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Ethnicity and baseline symptomatology in patients with an At Risk Mental State for psychosis

  • E. Velthorst (a1), D. H. Nieman (a1), W. Veling (a2), R. M. Klaassen (a3), S. Dragt (a1), J. Rietdijk (a4), H. Ising (a2), L. Wunderink (a5), D. H. Linszen (a1), L. de Haan (a1) and M. van der Gaag (a2) (a4)...
  • Please note a correction has been issued for this article.



Ethnicity has been associated with different incidence rates and different symptom profiles in young patients with psychotic-like disorders. No studies so far have examined the effect of ethnicity on symptoms in people with an At Risk Mental State (ARMS).


In this cross-sectional study, we analysed the relationship between ethnicity and baseline data on the severity of psychopathology scores in 201 help-seeking patients who met the ARMS criteria and agreed to participate in the Dutch Early Detection and Intervention (EDIE-NL) trial. Eighty-seven of these patients had a non-Dutch ethnicity. We explored the possible mediating role of ethnic identity.


Higher rates of negative symptoms, and of anhedonia in particular, were found in the ethnic minority group. This result could be attributed mainly to the Moroccan-Dutch and Turkish-Dutch subgroups, who also presented with more depression symptoms when the groups were examined separately. The ethnic minority group displayed a lower level of ethnic group identity compared to the immigrants of the International Comparative Study of Ethnocultural Youth (ICSEY). Ethnic identity was inversely related to symptoms in the Moroccan-Dutch patient group.


The prevalence of more severe negative symptoms and depression symptoms in ethnic minority groups deserves more attention, as the experience of attenuated positive symptoms when accompanied by negative symptoms or distress has proven to be predictive for transition to a first psychotic episode.


Corresponding author

*Address for correspondence: E. Velthorst, M.Sc., Academic Medical Centre, Department of Early Psychosis, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. (Email:


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Addington, D, Addington, N, Maticka-Tyndale, E, Joyce, J (1992). Reliability and validity of a depression rating scale for schizophrenics. Schizophrenia Research 6, 201208.
Arnold, LM, Keck, Jr. PE, Collins, J, Wilson, R, Fleck, DE, Corey, KB, Amicone, J, Adebimpe, VR, Strakowski, SM (2004). Ethnicity and first-rank symptoms in patients with psychosis. Schizophrenia Research 67, 207212.
Barrio, C, Yamada, AM, Atuel, H, Hough, RL, Yee, S, Berthot, B, Russo, PA (2003). A tri-ethnic examination of symptom expression on the positive and negative syndrome scale in schizophrenia spectrum disorders. Schizophrenia Research 60, 259269.
Beck, AT, Steer, RA, Ball, R, Ranieri, W (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment 67, 588597.
Berry, JW, Phinney, JS, Sam, DL, Vedder, PE (2006). Immigrant Youth in Cultural Transition. Acculturation, Identity, and Adaptation Across National Contexts. Lawrence Erlbaum Associates: Mahwah, NJ.
Bhugra, D, Hilwig, M, Corridan, B, Neehall, J, Rudge, S, Mallett, R, Leff, J (2000). A comparison of symptoms in cases with first onset of schizophrenia across four groups. European Journal of Psychiatry 14, 241249.
Blom, JD, Eker, H, Basalan, H, Aouaj, Y, Hoek, HW (2010). Hallucinations attributed to djinns [in Dutch]. Nederlands Tijdschrift voor de Geneeskunde 154, A973.
Cannon, TD, Cadenhead, K, Cornblatt, B, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, D, Tsuang, M, McGlashan, T, Heinssen, R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 2837.
Goldman, HH, Skodol, AE, Lave, TR (1992). Revising axis V for DSM-IV: a review of measures of social functioning. American Journal of Psychiatry 149, 11481156.
Harvey, I, Williams, M, McGuffin, P, Toone, BK (1990). The functional psychoses in Afro-Caribbeans. British Journal of Psychiatry 157, 515522.
Hutchinson, G, Sharpley, M (1999). Ethnicity and first year of contact with psychiatric services. British Journal of Psychiatry 175, 492.
Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB, Coid, JW (2008). Psychosis, ethnicity and socio-economic status. British Journal of Psychiatry 193, 1824.
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655664.
Morgan, C, Hutchinson, G (2010). Letter to the editor: Prevention is better than cure: a reply to McKenzie, March et al. and Selten & Cantor-Graae. Psychological Medicine 40, 876877.
Phinney, JS (1992). The Multigroup Ethnic Identity Measure: a new scale for use with adolescents and young adults from diverse groups. Journal of Adolescence 7, 156175.
Rathod, S, Kingdon, D, Phiri, P, Gobbi, M (2010). Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users' and health professionals' views and opinions. Behavioural and Cognitive Psychotherapy 38, 511533.
Reininghaus, U, Craig, TK, Fisher, HL, Hutchinson, G, Fearon, P, Morgan, K, Dazzan, P, Doody, GA, Jones, PB, Murray, RM, Morgan, C (2010). Ethnic identity, perceptions of disadvantage, and psychosis: findings from the ÆSOP study. Schizophrenia Research 124, 4348.
Rietdijk, J, Dragt, S, Klaassen, R, Ising, H, Nieman, D, Wunderink, L, Delespaul, P, Cuijpers, P, Linszen, D, van der Gaag, M (2010). A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an At Risk Mental State for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Trials 11, 30.
Selten, JP, Cantor-Graae, E (2005). Social defeat: risk factor for schizophrenia. British Journal of Psychiatry 187, 101102.
Simon, AE, Umbricht, D (2010). High remission rates from an initial ultra-high risk state for psychosis. Schizophrenia Research 116, 168172.
Strakowski, SM, Flaum, M, Amador, X, Bracha, HS, Pandurangi, AK, Robinson, D, Tohen, M (1996). Racial differences in the diagnosis of psychosis. Schizophrenia Research 23, 117124.
Veling, W, Hoek, HW, Wiersma, D, Mackenbach, JP (2010). Ethnic identity and the risk of schizophrenia in ethnic minorities: a case-control study. Schizophrenia Bulletin 36, 11491159.
Veling, W, Selten, JP, Mackenbach, JP, Hoek, HW (2007). Symptoms at first contact for psychotic disorder: comparison between native Dutch and ethnic minorities. Schizophrenia Research 95, 3038.
Velthorst, E, Nieman, DH, Becker, HE, van de Fliert, R, Dingemans, PM, de Haan, L, van Amelsvoort, T, Linszen, DH (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research 109, 6065.
Velthorst, E, Nieman, DH, Klaassen, RM, Becker, HE, Dingemans, PM, Linszen, DH, de Haan, L (2011). Three-year course of clinical symptomatology in young people at ultra high risk for transition to psychosis. Acta Psychiatrica Scandinavica 133, 3642.
WHO (1993). Composite International Diagnostic Interview (CIDI), Core Version 1.1. American Psychiatric Publishing: Arlington, VA.
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, JE, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.
Yung, AR, Buckby, JA, Cotton, SM, Cosgrave, EM, Killackey, EJ, Stanford, E, Godfrey, K, McGorry, PD (2006). Psychotic-like experiences in nonpsychotic help-seekers: associations with distress, depression, and disability. Schizophrenia Bulletin 32, 352359.
Yung, AR, McGorry, PD, McFarlane, CA, Jackson, HJ, Patton, GC, Rakkar, A (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22, 283303.
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis. A step towards indicated prevention of schizophrenia. British Journal of Psychiatry (Suppl.) 172, 1420.
Yung, AR, Phillips, LJ, Yuen, HP, Francey, SM, McFarlane, CA, Hallgren, M, McGorry, PD (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 2132.
Yung, AR, Yuen, HP, McGorry, PD, Philips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry 39, 964971.
Zandi, T, Havenaar, JM, Smits, M, Limburg-Okken, AG, van Es, H, Cahn, W, Algra, A, Kahn, RS, van den Brink, W (2010). First contact incidence of psychotic disorders among native Dutch and Moroccan immigrants in the Netherlands: influence of diagnostic bias. Schizophrenia Research 119, 2733.



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