Does cultural integration explain a mental health advantage for adolescents?

Abstract

Background: A mental health advantage has been observed among adolescents in urban areas. This prospective study tests whether cultural integration measured by cross-cultural friendships explains a mental health advantage for adolescents.

Methods: A prospective cohort of adolescents was recruited from 51 secondary schools in 10 London boroughs. Cultural identity was assessed by friendship choices within and across ethnic groups. Cultural integration is one of four categories of cultural identity. Using gender-specific linear-mixed models we tested whether cultural integration explained a mental health advantage, and whether gender and age were influential. Demographic and other relevant factors, such as ethnic group, socio-economic status, family structure, parenting styles and perceived racism were also measured and entered into the models. Mental health was measured by the Strengths and Difficulties Questionnaire as a 'total difficulties score' and by classification as a 'probable clinical case'.

Results: A total of 6643 pupils in first and second years of secondary school (ages 11-13 years) took part in the baseline survey (2003/04) and 4785 took part in the follow-up survey in 2005-06. Overall mental health improved with age, more so in male rather than female students. Cultural integration (friendships with own and other ethnic groups) was associated with the lowest levels of mental health problems especially among male students. This effect was sustained irrespective of age, ethnicity and other potential explanatory variables. There was a mental health advantage among specific ethnic groups: Black Caribbean and Black African male students (Nigerian/Ghanaian origin) and female Indian students. This was not fully explained by cultural integration, although cultural integration was independently associated with better mental health.

Conclusions: Cultural integration was associated with better mental health, independent of the mental health advantage found among specific ethnic groups: Black Caribbean and some Black African male students and female Indian students.

Figure 1

Trajectories of total difficulty score (TDS) between 12–16-year-olds by cultural identity and gender-adjusted mean TDS predicted from linear-mixed regression models. Age-specific TDS means predicted from gender-specific linear-mixed models adjusted for age, generational status, standard of living, experience of racism, place of worship attendance, family structure, parental care, parental control (control and control × age interaction), quality of the relationship with parents, proportion of free school meal and income dimension of the Index of Multiple Deprivation. The regressions were performed using 45 multiple imputations of missing outcome and covariate values. Predictions were derived using Rubin's rules