Health inequalities and social determinants of mental health

The Understanding Society study (Understanding Society: the United Kingdom Household Longitudinal Study), which began in 2009, is conducted by the Institute for Social and Economic Research, at the University of Essex. Understanding Society interviews around 40,000 households every year, with a focus on family and community behaviour, and helps researchers explore inequalities and how these may be changing over time. Inclusivity is built into the foundation of Understanding Society.

Using this dataset, our researchers have examined inequalities in mental health across a range of social and economic factors. Our NIHR East of England Applied Research Consortium mental health research team, led by Prof Susan McPherson, in collaboration with local and regional stakeholders, has been examining inequalities in undiagnosed mental health in the community across protected characteristics as defined by the UK Equality Act. Emerging findings from this work show that while women, younger people, single people and ethnic minorities do face disadvantages in accessing diagnosis and care, the greatest disadvantages are faced by sexual minorities and people living with a disability.

Analysis of the dataset by Dr Ben Etheridge also examines disadvantages faced by women whose mental health deteriorated more than men’s during the pandemic. The analysis shows the key role of loneliness in this growing gender-gap and highlights that younger women are at a particular disadvantage.

In the UK, trends in mental health show a growing crisis among young people which has been accelerated by the pandemic. Analysis of Understanding Society by Prof Alita Nandi shows that the deteriorating mental health in 16 to 24 year olds is particularly severe for unemployed or part-time White British young people living in deprived areas. Among 5 to 8 year olds, analysis by Prof Michaela Benzeval shows that the pandemic levelled out some prior inequalities in mental health whereby children of educated, employed parents with higher income showed deterioration in mental health.

However, White British boys living in deprived areas continued to have the poorest mental health and deteriorated most during the pandemic. Dr Emily Murray, Director of our new Centre for Coastal Communities is currently working on analysis of Understanding Society to show that living in a deprived coastal community also has a more detrimental impact on mental health of teenagers than living in a deprived inland area. Dr Murray is continuing to examine reasons for this through a new PhD studentship.

To capture some of the difficulties young people faced during the pandemic, University of Essex film maker Nic Blower co-created a moving documentary using video diaries that gave voice to teenagers navigating the pandemic during school closures. It highlighted the healing benefits of talking about the challenges teenagers faced and the uncertainty generated by the pandemic.

Given the growing crisis in young people’s mental health, there is a widespread view that social media use has some role in this. Dr Cara Booker has used the Understanding Society dataset to investigate this possible link and continues to research in this area to attempt to understand what types of social media in young people use may be harmful or beneficial, as the relationship is not straightforward.  One often assumed mechanism is that more time using social media may come at the cost of physical activity which has known benefits for mental health.

Research by psychologist Dr Nick Cooper has shown this not to be the case. The research confirmed an association between sports participation and mental wellbeing but found no evidence that children were replacing recreational activities with screen use. The research concluded that rather than recommending children have limited screen time, we need to consider other barriers to sports participation in order to generate policies to improve children’s mental wellbeing. Dr Ayten Bilgin is also currently researching in this area, examining whether early screen media exposure is linked to infant problems with crying, sleeping or feeding as well as childhood emotional and behavioural difficulties.

Although population level data from Understanding Society shows that White British people tend to have poorer mental health, some ethnic minority groups are nevertheless over-represented in mental health services for severe mental illness including inpatient wards.

Our researchers have explored this phenomenon using qualitative methods which enable a more in-depth understanding of individual experience. Our research shows that people from a Black ethnic background detained in inpatient care experience high levels of racism while receiving care as well as feeling stigmatized within their own ethnic communities.

Similarly, our research shows that people from a South Asian background with psychosis experience stigma from the public, from within their own communities and in NHS services for psychosis which fail to consider patient experiences in the context of their cultural and religious backgrounds.

Analysis of Understanding Society by Prof Alita Nandi also shows that people from religious minorities (including Pakistani and Bangladeshi Muslims) tend to have poor wellbeing compared to people with no religious affiliation. This could be connected to the intersection of belonging to a minority religion and being from a minority ethnic background. However, people who frequently attended religious services were more likely to have better wellbeing irrespective of religious affiliation suggesting attending religious or secular services can be beneficial for mental wellbeing.