Skip to main content
×
×
Home

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

  • Laia Bécares (a1), Michael E. Dewey (a2) and Jayati Das-Munshi (a2)
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.

Copyright
Corresponding author
Author for correspondence: Laia Bécares, E-mail: Laia.becares@manchester.ac.uk
Footnotes
Hide All
*

Contributed equally to the manuscript.

Footnotes
References
Hide All
Alegria, M, Molina, KM and Chen, CN (2014) Neighborhood characteristics and differential risk for depressive and anxiety disorders across racial/ethnic groups in the United States. Depression & Anxiety 31, 2737.
Aneshensel, CS, Wight, RG, Miller-Martinez, D, Botticello, AL, Karlamangla, AS and Seeman, TE (2007) Urban neighborhoods and depressive symptoms among older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences 62, S52S59.
Arévalo, SP, Tucker, KL and Falcón, LM (2015) Beyond cultural factors to understand immigrant mental health: neighborhood ethnic density and the moderating role of pre-migration and post-migration factors. Social Science & Medicine 138, 91100.
Bécares, L (2014) Ethnic density effects on psychological distress among Latino ethnic groups: an examination of hypothesized pathways. Health & Place 30, 177186.
Bécares, L, Cormack, D and Harris, R (2013) Ethnic density and area deprivation: neighbourhood effects on Maori health and racial discrimination in Aotearoa/New Zealand. Social Science & Medicine 88, 7682.
Bécares, L and Das-Munshi, J (2013) Ethnic density, health care seeking behaviour and expected discrimination from health services among ethnic minority people in England. Health & Place 22, 4855.
Bécares, L, Nazroo, J and Jackson, J (2014) Ethnic density and depressive symptoms among African Americans: threshold and differential effects across social and demographic subgroups. American Journal of Public Health 104, 23342341.
Bécares, L, Nazroo, J, Jackson, J and Heuvelman, H (2012 a) Ethnic density effects on health and experienced racism among Caribbean people in the US and England: a cross-national comparison. Social Science & Medicine 75, 21072115.
Bécares, L, Nazroo, J and Stafford, M (2009) The buffering effects of ethnic density on experienced racism and health. Health & Place 15, 670678.
Bécares, L, Shaw, R, Nazroo, J, Stafford, M, Albor, C, Atkin, K et al. (2012 b) Ethnic density effects on physical morbidity, mortality, and health behaviors: a systematic review of the literature. American Journal of Public Health 102, e33e66.
Bhui, K, Stansfeld, SA, Hull, S, Priebe, S, Mole, F and Feder, G (2003) Ethnic variations in pathways to and use of specialist mental health services in the UK. British Journal of Psychiatry 182, 105116.
Booth, JM (2014) The protective effect of community organization on distress in disadvantaged neighbourhoods: Considering the Latino experience in Chicago (Doctoral dissertation). Arizona State University. Published by ProQuest LLC. UMI 3619567.
Chinn, S (2000) A simple method for converting an odds ratio to effect size for use in meta-analysis. Statistics in Medicine 19, 31273131.
Choi, S, Kim, G and Lee, S (2016) Effects of nativity, length of residence, and county-level foreign-born density on mental health among older adults in the U.S. The Psychiatric Quarterly 87, 675688.
Das-Munshi, J, Bécares, L, Boydell, JE, Dewey, ME, Morgan, C, Stansfeld, SA et al. (2012) Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC). British Journal of Psychiatry 201, 282290.
Das-Munshi, J, Bécares, L, Dewey, ME, Stansfeld, SA and Prince, MJ (2010) Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England. BMJ 341, c5367.
Ecob, R and Williams, R (1991) Sampling Asian minorities to assess health and welfare. Journal of Epidemiology and Community Health 45, 93101.
English, D, Lambert, SF, Evans, MK and Zonderman, AB (2014) Neighborhood racial composition, racial discrimination, and depressive symptoms in African Americans. American Journal of Community Psychology 54, 219228.
Feng, X, Astell-Burt, T and Kolt, GS (2013) Do social interactions explain ethnic differences in psychological distress and the protective effect of local ethnic density? A cross-sectional study of 226 487 adults in Australia. BMJ Open 3, e002713. doi: 10.1136/bmjopen-2013-002713.
Halpern, D and Nazroo, J (2000) The ethnic density effect: results from a national community survey of England and wales. International Journal of Social Psychiatry 46, 3446.
Jarrin, I, Garcia-Fulgueiras, A, Ibanez-Rojo, V, Alvarez, D, Garcia-Pina, R, Fernandez-Liria, A et al. (2013) Absence of protective ethnic density effect on Ecuadorian migrants’ mental health in a recent migration setting: a multilevel analysis. Social Psychiatry and Psychiatric Epidemiology 48, 95103.
Kaufman, J and Cooper, R (2001) Considerations for use of racial/ethnic classification in etiologic research. American Journal of Epidemiology 154, 291298.
Khan, KS, Riet, GT, Popay, J, Nixon, J and Kleijnen, J (2001) STAGE II: conducting the review; PHASE 5: study quality assessment. In Khan, KS, Riet, GT, Glanville, H, Sowden, AJ and Kleijnen, J (eds). CRD Report Number 4, pp. 120. York, UK: NHS Centres for Reviews and Dissemination (CRD).
Kirkbride, JB, Boydell, J, Ploubidis, GB, Morgan, C, Dazzan, P, McKenzie, K et al. (2008) Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychological Medicine 38, 10831094.
Kirkbride, JB, Jones, PB, Ullrich, S and Coid, JW (2014) Social deprivation, inequality, and the neighborhood-level incidence of psychotic syndromes in East London. Schizophrenia Bulletin 40, 169180.
Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM and Jones, PB (2007) Neighbourhood-level effects on psychoses: re-examining the role of context. Psychological Medicine 37, 14131425.
Kwag, KH, Jang, Y, Rhew, SH and Chiriboga, DA (2011) Neighborhood effects on physical and mental health: a study of Korean American older adults. Asian American Journal of Psychology 2, 91100.
Leu, J, Walton, E and Takeuchi, D (2011) Contextualizing acculturation: gender, family, and community reception influences on Asian immigrant mental health. American Journal of Community Psychology 48, 168180.
Lorant, V, Deliège, D, Eaton, W, Robert, A, Philippot, P and Ansseau, M (2003) Socioeconomic inequalities in depression: a meta-analysis. American Journal of Epidemiology 157, 98112.
Mair, C, Roux, AVD, Osypuk, TL, Rapp, SR, Seeman, T and Watson, KE (2010) Is neighborhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis. Social Science & Medicine 71, 541550.
Menezes, NM, Georgiades, K and Boyle, MH (2011) The influence of immigrant status and concentration on psychiatric disorder in Canada: a multi-level analysis. Psychological Medicine 41, 22212231.
Mezuk, B, Li, X, Cederin, K, Concha, J, Kendler, KS, Sundquist, J et al. (2015) Ethnic enclaves and risk of psychiatric disorders among first- and second-generation immigrants in Sweden. Social Psychiatry and Psychiatric Epidemiology 50, 17131722.
Murray, C and Lopez, A (1996). The Global Burden of Disease. Cambridge, MA: Harvard University Press.
Neeleman, JAN and Wessely, S (1999) Ethnic minority suicide: a small area geographical study in south London. Psychological Medicine 29, 429436.
Ostir, G, Eschbach, K, Markides, K and Goodwin, J (2003) Neighbourhood composition and depressive symptoms among older Mexican Americans. Journal of Epidemiology and Community Health 57, 987992.
Pickett, K and Pearl, M (2001) Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiology & Community Health 55, 111122.
Pickett, K and Wilkinson, R (2008) People like us: ethnic group density effects on health. Ethnicity & Health 13, 321334.
Popay, J, Roberts, H, Sowden, A, Petticrew, M, Arai, L, Rodgers, M et al. (2006) Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: A Product from the ESRC Methods Programme. Lancaster University. Available online at http://www.lancs.ac.uk/shm/research/nssr/research/dissemination/publications.php (3 November 2017).
Propper, C, Jones, K, Bolster, A, Burgess, S, Johnston, R and Sarker, R (2005) Local neighbourhood and mental health: evidence from the UK. Social Science & Medicine 61, 20652083.
Robinson, D and Reeve, K (2006) Neighbourhood Experiences of new Immigration. Reflections from the Evidence Base. York: Joseph Rowntree Foundation.
Schrier, AC, Peen, J, de Wit, MAS, van Ameijden, EJC, Erdem, Ö, Verhoeff, AP et al. (2014) Ethnic density is not associated with psychological distress in Turkish-Dutch, Moroccan-Dutch and Surinamese-Dutch ethnic minorities in the Netherlands. Social Psychiatry and Psychiatric Epidemiology 49, 15571567.
Selten, JP and Cantor-Graae, E (2005) Social defeat: risk factor for schizophrenia? British Journal of Psychiatry 187, 101102.
Shaw, RJ, Atkin, K, Bécares, L, Albor, CB, Stafford, M, Kiernan, KE et al. (2012) Impact of ethnic density on adult mental disorders: narrative review. British Journal of Psychiatry 201, 1119.
Shaw, RJ and Pickett, KE (2011) The association between ethnic density and poor self-rated health among US black and Hispanic people. Ethnicity & Health 16, 225244.
Shell, AM, Peek, MK and Eschbach, K (2013) Neighborhood Hispanic composition and depressive symptoms among Mexican-descent residents of Texas city, Texas. Social Science & Medicine 99, 5663.
Stafford, M, Newbold, BK and Ross, NA (2011) Psychological distress among immigrants and visible minorities in Canada: a contextual analysis. International Journal of Social Psychiatry 57, 428441.
Stewart, E and Shaffer, M (2015) Moving on? Dispersal Policy, Onward Migration and Integration of Refugees in the UK. Glasgow: University of Strathclyde.
Syed, M and Juan, MJD (2012) Discrimination and psychological distress: examining the moderating role of social context in a nationally representative sample of Asian American adults. Asian American Journal of Psychology 3, 104120.
Team, RC (2015) R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing.
Termorshuizen, F, Braam, AW and van Ameijden, EJC (2015) Neighborhood ethnic density and suicide risk among different migrant groups in the four big cities in the Netherlands. Social Psychiatry and Psychiatric Epidemiology 50, 951962.
United Nations, Department of Economic and Social Affairs, Population Division (2016) International Migration Report 2015 (ST/ESA/SER.A/384). United Nations.
Viechtbauer, W (2010) Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36, 148.
Veling, W, Susser, E, van Os, J, Mackenbach, JP, Selten, J-P and Hoek, HW (2008) Ethnic density of neighborhoods and incidence of psychotic disorders Among immigrants. American Journal of Psychiatry 165, 6673.
Vogt Yuan, AS (2007) Racial composition of neighborhood and emotional well-being. Sociological Spectrum 28, 105129.
Whiteford, H, Degenhardt, L, Rehm, J, Baxter, A, Ferrari, A, Erskine, H et al. (2013) Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet 382, 15751586.
Wight, RG, Cummings, JR, Karlamangla, AS and Aneshensel, CS (2009) Urban neighborhood context and change in depressive symptoms in late life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 64B, 247251.
Wight, RG, Ko, MJ and Aneshensel, CS (2011) Urban neighborhoods and depressive symptoms in late middle age. Research on Aging 33, 2850.
Williams, DR and Collins, C (2001) Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Reports 116, 404416.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Bécares et al. supplementary material
Bécares et al. supplementary material 1

 Unknown (72 KB)
72 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed