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Ethnic inequalities in the use of health services for common mental disorders in England

Social Psychiatry and Psychiatric Epidemiology volume 48, pages 685–692 (2013)Cite this article

Abstract

Purpose

The purpose of this study is to investigate whether minority ethnic people were less likely to receive treatment for mental health problems than the white population were, controlling for symptom severity.

Method

We analysed data from 23,917 participants in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. Survey response rates were 79, 69 and 57 %, respectively. The revised Clinical Interview Schedule was used to adjust for symptom severity.

Results

Black people were less likely to be taking antidepressants than their white counterparts were (Odds ratio 0.4; 95 % confidence interval 0.2–0.9) after controlling for symptom severity. After controlling for symptom severity and socioeconomic status, people from black (0.7; 0.5–0.97) and South Asian (0.5; 0.3–0.8) ethnic groups were less likely to have contacted a GP about their mental health in the last year.

Conclusions

Interventions to reduce these inequalities are needed to ensure that NHS health care is delivered fairly according to need to all ethnic groups.

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References

  1. House of Commons (2010) Equality act. House of Commons, London

    Google Scholar 

  2. National Institute for Health and Clinical Excellence (NICE) (2011) TA217 Alzheimer’s disease—donepezil, galantamine, rivastigmine and memantine: guidance

  3. 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(12):939–946

    PubMed  Article  Google Scholar 

  4. Weich S, Nazroo J, Sproston K, McManus S, Blanchard M, Erens B et al (2004) Common mental disorders and ethnicity in England: the EMPIRIC Study. Psychol Med 34(8):1543–1551

    PubMed  Article  Google Scholar 

  5. Cooper C, Bebbington P, McManus S, Meltzer H, Stewart R, Farrell M et al (2010) The treatment of common mental disorders across age groups: results from the 2007 adult psychiatric morbidity survey. J Affect Disord 127(1–3):96–101

    PubMed  Article  Google Scholar 

  6. Nazroo JY (1998) Rethinking the relationship between ethnicity and mental health: the British Fourth National Survey of Ethnic Minorities. Soc Psychiatry Psychiatr Epidemiol 33(4):145–148

    PubMed  Article  CAS  Google Scholar 

  7. Bhui K, Christie Y, Bhugra D (1995) The essential elements of culturally sensitive psychiatric services. Int J Soc Psychiatry 41(4):242–256

    PubMed  Article  CAS  Google Scholar 

  8. Alegria M, Canino G, Rios R, Vera M, Calderon J, Rusch D et al (2002) Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv 53(12):1547–1555

    PubMed  Article  Google Scholar 

  9. Maginn S, Boardman AP, Craig TKJ, Haddad M, Heath G, Stott J (2004) The detection of psychological problems by General Practitioners—influence of ethnicity and other demographic variables. Soc Psychiatry Psychiatr Epidemiol 39(6):464–471

    PubMed  Article  CAS  Google Scholar 

  10. Snowden LR, Yamada AM (2005) Cultural differences in access to care. Annu Rev Clin Psychol 1:143–166

    PubMed  Article  Google Scholar 

  11. Alegria M, Chatterji P, Wells K, Cao Z, Chen CN, Takeuchi D et al (2008) Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv 59(11):1264–1272

    PubMed  Article  Google Scholar 

  12. Wells K, Klap R, Koike A, Sherbourne C (2001) Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatry 158(12):2027–2032

    PubMed  Article  CAS  Google Scholar 

  13. Williams DR, Gonzalez HM, Neighbors H, Nesse R, Abelson JM, Sweetman J et al (2007) Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites—results from the National Survey of American Life. Arch Gen Psychiatry 64(3):305–315

    PubMed  Article  Google Scholar 

  14. Breslau J, Kendler KS, Su M, Gaxiola-Aguilar S, Kessler RC (2005) Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 35(3):317–327

    PubMed  Article  Google Scholar 

  15. Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B (2009) Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behav Res Ther 47(11):910–920

    PubMed  Article  Google Scholar 

  16. National Institute for Clinical Excellence (NICE) (2007) Depression: full guideline (amended). Report No.: CG23

  17. Brugha TS, Bebbington PE, Singleton N, Melzer D, Jenkins R, Lewis G et al (2004) Trends in service use and treatment for mental disorders in adults throughout Great Britain. Br J Psychiatry 185:378–384

    PubMed  Article  Google Scholar 

  18. Moore M, Yuen HM, Dunn N, Mullee MA, Maskell J, Kendrick T (2009) Explaining the rise in antidepressant prescribing: a descriptive study using the general practice research database. Br Med J 15:339

    Google Scholar 

  19. Jenkins R, Bebbington P, Brugha T, Farrell M, Gill B, Lewis G et al (1997) The National Psychiatric Morbidity Surveys of Great Britain—strategy and methods. Psychol Med 27(4):765–774

    PubMed  Article  CAS  Google Scholar 

  20. Singleton G, Bumpstead R, O’Brien T, Lee A, Meltzer H (2001) Psychiatric morbidity among adults living in private households. TSO, London

    Google Scholar 

  21. The Health & Social Care Information Centre, Social Care Statistics (2009) Adult psychiatric morbidity in England, 2007: results of a household survey

  22. Government Statistical Service (2003) Harmonised concepts and questions for governmental social surveys. Office of National Statistics, London

    Google Scholar 

  23. Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric-disorder in the community—a standardized assessment for use by lay interviewers. Psychol Med 22(2):465–486

    PubMed  Article  CAS  Google Scholar 

  24. Jordanova V, Wickramesinghe C, Gerada C, Prince M (2004) Validation of two survey diagnostic interviews among primary care attendees: a comparison of CIS-R and CIDI with SCAN ICD-10 diagnostic categories. Psychol Med 34(6):1013–1024

    PubMed  Article  CAS  Google Scholar 

  25. STATA/IC 10.0 for Windows [computer program]. 2007

  26. (2001) Census ethnic composition. National Statistics website. 6-20-0011. Ref Type: Internet Communication

  27. Wu CH, Erickson SR, Kennedy J (2009) Patient characteristics associated with the use of antidepressants among people diagnosed with DSM-IV mood disorders: results from the National Comorbidity Survey Replication. Curr Med Res Opin 25(2):471–482

    PubMed  Article  Google Scholar 

  28. Karlsen S, Nazroo JY, McKenzie K, Bhui K, Weich S (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychol Med 35(12):1795–1803

    PubMed  Article  Google Scholar 

  29. La Fontaine J, Ahuja J, Bradbury NM, Phillips S, Oyebode JR (2007) Understanding dementia amongst people in minority ethnic and cultural groups. J Adv Nurs 60(6):605–614

    PubMed  Article  Google Scholar 

  30. Marwaha S, Livingston G (2002) Stigma, racism or choice. Why do depressed ethnic elders avoid psychiatrists? J Affect Disord 72(3):257–265

    PubMed  Article  Google Scholar 

  31. Mukadam N, Cooper C, Livingston G (2011) A systematic review of ethnicity and pathways to care in dementia. Int J Geriatr Psychiatry 26(1):12–20

    PubMed  Article  Google Scholar 

  32. Fountain J, Hicks J (2010) Delivering race equality in mental health care: report on the findings and outcomes of the community engagement programme 2005–2008. International School for Communities, Rights and Inclusion (ISCRI), University of Central Lancashire, Lancashire

  33. Afuwape SA, Craig TKJ, Harris T, Clarke M, Flood A, Olajide D et al (2010) The Cares of Life Project (CoLP): an exploratory randomised controlled trial of a community-based intervention for black people with common mental disorder. J Affect Disord 127(1–3):370–374

    PubMed  Article  Google Scholar 

  34. Gater R, Waheed W, Husain N, Tomenson B, Aseem S, Creed F (2010) Social intervention for British Pakistani women with depression: randomised controlled trial. Br J Psychiatry 197(3):227–233

    PubMed  Article  Google Scholar 

  35. Miranda J, Cooper LA (2004) Disparities in care for depression among primary care patients. J Gen Intern Med 19(2):120–126

    PubMed  Article  Google Scholar 

  36. Bogner HR, de Vries HF (2010) Integrating type 2 diabetes mellitus and depression treatment among African Americans a randomized controlled pilot trial. Diabetes Educ 36(2):284–292

    PubMed  Article  Google Scholar 

  37. National Centre for Social Research (2002) Ethnic minority psychiatric illness rates in the community (EMPIRIC)—Quantitative Report. The Stationery Office, London

    Google Scholar 

  38. Bradby H (2003) Describing ethnicity in health research. Ethn Health 8(1):5–13

    PubMed  Article  Google Scholar 

  39. Baker RPBNM, Johnson RA (1995) Computer-assisted personal interviewing: an experimental evaluation of data quality and cost. J Off Stat 11:413–431

    CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Mental Health Sciences (Bloomsbury Campus), UCL, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London, W1W 7EJ, UK

    Claudia Cooper, Gill Livingston & Paul Bebbington

  2. Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester, LE1 6TP, UK

    Nicola Spiers, Howard Meltzer & Terry Brugha

  3. Institute of Psychiatry, De Crespigny Park, Box P035, London, UK

    Rachel Jenkins

  4. National Centre for Social Research, London, UK

    Sally McManus

  5. Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Scott Weich

Authors
  1. Claudia Cooper
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  2. Nicola Spiers
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  3. Gill Livingston
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  4. Rachel Jenkins
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  5. Howard Meltzer
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  6. Terry Brugha
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  7. Sally McManus
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  8. Scott Weich
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  9. Paul Bebbington
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Corresponding author

Correspondence to Claudia Cooper.

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Cooper, C., Spiers, N., Livingston, G. et al. Ethnic inequalities in the use of health services for common mental disorders in England. Soc Psychiatry Psychiatr Epidemiol 48, 685–692 (2013). https://doi.org/10.1007/s00127-012-0565-y

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  • DOI: https://doi.org/10.1007/s00127-012-0565-y

Keywords

  • Ethnicity
  • Mental health services
  • Inequality