Does childhood disadvantage lead to poorer health in second generation Irish people living in Britain?

Lead Research Organisation: King's College London
Department Name: Inst of Psychiatry School Offices

Abstract

Second generation Irish people living in Britain die earlier and have poorer mental and physical health than non-Irish people, despite improvements in social class over generations. They are Britain’s largest minority group, yet little is known about their early life experiences which might lead to poor health in adulthood. How far is the experience of growing up as second-generation Irish in Britain protective or harmful for adult health? Are second-generation Irish people more upwardly socially-mobile, and if so, is this less health-protective for them when compared to non-Irish people? Records spanning the lives of 17,000 babies born in a single week in 1958 and 1970, will be analysed. Early life risk factors predisposing to adult psychological illness, chronic illness, alcohol misuse, diabetes, obesity, high blood pressure and smoking, will be analysed and compared between second-generation Irish and non-Irish people. This will hopefully provide insights into how Irish people differ in their early life chances compared with non-Irish British people, and how this might predispose to poorer adult health. The findings will possibly be of use to health and welfare agencies and potentially contribute to the development of early interventions supporting second-generation Irish and other migrant groups growing up in Britain.

Technical Summary

Three decades of research has shown that Irish people living in Britain suffer elevated mortality and increased psychiatric morbidity, compared with the non-migrant British population and other migrant groups. These adverse health outcomes affect second and third generations, and are not fully explained by social class.

This study will use the National Child Development Survey (NCDS) and the 1970 British Birth Cohort (BCS70) to analyse the health of second generation Irish people born in Britain. Both cohorts surveyed 17,000 babies born in a single week in 1958 and 1970, and followed into adulthood. There are 627 cohort members who are second-generation Irish in the 1958 cohort, and 847 second-generation Irish people in the 1970 cohort. Prevalence rates of illness in adulthood (common mental disorders, alcohol misuse, self-reported longstanding illness, hypertension (NCDS); common mental disorders, hazardous alcohol use and self-reported longstanding illness (BCS70)) will be examined, alongside antecedent factors in childhood and early adulthood. Prevalence figures for these illnesses in adulthood will be compared to age and gender-adjusted rates from the Ethnicity Minority Psychiatric Illness Rates in the Community survey; a separate cross-sectional survey which interviewed 733 Irish respondents. Using a life-course approach, factors which might account for poorer health in adulthood amongst second-generation Irish people born in Britain will be examined, in particular: 1) Whether a concentration of adverse experiences in childhood amongst the children of Irish-born migrants predisposes to poorer health in adulthood; 2) Whether the effect of upward social mobility amongst Irish-descended people is less protective for adverse adult health outcomes, compared to non-Irish cohort members also upwardly socially mobile; 3) Whether tobacco use and hazardous alcohol use in adulthood is predicted by increased psychological morbidity across the life course, in Irish compared to non-Irish cohort members.

Logistic regression and structural equation modelling will be used to analyse the data.

The findings of this study will be of importance in elucidating early life factors impacting on the adult health of second-generation Irish people in Britain, and may also shed light on the health of other migrant groups living in Britain. Through this study it might be possible to begin to understand how adverse health may be ‘transmitted‘ across generations, amongst migrant groups living in Britain. This study will therefore enable the identification of earlier intervention time-points which could help in preventing adverse health outcomes in adulthood, amongst second generation migrant groups.

Publications

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Das-Munshi J (2012) Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC). in The British journal of psychiatry : the journal of mental science

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Das-Munshi J (2013) Authors' reply. in The British journal of psychiatry : the journal of mental science

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Das-Munshi J (2008) Public health significance of mixed anxiety and depression: beyond current classification. in The British journal of psychiatry : the journal of mental science

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Das-Munshi, Jayati (2011) Born into adversity: The intergenerational 'transmission' of psychological morbidity in second generation Irish children growing up in Britain in Society for Eoidemiological Research (published in 'American Journal of Epidemiology')

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Singer S (2010) Prevalence of mental health conditions in cancer patients in acute care--a meta-analysis. in Annals of oncology : official journal of the European Society for Medical Oncology

 
Description Annual report of the Chief Medical Officer 2013
Geographic Reach National 
Policy Influence Type Citation in other policy documents
URL http://www.psymaptic.org/files/2014/09/CMO-Annual-Report-2013-Public-Mental-Health.pdf
 
Description Annual report of the Chief Medical officer 2013
Geographic Reach National 
Policy Influence Type Citation in other policy documents
 
Description Citation in NIH Funding Opportunity Announcement document
Geographic Reach North America 
Policy Influence Type Citation in other policy documents
URL http://grants.nih.gov/grants/guide/rfa-files/RFA-MH-12-090.html
 
Description Citation in a document to Department of Health
Geographic Reach National 
Policy Influence Type Participation in a national consultation
 
Description Citation in a report compiled by Irish organisations
Geographic Reach National 
Policy Influence Type Citation in other policy documents
 
Description Report in national press
Geographic Reach National 
Policy Influence Type Citation in other policy documents
 
Description Reporting of research in Spain's national newspaper "El Mundo"
Geographic Reach Europe 
Policy Influence Type Citation in other policy documents
Impact In national press- Raised awareness through national press in Europe on mental health associated with migration and settlement
URL http://www.elmundo.es/elmundosalud/2010/10/21/neurociencia/1287675143.html
 
Description presentation of research findings to event organised in conjunction with UK All-Party Parliamentary Group on Ireland and the Irish in Britain.
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Clinician Scientist Fellowship
Amount £636,897 (GBP)
Organisation The Health Foundation and the Academy of Medical Sciences 
Sector Academic/University
Country United Kingdom
Start 06/2014 
End 06/2020
 
Description Small fund grant
Amount £1,000 (GBP)
Organisation King's College London 
Department Social Psychiatry
Sector Academic/University
Country United Kingdom
Start 06/2008 
End 06/2009
 
Description Travel scholarship
Amount $500 (USD)
Organisation American Psychosomatic Society 
Sector Learned Society
Country United States
Start 03/2013 
End 04/2013
 
Title Using linked data to conduct multi-level modelling of area and mental health 
Description I linked area level data (ethnic density and area level deprivation) to individual level data (EMPIRIC) and conducted multi-level regression analyses. At the time this was a novel method which allowed us to assess area based effects on individual mental health 
Type Of Material Data analysis technique 
Provided To Others? No  
Impact There have been many others who have cited and built on our work on this field. 
 
Description Collaboration with Stephen Stansfeld (QMW) and Crick Lund (University of Cape Town) 
Organisation Queen Mary University of London
Department Barts and The London School of Medicine and Dentistry
Country United Kingdom 
Sector Academic/University 
PI Contribution This collaboration was as a result of my research interests in mentL health inequalities
Collaborator Contribution I collaborated with Professors Stansfeld & Lund and led on an analysis of South African data on adolescent mental health.
Impact paper which is about to be submitted to peer reviewed journal "Mental health inequalities in adolescents growing up in post-apartheid South Africa: Cross-sectional survey, SHaW Study"
Start Year 2014
 
Description Collaboration with Stephen Stansfeld (QMW) and Crick Lund (University of Cape Town) 
Organisation University of Cape Town
Country South Africa 
Sector Academic/University 
PI Contribution This collaboration was as a result of my research interests in mentL health inequalities
Collaborator Contribution I collaborated with Professors Stansfeld & Lund and led on an analysis of South African data on adolescent mental health.
Impact paper which is about to be submitted to peer reviewed journal "Mental health inequalities in adolescents growing up in post-apartheid South Africa: Cross-sectional survey, SHaW Study"
Start Year 2014
 
Description collaboration as a co-applicant on a grant 
Organisation University of Sao Paulo
Department Institute of Psychiatry
Country Brazil 
Sector Academic/University 
PI Contribution I am a co-applicant on a grant which is a feasibility study developing and evaluating a peer support intervention for ethnic minority elders (Indian and black Caribbean people) with dementia. This role involves my expertise in using electronic records from primary and secondary care to assess rates of service use, my expertise in quantitative data analysis, as well as my expertise as an old age psychiatrist and subject area expertise relating to health inequalities in ethnic minority communities. One of the datasets which will be used for this award comes from data I am using for my fellowship
Collaborator Contribution Dr Vanessa Lawrence is the lead applicant for this grant application
Impact 1. Protocol for systematic review (see URL in previous question) 2. I am supervising an MSc student to complete synthesis of findings from retrieved papers using systematic searches, with a view to producing a peer-reviewed manuscript (Dr Lawrence has been involved). 3. Grant application for feasibility study submitted to NIHR, will be submitted to other bodies
Start Year 2014
 
Description collaboration with Jane Boydell 
Organisation King’s Health Partners
Country United Kingdom 
Sector Academic/University 
PI Contribution Advised on an analysis which was led by the collaborator
Collaborator Contribution The collaborator (Jane Boydell) led on the analysis
Impact Manuscript for peer reviewed publication- has been submitted
Start Year 2013
 
Description Findings reported in a national newspaper 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Reported in a newspaper read by Irish people living in Britain

Engagement of non-research audiences
Year(s) Of Engagement Activity 2013
URL http://www.centreforglobalmentalhealth.org/news-events/news/irish-post-features-cgmh-study-health-in...
 
Description Interview by email with American newspaper 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Health professionals
Results and Impact I responded to questions asked by an American journalist which were put into a short feature on research for an American magazine read by Psychiatrists

Dissemination outside of UK
Year(s) Of Engagement Activity 2010
 
Description Podcast for BMJ 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Health professionals
Results and Impact Invited to give a podcast relating to one of the studies which had been published in the BMJ. Involved questions and answers with an interviewer (journalist)

Received enquiries from the media and comments on 'rapid responses' on BMJ website
Year(s) Of Engagement Activity 2010
 
Description presentation to members of 'Irish in Britain' group at event organised in conjunction with All-Party Parliamentary Working Group on Irish and Irish in Britain 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact 30-50 people from UK political parties (MPs and associated) and people from third sector organisations attended an event held in Westminster on identity and the health of second generation Irish people in Britain. I presented findings from this project which informed further debate and discussion and was later discussed on social media.
Year(s) Of Engagement Activity 2017
URL http://www.irishinbritain.org/whats-on/729/health-and-identity-of-irish-in-britain-discussion-
 
Description press release over internet (weblink and twitter) 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact The newspaper story of main findings from our study was cited on the departmental webpage and tweeted- this is read by national and international audiences

public engagement
Year(s) Of Engagement Activity 2013
URL http://www.centreforglobalmentalhealth.org/news-events/news/irish-post-features-cgmh-study-health-in...