Peer-reviewed article
Ethnic and income-related inequalities in mental health among adolescents: a cross-sectional study in Bradford, UK.
Lewer D, Bhopal S, Dale H, Hammad M, McEachan RRC et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined mental health inequalities among adolescents aged 12-15 in Bradford, UK, using data from nearly 9,500 young people. Pakistani adolescents reported better mental health outcomes than white British peers across most measures, despite living in more deprived areas. Adolescents from low-income families (identified by free school meal eligibility) experienced consistently worse mental health across all measures including anxiety, depression, loneliness, and behavioural problems. Girls reported poorer mental health than boys, with wider ethnic differences among female adolescents.
Key points
- Pakistani adolescents had significantly fewer anxiety and depression symptoms, higher well-being, and fewer emotional and behavioural problems compared to white British adolescents (Cohen's d effect sizes ranging from -0.40 to 0.15)
- Poverty was consistently associated with poorer mental health outcomes across all measured domains: anxiety/depression, well-being, loneliness, emotional/behavioural problems, eating problems, and psychosis-like experiences
- Adolescents eligible for free school meals showed worse outcomes across all mental health measures, with effect sizes ranging from 0.06 to 0.17
- Girls reported poorer mental health overall, and ethnic differences in mental health were wider among girls than boys
- Despite 62% of the sample living in the most deprived neighbourhoods in England, Pakistani adolescents showed resilience with better outcomes than their white British counterparts
Limitations
As a cross-sectional study, it cannot establish causality or explain the mechanisms behind the observed differences in mental health between ethnic groups or income levels. The study is limited to one geographical location (Bradford, UK) and may not be generalisable to other regions or countries.
Abstract
Introduction Poverty is a well-established determinant of adolescent mental health, but associations between ethnicity and mental health are less clear. We quantified inequalities in mental health and well-being among adolescents in Bradford, UK. Methods We conducted a cross-sectional analysis of the Born in Bradford birth cohort, using surveys from 2023/2024 (ages 12-15). Participants completed validated measures of anxiety and depression (Revised Child Anxiety and Depression Scale 25), well-being (Short Warwick-Edinburgh Mental Well-being Scale), emotional and behavioural problems (Strengths and Difficulties Questionnaire), loneliness (UCLA Loneliness Scale 4), eating-related problems (Eating Disorders Examination Questionnaire-Short) and psychosis-like experiences (Psychosis-Like Symptoms Scale 8). We used linear regression to estimate associations with ethnicity and family income (measured by free school meals eligibility). Results We included 9496 participants (median age 13.9 years; 52.1% female; 40.9% Pakistani ethnicity; 34.4% white British ethnicity; 24.6% other ethnicities; and 62.0% living in the most deprived quintile of neighbourhoods in England). Compared with adolescents of white British ethnicity, those of Pakistani ethnicity had fewer anxiety and depression symptoms (Cohen's d=-0.31, 95% CI -0.37 to -0.24); higher well-being (d=0.15, 95% CI 0.10 to 0.20), fewer emotional and behavioural problems (d=-0.40; 95% CI -0.48 to -0.32); less loneliness (d=-0.22, 95% CI -0.26 to -0.17), fewer eating-related problems (d=-0.07; 95% CI -0.11 to -0.02) and no evidence of a difference in psychosis-like experiences (d=-0.07; 95% CI -0.17 to 0.02). Estimates for other minority ethnic groups were less precise but generally suggested better mental health than white British adolescents. Adolescents eligible for free school meals had poorer outcomes across all measures: anxiety and depression (d=0.13; 95% CI 0.07 to 0.18); well-being (d=-0.17; 95% CI -0.22 to -0.12); loneliness (d=0.09; 95% CI 0.04 to 0.14); emotional and behavioural problems (d=0.14; 95% CI 0.06 to 0.22); eating-related problems (d=0.06; 95% CI 0.01 to 0.11); and psychosis-like experiences (d=0.10; 95% CI 0.01 to 0.20). In exploratory sex-stratified analyses, girls reported poorer mental health and ethnic differences were wider among girls than boys. Conclusions Poverty was consistently associated with poorer adolescent mental health. Despite higher deprivation, Pakistani adolescents reported substantially better outcomes than white British adolescents, particularly for emotional and behavioural problems.