Exploring rates of psychosis in Asians and non-Asians seeking outpatient services in the United States

Asians in the United States often demonstrate lower rates of mental-health service use than the rest of the population. It is not clear if this also applies to care-seeking for psychosis. The objective of this paper is to compare the diagnostic patterns of psychosis to depression, anxiety, personality disorders and substance use disorders (DAPS) in Asians and people of other races within a help-seeking, outpatient sample and discuss possible explanations for our findings. This has not been previously studied in the United States. 3,521,905 US-based adults who received mental health services provided or funded through state mental health agencies in 2018 and were captured in the SAMHSA Mental Health Client-Level Data Annual Report were examined. Prevalence ratios and odds ratios were calculated for our dataset to address the primary aims of the study. In our sample, relative to Asian individuals, the proportion of individuals with a recorded psychosis diagnosis was 49% lower among non-Asian/non-Black individuals (PR = 0.51) and 6% higher among Black/African American individuals (PR = 1.06). The results for DAPS were more nuanced, with varying patterns across racial groups. Asian Americans had higher odds of having a recorded psychosis diagnosis than non-Asian/non-Black individuals. Black/African American individuals had modestly higher odds of a recorded psychosis diagnosis than Asian individuals, although the magnitude of this difference was relatively small. Our study represents an initial effort to understand the differential rates of psychosis and DAPS in Asians when compared to other racial groups in the United States in a help-seeking sample. Future studies aimed at identifying culture- and race-specific factors that impact people seeking mental health services in the US could be crucial in improving functional outcomes.