22 August 2022
IoPPN Youth Awards blog of paper titled: Ethnic inequalities in mental and physical multimorbidity in women of reproductive age: a data linkage cohort study
Aya, age 18
IoPPN Youth Awards blog 2022
Dr. Catalao et al. (2022) investigated ethnic differences in risk factors, mental and physical health multi-morbidity in women. They specifically collected data in the culturally diverse London borough of Lambeth in order to explore these differences.
The Longitudinal study extracted data from Lambeth DataNet (LDN) of anonymised primary care data from January 2008 to December 2018. Electronic health records were also extracted from the Clinical Record Interactive Search (CRIS) which supplied the secondary care data. They specifically targeted women aged between 15 and 40 years and excluded women who were pregnant or had previously been pregnant. After the screening process there were 3,817 participants. Most of the participants were ages 20-24 (23.6%). The most frequently reported ethnicity was Other white (38.5%), followed by “Other” (22.5%), White British (20.6%) and Black (11.6%), including Asian (6.9%).
In terms of health outcomes, it was discovered that all women who used mental health services had a higher prevalence of all risk factors, including high-risk alcohol use, drug use, and physical health diagnoses (such as diabetes and hypertension). Eighteen percent of women received a diagnosis of a Severe Mental Illness (SMI; such as schizophrenia and bipolar affective disorder).
A result that stood out was that women in contact with mental health services had more face-to-face primary care clinical consultations were more likely to die, and most deaths were among those without a SMI diagnosis. The reasons for those deaths weren’t specified and I hypothesise that those diagnosed with a SMI may have received greater contact with medical professionals which may have increased the likelihood of receiving other medical care and therefore explaining the difference in deaths compared to those without SMI but in contact with mental health services. Black women were more likely to be prescribed antipsychotics regardless of their diagnosis, which may indicate that there is a bias towards treatment options for ethnic (specifically black) women.
In addition to this the study highlighted that black woman were the most likely to be diagnosed with a SMI, and less likely to be diagnosed with common mental disorders, compared to the other ethnic groups, maybe due to detection bias. However, ethnic minority groups face trauma, such as racism and inequality, which may cause stress and an added vulnerability to develop the severe illnesses. However, their mental health symptoms may also be misunderstood by clinical practitioners which may contribute to this disparity in diagnosis. Looking at the risk factors present I found it surprising that black women were four times more likely to be diagnosed with hypertension and diabetes compared with white British women. This may link to late medical intervention, which may be due to distrust of medical professionals or cultural differences in help seeking within different ethnic groups. This could link the severity of mental illness to the physical illnesses found in the different ethnicities pointed out by the data collected.
Overall, this research highlighted the inequalities in healthcare and health experiences between women of different ethnicities, particularly for Black and Asian women.
In this research paper the use of this large cohort is a strength as it covers a broad range of different factors such as different risk factors (e.g., smoking). Moreover, the different ethnic categories are broad. More research on subcategories for black women, such as Caribbean/African, could provide a more detailed account of inequities.
Qualitative data provides rich detail and information about patient perspectives on their experiences. A qualitative study using thematic analysis to examine those experiences could potentially solve this.
This research shines a light on the issue of how women of different ethnicities experience physical and mental health and how this presents in our mental health services. This could encourage change, like reflective clinical groups to tackle biases that are observed and wider structural change including involvement of the marginalised communities in development and delivery of services. This perhaps could further allow for national intervention to change how mental and physical illnesses are treated encourage them to be considered together to help tackle health issues among ethnic minority groups before they become more severe. This could lessen the strain on mental health services, such as inpatient services and allow for women to receive the appropriate help earlier.
Written by Aya, age 18.