Ethnoracially incongruent environments predict state increases in negative symptoms of schizophrenia:Evidence from geocoding and digital phenotyping

BACKGROUND: Cultural contexts, such as whether one's immediate environment is ethnoracially congruent, are known to influence emotional expression, emotional experience, motivation, and social behavior in healthy individuals. However, it is unclear whether such cultural factors play a role in state exacerbations in negative symptoms that occur in schizophrenia (SZ). AIMS: The current study combined GPS data, environmental geocoding, and ecological momentary assessment (EMA) to test the hypothesis that ethnoracial incongruence encountered in daily-life situations predicts state increases in negative symptoms in SZ. METHOD: Participants included outpatients with SZ (n = 37) and healthy controls (CN: n = 41) with marginalized ethnoracial identities who completed EMA and passive digital phenotyping recordings. Geolocation was used to pair participant GPS location at the time of completing EMA symptom surveys with geocoded measures of that location's ethnoracial density based on government census records. Ethnoracial congruence was determined in relation to the match between a participant's identified ethnoracial identity and the ethnoracial density of their location at the time of EMA survey. RESULTS: Results indicated that ethnoracially incongruent contexts were associated with state increases in negative symptoms in individuals with SZ, but not CN. CONCLUSIONS: These findings suggest that interactions between one's own ethnoracial identity and the ethnoracial context of the current environment contributes to negative symptom exacerbations in SZ. Identity factors are not typically considered in the assessment and treatment of negative symptoms in SZ, but it would be beneficial to do so.