A Theoretical Model of Racial Stress Shaping Negative Symptoms in Schizophrenia Spectrum Disorders

Schizophrenia-spectrum disorders (SSD) are often lifelong with chronic functional impairment. Negative symptoms are strongly related to functional impairment but are poorly treated. A potentially important but neglected aspect of negative symptoms is how they can be influenced by and reflect enduring interaction patterns with the environment. Consistent with this, the current paper presents a model for how one environmental factor, racial stress, influences negative symptoms in Black Americans, a group with increased rates of SSD. Following Strauss1, we use Bronfenbrenner’s bioecological model to examine how racial stress occurring across multiple environmental levels can affect negative symptoms. We propose that one critical factor is that racial stress can help create negative self-beliefs. Following Beck’s Generic Cognitive Model, these negative self-beliefs can then affect motivation, goal-directed behavior, and social withdrawal. Importantly, we also propose that a strong racial identity can act as a buffer and prevent the development of negative self-beliefs. This model proposes a novel environmental pathway that might increase negative symptoms in Black Americans and identifies a potentially critical way that future treatment and prevention efforts might decrease or stop the onset of negative symptoms in SSD. By further illustrating how environmental factors can increase negative symptoms, our model helps further lay the groundwork for how other environmental models could help identify precision medicine approaches to treating and preventing negative symptoms in SSD.