Psychological distress during pregnancy in a multi-ethnic community: findings from the born in Bradford cohort study.

PURPOSE: Antenatal anxiety and depression are predictive of future mental distress, which has negative effects on children. Ethnic minority women are more likely to have a lower socio-economic status (SES) but it is unclear whether SES is an independent risk factor for mental health in pregnancy. We described the association between maternal mental distress and socio-demographic factors in a multi-ethnic cohort located in an economically deprived city in the UK. METHODS: We defined eight distinct ethno-language groups (total N = 8,454) and classified a threshold of distress as the 75th centile of within-group GHQ-28 scores, which we used as the outcome for univariate and multivariate logistic regression for each ethnic group and for the sample overall. RESULTS: Financial concerns were strongly and independently associated with worse mental health for six out of the eight ethnic groups, and for the cohort overall. In some groups, factors such as working status, education and family structure were associated with worse mental health, but for others these factors were of little importance. CONCLUSIONS: The diversity between and within ethnic groups in this sample underlines the need to take into consideration individual social, migration and economic circumstances and their potential effect on mental health in ethnically diverse areas.

Impact of ethnic density on adult mental disorders: narrative review.

BACKGROUND: The 'ethnic density hypothesis' is a proposition that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. Investigations into this hypothesis have resulted in a complex and sometimes disparate literature. AIMS: To systematically identify relevant studies, summarise their findings and discuss potential explanations of the associations found between ethnic density and mental disorders. METHOD: A narrative review of studies published up to January 2011, identified through a systematic search strategy. Studies included have a defined ethnic minority sample; some measure of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder. RESULTS: A total of 34 papers from 29 data-sets were identified. Protective associations between ethnic density and diagnosis of mental disorders were most consistent in older US ecological studies of admission rates. Among more recent multilevel studies, there was some evidence of ethnic density being protective against depression and anxiety for African American people and Hispanic adults in the USA. However, Hispanic, Asian-American and Canadian 'visible minority' adolescents have higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses. CONCLUSIONS: The most consistent associations with ethnic density are found for psychoses. Ethnic density may also protect against other mental disorders, but presently, as most studies of ethnic density have limited statistical power, and given the heterogeneity of their study designs, our conclusions can only be tentative.

Parents' mental health and children's cognitive and social development: families in England in the Millennium Cohort Study.

BACKGROUND: The development of children of parents who are experiencing mental health difficulties is a continuing cause of concern for professionals working in health, social care and education as well as policy makers. In light of this interest our study investigates the interplay between the mental health of mothers and fathers and family socioeconomic resources, and the impact for children's cognitive and social development. METHODS: The study uses survey data from the Millennium Cohort Study linked with the Foundation Stage Profile assessment for children in the primary year of school in England between 2005 and 2006. The study includes 4,781 families from England where both parents' mental health had been assessed using the Kessler 6 scale. Associations between parents' mental health and children's cognitive and social development were estimated using regression models. Multivariate models were used to explore the mediating role of the families' socioeconomic resources. Gender interaction models were used to explore whether effects of parents' mental health differ for girls and boys. RESULTS: The study finds lower attainment in communication, language and literacy, mathematical development and personal, social and emotional development among children whose parents were experiencing high levels of psychological distress. Parents' age and qualifications and families' socioeconomic resources strongly mediated the effects of parents' psychological distress on children's attainment, and although independent effects of mother's mental health were maintained, effects of father's mental health were not. Stronger effects of mothers' mental health were found for boys than for girls. CONCLUSIONS: These findings highlight the interplay between the mental health of parents, families' socioeconomic resources and children's development which speaks for the need for close integration of mental health and social interventions to improve the well being of families.

Ethnic density effects on maternal and infant health in the Millennium Cohort Study.

Studies have suggested that members of ethnic minority groups might be healthier when they live in areas with a high concentration of people from their own ethnic group - in spite of higher levels of material deprivation typically found within such areas. We investigated the effects of area-level same-ethnic density on maternal and infant health, independent of area deprivation and individual socioeconomic status, in five ethnic minority groups. The study was a cross-sectional analysis within the UK Millennium Cohort Study and included mothers in five ethnic minority groups (Black African n=367, Bangladeshi n=369, Black Caribbean n=252, Indian n=462 and Pakistani n=868) and their 9-month-old infants. Outcome measures included: low birth weight, preterm delivery, maternal depression, self-rated health and limiting long-standing illness. Compared to those who live in areas with less than 5% of people from the same-ethnic minority population, Indian and Pakistani mothers were significantly less likely to report ever being depressed in areas with high same-ethnic density. There was a protective effect of ethnic density for limiting long-term illness among Bangladeshi mothers at 5-30% density and Pakistani mothers at all higher densities. Ethnic density was unrelated to infant outcomes and maternal self-rated health, and unrelated to any outcomes in Black African and Black Caribbean mothers and infants, possibly because no families in these groups lived at higher levels of same-ethnic density. Results were similar whether we examined smaller or larger residential areas. We conclude that, among ethnic minority mothers and infants in England, the relationship of ethnic density to health varies by ethnicity and outcome. For some measures of maternal health, in some ethnic groups, the psychosocial advantages of shared culture, social networks and social capital may override the adverse effects of material deprivation.

Economic deprivation, maternal depression, parenting and children's cognitive and emotional development in early childhood.

This study uses data from the UK Millennium Cohort Study to examine the extent to which economic circumstances in infancy and mother's mental well-being are associated with children's cognitive development and behaviour problems at age 3 years, and what part parenting behaviours and attitudes play in mediating these factors. The analyses derived from Structural Equation Modelling show that economic deprivation and maternal depression separately and collectively diminish the cognitive and emotional well-being of children, and part of this diminution emanates from less nurturing and engaged parenting by those with less economic and emotional resources.