Background An ethnic density effect in psychosis has been observed whereby the risk of psychosis in minority group individuals is inversely related to the neighbourhood-level proportion of others belonging to the same group. However, there is conflicting evidence over whether this effect differs between minority groups and limited investigation into other moderators. We aimed to conduct a comprehensive systematic review and meta-analysis of the ethnic density effect in psychosis and examine moderators.
Methods Four databases were systematically searched. A narrative review was conducted, and a three-level meta-analysis was performed. The potential moderating effect of crudely and specifically defined minority groups was assessed. Country, time, area size, and whether studies used clinical or non-clinical outcomes were also tested as moderators.
Results Thirty-two studies were included in the narrative review and ten in the meta-analysis. A ten percentage-point decrease in own-group density was associated with a 20% increase in psychosis risk [OR=1.20 (CI95%=1.09–1.32), p<0.001]. The pooled effect was moderated by crudely defined minority groups [F 6,68=6.86, p<0.001], with the strongest associations observed in Black populations, followed by a White Other sample. Greater heterogeneity was observed when specific minority groups were assessed [F 25,49=7.26, p<0.001].
Conclusion This is the first review to provide meta-analytic evidence that the risk of psychosis posed by lower own-group density areas is not equally distributed across minority groups. The most robust associations were observed in Black individuals. Heterogeneity in effect sizes may reflect distinctive social experiences of specific minority groups. Mechanisms are discussed, along with the implications of findings and suggestions for future research.
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