Resilience in the city? Evidence from the Determinants of young Adult Social wellbeing and Health (DASH) longitudinal study of diverse young adults

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BackgroundThe potential effects of urban life and ethnic diversity on wellbeing and social capital have gained recent attention. However, much research does not sufficiently conceptualise which aspects of city living might affect wellbeing among diverse social groups. The Determinants of young Adult Social wellbeing and Health (DASH) study showed better mental health in adolescence among many ethnic minority groups in London than among white British groups, despite more material disadvantage. Key influences on mental health were family connectedness, attending a place of worship, and ethnic diversity of friendships. In follow-up at 21–23 years, we examined whether this mental health advantage was maintained and factors that might contribute to this. Methods6643 11–13-year-olds from 51 schools participated in the baseline survey in 2002–03 and were assessed again at age 14–16 years. In 2013, 48 participants aged 21–23 years took part in semi-structured interviews. Sampling achieved broad representation by key social determinants in each ethnic group (eg, sex, family type, religion, socioeconomic circumstances [SEC]). Participants completed the strengths and difficulties questionnaire (SDQ) in adolescence and the general health questionnaire (GHQ-12) in adulthood alongside questions about social circumstances. Interview topics included social relationships, identity, and transitions to adulthood. Interviews were digitally recorded and transcribed. Quantitative and qualitative data were analysed iteratively through constant comparison. Ethnic differences in adolescence were examined by the SDQ with sex-specific linear mixed models and at 21–23 years with the GHQ-12 with non-parametric tests. Transcripts were analysed to identify deductive themes and inductively to identify emerging themes. FindingsIn adolescence, mean SDQ scores were generally lower for ethnic minority groups than for white groups. Among boys, for example, the largest difference in mean score between whites and minority groups, adjusted for SEC, was for Nigerian and Ghanaian boys (−2·34, 95% CI −3·04 to −1·65) and the smallest was for Pakistani boys (−1·00, −1·68 to −0·31). GHQ scores suggested tracking of better mental health for some groups (Pakistani, Bangladeshi, and Indian boys). In qualitative interviews, participants expressed flexible but secure identities with greater diversity in aspects such as language use, religious practice, and diet compared with their parents. Awareness of parents' migration experience, and the investment and opportunity that this represented, instilled obligations to family and aspirations for education and work. For a substantial minority, premature parental morbidity led to early adoption of caring roles. Religion was an important social and moral influence for many ethnic minority participants, whether or not religious practice continued into adulthood. Neighbourhoods were valued for familiarity and sociality, although some were perceived as less cohesive. Inter-ethnic interactions and friendships were regarded as integral to London life. Problematic relationships, poor educational attainment, and prolonged difficulties finding employment were linked to mental ill health. InterpretationThese findings challenge hypotheses regarding the negative effect of diversity and urbanicity on social capital and mental health and suggest tracking of resilience among ethnic minorities in London. For the DASH cohort, experiences of family life and diversity in childhood seem to have enduring effects on mental health. A mixed-method design added interpretative value and suggested additional follow-up measures, such as informal family caring. This is a small pragmatic sample for a feasibility study. Participants with worst mental health may be least likely to consent to follow-up, albeit there were very few refusals. Recall and response bias is a risk in questionnaires and interviews as well as contextual influences such as examination stress, particularly during transitions of young adulthood. Enduring mental health difficulties may become more prevalent as participants age. FundingThe DASH study is funded by the UK MRC (MC_U130015185/MC_UU_12017/1).