Unequal effects of climate change and pre-existing inequalities on the mental health of global populations

Climate change is already having unequal effects on the mental health of individuals and communities and will increasingly compound pre-existing mental health inequalities globally. Psychiatrists have a vital part to play in improving both awareness and scientific understanding of structural mechanisms that perpetuate these inequalities, and in responding to global calls for action to promote climate justice and resilience, which are central foundations for good mental and physical health

Exploring experiences with alcohol and how drinking has changed over time among minority ethnic groups with a diagnosed mental health problem

Introduction: Minority ethnic groups are more likely to experience poor mental health but lesslikely to seek formal support. Mental health problems and alcohol use (including non-drinking)co-occur, the reasons for this among minority ethnic groups are not well understood. This studyexplored i) alcohol use among minority ethnic individuals with a mental health problem,ii) howalcohol was used before individuals received support for their mental health,iii) how alcoholchanged whilst and after individuals received treatment for their mental health.Methods: Participants were purposively sampled through community/online mental healthorganisations. Participants took part if they i)were not White British, ii) had a mental healthdiagnosis, iii) drank at hazardous and above levels or former drinkers. Telephone/online semistructured interviews were conducted. Data were analysed using framework analysis with anintersectional lens.Results: 25 participants took part. Four themes were developed; “drinking motivations”, “mentalhealth literacy and implications on drinking behaviour”, “cultural expectations and its influenceon mental health problems and drinking practices”, and “reasons for changes in drinking”. Themesreflect reasons for drinking and the role of understanding the range of mental health problems andimplicit cultural expectations. An intersectional lens indicated gendered, ethnic and religiousnuances in experiences with alcohol and seeking support. Engaging with formal support promptedchanges in drinking which were facilitated through wider support.Conclusion: There were specific reasons to cope among minority ethnic individuals who have amental health problem. Applying an intersectional lens provided an insight into the role of culturaland gendered expectations on mental health and drinking practices. Mental health literacy andimplicit cultural expectations within specific minority ethnic groups can affect both mental healthand drinking practices. Healthcare professionals and wider community play an important role inprompting changes in drinking among minority ethnic groups who have a mental health problem.<br/

Ethnic density effects for adult mental health: systematic review and meta-analysis of international studies

Background Despite increased ethnic diversity in more economically developed countries it is unclear whether residential concentration of ethnic minority people (ethnic density) is detrimental or protective for mental health. This is the first systematic review and meta-analysis covering the international literature, assessing ethnic density associations with mental health outcomes. Methods We systematically searched Medline, PsychINFO, Sociological Abstracts, Web of Science from inception to 31 March 2016. We obtained additional data from study authors. We conducted random-effects meta-analysis taking into account clustering of estimates within datasets. Meta-regression assessed heterogeneity in studies due to ethnicity, country, generation, and area-level deprivation. Our main exposure was ethnic density, defined as the residential concentration of own racial/ethnic minority group. Outcomes included depression, anxiety and the common mental disorders (CMD), suicide, suicidality, psychotic experiences, and psychosis. Results We included 41 studies in the review, with meta-analysis of 12 studies. In the meta-analyses, we found a large reduction in relative odds of psychotic experiences [odds ratio (OR) 0.82 (95% confidence interval (CI) 0.76–0.89)] and suicidal ideation [OR 0.88 (95% CI 0.79–0.98)] for each 10 percentage-point increase in own ethnic density. For CMD, depression, and anxiety, associations were indicative of protective effects of own ethnic density; however, results were not statistically significant. Findings from narrative review were consistent with those of the meta-analysis. Conclusions The findings support consistent protective ethnic density associations across countries and racial/ethnic minority populations as well as mental health outcomes. This may suggest the importance of the social environment in patterning detrimental mental health outcomes in marginalized and excluded population groups

Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England

Objectives To determine if living in areas where higher proportions of people of the same ethnicity reside is protective for common mental disorders, and associated with a reduced exposure to discrimination and improved social support. Finally, to determine if any protective ethnic density effects are mediated by reduced exposure to racism and improved social support

How is city living associated with psychosis? Findings from a novel data linkage of 612,988 people from an urban and ethnically diverse area

Objectives UK cities show higher incidence of psychotic disorders, but the reasons remain unclear. This case-control study uses data from one of the first and largest person-level data linkages between mental health records and the UK census to explore associations previously only assessed using ecological or smaller studies in England. Methods The SocioEconomic Predictors of Mental Disorders (SEP-MD) project dataset comprises of data extracted from electronic health records (EHR) from the South London and Maudsley NHS Foundation trust (SLaM). These EHRs were linked to the 2011 UK census as a collaboration between SLaM, the ONS and King’s College London. Cases with clinical diagnoses of non-affective (schizophrenia-spectrum) and affective psychoses (bipolar disorder, depression with psychosis) were identified. Population controls were sampled from the locality. Logistic regression models were used to calculate weighted adjusted (age and sex) odds ratios (waOR) to assess associations. Robust standard errors were used to account for clustering. Results 16,863 linked cases with psychosis (affective n=5,694; non-affective n=11,169) were identified alongside 596,125 population controls. Cases with psychosis were more likely to live in areas with the highest population density (waOR 1.17 (1.05, 1.30)) when comparing the lowest quintile to the highest. Non-affective disorders showed the highest association with population density. Being born within the UK was associated with a higher risk of psychosis, and migrants living in the country for longer were at a significantly higher risk than those living in the UK for less time. Socioeconomic predictors, including education, occupation and tenure, were all associated with higher psychosis risk. Racialised minorities were at higher risk of specifically non-affective psychoses. Indicators of isolation (marital status and living alone) were highly associated with psychosis risk. Conclusions Our findings regarding urbanicity, ethnicity, migration socioeconomic position and social circumstances both confirm and provide further depth to previously identified associations. Novel findings relating to migration and interactions with ethnicity will require further investigation. These insights will provide valuable information for future public health and policy development

Neighbourhood ethnic density and psychosis — is there a difference according to generation?

Background For different migrant groups living in an area with few people from the same ethnic background is associated with increased psychosis incidence (the ethnic density effect). We set out to answer the question: are there generational differences in this effect? Methods Analysis of a population based cohort (2.2 million) comprising all those born 1st January 1965, or later, living in Denmark on their 15th birthday. This included 90,476 migrants from Africa, Europe (excluding Scandinavia) and the Middle East, with 55% first generation and the rest second-generation migrants. Neighbourhood co-ethnic density was determined at age 15 and we adjusted for age, gender, calendar period, parental psychiatric history and parental income. Results For first-generation migrants from Africa, there was no statistically significant difference (p = 0.30) in psychosis rates when comparing lowest with highest ethnic density quintiles, whereas the second generation showed a 3.87-fold (95% CI 1.77–8.48) increase. Similarly, for migrants from the Middle East, the first generation showed no evidence of an ethnic density effect (p = 0.94) while the second showed a clear increase in psychosis when comparing lowest with highest quintiles, incidence rate ratio (IRR) 2.43 (95% CI, 1.18–5.00). For European migrants, there was some limited evidence of an effect in the first generation, (IRR) 1.69 (95% CI, 1.19–2.40), with this slightly raised in the second: IRR 1.80 (95% CI, 1.27–2.56). Conclusions We found strong evidence for an ethnic density effect on psychosis incidence for second-generation migrants but this was either weak or absent for the first generation

Does social disadvantage over the life-course account for alcohol and tobacco use in Irish people? Birth cohort study

Medical Research Council (MRC) training fellowship awarded to J.D-M; Grant number: G0701595/