Skip to main content
×
×
Home

Impact of ethnic density on adult mental disorders: narrative review

  • Richard J. Shaw (a1), Karl Atkin (a2), Laia Bécares (a3), Christo B. Albor (a2), Mai Stafford (a4), Kathleen E. Kiernan (a5), James Y. Nazroo (a6), Richard G. Wilkinson (a7) and Kate E. Pickett (a8)...
Abstract
Background

The ‘ethnic density hypothesis' is a proposition that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. Investigations into this hypothesis have resulted in a complex and sometimes disparate literature.

Aims

To systematically identify relevant studies, summarise their findings and discuss potential explanations of the associations found between ethnic density and mental disorders.

Method

A narrative review of studies published up to January 2011, identified through a systematic search strategy. Studies included have a defined ethnic minority sample; some measure of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder.

Results

A total of 34 papers from 29 data-sets were identified. Protective associations between ethnic density and diagnosis of mental disorders were most consistent in older US ecological studies of admission rates. Among more recent multilevel studies, there was some evidence of ethnic density being protective against depression and anxiety for African American people and Hispanic adults in the USA. However, Hispanic, Asian–American and Canadian ‘visible minority’ adolescents have higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses.

Conclusions

The most consistent associations with ethnic density are found for psychoses. Ethnic density may also protect against other mental disorders, but presently, as most studies of ethnic density have limited statistical power, and given the heterogeneity of their study designs, our conclusions can only be tentative.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Impact of ethnic density on adult mental disorders: narrative review
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Impact of ethnic density on adult mental disorders: narrative review
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Impact of ethnic density on adult mental disorders: narrative review
      Available formats
      ×
Copyright
Corresponding author
Richard J. Shaw, PhD, School of Social Sciences, Murray Building (58), University of Southampton, Southampton SO17 3BJ, UK. Email: dr.richard.shaw@gmail.com
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Weich, S, Nazroo, J, Sproston, K, McManus, S, Blanchard, M, Erens, B, et al. Common mental disorders and ethnicity in England: the EMPIRIC Study. Psychol Med 2004; 34: 1543–51.
2 Riolo, SA, Nguyen, TA, Greden, JF, King, CA. Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III. Am J Public Health 2005; 95: 9981000.
3 Nazroo, JY. Rethinking the relationship between ethnicity and mental health: the British Fourth National Survey of Ethnic Minorities. Soc Psychiatry Psychiatr Epidemiol 1998; 33: 145–8.
4 King, M, Nazroo, J, Weich, S, McKenzie, K, Bhui, K, Karlson, S, et al. Psychotic symptoms in the general population of England. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 375–81.
5 Jarvis, GE. The social causes of psychosis in North American psychiatry: a review of a disappearing literature. Can J Psychiatry 2007; 52: 287–94.
6 Reeves, SJ, Sauer, J, Stewart, R, Granger, A, Howard, RJ. Increased first-contact rates for very-late-onset schizophrenia-like psychosis in African- and Caribbean-born elders. Br J Psychiatry 2001; 179: 172–4.
7 Raleigh, VS. Suicide patterns and trends in people of Indian subcontinent and Caribbean origin in England and Wales. Ethnic Health 1996; 1: 5563.
8 McKenzie, K, Bhui, K, Nanchahal, K, Blizard, B. Suicide rates in people of South Asian origin in England and Wales: 1993–2003. Br J Psychiatry 2008; 193: 406–9.
9 Williams, D. Race, SES, and health; the added effects of racism and discrimination. Ann NY Acad Sci 1999; 896: 173–88.
10 Nazroo, JY. South Asian people and heart disease: an assessment of the importance of socioeconomic position. Ethnic Dis 2001; 11: 401–11.
11 Platt, L. Poverty and Ethnicity in the UK. Policy Press, 2007.
12 Collins, CA, Williams, DR. Segregation and mortality: the deadly effects of racism? Sociol Forum 1999; 14: 495523.
13 LeClere, FB, Rogers, RG, Peters, KD. Neighbourhood social context and racial differences in women's heart disease mortality. J Health Soc Behav 1998; 39: 91107.
14 Acevedo-Garcia, D, Lochner, K. Residential segregation and health. In Neighborhoods and Health (eds I Kawachi, L Berkman): 265–87. Oxford University Press, 2001.
15 Faris, RE, Dunham, HW. Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses. University of Chicago Press, 1939.
16 Halpern, D. Minorities and mental-health. Soc Sci Med 1993; 36: 597607.
17 Pickett, KE, Wilkinson, RG. People like us: ethnic group density effects on health. Ethnic Health 2008; 13: 321–34.
18 Cochrane, R, Bal, SS. Ethnic density is unrelated to incidence of schizophrenia. Br J Psychiatry 1988; 153: 363–6.
19 Klee, G, Spiro, E, Bahm, E, Gorwitz, K. An ecological analysis of diagnosed mental illness in Baltimore. In Psychiatric Epidemiology and Mental Health Planning. Psychiatric Research 22 (eds R Monroe, G Klee, E Brody): 107–48. American Psychiatric Association, 1967.
20 Krupinski, J. Psychological maladaptations in ethnic concentrations in Victoria. In Cultures in Collision (ed. I Pilowsky): 4958. Australian National Association for Mental Health, 1975.
21 Levy, L, Rowitz, L. The Ecology of Mental Disorder. Behavioral Publications, 1973.
22 Mintz, NL, Schwartz, DT. Urban ecology and psychosis: community factors in the incidence of schizophrenia and manic-depression among Italians in Greater Boston. Int J Soc Psychiatry 1964; 10: 101–18.
23 Muhlin, GL. Mental hospitalisation of the foreign-born and the role of cultural isolation. Int J Soc Psychiatry 1979; 25: 595605.
24 Rabkin, JG. Ethnic density and psychiatric hospitalization: hazards of minority status. Am J Psychiatry 1979; 136: 1562–66.
25 Abada, T, Hou, F, Ram, B. Racially mixed neighborhoods, perceived neighborhood social cohesion, and adolescent health in Canada. Soc Sci Med 2007; 65: 2004–17.
26 Aneshensel, CS, Wight, RG, Miller-Martinez, D, Botticello, AL, Karlamangla, AS, Seeman, TE. Urban neighborhoods and depressive symptoms among older adults. J Gerontol B Psychol 2007; 62: S529.
27 Das-Munshi, J, Becares, L, Dewey, ME, Stansfeld, SA, Prince, MJ. Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England. BMJ 2010; 324: c5367.
28 Ecob, R, Williams, R. Sampling Asian minorities to assess health and welfare. J Epidemiol Community Health 1991; 45: 93101.
29 Halpern, D, Nazroo, J. The ethnic density effect: results from a national community survey of England and Wales. Int J Soc Psychiatry 2000; 46: 3446.
30 Henderson, C, Diez Roux, AV, Jacobs, DR, Kiefe, CI, Williams, DR. Neighbourhood characteristics, individual level socioeconomic factors, and depressive symptoms in young adults: the CARDIA study. J Epidemiol Community Health 2005; 59: 322–8.
31 Hybels, CF, Blazer, DG, Pieper, CF, Burchett, BM, Hays, JC, Fillenbaum, GG, et al. Sociodemographic characteristics of the neighborhood and depressive symptoms in older adults: using multilevel modeling in geriatric psychiatry. Am J Geriatr Psychiatry 2006; 14: 498506.
32 Mair, C, Diez Roux, A, Osypuk, T, Rapp, S, Seeman, T, Watson, K. Is neighbourhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis. Soc Sci Med 2010; 71: 541–50.
33 Oliver, JE. Mental life and the metropolis in suburban America – the psychological correlates of metropolitan place characteristics. Urban Aff Rev 2003; 39: 228–53.
34 Ostir, GV, Eschbach, K, Markides, KS, Goodwin, JS. Neighbourhood composition and depressive symptoms among older Mexican Americans. J Epidemiol Community Health 2003; 57: 987–92.
35 Pickett, KE, Shaw, RJ, Atkin, K, Kiernan, KE, Wilkinson, RG. Ethnic density effects on maternal and infant health in the Millennium Cohort Study. Soc Sci Med 2009; 69: 1476–83.
36 Propper, C, Jones, K, Bolster, A, Burgess, S, Johnston, R, Sarker, R. Local neighbourhood and mental health: evidence from the UK. Soc Sci Med 2005; 61: 2065–83.
37 Shields, MA, Wailoo, A. Exploring the determinants of unhappiness for ethnic minority men in Britain. Scot J Polit Econ 2002; 49: 445–66.
38 Tweed, DL, Goldsmith, HF, Jackson, DJ, Stiles, D, Rae, DS, Kramer, M. Racial congruity as a contextual correlate of mental disorder. Am J Orthopsychiatry 1990; 60: 392403.
39 Wickrama, KAS, Noh, S, Bryant, CM. Racial differences in adolescent distress: differential effects of the family and community for blacks and whites. J Community Psychol 2005; 33: 261–82.
40 Wight, RG, Aneshensel, CS, Botticello, AL, Sepulveda, JE. A multilevel analysis of ethnic variation in depressive symptoms among adolescents in the United States. Soc Sci Med 2005; 60: 2073–84.
41 Wight, RG, Cummings, JR, Karlamangla, AS, Aneshensel, CS. Urban neighborhood context and change in depressive symptoms in later life. J Gerontol B Psychol Sci Soc Sci 2009; 64: 247–51.
42 Ying, Y-W, Akutsu, PD. Psychological adjustment of Southeast Asian refugees: the contribution of sense of coherence. J Community Psychol 1997; 25: 125–39.
43 Yuan, ASV. Racial composition of neighborhood and emotional well-being. Sociol Spectr 2008; 28: 105–29.
44 BeAcares, L, Nazroo, J, Stafford, M. The buffering effects of ethnic density on experienced racism and health. Health Place 2009; 15: 700–8.
45 Boydell, J, van Os, J, Mckenzie, K, Allardyce, J, Goel, R, McCreadie, RG, et al. Incidence of schizophrenia in ethnic minorities in London: ecological study into interactions with environment. BMJ 2001; 323: 1336–8.
46 Kirkbride, JB, Morgan, C, Fearon, P, Dazzan, P, Murray, RM, Jones, PB. Neighbourhood-level effects on psychoses: re-examining the role of context. Psychol Med 2007; 37: 1413–25.
47 Kirkbride, JB, Boydell, J, Ploubidis, GB, Morgan, C, Dazzan, P, Mckenzie, K, et al. Testing the association between the incidence of schizophrenia and social capital in an urban area. Psychol Med 2008; 38: 1083–94.
48 Schoefield, P, Ashworth, M, Jones, R. Ethnic isolation and psychosis: re-examining the ethnic density effect. Psychol Med 2010; 22: 17.
49 Veling, W, Susser, E, van Os, J, Mackenback, JP, Selten, JP, Hoek, HW. Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. Am J Psychiatry 2008; 165: 6673.
50 Neeleman, J, Wessely, S. Ethnic minority suicide: a small area geographical study in south London. Psychol Med 1999; 29: 429–36.
51 Neeleman, J, Wilson-Jones, C, Wessely, S. Ethnic density and deliberate self harm; a small area study in south east London. J Epidemiol Community Health 2001; 55: 8590.
52 Islam, MK, Merlo, J, Kawachi, I, LindstroUm, M, Gerdtham, U. Social capital and health: does egalitarianism matter? A literature review. Int J Equity Health 2006; 5: 3.
53 Walker, A, Coulthard, M. Developing and understanding indicators of social capital. In Social Capital for Health: Issues of Definition, Measurement and Links to Health (eds A Morgan, C Swann): 2539. Health Development Agency, 2004.
54 Paradies, Y. A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 2006; 35: 888901.
55 BeAcares, L, Stafford, M, Nazroo, J. Fear of racism, employment and expected organizational racism: their association with health. Eur J Public Health 2009; 19: 504–10.
56 Yen, IH, Kaplan, GA. Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study. Am J Epidemiol 1999; 149: 898907.
57 Winkleby, M, Cubbin, C, Ahn, D. Effect of cross-level interaction between individual and neighborhood socioeconomic status on adult mortality rates. Am J Public Health 2006; 96: 2145–53.
58 Albor, C, Pickett, K, Wilkinson, RG, Ballas, D. Are poor mothers and their infants healthier in richer areas? The protective effect of area socio-economic density. J Epidemiol Community Health 2009; 63: 91.
59 Wechsler, H, Pugh, TF. Fit of individual and community characteristics and rates of psychiatric hospitalization. Am J Sociol 1967; 73: 331–8.
60 Rosenberg, M. The dissonant religious context and emotional disturbance. Am J Sociol 1962; 68: 110.
61 Jenkins, R. Social Identity. Routledge, 2004.
Recommend this journal

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

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Shaw et al. supplementary material
Supplementary Material

 PDF (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

Impact of ethnic density on adult mental disorders: narrative review

  • Richard J. Shaw (a1), Karl Atkin (a2), Laia Bécares (a3), Christo B. Albor (a2), Mai Stafford (a4), Kathleen E. Kiernan (a5), James Y. Nazroo (a6), Richard G. Wilkinson (a7) and Kate E. Pickett (a8)...
Submit a response

eLetters

Ethnicity as a form of data

Adnan Sharaf, CT1 Psychiatrist
09 October 2012

Dear Sir,

Dr Shaw and colleagues' review paper on the ethnic density1 effect makes for interesting reading. I feel they have made an important omission when they describe the limitations of their paper. The way the data is presented is such that it appears that ethnicity has been categorised as discrete data. I do not believe that this is the correct way to describe ethnicity with a view to data analysis.

The Oxford English Dictionary defines the adjective ethnic as relating to a population subgroup with a common national or cultural tradition. The society which we live in is fluid and hence allocating people to a specific subgroup based on tradition is an unrealistic aim. Migration and intermarriage have made the labelling of people under these headings an outdated concept. To illustrate my point I would like to use my family as examples. If the definition used above is kept to, then overthe years the ethnicity of my father could have been described as Bihari, Pakistani or British. My son could be described as British, English, British Pakistani, Anglo-Pakistani, Pakistani or Mixed. My (anglosaxon) stepdaughter could be British, English or Anglo-Pakistani. If terms such as Black or White are used to describe ethnic background then how would myson be termed? Would he be beige?

Given the fluidity and multicultural nature of modern society I feel that trying to categorise ethnicity is an impossible task. If we can accept that ethnicity is an example of continuous data rather than discrete data then we must accept it as a limitation in any study.

Yours sincerelyAdnan SharafCT1 Community Psychiatry

1 Shaw RJ, Atkin A, Becares L, Albor CB, Stafford M, Kiernan KE, Nazroo JY, Wilkinson RG, Pickett KE. Impact of ethnic density on adult mental disorders: narrative review. BJP 2012, 201:11-19.

... More

Conflict of interest: None declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *