Social Defeat and Psychosis in the United States: A Replication and Critical Reconceptualization.

Abstract

Background and hypothesis: The social defeat hypothesis posits that exclusion and discrimination experienced by socially marginalized populations predict psychotic experiences (PEs), particularly when perceived as defeatist. However, its emphasis on individual-level factors may obscure the role of structural and systemic influences. This is significant for the US context, given US histories of pronounced structural racism and economic inequality. This study extends the social defeat hypothesis by examining established indicators of social defeat, along with US-specific factors that capture structural influences on individuals' perceptions of discrimination and exclusion as defeatist.

Design: Data from the National Survey of Poly-victimization and Mental Health (N = 1 584) were analyzed to investigate cross-sectional associations between individual-level and structural indicators of marginalization and social defeat and self-reported PEs among young adults.

Study results: BIPOC participants had 60% higher odds of reporting PEs in the past year (OR = 1.60; 95% CI, 1.27-2.03; P = .003). Furthermore, participants with at least 1 experience of police violence in the past year have 52% higher odds of reporting PEs (OR = 1.52; 95% CI, 1.16-2.00; P = .003). Several additional indicators were associated with increased odds of PE, including race (non-White compared to White), high-frequency substance use, everyday discrimination, exposure to childhood abuse or bullying.

Conclusions: Findings align with European social defeat literature, confirming the relevance of the hypothesis in the US context. However, prominence of structural factors (racism, police violence) suggests that the social defeat hypothesis should incorporate systemic influences, emphasizing the need for interventions addressing societal contributors to psychosis risk.