Abstract
Purpose
The relative prevalence of common mental health problems among different ethnic groups in Britain is one of the least researched topics in health variations research. We calculate and compare income-related inequalities in common mental disorders among ethnic groups in Britain.
Method
Data from a nationally representative survey of ethnic minorities (the EMPIRIC survey) were used to calculate concentration index values to indicate the extent of income-related inequalities within and across ethnic groups.
Results
Looking at income-related inequalities in common mental disorders within each of the ethnic groups, it was found that the burden of these disorders were greater for the lower income groups among the Irish, White and African Caribbean communities. Within-group inequality was less clearly defined for each of the three Asian communities: Indian, Bangladeshi and Pakistani. However, when the data were pooled and individuals were assigned income ranks in the pooled set (not within their own ethnic group), the relative position of those in lower income groups among the different groups was striking. The poor among the Bangladeshi, Pakistani and the African Caribbean groups clearly suffered both from low income and a greater burden of mental health morbidity than the other three groups. The effect of lower income is thus worse for the mental health of populations if they are African Caribbean, Pakistani or Bangladeshi than if they are White, Irish or Indian.
Conclusion
Inequality in mental health morbidity between and within ethnic groups is at least partly linked to income, and thus to employment and education. Tackling disadvantage and discrimination in these areas could help to tackle the challenge of mental ill-health.
Similar content being viewed by others
References
Townsend P, Davidson N (1982) Inequalities in health (the Black Report). Penguin, Middlesex
Davey Smith G, Bartley M, Blane D (1990) The Black Report on socioeconomic inequalities in health 10 years on. BMJ 301:373–377
Benzeval M, Judge K, Whitehead M (1995) Tackling inequalities in health: an agenda for action. Kings Fund Institute, London
Weich S, Lewis G, Jenkins S (2001) Income inequality and the prevalence of mental disorders in Britain. Br J Psychiatry 178:222–227
Lewis G, Bebbington P, Brugha T, Farell M, Gill B, Jenkins R, Meltzer H (2003) Socio-economic status, standard of living and neurotic disorder. Int Rev Psychiatry 15:91–96
Social Exclusion Unit (2004) Mental health and social exclusion. Office of the Deputy Prime Minister, London
Mangalore R, Knapp M, Jenkins R (2007) Income-related inequality in mental health in Britain: the concentration index approach. Psychol Med 37:1037–1046
Nazroo JY (1999) The racialisation of ethnic inequalities in health. In: Dorling D, Simpson S (eds) Statistics in society: the arithmetic of politics. Arnold, London
Nazroo JY (2001) Ethnicity, Class and Health. Policy Studies Institute, London
Brugha T, Jenkins R, Bebbington P, Meltzer H, Lewis G, Farrell M (2004) Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain. Soc Psychiatry Psychiatr Epidemiol 39:939–946
Hoberman HM (1992) Ethnic minority status and adolescent mental health services utilization. J Behav Health Serv R 19:246–267
Nazroo James Y (2003) The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. Am J Public Health 93:277–284
Miranda J, Siddique J, Belin TR, Kohn-Wood LP (2005) Depression prevalence in disadvantaged young black women African and Caribbean immigrants compared to US-born African Americans. Soc Psychiatry Psychiatr Epidemiol 40:253–258
Bresnahan M, Begg MD, Brown A, Schaefer C, Sohler N, Insel B, Vella L, Susser E (2007) Race and risk of schizophrenia in a US birth cohort: another example of health disparity? Int J Epidemiol 36:751–758
Simning A, Wijngaarden EV and Conwell Y (2010) Anxiety, mood, and substance use disorders in United States African-American public housing residents. Soc Psychiatry Psychiatr Epidemiol (online first, 9 July)
Wang JL (2004) The difference between single and married mothers in the 12-month prevalence of major depressive syndrome, associated factors and mental health service utilization. Soc Psychiatry Psychiatr Epidemiol 39:126–132
Dekker J, Peen J, Goris A, Heijnen H, Kwakman H (1997) Social deprivation and psychiatric admission rates in Amsterdam. Soc Psychiatry Psychiatr Epidemiol 32:485–492
Veling W, Selten JP, Susser E, Laan W, Mackenbach JP, Hoek HW (2007) Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands. Int J Epidemiol 36:761–768
Wittkampf LC, Smeets HM, Knol MJ, Geerlings MI, Braam AW et al (2010) Differences in psychotropic drug prescriptions among ethnic groups in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 45:819–826
Sagatun A, Lien L, Søgaard AJ, Bjertness E, Heyerdahl S (2008) Ethnic Norwegian and ethnic minority adolescents in Oslo, Norway: a longitudinal study comparing changes in mental health. Soc Psychiatry Psychiatr Epidemiol 43:287–295
Cochrane R and Sashidharan SP (1996) Mental health and ethnic minorities: a review of the literature and implications for services. In: Ethnicity and health, CRD Report 5. NHS Centre for reviews and Dissemination, Social Policy Research Unit: University of York, York
McKenzie K, Bhui K (2007) Institutional racism in mental health care. BMJ 334:649–650
World Bank (2003) Quantitative techniques for health equity analysis—technical notes. (http://siteresources.worldbank.org/INTPAH/Resources/Publications/Quantitative-Techniques/health.eqtn07.pdf). Accessed 15 February 2006
Van Doorslaer E, Koolman X, Jones AM (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 13:629–647
Sproston K, Nazroo J (eds) (2002) Ethnic minority psychiatric illness rates in the community (EMPIRIC). The Stationery Office, London
Lewis G, Pelosi AJ (1990) Manual of the revised clinical interview schedule. (CIS-R), Institute of Psychiatry
Bebbington P, Nayani T (1995) The psychosis screening questionnaire. Int J Methods Psychiatr Res 5:11–20
Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey construction of scales and preliminary tests of reliability and validity. Med Care 34:200–223
Ware JE, Kosinski M, Keller SD (1998) How to score the SF-12 physical and mental summary scales, 3rd edn. The Health Institute, New England Medical Center, Boston, MA
Wilkinson R (2000) Mind the gap: hierarchies, health and human evolution. Weidenfeld and Nicolson, London
Krieger N, Rowley DL, Herman AA, Avery B, Philips MT (1993) Racism, sexism and social class: implications for studies of health, disease and wellbeing. Am J Prev Med 9(Suppl 2):82–122
Madood T, Berthoud R, Lakey J, Nazroo JY, Smith P, Virdee S, Beishon S (1997) Ethnic minorities in Britain: diversity and disadvantage. Policy Studies Institute, London
Nazroo JY (1998) Genetic, cultural or socioeconomic vulnerability? Expanding ethnic inequalities in health. Soc Health Illness. 20:714–734
Nazroo J, Davey Smith G (2000) The contribution of socioeconomic position to health differentials between ethnic groups: evidence from the United States and Britain. In: Macbeth H, Shetty P (eds) Health and ethnicity: society for the study of human biology series: 41. Taylor and Francis, London, England, pp 41–58
Department of Health (2008) Health inequalities: progress and next steps. Department of Health: London
Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H (2001) Psychiatric morbidity among adults living in private households 2000. HMSO, London
Boydell J, Os VJ, McKenzie K, Murray RM (2004) The association of inequality with the incidence of schizophrenia: an ecological study. Soc Psychiatry Psychiatr Epidemiol 39:597–599
Harrison J, Barrow S, Creed F (1997) Mental health in the north west region of England: associations with deprivation. Soc Psychiatry Psychiatr Epidemiol 33:124–128
Reininghaus UA, Morgan C, Simpson J, Dazzan P, Morgan K et al (2008) Unemployment, social isolation, achievement—expectation mismatch and psychosis: findings from the ÆSOP Study. Soc Psychiatry Psychiatr Epidemiol 43:743–751
Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Weich S (2005) Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of ethnic minority groups in the United Kingdom. Am J Public Health 95:496–501
Maginn S, Boardman AP, Craig TKL, Haddad M, Heath G et al (2004) The detection of psychological problems by general practitioners influence of ethnicity and other demographic variables. Soc Psychiatry Psychiatr Epidemiol 39:464–471
Gater R, Tomenson B, Percival C, Chaudhry N, Waheed W et al (2009) Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK. Soc Psychiatry Psychiatr Epidemiol 44:198–207
Maynard MJ, Harding S, Minnis H (2007) Psychological well-being in Black Caribbean, Black African, and white adolescents in the UK Medical Research Council DASH study. Soc Psychiatry Psychiatr Epidemiol 42:759–769
Kirbride JB, Barker D, Cowden F, Stamps R, Yang M, Jones PB, Coid JW (2008) Psychoses, ethnicity and socio-economic status. Br J Psychiatry 193:18–24
Van Os J, Castle DJ, Takei N, Der G, Murray RM (1996) Psychotic illness in ethnic minorities: clarification from the 1991 census. Psychol Med 26:203–208
Fearon P, Kirkbride J, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Fung A, Holloway J, Mallet R, Harrison G, Leff J, Jones P, Murray R (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychol Med 36:1541–1550
Health Care Commission (2005) Count me in: results of a National Census of Inpatients in Mental Health Hospitals and Facilities in England and Wales. Health Care Commission, London
Harrison G, Owens D, Holton A, Neilson D, Boot D (1998) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 18:643–657
Cochrane R, Bal S (1989) Mental hospital admission rates of immigrants to England: a comparison of 1971 and 1981. Soc Psychiatry 24:2–11
Priebe S, Want A, Saidi M, Mangalore R, Knapp M (2009) Housing services for people with mental disorders in England: patient characteristics, care provision and costs. Soc Psychiatry Psychiatr Epidemiol 44:805–814
Equalities Review (2007) Fairness and freedom: final report of the Equalities Review. Cabinet Office, London
Office of National Statistics (2004) Focus on social inequalities. Palgrave Macmillan, London
Thornicroft G (2006) Shunned. Oxford University Press, Oxford
Shams M (1993) Social support and psychological well-being among unemployed British Asian Men. Soc Behav Personal 21:175–186
Shams M, Jackson PR (1994) The impact of unemployment on the psychological well-being of British Asians. Psychol Med 24:347–355
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mangalore, R., Knapp, M. Income-related inequalities in common mental disorders among ethnic minorities in England. Soc Psychiatry Psychiatr Epidemiol 47, 351–359 (2012). https://doi.org/10.1007/s00127-011-0345-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-011-0345-0