scale). However, acculturation strategy did predict QoL (measured from the Quality of Life Inventory), and results were in line with Berry's model. Marginalization may exacerbate issues surrounding social identity in schizophrenia, including low self-concept clarity and internalized stigma. Encouraging bicultural individuals with schizophrenia to interact with the host culture while also practicing traditions from their minority culture may help improve their quality of life.