Social capital, ethnic density and mental health among ethnic minority people in England: a mixed-methods study.

OBJECTIVES: Ethnic minority people have been suggested to be healthier when living in areas with a higher concentration of people from their own ethnic group, a so-called ethnic density effect. Explanations behind the ethnic density effect propose that positive health outcomes are partially attributed to the protective and buffering effects of increased social capital on health. In fact, a parallel literature has reported increased levels of social capital in areas of greater ethnic residential diversity, but to date, no study in England has explored whether increased social capital mediates the relationship between protective effects attributed to the residential concentration of ethnic minority groups and health. DESIGN: We employ a mixed-methods approach to examine the association between ethnicity, social capital and mental health. We analyse geocoded data from the 2004 Health Survey for England to examine the association between (1) ethnic residential concentration and health; (2) ethnic residential concentration and social capital; (3) social capital and health; and (4) the mediating effect of social capital on the association between the residential concentration of ethnic groups and health. To further add to our understanding of the processes involved, data from a qualitative study of quality older ethnic minority people were be used to examine accounts of the significance of place of residence to quality of life. RESULTS: The association between ethnic density and social capital varies depending on the level of measurement of social capital and differed across ethnic minority groups. Social capital was not found to mediate the association between ethnic density and health. Structural differences in the characteristics of the neighbourhoods where different ethnic groups reside are reflected in the accounts of their daily experiences, and we observed different narratives of neighbourhood experiences between Indian and Caribbean respondents. The use of mixed methods provides an important contribution to the study of ethnic minority people's experience of their neighbourhood, as this approach has allowed us to gain important insights that cannot be inferred from quantitative or qualitative data alone.

Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England.

OBJECTIVES: To determine if living in areas where higher proportions of people of the same ethnicity reside is protective for common mental disorders, and associated with a reduced exposure to discrimination and improved social support. Finally, to determine if any protective ethnic density effects are mediated by reduced exposure to racism and improved social support. DESIGN: Multi-level logistic regression analysis of national survey data, with area-level, own-group ethnic density modelled as the main exposure. Participants and setting 4281 participants of Irish, black Caribbean, Indian, Pakistani, Bangladeshi, and white British ethnicity, aged 16-74 years, randomly sampled from 892 "middle layer super output areas" in England. MAIN OUTCOME MEASURES: Common mental disorders (assessed via structured interviews); discrimination (assessed via structured questionnaire); and social support and social networks (assessed via structured questionnaire). RESULTS: Although the most ethnically dense areas were also the poorest, for each 10 percentage point increase in own-group ethnic density, there was evidence of a decreased risk of common mental disorders, for the full ethnic minority sample (odds ratio 0.94 (95% confidence interval 0.89 to 0.99); P=0.02, trend), for the Irish group (odds ratio 0.21 (0.06 to 0.74); P=0.01, trend), and for the Bangladeshi group (odds ratio 0.75 (0.62 to 0.91); P=0.005, trend), after adjusting for a priori confounders. For some groups, living in areas of higher own-group density was associated with a reduction in the reporting of discrimination and with improved social support and improved social networks. However, none of these factors mediated ethnic density effects. CONCLUSIONS: A protective effect of living in areas of higher own-group ethnic density was present for common mental disorders for some minority groups. People living in areas of higher own-group density may report improved social support and less discrimination, but these associations did not fully account for density effects.