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A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England

Rhead, R. D., Woodhead, C., Ahmad, G. , Das-Munshi, J., McManus, S. ORCID: 0000-0003-2711-0819 & Hatch, S. L. (2022). A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England. Social Psychiatry and Psychiatric Epidemiology, doi: 10.1007/s00127-022-02259-1

Abstract

Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014–2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45–2.02), economically inactive (AOR 2.02, 95% CI:1.05–3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02–1.74), and Black (AOR 0.36 95% CI:0.20–0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group (“White British, highly educated, employed, high social class”), “Retired WhiteBritish” had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while “Employed migrants” had lower odds (AOR 0.39, 95% CI:0.27–0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but—except for sexual minorities—adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.

Publication Type: Article
Additional Information: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Publisher Keywords: Inequalities, Discrimination, Mental health, Latent class analysis, Intersectionality
Subjects: B Philosophy. Psychology. Religion > BF Psychology
H Social Sciences > HT Communities. Classes. Races
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: City, University of London (-2022) > School of Arts & Social Sciences
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