Why do British Indian children have an apparent mental health advantage?
Anna Goodman1, Vikram Patel, David A Leon
1London School of Hygiene & Tropical Medicine, London, UK. anna.goodman@lshtm.ac.uk
Insights
British Indian children show a significant mental health advantage, especially in externalizing problems. This advantage persists even after accounting for family and academic factors, suggesting deeper, unexplained reasons for improved child mental health outcomes.
Area of Science:
- Child and Adolescent Psychiatry
- Mental Health Research
- Ethnic Disparities in Health
Background:
- Previous research indicates a mental health advantage in British Indian children, particularly concerning externalizing problems.
- The underlying causes for this observed ethnic mental health advantage remain largely unknown.
Purpose of the Study:
- To investigate the extent and nature of mental health differences between British Indian and White children.
- To identify potential mediating or confounding factors, such as family structure, academic performance, and socioeconomic status, that may explain ethnic variations in child mental health.
Main Methods:
- Utilized data from the British Child and Adolescent Mental Health Surveys, including 13,836 White and 361 Indian children aged 5-16 years.
- Assessed mental health using parent, teacher, and child Strengths and Difficulties Questionnaires (SDQ), diagnostic interviews, and clinician-rated diagnoses.
- Examined multiple child, family, school, and area-level factors as potential mediators or confounders.
Main Results:
- Indian children demonstrated a significant advantage in externalizing problems and disorders compared to White children.
- This ethnic advantage in externalizing behaviors was partially mediated by factors like living in two-parent families and having fewer academic difficulties.
- A substantial, unexplained Indian advantage for externalizing problems remained after adjusting for covariates, particularly in families of lower socioeconomic status.
Conclusions:
- The observed mental health advantage in British Indian children is real and specific to externalizing problems.
- While family type and academic abilities partially explain the advantage, most of it remains unexplained by major risk factors.
- The absence of a socioeconomic gradient in mental health among Indian children is also unexplained, suggesting potential avenues for promoting child mental health equity across all ethnic groups.
Background:
Previous studies document a mental health advantage in British Indian children, particularly for externalising problems. The causes of this advantage are unknown.
Methods:
Subjects were 13,836 White children and 361 Indian children aged 5-16 years from the English subsample of the British Child and Adolescent Mental Health Surveys. The primary mental health outcome was the parent Strengths and Difficulties Questionnaire (SDQ). Mental health was also assessed using the teacher and child SDQs; diagnostic interviews with parents, teachers and children; and multi-informant clinician-rated diagnoses. Multiple child, family, school and area factors were examined as possible mediators or confounders in explaining observed ethnic differences.
Results:
Indian children had a large advantage for externalising problems and disorders, and little or no difference for internalising problems and disorders. This was observed across all mental health outcomes, including teacher-reported and diagnostic interview measures. Detailed psychometric analyses provided no suggestion of information bias. The Indian advantage for externalising problems was partly mediated by Indian children being more likely to live in two-parent families and less likely to have academic difficulties. Yet after adjusting for these and all other covariates, the unexplained Indian advantage only reduced by about a quarter (from 1.08 to .71 parent SDQ points) and remained highly significant (p < .001). This Indian advantage was largely confined to families of low socio-economic position.
Conclusion:
The Indian mental health advantage is real and is specific to externalising problems. Family type and academic abilities mediate part of the advantage, but most is not explained by major risk factors. Likewise unexplained is the absence in Indian children of a socio-economic gradient in mental health. Further investigation of the Indian advantage may yield insights into novel ways to promote child mental health and child mental health equity in all ethnic groups.
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