Racial-Ethnic Disparities in First-Episode Psychosis Treatment Outcomes From the RAISE-ETP Study

• Published in: Psychiatric services (Washington, D.C.) Vol. 69; no. 11; pp. 1138 - 1145
• Main Authors: Oluwoye, Oladunni, Stiles, Bryan, Monroe-DeVita, Maria, Chwastiak, Lydia, McClellan, Jon M, Dyck, Dennis, Cabassa, Leopoldo J, McDonell, Michael G
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01.11.2018; American Psychiatric Publishing, Inc
• Subjects: Adult; African Americans - ethnology; Clinical outcomes; Clinical trials; Community Mental Health Services - statistics & numerical data; Consumer Health Information - statistics & numerical data; Cultural differences; European Continental Ancestry Group - ethnology; Family; Female; Health disparities; Health Status Disparities; Healthcare Disparities; Hispanic Americans - statistics & numerical data; Humans; Male; Minority & ethnic groups; Psychosis; Psychotherapy - statistics & numerical data; Psychotic Disorders - ethnology; Psychotic Disorders - therapy; Schizophrenia - ethnology; Schizophrenia - therapy; Young Adult; African Americans; Coordinated specialty care; First-episode psychosis; Racial disparities; Family psychoeducation; Mental health
• ISSN: 1075-2730; 1557-9700; 1557-9700
• DOI: 10.1176/appi.ps.201800067

Objective:This study examined racial and ethnic differences in treatment outcomes among participants in a randomized controlled trial of an intervention for first-episode psychosis called NAVIGATE.Methods:Secondary data analyses were conducted for participants randomly assigned to usual community care (N=181) and NAVIGATE (N=223). Generalized estimating equations assessed whether race and ethnicity were associated with psychiatric symptoms and service use (medication management, family psychoeducation, and individual therapy) over a 24-month treatment period, accounting for baseline symptoms, duration of untreated psychosis, and insurance status.Results:Among persons in usual community care, non-Hispanic blacks scored significantly higher throughout treatment on measures of positive symptoms (β=2.15, p=.010), disorganized thoughts (β=1.15, p=.033), and uncontrolled hostility (β=.74, p=.027), compared with non-Hispanic whites, and non-Hispanic blacks were less likely than non-Hispanic whites to receive individual therapy (OR=.45, p=.001). Families of Hispanic participants in usual community care were less likely than non-Hispanic white families to receive family psychoeducation (OR=.20, p=.01). For NAVIGATE participants, race and ethnicity were not associated with differences in psychiatric symptoms over time; families of non-Hispanic black participants were less likely than those of non-Hispanic white participants to receive family psychoeducation (OR=.53, p=.009). Hispanic participants in NAVIGATE were more likely than non-Hispanic white participants to receive medication management (OR=2.93, p=.001).Conclusions:In usual community care, non-Hispanic blacks scored higher on measures of psychiatric symptoms and were less likely to receive important services, compared with non-Hispanic whites. In NAVIGATE, racial and ethnic differences in psychiatric symptoms were not evident, although non-Hispanic blacks were less likely than non-Hispanic whites to receive family psychoeducation.