Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators

Abstract

Background: This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care.

Methods: A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions. A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018. Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included.

Results: Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints.

Conclusions: The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making.

Systematic review registration: Not applicable.

Keywords: Equality; Health economics; Inequalities; Mapping review; Mental health; Qualitative research.

Fig. 1

PRISMA flow diagram of research studies search

Fig. 2

Mapping diagram of primary studies. *Studies examining these characteristics were only included if they also looked at other characteristics. **Specific populations are those who may have a specific set of characteristics and experiences placing them at risk of experiencing mental health inequalities and therefore may already be defined by multiple characteristics (e.g. refugees). Circle size area is asscociated with the number of primary studies that consider a population characteristic. The lines between the circles indicate where characteristics were considered together, while the thickness of the lines indicates the frequency of the association. 49 studies examined 2 population characteristics; the most frequent association was between age and socioeconomic factors. 24 studies examined 3 characteristics, of which age, race and socioeconomic factors were the most frequent associations. 8 studies examined 4 characteristics. 3 studies examined 5 characteristics. 3 studies examined 6 characteristics