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Ethnic density effects for adult mental health: systematic review and meta-analysis of international studies

Published online by Cambridge University Press:  14 December 2017

Laia Bécares ,
Michael E. Dewey  and
Jayati Das-Munshi
Laia Bécares*
Affiliation:
Department of Social Statistics, University of Manchester, Manchester, UK
Michael E. Dewey
Affiliation:
Department of Health Services & Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
Jayati Das-Munshi
Affiliation:
Department of Health Services & Population Research, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
*
Author for correspondence: Laia Bécares, E-mail: [email protected]
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Abstract

Background

Despite increased ethnic diversity in more economically developed countries it is unclear whether residential concentration of ethnic minority people (ethnic density) is detrimental or protective for mental health. This is the first systematic review and meta-analysis covering the international literature, assessing ethnic density associations with mental health outcomes.

Methods

We systematically searched Medline, PsychINFO, Sociological Abstracts, Web of Science from inception to 31 March 2016. We obtained additional data from study authors. We conducted random-effects meta-analysis taking into account clustering of estimates within datasets. Meta-regression assessed heterogeneity in studies due to ethnicity, country, generation, and area-level deprivation. Our main exposure was ethnic density, defined as the residential concentration of own racial/ethnic minority group. Outcomes included depression, anxiety and the common mental disorders (CMD), suicide, suicidality, psychotic experiences, and psychosis.

Results

We included 41 studies in the review, with meta-analysis of 12 studies. In the meta-analyses, we found a large reduction in relative odds of psychotic experiences [odds ratio (OR) 0.82 (95% confidence interval (CI) 0.76–0.89)] and suicidal ideation [OR 0.88 (95% CI 0.79–0.98)] for each 10 percentage-point increase in own ethnic density. For CMD, depression, and anxiety, associations were indicative of protective effects of own ethnic density; however, results were not statistically significant. Findings from narrative review were consistent with those of the meta-analysis.

Conclusions

The findings support consistent protective ethnic density associations across countries and racial/ethnic minority populations as well as mental health outcomes. This may suggest the importance of the social environment in patterning detrimental mental health outcomes in marginalized and excluded population groups.

Keywords

raceethnicityethnic densitycommon mental disordersdepressionanxietypsychosispsychotic experiencessuicidal ideassuicidemental healthsystematic reviewmeta-analysis
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 12 , September 2018 , pp. 2054 - 2072
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

*

Contributed equally to the manuscript.

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