Income-related inequalities in common mental disorders among ethnic minorities in England

Original Paper



The relative prevalence of common mental health problems among different ethnic groups in Britain is one of the least researched topics in health variations research. We calculate and compare income-related inequalities in common mental disorders among ethnic groups in Britain.


Data from a nationally representative survey of ethnic minorities (the EMPIRIC survey) were used to calculate concentration index values to indicate the extent of income-related inequalities within and across ethnic groups.


Looking at income-related inequalities in common mental disorders within each of the ethnic groups, it was found that the burden of these disorders were greater for the lower income groups among the Irish, White and African Caribbean communities. Within-group inequality was less clearly defined for each of the three Asian communities: Indian, Bangladeshi and Pakistani. However, when the data were pooled and individuals were assigned income ranks in the pooled set (not within their own ethnic group), the relative position of those in lower income groups among the different groups was striking. The poor among the Bangladeshi, Pakistani and the African Caribbean groups clearly suffered both from low income and a greater burden of mental health morbidity than the other three groups. The effect of lower income is thus worse for the mental health of populations if they are African Caribbean, Pakistani or Bangladeshi than if they are White, Irish or Indian.


Inequality in mental health morbidity between and within ethnic groups is at least partly linked to income, and thus to employment and education. Tackling disadvantage and discrimination in these areas could help to tackle the challenge of mental ill-health.


Inequality Equity Ethnicity Income Neurosis Common mental disorders 


Conflict of interest



  1. 1.
    Townsend P, Davidson N (1982) Inequalities in health (the Black Report). Penguin, MiddlesexGoogle Scholar
  2. 2.
    Davey Smith G, Bartley M, Blane D (1990) The Black Report on socioeconomic inequalities in health 10 years on. BMJ 301:373–377CrossRefGoogle Scholar
  3. 3.
    Benzeval M, Judge K, Whitehead M (1995) Tackling inequalities in health: an agenda for action. Kings Fund Institute, LondonGoogle Scholar
  4. 4.
    Weich S, Lewis G, Jenkins S (2001) Income inequality and the prevalence of mental disorders in Britain. Br J Psychiatry 178:222–227PubMedCrossRefGoogle Scholar
  5. 5.
    Lewis G, Bebbington P, Brugha T, Farell M, Gill B, Jenkins R, Meltzer H (2003) Socio-economic status, standard of living and neurotic disorder. Int Rev Psychiatry 15:91–96PubMedCrossRefGoogle Scholar
  6. 6.
    Social Exclusion Unit (2004) Mental health and social exclusion. Office of the Deputy Prime Minister, LondonGoogle Scholar
  7. 7.
    Mangalore R, Knapp M, Jenkins R (2007) Income-related inequality in mental health in Britain: the concentration index approach. Psychol Med 37:1037–1046PubMedCrossRefGoogle Scholar
  8. 8.
    Nazroo JY (1999) The racialisation of ethnic inequalities in health. In: Dorling D, Simpson S (eds) Statistics in society: the arithmetic of politics. Arnold, LondonGoogle Scholar
  9. 9.
    Nazroo JY (2001) Ethnicity, Class and Health. Policy Studies Institute, LondonGoogle Scholar
  10. 10.
    Brugha T, Jenkins R, Bebbington P, Meltzer H, Lewis G, Farrell M (2004) Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain. Soc Psychiatry Psychiatr Epidemiol 39:939–946PubMedCrossRefGoogle Scholar
  11. 11.
    Hoberman HM (1992) Ethnic minority status and adolescent mental health services utilization. J Behav Health Serv R 19:246–267Google Scholar
  12. 12.
    Nazroo James Y (2003) The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. Am J Public Health 93:277–284PubMedCrossRefGoogle Scholar
  13. 13.
    Miranda J, Siddique J, Belin TR, Kohn-Wood LP (2005) Depression prevalence in disadvantaged young black women African and Caribbean immigrants compared to US-born African Americans. Soc Psychiatry Psychiatr Epidemiol 40:253–258PubMedCrossRefGoogle Scholar
  14. 14.
    Bresnahan M, Begg MD, Brown A, Schaefer C, Sohler N, Insel B, Vella L, Susser E (2007) Race and risk of schizophrenia in a US birth cohort: another example of health disparity? Int J Epidemiol 36:751–758PubMedCrossRefGoogle Scholar
  15. 15.
    Simning A, Wijngaarden EV and Conwell Y (2010) Anxiety, mood, and substance use disorders in United States African-American public housing residents. Soc Psychiatry Psychiatr Epidemiol (online first, 9 July)Google Scholar
  16. 16.
    Wang JL (2004) The difference between single and married mothers in the 12-month prevalence of major depressive syndrome, associated factors and mental health service utilization. Soc Psychiatry Psychiatr Epidemiol 39:126–132CrossRefGoogle Scholar
  17. 17.
    Dekker J, Peen J, Goris A, Heijnen H, Kwakman H (1997) Social deprivation and psychiatric admission rates in Amsterdam. Soc Psychiatry Psychiatr Epidemiol 32:485–492PubMedGoogle Scholar
  18. 18.
    Veling W, Selten JP, Susser E, Laan W, Mackenbach JP, Hoek HW (2007) Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands. Int J Epidemiol 36:761–768PubMedCrossRefGoogle Scholar
  19. 19.
    Wittkampf LC, Smeets HM, Knol MJ, Geerlings MI, Braam AW et al (2010) Differences in psychotropic drug prescriptions among ethnic groups in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 45:819–826PubMedCrossRefGoogle Scholar
  20. 20.
    Sagatun A, Lien L, Søgaard AJ, Bjertness E, Heyerdahl S (2008) Ethnic Norwegian and ethnic minority adolescents in Oslo, Norway: a longitudinal study comparing changes in mental health. Soc Psychiatry Psychiatr Epidemiol 43:287–295CrossRefGoogle Scholar
  21. 21.
    Cochrane R and Sashidharan SP (1996) Mental health and ethnic minorities: a review of the literature and implications for services. In: Ethnicity and health, CRD Report 5. NHS Centre for reviews and Dissemination, Social Policy Research Unit: University of York, YorkGoogle Scholar
  22. 22.
    McKenzie K, Bhui K (2007) Institutional racism in mental health care. BMJ 334:649–650PubMedCrossRefGoogle Scholar
  23. 23.
    World Bank (2003) Quantitative techniques for health equity analysis—technical notes. ( Accessed 15 February 2006
  24. 24.
    Van Doorslaer E, Koolman X, Jones AM (2004) Explaining income-related inequalities in doctor utilisation in Europe. Health Econ 13:629–647PubMedCrossRefGoogle Scholar
  25. 25.
    Sproston K, Nazroo J (eds) (2002) Ethnic minority psychiatric illness rates in the community (EMPIRIC). The Stationery Office, LondonGoogle Scholar
  26. 26.
    Lewis G, Pelosi AJ (1990) Manual of the revised clinical interview schedule. (CIS-R), Institute of PsychiatryGoogle Scholar
  27. 27.
    Bebbington P, Nayani T (1995) The psychosis screening questionnaire. Int J Methods Psychiatr Res 5:11–20Google Scholar
  28. 28.
    Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey construction of scales and preliminary tests of reliability and validity. Med Care 34:200–223CrossRefGoogle Scholar
  29. 29.
    Ware JE, Kosinski M, Keller SD (1998) How to score the SF-12 physical and mental summary scales, 3rd edn. The Health Institute, New England Medical Center, Boston, MAGoogle Scholar
  30. 30.
    Wilkinson R (2000) Mind the gap: hierarchies, health and human evolution. Weidenfeld and Nicolson, LondonGoogle Scholar
  31. 31.
    Krieger N, Rowley DL, Herman AA, Avery B, Philips MT (1993) Racism, sexism and social class: implications for studies of health, disease and wellbeing. Am J Prev Med 9(Suppl 2):82–122PubMedGoogle Scholar
  32. 32.
    Madood T, Berthoud R, Lakey J, Nazroo JY, Smith P, Virdee S, Beishon S (1997) Ethnic minorities in Britain: diversity and disadvantage. Policy Studies Institute, LondonGoogle Scholar
  33. 33.
    Nazroo JY (1998) Genetic, cultural or socioeconomic vulnerability? Expanding ethnic inequalities in health. Soc Health Illness. 20:714–734Google Scholar
  34. 34.
    Nazroo J, Davey Smith G (2000) The contribution of socioeconomic position to health differentials between ethnic groups: evidence from the United States and Britain. In: Macbeth H, Shetty P (eds) Health and ethnicity: society for the study of human biology series: 41. Taylor and Francis, London, England, pp 41–58Google Scholar
  35. 35.
    Department of Health (2008) Health inequalities: progress and next steps. Department of Health: LondonGoogle Scholar
  36. 36.
    Singleton N, Bumpstead R, O’Brien M, Lee A, Meltzer H (2001) Psychiatric morbidity among adults living in private households 2000. HMSO, LondonGoogle Scholar
  37. 37.
    Boydell J, Os VJ, McKenzie K, Murray RM (2004) The association of inequality with the incidence of schizophrenia: an ecological study. Soc Psychiatry Psychiatr Epidemiol 39:597–599PubMedCrossRefGoogle Scholar
  38. 38.
    Harrison J, Barrow S, Creed F (1997) Mental health in the north west region of England: associations with deprivation. Soc Psychiatry Psychiatr Epidemiol 33:124–128CrossRefGoogle Scholar
  39. 39.
    Reininghaus UA, Morgan C, Simpson J, Dazzan P, Morgan K et al (2008) Unemployment, social isolation, achievement—expectation mismatch and psychosis: findings from the ÆSOP Study. Soc Psychiatry Psychiatr Epidemiol 43:743–751PubMedCrossRefGoogle Scholar
  40. 40.
    Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Weich S (2005) Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of ethnic minority groups in the United Kingdom. Am J Public Health 95:496–501PubMedCrossRefGoogle Scholar
  41. 41.
    Maginn S, Boardman AP, Craig TKL, Haddad M, Heath G et al (2004) The detection of psychological problems by general practitioners influence of ethnicity and other demographic variables. Soc Psychiatry Psychiatr Epidemiol 39:464–471PubMedCrossRefGoogle Scholar
  42. 42.
    Gater R, Tomenson B, Percival C, Chaudhry N, Waheed W et al (2009) Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK. Soc Psychiatry Psychiatr Epidemiol 44:198–207PubMedCrossRefGoogle Scholar
  43. 43.
    Maynard MJ, Harding S, Minnis H (2007) Psychological well-being in Black Caribbean, Black African, and white adolescents in the UK Medical Research Council DASH study. Soc Psychiatry Psychiatr Epidemiol 42:759–769PubMedCrossRefGoogle Scholar
  44. 44.
    Kirbride JB, Barker D, Cowden F, Stamps R, Yang M, Jones PB, Coid JW (2008) Psychoses, ethnicity and socio-economic status. Br J Psychiatry 193:18–24CrossRefGoogle Scholar
  45. 45.
    Van Os J, Castle DJ, Takei N, Der G, Murray RM (1996) Psychotic illness in ethnic minorities: clarification from the 1991 census. Psychol Med 26:203–208CrossRefGoogle Scholar
  46. 46.
    Fearon P, Kirkbride J, Morgan C, Dazzan P, Morgan K, Lloyd T, Hutchinson G, Tarrant J, Fung A, Holloway J, Mallet R, Harrison G, Leff J, Jones P, Murray R (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychol Med 36:1541–1550PubMedCrossRefGoogle Scholar
  47. 47.
    Health Care Commission (2005) Count me in: results of a National Census of Inpatients in Mental Health Hospitals and Facilities in England and Wales. Health Care Commission, LondonGoogle Scholar
  48. 48.
    Harrison G, Owens D, Holton A, Neilson D, Boot D (1998) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 18:643–657CrossRefGoogle Scholar
  49. 49.
    Cochrane R, Bal S (1989) Mental hospital admission rates of immigrants to England: a comparison of 1971 and 1981. Soc Psychiatry 24:2–11Google Scholar
  50. 50.
    Priebe S, Want A, Saidi M, Mangalore R, Knapp M (2009) Housing services for people with mental disorders in England: patient characteristics, care provision and costs. Soc Psychiatry Psychiatr Epidemiol 44:805–814PubMedCrossRefGoogle Scholar
  51. 51.
    Equalities Review (2007) Fairness and freedom: final report of the Equalities Review. Cabinet Office, LondonGoogle Scholar
  52. 52.
    Office of National Statistics (2004) Focus on social inequalities. Palgrave Macmillan, LondonGoogle Scholar
  53. 53.
    Thornicroft G (2006) Shunned. Oxford University Press, OxfordGoogle Scholar
  54. 54.
    Shams M (1993) Social support and psychological well-being among unemployed British Asian Men. Soc Behav Personal 21:175–186CrossRefGoogle Scholar
  55. 55.
    Shams M, Jackson PR (1994) The impact of unemployment on the psychological well-being of British Asians. Psychol Med 24:347–355PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Social PolicyLondon School of Economics and Political ScienceLondonUK
  2. 2.Personal Social Services Research UnitLondon School of Economics and Political ScienceLondonUK

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