Pakistani Women in the UK: How do Social Networks affect Access

to Mental Health Services?

Dharmi Kapadia2nd Year PhD Student, CCSR

Manchester Social Networks Group Seminar29th January 2014

What I’m talking about today• Results of Phase 1 of PhD: Systematic

review• Preliminary results from Phase 2:

Secondary Data Analysis

PhD Aim• Overall Aim: – To investigate the nature of Pakistani women’s

social networks and how they affect access to mental health services (compared with women from other ethnic groups).

Background• Pakistani women in the UK have higher

levels of mental illness but lower levels of mental health service use

• Individual factors cited much more than social aspects e.g. age, ethnic group, attitudes (stigma)– Candidacy approach, navigation of services

(Dixon-Woods et al., 2005)

• Tentative evidence of social gradient• Social network approach– Network Episode Model (Pescosolido, 1992)

‘Mixed’ Systematic ReviewResearch Questions:1. How does access to mental health services for Pakistani women in the UK compare with women from other ethnic groups?

2. What is the nature of Pakistani women’s social networks and how does this compare with women from other ethnic groups?

3. What are the reasons for the differences in the mental health services utilisation patterns of Pakistani women? Are social networks implicated in the help-seeking and access process?

Review: Results1. How does access to mental health services for Pakistani women in the UK compare women from other ethnic groups? • Inpatient Services – lower compared to White

British from Count me in Censuses (2005-2010)• Outpatient Services – lower compared to White

British for some services (Crisis Resolution Home Treatment, Improving Access to Psychological Therapies) BUT about the same for Assertive Outreach and HIGHER for Early Intervention Services

• GP Consultation for mental health problems – about the same as women from other ethnic groups

Review: Results2. What is the nature of Pakistani women’s social networks and how does this compare to women from other ethnic groups?

•Network Content– “Pakistani communities as self-contained units”. (Campbell &

McLean, 2003 p.17) – mainly relatives and other people from Pakistani ethnic group.

– Less likely to see friends and more likely to have seen relatives compared to women from other ethnic groups

– Social isolation and lack of involvement in wider community

• Network Function– Often family cited as the only support network– Low levels of social support AND high negative aspects of support

Review: Results3. What are the reasons for the mental health service utilisation patterns of Pakistani women? Are social networks implicated?

• Coping alone as a result of the stigma of mental illness. (High levels amongst Pakistani women but no comparative data)

• Double-edged sword” of ethnicity (Cinnirella & Loewenthal, 1999 p.514)

• Lack of knowledge of services• Language barriers

What was missing? • Lower rates are evident and varying

explanations given BUT• Many of quantitative studies did not adjust

rate of use of services by mental illness or socioeconomic status indicators

• NONE explicitly looked at how social networks (no. of people in network, social support) impacted on mental health service use

Secondary Data AnalysisResearch Questions•How do social networks influence usage of mental health services for Pakistani women?– Size of network– Relationships within the network– Frequency of contact with friends and relatives– Social support

•How does this association differ between Pakistani women and women from other ethnic groups?

Data• English survey data: Ethnic Minority

Psychiatric Illness Rates in the Community (EMPIRIC, 2000)

• N=4281 (2340 females, 387 Pakistani ethnic group)

• 6 ethnic groups: White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani

Data: Mental Health Service Use• Mental health service use in the past 6

months – 2 measures:1.Saw a doctor for an emotional or stress-

related problem (0=No, 1=Yes)2.Saw a counsellor, psychologist or

Community Psychiatric Nurse (CPN) (0=No, 1=Yes)

Data: Social Network Variables1. Number of close people2. Relatives

i. Regular contact (Yes/No)ii. Frequency of contact (5 options)iii. Frequency of face to face contact (5 options)iv. Number seen once a month or more

3. Friendsi. 4 categories as above

4. Relationship type of 2 nominated closest people (3 categories: partner/spouse, friend and relative)

(cont…)

Data: Social Network Variables“Thinking about the person that you are closest to, please say how you would rate the practical and emotional support they have provided to you in the last 12 months. How much in the last 12 months…”Options: 1: Not at all, 2: A little, 3: Quite a lot, 4: A great deal.

a …did this person give you information, suggestions and guidance that you found helpful?

b …could you rely on this person? Was this person there when you needed them?

c …did this person make you feel good about yourself?

d …did you share interests, hobbies and fun with this person?

e …did this person give you worries, problems and stress?

f …did you want to confide in, talk frankly or share feelings with this person?

g …did you confide in this person?

h …did you trust this person with your most personal worries and problems?

i …would you have liked to have confided more in this person?

j …did talking to this person make things worse?

k …did he/she talk about his/her personal worries with you?

l…did you need practical help from this person with major things, for example looking after you when ill, help with finances, children?

m …did this person give you practical help with major things?

n …would you have liked more practical help with major things from this person?

o…did this person give you practical help with small things when you needed it, for example, chores, shopping, watering plants etc. ?

Data: Other variables• Mental Illness measured by Clinical

Interview Schedule-Revised (CIS-R, Lewis et al, 1992)

• Age• Social class/ income (to be decided)

Results: Is there variation by ethnic group in the use of services?

Ethnic Group % used a mental health service

Irish 13.5

White 10.8

Black Caribbean 10.6

Indian 10.5

Pakistani 7.1

Bangladeshi 5.3

Total 9.8

Results: Differences in social networks by mental health service use

Used a MH service Mean (S.E)

Not used a MH serviceMean (S.E)

No of close people 5.72 (0.48) 6.06 (0.12)

No of relatives seen once a month or more

4.45 (0.49) 5.60 (0.19)

No of friends seen once a month or more

8.07 (1.16) 7.74 (0.32)

Confiding and emotional support

15.1 (0.27) 15.0 (0.09)

Practical support 4.62 (0.20) 4.89 (0.06)

Negative aspects of support

3.41 (0.19) 2.82 (0.05)

Results: Differences in social networks by MH service use

% within categories of service use

Used a MH service

Not used a MH service

Regular contact with relatives (Yes) 88.2% 90.7%

Contact relatives once a week or more 79.5% 81.0%Face to face contact with relatives once a week or more 44.7% 58.4%

Regular contact with friends 86.1% 88.7%

Contact friends more than once a week 83.4% 83.6%Face to face contact with friends once a week or more 65.9% 64.7%

First closest personSpouse/ partnerRelativeFriend

38.0%42.5%19.5%

46.2%42.7%11.1%

Second closest personSpouse/ partnerRelativeFriend

10.8%66.3%22.9%

8.4%

74.0%17.6%

.05

.1.1

5.2

P (

usin

g a

MH

se

rvic

e)

0 1 2 3 4 5 6 7 8 9 10 11 12Negative aspects of support

White IrishBlack Caribbean BangladeshiIndian Pakistani

Mental health service use by negative aspects of support

.05

.1.1

5P

(us

ing

a M

H s

erv

ice

)

0 10 20 30 40 50 60 70 80 90 100No of friends seen once a month or more

White IrishBlack Caribbean BangladeshiIndian Pakistani

Mental health service use by no of friends seen

Thank you for listening!

Comments and Questions?

dharmi.kapadia@manchester.ac.uk

@DharmiKapadia