1. 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

2. 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

3. 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…

4. UK Data Service

5. 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?

6. 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

7. 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

8. Ethnic Inequalities
Per cent (%) using mental health services

9. Network Size
Per cent (%) using mental health services

10. Network Content
Per cent (%) using mental health services

11. Network Contact
Relatives
Friends

12. Network Support

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

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

15. 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

16. 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

17. 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’

18. 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

19. 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, 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),
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