Use this URL to cite or link to this record in EThOS:
Title: Ethnicity and psychosis : an investigation of the validity of psychosis screening instruments in the context of cross-cultural population-based survey research
Author: Heuvelman, Hein Hendrik Pieter
ISNI:       0000 0004 5359 3049
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2014
Availability of Full Text:
Access from EThOS:
Access from Institution:
Population-based evidence suggests that the prevalence of psychotic symptoms varies with ethnicity. However, the validity of these self-reported experiences, both as measures of psychotic symptoms per se and as measures of ethnic variation in risk for reporting these symptoms, is questionable. Cultural background and social position may affect the experience and expression of symptoms, which may in turn affect their measurement in survey research. This thesis explores these issues by assessing the psychometric properties of psychosis screening instruments as measures of ethnic differences in psychosis risk in two contexts, Great Britain and the United States. Following this, differences in risk for reporting psychotic symptoms were examined in the context of the varying social and economic conditions to which different ethnic groups and migrant generations are exposed. This was accomplished in the following way: Firstly, the prevalence of self-reported psychotic symptoms was examined across ethnic and generational groups in two large samples of British and American populations; Secondly, the construct validity of the instruments was assessed by means of exploratory and confirmatory factor analyses of response to their symptom indicators. The concurrent validity of the symptoms with measures of self-perceived cognitive and social dysfunction was then examined in a structural equation modeling framework; Thirdly, the cross-ethnic and cross-generational validity of response to these screening instruments was assessed in a multiple-group confirmatory factor analysis framework in which in which the psychometric characteristics of the instruments were compared; And finally, ethnic and generational differences in risk for reporting psychotic symptoms were examined in the context of differential exposure to racial discrimination. Both instruments had construct validity in their measurement of psychotic symptoms, with the exception of one item in the British instrument, as well as concurrent validity with measures of self-perceived cognitive or social dysfunction. The British instrument performed adequately in the measurement of psychotic symptoms across ethnic groups, but did not across migrant generations. The American instrument performed adequately in the measurement of psychotic symptoms across generations, but not across ethnic groups. The effect of measurement noninvariance on the estimation of risk across groups was, however, modest in size. Finally, there was evidence for risk of reporting psychotic symptoms being raised among those who were exposed to racial discrimination. These findings suggest that these self-reported psychotic symptoms constitute clinically relevant phenomena which appear phenotypically similar to the clinical symptoms in diagnosed psychotic disorder. Risk is distributed unevenly over ethnic groups in Britain and the US, is higher among minorities who were exposed to social adversity, and higher among the second generation (in most cases). These patterns are, therefore, highly suggestive of social causation in the aetiology of these self-reported symptoms.
Supervisor: Tranmer, Mark; Nazroo, James Sponsor: Economic and Social Research Council (ESRC)
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Ethnicity ; Psychotic symptoms ; Racism ; Socioeconomic disadvantage ; Measurement ; Factor analysis ; Structural equation modeling