Health Disparities
Does history repeat itself? Racial disparities in emergency department visits for schizophrenia/psychosis following the police killing of George Floyd. Parvati Singh* Parvati Singh Geoffrey Carney-Knisely Kamesha S. Spates Marquianna Griffin Amy Fairchild Tim A. Bruckner
In the United States, Black persons are disproportionately diagnosed with schizophrenia relative to Whites. Clinician bias stemming from racialized diagnostic criteria for schizophrenia/psychosis, and inappropriate contextualization of attributes among Black persons as pathological, may underlie this disparity. Symptoms of schizophrenia such as agitation, delusion, and non-compliance, were part of the (now discontinued) disorder termed the “protest psychosis” as a type of reactive psychosis stemming from racial tensions during the Civil Rights movement in the 1950s and 1960s. This disorder included the rejection of “Caucasian values” and a “repudiation of white civilization”, and was utilized to characterize Civil Rights protestors as severely mentally ill. The legacy of these targeted and discriminatory diagnostic criteria may continue to permeate the modern context. In May 2020, the police killing of George Floyd sparked widespread protests through the Black Lives Matter Movement against police brutality and racial injustices in the US. Given the historical precedence of “protest psychosis” in response to the Civil Rights Movement, we sought to examine disparities in schizophrenia-related Emergency Department (ED) visits immediately following the police killing of George Floyd in May 2020. We used monthly data on ED visits from January 2016 to December 2020 across 5 University of California health systems and examined whether ED visits with a diagnosis of schizophrenia increased selectively among Black persons in June 2020, controlling for (1) all other psychiatric ED visits among Black persons, and (2) ED visits for schizophrenia among White persons. Results from time-series AutoRegressive Integrated Moving Average (ARIMA) analyses indicate 47 additional ED visits for schizophrenia/psychosis among Black persons in June 2020 (p<0.01). These results indicate perpetuation of historical trends and align with expectations from the legacy of “protest psychosis”.
