Schizophrenia Diagnosis and Treatment in Black People

Medically Reviewed by Melinda Ratini, MS, DO on May 06, 2022
4 min read

Some statistics show Black people are more often diagnosed with schizophrenia than people of other races. But scientists say that doesn’t necessarily mean they’re actually more likely to have this serious mental health condition.

It’s a complicated issue. In 2018, researchers who reviewed more than 50 studies found that Black people were nearly 2 1/2 times more likely to be diagnosed with schizophrenia than white people. That study didn’t look at rates among other ethnic and racial groups.

Yet other research found that the percentage of American adults who’ve had psychotic symptoms during their lifetimes was:

  • 15% of Black people
  • 13% of Latino people
  • 9% of both Asian and white people

Psychosis, which is when someone loses touch with reality, isn’t the same thing as schizophrenia. But it often happens to people with schizophrenia. Overall, less than 1% of Americans have schizophrenia.

One possible explanation for the difference in diagnosis rates is racial bias. A doctor of another race who examines a Black patient may not consider certain cultural characteristics. For example, Black people tend to place less trust in the health care system. That’s at least in part because of experiences like the Tuskegee experiment of 1932-1973, in which Black men with syphilis were left untreated.

This mistrust could make Black people less open about their symptoms and experiences. A doctor might read that hesitance as paranoia, a common symptom of schizophrenia.

The disparity has not improved over time. In the 2018 review, researchers looked at studies published between 1983 and 2017. They found similar levels of racial differences in diagnosis over the 34-year period.

Another issue researchers have noted is that mental health professionals may tend to downplay mood symptoms in Black people while emphasizing symptoms of psychosis, such as hallucinations and delusions. This means they could overlook a mood disorder like depression and, instead, give that person a diagnosis of schizophrenia. A 2018 study found that Black people with severe depression were likely to be misdiagnosed with schizophrenia.

Misdiagnosis can have serious consequences. Black people diagnosed with schizophrenia are more likely to be hospitalized and to get higher doses of antipsychotic medications. They’re also more often prescribed older medications rather than more recently developed drugs. And if they get the wrong diagnosis, they don’t get treatment for the mental health condition they do have.

Black people also may be more likely to be diagnosed with schizophrenia because of the conditions in which they live. Structural racism, in particular, may increase the risk of schizophrenia. Some experts maintain that racism burdens Black people with ongoing psychological and physical stress. Over time, that raises their odds of health problems, including schizophrenia .

Simply being Black doesn’t make you more likely to have schizophrenia, according to the authors of a 2021 review study that looked at the social roots of psychosis. Instead, the racism Black people face may make higher rates inevitable.

For example, the neighborhood in which you live may help determine your risk of schizophrenia, they say. How? Due to the chronic stress of living in areas with less access to healthy foods, safe water, health care, childcare, jobs, and safe housing. Some research has shown that people at the bottom of the socioeconomic ladder, which includes many people of color, are at higher risk of psychosis.

Trauma also ups your odds of psychosis. Research suggests that as many as 97% of people at high risk of psychosis had at least one traumatic event. Studies have also shown that trauma and adversity are higher for racial minorities than for white people. Such trauma might include physical or sexual abuse, domestic violence, separation from a parent, or the death of a parent. As children, racial minorities are more likely to experience maltreatment and be exposed to violence.

But the risk of schizophrenia may be heightened even before birth. During the second trimester of pregnancy, Black women are likely to have lower levels of a stress hormone called cortisol. Researchers say that may be related to a lifetime of stress caused by discrimination. That drop in cortisol, as well as other complications of pregnancy that are more common in Black women, may raise their child’s future risk of schizophrenia.

Black people also may have more trouble getting treatment for schizophrenia. Some studies have shown that the Black community tends to stigmatize mental illness, seeing it as a sign of weakness. Those with mental health conditions such as schizophrenia may worry that it will lead others to discriminate against them. That could make them less likely to talk about their illness or to seek care.

Experts believe that up to 81% of people with schizophrenia inherited genes from their parents that boosted their risk of the condition. Unfortunately, most gene studies have focused on people of European descent.

That has begun to change, according to a 2019 genetic study of people of African descent. But much more research needs to be done to understand Black people’s genetic risk of schizophrenia. Some of the genes that raise the risk of schizophrenia are found among many different populations, including people of African, European, and East Asian descent.