Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom

Religious minority status and risk of hypertension in women: Evidence from Bangladesh

Discrimination based on religion and communal violence against religious minorities have been on the rise worldwide. Despite growing incidences of violence against religious minorities, little is known on the relationship between minority status and population health outcomes in the low-and-middle income countries (LMICs). This study intends to fill this gap by assessing the prevalence of hypertension among religious minority women in Bangladesh, a South Asian country with high levels of social hostilities involving religion. Using data from the Bangladesh Demographic and Health Survey (BDHS) 2017-18, we examined whether religious minority women had a differential risk of having hypertension. We estimated logistic regression models to obtain the odds in favor of being hypertensive among women aged 18-49 years and compared the odds for religious minority women with that of their non-minority counterparts. We then estimated linear regression models to examine how average systolic- and diastolic-blood pressure measures differ across minority and non-minority women. We found that the odds of being hypertensive for minority women were 1.43 (95 % CI: 1.14-1.79) times that of their non-minority counterparts. The adjusted odds ratio was very similar, 1.45 (95 % CI: 1.14-1.84), when various sociodemographic and other risk factors were accounted for. The conditional average SBP and DBP levels were respectively 3.42 mmHg (95 % CI: 1.64-5.20) and 1.44 mmHg (95 % CI: 0.37-2.51) higher among minority women. Thus, we found evidence that religious minority women in Bangladesh had a disproportionately higher risk of having hypertension compared to their non-minority peers. These results call for further research on psychological distress from systematic discrimination and collective trauma among religious minorities in Bangladesh.

Exploring the mechanisms underlying increased risk of depressive disorder in ethnic minority populations in Europe: A causal loop diagram

BACKGROUND

Multiple ethnic minority populations in Europe show high risk of major depressive disorder (MDD), with ethnic discrimination and low socioeconomic position (SEP) as established risk factors. How this risk is shaped by the interactions between these, and other social factors, remains to be elucidated. We aimed to develop a causal-loop diagram (CLD) to gain a better understanding of how factors at the intersection of ethnic discrimination and SEP dynamically interact to drive MDD risk.

METHODS

We iteratively mapped the interactions and feedback loops between factors at the intersection of ethnic discrimination and SEP, drawing input from (i) a series of two interviews with a range of MDD domain experts, (ii) an existing CLD mapping the onset of MDD across psychological, biological, and social dimensions at the level of the individual, and (iii) other relevant literature.

RESULTS

Through tracing the feedback loops in the resulting CLD, we identified ten driving mechanisms for MDD onset in ethnic minorities (two related to ethnic discrimination, SEP, social network and support, and acculturation, as well as one relating to the living environment and self-stigma towards MDD); and four factors that modulate these mechanisms (recent migration, religious affiliation, neighborhood social environment, and public stigma towards MDD). The intersecting nature of ethnic discrimination and SEP, combined with the reinforcing dynamics of the identified driving mechanisms across time- and spatial scales, underscores the excess exposure to circumstances that increase MDD risk in ethnic minorities.

CONCLUSIONS

While this CLD requires validation through future studies, the intersecting and reinforcing nature of the identified driving mechanisms highlights that tackling the high risk of MDD in ethnic minorities may require intervening at multiple targets, from the individual (e.g., psychological interventions targeting negative beliefs or reducing stress) to the societal level (e.g., addressing labor market discrimination).

Occupation-related factors affecting the health of migrants working during the COVID-19 pandemic - a qualitative study in Norway

BACKGROUND

The effects of the COVID-19 pandemic were more pronounced among migrants than in the majority population and went beyond those directly caused by the virus. Evidence suggests that this overburden is due to complex interactions between individual and structural factors. Some groups of working migrants were in vulnerable positions, overrepresented in essential jobs, under precarious work conditions, and ineligible for social benefits or special COVID-19 economic assistance. This study aimed to explore the experience of migrants working in Norway during the COVID-19 pandemic to gather an in-depth understanding of the pandemic´s impact on their health and well-being, focusing on occupation-related factors.

METHODS

In-depth personal interviews with 20 working migrants from different job sectors in Bergen and Oslo were conducted. Recruitment was performed using a purposive sampling method. Thematic analysis was used.

RESULTS

At the workplace level, factors such as pressure to be vaccinated, increased in occupational hazards, and increased structural discrimination negatively impacted migrants' health. Other factors at the host country context, such as changes in social networks in and out of the workplace and changes in the labour market, also had a negative effect. However, the good Norwegian welfare system positively impacted migrants' well-being, as they felt financially protected by the system. Increased structural discrimination was the only factor clearly identified as migrant-specific by the participants, but according to them, other factors, such as changes in social networks in and out of the workplace and social benefits in Norway, seemed to have a differential impact on migrants.

CONCLUSIONS

Occupational-related factors affected the health and well-being of working migrants during the pandemic. The pressure to get vaccinated and increased structural discrimination in the workplace need to be addressed by Norwegian authorities as it could have legal implications. Further research using intersectional approaches will help identify which factors, besides discrimination, had a differential impact on migrants. This knowledge is crucial to designing policies towards zero discrimination at workplaces and opening dialogue arenas for acknowledging diversity at work.

Mental health among people with a migration background in Belgium over the past 20 years: how has the situation evolved?

BACKGROUND

Poor mental health is highly stigmatized and stereotyped, even more when it comes to migrant and ethnic minority groups (MEM). Belgium, which has a long history of immigration, is a good case study for analysing how the prevalence of mental illness (MI) has evolved over time and how such evolution had differed between MEM. This paper seeks to explore the prevalence of MI and potential inequalities among MEM compared to native Belgians between 1997 and 2018, shedding light on this important issue.

METHODS

The data set is composed of the six cross-sectional waves of the Belgian Health Interview Survey from 1997 to 2018. The 12-item General Health Questionnaire was used to assess the average level of mental health and the prevalence of MI (score ≥ 4) among five major MEM groups in Belgium (Belgian, Moroccan, Turkish, European migrants, and non-European migrants). Multivariate logistic and linear regression models were used to assess the likelihood of having a MI in the different MEM groups and survey years. The minimal clinically important difference (MID) was also calculated for the severity of MI.

RESULTS

After controlling for socioeconomic status, the average marginal effect indicated a decrease in mental health among Moroccans and Turks in Belgium between 1997 and 2018, compared to Belgians. This result was confirmed by the Chi²-test, which showed that Turkish (χ²=17.75, p < 0.001) and Moroccans respondents (χ²=4.19, p < 0.04) had a higher overall level of mental distress than Belgians. Furthermore, in 2018, even after adjusting for age, sex and education level, having a mother born in a non-EU country increased the risk of mental illness.

CONCLUSIONS

Mental health inequalities between migrant and ethnic groups are on the rise in Belgium. To address this issue, particular attention should be given to the Moroccan and Turkish background populations. Specific interventions and policies must be implemented to prevent the increase of psychological distress among migrants and ethnic minorities, on the one hand, and ensure that high-quality mental health care is accessible to all, regardless of ethnicity, on the other hand. Additionally, we recommend that future research on ethnic mental healthcare includes better data collection on the country of birth of respondents and their parents.

Understanding self-harm and suicidal behaviours in South Asian communities in the UK: systematic review and meta-synthesis

BACKGROUND

Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people.

AIMS

The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK.

METHOD

Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach.

RESULTS

Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. 'Behind self-harm' refers to factors associated with self-harm and suicide. 'Functions of self-harm' captures the meaning attributed to self-harm and suicide. 'Recovery from self-harm' encapsulates personal and professional help, and practical suggestions for the improvement of mental health services.

CONCLUSIONS

Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.

Maternal psychological functioning mediates the association between infant behavior and subsequent child psychological functioning

Symptoms of psychopathology that onset during childhood are often more severe, chronic, and difficult to treat than symptoms that first appear later in life. Maternal psychological symptoms are associated with the development of psychological symptoms in children. However, less research focuses on whether children's behaviors may presage maternal psychological difficulties that, in turn, contribute to the child's own psychological functioning. Identifying psychological difficulties in families and intervening in early life may lower risk for intergenerational transmission of subsequent psychological symptoms. Even at non-clinical or normative levels, exploring transactional models of parent-child behavior and psychological functioning may provide insight into the development of later psychological difficulties or symptoms within families. Thus, the current study examined whether difficult infant behavior (e.g., fussiness, unpredictability) is associated with future maternal psychological difficulties and subsequently, the child's own psychological functioning in early childhood. The current sample includes 847 dyads from a multi-wave birth cohort in England ('Born in Bradford'), who identified as predominantly non-White (62.2%) and socioeconomically diverse. Mothers reported on their child's behaviors at 6 months, their own psychological functioning during pregnancy and at 18 months postpartum, and their child's psychological functioning at age 3. Results of a mediation model revealed that the association between infant behavior at 6 months and child psychological functioning at 3 years is partially explained by maternal psychological functioning at 18 months, even after accounting for psychological difficulties during pregnancy, maternal age at birth, child sex, family income, and ethnicity. Post-hoc exploratory analyses revealed that the association between infant behavior, maternal psychological functioning, and subsequent child psychological functioning was significant for Pakistani British families but not White British families. These findings provide preliminary evidence that infant behaviors (e.g., temperament) may presage future maternal psychological difficulties and subsequent child psychological functioning, above and beyond previous maternal psychological functioning. Importantly, these results highlight infant behavior as a potential catalyst for later psychological difficulties within families.

Racial discrimination and its impact on mental health

There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.

Observed and personally experienced discrimination: findings of a cross-sectional survey of physicians and nursing staff

BACKGROUND

Discrimination against hospital staff based on ascribed features is prevalent in healthcare systems worldwide. Detrimental effects on health and quality of patient care have been shown. Our study aims to describe and analyse the discrimination experiences of both physicians and nurses, specifically for the German hospital context.

METHODS

A cross-sectional online survey on observed and personally experienced discrimination at work addressed staff from 22 hospitals of two organizations in Germany. Sociodemographic and occupational as well as institutional characteristics served as independent variables. In multivariable analyses, block- and stepwise logistic regressions were calculated for the two dependent variables (witness and victim of discrimination). Sensitivity analyses with imputed data for missings were performed.

RESULTS

N = 800 healthcare professionals (n = 243 physicians, n = 557 nurses; response rate: 5.9%) participated in the survey. 305 respondents (38.1%) were witnesses of discrimination, while 108 respondents (13.5%) were victims of discrimination in their wards. Reasons for observed discriminatory acts were predominantly attributed to the ethnicity of the person concerned, their appearance and language, whereas personally affected staff most frequently cited gender as a reason, followed by ethnicity, and physical appearance. In multivariable models, cultural competence significantly increased the likelihood of witnessing discrimination (β = .575; p = .037). In terms of the likelihood of being a victim of discrimination, in addition to cultural competence (β = 2.838; p =  < .001), the interaction of the effects of gender and professional group was statistically significant (β = .280; p = .010).

CONCLUSIONS

Given the extent of experienced and observed discrimination, appropriate institutional responses are needed. Further research on discriminatory structures in the German-speaking health care system should focus on discrimination at the intersection of ethnicity, gender and occupation.

What factors are truly associated with risk for radicalisation? A secondary data analysis within a UK sample

Radicalisation and extremist violence are of increasing concern internationally. The unconventional, decentralised, and transnational nature of modern terrorism involves an active process of radicalisation requiring national security responses to reflect findings from recent empirical research. This study aims to identify factors that relate to extremist attitudes and potential vulnerability to radicalisation in order to inform preventative action. A cross-sectional survey was conducted of a representative population sample of men and women aged 18-45 of Muslim heritage recruited by quota sampling in two English cities. Logistic regressions were performed on a seven-item dichotomised measure based on our previously developed scale of 'sympathy for terrorist acts'. Scores representing 'non-condemnation of these acts' were deemed to represent risk for radicalisation. Thirteen respondents had a positive score on the sympathy for terrorism measure (2.4%), 39 scored zero (6.41%) and the remainder (91.4%) had a negative score representing condemnation of terrorist acts. There was a significant association between sympathy for terrorism and belonging to the local or global Muslim community, anxiety, and support for the use of defensive violence. Gender, religious identity, country of birth, belief in Sharia law, the importance of religion in life, and mosque attendance were all not associated with sympathy for terrorism. The results contribute to an understanding of the radicalisation process and have potential value in developing preventative public health interventions.

Racism and mental health and the role of mental health professionals

The concept of "race" and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be "the others," who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of "the other" on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of "race" is genetically incorrect. Therefore, the implicit racism that underlies many established "scientific" paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.

Ethnic Identity as a Mediator of the Relationship between Discrimination and Psychological Well-Being in South-South Migrant Populations

There is abundant evidence about the negative impact of discrimination on well-being, but less research on factors that can reduce this negative effect, mainly focused on North American samples and with incipient development on South-South migration. The objective of this research was to analyze the effect of ethnic identity on the relationship between the experience of racial and ethnic discrimination and psychological well-being in Colombian immigrants living in Chile. A total of 962 immigrants over the age of 18 from three cities in Chile participated. Of these, 50.7% were women. The average age was 35 years (SD = 10.23). Participants were evaluated using Ryff's Psychological Well-Being Scales, Phinney's adapted version of the Multigroup Ethnic Identity Scale, and Krieger's Discrimination Experience Scale. After the analysis of the measurement models, a mediation model was analyzed using structural equations. The results provide evidence that ethnic and racial discrimination have negative effects on psychological well-being, with the effect of racial discrimination being greater. Likewise, ethnic identity has positive effects on psychological well-being and partially and completely mediates the effects of ethnic and racial discrimination on psychological well-being. The full effect of discrimination on psychological well-being, mediated by ethnic identity, is exercised only by racial discrimination and not by ethnic discrimination.

[Racism and mental health]

Der Beitrag gibt einen Überblick zu Rassismusdiskursen in Forschung und Praxis im Gesundheitsbereich und erörtert individuelle und institutionelle Auswirkungen von Rassismus und Diskriminierung auf die psychische Gesundheit. Daran anschließend wird erörtert, welche rassismuskritischen Transformationen in den Versorgungsstrukturen für psychisch erkrankte Personen notwendig sind, um eine gleichberechtigte Teilhabe von Menschen, die von Diskriminierung und Rassismus betroffen sind, zu ermöglichen.

Extremism and common mental illness: cross-sectional community survey of White British and Pakistani men and women living in England

BACKGROUND

Mental illnesses may explain vulnerability to develop extremist beliefs that can lead to violent protest and terrorism. Yet there is little evidence.

AIMS

To investigate the relationship between mental illnesses and extremist beliefs.

METHOD

Population survey of 618 White British and Pakistani people in England. Extremism was assessed by an established measure of sympathies for violent protest and terrorism (SVPT). Respondents with any positive scores (showing sympathies) were compared with those with all negative scores. We calculated associations between extremist sympathies and ICD-10 diagnoses of depression and dysthymia, and symptoms of anxiety, personality difficulties, autism and post-traumatic stress. Also considered were demographics, life events, social assets, political engagement and criminal convictions.

RESULTS

SVPT were more common in those with major depression with dysthymia (risk ratio 4.07, 95% CI 1.37-12.05, P = 0.01), symptoms of anxiety (risk ratio 1.09, 95% CI 1.03-1.15, P = 0.002) or post-traumatic stress (risk ratio 1.03, 95% CI 1.01-1.05, P = 0.003). At greater risk of SVPT were: young adults (<21 versus ≥21: risk ratio 3.05, 95% CI 1.31-7.06, P = 0.01), White British people (versus Pakistani people: risk ratio 2.24, 95% CI 1.25-4.02, P = 0.007) and those with criminal convictions (risk ratio 2.23, 95% CI 1.01-4.95, P = 0.048). No associations were found with life events, social assets and political engagement.

CONCLUSION

Depression, dysthymia and symptoms of anxiety and post-traumatic stress are associated with extremist sympathies.

Does exposure to workplace hazards cluster by occupational or sociodemographic characteristics? An analysis of foreign-born workers in Australia

BACKGROUND

Disparities in exposure to occupational hazards may be linked to social position as well as the type of job a person holds. This study aimed to describe the prevalence of exposure to workplace hazards among three migrant worker groups and to assess whether social disparities in exposure for these groups remain after adjusting for occupational characteristics.

METHODS

Data were collected in 2017/2018 from 1630 Australian workers born in New Zealand, India, and the Philippines. Weighted estimated prevalence of exposure to 10 carcinogens and four psychosocial hazards (discrimination, job strain, vulnerability, and insecurity) was calculated for sociodemographics and occupation. Regression estimated the likelihood of exposure by sociodemographics after adjustment for occupational characteristics.

RESULTS

Exposure to workplace hazards ranged from 11.7% (discrimination) to 61.2% (exposed to at least one carcinogen). Compared with workers born in India, New Zealand born workers were over twice as likely to be exposed to diesel engine exhaust (adjusted odds ratio [aOR] = 2.60) and 60% more likely to be exposed to at least one carcinogen (aOR = 1.60) but less likely to be exposed to any psychosocial hazard. Social disparities by country of birth, sex, age, education, and number of years in Australia, as well as company size, employment type, and hours, worked remained associated with greater likelihood of reporting one or more workplace hazards after adjusting for occupational characteristics.

CONCLUSION

Examining sociodemographic as well as occupational characteristics helps to clarify groups most likely to be exposed to workplace hazards who can be hidden when examining occupational characteristics alone.

Effect of Work Environment on Presenteeism among Aging American Workers: The Moderated Mediating Effect of Cynical Hostility

Cynical hostility in the workplace has been studied. However, there is still no complete study examining how cynical hostility affects work performance. We examined how work environment impacts presenteeism through the mediation of cynical hostility and how chronic work discrimination moderates the relationship between work environment and cynical hostility among ageing workforces. The psychosocial vulnerability model supplies theoretical support for our model. We analyzed data from a sample of 2926 aging workforces from the Health and Retirement Study. Structural equation modeling (SEM) was used to examine the relationships with a moderated mediation model. In the final SEM model, our results showed that work environment was directly negatively associated with presenteeism. Moreover, cynical hostility was significantly inversely correlated with work environment and positively correlated with presenteeism. We found that the significant indirect effect between work environment and presenteeism can be significantly mediated by cynical hostility. In addition, cynical hostility is more likely to be affected by work environment among ageing workforces with lower levels of chronic work discrimination than those with higher levels. Enterprise, government, and employees themselves should be aware of the impact of presenteeism on ageing workforces with high levels of cynical hostility.

Unravelling the complexities of inequalities in mental healthcare and outcomes for cultural and linguistic minorities

This is a reappraisal of psychiatric morbidity in North Americans from Indigenous backgrounds, or those from longstanding minority communities. Psychiatric morbidity is often no higher when compared with controls that are similar in other sociodemographic features. Interventions should therefore take into account that disadvantage is rarely from one cause.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Cultural competency training in psychiatry

Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.

Challenges of healthcare professionals in providing care to South Asian ethnic minority patients in Hong Kong: A qualitative study

Ethnic minorities across the globe encounter disparities in healthcare. While a great deal of research has been conducted on the experiences of these patients, studies focusing on the perspectives of healthcare professionals are limited, particularly in the context of Asia. This study explores the perceptions of and challenges faced by Hong Kong healthcare professionals in the provision of culturally appropriate care to South Asian ethnic minority patients. Taking a qualitative approach, interviews were conducted with 22 healthcare professionals. Two main themes were identified: 'lack of support' at the healthcare system level and 'dysfunctional relationship with South Asian ethnic minority patients' at the interpersonal level. Challenges at the healthcare system level include information outreach, cultural competency, utilisation of available resources and time and workload, whereas challenges at the interpersonal level include patient-provider interaction, patient-provider perceptions of illness and care and patient-provider sociocultural discordance. Intercultural care was found to be influenced by both the healthcare system and interpersonal characteristics. The study highlights the need for healthcare professional education and training in cultural competency, in order to improve the provision of intercultural care. Identifying the challenges faced by healthcare professionals and the implications of these challenges for the provision of healthcare to South Asian ethnic minority patients will help practitioners, policy makers and care provider agencies to improve quality of care and health outcomes for culturally diverse patients.

Discrimination in the United States: Experiences of Asian Americans

Objective

To examine experiences of racial discrimination among Asian Americans, which broadly contribute to poor health outcomes.

Data Source and Study Design

Data come from a nationally representative, probability‐based telephone survey, including 500 Asian and a comparison group of 902 white US adults, conducted January to April 2017.

Methods

We calculated the percent of Asian Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Asian‐white difference in odds of discrimination, and among Asians only to examine variation by geographic heritage group (South Asian versus East Asian) and gender.

Principal Findings

13 percent of Asians reported discrimination in healthcare encounters. At least one in four adults reported experiencing discrimination in employment (27 percent job applications, 25 percent equal pay/promotions); housing (25 percent); and interpersonal interactions (35 percent microaggressions, 32 percent racial slurs). In unadjusted models, East and South Asians were more likely than whites to report experiences of institutional discrimination, and South Asians were more likely than whites to report microaggressions. In adjusted models, Asians had higher odds than whites of reporting avoiding health care due to discrimination concerns and also when obtaining housing.

Conclusions

Asians in the United States experience discrimination interpersonally and across many institutional settings, including housing and health care. South Asians may be especially vulnerable to forms of institutional discrimination and microaggressions. These results illustrate a need for greater investigation into the unique experiences of Asian subgroups and greater protections for groups at higher risk of discrimination, within health care and beyond.

Religion, social integration, and depression in Europe: Evidence from the European Social Survey

Western Europe's growing Muslim population has occasioned considerable debate regarding cultural integration, immigration, and social isolation. In this study I explore the relationship between religious identification and depression in European countries, focusing in particular on the situation of Muslims, but comparing across other religious groups, as well as those who are unaffiliated with any religion. The analysis is based on countries sampled in the sixth round of the European Social Survey, conducted in 2012. The results reveal the dueling effects of religious identity: religious involvement involves social integration among like-minded friends, but can also invite discrimination from others. This dueling effect implies significant differences between groups. Among Protestants and Catholics greater religious identification is associated with progressively lower depression, relative to those with no affiliation. Among Muslims lower levels of identification are associated with significantly more depression. Muslims of the highest level of identification are statistically indistinguishable from those with no religious affiliation. These patterns among Muslims are not born of poor social integration, but rather reflect more experiences with discrimination. Overall differences among religious groups are very strong: the difference in depression between Muslims and Protestants, for instance, exceeds the difference between men and women.

Measuring the impact of multiple discrimination on depression in Europe

BACKGROUND

The study of the health effects of perceived discrimination based on ethnic and social traits has a long-standing and widespread tradition in epidemiological research, but less attention has been paid to the study of multiple discrimination, particularly its effects on mental health. The present work aims to analyse the association between multiple discrimination and depressive symptoms in Europe, and the impact of contextual socioeconomic circumstances on this relationship.

METHODS

In this study, data from the 7th Round of the European Social Survey was used. Given that the outcome variable, CES-D8, is a depression scale from 0 to 24 possible values and the hierarchical organisation of individuals (level-1 units) clustered within countries (level-2 units), a linear multilevel model was carried out.

RESULTS

Our findings suggest that multiple discrimination increases our risk of suffering depressive disorder, but in addition this work provides an important step forward to explain and understand how the relationship between multiple discrimination and depression might vary depending the socioeconomic context. In particular, we can observe that differences in the prevalence of depressive symptoms along multiple discrimination levels decrease as GDP per capita increases among European countries.

CONCLUSION

This study is relevant since provides new evidence on how the association between multiple discrimination and depression operates at the micro and macro-level context, which is fundamental to understand how macro-economic fluctuations of countries may determine depressive disorders through the effect of single and combined forms of discrimination.

Work hazards and workers' mental health: an investigation based on the fifth European Working Conditions Survey

Background:

Workplace hazards are a significant source of health impairment for workers and of financial losses for firms. EU directives on workers’ health and safety standards significantly contributed to reduce reported occupational injuries, yet the incidence and prevalence of work-related mental illness is still very high.

Objectives:

We investigated the association between work-related hazards and individuals’ perceived mental health. We reviewed the existing evidence on the channels through which task-related factors, adverse agents and psychosocial factors are expected to affect workers’ health, with specific regard to mental health.

Methods:

We used data from the fifth wave of the European Working Conditions Survey, covering over 40,000 face-to-face interviews with workers in 34 countries, which includes information on socio-demographic characteristics, firms and jobs attributes, employment status, as well as working conditions and health status. We carried out an empirical analysis with multivariate regression models in order to estimate the relationship between workers’ mental health problems and workplace risk factors.

Results:

21,020 interviews were used in the multivariate analysis. We found strong correlations between hazards and various indicators of mental health. Among hazardous agents, low temperatures (β=0.0287) and contact with infectious materials (β=0.0394) were positively associated with mental health outcomes. Among task/sequence-related factors, tiring or painful positions (β=0.0713), repetitive hand/arm movements (β=0.0255), working with VDUs (β=0.0301), repetitive tasks <10 min (β=0.0859) and working in evenings (β=0.00754) were positively associated with mental health. Various psychosocial risk factors related to both the content of the job (for example, frequent disruptive interruptions: β=0.219, working in free time: β=0.0759, poor work-life balance: β=0.228) as well as the job context (for example, bad employment prospects: β=0.177, low decisional autonomy: β=0.245, bad social relations: β=0.186, workplace violence: β=0.411) were positively associated with mental health. The main results of the decomposition show that an important contribution to workers’ overall mental distress at work is associated with psychosocial risk factors (up to 60% for depression/anxiety symptoms and sleep disorders), while the contribution of somatic factors is on average lower (up to 20% for overall fatigue).

Conclusions:

We argue that action is needed to improve workers’ mental well-being, and reduce the economic costs for both the national health system and employers. Regulations and traditional economic measures are unlikely to prove successful in providing adequate standards of primary and secondary preventive measures in the work place without an appropriate and reliable Risk Assessment Procedure.

The buffering effect of social support on the relationship between discrimination and psychological distress among church-going African-American adults

Discrimination is a pervasive stressor among African-American adults. Social support is an important protective factor for psychological distress, especially among minority populations. Although a number of studies have examined social support in relation to discrimination, little research has examined how social support may serve as an important protective factor against both physical and psychological symptoms related to overall psychological distress within this group. The current study examined social support as a moderator of the relationship between discrimination and overall psychological distress as measured by the Brief Symptom Inventory among a community sample of 122 African-American church-going adults. Results indicated that social support buffered the associations of discrimination and overall psychological distress (p < 0.0001) in expected directions. Findings highlight the importance of cultivating strong social relationships to attenuate the effects of this social determinant on mental health disparities among this group.

Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London)

BACKGROUND

According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds.

AIMS

To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds.

METHOD

Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context.

RESULTS

Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations.

CONCLUSIONS

Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.

The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment

Background

There is limited evidence for public health policy-makers on the health impacts of urban regeneration programmes.

Objectives

To assess whether or not the London 2012 Olympic and Paralympic Games, and related urban regeneration, were associated with an increase in physical activity and mental health and well-being; to assess whether or not any benefits were sustained over time; and to capture the experiences of residents of the Olympic host boroughs.

Design

Quasi-experimental prospective cohort study of adolescents and their parents/carers, with a nested qualitative longitudinal study of families.

Setting

London boroughs of Newham, Barking and Dagenham, Tower Hamlets and Hackney.

Participants

A cohort of 2254 adolescents in 25 schools; a repeat cross-sectional study of parents/carers and a sample of 20 families for the qualitative study.

Intervention

The London 2012 Olympic and Paralympic Games, and urban regeneration primarily associated with the redevelopment of the Olympic Park for legacy use.

Primary outcome measures

Change in the proportion of respondents meeting physical activity recommendations (using self-reported physical activity); change in the proportion of respondents reporting depression and anxiety and change in well-being score.

Main results

At 6 months, adolescents who became inactive were less likely to come from the intervention borough (Newham) than from comparison boroughs [risk ratio (RR) = 0.69, 95% confidence interval (CI) 0.51 to 0.93]. At 18 months, there were no statistically significant differences between intervention and comparison boroughs for all adolescent physical activity and screen-time transitions. Those who visited the Olympic Park more than once a month were the least likely to remain inactive (RR 0.11, 95% CI 0.02 to 0.48) and the least likely to become inactive (RR 0.38, 95% CI 0.24 to 0.60) compared with those who were active at baseline and at the 18-month follow-up. No impacts on parental/carer physical activity were observed. Adolescents who were ‘no longer depressed’ (RR 1.53, 95% CI 1.07 to 2.20) or ‘remained depressed’ (RR 1.78, 95% CI 1.12 to 2.83) at 6 months were more likely to be from the intervention borough. For well-being, there was no association between boroughs and change in well-being between baseline and the 6-month follow-up. At 18 months’ follow-up, adolescents who ‘remained depressed’ (RR 1.93, 95% CI 1.01 to 3.70) were more likely to be from the intervention borough than from comparison boroughs. No associations were observed for well-being at 18 months. There was limited evidence of change for parental mental health and well-being. The qualitative study found that residents generally welcomed the unexpected chance to live in a cleaner, safer and more unified environment. The findings suggested that the Games temporarily alleviated certain stressors in the social and physical environment. Overall, the Games lessened participants’ sense of social exclusion and appeared to generate a sense of inclusion and respite, even if this was only temporary. Study limitations include the potential for adolescents to not be assigned the correct level of exposure to urban regeneration and the effect of reductions in central and local public budgets owing to the UK Government’s deficit reduction programme.

Conclusions

This study provided the highest quality data to date on the short- and medium-term social and health impacts of sporting mega-events. We found limited evidence that the London 2012 Olympic and Paralympic Games had a positive effect on adolescent or parental physical activity, mental health or well-being.

Funding

The National Institute for Health Research Public Health Research programme.

Interpersonal and institutional ethnic discrimination, and mental health in a random sample of Palestinian minority men smokers in Israel

PURPOSE

We sought to extend research into the health effects of discrimination to a non-Western context. We examined the associations between interpersonal and institutional ethnic discrimination, and anxiety and depression among Palestinian-Arab minority men citizens of Israel.

METHODS

We used data from a nationwide stratified random sample of 964 Arab men in Israel, current or former smokers (age 18-64), who were interviewed as part of a 2012-2013 study on cessation. The questionnaire included an adapted Arabic version of the Experiences of Discrimination scale and a new scale on perceived institutional group discrimination. Logistic regression models estimated the effects of both forms of discrimination on depressive symptoms (Center for Epidemiological Studies Depression Scale) and anxiety (State-Trait Anxiety Inventory), while adjusting for socio-demographic and economic factors.

RESULTS

The prevalence of depressive symptoms was 24.7% and anxiety 45.5%. Approximately 42% of men reported experiencing interpersonal discrimination, and 50.8% reported perceived institutional group discrimination. Controlling for covariates, experiencing interpersonal discrimination was associated with higher odds for depressive symptoms [OR = 2.36, 95% confidence intervals (CI) = 1.69-1.57] and anxiety (OR = 1.92, 95% CI = 1.45-2.55). Perceived institutional group discrimination was associated only with anxiety (OR = 1.76, 95% CI = 1.32-2.35). Introducing both forms of discrimination into the same model slightly attenuated these associations.

CONCLUSIONS

Interpersonal and institutional forms of ethnic discrimination are independently associated with poorer mental health among Arab minority men current and former smokers in Israel. Future research is warranted into both forms of discrimination in the general Arab population in Israel, including women.

Workplace psychosocial stressors experienced by migrant workers in Australia: A cross-sectional study

OBJECTIVE

To explore work-related psychosocial stressors among people of Chinese, Vietnamese and Arabic-speaking backgrounds currently working in Australia.

METHODS

In 2015, a telephone survey of 585 Vietnamese, Chinese and Arabic-speaking workers asked about workplace bullying, ethnic discrimination, job complexity, degree of control, security and fairness of payment along with demographic and employment information. Estimates of job-related psychosocial stressors were derived and regression analyses used to identify significant associations.

RESULTS

At least one workplace stressor was reported by 83% of the workers in the study. Education was significantly associated with experiencing any psychosocial stressor and also with the total number of stressors. Workers aged 45 years and older were more likely to be bullied or experience racial discrimination compared with younger workers of any ethnicity. There was a greater likelihood of reporting low control over a job when the interview was conducted in a language other than English and the workers were either Chinese or Arabic. Workers on a fixed-term contract, independent of ethnicity were more likely to report a job with low security. Overall psychosocial job quality decreased with education and was associated with occupation type which interacted with ethnicity and gender.

CONCLUSIONS

The results suggest that job-related psychosocial stressors are widespread but not uniform across ethnic groups. Further research into what drives differences in work experience for migrant groups would provide information to guide both employers and migrants in ways to reduce workplace psychosocial stressors.

Radicalisation and mental health. Nord J Psychiatry 2018;72:S16-S19. [PMID: 30383461 DOI: 10.1080/08039488.2018.1525640]

BACKGROUND

Although radicalisation is invoked to explain how people become terrorists, there is little empirical evidence.

AIMS

To set out the approaches to understand radicalisation, ethical and definitional issues, and how public health approaches may help.

METHODS

A non-systematic narrative review.

RESULTS

Radicalisation is proposed to explain how people become terrorists. Factors such as social connections, political engagement, group belonging, mental illnesses and other social and cultural influence show a complex interplay that we are still trying to understand. Common mental illnesses appear to be a risk factor at a population level for developing extremist beliefs, and psychoses and autism are reported as more common amongst some terrorist offenders. The activation of stereotypical and reactive fears and fantasies may distort our understanding of how to prevent radicalisation and terrorism.

CONCLUSIONS

A public health framework offers a societal, inclusive, and positive approach to preventing radicalisation, alongside criminal justice actions.

Size and clustering of ethnic groups and rates of psychiatric admission in England

Aims and methodTo compare rates of admission for different types of severe mental illness between ethnic groups, and to test the hypothesis that larger and more clustered ethnic groups will have lower admission rates. This was a descriptive study of routinely collected data from the National Health Service in England.

RESULTS

There was an eightfold difference in admission rates between ethnic groups for schizophreniform and mania admissions, and a fivefold variation in depression admissions. On average, Black and minority ethnic (BME) groups had higher rates of admission for schizophreniform and mania admissions but not for depression. This increased rate was greatest in the teenage years and early adulthood. Larger ethnic group size was associated with lower admission rates. However, greater clustering was associated with higher admission rates.Clinical implicationsOur findings support the hypothesis that larger ethnic groups have lower rates of admission. This was a between-group comparison rather than within each group. Our findings do not support the hypothesis that more clustered groups have lower rates of admission. In fact, they suggest the opposite: groups with low clustering had lower admission rates. The BME population in the UK is increasing in size and becoming less clustered. Our results suggest that both of these factors should ameliorate the overrepresentation of BME groups among psychiatric in-patients. However, this overrepresentation continues, and our results suggest a possible explanation, namely, changes in the delivery of mental health services, particularly the marked reduction in admissions for depression.Declaration of interestNone.

A systematic review of working conditions and occupational health among immigrants in Europe and Canada

Background

A systematic attempt to summarize the literature that examines working conditions and occupational health among immigrant in Europe and Canada.

Methods

We established inclusion criteria, searched systematically for articles included in the Medline, Embase and Social Sciences Citation Index databases in the period 2000–2016 and checked the reference lists of all included papers.

Results

Eighty-two studies were included in this review; 90% were cross-sectional and 80% were based on self-report. Work injuries were consistently found to be more prevalent among immigrants in studies from different countries and in studies with different designs. The prevalence of perceived discrimination or bullying was found to be consistently higher among immigrant workers than among natives. In general, however, we found that the evidence that immigrant workers are more likely to be exposed to physical or chemical hazards and poor psychosocial working conditions is very limited. A few Scandinavian studies support the idea that occupational factors may partly contribute to the higher risk of sick leave or disability pension observed among immigrants. However, the evidence for working conditions as a potential mediator of the associations between immigrant status and poor general health and mental distress was very limited.

Conclusion

Some indicators suggest that immigrant workers in Europe and Canada experience poorer working conditions and occupational health than do native workers. However, the ability to draw conclusions is limited by the large gaps in the available data, heterogeneity of immigrant working populations, and the lack of prospectively designed cohort studies.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5703-3) contains supplementary material, which is available to authorized users.

Personal-Level and Group-Level Discrimination and Mental Health: the Role of Skin Color

OBJECTIVE

This study investigates the association between personal-level and group-level discrimination and common mental disorders (CMDs) among Afro-Brazilian women, aiming to explore the role of skin color on this association.

METHODS

This is a cross-sectional study involving 1130 women who were participating in the Social Change, Asthma and Allergy in Latin America (SCAALA) study, whose children were recruited from 24 geographical micro-regions representative of the population without sanitation. Measures of discrimination were defined by: experiences (personal-level) and concern about discrimination (group-level) using the Experiences of Discrimination Scale. Skin color was registered by self-declaration, being classified as white, brown, and black. The association between "self-reported" discrimination and CMDs was evaluated using Poisson regression analysis.

RESULTS

Prevalence of CMDs was high (38.3%), especially in the group exposed to discriminatory experiences and black women. Experiences and concern about discrimination were positive and significantly associated with mental health, before and after adjustment for potential confounders. The effect of discrimination on CMDs was lower among black women, suggesting the development of other strategies to confront racism.

CONCLUSION

This study emphasizes the use of both personal- and group-level discrimination measures, as well as skin color, for the evaluation of mental disorders in public health research. Further studies of health consequences of discrimination will require investigation of protective factors for mental disorders in the population suffering discrimination and racism.

Associations of multicultural status with depressive mood and suicidality among Korean adolescents: the roles of parental country of birth and socioeconomic position

Background

The mental health of the offspring of immigrants is a major public health concern. In this study, we examined associations of multicultural status and parental country of birth with adolescent mental health in South Korea, and assessed the effect of socioeconomic position (SEP) on these associations.

Methods

We used four waves of the Korea Youth Risk Behavior Web-based Survey (KYRBS) between 2011 and 2014, including 294,324 participants (149,219 boys and 145,105 girls aged 13–18 years) as study subjects. KYRBS is a cross-sectional survey conducted annually by the Korea Centers for Disease Control and Prevention. The participants in the KYRBS were drawn as stratified multistage clustered samples from Korean middle schools and high schools. We calculated the age-adjusted 12-month prevalence of depressive mood and suicidal behaviors by parental country of birth, and estimated the effects of SEP indicators on the relationship.

Results

The age-standardized prevalence of suicidality (suicide ideation, plans, and attempts) was significantly different between multicultural and non-multicultural boys. The impact of multicultural status on mental health varied with parental foreign-born status and maternal country of birth. Compared with non-multicultural counterparts, boys with Japan-born mothers showed lower prevalence ratios (PRs) of suicidal plans (PR = 0.34, 95% CI 0.16–0.70). Girls with Japan-born mothers also showed lower PRs of depressive mood (PR = 0.77, 95% CI 0.63–0.95) and suicidal ideation (PR = 0.59, 95% CI 0.41–0.83), while adolescents with Korean-Chinese mothers showed similar PRs. Boys with foreign-born fathers as well as boys with two foreign-born parents were at a greater risk of suicidality than non-multicultural boys. The magnitude of the relationship between multicultural status and mental health outcomes was generally attenuated after adjusting for SEP indicators.

Conclusions

In general, adolescents with Japan-born mothers showed lower PRs of depressive mood and suicidality than non-multicultural adolescents, while those with Korean-Chinese mothers showed similar PRs. Boys who had foreign-born fathers generally showed greater PRs of depressive mood and suicidality than non-multicultural boys. To ensure the effective implementation of policies to reduce mental health problems among multicultural adolescents in South Korea, detailed information should be considered regarding the cultural and socioeconomic backgrounds of families, such as parental country of birth and SEP.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4044-y) contains supplementary material, which is available to authorized users.

Pathways to sympathies for violent protest and terrorism

BACKGROUND

Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities.

AIMS

To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT).

METHOD

A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis.

RESULTS

Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59-4.23, P<0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT (death of a close friend: OR = 0.24, 95% CI 0.07-0.74; donating money to a charity: OR = 0.52, 95% CI 0.3-0.9).

CONCLUSIONS

Independent of SVPT associations with depressive symptoms, some expressions of social connectedness (measured as life events and political engagement) are associated with a lower risk of SVPT.

Discrimination and psychiatric disorder among Asian American immigrants: a national analysis by subgroups

Although considerable evidence suggests that discrimination negatively affects mental health for Asian American (AA) immigrants, few studies have disaggregated this heterogeneous community and/or differentiated effects of different forms of discrimination. Using the first nationally representative data on AA immigrants in US, this study examines whether perceived racial discrimination, perceived language discrimination, and vicarious racism experiences increase the risk of psychiatric disorder for different Asian immigrant groups in the past 12 months. Results from group specific logistic regressions show that both perceived racial and language discrimination have strong deleterious effects on mental health only for Filipinos, while Vietnamese and Chinese are more likely to be affected by vicarious racism experiences. No significant association was found between racial discrimination and the mental health outcome for Vietnamese and Chinese. Findings were discussed in the light of inter-racial contact pattern and acculturation status for each group.

Discrimination, poor mental health, and mental illness

Discrimination is a major public health issue. Discrimination is known and well recognized to be associated with poor physical and mental health, as well as creating social divisions and fear that undermines the success of society and economic progress. Policies to eradicate discrimination and prejudice in the public sphere, and in public life, need thoughtful and careful planning and engagement by all public institutions and in the way they conduct their business. This forms the basis of social justice. Employers, politicians, and public servants, as well as other stakeholders, irrespective of their professional status, all have ethical responsibilities to uphold such actions and policies, values, and supporting behaviours, as a core principle of successful societies.

Ethnic Differences in Suicidal Ideation and its Correlates among South Asian American Emerging Adults

Prior research on suicidal ideation and its correlates among South Asian American individuals has been limited. Given that South Asian American individuals are a burgeoning ethnic subgroup in the United States population, research regarding these factors is necessary to inform culturally competent suicide screening, prevention, and intervention among this increasingly prominent group. We examined depressive symptoms, hopelessness, and suicidal ideation among a sample of 204 undergraduate South Asian American (96 Bangladeshi American, 67 Asian Indian, and 41 Pakistani American) emerging adult students (66% female), ages 18 to 24 (M = 18.52, SD = 0.93). Participants completed measures of hopelessness, depressive symptoms, and suicidal ideation. Bangladeshi American ethnicity was associated with significantly lower levels of suicidal ideation than Asian Indian ethnicity. There was a non-significant trend for Pakistani American ethnicity to be associated with lower levels of suicidal ideation than Asian Indian ethnicity. Additionally, Bangladeshi American ethnicity and Pakistani American ethnicity each interacted with hopelessness, such that hopelessness was associated with lower levels of suicidal ideation among these groups than among their Asian Indian peers. Being of Asian Indian ethnicity may deleteriously influence vulnerability to suicidal ideation, while being of other South Asian American ethnicities may buffer against suicidal ideation, both independently and in interaction with hopelessness. Such contingencies should be considered during suicide screening, prevention, and intervention.

Transnational Relationships and Cultural Identity of Older Migrants

Abstract. We take a social identity approach to explore the associations between cultural heritage, social class, social-support networks, transnational relationships and cultural identity. Data for 815 older people (≥ 55 years) from six ethnic groups living in England and Wales are used to help understand older migrants’ ethnic identity, cultural identity with the family’s country of origin, and British identity. Regression models explain a low amount of variance. Different configurations of the independent variables – cultural heritage, social class, social-support networks and transnational relationships (with children, siblings, other relatives) – predicted different forms of cultural identity. Transnational relationships provide migrants with a range of alternative identities into which they self-categorize or contrast to their group identity.

Residential segregation, dividing walls and mental health: a population-based record linkage study

Background

Neighbourhood segregation has been described as a fundamental determinant of physical health, but literature on its effect on mental health is less clear. While most previous research has relied on conceptualised measures of segregation, Northern Ireland is unique as it contains physical manifestations of segregation in the form of segregation barriers (or ‘peacelines’) which can be used to accurately identify residential segregation.

Methods

We used population-wide health record data on over 1.3 million individuals, to analyse the effect of residential segregation, measured by both the formal Dissimilarity Index and by proximity to a segregation barrier, on the likelihood of poor mental health.

Results

Using multilevel logistic regression models, we found residential segregation measured by the Dissimilarity Index poses no additional risk to the likelihood of poor mental health after adjustment for area-level deprivation. However, residence in an area segregated by a ‘peaceline’ increases the likelihood of antidepressant medication by 19% (OR=1.19, 95% CI 1.14 to 1.23) and anxiolytic medication by 39% (OR=1.39, 95% CI 1.32 to 1.48), even after adjustment for gender, age, conurbation, deprivation and crime.

Conclusions

Living in an area segregated by a ‘peaceline’ is detrimental to mental health suggesting segregated areas characterised by a heightened sense of ‘other’ pose a greater risk to mental health. The difference in results based on segregation measure highlights the importance of choice of measure when studying segregation.

Discrimination and common mental disorder among migrant and ethnic groups: findings from a South East London Community sample

PURPOSE

Few studies have examined discrimination and mental health in the UK, particularly by migrant status and in urban contexts with greater demographic diversity. This study aims to (1) describe the prevalence of discrimination experiences across multiple life domains; (2) to describe associations between discrimination experiences and common mental disorder (CMD); (3) to determine whether or not the relationship between discrimination and CMD varies by migrant status and ethnicity.

METHODS

Data on major, anticipated and everyday discrimination and CMD symptoms were collected from an ethnically diverse prospective sample of 1052 participants followed up from 2008 to 2013 in the South East London Community Health study, a population-based household survey.

RESULTS

With few exceptions, discrimination was most prevalent among those in the Black Caribbean group. However, those in the White Other ethnic group had similar or greater reporting major and anticipated discrimination to Black or mixed ethnic minority groups. The effects of discrimination on CMD were most pronounced for individuals who had recently migrated to the UK, an ethnically heterogeneous group, and for Black and Mixed ethnic minority groups in partially adjusted models. Prior CMD accounted for differences between the Mixed and White British ethnic groups, but the strength of the association for the most recent migrant group and the Black ethnic groups remained two or more times greater than the reference groups.

CONCLUSIONS

The strength of the relationship suggests a need for more consideration of migration status along with ethnicity in examining the impact of discrimination on mental disorder in community and clinical samples.

Religious discrimination and common mental disorders in England: a nationally representative population-based study

PURPOSE

Although the impact of discrimination on mental health has been increasingly discussed, the effect of religious discrimination has not been examined systematically. We studied the prevalence of perceived religious discrimination and its association with common mental disorders in a nationally representative population-based sample in England.

METHODS

We used data from the Adult Psychiatric Morbidity Survey 2007 that represents all adults age 16 years and over living in private households in England. Common mental disorders were ascertained using the Revised Clinical Interview Schedule. Experience of discrimination was assessed by a computer-assisted self-report questionnaire and potential paranoid traits by the Psychosis Screening Questionnaire.

RESULTS

From the total of 7318 participants, 3873 (52.4%) reported adhering to religion. 108 subjects (1.5%) reported being unfairly treated in the past 12 months due to their religion. Non-Christian religious groups were more likely to report perceived religious discrimination compared to Christians (OR 11.44; 95% CI 7.36-17.79). People who experienced religious discrimination had increased prevalence of all common mental disorders. There was a two-fold increase in the risk of common mental disorders among people who reported experience of religious discrimination independent of their ethnicity, skin colour or suspected paranoid traits.

CONCLUSIONS

The impact of perceived religious discrimination on mental health should be given more consideration in treatment and future preventative policies.

Measuring the effect of ethnic and non-ethnic discrimination on Europeans' self-rated health

OBJECTIVES

The study of perceived discrimination based on race and ethnic traits belongs to a long-held tradition in this field, but recent studies have found that non-ethnic discrimination based on factors such as gender, disability or age is also a crucial predictor of health outcomes.

METHODS

Using data from the European Social Survey (2010), and applying Boolean Factor Analysis and Ordered Logistic Regression models, this study is aimed to compare how ethnic and non-ethnic types of discrimination might affect self-rated health in the European context.

RESULTS

We found that non-ethnic types of discrimination produce stronger differences on health outcomes. This result indicates that the probabilities of presenting a poor state of health are significantly higher when individuals feel they are being discriminated against for social or demographic conditions (gender, age, sexuality or disability) rather than for ethnic reasons (nationality, race, ethnicity, language or religiosity).

CONCLUSIONS

This study offers a clear comparison of health inequalities based on ethnic and non-ethnic types of discrimination in the European context, overcoming analytical based on binary indicators and simple measures of discrimination.