Abstract
Pakistani women in the UK are an at‐risk group with high levels of mental health problems, but low levels of mental health service use. However, the rates of service use for Pakistani women are unclear, partly because research with South Asian women has been incorrectly generalised to Pakistani women. Further, this research has been largely undertaken within an individualistic paradigm, with little consideration of patients’ social networks, and how these may drive decisions to seek help. This systematic review aimed to clarify usage rates, and describe the nature of Pakistani women's social networks and how they may influence mental health service use. Ten journal databases (ASSIA, CINAHL Plus, EMBASE, HMIC, IBSS, MEDLINE, PsycINFO, Social Sciences s, Social Science Citation Index and Sociological s) and six sources of grey literature were searched for studies published between 1960 and the end of March 2014. Twenty‐one studies met inclusion criteria. Ten studies (quantitative) reported on inpatient or outpatient service use between ethnic groups. Seven studies (four quantitative, three qualitative) investigated the nature of social networks, and four studies (qualitative) commented on how social networks were involved in accessing mental health services. Pakistani women were less likely than white (British) women to use most specialist mental health services. No difference was found between Pakistani and white women for the consultation of general practitioners for mental health problems. Pakistani women's networks displayed high levels of stigmatising attitudes towards mental health problems and mental health services, which acted as a deterrent to seeking help. No studies were found which compared stigma in networks between Pakistani women and women of other ethnic groups. Pakistani women are at a considerable disadvantage in gaining access to and using statutory mental health services, compared with white women; this, in part, is due to negative attitudes to mental health problems evident in social support networks.
Highlights
The Delivering Race Equality programme (Department of Health, 2005) aimed to provide equitable, non-racist mental health services to people in England and Wales
The community surveys [(Health Survey for England 1999 and Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC)] provided figures for consultations with general practitioners (GPs) for mental illness based on participant self-report and related to the previous 6 (EMPIRIC) or 12 (HSE 1999) months
The review shows the importance of analysing Pakistani women separately from Indian and Bangladeshi women: future research and Department of Health published figures, should report and analyse Pakistani women as a separate group in order to provide accurate information on usage of mental health services
Summary
The Delivering Race Equality programme (Department of Health, 2005) aimed to provide equitable, non-racist mental health services to people in England and Wales. Pakistani women’s use of mental health services. South Asian (Pakistani, Indian and Bangladeshi) women are one group for whom inequalities (low rates of usage of mental health services) are evident Within this group, Pakistani women may be disadvantaged, as they have high levels of mental illness (Gater et al 2009, Chaudhry et al 2012), but low levels of service use. It is not appropriate to do this, as there are indications that Pakistani women have higher mental illness rates than Indian and Bangladeshi women (Nazroo 2001, Weich et al 2004), but lower usage of mental health services than Indian women (Care Quality Commission & National Mental Health Development Unit, 2010, 2011)
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