Do Social Networks Help you to ‘get help’ Do Social Networks Help you to ‘get help’? Usage of Mental Health Services in Women of different Ethnic Groups in England, UK Dharmi Kapadia 3rd Year PhD Student, Social Statistics & The Cathie Marsh Institute for Social Research (CMIST) Supervisors: Professor James Nazroo & Dr Mark Tranmer Funders: Economic & Social Research Council (ESRC) 23rd October 2014

My PhD Ethnic inequalities in mental health service use in UK Under-utilisation evident for “South Asian women” Pakistani women have high rates of mental illness Not much on how the people we know (friends and family) influence decisions to seek help

Plan of Action Initially Then decided on Now Primary data collection Then decided on Secondary data analysis + primary data collection Now Secondary data analysis only (because of time constraints!) Decided on primary data collection before I looked at what was available Question: Should we make use of existing data before we start spending time/ money collecting new data? Maybe, if existing data can answer our research questions…

UK Data Service

Research Questions How does the usage of mental health services for Pakistani women in England, compare with women from other ethnic groups? Are social networks associated with the usage of mental health services? Is the effect of social networks the same for Pakistani women, as for women from other ethnic groups?

Data Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC, 2000), n=2340 Outcome: Mental Health (MH) service usage (outpatient) Ethnic group: Pakistani, White, White Irish, Black Caribbean, Indian, Bangladeshi Main explanatory variable: Social Network (SN) (1) Size, (2) Content, (3) Contact, (4) Support Other variables: mental illness, English proficiency, foreign born status, age, marital status, income, employment status

Methods Weighted bar charts Logistic regression modelling (0: not used mental health services, 1: used mental health services) Data are weighted, using ‘svy’ command in Stata 13 Odds ratios, confidence intervals, alpha level of 5% Pakistani women reference category

Ethnic Inequalities Per cent (%) using mental health services

Network Size Per cent (%) using mental health services

Network Content Per cent (%) using mental health services

Network Contact Relatives Friends

Network Support

Odds of using MH services Model adjusted for mental illness score (CIS-R) and age

We might have expected that but is there an effect of social networks?

OR 95% CI P value Ethnic group (ref. Pakistani) White White Irish Black Caribbean Bangladeshi Indian   4.54 5.79 3.67 2.44 4.26 1.39 – 14.83 1.88 – 17.78 1.25 – 10.83 0.80 – 7.48 1.44 – 12.55 0.012 0.002 0.018 0.118 0.009 Network Size (ref. 0 to 2 ) 3 to 7 8 or more 1.82 0.50 0.65 – 5.11 0.13 – 1.93 0.256 0.314 Network Content (ref. Spouse & Relative) Spouse & Friend Friend & Relative Relatives Friends 0 or 1 close person 0.41 0.75 1.64 1.42 0.35 0.12 – 1.38 0.15 – 3.65 0.35 – 7.74 0.09 – 22.00 0.07 – 1.73  0.149 0.720 0.532 0.802 0.197 Contact with relatives (ref. No contact) Frequent contact Contact with friends (ref. No contact)  0.44 0.89  0.21 – 0.89 0.40 – 1.97  0.022 0.777 Network Support Positive Support Inadequate Support 1.01 1.68 0.60 – 1.67 0.94 – 3.02 0.984 0.081

Does the effect of SN differ? Interaction term of ethnic group and contact with relatives added No differential effect of networks by ethnic group (none of interaction terms significant) But odds ratio for difference between Pakistani and Indian women no longer statistically significant

So what? Differences within South Asian group Contact with relatives lowers service use Because relatives protect against mental illness? – UNLIKELY Because they deter service use through negative views? – POSSIBLE BUT UNTESTABLE Stigma of mental illness for different ethnic groups – not answerable with UK data (Clement, 2014; Pescosolido, 2013) Certain aspects of social networks might not help you to ‘get help’

Limitations & Future Work Data is from 2000, how applicable to current context? Cross sectional survey, possibility of effects in opposite direction Extension to this work: structural equation modelling (SEM) approach to develop latent classes of networks & use in path analysis

Thank you for listening References Chew-Graham, C., Bashir, C., Chantler, K., Burman, E., & Batsleer, J. (2002). South Asian women, psychological distress and self-harm: lessons for primary care trusts. Health & Social Care in the Community, 10(5), 339–47. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., et al. (2014). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 1-17. Sproston, K., & Nazroo, J. (2002). Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC). London: The Stationery Office. Pescosolido, B. A., Medina, T. R., Martin, J. K., & Long, J. S. (2013). The “Backbone” of Stigma: Identifying the Global Core of Public Prejudice Associated with Mental Illness. American Journal of Public Health, 103(5), 853–60. Pescosolido, B. A. (1992). Beyond Rational Choice: The Social Dynamics of How People Seek Help. American Journal of Sociology, 97(4), 1096-1138. dharmi.kapadia@manchester.ac.uk @DharmiKapadia