Is cognitive remediation effective across ethnic groups?

Matt Kurtz, Professor of Psychology and Neuroscience and Behaviour, Wesleyan University, CT, USA

In US systems of mental health care, there are substantial differences in diagnostic rates, treatment, and health outcomes for individuals from ethnic minority groups (e.g., Black Americans, Hispanic Americans and other minority groups) diagnosed with schizophrenia-spectrum illnesses (SSI) compared to their white counterparts. Minority groups are more likely to be given a diagnosis of SSI and are less likely to use needed psychiatric services.

These discrepancies may relate to how healthcare professionals interpret psychiatric symptoms in individuals from different ethnic groups, and how these individuals describe or interpret their symptoms themselves. In psychosocial intervention programs that target improved social relationships, illness management, and improved employment-related skills, individuals from ethnic minorities with SSI also show poorer outcomes. To improve access to effective culturally informed interventions, reduce drop-out and improve outcomes, we need to understand these differences as a first step to modifying treatments to suit the needs of everyone with SSI.

We analyzed data from two randomized, controlled clinical trials that included 119 outpatients with SSI who were enrolled in a 3-day-per-week intensive rehabilitation program. The trials compared a computer-assisted cognitive remediation program designed to improve thinking skills to computer-assisted lessons in MS Office. Our aim was to measure the degree to which participants’ ethnic background influenced their treatment response. We predicted that individuals from ethnic minorities would drop out of both treatments in greater numbers, have more thinking skill and daily function impairment at the start of the study, and show less improvement after treatment.

Unexpectedly, our study revealed largely negative findings. White and non-white minority groups showed similar thinking skill and function impairment and symptom severity at the start of the study. Drop-out rates were similar, and both groups showed similar responses to cognitive training. There was only one exception: racial/ethnic minority group participants showed more improvement in working memory relative to their white peers. At the beginning of the study those in the non-white group had poorer working memory performance, although not significantly so. The differential improvement might therefore reflect that the ethnic minority group had more likelihood of showing improvement.

These findings suggest that cognitive remediation treatments are effective at addressing cognitive deficits in ethnic minorities. They also support cognitive remediation as a treatment that may help address ethnic disparities in other domains such as everyday function. Future studies with larger numbers are needed to substantiate these findings and ensure they are robust across different forms of CR, across different treatment settings, and across a range of different ethnic minority groups, at least in the US.

The full paper is available from Schizophrenia Research: https://doi.org/10.1016/j.schres.2024.08.009

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