A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England

TY - JOUR

T1 - A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England

AU - Rhead, Rebecca

AU - Woodhead, Charlotte

AU - Ahmad, Gargie

AU - Das-Munshi, Jayati

AU - McManus, Sally

AU - Hatch, Stephani

N1 - Funding Information: This work was supported by the Wellcome Trust [203380/Z/16/Z] and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. CW and SH are supported by the Economic and Social Research Council (ESRC) Centre for Society and Mental Health at King’s College London (ESRC Reference: ES/S012567/1). JD is part supported by the ESRC Centre for Society and Mental Health at King’s College London (ESRC Reference: ES/S012567/1), grants from the ESRC (ES/S002715/1), by the Health Foundation working together with the Academy of Medical Sciences, for a Clinician Scientist Fellowship, and by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. GA is supported by an ESRC PhD studentship, via the London Interdisciplinary Social Science Doctoral Training Partnership, (ESRC reference: ES/P000703/1). SM is supported by the UKRI (MR-VO49879/1). The views expressed are those of the authors and not necessarily those of the funders. The funders did not have a role in the study design; collection, analysis, or interpretation of data; the writing of the manuscript; or in the decision to submit the manuscript for publication. Publisher Copyright: © 2022, The Author(s).

PY - 2022/10

Y1 - 2022/10

N2 - Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014–2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45–2.02), economically inactive (AOR 2.02, 95% CI:1.05–3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02–1.74), and Black (AOR 0.36 95% CI:0.20–0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group (“White British, highly educated, employed, high social class”), “Retired WhiteBritish” had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while “Employed migrants” had lower odds (AOR 0.39, 95% CI:0.27–0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but—except for sexual minorities—adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.

AB - Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014–2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45–2.02), economically inactive (AOR 2.02, 95% CI:1.05–3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02–1.74), and Black (AOR 0.36 95% CI:0.20–0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group (“White British, highly educated, employed, high social class”), “Retired WhiteBritish” had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while “Employed migrants” had lower odds (AOR 0.39, 95% CI:0.27–0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but—except for sexual minorities—adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.

UR - http://www.scopus.com/inward/record.url?scp=85125752393&partnerID=8YFLogxK

U2 - 10.1007/s00127-022-02259-1

DO - 10.1007/s00127-022-02259-1

M3 - Article

SN - 0933-7954

VL - 57

SP - 2049

EP - 2063

JO - Social Psychiatry and Psychiatric Epidemiology

JF - Social Psychiatry and Psychiatric Epidemiology

IS - 10

ER -