Skip to main content Accessibility help
×
Home
Hostname: page-component-5bf98f6d76-94zm5 Total loading time: 0.557 Render date: 2021-04-20T21:24:21.944Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Ethnic density – meaning and implications

Published online by Cambridge University Press:  02 January 2018

James Rodger
Affiliation:
South Devon CAMHS. Email: j.rodger@exeter.ac.uk
Corresponding
E-mail address:
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2016 

The ecological study by Keown et al Reference Keown, McBride, Twigg, Crepaz-Keay, Cyhlarova and Parsons1 is undoubtedly of value, both methodologically and in relation to the further exposition as to how ‘structural and social issues can shape mental health’, as Burns and Rugkåsa Reference Burns and Rugkåsa2 (p. 97) note in their related editorial. However, some clarification of the authors' use and operationalisation of the term ‘ethnic density’ is required to more fully understand the study's implications and limitations.

The study documents ‘a positive association between ethnicity and compulsory in-patient treatment’ in urban areas (p. 158), but as the denominator of population analysis is relatively large (divided by primary care trusts (PCTs) with an average population of 350 000), it is unclear whether ‘ethnic density’ is defined in their study according to the overall prevalence of different ethnic groups within these relatively large unit PCT populations under study, or whether smaller and more relevant unit neighbourhood-level measures of ethic density have been used.

An important earlier study using such neighbourhood-level measures, by Das-Munshi et al, Reference Das-Munshi, Bécares, Boydell, Dewey, Morgan and Stansfeld3 demonstrated that ‘people resident in neighbourhoods of higher own-group density experience “buffering” effects from the social risk factors for psychosis’ (p. 282). As psychotic presentations are more likely to result in compulsory admission, Das-Munshi et al's findings would be expected to predict, when controlling for other variables highlighted by Keown et al – in particular, age and deprivation indices – that higher ethnic density, through ‘buffering effects’, would lead to lower levels of compulsory admission. Although it is possible that the findings of Das-Munshi et al and Keown et al are therefore in contradiction, it seems more likely that the Keown et al study did not measure ethnic density at the more relevant neighbourhood level in which buffering effects are manifest, and therefore that their measure of ‘ethnic density’ is less meaningful.

Ecological studies, by definition, attempt to attend to these more proximal influences on the immediate living environment. Reference Jadhav, Jain, Kannuri, Bayetti and Barua4 Although the data-set used by Keown et al no doubt precluded this, the contingent limitations of such data, if this was the case, are therefore important to further acknowledge. Neighbourhood-level ethnic density data would also be needed to confirm the significance of Keown et al's unexpected finding of a lack of association between ethnicity and compulsion in rural areas, where genuine neighbourhood-level ethnic density might be expected to be low, at least in some areas. Nonetheless, Keown et al's study alerts us to the importance of attending to both social and cultural factors influencing the genesis, precipitation and maintenance of mental illness, including psychosis, which may be variously protective or risk-amplifying, and which interact in complex – sometimes counterintuitive – ways, influencing prognosis, Reference Rodger and Steel5 hospital admission and compulsion.

References

1 Keown, P, McBride, O, Twigg, L, Crepaz-Keay, D, Cyhlarova, E, Parsons, H, et al. Rates of voluntary and compulsory psychiatric in-patient treatment in England: an ecological study investigating associations with deprivation and demographics. Br J Psychiatry 2016; 209: 157–61.CrossRefGoogle ScholarPubMed
2 Burns, T, Rugkåsa, J. Hospitalisation and compulsion: the research agenda. Br J Psychiatry 2016; 209: 97–8.CrossRefGoogle ScholarPubMed
3 Das-Munshi, J, Bécares, L, Boydell, JE, Dewey, ME, Morgan, C, Stansfeld, SA, et al. Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC). Br J Psychiatry 2012; 201: 282–90.CrossRefGoogle Scholar
4 Jadhav, S, Jain, S, Kannuri, N, Bayetti, C, Barua, M. Ecologies of suffering: mental health in India. Econ Polit Wkly 2015; 50: 12–5.Google Scholar
5 Rodger, J, Steel, Z. Between Trauma and the Sacred: the Cultural Shaping of Remitting-Relapsing Psychosis in Post-Conflict Timor-Leste. Springer, 2016.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 83
Total number of PDF views: 110 *
View data table for this chart

* Views captured on Cambridge Core between 02nd January 2018 - 20th April 2021. This data will be updated every 24 hours.

You have Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Ethnic density – meaning and implications
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Ethnic density – meaning and implications
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Ethnic density – meaning and implications
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *