Inequalities In Mental Health Research Articles

Testing the associations between poverty stigma and mental health: The role of received stigma and perceived structural stigma.

Previous research has documented how people living on low incomes in the United Kingdom (UK) and internationally experience various forms of poverty stigma. The purpose of this study was to quantitatively examine how experiences of poverty stigma are associated with mental health outcomes. An online, cross-sectional survey was conducted with 1,000 adults living in predominantly low- and middle-income households in the UK. The survey included a questionnaire designed to measure participants' experiences of different forms of poverty stigma, as well as measures of anxiety, depression and mental well-being. Exploratory and confirmatory factor analyses of the poverty stigma questionnaire supported a two-factor solution. One factor reflected participants' experiences of being mistreated and judged unfairly by other people because they live on low income (received stigma) and the other factor reflected participants' perceptions of how people living in poverty are treated by media outlets, public services and politicians (perceived structural stigma). Both received and perceived structural stigma were independently associated with anxiety, depression and mental well-being and these relationships persisted after controlling for socioeconomic indicators. There was also evidence that received stigma and perceived structural stigma partially mediated the relationships between financial hardship and mental health outcomes. Experiences of received and perceived structural poverty stigma are both associated with mental health and well-being. This suggests that addressing interpersonal and structural forms of poverty stigma may help to narrow socioeconomic inequalities in mental health.

A controlled trial comparing the impact of guided forest bathing or a mindful urban walk on heart rate, blood pressure, and mood in young Thai adults

Abstract In Thailand, cardiovascular disease and mental health cause a large health and economic burden, with 10% of Thai adults and 32% of adolescents reporting depression. Forest bathing (FB) (mindful nature walking) is growing in popularity globally as a preventative health intervention. Most FB research compares FB with a non‐active control of unguided urban walking, finding improved health and well‐being in FB but not the urban condition. This controlled trial offers a unique and robust comparison of guided FB with an active control of guided mindful urban walking. This is also the first study testing the acceptability and effectiveness of guided FB in Thailand. In a crossover design, heart rate, heart rate variability, blood pressure, and mood in 30 participants were compared before and after 1 h of guided FB and a guided mindful urban walk. MANOVA and t‐test analyses revealed that heart rate and blood pressure reduced in both conditions, but more in the mindful urban condition. Whilst negative mood was reduced in the FB condition but increased in the mindful urban condition. The study offers evidence for the promising health and well‐being benefits of both guided FB and mindful urban walking. Poor mental health and health inequalities are of increasing global concern, hence further research into the effectiveness of alleviating these difficulties through inexpensive interventions such as guided FB and mindful walking are encouraged. The study also offers the first data indicating that FB was acceptable and effective in a Thai population. Read the free Plain Language Summary for this article on the Journal blog.

Using artificial intelligence to address mental health inequalities: co-creating machine learning algorithms with key stakeholders and citizen engagement

Purpose Artificial intelligence (AI) is poised to reshape mental health practices, policies and research in the coming decade. Simultaneously, mental health inequalities persist globally, imposing considerable costs on individuals, communities and economies. This study aims to investigate the impact of AI technologies on future citizenship for individuals with mental health challenges (MHCs). Design/methodology/approach This research used a community-based participatory approach, engaging peer researchers to explore the perspectives of adults with MHCs from a peer-led mental health organisation. This study evaluated potential threats and opportunities presented by AI technologies for future citizenship through a co-created film, depicting a news broadcast set in 2042. Data were gathered via semi-structured interviews and focus groups and were analysed using a reflexive thematic approach. Findings The analysis identified four key themes: Who holds the power? The divide, What it means to be human, and Having a voice. The findings indicate that adults with living experiences of MHCs are eager to influence the development of AI technologies that affect their lives. Participants emphasised the importance of activism and co-production while expressing concerns about further marginalisation. Originality/value This study provides new insights into the intersection of AI, technology and citizenship, highlighting the critical need for inclusive practices in technological advancement. By incorporating the perspectives of individuals with living experiences, this study advocates for participatory approaches in shaping AI technologies in mental health. This includes the co-creation of machine learning algorithms and fostering citizen engagement to ensure that advancements are equitable and empowering for people with MHCs.

Economic inequalities in adolescents’ internalising symptoms: longitudinal evidence from eight countries

Research, mainly conducted in Europe and North America, has shown an inequitable burden of internalising mental health problems among adolescents from poorer households. We investigated whether these mental health inequalities differ across a diverse range of countries and multiple measures of economic circumstances. In this longitudinal observational cohort study, we analysed data from studies conducted in eight countries (Australia, Ethiopia, India, Mexico, Peru, South Africa, the UK, and Viet Nam) across five global regions. All studies had self-reported measures of internalising symptoms using a validated scale at two timepoints in adolescence; a measure of household income, household consumption expenditure, or subjective wealth; and data collected between 2000 and 2019. Household income (measured in four countries), consumption expenditure (six countries), and adolescents' subjective assessment of household wealth (five countries) were measured in mid-adolescence (14-17 years). The primary outcome (internalising symptoms, characterised by negative mood, affect, and anxiety) was measured later in adolescence between age 17 and 19 years. Analyses were linear regression models with adjustment. Effect estimates were added to random-effects meta-analyses to aid understanding of cross-country differences. The overall pooled sample of eight studies featured 18 910 adolescents (9568 [50·6%] female and 9342 [49·4%] male). Household income had a small or null association with adolescents' internalising symptoms. Heterogeneity (I2 statistic) was 71·04%, falling to 39·71% after adjusting for baseline symptoms. Household consumption expenditure had a stronger association with internalising symptoms (decreases of 0·075 SD in Peru [95% CI -0·136 to -0·013], 0·034 SD in South Africa [-0·061 to -0·006], and 0·141 SD in Viet Nam [-0·202 to -0·081] as household consumption expenditure doubled). The I2 statistic was 74·24%, remaining similar at 74·83% after adjusting for baseline symptoms. Adolescents' subjective wealth was associated with internalising symptoms in four of the five countries where it was measured. The I2 statistic was 57·09% and remained similar after adjusting for baseline symptoms (53·25%). We found evidence for cross-country differences in economic inequalities in adolescents' internalising symptoms, most prominently for inequalities according to household consumption expenditure. Subjective wealth explained greater variance in symptoms compared with the objective measures. Our study suggests that economic inequalities in adolescents' mental health are prevalent in many but not all countries and vary by the economic measure considered. Variation in the magnitude of inequalities suggests that the wider context within countries plays an important role in the development of these inequalities. Wellcome Trust.

Building decolonial nursing curricula to address disparities in Indigenous women's maternal health

Social and health inequities and inequalities are rising all over the world (Smith, 2012; McGibbon et al., 2014; Chinn and Falk‐Rafael, 2018). Nursing students should therefore be educated to understand the multifaceted factors creating health inequities and the degree to which non-biological elements can be embodied and become biological (e.g., environmental stress leading changes in health.). The need for innovative undergraduate nursing curricula reform is apparent. The lack of nursing courses highlighting the effects of colonization, environmental justice, upstream structural and social determinants of health, globalization, and state violence must be addressed. Colonization, broadly speaking, characterizes the Eurocentric project to “civilize” the rest of the world utilizing various forms of violence (McGibbon et al., 2014). The persistent and ongoing reproduction and recurrence of colonialism, enacting cycles of disenfranchisement and oppression, creates significant inequities in physical, mental, and emotional health and well-being for historically marginalized groups of people (Smith, 2012). Because gaps in nursing curricula and outdated teaching practices may support persistent inequities, scholars and students have advocated for decolonization of nursing curricula (Smith, 2012; McGibbon et al., 2014; Chinn and Falk‐Rafael, 2018). This analysis utilizes decolonial theory and postcolonial feminism to suggest pathways to decolonize nursing curricula and pedagogy through decentering the colonial knowledge structures and practices that harm Indigenous health and wellbeing.

Cross-National Trends in Adolescents Psychological and Somatic Complaints Before and After the Onset of COVID-19 Pandemic

PurposeBuilding on research suggesting that the COVID-19 pandemic may have led to an exacerbation of deteriorating trends in mental health among adolescents, this paper examined trends in adolescents' psychological and somatic complaints across 35 countries from 2010 to 2022, and tested trends in sociodemographic inequalities in these outcomes between 2018 and 2022. MethodsUsing data from 792,606 adolescents from 35 countries (51% girls; mean age = 13.5; standard deviation 1.6) across four Health Behaviour in School-aged Children surveys (2010, 2014, 2018, 2022), hierarchical multilevel models estimated cross-national trends in adolescent psychological and somatic complaints. We tested whether observed values in 2022 were in line with predicted values based on 2010–2018 linear trends. Finally, moderation effects of age, family affluence, and family structures on the outcomes were tested (2018–2022). ResultsBoth girls and boys showed substantially higher levels of psychological complaints in 2022 compared with the predicted values. For somatic complaints, higher levels than predicted in 2022 were observed only in girls. Moderation analyses revealed an increase from 2018 to 2022 in age gaps and a narrowing in the socioeconomic gap for both outcomes. Also, there was a widening gap between adolescents living with 2 parents and those living in a single parent household in 2022 compared to 2018. DiscussionCross-national increases in adolescent psychological and somatic complaints were higher than expected in 2022, based on previous trends. Magnitudes of change varied across different sociodemographics groups, with implications for pre-existing mental health inequalities.

Exploring racial inequalities in maternal mental health outcomes

Abstract Perinatal mental illness affects around 1 in 5 birthing people globally and is associated with adverse outcomes for those affected and their families. Such adverse outcomes are not inevitable and there is now good evidence for a range of both preventive and treatment interventions. There are well-documented inequalities in mental health outcomes across a range of social determinants, including race; such inequalities are also apparent during the perinatal period. There are also racial disparities in mental health care delivery during the perinatal period. Racial inequalities in perinatal mental health are now being recognized as key policy priorities in both the United States and the United Kingdom. This presentation will present routinely collected epidemiological data, investigating the drivers of these racial inequalities in access to perinatal mental health services and associated maternal and child outcomes. It also will present qualitative approaches to exploring current initiatives to reduce inequalities. Findings have the potential to inform the development of culturally sensitive interventions to promote equity in this area for underserved populations in the U.K., U.S., and elsewhere.

Social Inequalities in mental health service use and perceived helpfulness: A global analysis across 111 countries

Abstract Social inequalities in mental health are evident in the prevalence of mental health problems, but also the utilisation and patents’ perceived benefits of treatment. However, the extent of these disparities on a global scale and whether there are country-level differences in the predictors of mental health service use remain unknown. This study uses data from the Wellcome Global Monitor 2020, a nationally representative survey encompassing 111 countries and 117,088 individuals. We examine the association of socio-economic factors (such as household income and education), psycho-social factors (including stigma perception and trust in health professionals), and country-level variables (such as GDP, Gini coefficient, and health expenditure) with mental health service use and perceived effectiveness of treatment. Multi-level logistic regression models were employed for analysis. The utilisation of mental health professions of people with depression or anxiety symptomology is higher in HICs (predicted probability of 62% CI[0.60 - 0.65]) compared to LIMCs (predicted probability of 33% CI[0.31 - 0.34]). Higher country GDP (OR = 1.26 CI[1.08-1.47]) and health expenditure (OR = 1.11 CI[1.04-1.19] per percentage of health expenditure) are associated with higher treatment utilisation. On the individual level, those in the wealthiest quintile are more likely to engage with mental health professionals (OR = 1.25[1.14-1.36]) and perceive this treatment as highly beneficial (OR = 1.23[1.07-1.40]). Trust in healthcare practitioners and perceived stigma are also associated with mental healthcare use. This analysis shows strong patterns of mental healthcare use and perceived benefits depending on the wealth of the country, health expenditure and individual socio-economic status. Moreover, disparities in treatment utilization and effectiveness are also influenced by trust in healthcare professionals and perceived mental health stigma.

Exploring anxiety and depression trends: insights from the BELHEALTH cohort 2022-2024 in Belgium

Abstract Background The swift impact of the COVID-19 pandemic and ensuing restrictions on the mental health of the Belgian population prompted the need for a sustainable system to monitor its evolution. Repeated COVID-19 surveys were conducted between 2020 and 2022 to address this issue, followed by the launch of the BELHEALTH cohort project. Our study aims to analyze the trajectory of anxiety and depression at the post-pandemic period, using data from five waves of the BELHEALTH longitudinal surveys from October 2022 to March 2024. High-risk groups and the potential of social support and resilience to mitigate anxiety and depression were explored. Methods The BELHEALTH follow-up cohort of around 7,300 Belgian residents uses online surveys to assess anxiety (with the GAD-7), and depression (with the PHQ-9). The analyses were performed using linear mixed models on the 3,676 individuals who participated in all five waves. Results Preliminary results indicated that more people were affected by anxiety in October 2022 (16%) compared to June 2023 (14%), while depression rates were lower in October 2022 (13%) compared to February 2023 (14%) and March 2024 (15%). However, the trajectory of mental health varied across demographic subgroups, with worse outcomes observed among unemployed and younger individuals, as well as those living alone, in the Walloon Region (South of Belgium). Overall, people with a low level of resilience or a low level of social support exhibited higher odds of experiencing depression. Conclusions Reducing these social inequities in mental health necessitates the development of structural prevention measures and interventions at the regional level. These measures should target factors such as unemployment, which is particularly prevalent among younger individuals and those living in Wallonia. Additionally, fostering protective factors such as social support and resilience is crucial for mitigating mental health inequalities over time. Key messages • Monitoring mental health and its determinants remains crucial to identify and address social inequities, tailor interventions, and support vulnerable populations. • Unemployed, younger people, and those residing in the Walloon region are at particular risk.

2.M. Scientific session: Economics of Mental Health in the interplay between health systems and public health

Abstract Mental health systems and services are essential components of the public health infrastructure, serving as frontline for prevention and intervention for health overall. Despite this, access to mental health services remains largely inadequate, with the OECD calculating that only about one in three people with mental health problems has access to quality treatment across 19 EU Member States. The economics of mental health play an important role in determining the allocation of resources, the accessibility of services and the overall effectiveness of interventions. Effective planning requires an understanding of population needs, service gaps and utilization patterns, in order to ensure equity and health improvement. In fact, the conceptualisation of the economic dimensions of mental health enables policymakers, practitioners, and stakeholders to make informed decisions that optimize resource utilization and maximize societal benefits. The proposed workshop will build on previous activities of the EUPHA Section on Public Health Economics at EPH, including the recent establishment of a working group on the economics of mental health. The aim of the meeting is to promote the adoption of best practices and methodologies in the conduct of economic studies on mental health. As such, the workshop will provide an opportunity to discuss the unique challenges of economic evaluation in this field and to present relevant ongoing activities by members of the Section and other invited experts. Key messages • Mental health, its distribution and at-risk populations influence resource allocation and policy decisions within mental health systems. • Tackling inequalities in mental health is essential for promoting health equity and social justice, requiring evidence-based interventions and policy initiatives to empower marginalized communities.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.

Youth mental health outreach interventions: lessons from an experience capitalisation process

Abstract Issue Young people face socioeconomic, geographical and cultural barriers to access care and support in mental health. Practitioners implement outreach initiatives to improve mental health and address health inequalities, mostly developed in a ‘no-request for care’ context. Methods To better understand the implementation mechanisms of these initiatives, Fondation de France commissioned the French Society for Public Health to carry out an experience capitalisation to inspire other professionals. Experience capitalisation method was used, based on in depth interviews with project stakeholders. Covered themes were: the description of history, strategies and activities; identification of key moment and key levers; skills and knowledge used. Results Nine mental health outreach projects implemented across regions of France were selected with the help of a multidisciplinary steering committee. Each project was synthetised in a capitalisation document and a cross-sectional analysis was undertaken. Lessons • A variety of outreach approaches were carried on: meeting adolescents in the street or at coffee shops; home-based interventions; consultations in converted van etc. • Outreach is not just a matter of physically moving outside health structures but requires non-judging and flexible stance to adjust to the youth’s pace and will. To extend their approach to mobility, professionals deepen their team’s multidisciplinarity, broaden cross-sector partnerships and mobilise new skills and creativity. • Adolescents’ participation to care or support plans was one of projects strengths, whether they suffer from anxiety or mental disorders. However, their participation in governance and decisions regarding global projects remained limited. Key messages • To reduce mental health inequalities and enhance youth participation in outreach interventions, empowerment and wellbeing of interventions practitioners should also be supported. • Capitalisation of experience in health promotion is a promising method contributing to professional acknowledgment and development of shared knowledge on interventions implementation.

“I stayed on the street, as if there was no COVID-19”: enacting practices of care with youth at risk of violence and social exclusion in Portugal

As the COVID-19 pandemic unfolded, a world of carelessness was made visible. Public health guidelines against the spread of COVID-19 (e.g., school closures, staying home, social distancing) have substantially affected youth’s health and well-being and highlighted the need for context-specific understandings of infection, risk, and care. Our research aims to contribute to a deeper understanding of the impacts of COVID-19 on boys and girls serving educational measures and placed in the custody of the juvenile justice system in Portugal during the pandemic. Sustained by the use of ethnographic principles and methods along with participatory techniques, this article uncovers complex entanglements between the public health measures to mitigate contagion and the dynamics that exacerbated socio-spatial dynamics of social exclusion and isolation, educational and (mental) health inequities, and lived and practiced forms of violence by youth-serving tutelary measures in Portugal’s six educational centers. Following Tronto’s feminist ethical–political proposal of care, I argue that COVID-19 became a lens to access youth care needs — self-care, care for others, care as essential work of nurturing affective trajectories and solidarities and promoting positive and non-violent relationships. By caring for youth stories, the engagement of researchers and professionals in this action-oriented research aimed to promote the enactment of practices of care with youth in the Portuguese detention centers as a way to positively affect their inhabited present, promote healthier lives and nurture the construction of caring and non-violent post-pandemic futures.

Gender Nonconformity, Minority Stress, and Psychological Distress Among Sexual Minority Adolescents.

Purpose: Sexual minority adolescents (SMAs) have disproportionate experiences of mental health symptoms during adolescence, and minority stress contributes to mental health inequities among SMAs. Gender nonconformity (GNC) could place SMAs at higher risk for minority stress and subsequent mental health symptoms. The current study was designed to examine associations between GNC, minority stress, and psychological distress among SMAs. Method: SMAs ages 12-17 years (n = 455; mean age = 15.52 years) in the United States completed a cross-sectional online survey from February to July 2022, including measures of GNC, peer victimization, family rejection, negative expectations, negative disclosure experiences, internalized homonegativity, and psychological distress. We conducted path analysis to examine associations between GNC, minority stressors, and psychological distress, including indirect effects of GNC on psychological distress via minority stress. Results: In multivariable path analysis adjusted for demographic characteristics, GNC was associated with higher levels of peer victimization and negative expectations and lower internalized homonegativity among SMAs. Higher levels of peer victimization and negative expectations were associated with higher psychological distress. GNC was indirectly related to higher levels of psychological distress via higher peer victimization. Conclusions: The current study is the first to document associations between GNC and multiple minority stress experiences among SMAs, and GNC was indirectly related to psychological distress among SMAs via peer victimization. Although all SMAs would benefit from interventions designed to reduce peer victimization and increase their capacity to cope with minority stress, such interventions may be particularly beneficial for SMAs who are gender nonconforming.

Social inequalities in child mental health trajectories: a longitudinal study using birth cohort data 12 countries

BackgroundSocial inequalities in child mental health are an important public health concern. Whilst previous studies have examined inequalities at a single time point, very few have used repeated measures outcome data to describe how these inequalities emerge. Our aims were to describe social inequalities in child internalising and externalising problems across multiple countries and to explore how these inequalities change as children age.MethodsWe used longitudinal data from eight birth cohorts containing participants from twelve countries (Australia, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Poland, Norway, Spain and the United Kingdom). The number of included children in each cohort ranged from N = 584 (Greece) to N = 73,042 (Norway), with a total sample of N = 149,604. Child socio‐economic circumstances (SEC) were measured using self‐reported maternal education at birth. Child mental health outcomes were internalising and externalising problems measured using either the Strengths and Difficulties Questionnaire or the Child Behavior Checklist. The number of data collection waves in each cohort ranged from two to seven, with the mean child age ranging from two to eighteen years old. We modelled the slope index of inequality (SII) using sex‐stratified multi‐level models.ResultsFor almost all cohorts, at the earliest age of measurement children born into more deprived SECs had higher internalising and externalising scores than children born to less deprived SECs. For example, in Norway at age 2 years, boys born to mothers of lower education had an estimated 0.3 (95% CI 0.3, 0.4) standard deviation higher levels of internalising problems (SII) compared to children born to mothers with high education. The exceptions were for boys in Australia (age 2) and both sexes in Greece (age 6), where we observed minimal social inequalities. In UK, Denmark and Netherlands inequalities decreased as children aged, however for other countries (France, Norway, Australia and Crete) inequalities were heterogeneous depending on child sex and outcome. For all countries except France inequalities remained at the oldest point of measurement.ConclusionsSocial inequalities in internalising and externalising problems were evident across a range of EU countries, with inequalities emerging early and generally persisting throughout childhood.

The Longitudinal Impact of Family, Religious, and School Support on the Mental Health of Filipino and Korean American Youth Across Adolescence.

Asian Americans, currently the most rapidly expanding racial group in the USA, are experiencing persistent mental health inequities. These inequities are particularly pronounced during adolescence, highlighting the critical need for dedicated focus on this demographic. Social support is a key shield against mental distress among these adolescents, yet little research has examined the collective impact of multiple sources of support over time, across developmental stages, and for different ethnic subgroups. Drawing on the integrated conceptual framework, this longitudinal study is the first to our knowledge to examine how support from families, religious organizations, and schools together predicts mental health over time across adolescents' developmental stages. We further examined how these relationships may be moderated by age groups, distinguishing between the early adolescence cohort and the middle adolescence cohort. Data were from the Midwest Longitudinal Study of Asian American Families (MLSAAF) project that survey-interviewed 378 Filipino American and 408 Korean American adolescents (Mage = 15years). Findings reveal that family support consistently buffers against mental distress throughout adolescence for both groups. Religious support distinctly aids Filipino American early adolescents, while school support notably benefits early adolescents regardless of ethnicity. These findings emphasize the universal protective effects of social support, while also highlighting the nuanced ways that developmental stage and ethnicity may influence how different sources of support impact mental health. This underscores the need for developmentally and culturally sensitive mental health strategies for Asian American adolescents.

Linking housing, socio-demographic, environmental and mental health data at scale

Mental disorders are a growing problem worldwide, putting pressure on healthcare systems and wider society. Anxiety and depression are estimated to cost the global economy US$1 trillion per year, yet only 2% of global median government healthcare expenditure goes towards mental health. There is growing evidence linking housing, socio-economic status and local environmental conditions with mental health inequalities. The aim of this paper is to link several open-access datasets at the local area level (N = 32,844) for England to clinical mental health metrics and describe initial statistical findings. Two mental health metrics were used: Small Area Mental Health Index (SAMHI) and diagnosed depression prevalence. To demonstrate the utility of the longitudinal mental health data, changes in depression prevalence were investigated over two study periods (2011–19, i.e. austerity; and 2019–22, i.e. COVID-19). These data were linked to housing data (energy efficiency, floor area, year built, type and tenure) from Energy Performance Certificates (EPCs); socio-demographic data (age, sex, income and education deprivation, household size) from administrative records; and local environment data (winter temperature, air pollution and access to green space). The linked dataset provides a useful resource with which to investigate the social and environmental determinants of mental health. Practice relevance Initial observations of the data revealed a non-linear relationship between home energy efficiency (EPC band) and the mental health metrics, with depression prevalence higher in local areas where the mode EPC bands were C and D, compared with B and E. Researchers can further investigate this relationship using the dataset through robust statistical analysis, adjusting for confounding variables. National and local governments may use the dataset to help allocate resources to prevent and treat mental health conditions. Practitioners can map and interrogate the data to describe their local areas and make preliminary conclusions about the relationships between the built environment and mental health. This preliminary analysis of the data demonstrated a gradient in SAMHI and depression prevalence with income and employment deprivation at the local area level.

Inequalities in adolescent mental health and allocation of students to selective classes in comprehensive schools in Finland: a longitudinal study

BackgroundLower socioeconomic positions (SEP) and poor academic achievement increase children’s risk for mental health problems. The Finnish education system is officially non-selective and unified, but a part of children can...

Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent.

COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.

To what extent could eliminating racial discrimination reduce inequities in mental health and sleep problems among Aboriginal and Torres Strait Islander children? A causal mediation study

BackgroundRacism is a fundamental cause of health inequities for Aboriginal and Torres Strait Islander children. We estimated the potential reduction in inequities in Aboriginal and Torres Strait Islander children’s mental health and sleep problems if interpersonal racial discrimination was eliminated. MethodsWe drew on cross-sectional data from the Speak Out Against Racism (SOAR; N=2818) and longitudinal data from the Longitudinal Study of Australian Children (LSAC; N=8627). The SOAR was completed in 2017 and the LSAC followed children from 2004 to 2014 in the kindergarten cohort and from 2008 to 2018 in the birth cohort. Exposure: Aboriginal and Torres Strait Islander status (Aboriginal and Torres Strait Islander/Anglo-European), a proxy measure of structural racism (SOAR: 10-15 years; LSAC: 4-5 years); Mediator: interpersonal racial discrimination (yes/no) (SOAR: 10-15 years; LSAC: 12-13 years); Outcomes: mental health problems (yes/no) and sleep problems (yes/no) (SOAR: 10-15 years; LSAC: 14-15 years). An interventional effects causal mediation approach was used. FindingsAboriginal and Torres Strait Islander children had higher prevalence of mental health problems (SOAR: 40·1% versus 13·5%; LSAC: 25·3% versus 7·6%) and sleep problems (SOAR: 28·5% versus 18·4%; LSAC: 14·0% versus 9·9%) than Anglo-European children. Hypothetical interventions eliminating Aboriginal and Torres Strait Islander children’s experiences of interpersonal racial discrimination could reduce 42·4% and 48·5% of mental health and sleep inequities in SOAR (equivalent to 11·2% and 4·7% absolute reductions) and 25·6% and 1·6% of mental health and sleep inequities in LSAC (equivalent to 5·5% and 0·1% absolute reductions). Absolute remaining inequities were similar across both studies for both outcomes. InterpretationTargeted policy interventions that eliminate racial discrimination against Aboriginal and Torres Strait Islander children could have high potential to reduce inequities in mental health and sleep problems. Addressing racism and racial discrimination needs a multi-component and multi-level approach directed by Aboriginal and Torres Strait Islander communities.Funding: National Health and Medical Research Council of Australia and Medical Research Future Fund of Australia