Disability-related inequalities in the prevalence of loneliness across the lifespan: trends from Australia, 2003 to 2020.

BACKGROUND: Experiencing loneliness can be distressing and increasing evidence indicates that being lonely is associated with poor physical and mental health outcomes. Cross-sectional studies have demonstrated that people with disability have increased risk of experiencing loneliness compared to people without disability. However, we do not know if these inequalities have changed over time. This study investigated the prevalence of loneliness for people with disability in Australia annually from 2003 to 2020 to examine whether disability-related inequalities in loneliness have changed over time, and disaggregated results for subgroups of people with disability by age group, sex, and disability group. METHODS: We used annual data (2003-2020) from the Household, Income and Labour Dynamics in Australia Survey. Loneliness was measured by a single question assessing the subjective experience of loneliness. For each wave, we calculated population-weighted age-standardised estimates of the proportion of people experiencing loneliness for people with and without disability. We then calculated the absolute and relative inequalities in loneliness between people with and without disability for each wave. Analyses were stratified by 10-year age groups, sex, and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). RESULTS: From 2003 to 2020, the prevalence of loneliness was greater for people with disability, such that people with disability were 1.5 to 1.9 times more likely to experience loneliness than people without disability. While the prevalence of loneliness decreased for people without disability between 2003 and 2020, the prevalence of loneliness did not decrease for people with disability during this period. Inequalities in loneliness were more substantial for people with intellectual or learning disabilities, psychological disability, and brain injury or stroke. CONCLUSION: This study confirms that people with disability have increased risk of loneliness compared to people without disability. We add to the existing evidence by demonstrating that disability-related inequalities in loneliness have persisted for two decades in Australia without improvement. Our findings indicate that addressing inequalities in loneliness for people with disability is a critical public health concern given that loneliness is associated with a wide range of poor health outcomes.

The wellbeing of women and men with and without disabilities: evidence from cross-sectional national surveys in 27 low- and middle-income countries.

BACKGROUND: Little is known about disability-related inequities in personal wellbeing (PWB) in low- and middle-income countries (LMICs). METHOD: Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys (MICS) undertaken in 27 LMICs (n = 296,693 women, 66,557 men). Data were aggregated across countries by mixed effects multi-level modelling and meta-analysis. RESULTS: Women and men with disabilities were less likely than their non-disabled peers to report being happy and to be satisfied with their life. These differences were evident in all countries for women and in 18 of 22 countries for men. Aggregated data indicated that: (1) women with disabilities were 14-15% less likely to be happy and 17% less likely to be satisfied with their lives; (2) men with disabilities were 15-17% less likely to be happy and 17-19% less likely to be satisfied with their lives; (3) disability-related inequalities in personal wellbeing were reduced by 22-26% for women and 11-22% for men by adjusting for differences in living conditions. CONCLUSIONS: Future releases of MICS data could prove a valuable resource in monitoring country-level progress to realising Sustainable Development Goal 3 and the extent to which progress is equitable between women and men and between people with/without disabilities. Results also suggest that a significant proportion of the disability-related inequities in wellbeing may be accounted for by modifiable differences in their living conditions and life experiences.

Impact of informal care on the mental health of caregivers during the COVID-19 pandemic.

BACKGROUND: Informal care can affect the mental health of caregivers. The COVID-19 pandemic precipitated many people into informal care. Little is known about the longitudinal effect of informal care throughout the pandemic. We investigate changes in mental health in relation to changes in informal care between July 2020 and September 2021. METHODS: Using data from Understanding Society, we applied fixed-effects modelling to assess mental health variations associated with changes in caregiving among 13 557 participants (50 430 observations). Hours of weekly care were categorized as 0, 1-19, ≥20. Mental health was measured using the General Health Questionnaire (GHQ-12) as a continuous score and a binary indicator. Main analyses were stratified by gender. RESULTS: Compared to when delivering 0 hours care/week, the GHQ-12 scores of women providing care for 1-19 hours/week were 0.46 points higher (95%CI: -0.11, 1.09), while their mental health scores were 0.99 higher (95%: 0.08, 1.90) when caring for ≥20 hours/week. Changes on the binary GHQ-12 measure were only evident for women when providing ≥20 hours of weekly care. These changes were not substantial among men. CONCLUSION: Informal care adversely impacted the mental health of women carers during the COVID-19 pandemic. Support programmes for informal carers should focus on alleviating caregiving loads in women.

Health and wellbeing outcomes associated with loneliness for people with disability: a scoping review.

BACKGROUND: Loneliness is a significant public health concern due to its detrimental impact on health and wellbeing. Despite people with disability reporting higher levels of loneliness than the general population, there has been little research into how this is affecting their health and wellbeing. In light of this, the aim of our study was to scope both the existing evidence about the health and wellbeing outcomes associated with loneliness for people with disability, as well as the conceptual frameworks and measures utilised in this field of research. METHODS: To conduct this scoping review, we followed the methodology outlined by JBI and searched MEDLINE, Scopus, Informit, Embase, and Web of Science for peer-reviewed, English-language articles published between 1 January 2000 and 8 February 2023. Two independent reviewers completed screening, full-text review and data extraction, with consensus sought at each stage. Data were analysed using content analysis and presented both numerically and narratively. RESULTS: Out of the initial 1602 publications identified in the scoping review, only nine were included after duplicate removal, title and abstract screening, and full-text review. This limited number of studies, with the earliest study one published in 2015, represents a key finding. Eight of the nine studies were quantitative, and all were conducted in high income countries. Most of these studies utilised a version of the University of Los Angles Loneliness Scale to measure loneliness and addressed specific impairment groups. Notably, most of the studies identified associations between loneliness and health and wellbeing outcomes for people with disability. CONCLUSIONS: This scoping review highlights the current scarcity of studies examining the effect that loneliness has on the health and wellbeing outcomes of people with disability. As most of the reviewed studies relied on loneliness measures designed for individuals without disability, they potentially overlook the unique life experiences of people with disability. Given that loneliness is an international public health concern, it is imperative that people with disability are not left behind or overlooked in efforts to address the impact of loneliness on health and wellbeing.

Disability and loneliness in the United Kingdom: cross-sectional and longitudinal analyses of trends and transitions.

BACKGROUND: Loneliness can have a detrimental impact on health, yet little is known about the association between disability and loneliness. METHODS: Secondary analysis of three waves of data collected between 2017 and 2020 by the UK's annual household panel study, Understanding Society. Direct age-standardisation was used to compare the prevalence of loneliness at each wave and the persistence of loneliness across all three waves for participants with/without disabilities aged 16-65 years. Transitional probabilities for the stability of loneliness, the stability of non-loneliness, the onset of loneliness and the offset of loneliness between consecutive waves were also estimated. RESULTS: At each wave, the prevalence of loneliness was significantly higher among respondents with disabilities than respondents without disabilities; these inequalities persisted with no evidence of change over time. The prevalence of persistent loneliness was 46% for respondents with disabilities compared with 22% for respondents without disabilities. Risk factors for the likelihood of persistent loneliness included disability, financial stress, not living as a couple, living in rented accommodation, being female and not being employed. The probability of the onset and stability of loneliness between successive waves were markedly higher for people with disabilities compared with people without disabilities. CONCLUSION: Adults with disabilities were more likely to experience loneliness, become lonely and remain lonely over time than their peers. Policies and interventions aimed at reducing loneliness should ensure that they are accessible and effective for people with disabilities. Further research is needed to explore the health outcomes of persistent loneliness among people with/without disabilities.

Parental Report of Signs of Anxiety and Depression in Children and Adolescents with and Without Disability in Middle- and Low-Income Countries: Meta-analysis of 44 Nationally Representative Cross-Sectional Surveys.

Population-based studies undertaken in high-income countries have indicated that children and adolescents with disabilities are more likely than their non-disabled peers to experience emotional difficulties such as anxiety and depression. Very little is known about the association between disability and emotional difficulties among children growing up in low and middle-income countries (LMICs). We aimed to estimate the strength of association between disability and two forms of emotional difficulties (anxiety, depression) in a range of LMICs and to determine whether the strength of this relationship was moderated by child age and gender. Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys undertaken in 44 LMICs (combined n = 349,421). Data were aggregated across countries by both mixed effects multi-level modelling and restricted maximum likelihood meta-analysis. Young people with disabilities, when compared with their non-disabled peers, were approximately two and a half times more likely to be reported by parents to show daily signs of either anxiety or depression. The level of risk among young people with disabilities was highest in upper middle-income countries and lowest in low-income countries. We estimated that approximately 20% of young people with frequent anxiety or depression also had a disability. All approaches to mental health interventions (from primary prevention to clinical interventions) need to make reasonable accommodations to their services to ensure that the young people with emotional difficulties who also have a disability are not 'left behind'.

COVID-19 vaccination coverage and vaccine hesitancy among Australians with disability and long-term health conditions.

ISSUE ADDRESSED: COVID-19 vaccination is the cornerstone of managing Australia's COVID-19 pandemic and the success of the vaccination program depends on high vaccination coverage. This paper examined differences in COVID-19 vaccination coverage and vaccine hesitancy for people with disability, long-term health conditions, and carers - subgroups that were prioritised in Australia's vaccination program. METHODS: Using data from 2400 Australians who participated in two waves of the Taking the Pulse of the Nation survey in April and May 2021, we described vaccination coverage and hesitancy among people with disability, severe mental health conditions, severe long-term health conditions, frequent need for assistance with everyday activities, and carers. RESULTS: Vaccination coverage was estimated to be 8.2% in the population overall and was similar for people with disability, those with frequent need for assistance, and carers. It was higher for people with severe long-term health conditions (13.4%) and lower for people with severe mental health conditions (4.3%). Vaccine hesitancy was high overall (35.6%) and was similarly high across the priority groups, with only small differences for people with disability, severe long-term health conditions and frequent need for assistance. CONCLUSIONS: This study highlights a lack of difference in vaccination coverage for people with disability, long-term health conditions, and carers compared to the general population. So what? Sub-optimal vaccination coverage for people in the priority groups leaves many people at significant risk of serious disease or death if exposed to COVID-19, particularly in light of easing of disease-control restrictions across Australia and the emergence of new variants.

The impact of disability on employment and financial security following the outbreak of the 2020 COVID-19 pandemic in the UK.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have a greater impact on people with disabilities than non-disabled people. Our aim was to compare the short-term impact of the 2020 COVID-19 pandemic and first lockdown on the employment and financial security of working age adults with and without disabilities in the UK. METHODS: Secondary analysis of data collected in Wave 9 and the special April, May and June COVID-19 monthly surveys of 'Understanding Society', the UK's main annual household panel study. RESULTS: During the first 3 months of the introduction of the COVID-19 lockdown in the UK, respondents with disability were more likely than their peers to be working reduced hours and experience higher levels of financial stress. These differences were attenuated, but not eliminated, when estimates were adjusted to take account of pre-lockdown financial status. CONCLUSIONS: Working age adults with disability were particularly disadvantaged by the financial impact of the COVID-19 lockdown in the UK. The UN Secretary-General António Guterres has stated the need for a disability-inclusive COVID-19 government response. The results of our analysis suggest that these pleas have either not been heeded, or if measures have been implemented, they have so far been ineffectual in the UK.

Overt acts of perceived discrimination reported by British working-age adults with and without disability.

BACKGROUND: Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. METHODS: Secondary analysis of de-identified cross-sectional data from the three waves of the UK's 'Life Opportunities Survey'. RESULTS: In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. CONCLUSIONS: Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Disability, Loneliness and Health in the UK: cross-sectional survey.

BACKGROUND: Research has suggested that exposure to loneliness can have a powerful detrimental impact on health, including mental health. Addressing socially determined health inequity requires understanding of the situation of marginalized or vulnerable groups. People with disability are increasingly being recognized as one such group. Little population-based research has addressed the association between loneliness and health among working age adults with and without disability. METHODS: Secondary analysis of data collected in waves 8 and 9 of Understanding Society, the UK's main annual household panel study. RESULTS: Rates of exposure to substantial loneliness were 25.4% (95%CI 23.5-27.3%) among adults with persistent disability (disability at W8 and W9), 15.4% (13.3-17.5%) among adults with disability onset (disability at W9 only), 12.3% (10.1-14.5%) among adults with disability offset (disability at W8 only), and 6.9% (6.5-7.3%) among adults with no disability. Exposure to loneliness was positively associated with the incidence (GHQ-12) and prevalence (SF-12 Mental) of mental health problems, but not the prevalence of physical health problems (SF-12 Physical). Disability status appeared to moderate the association between loneliness and health, with the difference between the persistent disability and no disability group increasing with exposure to greater levels of loneliness. CONCLUSION: Loneliness may be an important determinant of the poorer mental health of working age adults with disability in the UK. Exposure rates are significantly higher than among the non-disabled population. The strength of association between exposure to loneliness and poorer mental health is greater for people with persistent disability than people with no disability.

Youth with disabilities are more likely than their peers to engage in hazardous child labour.

BACKGROUND: Little is known about the extent to which children and adolescents with disabilities are exposed to child labour. OBJECTIVE: To estimate prevalence rates and adjusted rate ratios of exposure to child labour among children and adolescents with/without disability in middle- and low-income countries and to determine whether these rates vary between functional limitations associated with disability. PARTICIPANTS AND SETTING: Nationally representative samples involving 142,499 children aged 5-14 from 15 countries. METHODS: Secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys. RESULTS: Overall children and youth with disability were not at significantly greater risk of exposure than children without disability to child labour when demographic and contextual factors were taken into account. However, children and youth with disability were at significantly greater risk of exposure than children without disability to hazardous child labour (adjusted relative risk [ARR] = 1.15 [1.10-1.21], P < 0.001). Specifically, children and youth with impairments related to poorer mental health or cognitive functioning were at significantly greater risk of exposure to hazardous child labour (e.g., ARR for learning impairment = 1.27 [1.14-1.42], P < 0.001). In contrast, children with impairments related to sensory functioning, mobility and expressive communication were at no greater risk of exposure than children with no disability. CONCLUSIONS: Children and youth with disability are at greater risk of exposure to hazardous child labour than children with no disability in middle- and low-income countries. Responses to eradicate hazardous child labour need to take account of the situation of children and youth with disability.

Hierarchical Models for International Comparisons: Smoking, Disability, and Social Inequality in 21 European Countries.

BACKGROUND: International comparisons of social inequalities in health outcomes and behaviors are challenging. Due to the level of disaggregation often required, data can be sparse and methods to make adequately powered comparisons are lacking. We aimed to illustrate the value of a hierarchical Bayesian approach that partially pools country-level estimates, reducing the influence of sampling variation and increasing the stability of estimates. We also illustrate a new way of simultaneously displaying the uncertainty of both relative and absolute inequality estimates. METHODS: We used the 2014 European Social Survey to estimate smoking prevalence, absolute, and relative inequalities for men and women with and without disabilities in 21 European countries. We simultaneously display smoking prevalence for people without disabilities (x-axis), absolute (y-axis), and relative inequalities (contour lines), capturing the uncertainty of these estimates by plotting a 2-D normal approximation of the posterior distribution from the full probability (Bayesian) analysis. RESULTS: Our study confirms that across Europe smoking prevalence is generally higher for people with disabilities than for those without. Our model shifts more extreme prevalence estimates that are based on fewer observations, toward the European mean. CONCLUSIONS: We demonstrate the utility of partial pooling to make adequately powered estimates of inequality, allowing estimates from countries with smaller sample sizes to benefit from the increased precision of the European average. Including uncertainty on our inequality plot provides a useful tool for evaluating both the geographical patterns of variation in, and strength of evidence for, differences in social inequalities in health.

Early Years Parenting Mediates Early Adversity Effects on Problem Behaviors in Intellectual Disability.

A family developmental framework was applied to data from families of children with intellectual disabilities to understand the role of parenting in the path from early adversity to problem behaviors in mid-childhood. Data from 9 months to 11 years tested the Family Stress Model in families of 555 children. Adversarial parenting between 3 and 5 years mediated the path from early adversity (family poverty and maternal psychological distress at nine months) to problem behaviors at 7 and 11 years. Positive parent-child relationship only mediated the path to conduct problems. Multiple mediation was not present. Early adversity impacts both positive parent-child relationship and adversarial parenting between three and five, but the latter is crucial for problem behaviors in mid-childhood.

Developmental trajectories of behaviour problems and prosocial behaviours of children with intellectual disabilities in a population-based cohort.

BACKGROUND: The study examined developmental trajectories of prosocial behaviours, internalising and externalising behaviour problems in children with intellectual disabilities (ID) between pre-school and middle childhood. METHOD: Growth models examined the best-fitting trajectories for internalising and externalising behaviour problems, as well as prosocial behaviours, in 555 children with ID between the ages of three and 11 years from the UK Millennium Cohort Study. Models were also fitted to examine the association of child outcomes with time-varying maternal psychological distress and life satisfaction. Finally, models were extended to compare trajectories with typically developing children. RESULTS: Externalising behaviour problems and prosocial behaviours generally improved, whereas internalising problems did not change systematically over time. A cubic trend indicated a slowing down of improvement between ages 5 and 7 for prosocial behaviours and externalising problems. Maternal psychological distress positively co-varied with internalising and externalising behaviour problems over time. Life satisfaction was not related to changes in child behaviours over time. Compared to behavioural trajectories in typical development, intercepts were worse and trajectories also differed in the ID group. CONCLUSIONS: Over an 8-year period, externalising behaviour problems and prosocial behaviours of children with ID tended to improve. These behavioural improvements slowed between five and seven years, possibly coinciding with school-related environmental changes. Children with ID significantly differ from children with typical development in both the initial level of difficulties (exhibiting higher externalising and internalising behaviours, and lower prosocial behaviours) and subsequent development as they age, showing comparatively lower decreases in both externalising and internalising behaviours, and lower increases in prosocial behaviours. Findings also highlight the significant role of maternal mental health problems in the trajectory of child behaviour problems.

Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort.

BACKGROUND: To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity. METHODS: We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity. RESULTS: Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity. CONCLUSIONS: The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.

The relationship between disability and suicide: prospective evidence from the Ten to Men cohort.

BACKGROUND: People with disabilities often face a range of social and economic adversities. Evidence suggests that these disadvantages result in poorer mental health. Some research also indicates that people with disabilities are more likely experience thoughts about suicide than people without disability, although most of this research is based on small cross-sectional samples. METHODS: We explored the relationship between self-reported disability (measured at baseline) and likelihood of reporting thoughts of suicide (measured at follow up) using a large longitudinal cohort of Australian males. A logistic regression model was conducted with thoughts of suicide within the past 12 months (yes or no) as the outcome and disability as the exposure. The models adjusted for relevant confounders, including mental health using the SF-12 MCS, and excluded males who reported thoughts of suicide at baseline. RESULTS: After adjustment, there was a 1.48 (95% CI: 0.98-2.23, P = 0.063) increase in the odds of thoughts of suicide among men who also reported a disability. The size of association was similar to that of being unemployed. CONCLUSIONS: Males reporting disability may also suffer from thoughts of suicide. We speculate that discrimination may be one explanation for the observed association. More research on this topic is needed.

Vaccine Coverage among Children with and without Intellectual Disabilities in the UK: Cross Sectional Study.

BACKGROUND: Universal childhood vaccination programmes form a core component of child health policies in most countries, including the UK. Achieving high coverage rates of vaccines is critical for establishing 'herd immunity' and preventing disease outbreaks. Evidence from the UK has identified several groups of children who are at risk of not being fully immunised. Our aim was to determine whether children with intellectual disabilities constitute one such group. METHODS: Secondary analysis of parental report data on child vaccination collected in the UK's Millennium Cohort Study when the children were 9 months, 3 years, 5 years and 14 years old. RESULTS: With one exception (MMR coverage at age 5) vaccination coverage rates were lower for children with intellectual disabilities (when compared to children without intellectual disability) for all vaccinations at all ages. Complete coverage rates were significantly lower for children with intellectual disabilities at ages 9 months (unadjusted PRR non-vaccination = 2.03 (1.14-3.60), p < 0.05) and 3 years (unadjusted PRR = 2.16 (1.06-4.43), p < 0.05), but not at age 5 years (unadjusted PRR = 1.91 (0.67-5.49)). HPV vaccination was lower (but not significantly so) at age 14 (PRR = 1.83 (0.99-3.37), p = 0.054). Adjusting PRRs for between group differences in family socio-economic position and other factors associated with coverage reduced the strength of association between intellectual disability and coverage at all ages. However, incomplete vaccination remained significantly elevated for children with intellectual disabilities at ages 9 months and 3 years. There were no statistically significant differences between parents of children with/without intellectual disability regarding the reasons given for non-vaccination. CONCLUSIONS: Children with intellectual disabilities in the UK are at increased risk of vaccine preventable diseases. This may jeopardise their own health, the health of younger siblings and may also compromise herd immunity.

Mental health of adolescents: variations by borderline intellectual functioning and disability.

Adolescence is a period of elevated stress for many young people, and it is possible that the challenges of adolescence are different for vulnerable groups. We aimed to document the depressive and anxiety symptoms, emotional-behavioural difficulties and suicidal/self-harming behaviours among adolescents with borderline intellectual functioning (BIF) or a disability, compared to those with neither disability nor BIF. Data were drawn from the nationally representative Longitudinal Study of Australian Children. Participants were 2950 adolescents with complete data for waves 3-6 (years 2008-2014), aged 14-15 years in 2014. Anxiety and depression symptoms and self-harming/suicidal thought/behaviours were self-reported. Emotional-behavioural difficulties items came from the Strengths and Difficulties Questionnaire, and were parent-, and adolescent-reported. Results of logistic regression analyses indicate that the emotional-behavioural difficulties of adolescents with either a disability or BIF, were worse than for those with neither disability nor BIF. While adolescents with a disability reported more anxiety symptoms, no clear associations were observed for self-harming/suicidal thoughts/behaviours or depressive symptoms for those with either BIF or a disability. Adolescents with BIF or a disability are at higher risk of poor mental health than those with neither disability nor BIF, and it is vital that factors contributing to these differences are identified in order to reduce these mental health inequalities.

What do we know about the health and health care of people with intellectual disabilities from minority ethnic groups in the United Kingdom? A systematic review.

BACKGROUND: People with from minority ethnic communities face inequalities in health and health care. This systematic review considers the question of what we know about the health and health care of children and adults with intellectual disabilities from ethnic minority communities in the UK. METHOD: Studies published from 1990 to 2018 were identified via electronic literature databases, email requests and cross-citations. Studies were reviewed narratively in relation to identified themes. RESULTS: Twenty-three studies were identified, most commonly focusing on South Asian communities. Very little information was identified on physical health or physical health care, with the identified evidence tending to focus on mental health care, access to specialist intellectual disability services, and inpatient services. CONCLUSION: Little is known about the health status of people with intellectual disabilities from minority ethnic groups in the UK. It is clear that they may experience barriers to accessing specialist intellectual disability services and other forms of health care.

The association between employment and the health of people with intellectual disabilities: A systematic review.

BACKGROUND: There is strong evidence indicating that paid employment is generally good for the physical and mental health of the general population. This systematic review considers the association between employment and the health of people with intellectual disabilities. METHODS: Studies published from 1990 to 2018 were identified via electronic literature databases, email requests and cross-citations. Identified studies were reviewed narratively. RESULTS: Twelve studies were identified. Studies were generally consistent in reporting an association between being in paid employment and better physical or mental health status. CONCLUSIONS: This review supports the view that the well-established association between employment and better health is similar for adults with and without intellectual disabilities. However, evidence establishing causality is lacking and further research to determine specific health benefits attributable to employment for people with intellectual disabilities and the causal pathways that operate is required.