Introduction
In England and Wales, it is estimated that 81.7% of the population are White, 9.3% Asian/Asian British/Asian Welsh, 4.0% Black/Black British/Black Welsh/Caribbean/African, 2.9% Mixed, and 2.1% Other Ethnic group. In the UK, the prevalence of alcohol use is highest among White British groups, however, minority ethnic groups may experience greater harms from alcohol due to these groups being more likely to experience inequalities and being less likely to engage with formal support compared to White groups. Minority ethnic groups may also be at greater risk of experiencing poor mental health due to experiences of racial discrimination and delaying seeking support for their mental health because of the way in which it is perceived in specific communities.
It is established that alcohol and mental health problems commonly co-occur but there is little research establishing whether the association between mental health and alcohol use differs across ethnic groups. It could be argued that minority ethnic groups are at greater risk of experiencing co-occurring alcohol and mental health problems because of the associated stigma towards both problems, therefore, they may be even less likely to seek formal support. While there are recommendations in place from the Office for Health Improvement and Disparities to ensure that people with co-occurring problems have access to different services, the barriers to accessing support may be compounded for minority ethnic groups. Cultural and structural factors could increase the barriers to accessing and using services for minority ethnic groups because assumptions may be made about the likelihood of someone drinking for people from minority ethnic groups, with implications for both identification of problems and assessment of the need for specialist support.
Taken together, generally there is a lack of evidence to show the patterns of alcohol use across different minority ethnic groups, and whether some ethnic groups are more likely to drink at problematic levels if they have a mental health problem. There is also a need to understand the mechanisms behind alcohol use among minority ethnic groups who have a mental health problem, and other factors which may play a role in that. Finally, it is also necessary to understand how mental healthcare staff assess and treat alcohol and what the experiences are of minority ethnic service users. Exploring these issues will have implications on the appropriate commissioning of mental health and alcohol services and on how staff in both mental health and alcohol services assess and treat the other issue.
Therefore, this project aimed to:
- Establish how the prevalence of alcohol use, including non-drinking, differs across ethnic groups and to then determine the associations between alcohol use with mental health, across ethnic groups.
- Understand experiences with alcohol among minority ethnic groups who have a mental health problem.
- Understand how alcohol is assessed and treated within community mental healthcare services, and whether approaches are tailored for minority ethnic groups from the perspectives of those managing services, community mental health staff, and minority ethnic service users.
Methods
Taking an intersectional approach, this project consisted of three studies using:
- Secondary data sources to establish the prevalence and associations of alcohol use and mental health across ethnic groups
- Qualitative interview approach to explore experiences of alcohol use among minority ethnic groups with a mental health problem.
- Rapid appraisal approach in community mental health services within a single mental health trust to establish whether and how alcohol is screened and treated.
The first study used data from eight secondary datasets; 2007 and 2014 Adult Psychiatric Morbidity Survey (APMS, N=14,949), phase 1 of South-East London Community Health study (SELCoH, N=1,695), wave 8 of Next Steps (N=7,707), wave 7 of Understanding Society (N=39,377), 1999 and 2004 Health Survey for England (HSE, N=37,244), and sweep 7 of Millennium Cohort Study (MCS, N=11,859). The APMS and HSE were cross-sectional studies while SELCoH, Next Steps, Understanding Society and MCS were cohort studies. These datasets were used because they included validated measures of alcohol and mental health, and some oversampled minority ethnic groups allowing for statistical analysis. Ethnic categories were determined based on using the most specific ethnic category available and were consistently measured across all datasets (e.g. Indian, Pakistani, Bangladeshi). Where ethnic groups were vague (e.g. any other ethnic group), these were removed from the analysis. The first study used data from eight secondary datasets; 2007 and 2014 Adult Psychiatric Morbidity Survey (APMS, N=14,949), phase 1 of South-East London Community Health study (SELCoH, N=1,695), wave 8 of Next Steps (N=7,707), wave 7 of Understanding Society (N=39,377), 1999 and 2004 Health Survey for England (HSE, N=37,244), and sweep 7 of Millennium Cohort Study (MCS, N=11,859). The APMS and HSE were cross-sectional studies while SELCoH, Next Steps, Understanding Society and MCS were cohort studies. These datasets were used because they included validated measures of alcohol and mental health, and some oversampled minority ethnic groups allowing for statistical analysis. Ethnic categories were determined based on using the most specific ethnic category available and were consistently measured across all datasets (e.g. Indian, Pakistani, Bangladeshi). Where ethnic groups were vague (e.g. any other ethnic group), these were removed from the analysis.
Pooled proportions and associations were calculated of individuals from specific ethnic groups who reported being a i) non-drinker, ii) low-risk drinker, iii) hazardous drinker, or iv) binge-drinker which were then re-calculated by whether individuals from specific ethnic groups were or were not experiencing poor mental health.
The second study used qualitative interviews to explore experiences with alcohol among minority ethnic groups who had a diagnosed mental health problem, and who either drank at hazardous and above levels or no longer drank alcohol. A framework analysis was conducted to explore experiences across different minority ethnic, religious and demographic groups.
The third and final study used rapid appraisal methods where individuals who manage support services, NHS community mental health staff, and minority ethnic service users with community mental healthcare services were either interviewed in a one-to-one setting or through focus groups. These methods were used to understand how alcohol was screened and treated within a mental healthcare or support service setting, and the experiences of this from a range of perspectives. A framework analysis was conducted to explore these experiences across staff and minority ethnic service users.
The project also involved a project advisory group and public involvement group. The project advisory group comprised of representatives from mental health services, minority ethnic support services, Office for Health Improvement and Disparities, and academics with expertise in the alcohol field. The public involvement group comprised of minority ethnic individuals who have lived experience of alcohol and/or mental health problems. Both groups were involved in development of the research design and interpretation of results throughout the project and its work packages.
There is an accompanying poster for this project which you can download here.
