Abstract
It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality. Using data from the South East London Community Health study (n = 1698) we investigated associations between minority status (defined by: ethnicity, household status and occupational social class) and risk of psychotic experiences, common mental disorders and parasuicide. We used a multilevel logistic model to examine cross-level interactions between minority status at individual and neighbourhood levels. Being Black in an area where this was less common (10%) was associated with higher odds of psychotic experiences [odds ratio (OR) 1.34 95% confidence interval (CI) 1.07-1.67], and attempted suicide (OR 1.84 95% CI 1.19-2.85). Living alone where this was less usual (10% less) was associated with increased odds of psychotic experiences (OR 2.18 95% CI 0.91-5.26), while being in a disadvantaged social class where this was less usual (10% less) was associated with increased odds of attempted suicide (OR 1.33 95% CI 1.03-1.71). We found no evidence for an association with common mental disorders. The relationship between minority status and mental distress was most apparent when defined in terms of broad ethnic group but was also observed for individual household status and occupational social class.
Highlights
Having a minority status, in terms of a defining social characteristic that differs from others in a locality, has been associated with an increased risk of mental illness (van Os et al 2010; Zammit et al 2010; Shaw et al 2012)
For the effect of single household status our results are very similar to the previous Maastricht study where schizophrenia risk was almost doubled in areas with below average rates of single people (RR 10.3, 95% CI 5.6–19.2) compared to areas with above average rates (RR 4.2, 95% CI 1.9–9.3)
While we looked at a subclinical measure of psychotic experiences, the fact that our results so clearly mirror previous research on schizophrenia is perhaps not surprising as a number of studies have shown the PSQ to be related to risk factors for clinical psychosis (Morgan et al 2009; Das-Munshi et al 2012)
Summary
In terms of a defining social characteristic that differs from others in a locality, has been associated with an increased risk of mental illness (van Os et al 2010; Zammit et al 2010; Shaw et al 2012). A number of explanations for the ethnic density effect have been proposed including: the absence of social support and social capital, greater vulnerability to discrimination, and increased negative self-perception and diminished social identity (Kirkbride et al 2007; Yuan, 2007; Pickett & Wilkinson, 2008; Becares et al 2009; Shaw et al 2012) These are relevant, to varying degrees, where there is a lack of fit between other examples of individual characteristics, such as family and socioeconomic status, and the neighbourhood social environment. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is usual in a locality
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