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Ethnic and sexual orientation inequalities in mental health-obesity comorbidity, self-harm, and attempted suicide among British adolescents

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Abstract

Purpose

Mental illness and obesity (MH-OB) may co-occur in adolescence and have a strong risk to track into adulthood. Using an intersectional framework, we explored associations between ethnic-sexual identities and MH-OB comorbidity in adolescents. We examined the risk of self-harm (SH) and attempted suicide (AS) by comorbidity status and ethnic-sexual identities.

Methods

Participants included 9,789 adolescents (aged 17 years) from the UK-wide Millennium Cohort Study with data on self-identified ethnicity and sexuality. Participants were categorised as White-heterosexual, White-sexual minority (SM), Ethnic Minority (EM) heterosexual or EM-SM adolescents. We used multivariable logistic regression to examine associations between 1.dual ethnic-sexual identities and MH-OB comorbidity, 2.risk for self-harm (or attempted suicide) in relation to comorbidity and ethnic-sexual identities (including interactions between the comorbidity and ethnic-sexual identities variables to assess whether risk for self-harm differed by ethnic-sexual identities and comorbidity status).

Results

Comorbidity was higher among White-SM (OR = 3.73, 95%CI 2.42–5.75) and EM-SM (OR = 1.96, 1.03–3.73) adolescents. SM identities (OR = 3.02, 2.41–3.78 for White-SM) and having comorbidity (OR = 2.83, 2.03–3.95) were independently associated with SH or AS. Risk of SH among White-heterosexual individuals was greater among comorbid individuals (40%) relative to non-comorbid individuals (19%). Risk of SH was higher in SM individuals (58% vs. 41% in White-SM and 50% vs. 29% in EM-SM individuals with and without comorbidity, respectively). Risk of AS was 5% and 19% in comorbid and non-comorbid White-heterosexual individuals, respectively; the corresponding figures for White-SM individuals were 14% and 17%.

Conclusion

Irrespective of ethnicity, SM adolescents have a significantly greater risk of SH and AS. Comorbidity further amplifies this risk.

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References

  1. The global economic burden of noncommunicable diseases. Geneva (2011) World Economic Forum and the Harvard School of Public Health

  2. Obesity (2020) and overweight World Health Organisation

  3. Depression (2020) World Health Organisation

  4. Meldrum DR, Morris MA, Gambone JC (2017) Obesity pandemic: causes, consequences, and solutions-but do we have the will? Fertil Steril 107(4):833–839. https://doi.org/10.1016/j.fertnstert.2017.02.104

    Article  PubMed  Google Scholar 

  5. Vigo D, Thornicroft G, Atun R (2016) Estimating the true global burden of mental illness (vol 3, pg 171, 2016). Lancet Psychiat 3 (7):602–602

  6. Bann D, Johnson W, Li L, Kuh D, Hardy R (2018) Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies. Lancet Public Health 3(4):E194–E203. https://doi.org/10.1016/S2468-2667(18)30045-8

    Article  PubMed  PubMed Central  Google Scholar 

  7. Collaboration NCDRF (2017) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet 390(10113):2627–2642. https://doi.org/10.1016/S0140-6736(17)32129-3

    Article  Google Scholar 

  8. Adolescent mental health (2021) World Health Organisation, Geneva

  9. Vizard T, Sadler K, Ford T, Newlove-Delgado T, McManus S, Marcheselli F, Davis J, Williams T, Leach C, Mandalia D, Cartwright C (2020) Mental Health of Children and Young People in England, 2020. United Kingdom

  10. Mental health of children and young people in England (2020) : Wave 1 follow up to the 2017 survey (2020). London

  11. State of Child Health (2020) Royal College of Paediatrics and Child Health London

  12. Bilsen J (2018) Suicide and youth: risk factors. Front Psychiatry 9:540. https://doi.org/10.3389/fpsyt.2018.00540

    Article  PubMed  PubMed Central  Google Scholar 

  13. Christiansen E, Goldney RD, Beautrai AL, Agerbo E (2011) Youth suicide attempts and the dose-response relationship to parental risk factors: a population-based study. Psychol Med 41(2):313–319. https://doi.org/10.1017/S0033291710000747

    Article  CAS  PubMed  Google Scholar 

  14. Stallard P, Spears M, Montgomery AA, Phillips R, Sayal K (2013) Self-harm in young adolescents (12–16 years): onset and short-term continuation in a community sample. BMC Psychiatry 13:328. https://doi.org/10.1186/1471-244X-13-328

    Article  PubMed  PubMed Central  Google Scholar 

  15. Quintana SM, Aboud FE, Chao RK, Contreras-Grau J, Cross WE, Hudley C, Hughes D, Liben LS, Nelson-Le Gall S, Vietze DL (2006) Race, ethnicity, and culture in child development: contemporary research and future directions. Child Dev 77(5):1129–1141. https://doi.org/10.1111/j.1467-8624.2006.00951.x

    Article  PubMed  Google Scholar 

  16. Faith MS, Butryn M, Wadden TA, Fabricatore A, Nguyen AM, Heymsfield SB (2011) Evidence for prospective associations among depression and obesity in population-based studies. Obes Rev 12(501):e438–e453. https://doi.org/10.1111/j.1467-789X.2010.00843.x

    Article  CAS  PubMed  Google Scholar 

  17. Gariepy G, Nitka D, Schmitz N (2010) The association between obesity and anxiety disorders in the population: a systematic review and meta-analysis. Int J Obes 34(3):407–419. https://doi.org/10.1038/ijo.2009.252

    Article  CAS  Google Scholar 

  18. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, Zitman FG (2010) Overweight, obesity, and Depression a systematic review and Meta-analysis of Longitudinal studies. Arch Gen Psychiat 67(3):220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2

    Article  PubMed  Google Scholar 

  19. Pereira-Miranda E, Costa PRF, Queiroz VAO, Pereira-Santos M, Santana MLP (2017) Overweight and Obesity Associated with higher depression prevalence in adults: a systematic review and Meta-analysis. J Am Coll Nutr 36(3):223–233. https://doi.org/10.1080/07315724.2016.1261053

    Article  PubMed  Google Scholar 

  20. Atlantis E, Ball K (2008) Association between weight perception and psychological distress. Int J Obes 32(4):715–721. https://doi.org/10.1038/sj.ijo.0803762

    Article  CAS  Google Scholar 

  21. Konttinen H, Mannisto S, Sarlio-Lahteenkorva S, Silventoinen K, Haukkala A (2010) Emotional eating, depressive symptoms and self-reported food consumption. A population-based study. Appetite 54(3):473–479. https://doi.org/10.1016/j.appet.2010.01.014

    Article  PubMed  Google Scholar 

  22. Patten SB, Williams JVA, Lavorato DH, Eliasziw M (2009) A longitudinal community study of major depression and physical activity. Gen Hosp Psychiat 31(6):571–575. https://doi.org/10.1016/j.genhosppsych.2009.08.001

    Article  Google Scholar 

  23. Sarlio-Lahteenkorva S, Lahelma E, Roos E (2004) Mental health and food habits among employed women and men. Appetite 42(2):151–156. https://doi.org/10.1016/j.appet.2003.08.014

    Article  PubMed  Google Scholar 

  24. Apovian CM (2016) Obesity: definition, comorbidities, causes, and Burden. Am J Manag Care 22 (7)

  25. Milaneschi Y, Simmons WK, van Rossum EFC, Penninx BWJH (2019) Depression and obesity: evidence of shared biological mechanisms. Mol Psychiatr 24(1):18–33. https://doi.org/10.1038/s41380-018-0017-5

    Article  CAS  Google Scholar 

  26. Patalay P, Hardman CA (2019) Comorbidity, Codevelopment, and temporal associations between Body Mass Index and internalizing symptoms from early childhood to adolescence. Jama Psychiat 76(7):721–729. https://doi.org/10.1001/jamapsychiatry.2019.0169

    Article  Google Scholar 

  27. Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, Thoma BC, Murray PJ, D’Augelli AR, Brent DA (2011) Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health 49(2):115–123. https://doi.org/10.1016/j.jadohealth.2011.02.005

    Article  PubMed  PubMed Central  Google Scholar 

  28. Russell ST, Fish JN (2016) Mental Health in Lesbian, Gay, Bisexual, and Transgender (LGBT) Youth. Annu Rev Clin Psychol 12:465–487. https://doi.org/10.1146/annurev-clinpsy-021815-093153

    Article  PubMed  PubMed Central  Google Scholar 

  29. Toomey RB, Huynh VW, Jones SK, Lee S, Revels-Macalinao M (2017) Sexual minority youth of color: a content analysis and critical review of the literature. J Gay Lesbian Ment Health 21(1):3–31. https://doi.org/10.1080/19359705.2016.1217499

    Article  PubMed  Google Scholar 

  30. Khanolkar AR, Frost DM, Tabor E, Redclift V, Amos R, Patalay P (2022) Ethnic and sexual identity-related inequalities in Adolescent Health and Well-being in a National Population-based study. LGBT Health. https://doi.org/10.1089/lgbt.2021.0473

    Article  PubMed  Google Scholar 

  31. Abu-Ras W, Suarez ZE, Breiwish RR (2021) Beyond the axes of Inequality: Religion, Race, and everything in between. Am J Orthopsychiat 91(2):217–235. https://doi.org/10.1037/ort0000478

    Article  PubMed  Google Scholar 

  32. Bauer GR, Churchill SM, Mahendran M, Walwyn C, Lizotte D, Villa-Rueda AA (2021) Intersectionality in quantitative research: a systematic review of its emergence and applications of theory and methods. Ssm-Popul Hlth 14. https://doi.org/10.1016/j.ssmph.2021.100798

  33. Khanolkar AR, Bolster A, Tabor E, Frost DM, Patalay P, Redclift V (2022) Lived experiences and their consequences for health in sexual and ethnic minority young adults in the UK – A qualitative study. London

  34. Khanolkar AR, Amin R, Taylor-Robinson D, Viner RM, Warner J, Stephenson T (2019) Inequalities in glycemic control in childhood onset type 2 diabetes in England and Wales-A national population-based longitudinal study. Pediatr Diabetes 20(7):821–831. https://doi.org/10.1111/pedi.12897

    Article  CAS  PubMed  Google Scholar 

  35. Strugnell C, Mathrani S, Sollars L, Swinburn B, Copley V (2020) Variation in the socioeconomic gradient of obesity by ethnicity - England’s National Child Measurement Programme. Obes (Silver Spring) 28(10):1951–1963. https://doi.org/10.1002/oby.22970

    Article  Google Scholar 

  36. Connelly R, Platt L (2014) Cohort profile: UK Millennium Cohort Study (MCS). Int J Epidemiol 43(6):1719–1725. https://doi.org/10.1093/ije/dyu001

    Article  PubMed  Google Scholar 

  37. Bauer GR, Churchill SM, Mahendran M, Walwyn C, Lizotte D, Villa-Rueda AA (2021) Intersectionality in quantitative research: a systematic review of its emergence and applications of theory and methods. SSM Popul Health 14:100798. https://doi.org/10.1016/j.ssmph.2021.100798

    Article  PubMed  PubMed Central  Google Scholar 

  38. S. BTSBST (2017) International Encyclopedia of Public Health (Second Edition). In: Quah SR (ed). Elsevier Inc. https://doi.org/10.1016/B978-0-323-99967-0.00175-7

  39. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. Bmj-Brit Med J 320(7244):1240–1243. https://doi.org/10.1136/bmj.320.7244.1240

    Article  CAS  Google Scholar 

  40. Grammer AC, Byrne ME, Pearlman AT, Klein DA, Schvey NA (2019) Overweight and obesity in sexual and gender minority adolescents: a systematic review. Obes Rev 20(10):1350–1366. https://doi.org/10.1111/obr.12906

    Article  PubMed  Google Scholar 

  41. Pachankis JE, Goldfried MR, Ramrattan ME (2008) Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. J Consult Clin Psychol 76(2):306–317. https://doi.org/10.1037/0022-006X.76.2.306

    Article  PubMed  Google Scholar 

  42. Gili M, Castellvi P, Vives M, de la Torre-Luque A, Almenara J, Blasco MJ, Cebria AI, Gabilondo A, Perez-Ara MA, Lagares AMM, Pares-Badell C, Piqueras O, Rodriguez-Jimenez JA, Rodriguez-Marin T, Soto-Sanz J, Alonso V, Roca J M (2019) Mental disorders as risk factors for suicidal behavior in young people: a meta-analysis and systematic review of longitudinal studies. J Affect Disord 245:152–162. https://doi.org/10.1016/j.jad.2018.10.115

    Article  PubMed  Google Scholar 

  43. Matthews AK, Li CC, McConnell E, Aranda F, Smith C (2016) Rates and predictors of obesity among African American sexual minority women. LGBT Health 3(4):275–282. https://doi.org/10.1089/lgbt.2015.0026

    Article  PubMed  Google Scholar 

  44. Matthews AK, Hotton A, Li CC, Miller K, Johnson A, Jones KW, Thai J (2016) An internet-based study examining the Factors Associated with the physical and Mental Health Quality of Life of LGBT Cancer survivors. LGBT Health 3(1):65–73. https://doi.org/10.1089/lgbt.2014.0075

    Article  PubMed  Google Scholar 

  45. Shenkman G, Ifrah K, Shmotkin D (2022) The moderation of socio-demographics in physical and mental health disparities among Israeli gay and heterosexual middle-aged and older men. Aging Ment Health 26(5):1061–1068. https://doi.org/10.1080/13607863.2021.1901259

    Article  PubMed  Google Scholar 

  46. VanKim NA, Laska MN (2021) Sexual orientation and obesity: what do we know? Curr Obes Rep 10(4):453–457. https://doi.org/10.1007/s13679-021-00454-w

    Article  PubMed  Google Scholar 

  47. Kokka I, Mourikis I, Bacopoulou F (2023) Psychiatric Disorders and Obesity in Childhood and Adolescence-A systematic review of cross-sectional studies. Child (Basel) 10(2). https://doi.org/10.3390/children10020285

  48. Meyer IH (2016) The Elusive Promise of LGBT Equality. Am J Public Health 106(8):1356–1358. https://doi.org/10.2105/AJPH.2016.303221

    Article  PubMed  PubMed Central  Google Scholar 

  49. Mereish EH, Poteat VP (2015) A relational model of sexual minority mental and physical health: the negative effects of shame on relationships, loneliness, and health. J Couns Psychol 62(3):425–437. https://doi.org/10.1037/cou0000088

    Article  PubMed  PubMed Central  Google Scholar 

  50. Clark KA, Salway T, McConocha EM, Pachankis JE (2022) How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts. SSM Qual Res Health 2. https://doi.org/10.1016/j.ssmqr.2022.100044

  51. Bhugra D (1997) Coming out by south Asian gay men in the United Kingdom. Arch Sex Behav 26(5):547–557. https://doi.org/10.1023/a:1024512023379

    Article  CAS  PubMed  Google Scholar 

  52. Mustanski B, Birkett M, Greene GJ, Rosario M, Bostwick W, Everett BG (2014) The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students. Am J Public Health 104(2):237–244. https://doi.org/10.2105/AJPH.2013.301451

    Article  PubMed  PubMed Central  Google Scholar 

  53. Gorczynski PF, F (2022) Loneliness in sexual minority and heterosexual individuals: a comparative meta-analysis. J Gay Lesbian Mental Health 26(2):112–129. https://doi.org/10.1080/19359705.2021.1957742

    Article  Google Scholar 

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Acknowledgements

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Funding

This study was not supported by any specific source of funding.

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, Guy’s Campus, London, UK

    Amal R. Khanolkar & Tuba Mazhari

  2. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden

    Amal R. Khanolkar

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  2. Tuba Mazhari
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Contributions

ARK was responsible for conceptualization, data curation, formal analysis and visualization. ARK and TM were responsible for interpretation of findings. Both authors wrote, reviewed and edited the original and subsequent drafts. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Amal R. Khanolkar.

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The authors declare no competing interests.

Data sharing statement

All data used in this study was collected during the age 17 assessment (MCS 7) of the Millennium Cohort Study. All data is anonymised and is freely available to use for researchers. Data can be downloaded by registering with the UK Data Service. For more information please visit: https://ukdataservice.ac.uk/. For more information on the Millennium Cohort Study including supporting documents such as technical reports and data dictionaries, please see https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/.

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The funders had no role in study design, analysis and interpretation.

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All authors confirm that they had full access to all data used in the study and accept responsibility to submit for publication. All authors read and approved the final version of the manuscript. All authors declare no conflicts of interest.

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Khanolkar, A.R., Mazhari, T. Ethnic and sexual orientation inequalities in mental health-obesity comorbidity, self-harm, and attempted suicide among British adolescents. Soc Psychiatry Psychiatr Epidemiol (2024). https://doi.org/10.1007/s00127-024-02658-6

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