President Joe Biden addresses attendees at the Pieper-Hillside Boys and Girls Club in Milwaukee on March 13, 2024. Photo by Scott Olson/Getty Images.
Feb 14, 2024 Story by: Editor
In the Columbia Mailman Psychiatric Epidemiology Training (PET) Program, fellows receive five years of funding and are encouraged to deeply explore significant issues in the field. During weekly seminars, faculty offer guidance and promote thoughtful discussions. “For the first three, sometimes four years, we encourage fellows to make a presentation that doesn’t include data—focus on what interests you, what bugs you; tell us what you care about,” says Professor of Epidemiology Katherine Keyes, who co-directs the program. “The scholars we produce know how to generate important questions with high-quality study designs underlying them.”
PET faculty members set a strong example by investigating racial disparities in mental health diagnoses in the United States. “At the end of the day, we know that Black folks and people of color have very different lived experiences in this country and that has affected their health outcomes,” says former PET fellow John R. Pamplin II, MPH ’14, PhD ’20, now a Columbia Mailman assistant professor of epidemiology.
Racial differences have been documented in asthma rates, cardiovascular disease, diabetes, maternal and infant health outcomes, and overall lifespan, with stark disparities highlighted during the COVID-19 pandemic. Pamplin’s doctoral research examined differences in depression and suicidality, topics that Keyes, MPH’06, PhD’10, also a former PET fellow, has studied for over a decade.
Recently, PET faculty, including Pamplin and Keyes, have focused on the role of structural racism in schizophrenia. “When it comes to schizophrenia and psychosis, there’s evidence that folks from marginalized racial groups—in particular, folks with Black, African, or Caribbean racial/ethnic identity in Denmark, the Netherlands, the United Kingdom, and the United States—have a higher prevalence of schizophrenia,” Pamplin explains. “Those prevalences aren’t as elevated in places where those groups are dominant. It has to do with racial marginalization.”
Ezra Susser, the Anna Cheskis Gelman and Murray Charles Gelman Professor of Epidemiology, who has a long history of research in this area, points to structural racism as a critical framework for understanding disparities in schizophrenia. His work has examined the impact of paternal age, maternal nutrition, and complications during pregnancy on schizophrenia. “It’s not just for unpacking what’s going on,” Susser says. “It suggests that you also need changes to that system. Ideally, you would change the structures, and if you can’t change them, at least mitigate the effects.”
Efforts to untangle the causes of disparities in psychiatric diagnoses have been fraught with bias and flawed data. For instance, the search for genetic explanations has often overlooked significant factors. Pamplin notes, “The genetic variation among Black people is greater than that between Black and white folks. That should give us pause as to whether genetic differences are the relevant factors to explain racial differences in health.” Susser emphasizes humility in this quest for understanding, especially considering the history of racism in psychiatry. Despite advancements in diagnostic criteria and treatment for schizophrenia over the past 50 years, race-based disparities in diagnosis rates persist.
Susser and Pamplin began discussing these issues early in Pamplin’s doctoral studies. They suspected there was more to the story than diagnostic bias. In 2023, the American Journal of Psychiatry published Susser’s editorial with Els van der Ven, a clinical psychologist at the University of Amsterdam, on ethnoracial differences in the incidence of treated psychotic disorders among nearly 6 million people insured by Kaiser Permanente Northern California. They highlighted the scarcity of high-quality population-based incidence data and the absence of measures for diagnostic bias as barriers to understanding the underlying causes of disparities.
Keyes underscores the long-standing legacy of PET scholars in addressing contemporary public health challenges, from HIV to young adult mental health and homelessness. “Structural racism is a huge determinant of population mental health, especially for racially minoritized populations,” she says. “We have a responsibility to develop measures, insights, into how these processes work.”
By focusing on these critical issues, PET scholars aim to generate impactful research and drive systemic changes to improve mental health outcomes for marginalized communities. Source: Mailman School of Public Health Columbia
