“We need to slowly break down this barrier”: understanding the barriers and facilitators that Afro-Caribbean undergraduates perceive towards accessing mental health services in the UK

A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action

BACKGROUND

Measurable differences in the experience and treatment of mental health conditions have been found to exist between different racial categories of community groups. The objective of this research was to review the reported mental health of Black African-Caribbean communities in the UK, determinants of mental health, and interventions to enhance their experiences of mental health services.

METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was applied. To be included, papers must be published in a peer reviewed journal; report on adult populations (over 18) from any of Black African, Black Caribbean or Black mixed people in the UK; and assess (quantitative), or discuss (qualitative) mental health experiences, determinants of mental health, or interventions intended to enhance experiences of mental health services among the target population. The aims, inclusion criteria, data extraction, and data quality evaluation were specified in advance. Searches were conducted using EBSCO (PsychInfo; MEDLINE; CINAHL Plus; psychology and behavioural sciences collection). The search strategy included search terms relating to the aim. Risk of bias was assessed using a standard tool, records were organised using Endnote, and data were extracted and synthesised using Microsoft Excel.

RESULTS

Thirty-six studies were included, of which 26 were quantitative and six reported exclusively on Black participants. Black populations were less likely to access mental health support via traditional pathways due to stigma and mistrust of mental health services. Black Africans especially, sought alternative help from community leaders, which increased the likelihood of accessing treatment at the point of crisis or breakdown, which in turn increased risk of being detained under the Mental Health Act and via the criminal justice system.

DISCUSSION

Findings suggest a cycle of poor mental health, coercive treatment, stigma, and mistrust of services as experienced by Black communities. Evidence was limited by poorly defined ethnic categories, especially where Black populations were subsumed into one category. It is recommended that mental health services work collaboratively with cultural and faith communities in supporting Black people to cope with mental illness, navigate mental health pathways, and provide culturally appropriate advice. Protocol Registration Number PROSPERO CRD42021261510.

Self-esteem among college students: the intersectionality of psychological distress, discrimination and gender

Purpose

The purpose of this study was to assess the prevalence of low self-esteem among college students and how exogenous and endogenous factors, such as experiences of discrimination and psychological distress, respectively, impact such an outcome.

Design/methodology/approach

General education courses were used to conduct a quantitative cross-sectional study among undergraduate college students. The primary outcome variable of interest in this study was self-esteem, which was measured using the Rosenburg’s self-esteem scale. Primary independent variable was psychological distress (measured using Kessler 6 scale). Discrimination experiences were measured using the Everyday Discrimination Scale (EDS). Descriptive, bivariate and multiple linear regressions were conducted to find associations among such variables.

Findings

Among 308 young adults in this study, psychological distress was significantly related to low self-esteem (ß = −6.50, p < 0.001). In addition, increasing EDS score (ß = −0.37, p = 0.019) and women gender (ß = −1.29, p = 0.038) were also associated with low self-esteem.

Research limitations/implications

The study was cross-sectional and thus cannot provide causal relationship. The self-reported data is susceptible to recall bias. College students continue to face negative social experiences that impact their self-esteem, and discrimination plays a substantial role.

Practical implications

Gender-specific self-esteem coaching is needed among college students with psychological distress and among those with experiences of discrimination.

Social implications

The results of the current study provide information for understanding the role of discrimination and psychological well-being on self-esteem of college students, and thus further address the importance of social determinants of health and well-being.

Originality/value

This study provides a unique insight into the disparities faced by college students. Understanding self-esteem at the individualistic and collectivistic levels will allow for the planning and implementation of comprehensive interventions that address gender differences and psychological distress that will increase the positive health outcomes and decrease the negative health outcomes.