Stressful Life Events and Coping Behaviours as Risk Factors for Common Mental Disorders Do Ethnicity and Migrant Status confound these relationships

Abstract

Background
Research suggests the influences of cumulative stressors are important risk factors for mental health. There is limited research into the effects of coping behaviours in the relationship between Stressful Life Events (SLE) and Common Mental Disorders (CMD) in ethnically diverse urban populations.

Methods
The analytic sample included 1053 cohort participants from phase two of the South-East London Community Health (SELCoH) study, a population cohort survey. The prevalence of severity of CMD, the cumulative lifetime experience of SLE, and coping behaviours were estimated across ethnic and migrant groups. Multinomial logistic regression models were used to examine the effects of cumulative stressful life events at Phase 1 on severity of common mental disorder at Phase 2; the effects of coping behaviours in this association was explored. Models adjusted for covariates including ethnicity, migrant status and SES indicators.

Results
The estimated prevalence for clinically significant CMD symptoms in the sample was 13.1% (95% C.I. 11.0-15.4). There were no significant differences across ethnic and migrant groups in CMD prevalence. Coping by praying and avoidant coping were prominent in Black and Minority ethnic (BME) and migrant groups. Cigarette smoking and alcohol consumption coping behaviours were reported most by non-migrant White-British groups. Cumulative SLE was significantly associated with clinically significant CMD symptoms, but was attenuated and became insignificant in the fully adjusted model, which controlled for CMD at Phase 1 alongside other covariates. Ethnicity and migrant status were not confounders in this association. Praying and cigarette smoking remained significant risk factors for CMD in all models.

Conclusion
Cumulative SLE is not associated with risk of CMD onset over time, but its synergetic interactions with other risk factors and covariates pose a strong risk for clinically significant CMD symptoms. The noteworthy differences in coping strategies across ethnic and migrant groups, and the substantial mental health risks associated with coping by praying and cigarette smoking found in this study have implications for culturally sensitive health interventions targeting at risk groups, and require comprehensive research into the underlying mechanisms of these findings.

Date of Award	Sept 2015
Original language	English
Awarding Institution	King's College London
Supervisor	Stephani Hatch (Supervisor)