title: The Role of Social Identity in the Understanding of Elevated Rates of Psychosis in Ethnic Minority Groups
Creators: name: Qi, Robert
Publisher: name: University of Liverpool Repository
Year: 2024

description: The risk of developing psychosis, described broadly as a range of psychopathological symptoms and behavioural changes indicating impairment in reality testing (including symptoms such as delusions, hallucinations, amongst others), is higher in certain ethnic minority groups when compared to majority populations in the Western world. In the UK, Black African and Caribbean, and South Asian ethnic groups have been found to be particularly at risk. The Social Identity Approach (SIA), comprising of Self-Categorisation Theory and Social Identity Theory has been suggested as a potential framework to understand elevated rates of psychosis in such groups. Social adversities such as racism, discrimination, and lower social support have been found to relate to psychosis in minority groups, and it is proposed that such effects relate to the disruption of positive social identity formation. In Chapter 1, psychosis is defined, alongside current prevalence and incidence rates. Different biological and environmental risk factors are then discussed in the context of theoretical models such as the SIA, with a focus on how these factors may impact upon risk of psychosis through relevant psychosocial processes. 

In Chapter 2, we applied a novel, symptom-specific approach, using nationally representative survey data in the UK, and found a higher risk of paranoia symptoms and strange experiences for the Black/Black British population in comparison to the White British majority. Factors related to social identity, including perceived racial discrimination, neighbourhood identity, and social support partially mediated risk of paranoia, suggesting that social identity may be a possible explanatory mechanism for such symptoms in ethnic minority groups. The ethnic density effect is then explored in Chapter 3, which provides key evidence for the influence of social factors (such as discrimination and social support) at a neighbourhood level on risk of psychosis in ethnic minority groups. For the Pakistani population in the UK, past survey studies indicating an unexplained lack of protective ethnic density effects have been hampered by certain methodological limitations. In Chapter 3, we improve on these limitations by using a clinical outcome measure of first episode psychosis at the detailed Lower Super Output Area level, demonstrating a protective ethnic density effect in a UK Pakistani population for the first time, further supporting the SIA. In Chapter 4, qualitative evidence in relation to experiences and content of clinical delusions is synthesised, examining different social identities such as ethnicity/race, gender, sexuality and religion. While some support for social identity is indicated, a lack of qualitative evidence is highlighted. The PhD researcher’s reflection on personal identity, epistemology, methods, and community engagement is then given in Chapter 5. Overall, results in this thesis indicate support for a role of social identity in the understanding of elevated risk of psychosis amongst ethnic minority groups, summarised in Chapter 6, alongside general limitations, implications, and suggestions for future research.