Understanding differences in mental health service use by men: an intersectional analysis of routine data

Smyth, Natasha; Buckman, Joshua E J; Naqvi, Syed Ali; Aguirre, Elisa; Cardoso, Ana Amélia; Pilling, Stephen

doi:10.1007/s00127-022-02256-4

Cited by 12 publications

(9 citation statements)

References 57 publications

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“…In this context, we found that intersections relating to experiences of racism, migration, fragile social circumstances, complex trauma, social marginalisation, the important role of religion in a person’s life, and English language proficiency were more conceptually important and useful than crude ethnic group classifications. A recent quantitative study exploring mental health service use in men also found important intersections between social deprivation, religion, and ethnicity [ 120 ].…”

Section: Discussionmentioning

confidence: 99%

Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography

et al. 2022

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Background Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention. Methods and findings Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to “ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view).” We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as “medical” and “Eurocentric”) and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections. Conclusions In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.

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Section: Discussionmentioning

confidence: 99%

Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography

et al. 2022

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“…R/S is a complex phenomenon with multidimensional and multi-stratificational characteristics having disparate roles and impacts in different populations and R/S groups [ 29 ]. Consequently, the social and psychological aspects of R/S may have disparate functions in the individual’s life [ 53 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite having poorer mental health, Indigenous peoples and other ethnic minorities are often under-users of mental health services [ 25–28 ] or have an increased risk of disengaging from treatment [ 29 ]. This phenomenon is often due to language and cultural barriers, the lack of culturally sensitive services, alternative aetiological conceptions of mental diseases, social stigma, and mistrust towards Western psychiatry [ 25 , 26 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

The association of religious factors with mental health-service utilisation and satisfaction in a mixed Sámi and Norwegian adult population: Adopting the SAMINOR 2 Questionnaire Survey

Kiærbech¹,

Broderstad²,

Silviken

et al. 2023

International Journal of Circumpolar Health

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The Indigenous Sámi have poorer mental health than the majority population and fairly equal access to professional mental healthcare. Despite this condition, certain studies indicate that this group is underrepresented among the users of such services. Religion or spirituality (R/S) often influences mental health-service utilisation and satisfaction among other Indigenous peoples and ethnic minorities. Thus, this study examines the situation in Sámi-Norwegian areas. We utilised cross-sectional data from the population-based SAMINOR 2 Questionnaire Survey (2012; subsample n = 2,364; 71% non-Sámi) in mixed Sámi-Norwegian regions of Northern and Central Norway. We analysed the associations between R/S factors and past-year mental health-service utilisation and satisfaction among individuals reporting mental health problems, substance use, or addictive behaviours. Multivariable-adjusted regression models considering sociodemographic factors, including Sámi ethnicity, were applied. Religious attendance was significantly associated with infrequent past-year use of mental health services (OR = 0.77) and fewer mental health problems, indicating that the R/S fellowship may buffer mental distress and represent an alternative psychological support to professional services. R/S was not significantly associated with lifetime mental health-service satisfaction. We found no ethnic differences in service utilisation or satisfaction.

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“…A retrospective cohort was formed of those who have completed a course of treatment (at least two IAPT treatment sessions as per previous research and NHS Digital guidelines 26 , 27 ). When individuals had received several courses of IAPT treatment between 2012 and 2019, the first course of treatment was considered as per previous research 28 to maximise the length of the study follow-up. As prevalence of CVD rises between the age of 45 and 54, 29 individuals were included in the analytic cohort if they were over 45 years of age at the time of IAPT referral, had completed depression symptom measures pre- and post-treatment, and had at least one linked HES or ONS record available.…”

Section: Methodsmentioning

confidence: 99%

Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England

Baou¹,

Desai²,

Cooper

et al. 2023

European Heart Journal

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Aims People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD. Methods and results A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES–ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses. Conclusion Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.

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Understanding differences in mental health service use by men: an intersectional analysis of routine data

Cited by 12 publications

References 57 publications

Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography

Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography

The association of religious factors with mental health-service utilisation and satisfaction in a mixed Sámi and Norwegian adult population: Adopting the SAMINOR 2 Questionnaire Survey

Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England

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