TY - JOUR
T1 - The association of migration and ethnicity with use of the Improving Access to Psychological Treatment (IAPT) programme
T2 - a general population cohort study
AU - Bhavsar, Vishal
AU - Jannesari, Sohail
AU - McGuire, Philip
AU - MacCabe, James
AU - Das-Munshi, Jayati
AU - Bhugra, Dinesh
AU - Dorrington, Sarah
AU - Brown, June
AU - Hotopf, Matthew
AU - Hatch, Stephani
N1 - Funding Information:
We acknowledge the assistance of Shirlee MacCrimmon and the SELCoH study team, Amelia Jewell and the SLaM-BRC CDLS, and Robin Murray. We thank SELCoH participants. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. These data can be accessed through the corresponding author. The SELCoH 2 study team: Matthew Hotopf, Stephani L. Hatch, Souci Frissa, Laura Goodwin, Bwalya Kankulu, Billy Gazard, Natasha Smyth, Karolina M. Bogdanowicza, Giouliana Kadra, Jatinder Bisla, Maria Calem, Roopal Desai and Robert Medcalf.
Funding Information:
Data linkage and preliminary analyses performed for this study was carried out, while Vishal Bhavsar was Wellcome Clinical Research Training Fellow (101681/Z/13/Z). This work was also supported by the Economic and Social Research Council (RES-177-25-0015) and the Economic and Social Research Council Centre for Society and Mental Health at King’s College London (ES/S012567/1). SL Hatch and M Hotopf receive salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The funders did not have a role in the study design; collection, analysis or interpretation of data; the writing of the manuscript; or in the decision to submit the manuscript for publication. This research was supported by the Biomedical Research Nucleus data management and informatics facility at South London and Maudsley NHS Foundation Trust, which is funded by the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/11
Y1 - 2021/11
N2 - Background: Common mental disorders (CMD), such as depression and anxiety, are an important cause of morbidity, economic burden and public mental health need. The UK Improving Access to Psychological Therapies (IAPT) programme is a national effort to reduce the burden and impact of CMD, available since 2008. Aims: To examine ethnic and migration-related differences in use of IAPT-based psychological treatment using a novel epidemiological dataset with linkage to de-identified IAPT records. Method: Data from a psychiatric morbidity survey of two South East London boroughs (2008–2010) were individually-linked to data on IAPT services serving those boroughs. We used Poisson regression to estimate association between ethnicity and migration status (including years of UK residence), with rate of subsequent use of psychological treatment. Results: The rate of psychological treatment use was 14.4 cases per thousand person years [cases/1000 pyrs, 95% confidence intervals (95% CI) 12.4, 16.7]. There was strong statistical evidence that compared to non-migrants, migrants residing in the UK for less than 10 years were less likely to use psychological treatment after adjustment for probable sociodemographic predictors of need, life adversity, and physical/psychiatric morbidity at baseline [rate ratio (RR) 0.4 (95% CI 0.20, 0.75]. This difference was not explained by migration for asylum/political reasons, or English language proficiency, and was evident for both self- and GP referrals. Conclusions: Lower use of IAPT among recent migrants is unexplained by sociodemographics, adversity, and baseline morbidity. Further research should focus on other individual-level and societal barriers to psychological treatment use among recent migrants to the UK, including in categories of intersecting migration and ethnicity.
AB - Background: Common mental disorders (CMD), such as depression and anxiety, are an important cause of morbidity, economic burden and public mental health need. The UK Improving Access to Psychological Therapies (IAPT) programme is a national effort to reduce the burden and impact of CMD, available since 2008. Aims: To examine ethnic and migration-related differences in use of IAPT-based psychological treatment using a novel epidemiological dataset with linkage to de-identified IAPT records. Method: Data from a psychiatric morbidity survey of two South East London boroughs (2008–2010) were individually-linked to data on IAPT services serving those boroughs. We used Poisson regression to estimate association between ethnicity and migration status (including years of UK residence), with rate of subsequent use of psychological treatment. Results: The rate of psychological treatment use was 14.4 cases per thousand person years [cases/1000 pyrs, 95% confidence intervals (95% CI) 12.4, 16.7]. There was strong statistical evidence that compared to non-migrants, migrants residing in the UK for less than 10 years were less likely to use psychological treatment after adjustment for probable sociodemographic predictors of need, life adversity, and physical/psychiatric morbidity at baseline [rate ratio (RR) 0.4 (95% CI 0.20, 0.75]. This difference was not explained by migration for asylum/political reasons, or English language proficiency, and was evident for both self- and GP referrals. Conclusions: Lower use of IAPT among recent migrants is unexplained by sociodemographics, adversity, and baseline morbidity. Further research should focus on other individual-level and societal barriers to psychological treatment use among recent migrants to the UK, including in categories of intersecting migration and ethnicity.
KW - Common mental disorders
KW - Ethnicity
KW - Health inequalities
KW - Migration
KW - Psychological treatment
UR - http://www.scopus.com/inward/record.url?scp=85100941409&partnerID=8YFLogxK
U2 - 10.1007/s00127-021-02035-7
DO - 10.1007/s00127-021-02035-7
M3 - Article
AN - SCOPUS:85100941409
SN - 0933-7954
VL - 56
SP - 1943
EP - 1956
JO - Social Psychiatry and Psychiatric Epidemiology
JF - Social Psychiatry and Psychiatric Epidemiology
IS - 11
ER -
