An exploration into the evidence base, experiences and practices concerning anxiety, depression and wellbeing among BAME populations

Health inequality can be defined as preventable variations in health of a population and amongst different groups within a society. Yet, in the UK, despite these preventable variations, Black, Asian and Minority Ethnic (BAME) groups experience reduced access to health care, and less favourable health outcomes. Consequently, BAME populations are at an increased risk of being multi-morbid, experiencing mitigated quality of life and premature mortality. This thesis investigated the impact of health inequalities on mental wellbeing among BAME groups living in the UK. At present, there is limited research on how to reduce health disparities through evidence-based practice. The aims of this research were (i) to identify psychotherapeutic approaches to mental health in BAME populations (Chapter 2); (ii) to examine differences in stigma, depression, anxiety and subjective wellbeing between ethnicities and age groups (Chapter 3); (iii) to assess the relationship between stigma, anxiety, depression, subjective wellbeing and sociodemographic variables (Chapter 3); (iv) to explore perceptions and experiences of mental health and wellbeing, psychotherapeutic practices and healthcare, including any associated stigma, within BAME populations (Chapter 4); (v) to explore the experiences and challenges that health professionals have regarding health and mental wellbeing practices among BAME patients (Chapter 5); and (vi) to unify key findings for how to address health inequalities in BAME mental health to inform future policy and practice for the public and private sector (Chapter 6). Chapter 2 was a systematic review of n=64 psychotherapeutic interventions applied to BAME populations, showing that Cognitive Behaviour Therapy (CBT) and Culturally Adapted CBT (CA-CBT) were the most common and effective interventions. Chapter 3 presented quantitative results from n=204 participants highlighting increased stigma severity in Black African/Caribbean relative to other BAME populations, whilst Asian populations had higher levels of anxiety, depression and low levels of subject wellbeing than other groups. Chapter 4, using the Interpretative Phenomenological Analysis (IPA) method, explored the experiences of n=14 BAME service users with service providers, highlighting the prevalence of stigma among different ethnic cohorts and their desire for cultural adaptations. Chapter 5 was also a qualitative study, using IPA, and explored the experiences of n=10 health care practitioners working with BAME patients. It was found that a tension exists between adaptations that improve therapy outcomes versus adaptations that help reduce costs for running the practice and are scalable. Chapter 6 recommends that future research should focus on identifying effective adaptations for specific BAME populations and explore economic models to help policymakers and researchers assess the costs of implementing these cultural adaptations. This recommendation could be achieved by conducting randomised controlled trials, examining which specific cultural adaptation is more effective in eliciting desirable psychotherapeutic outcomes for BAME populations. Additionally, a cost-benefit analysis could be carried out to conclude the benefits versus costs of implementing specific adaptations to therapy for different ethnic minority groups.