Table 1. Studies investigating ethnic density effects with mental health outcomes. Studies ranked according to quality assessment by outcome.
| Reference | Dataset, country | Sample | Instrument | Area Unit | Ethnic density measure | Covariates | Method | Results [threshold/nonlinearity] | QA score |
|---|---|---|---|---|---|---|---|---|---|
| DEPRESSION | |||||||||
| *Arévalo et al, 2015(Arévalo et al., 2015) | Boston Puerto Rican Health Study (USA) | 1142 Puerto Ricans from initial sample of 1504 (76%) with complete baseline and follow up assessment. Aged 45-75. | Center for Epidemiologic Studies-Depression (CES-D). | census tract | Percentage Puerto Ricans | Gender, age, education, depressive symptoms at baseline (for follow up assessment), Neighbourhood poverty level, pre-migration urbanicity, reasons for migration, length of stay, acculturation, discrimination, recreational/ friend/ neighbour/ family/ church activities |
Multilevel multivariate linear regression | At 2 year follow up, after adjusting for all covariates and baseline CES-D, men living in high vs. low ethnic density neighbourhoods had lower CES-D scores but not women | 14 |
| Booth, 2014(Booth, 2014) | Chicago Community Adult Health Survey (CCAHS) 2001-2003 (USA) | 802 Latino people; 64% Mexican American, 17% Puerto Rican, 19% other Hispanic/Latino | Center for Epidemiologic Studies-Depression (CES-D) | 343 neighbourhood ‘clusters’ consisting of one or more contiguous census tracts, from 865 aggregated census tracts | Percentage of Hispanic people, continuous according to 2000 US census | Gender, age, education Neighbourhood-level disadvantage, generational status |
Multilevel regression models | Protective association of increasing own Hispanic density in crude models and models adjusting for individual and area-level covariates excluding generational status and acculturation. | 14 |
| Alegria et al., 2014(Alegria et al., 2014) | 2001-2003 Collaborative Psychiatric Epidemiology Surveys (CPES)- these included National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL), the National Latino and Asian American Study (NLAAS) (USA) | 4180 Non-Latino white, 2554 Latino, 2095 Asian, 3570 African American and 1438 African Caribbean residents | World Health Organization World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI) | Census tracts | Percentage Latino and foreign-born population – interacted with race/ethnicity | Individual-race/ethnicity, age, gender, marital status, education, poverty status, work status, and nativity. Neighbourhood-Disadvantage, Latino/immigrant concentration, affluence, and residential instability |
Multi-level logistic regression models | In an interaction between individual-level ethnicity (Latino vs. non-Latino White), there wasn’t a statistically significant association between increased Latino/immigrant ethnic density and depressive disorders. | 14 |
| *Bécares et al., 2014(Bécares et al., 2014) | NSAL; (USA) | 3570 African Americans | Center for Epidemiologic Studies-Depression (CES-D). | Census tract | Percentage black residents | Age, gender, marital status, household income, education, employment Area deprivation score composed of 4 indicators |
Multi-level logistic regression models |
Increased black ethnic density up to 85% associated with decreased depressive symptoms. Increased black ethnic density from 85% onwards associated with increased depressive symptoms. |
14 |
| Mair et al., 2010(Mair et al., 2010) | Multi-Ethnic Study of Atherosclerosis (MESA); (USA) | 837 African American women, 669 African American men, 608 Hispanic women, 571 Hispanic men, 339 Chinese women, 321 Chinese men |
Center for Epidemiologic Studies-Depression (CES-D) | Census tract | Percent non-Hispanic African American, Hispanic, non-Hispanic white, and non-Hispanic Asian. | Age, income, marital status, education and nativity. Analyses stratified by gender. Neighbourhood social cohesion, safety, problems, aesthetic quality and socioeconomic factors. |
Multilevel regression models. |
Living in a neighbourhood with a higher ethnic density was associated with increased CES-D scores in African American men. When adjusted for area deprivation, Hispanic ethnic density was association with decreased CES-D scores among Hispanic men. No association between ethnic density and depression for the other racial/ethnic and gender categories. |
13 |
| Wight et al., 2009(Wight et al., 2009) | Study of Assets and Health Dynamics Among the Oldest Old (AHEAD); (USA) | 3442 older adults at Time 1 (17% African American, 6% Hispanic), 2632 at Time 2 (16% African American, 6% Hispanic), 1871 at Time 3 (16% African American, 6% Hispanic) |
8-item Center for Epidemiologic Studies-Depression (CES-D). | Census tracts | Proportion of African American residents; proportion of Hispanic residents. Numerator is proportion of residents who are over the age of 65 years. |
Educational attainment, household income, household wealth, gender, age, ethnicity, marital status, religion, assistance with activities of daily living (ADL), heart problems, stroke, a count of other major medical conditions, and cognitive function. Neighbourhood-level SES factor based on proportion of residents aged 25+ without a high school degree, households receiving public assistance income, residents living below the poverty level, and unemployed residents aged 16+. Affluence indicator based on proportion of households with incomes of $50,000 or more. |
Multilevel regression models. | There was a trend for a protective, but not statistically significant association between Hispanic ethnic density and a reduction in depressive symptoms from Time 1 to Time 2, and from Time 2 to Time 3. There were no statistically significant associations for African American ethnic density, although the direction of the effect was detrimental from Time 1 to Time 2, and protective from Time 2 to Time 3. |
13 |
| Shell et al., 2013(Shell et al., 2013) | Texas City Stress and Health Study; (USA) | 1238 U.S.-born and Mexican-born Hispanics of Mexican descent | Center for Epidemiologic Studies Depression Revised scale (CES-DR) | 48 neighbourhoods, with boundaries defined using street patterns, residential patterns | Percentage of Hispanic people in the neighbourhood based on US Census 2000 data, in 6 groups: ≥ 16% > 16% - ≤ 20% > 20 - ≤ 25% > 25 - ≤ 35% > 35 - ≤ 45% >45% |
Gender, age, education, income, marital status, language spoken, life events, physical health, social support, discrimination, stress Residential stability, median house value |
Multilevel regression models. |
Living in the highest category of Hispanic ethnic density is associated with a reduction in depressive symptoms in models that adjust for individual-level demographic covariates and area level covariates. This association loses statistical significance after adjusting for social support. |
12.5 |
| *Ostir el al., 2003(Ostir et al., 2003) | Hispanic established population for the epidemiologic study of the elderly (HEPSE); (USA) | 2710 Mexican Americans aged 65 years or older | Center for Epidemiologic Studies-Depression (CES-D). Subjects with a score of 16 or more were classified as having high depressive symptomatology | Census tracts | Percentage Mexican American | Age, gender, marital status, highest grade of schooling completed, per capita household income, nativity, chronic disease and activities of daily living (ADL) limitations. Neighbourhood socioeconomic status |
Multilevel regression models. | There was a non-significant association between Mexican ethnic density and depression in models adjusted for age and sex only. After adjusting for individual-level covariates and for area deprivation, a 10% increase in percentage Mexican American was associated with reduced CES-D scores. |
12 |
| Wight et al., 2011(Wight et al., 2011) | Health and Retirement Study (HRS); (USA) | 4805 adults aged 52 to 63. 77% white, 13.18% African American, 7.37% Hispanic, 2.45% Other | Center for Epidemiologic Studies-Depression (CES-D) | Census tracts | Percentage of African American residents, and percentage of Hispanic residents | Education, household wealth, household income, religion, gender, age, ethnicity, marital status, activities of daily living, medical conditions. Socioeconomic disadvantage factor, neighbourhood affluence. |
Multilevel regression models. | No associations were found between ethnic density and depression. | 11.5 |
| English,et al., 2014(English et al., 2014) | Healthy Aging in Neighborhoods of Diversity across the Life Span study (HANDLS); (USA) | 2197 African American and 1523 white American adults aged 30-64 years | Center for Epidemiologic Studies-Depression (CES-D). | Census tract | Proportion African American and white American residents | Age, gender, poverty status (family income) | Structural Equation Modelling (SEM) | No association was found between African American ethnic density and depression, after adjusting for covariates | 11 |
| Kwag et al., 2011(Kwag et al., 2011) | Own data; (USA) | 567 Korean American adults aged 60+ | Geriatric Depression Scale-Short Form (GDS-SF) | Census block group | Proportion of racial/ ethnic minorities-comprising ‘Hispanic, non-Hispanic white, non-Hispanic black, Asian, native Hawaiian and Pacific islander, American Indian, Alaskan native and non-Hispanic multi-race’ | Age, gender, marital status, education, length of stay (US), chronic conditions, functional disability, health perceptions. Area-level proportion people living below poverty-line, proportion people>65 years, proportion ethnic minorities |
Multilevel multivariate linear regression | No association between proportion racial/ ethnic minorities and mean depression after adjusting for covariates | 11 |
| Yuan et al., 2008(Vogt Yuan, 2007) | 1995 Community, Crime, and Health Survey Illinois; (USA) | 2292 black and Hispanic respondents | Center for Epidemiologic Studies-Depression (CES-D). | Census tract | Percentage black and percentage Hispanic (logged) | Age, gender, education, household income, employment status, number of children, and marital status. Neighbourhood-level: % households below federal poverty threshold & %female headed households with children | Multilevel multiple linear regression models | Black Americans living in areas of higher own group density had lower mean depression in models adjusted for neighbourhood disadvantage | 11 |
| Aneshensel et al., 2007(Aneshensel et al., 2007) | AHEAD; (USA) | 3442 older adults (10% African American, 4% Hispanic) | 8-item Center for Epidemiologic Studies-Depression (CES-D). | Census tracts | Proportion of African American residents; proportion of Hispanic residents. | Gender, age, marital status, educational attainment, household wealth, household income, religion, assistance with activities of daily living, number of medical conditions, heart problems, stroke, cognition. Neighbourhood-level SES factor based on proportion of residents aged 25+ without a high school degree, households receiving public assistance income, residents living below the poverty level, and unemployed residents aged 16+. Affluence indicator based on proportion of households with incomes of $50,000 or more. |
Multilevel regression models. Tested census-tract variables for non-linear associations, especially threshold effects, but found no significant departures from linearity. |
No associations between ethnic density and depressive symptoms | 11 |
| Stafford et al., 2011(Stafford et al., 2011) | 2000–2001 Canadian Community Health Survey (CCHS); (Canada) | 108064 participants | Composite Diagnostic Interview Schedule Short Form for major depression | Health Region | Percentage immigrant population | Immigrant status, length of residence, visible minority status, gender, age, marital status, tenure, education | Multilevel regression models. | An increase in immigrant ethnic density was associated with lower likelihood of depression among immigrants and visible minority participants | 9 |
| ANXIETY | |||||||||
| Alegria et al., 2014(Alegria et al., 2014) | 2001-2003 CPES, NCS-R, NSAL, NLAAS; (USA) | 4180 Non-Latino white, 2554 Latino, 2095 Asian, 3570 African American and 1438 African Caribbean residents | World Health Organization World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI) | Census tracts | Percentage Latino and foreign-born population – interacted with race/ethnicity | Individual-race/ethnicity, age, gender, marital status, education, poverty status, work status, and nativity. Neighbourhood-Disadvantage, Latino/immigrant concentration, affluence, and residential instability |
Multi-level logistic regression models | In the interaction model of Latino vs non-Latino White, there was an adverse association between increased Latino/immigrant ethnic density and any-past year anxiety disorders, compared to non-Latino Whites. | 14 |
| Menezes et al., 2011(Menezes et al., 2011) | 2002 CCHS; (Canada) | 35708 individuals of which 21.8% immigrant and 78.2% non-immigrant | World Health Organization World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI) | Dissemination Area (DA) | Percentage immigrants | Age, gender, income, marital status, education. Mean income, % moving in the past 5 years, % rental & % below low income cut-off thresholds | Multilevel multivariate logistic regression models | Immigrants in the sample had reduced relative odds of mood and anxiety disorders with increasing immigrant density. | 12 |
| COMMON MENTAL DISORDERS | |||||||||
| *Das-Munshi et al., 2010(Das-Munshi et al., 2010) *Bécares and Das-Munshi, 2013(Bécares and Das-Munshi, 2013) |
Ethnic Minorities Psychiatric Illness Rates In the Community (EMPIRIC); (UK) | 837 white British, 733 Irish, 694 black Caribbean people, 650 Bangladeshi, 643 Indian and 724 Pakistani people | Clinical Interview Schedule-Revised (CIS-R) |
Middle super output level | Percentage people of same ethnic group | Age, gender, social class, education, marital status, area-level deprivation | Multilevel multivariate logistic regression |
Protective associations for common mental disorders in Irish and Bangladeshi people. No associations were found for other ethnic groups. |
15 |
| *Bécares 2014(Bécares, 2014) | NLAAS; (USA) | 577 Cubans, 495 Puerto Ricans, 868 Mexican Americans | 6-item Kessler Psychological Distress scale (K6) |
US County | Percentage Cuban residents, percentage Puerto Rican residents, percentage Mexican American residents, percentage Latin American immigrant residents, percentage Latino residents | Age, gender, household income, education, work status, marital status, language of interview, nativity. Area deprivation score composed of 3 indicators | Structural equation models accounting for clustering | Increased Cuban ethnic density was not associated with psychological distress for Cuban respondents. Increased Puerto Rican ethnic density was not associated with psychological distress for Puerto Rican respondents, but increased immigrant and Latino ethnic density were associated with decreased psychological distress for Puerto Rican respondents. These associations were stronger for the second generation. Increased Mexican American ethnic density was not associated with psychological distress among Mexican American participants. Among the first generation, an increase in own, immigrant and overall Latino ethnic density was associated with increased psychological distress. |
15 |
| Alegria et al., 2014(Alegria et al., 2014) | 2001-2003 CPES, NCS-R, NSAL, NLAAS; (USA) | 4180 Non-Latino white, 2554 Latino, 2095 Asian, 3570 African American and 1438 African Caribbean residents | World Health Organization World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI) | Census tracts | Percentage Latino and foreign-born population | Individual-race/ethnicity, age, gender, marital status, education, poverty status, work status, and nativity. Neighbourhood-Disadvantage, Latino/immigrant concentration, affluence, and residential instability |
Multi-level logistic regression models | Latinos residing in neighbourhoods with higher Latino/immigrant ethnic density had increased risk of any past year common mental disorder, compared to non-Latino whites. | 14 |
| *Bécares et al., 2013(Bécares et al., 2013) | New Zealand Health Survey (NZHS); (New Zealand) | 3160 Maori people | Doctor-diagnosed common mental disorders and 10-item Kessler Psychological Distress scale (K10) |
Census Area Units | Percentage Maori residents | Age, gender, education, household income and work status, area-level deprivation | Multilevel multivariate logistic and linear regression |
Increasing ethnic density was associated with a reduction in reporting doctor-diagnosed common mental disorders Ethnic density not associated with non-specific psychological distress (K10) |
13 |
| Choi et al., 2016(Choi et al., 2016) | 2004–2007 Medical Expenditure Panel Survey linked to county-level data from the Area Health Resources Files; (USA) | 29011 individuals categorised into U.S.-born individuals (n = 24225); earlier immigrants (≥15 years in the U.S.; n = 3866); and recent immigrants (<15 years in the U.S.; n = 920) |
6-item Kessler Scale (K-6) and the Patient Health Questionnaire (PHQ-2) |
County | Percentage of foreign-born individuals in the county (continuous variable) |
Age, gender, education, income, race/ethnicity, marital status, limiting illnesses. % foreign born in county; % uninsured in county; % unemployed in county; population density per square mile; % in poverty in county; % families with female head in county |
Multilevel linear regression with interactions between immigrant status and the percentage of foreign-born individuals in the county |
Increased foreign-born density associated with worse mental health among earlier immigrants when mental health was measured with the K6. When mental health was measured with the PHQ-2, increased foreign-born density was associated with worse mental health for recent and earlier immigrants. |
12 |
| *Schrier et al., 2014(Schrier et al., 2014) | G4 Monitor 2008; (Netherlands) | 1206 Surinamese-Dutch, 978 Turkish-Dutch and 784 Moroccan-Dutch citizens |
10-item Kessler Psychological Distress scale (K10) |
356 neighbourhoods. Mean population size of 5,853 inhabitants, ranging from 30 to 26,960. | Percentage native Dutch, Percentage Surinamese-Dutch, Percentage Turkish-Dutch Percentage Moroccan-Dutch |
Length of stay in the Netherlands, marital status, highest educational qualification, financial situation. Percentage of households in with an income under the national minimum poverty threshold, average house value in the neighbourhood | Multilevel regression models | Ethnic density was not associated with non-specific psychological distress in any of the three ethnic minority groups. | 12 |
| *Jarrin et al., 2013(Jarrin et al., 2013) | Own data; (Spain) | 568 Ecuadorians living in Spain, aged 18 to 55 | General Health Questionnaire (GHQ-28), dichotomised at 5+ | 17 city neighbourhoods and 16 municipalities (largely rural) within 4 regions in Spain (Alicante, Almeria, Madrid, Murcia) | Proportion of people with Ecuadorian nationality among all subjects recorded in the municipal council registry within the 33 areas. Ethnic density ranged from 0.9 to 19.5 % with a median of 4.7 % and a mean of 6.1 %. Categorised as: Low >5.9% High 6%+ | Gender, age, civil status, number of children, education, social support, social network diversity, emotional support, financial strain, income, employment, time since migration, discrimination. Proportion of people with less than primary education | Multilevel regression models. | In unadjusted models, residence in areas of high ethnic density was associated with increased odds of common mental disorders. No association between ethnic density and common mental disorders in fully adjusted models. |
11 |
| Syed & Juan, 2012(Syed and Juan, 2012) | NLAAS; (USA) | Vietnamese Americans (n=478), Chinese Americans (n=566), Filipino Americans (n=493) | 10-item Kessler Psychological Distress scale (K10) |
US county | Percentage Vietnamese, percentage Chinese, percentage Filipino, percentage any Asian American, percentage non-White. | Age, gender, nativity, English fluency, schooling, racial discrimination, social cohesion | Multilevel regression models | Vietnamese, Chinese and Filipino ethnic densities were not associated with psychological distress. | 11 |
| Leu et al., 2011(Leu et al., 2011) | NLAAS; (USA) | 1583 respondents including Vietnamese, Chinese, Filipino and ‘other Asian’ people | World Health Organization World Mental Health Composite International Diagnostic Interview (WHO WMH-CIDI); 12 month prevalence common mental disorders |
Census tract | Number of Asians divided by total population in census tract | Education, household income, subjective social status, employment, family size, marital status, age, ethnicity, citizenship, language, time in US, ethnic identification | Multivariate logistic regression |
Protective association for common mental disorders of Asian ethnic density in men only. | 11 |
| Propper et al., 2005(Propper et al., 2005) | 10 waves of the British Household Panel Survey (BHPS) (1991–2000); (UK) | 8184 individuals | General Health Questionnaire (GHQ-12) | Bespoke neighbourhoods, composed of approximately the nearest 500 – 800 people to the respondent’s home address | Percent Indian, percent black, percent Pakistani or Bangladeshi | Age, gender,ethnicity, and education, household income, number of adults, number of children, tenure, employment status of the head of household. Composite index of area characteristics | Multilevel regression models. Ethnic density analyses examined with interaction between individual and area-level ethnicity. | There was a significant interaction for ethnicity of area and ethnicity of the individual. Non-white participants in more ethnically mixed areas experience less negative mental ill health trajectories than whites. | 10.5 |
| *Halpern & Nazroo, 2000 (Halpern and Nazroo, 2000) | Fourth National Survey of ethnic minorities (FNS); (UK) | 2867 white British, 1205 black Caribbean, 1273 Indian, 728 African Asian, 1185 Pakistani, 591 Bangladeshi, 214 Chinese people | Clinical Interview Schedule-Revised (CIS-R) |
Ward | Percentage people of same ethnic group | Age, gender, hardship, language, age at migration | Multivariate linear regression (re-analysed using robust standard errors for meta-analysis) |
Ethnic minorities had a lower mean score on CIS-R in areas of higher ethnic density Indian and Caribbean people had lower mean scores on CIS-R in areas of higher ethnic density |
10 |
| *Feng et al., 2013(Feng et al., 2013) | 45 and up study; (Australia) | 226487 adults from 19 ethnic groups | 10-item Kessler Psychological Distress scale (K10) | Census collection districts | Percentage of people of same ethnic group | Age and gender | Multilevel multivariate logistic regression | Protective associations for common mental disorders with increasing ethnic density for Australians not born in Australia, English born in the UK, Scottish born in Australia, Irish born in Australia and Chinese born in Australia. | 9 |
| Ecob & Williams, 1991(Ecob and Williams, 1991) | Self-collected data in Glasgow from 1986 to 1987; (UK) | 173 Asians aged 30 – 40 years old | General Health Questionnaire (GHQ-12), dichotomised at 4+ | Postcode sectors | Proportion of Asian born. Three categories, high (>6%), medium (3 <6%), and low (<3%) | Age, gender, religion, household size, car ownership, house needing repair, number of household durables | Single-level regressions | Protective effect of ethnic density found for mental health (GHQ) and feeling sad or low. | 7 |
| PSYCHOSIS AND SCHIZOPHRENIA | |||||||||
| Mezuk et al 2015 | Swedish population based registries; (Sweden) | 1442931 adults age 15 to 60 years followed from 2005-2010. | Incident cases of non-affective and affective psychosis identified from psychiatric in-patient and out-patient registries | Small Area Market Statistics (SAMs) from Sweden used to determine ethnic enclaves | Proportion Iraqi people ‘enclave’ versus ‘non-enclave’ areas. | Age, gender, family income, education attainment, generation status | Multi-level logistic regression models | Iraqi people living in Iraqi enclaves did not have an increased risk of psychosis | 16 |
| Kirkbride, Morgan et al., 2007(Kirkbride et al., 2007) | Aetiology and Ethnicity in Schizophrenia and Other Psychoses study (AESOP); (UK) | 218 cases aged 16-64 identified during 565 000 person-years of follow-up over a 2-year period (1997–1999). | Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a modified Personal and Psychiatric History Schedule. Non-affective psychoses (F20–29), Schizophrenia (F20), Other non-affective psychoses (F21–29) | Census statistical wards (CAS wards) | Proportion of ethnic minorities in ward | Age, gender Population density, ethnic fragmentation, Index of Multiple Deprivation |
Multilevel Poisson regression with random effects | Trend for negative association between overall ethnic minority density and risk of schizophrenia for ethnic minority individuals. Association not statistically significant. | 12 |
| Kirkbride, Boydell et al., 2008(Kirkbride et al., 2008) | AESOP and postal survey conducted January and March 2004, and January and March 2006; (UK) | 4231 survey participants living in South London (8.2% Black Caribbean and 7% Black African) | Ethnic minorities living in neighbourhoods with the lowest proportion of ethnic minorities had higher risk of schizophrenia than white people. This increased risk was not statistically significant in areas of medium and high ethnic density. | ||||||
| Menezes et al, 2011(Menezes et al., 2011) | CCHS 2002; (Canada) | 35708 individuals of which 21.8% immigrant and 78.2% non-immigrant | WMH-CIDI; respondents given screening questions on whether they had a life time diagnosis of schizophrenia or any other psychosis | Dissemination Area (DA) | Percentage immigrants | Age, gender, income, marital status, education. Mean income, % moving in the past 5 years, % rental & % below low income cut-off thresholds | Multilevel multivariate logistic regression models | Very weak evidence supportive of immigrants in the sample having a reduced relative odds of reporting life-time schizophrenia or psychosis diagnosis with increasing immigrant density. | 12 |
| Kirkbride et al, 2014 (Kirkbride et al., 2014) | East London First Episode Study (ELFEP); (UK) | 484 people with First episode psychosis, aged 18-65; 68 white British, 38 non-British white, 55 black Caribbean, 49 black African, 53 Bangladeshi people | SCAN: Non-affective psychoses (schizophrenia, schizophreniform disorder, and schizoaffective disorder) & affective psychoses | ‘statistical wards’ based on information from LSOA | SD increase in own group density | Age at first contact, social class, gender, ethnicity | Bayesian hierarchical modelling of standardised incidence ratios | Reduced risk of psychosis in black African people with increasing own group density | 10.5 |
| Veling et al., 2008(Wim Veling et al., 2008) | Prospective first-contact incidence study of psychotic disorders in the Hague over 7-year period (from April 1, 1997 to April 1 1999 and October 1, 2000 to October 1, 2005); (Netherlands) | 463 subjects of Moroccan, Surinamese, Turkish, and native Dutch origin | Comprehensive Assessment of Symptoms and History | Neighbourhoods classified according to postal codes (n=44). Maximum of 38,000 inhabitants per neighbourhood. | Percentage immigrant group | Age, gender, marital status, area-level deprivation (average income, housing quality, proportion long-term unemployed, mean educational level) | Multilevel poisson regression |
Compared with native Dutch, immigrants had a higher incidence rate of schizophrenia in low ethnic density neighbourhoods, but not in high ethnic density neighbourhoods. Interactions between ethnic density and ethnicity showed a significant ethnic density effect for Moroccans only, so that elevated incidence rates of psychotic disorders was higher among Moroccan people living in low ethnic density neighborhoods. |
10 |
| PSYCHOTIC EXPERIENCES | |||||||||
| *Das-Munshi et al, 2012(Das-Munshi et al., 2012) *Bécares and Das-Munshi, 2013(Bécares and Das-Munshi, 2013) |
EMPIRIC; (UK) | 837 white British, 733 Irish, 694 black Caribbean people, 650 Bangladeshi, 643 Indian and 724 Pakistani people | Psychosis Screening Questionnaire (PSQ) | Middle super output level | Percentage people of same ethnic group | Age, gender, social class, education, marital status, area-level deprivation | Multilevel multivariate logistic regression |
Strong evidence of increased OR of psychotic experiences with decreasing ethnic density for Indian people. Weaker evidence of increased OR psychotic experiences with decreasing ethnic density for Irish and Bangladeshi people. No association for black Caribbean and Pakistani people. |
15 |
| *Bécares et al., 2009(Bécares et al., 2009) | FNS; (UK) | 2867 white British, 1205 black Caribbean, 1273 Indian, 728 African Asian, 1185 Pakistani, 591 Bangladeshi, 214 Chinese people | Psychosis Screening Questionnaire (PSQ) | Electoral ward | Percentage people of same ethnic group | Age, gender, socioeconomic position. A Classification of Residential Neighbourhoods (ACORN) measure of area deprivation | Regression models with robust standard errors |
Protective association between ethnic density and psychotic symptomatology for Indian and Bangladeshi respondents. Detrimental association for Pakistani respondents. |
14 |
| *Halpern et al, 2000(Halpern and Nazroo, 2000) | FNS; (UK) | 2867 white British, 1205 black Caribbean, 1273 Indian, 728 African Asian, 1185 Pakistani, 591 Bangladeshi, 214 Chinese people | Psychosis Screening Questionnaire (PSQ) | Electoral ward | Percentage people of same ethnic group | Age, gender, hardship, language, age at migration | Multivariate linear regression |
Ethnic minorities had a lower mean score on PSQ in areas of higher ethnic density Indian, Caribbean and Bangladeshi people had lower mean PSQ scores in areas of higher ethnic density |
10 |
| SUICIDE | |||||||||
| Termorshuizen et al., 2015(Termorshuizen et al., 2015) | Population registry linked to the causes of death registry of Statistics Netherlands, 2000-2011; (Netherlands) | 20240668 person years of observation (59% Dutch, 13% Other western, 5% Turkish, 5.5% Moroccan, 9.7% Surinamese/Antillean, 7.4% Other non-Western) | ICD-10 X60-84, ICD-10 Y10-34 | 384 neighbourhoods in Amsterdam, Rotterdam, Den Haag, and Utrecht | Percentage of observation time in 2000-2011 related to a specific ethnic group | Age, gender, mean neighbourhood income | Multilevel Poisson regression | Increasing minority density was associated with a decreased rate ratio (RR) of suicide among immigrants (both Western and non-Western), when compared to Dutch people. | 8 |
| Neeleman and Wessely, 1999(Neeleman and Wessely, 1999) | Coroners' records of suicides in Lewisham, Lambeth, Southwark, Greenwich between 1 January 1991 and 31 December 1993; (UK) | 902,008 cases | Deaths considered as suicides if suicide verdicts given, suicide notes found, methods unambiguously indicated suicide and/or communications of suicidal intent had been recorded | 109 electoral wards of the London boroughs of Lewisham, Lambeth, Southwark and Greenwich | Proportions of all ethnic minority groups combined in ward; proportion Afro-Caribbean residents in ward; proportion Asians in ward | Age, gender, local Jarman underprivileged area (UPA) scores excluding ethnicity | Random effects Poisson regression | Increased ethnic density was associated with lower suicide rates among ethnic minority groups | 7 |
| SUICIDAL IDEATION | |||||||||
| *Bécares and Das-Munshi, 2013(Bécares and Das-Munshi, 2013) | EMPIRIC; (UK) | 837 white British, 733 Irish, 694 black Caribbean people, 650 Bangladeshi, 643 Indian and 724 Pakistani people | Suicidal ideation | Middle super output level | Percentage people of same ethnic group | Age, gender, social class, education, marital status, generation, area-level deprivation | Multilevel multivariate logistic regression |
Protective associations for suicidal ideation in Bangladeshi and Irish people. No associations between ethnic density and suicidal ideation for the other ethnic minority groups. |
15 |
| *Bécares et al., 2012(Bécares et al., 2012a) | NSAL, (USA) and EMPIRIC, (UK) | 1568 black Caribbean American and 661 black English people. Aged 18 to 74 |
Suicidal ideation | Census tracts, middle super output level | Percentage born in the Caribbean Percentage black Percentage black Caribbean Percentage black African + black Caribbean + black Other |
Age, gender, household income, educational qualifications, employment, nativity, marital status, racism and discrimination, area-level deprivation | Multilevel multivariate logistic regression | No associations between any of the two ethnic density measures and suicidal ideation for black Caribbean American people. No associations between any of the two ethnic density measures and suicidal ideation for black Caribbean English people. |
13 15 |
Key: Bolded references refer to estimates included in meta-analyses; Green-colored text indicates protective ethnic density effects; Red-colored text indicates detrimental ethnic density effects.