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A comparison of mental health among minority ethnic elders and whites in East and North London

Age and Ageing, May, 1998 by Ellen R.T. Silveira, Shah Ebrahim

Introduction

Mortality studies among minority ethnic groups in Britain have revealed higher risks of disease compared with the whole population [1,2]. Higher overall mortality for coronary heart disease, diabetes, tuberculosis and liver cancer has been found among `Asians' (despite low levels of smoking and drinking) [3]. Among Afro-Caribbeans, higher mortality ratios have been reported for cerebrovascular disease, diabetes mellitus and accidents. Certain types of cancer (lung, stomach, rectum, breast and others), on the other hand, seem to have lower incidence in `black and Asian' migrants than in the general population [4].

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Morbidity rather than mortality rates may be a better indicator of population health patterns and, by extension, of the existence of health inequalities [5,6]. Barriers to access to health services such as language, may lead to health disadvantage in addition to factors such as low income and social support [7,8]. Due to the relevance of physical illness, in particular disability, to mental health and well-being in old age [9-11] and, given that elderly people are likely to represent a larger proportion of minority ethnic groups in the near future [12], studies are needed to clarify the nature of and reasons for the higher rates of `limiting long-term illness' among minority ethnic groups compared with the majority population demonstrated in the 1991 census [13].

Our previous work has demonstrated high levels of mood disorder in Bengali and Somali elders in East London [14] but no comparative data on white elders were available. We have also shown that Gujarati Asians, paradoxically, appeared to have lower levels of mood disorder than a comparison group of white people in North London [15]. In the present study, we aimed to extend these findings and to explore the underlying reasons for differences in mental health of elderly people from different ethnic groups. More specifically, we wanted to test the hypotheses that disease rates, mood, life satisfaction and physical disability do not vary between minority ethnic groups from East and North London and whites in both areas and that relationships between these variables are similar in different ethnic groups.

Methods

Research instruments

A standardized questionnaire was used by trained bilingual interviewers to collect information on demographic, social and health factors, use of health and social services and satisfaction with services provided.

Anxiety and depression was measured using the selfrating scale of symptoms of anxiety and depression (SAD) [16], which focuses on symptomatology in the past week. For each question (14 in total), scores are rated from 0 to 3, depending on the degree of distress reported (0 = none, 1 = a little, 2 = a lot, 3 = unbearable). Scores of 6 or above indicate a high likelihood of clinically important depression (4+ in the depression sub-scale). Cronbach's [Alpha] coefficients were 0.9 for Somalis, Bengalis and East London whites, 0.4 for Gujaratis and 0.6 for North London whites, indicating good internal consistency of the scale for most groups.

Life satisfaction was measured using a 13-item version of the life satisfaction index (LSI) [17], using a recommended threshold of 20 out of 26. Scores in individual questions range from 0 to 2 (1 = don't know; 0, 2 =either yes or no). The instrument has been applied to British [18] and Nigerian [19] elderly populations, [Alpha] coefficients (internal consistency) for the LSI were 0.8 for Somalis, Bengalis, East London whites and Gujaratis and 0.7 for North London whites.

Back-translation of both scales by skilled bilingual workers was followed by testing for language discrepancies in Bengali pensioners attending a community centre, Somali residents of a Seaman's Mission, `white' elders from a Bethnal Green general practice and Gujaratis and whites from a Finchley general practice, all of whom were excluded from the main study.

Relationships between mental health scores and chronic health problems, disability, weekly income (data not collected for Gujaratis and North London whites), age, marital status, gender and ethnic origin were examined using Spearman's rank correlation coefficient (r), Mann-Whitney test and univariate regression. Simple additive scales for chronic health problems (comprising reported presence of any of the following: asthma, incontinence, diabetes, high blood pressure, hardness of hearing, heart attack, stroke, arthritis/rheumatism and poor eye-sight) and disability (comprising reported inability to perform any of the following: walk outdoors, dress, bath independently) were produced. The influence of chronic health problems and disability, age and weekly income as predictors of mental health scores was studied using multiple regression analyses.

Subjects

Male participants in the Somali group were drawn from elderly people attending a luncheon club; women were reached mostly through `snowballing' (i.e. asking participants to provide names of additional people) from initial contacts. Bengalis were drawn from the age-sex register of a local general practice known to have a high proportion of Bengali patients; further people were contacted through snowballing using the initial contacts [14]. The white group was drawn from the age- sex register of the same general practice used to select the Bengali participants. The Gujarati and a North London `white' sample were drawn from the age-sex register of a Finchley general practice [15].

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A comparison of mental health among minority ethnic elders and whites in East and North London

Age and Ageing, May, 1998 by Ellen R.T. Silveira, Shah Ebrahim

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