Ethnic density and risk of mental ill health – The case of religious sectarianism in Northern Ireland: A population data linkage study

Abstract

An ethnic group that lives in a neighbourhood in which it is in the minority, termed 'lower ethnic density,' tends to report a higher incidence of mental ill-health. This population-based study investigated for the first time the existence of an own-group density effect among Catholic and Protestant communities in Northern Ireland. The entire Northern Ireland born Catholic and Protestant working age (n = 1, 004,060) enumerated population in the 2011 Census of Northern Ireland were included in the study via administrative data-linkage methodology. Catholics had a greater likelihood of reporting mental ill health in neighbourhoods with the largest proportion of Catholics (OR = 1.25, 95%CI 1.07-1.47), whereas mental health among Protestants was not associated with neighbourhood proportion of Protestants, after adjusting for socio-economic status and neighbourhood deprivation. The results indicate that a complex relationship exists between group identity, population composition of ethnic and religious groups and prevalence of community mental health.

Rates and predictors of anti-depressant prescribing in Northern Ireland 2011–2015: a data linkage study using the Administrative Data Research Centre (NI)

“…Compared to the Protestant/other Christian group the Catholic (OR=0.91), Other Faith/Philosophy (OR=0.78), and No Faith/Philosophy (OR=0.90) groups had significantly lower risk of antidepressant prescribing. This is in contrast to the findings of O' Reilly and Stevenson (2003) who reported no significant difference between Catholics and Protestants on scores on the General Health Questionnaire, and Bosqui et al (2017) who found that selfreported poor mental health was higher for Catholics (8.69%) than Protestants (7.06%), although the effect was moderated by the own-group religious neighbourhood density. It would appear, even if there are no differences in prevalence of depression, that the Protestant/other Christian group are more likely to be in receipt of anti-depressants.…”

Does physical ill-health increase the risk of suicide? A census-based follow-up study of over 1 million people

“…Mental health status was also based on the responses to the Census question that asked if people had experienced ‘ an emotional, psychological or mental health condition (such as depression or schizophrenia )’ which had lasted, or was expected to last at least 12 months. This indicator has been used as a measure of mental ill-health in a range of previous studies (Tseliou et al ., 2016; Bosqui et al ., 2017; Doebler et al ., 2017; Maguire et al ., 2017; Wright et al ., 2018; Rosato et al ., 2019).…”

Neighbourhood effects on psychotic and depressive symptoms in the context of religious sectarianism in Northern Ireland: A data linkage study

“…Studies on other mental disorders, namely depression and anxiety, found a more mixed picture, but an overall protective or neutral effect for ethnic minorities in the UK or USA (Shaw et al, 2012). The mechanisms of this protective effect are not well understood, and are impeded by limited studies in different contexts and populations, different minority experiences (Bosqui et al, 2017), and on symptom clusters and severity rather than incidence (Bardol et al, 2020).…”

“…This serves as a natural control for broader minority effects, enabling a concentration on minority experience at the neighbourhood level. A recent Census-based study on self-reported mental health using the entire enumerated population of Northern Ireland, found no group density effect for the Protestant population, and a strong reverse effect for the Catholic population, where own-group density was harmful for mental health (Bosqui et al, 2017). This is partially supported by findings from the Northern Ireland First Episode Psychosis Study (NIFEPS), which found an increased incidence risk of a psychotic disorder for both Catholics and Protestants in higher-own group density neighbourhoods, with a 7 times greater risk for Catholics compared to a low own-group area, and 5 times for Protestants, even after adjusting for area deprivation and urbanicity (Mulholland et al, under review) .…”

“…In Northern Ireland, a mediation effect has been found for inter-group forgiveness on the relationship between conflict-related victimhood and psychiatric morbidity (Myers et al, 2009), indicating a harmful effect of ongoing sectarian tensions. Adjustment for socio-economic disadvantage in area-level studies is unlikely to capture the complexity of sectarian and conflict-related identities (Bosqui et al, 2017). The reverse finding in ethno-religious populations compared to ethnic minority populations therefore raises questions about the mechanism of the density effect, and why it appears to be so consistently important for clinical populations with psychosis.…”