Child mental health differences amongst ethnic groups in Britain: a systematic review

Authors:
GOODMAN Anna, PATEL Vikram, LEON David A.
Journal article citation:
BMC Public Health, 8(258), July 2008, Online only
Publisher:
BioMed Central Ltd

This review compared the population-based prevalence of child mental disorders between ethnic groups in Britain, and related these findings to ethnic differences in mental health service use. Bibliographic databases were searched for population-based and clinic-based studies of children aged 0–19, including all ethnic groups and the main child mental disorders. 31 population-based and 18 clinic-based studies met the inclusion criteria. It was found that children in the main minority groups have similar or better mental health than White British children for common disorders, but may have higher rates for some less common conditions. The causes of these differences are unclear.

Extended abstract:
Author

GOODMAN Anna; PATEL Vikram; LEON David A.;

Child mental health differences amongst ethnic groups in Britain: a systematic review.

Journal citation/publication details

BMC Public Health, 8:258, July 2008.

Summary

Evidence from the 31 population-based studies and 18 clinic-based studies included in this review suggests that the mental health of children in the main minority ethnic groups is similar to or better than in White British children for the common disorders. Little evidence was found for the smaller minority ethnic groups. The limitations of the review, including study heterogeneity, publication bias and variation in study quality, are discussed.

Context

In Britain, the prevalence of mental health disorders in children has been estimated at 10%, but little is known about ethnic differences. The aim of this review was to look at: how the prevalence and proportional morbidity of mental health problems differ among ethnic groups in Britain, and; how differences in service use compare with the prevalence estimates and proportional morbidity.

Methods

What sources were searched?
Sixteen electronic databases and eight websites in the fields of health and social sciences were searched. Additional studies were sought by: hand searching the reference lists of included studies and key reviews; contacting experts in the field; emailing five special interest groups, and; carrying out a citation search on Science Citation Index. Details of the databases, websites, and special interest groups are available in Additional File 1. 

What search terms/strategies were used?
Searching was carried out between January and July 2007 using a combination of free text terms and subject index headings. There were no language or date restrictions. The search string used is presented in additional File 1.

What criteria were used to decide on which studies to include?
Studies had to include: young people aged 0 to 19 years, living in Britain; at least two ethnic groups or one minority group compared to a general population sample, and; a valid mental health outcome or data on referral or admission to a child mental health service. Population-based studies and clinic-based studies were eligible for inclusion; minimum sample sizes were specified for the eligible study types. Ethnicity was defined according to the categories used in the 2001 UK Census. 

Who decided on their relevance and quality?
The first author was responsible for screening the titles and abstracts of identified studies; a test-retest evaluation confirmed consistency. Subsequent assessment was carried out by the first author and a second epidemiologist; disagreements were resolved by consensus. Each study was assigned a code for each methodological limitation according to a set of criteria described in Additional File 1.

How many studies were included and where were they from?
Of the 6,286 articles initially identified, 125 were considered to be potentially relevant; 116 were subsequently retrieved for further assessment. Fifty eight studies were eventually included in the review. The selection process is outlined in Figure 1 and includes the number of studies excluded at each stage of the process, and the reasons for exclusion. The fifty eight studies that were excluded are summarised in Additional File 3.

How were the study findings combined?
A semi-quantitative descriptive approach was adopted in which the results of analyses were categorised according to whether each minority group considered showed evidence of more or fewer mental health problems than the White, White British or general population group of children in the study.


 

Findings of the review

The 58 studies were of 49 independent samples of children; 31 were population-based and 18 were clinic-based. All of the studies included a general population or White/White British sample.

Population-based studies
Five out of six studies of Black African children and eight out of twelve studies of Indian children reported at least one positive mental health finding compared to the White British children. Most studies of Black Caribbean, Pakistani and Bangladeshi children found no difference. The mental health of Mixed Race children was also similar to that of White British children. Four out of seven studies on eating disorders found higher scores in South Asian children. One study reported higher rates of psychotic–like experiences in Black Caribbean children.

Clinic-based studies
In ten out of 13 study populations Indian, Pakistani, Bangladeshi and South Asian children were ‘underrepresented’ in the clinic compared to the levels of representation in the base population. The findings for Black Caribbean, Black African, and Black children were inconsistent. Studies of proportional morbidity of different disorder types also reported mixed results.

Authors' conclusions

‘The prevalence of common mental health problems in the main minority ethnic groups in Britain seems to be similar to or, in some specific minorities, lower than that of White British children’ but there is a lack of evidence for several small minority groups. There is some suggestion ‘of more psychosis in Black children, more disordered eating attitudes in South Asians, and a greater unmet need for mental health services in Pakistani and Bangladeshi children’. 

Implications for policy or practice

None are discussed.

Subject terms:
mental health problems, mental health services, self-harm, black and minority ethnic people, children, eating disorders, ethnicity;
Content type:
systematic review
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ISSN online:
1471-2458

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