Abstract
Background: Mental health inequalities remain a major public health issue in the United Kingdom (UK). Inequalities such as poorer treatment outcomes are consistently associated with individual characteristics such as ethnicity, gender and socio-economic status. These disparities are complex and interrelated, yet few studies have employed a detailed approach to understand how these characteristics are jointly associated with mental health treatment outcomes. This study aimed to employ an intersectional approach to examine mental health inequalities in UK psychological therapy services.Method: Data from 46,684 patients who completed treatment in Improving Access to Psychological Therapies (IAPT) services in four South London boroughs were analysed. Regression models were used to identify inequalities in treatments indicators and outcomes, predicted by individual characteristics (ethnicity, gender, employment status) and at their intersection. Treatment indicators included treatment allocation (high versus low intensity) and number of treatment sessions attended (up to 12 sessions indicating lower level treatment provision versus more than 12 sessions indicating higher level treatment provision). Treatment outcome referred to recovery and symptom reduction following treatment.
Results: White Other patients had decreased odds of being allocated to a high intensity intervention compared to White British patients. With the exception of the Asian ethnic group, all other ethnic groups had increased odds of being allocated to a high intensity intervention compared to the White British ethnic group, after adjusting for confounders. Asian and Black (African, Caribbean, Other) ethnic groups were less likely to attend more than 12 treatment sessions compared to the White British ethnic group after adjusting for confounders. Reliable recovery was more likely for female and White British patients. Ethnic minority women showed greater reduction in depression scores compared to White British women, with no significant interaction effect with employment status. Ethnic minority men only showed a greater reduction in depression scores when employment status was considered.
Conclusions: Using an intersectional approach revealed disparities in depression change scores based on intersections between ethnicity, gender and employment status. Future studies should utilise intersectional approaches to ascertain inequalities in mental health treatment outcomes not previously identified.
| Date of Award | 1 Oct 2019 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Stephani Hatch (Supervisor) & Katharine Rimes (Supervisor) |