LOCAL LEVEL: SOUTH EAST LONDON COMMUNITY HEALTH (SELCOH) STUDY
Gazard, B., Chui, Z., Harber-Aschan, L., MacCrimmon, S., Bakolis, I., Rimes, K., Hotopf, M. & Hatch, S. L. (2018). Barrier or stressor? The role of discrimination experiences in health service use. BMC public health, 18(1), 1354.
- Background. Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences.
- Methods. Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented.
- Results. Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use.
- Conclusions. This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
NATIONAL LEVEL: ADULT PSYCHIATRIC MORBIDITY SURVEY (APMS 2014)
This study looks at patterns of mental health treatment or service use by social status (e.g. employment status, ethnicity) using 2014 Adult Psychiatric Morbidity Survey data. By accounting for differences in underlying need, any disparities may indicate unfair access to or uptake of help in the population. It looks at whether patterns of disparity vary if we consider people in terms of single categories of social status, or if we consider them in terms of their multiple social statuses (e.g. female non-working minority ethnic groups). We also see whether people reporting discrimination experiences are more or less likely to report mental health service use/treatment, and if this differs across single and multiple social statuses. Finally, we compare findings for people living in England as a whole to people living in South East London (a diverse urban area), to see if people’s experiences differ depending on where they live.
ELECTRONIC HEALTH RECORDS
Primary care: Lambeth Datanet
The Clinical Record Interactive Search (CRIS) dataset was successfully linked to Lambeth Datanet and held at the National Institute for Health Research (NIHR) Biomedical Research Centre at King’s College London. The linked dataset has been cleaned and the objective of the analysis is to identify how secondary service access, patterns of referral and treatment type differ across disorders by key social demographic characteristics, and to explore how identified inequalities differ for those experiencing multiple versus single disadvantaged statuses.
Secondary care: Clinical Record Interactive Search (CRIS) and Improving Access to Psychological Therapies (IAPT)
Using CRIS data, we are preparing a paper examining inequalities in referral source and referral location for young people (aged 12-29) accessing secondary mental health services in south London. Using Improving Access to Psychological Therapies (IAPT) data, we are preparing a paper investigating variations in access and usage of psychological therapies through the IAPT programme in south London.