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Impact of ethnic density on adult mental disorders: narrative review

  • Richard J. Shaw (a1), Karl Atkin (a2), Laia Bécares (a3), Christo B. Albor (a2), Mai Stafford (a4), Kathleen E. Kiernan (a5), James Y. Nazroo (a6), Richard G. Wilkinson (a7) and Kate E. Pickett (a8)...



The ‘ethnic density hypothesis' is a proposition that members of ethnic minority groups may have better mental health when they live in areas with higher proportions of people of the same ethnicity. Investigations into this hypothesis have resulted in a complex and sometimes disparate literature.


To systematically identify relevant studies, summarise their findings and discuss potential explanations of the associations found between ethnic density and mental disorders.


A narrative review of studies published up to January 2011, identified through a systematic search strategy. Studies included have a defined ethnic minority sample; some measure of ethnic density defined at a geographical scale smaller than a nation or a US state; and a measure ascertaining mental health or disorder.


A total of 34 papers from 29 data-sets were identified. Protective associations between ethnic density and diagnosis of mental disorders were most consistent in older US ecological studies of admission rates. Among more recent multilevel studies, there was some evidence of ethnic density being protective against depression and anxiety for African American people and Hispanic adults in the USA. However, Hispanic, Asian–American and Canadian ‘visible minority’ adolescents have higher levels of depression at higher ethnic densities. Studies in the UK showed mixed results, with evidence for protective associations most consistent for psychoses.


The most consistent associations with ethnic density are found for psychoses. Ethnic density may also protect against other mental disorders, but presently, as most studies of ethnic density have limited statistical power, and given the heterogeneity of their study designs, our conclusions can only be tentative.

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Corresponding author

Richard J. Shaw, PhD, School of Social Sciences, Murray Building (58), University of Southampton, Southampton SO17 3BJ, UK. Email:


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Impact of ethnic density on adult mental disorders: narrative review

  • Richard J. Shaw (a1), Karl Atkin (a2), Laia Bécares (a3), Christo B. Albor (a2), Mai Stafford (a4), Kathleen E. Kiernan (a5), James Y. Nazroo (a6), Richard G. Wilkinson (a7) and Kate E. Pickett (a8)...


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Impact of ethnic density on adult mental disorders: narrative review

  • Richard J. Shaw (a1), Karl Atkin (a2), Laia Bécares (a3), Christo B. Albor (a2), Mai Stafford (a4), Kathleen E. Kiernan (a5), James Y. Nazroo (a6), Richard G. Wilkinson (a7) and Kate E. Pickett (a8)...
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Ethnicity as a form of data

Adnan Sharaf, CT1 Psychiatrist
09 October 2012

Dear Sir,

Dr Shaw and colleagues' review paper on the ethnic density1 effect makes for interesting reading. I feel they have made an important omission when they describe the limitations of their paper. The way the data is presented is such that it appears that ethnicity has been categorised as discrete data. I do not believe that this is the correct way to describe ethnicity with a view to data analysis.

The Oxford English Dictionary defines the adjective ethnic as relating to a population subgroup with a common national or cultural tradition. The society which we live in is fluid and hence allocating people to a specific subgroup based on tradition is an unrealistic aim. Migration and intermarriage have made the labelling of people under these headings an outdated concept. To illustrate my point I would like to use my family as examples. If the definition used above is kept to, then overthe years the ethnicity of my father could have been described as Bihari, Pakistani or British. My son could be described as British, English, British Pakistani, Anglo-Pakistani, Pakistani or Mixed. My (anglosaxon) stepdaughter could be British, English or Anglo-Pakistani. If terms such as Black or White are used to describe ethnic background then how would myson be termed? Would he be beige?

Given the fluidity and multicultural nature of modern society I feel that trying to categorise ethnicity is an impossible task. If we can accept that ethnicity is an example of continuous data rather than discrete data then we must accept it as a limitation in any study.

Yours sincerelyAdnan SharafCT1 Community Psychiatry

1 Shaw RJ, Atkin A, Becares L, Albor CB, Stafford M, Kiernan KE, Nazroo JY, Wilkinson RG, Pickett KE. Impact of ethnic density on adult mental disorders: narrative review. BJP 2012, 201:11-19.

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