Investigating the relationship between multiple environmental exposures and inequalities in common mental disorders in England

Lead Research Organisation: University of Exeter
Department Name: Institute of Health Research


The high prevalence of depression and anxiety in England is well established. The cost of common mental disorders (CMD) to society and individuals, along with the burden placed on health services mean they are widely viewed as a major challenge in the United Kingdom and around the world. In England, depressive disorders account for 8.8% of disability adjusted life years, and anxiety affects around 6% of the adult population. To understand this critical public health issue and its challenges, it is necessary to consider the wider social and environmental determinants of mental health.
Health inequalities impacted by factors such as education, ethnicity, income and employment mean CMDs are more prevalent amongst more vulnerable parts of the population. As a result, the NHS has made prevention a "serious aim" and Public Health England (PHE) has prioritised the reduction of "avoidable and unfair" inequalities. The importance of these 'upstream' determinants presents a compelling case for research that informs action to reduce mental health inequalities.
Recent work emphasises the potential for neighbourhood regeneration to improve mental health, reducing health inequalities. This project aims to develop our understanding of how relevant environmental/social conditions are geographically distributed, and how they interact to influence mental health.

Research Questions
1. How do multiple physical and social environment factors influence the prevalence of depression and anxiety in the English population?
2. How do these factors shape inequalities in depression and anxiety between socioeconomic groups?
3. Which of these factors are most influential in reducing/widening mental health inequalities?
4. How can the findings inform and improve Public Health England's strategies for tackling health inequalities and improving lived environments for mental health?

We will analyse secondary datasets to explore the influence of multiple environmental exposures on depression and anxiety disorders in the English population. An initial literature review and work with PHE will identify additional factors likely to play a role in shaping population mental health, and those amenable to intervention through public health and planning policy. Analyses will then include integrating the Understanding Society data and Access to Health Assets and Hazards (AHAH) small-area index, along with any environmental factors identified. Additional data including the Adult Psychiatric Morbidity Survey(APMS) will also be used.

Analytical techniques will be developed and selected through the training aspects of the 1+3 PhD, but are likely to include: 1) application of Geographic Information Systems to allocate environmental exposures to individuals based on residence location; and 2) statistical modelling appropriate for spatial/longitudinal data such as multi-level modelling or generalised additive models.

Applications and benefits
The project will develop evidence relevant to tackling public mental health inequalities through environmental improvements. It will benefit from partnership working with public health colleagues at national and local levels. Relevant strategies include work between national and local public health authorities to deliver public health improvement on the ground. Project work across these levels of governance and policy mean that this PhD will contribute useable evidence to support local public health teams on mental health responsibilities.


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Studentship Projects

Project Reference Relationship Related To Start End Student Name
ES/P000630/1 01/10/2017 30/09/2027
2399778 Studentship ES/P000630/1 01/10/2020 30/09/2024 Joseph Lillis