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Prevalence of mental health disorders in adult minority ethnic populations in England: a systematic review

What do we want to know?

For minority ethnic groups living in the UK, mental health is an area of particular concern. Rates of mental health service use appear to differ between some ethnic groups and individual survey analyses indicate that the prevalence of mental ill-health in the English general population may be greater in some minority ethnic groups than others. Existing systematic reviews are restricted in their examination of ethnicity. This review used systematic methods to seek findings about the prevalence of different mental health disorders in different ethnic groups in the UK, and describe the extent and nature of the available survey evidence.

Who wants to know?

This project was commissioned by the Department of Health in England, and will be of interest in particular to commissioners of mental health services and research and to survey researchers. Findings are to be used to inform the design of a sampling strategy aimed at boosting the sample of people from minority ethnic groups in the Adult Psychiatric Morbidity Survey (APMS) due in 2021.

What did we find?

We found that there is very little recent information available from appropriately designed surveys on the rates of mental health disorders in English populations according to ethnic groupings. We found analyses for only six such surveys conducted from 1999 onwards. In only two of the surveys had sampling been designed to recruit people from minority ethnic groups in the kinds of numbers necessary for the identification of differences in prevalence between any two ethnic groups.

There were 15 different categories of mental health disorder examined in this review and we were able to look for patterns between estimates for ten (Any Common Mental Disorder, Mixed Anxiety and Depressive Disorder, Generalised Anxiety Disorder, Any Depressive Episode, Suicidal thoughts, Suicide attempts, Self-harm, Psychosis, Alcohol dependence and Problem gambling – using categories from the 2007 APMS). It was not possible to look for patterns between estimates for different ethnic groups across surveys in the case of Post-Traumatic Stress Disorder, Possible personality disorder, Attention Deficit Hyperactivity Disorder, Possible eating disorder, and Drug dependence.

We found only suggestions of differences in prevalence between different ethnic groups, and this was for only some mental health disorders. A relatively strong pattern was found for suicidal thoughts in both men and in adults as a whole, although for different ethnic groups in each case. Prevalence appeared relatively low for South Asian men and lower for South Asian men than it was for White men. Prevalence appeared relatively low for Black adults as a whole, and lower for this group than it was for White adults. A small number of weaker patterns were identified for a number of other disorders (Any Common Mental Disorder, Mixed Anxiety and Depressive Disorder, Any Depressive Episode, Suicidal thoughts, Suicidal attempts, Psychosis or probable psychosis, and Alcohol dependence).

What are the implications?

This is the first literature review that we are aware of that has used systematic methods to seek and synthesise reliable prevalence estimates of a range of mental health disorders among people in the UK in different ethnic groups.

The review has found published analyses of these surveys that, taken together, enable the identification of indicative patterns of prevalence between one or more ethnic groups for several mental health disorders. However, because we have not conducted formal statistical tests, the patterns that we present in this review should only be considered suggestive in nature.

The review found only a small number of surveys. While there is insufficient information in existing published analyses of these surveys, there is further, untapped potential in their data sets. Secondary analyses could produce additional prevalence estimates for people in specific ethnic groups. People in several ethnic groups are represented in the existing analyses of more than one survey only as being part of more general ethnic categories. These more general categories may well be hiding actual differences between groups.

For people in some less common or more recently established minority ethnic groups, existing data sets are likely to be insufficient for identifying the prevalence of mental health disorder with any precision or certainty, and further survey work that boosts sampling for these groups is likely to be required.

How did we get these results?

We achieved these results by undertaking a systematic review to:

  1. Provide a descriptive map of located research surveying the prevalence of MHDs in minority ethnic groups in the UK to inform discussions with an Advisory Group and the design of an in-depth analysis of the research findings
  2. Create an in-depth narrative synthesis of the prevalence findings. A set of algorithms was applied to identify patterns in relative prevalence between different ethnic groups across survey analyses. These patterns were classified as strong, weak or not evident. Because of the differences inherent in each survey, no attempts were made to aggregate estimate data across surveys numerically.

We asked the following research questions:

  • What survey work has been done, from 1999 onwards, to estimate prevalence rates for various mental health disorders (MHDs) amongst adults from minority ethnic groups living in private households in England, using probabilistic or other sampling designs?
  • What are the characteristics of these studies (e.g. representation of different minority ethnic groups, MHDs addressed, survey design features (including sampling and methods for measurement of MHDs) and additional demographic characteristics of the minority ethnic population/s surveyed)?
  • What is known from these studies about the prevalence of priority MHDs amongst people from minority ethnic groups in England (as sampled from 1999 onwards)?
  • What other characteristics of these studies might need to be taken into account when interpreting these studies’ prevalence estimates? What is known about key additional moderators of mental health in the study sample, e.g. gender, socioeconomic status/area deprivation and migration? What sampling and other study design components characterise the studies?

This report should be cited as:

Rees R, Stokes G, Stansfield C, Oliver E, Kneale D, Thomas J (2016) Prevalence of mental health disorders in adult minority ethnic populations in England: a systematic review. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.
ISBN: ISBN: 978-1-907345-84-5

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