Experiences and socio-environmental contexts in the lead-up to psychosis: a qualitative analysis of the narratives of persons with psychosis from different ethnic, racial and immigrant backgrounds

Salomé M. Xavier^1,2Adrianne Both³Els van Der Ven³Ferrari Manuela^1,2Amal Abdel-Baki^4,5Nicole van den Bogerd³Imke Lemmers-Jansen³Srividya N Iyer^1,2*

• ¹Douglas Mental Health University Institute, Montreal, Quebec, Canada
• ²McGill University, Montreal, Quebec, Canada
• ³VU Amsterdam, Amsterdam, Netherlands, Netherlands
• ⁴Centre de recherche du Centre hospitalier de l’Université de Montréal, Montréal, Canada
• ⁵Clinique JAP (Jeunes adultes psychotiques), Montréal, Canada

Introduction: previous research, predominantly quantitative, has attributed the excess risk for psychosis among immigrants and ethnic minorities to social adversity, discrimination and structural inequities. Although calls have acknowledged their potential for yielding nuanced insights, qualitative methods focused on first-person narratives have not been used in research into the social determinants of the development of psychosis. Methods: we explored the experiences and socio-environmental contexts of individuals with psychosis from diverse ethno-racial and immigrant backgrounds. We also gathered their perspectives on the causality of psychosis. We conducted in-depth interviews with 24 participants at early intervention services for psychosis in Montreal, Canada. Results: through thematic analysis, we identified five themes: "Spaces and societies of oppression"; "Nothing to hold on to"; "Mistreated, invisible or seen in the wrong light"; "Places of freedom, connection and safety"; and "Healing and well-being". Spaces described as oppressive fomented experiences of precarity, isolation and mistreatment. Spaces of freedom, connection and inclusivity enabled healing and well-being. Experiences of precarity, mistreatment and exclusion were more frequent for minoritized individuals. Participants attributed psychosis to multiple factors, many pertaining to social contexts. Discussion: our findings shed light on the processes through which social contexts shape the lives and illness development of individuals from diverse backgrounds. By framing them within particular life stories and places, we gain a fuller, more fine-grained understanding of the social-structural determinants that have been identified in quantitative studies. Our work highlights the need to attend closely to patients' social contexts and narratives and advocate for inclusivity, equity, and connection at the societal level. Keywords: psychosis, structural disadvantage, social determinants, immigrants, ethnic minorities