Examining differences in the effects and contexts of naturalistic psilocybin use for White participants vs. Participants of Color: A longitudinal online survey study

Jones and colleagues frame the paper against growing interest in psilocybin and the increasing use of psilocybin outside clinical settings. They note that earlier prospective studies had reported average improvements in depression, anxiety, cognitive flexibility, spiritual wellbeing, and other aspects of functioning after naturalistic psilocybin use, but that most psychedelic research has relied heavily on White participants. As a result, it remained unclear whether the effects and contexts of psilocybin use generalise to People of Color, especially given the underrepresentation of racially and ethnically minoritised groups in both clinical trials and observational studies. The study aimed to compare health outcomes, subjective effects, and use contexts after naturalistic psilocybin use in White participants versus Participants of Color. The authors specifically sought to determine whether race/ethnicity moderated changes over time in mental health and related psychological mechanisms, and whether there were differences in the setting, mindset, and acute experience surrounding use. The paper is presented as a longitudinal online survey study intended to address gaps in understanding about how psilocybin experiences may differ across racial and ethnic groups in real-world conditions.

The researchers analysed longitudinal online survey data from people who planned to use psilocybin in non-clinical, real-world contexts. The overall cohort was large, but the extracted text indicates that the main longitudinal analysis focused on participants who completed the relevant follow-up surveys and who reported a racial identity other than “prefer not to say”. At the initial longitudinal assessment point, the sample was mostly White, with an average age of about 40 years, 54% identifying as male, and participants reporting prior psilocybin experience on average 16-17 times. Data were collected at six time points: informed consent; 2-3 weeks before the psychedelic experience; 1 day before; 1-3 days after; 2-4 weeks after; and 2-3 months after the experience. The key comparison was between White participants and Participants of Color, with the latter grouped together because the number in each individual non-White category was too small for reliable separate analyses. This grouping was used to improve statistical power, although it also meant that distinct racial and ethnic subgroups were not analysed separately. The main analyses used mixed-effects regression models with a random intercept for each participant, which is suitable for repeated measures over time. The authors tested whether race moderated the association between time and outcomes measured at the longitudinal follow-up points. The outcomes included depression, anxiety, spiritual wellbeing, cognitive flexibility, and two forms of emotion regulation: expressive suppression and cognitive reappraisal. The models adjusted for age, gender, income, education level, prior psychedelic use, and marital status. The paper also included exploratory between-group comparisons of psilocybin use context and acute experience. These examined variables measured before the experience, such as mindset, whether an intention was set, whether a sitter was present, and surrender scores, as well as post-experience variables such as location, who the substance was taken with, who administered it, time distortion, speeding thoughts, sensory vividness, mystical-type effects, challenging experiences, overall valence, and persisting negative effects. Wilcoxon rank-sum tests were used for continuous variables and Pearson chi-squared tests for categorical variables. The authors did not correct these exploratory tests for multiple comparisons, so they explicitly describe those findings as preliminary.

At baseline, Participants of Color were somewhat younger than White participants, had a slightly lower proportion of men and a slightly higher proportion identifying as gender “other”, had lower income on average, and were much more likely to identify as Hispanic. The main moderation analyses showed significant race-by-time interactions at the 2-3 month follow-up, but not at the 2-4 week follow-up, for spiritual wellbeing, cognitive flexibility, and expressive suppression. The reported coefficients were beta = -1.8 for spiritual wellbeing, beta = -1.5 for cognitive flexibility, and beta = 0.25 for expressive suppression, all with p < 0.05. When the sample was split into White participants and Participants of Color, both groups showed reductions in depression and anxiety over time, and moderation tests for those outcomes were not significant. In the stratified models, White participants showed significant improvements in spiritual wellbeing at both follow-ups, reduced expressive suppression, and increased cognitive flexibility at both follow-ups. For Participants of Color, spiritual wellbeing improved at both follow-ups, but cognitive flexibility improved only at the 2-4 week point and was not sustained at 2-3 months. Expressive suppression did not change significantly in Participants of Color. In the exploratory analyses, Participants of Color were more likely than White participants to report setting an intention before use. There were no group differences in setting variables such as where psilocybin was taken or with whom it was taken, and most participants used it at home, either alone or with friends also using psilocybin. Participants of Color were more likely to report stronger mystical-type effects and a greater sense that thoughts sped up during the experience. However, there were no group differences in challenging experiences, autobiographical content, perceptual alterations, overall evaluation of the experience, or persisting negative effects such as depressive notions, loneliness, and mood fluctuations.

The authors interpret the findings as showing that naturalistic psilocybin use was associated with some common improvements across racial and ethnic groups, especially reductions in anxiety and depression, but that some longer-term psychological changes differed between White participants and Participants of Color. They emphasise that improvements in spiritual wellbeing and cognitive flexibility were present in both groups shortly after use, but appeared less durable among Participants of Color by 2-3 months. In contrast, White participants showed sustained gains in these domains and also showed reduced expressive suppression, whereas Participants of Color did not. They place these results alongside earlier studies suggesting that psilocybin and other psychedelics may be associated with mental health benefits more consistently in White participants than in some minoritised groups. They note, however, that the present study found no race differences for depression and anxiety, which differs from some nationally representative observational studies reporting weaker or inconsistent protective associations among racial and ethnic minority groups. The authors also highlight that Participants of Color were more likely to report entering the experience with an intention, and somewhat more likely to report mystical-type effects and speeding thoughts, but that most contextual features of use were similar across groups. The discussion offers several possible explanations for the differing patterns, including unmeasured social and environmental factors that may shape the experience and longer-term impact of psilocybin for minoritised participants. The authors briefly suggest that expressive suppression may have different functional meanings in minoritised communities, potentially linked to code-switching and navigating White-dominated social environments, but they present this as a possibility rather than a conclusion. They also note that qualitative work could help clarify why these differences occurred. The paper’s limitations include the anonymous online design, which prevented verification of participant reports; self-selection, which limits generalisability; possible response bias; limited statistical power due to the small number of Participants of Color; and the need to group all non-White participants together, which obscures differences between racial and ethnic subgroups. The authors conclude that although there were more similarities than differences in set and setting, there may be meaningful race- or ethnicity-related differences in the persistent psychological effects of psilocybin. They argue that future research should include larger and more diverse samples and should examine sociocultural factors, health disparities, criminal justice disparities, stigma, and access issues to better understand and optimise psychedelic use in culturally appropriate ways.

The authors conclude that naturalistic psilocybin effects may vary along racial and ethnic lines, particularly for longer-term psychological and spiritual outcomes, even though short-term reductions in depression and anxiety were seen across groups. They state that more data are needed from diverse samples to understand the reasons for these differences and to inform more equitable public policy and clinical implementation.