The role of negativity bias and facial affect recognition in the increased odds of first-episode psychosis in ethnic minority populations: Findings from the EU-GEI case-control study

Repeated exposure to social adversity may contribute to a biased, more negative interpretation of others' facial affect. This mechanism, termed negativity bias, may provide insight into the elevated rates of psychosis among ethnic minority groups. The current study examined whether negativity bias and facial affect recognition represent intermediary pathways linking ethnic minority status, a proxy for differential exposure to social adversity, with first-episode psychosis (FEP). Data were drawn from 1035 individuals with FEP and 1382 population-based controls across five European countries and Brazil. Potential indirect effects of negativity bias and facial affect recognition on the association between ethnic minority status and FEP case-control status were examined in Black, Mixed, Asian, North African, and Other groups versus the White (majority) reference group. Models were adjusted for age, sex, country, parental social class, and general facial recognition ability, with additional sensitivity analyses adjusting for processing speed. Following confounder adjustment, indirect effect estimates for negativity bias were observed in the Black (ORadj: 1.07; 95% CI: 1.00-1.13) group, but attenuated for the Mixed (ORadj: 1.03; 95% CI: 0.98-1.07) group. Similarly, indirect effect estimates were observed for facial affect recognition in both the Black (ORadj: 1.06; 95% CI: 1.01-1.11) and Mixed (ORadj: 1.05; 95% CI: 1.00-1.09) groups. However, following additional adjustment for processing speed, the effects were attenuated across all ethnic groups. Negativity bias and impaired facial affect recognition of ethnic majority faces may represent potential cognitive-affective pathways linking ethnic minority status with FEP. Given the modest indirect effects, these findings should be interpreted cautiously.