1) Pakistani women in the UK have lower rates of mental health service use compared to women from other ethnic groups despite having higher rates of mental illness. Social networks may play a role in this difference. 2) Analysis of survey data found that Pakistani women reported smaller social networks with less contact with friends, more negative aspects of social support, and lower rates of mental health service use compared to other groups. 3) Higher levels of negative social support and fewer close friends were associated with lower probabilities of mental health service use across all ethnic groups. This suggests social networks may influence mental health service access differently for Pakistani women.

1. Pakistani Women in the UK: How
do Social Networks affect Access
to Mental Health Services?
Dharmi Kapadia
2nd Year PhD Student, CCSR
Manchester Social Networks Group Seminar
29th January 2014

2. What I’m talking about today
• Results of Phase 1 of PhD: Systematic
review
• Preliminary results from Phase 2:
Secondary Data Analysis

3. PhD Aim
• Overall Aim:
– To investigate the nature of Pakistani women’s
social networks and how they affect access to
mental health services (compared with women
from other ethnic groups).

4. Background
• Pakistani women in the UK have higher
levels of mental illness but lower levels of
mental health service use
• Individual factors cited much more than
social aspects e.g. age, ethnic group,
attitudes (stigma)
– Candidacy approach, navigation of services
(Dixon-Woods et al., 2005)
• Tentative evidence of social gradient
• Social network approach
– Network Episode Model (Pescosolido, 1992)

5. ‘Mixed’ Systematic Review
Research Questions:
1. How does access to mental health services for Pakistani
women in the UK compare with women from other ethnic
groups?
2. What is the nature of Pakistani women’s social networks
and how does this compare with women from other ethnic
groups?
3. What are the reasons for the differences in the mental
health services utilisation patterns of Pakistani women?
Are social networks implicated in the help-seeking and
access process?

6. Review: Results
1. How does access to mental health services for Pakistani
women in the UK compare women from other ethnic groups?
• Inpatient Services – lower compared to White
British from Count me in Censuses (2005-2010)
• Outpatient Services – lower compared to White
British for some services (Crisis Resolution Home
Treatment, Improving Access to Psychological
Therapies) BUT about the same for Assertive
Outreach and HIGHER for Early Intervention
Services
• GP Consultation for mental health problems – about
the same as women from other ethnic groups

7. Review: Results
2. What is the nature of Pakistani women’s social networks and
how does this compare to women from other ethnic groups?
•Network Content
– “Pakistani communities as self-contained units”. (Campbell &
McLean, 2003 p.17) – mainly relatives and other people from
Pakistani ethnic group.
– Less likely to see friends and more likely to have seen relatives
compared to women from other ethnic groups
– Social isolation and lack of involvement in wider community
• Network Function
– Often family cited as the only support network
– Low levels of social support AND high negative aspects of support

8. Review: Results
3. What are the reasons for the mental health service utilisation
patterns of Pakistani women? Are social networks implicated?
• Coping alone as a result of the stigma of
mental illness. (High levels amongst
Pakistani women but no comparative data)
• Double-edged sword” of ethnicity
(Cinnirella & Loewenthal, 1999 p.514)
• Lack of knowledge of services
• Language barriers

9. What was missing?
• Lower rates are evident and varying
explanations given BUT
• Many of quantitative studies did not adjust
rate of use of services by mental illness or
socioeconomic status indicators
• NONE explicitly looked at how social
networks (no. of people in network, social
support) impacted on mental health service
use

10. Secondary Data Analysis
Research Questions
•How do social networks influence usage of
mental health services for Pakistani women?
–
–
–
–
Size of network
Relationships within the network
Frequency of contact with friends and relatives
Social support
•How does this association differ between
Pakistani women and women from other ethnic
groups?

11. Data
• English survey data: Ethnic Minority
Psychiatric Illness Rates in the Community
(EMPIRIC, 2000)
• N=4281 (2340 females, 387 Pakistani ethnic
group)
• 6 ethnic groups: White, Irish, Black
Caribbean, Bangladeshi, Indian and
Pakistani

12. Data: Mental Health Service Use
• Mental health service use in the past 6
months – 2 measures:
1.Saw a doctor for an emotional or stressrelated problem (0=No, 1=Yes)
2.Saw a counsellor, psychologist or
Community Psychiatric Nurse (CPN) (0=No,
1=Yes)

13. Data: Social Network Variables
1. Number of close people
2. Relatives
i.
ii.
iii.
iv.
Regular contact (Yes/No)
Frequency of contact (5 options)
Frequency of face to face contact (5 options)
Number seen once a month or more
3. Friends
i.
4 categories as above
4. Relationship type of 2 nominated closest people
(3 categories: partner/spouse, friend and
relative)
(cont…)

14. Data: Social Network Variables
“Thinking about the person that you are closest to, please say how you would rate the practical and
emotional support they have provided to you in the last 12 months. How much in the last 12 months…”
Options: 1: Not at all, 2: A little, 3: Quite a lot, 4: A great deal.
a
…did this person give you information, suggestions and guidance that you found helpful?
b
…could you rely on this person? Was this person there when you needed them?
c
…did this person make you feel good about yourself?
d
…did you share interests, hobbies and fun with this person?
e
…did this person give you worries, problems and stress?
f
…did you want to confide in, talk frankly or share feelings with this person?
g
…did you confide in this person?
h
…did you trust this person with your most personal worries and problems?
i
…would you have liked to have confided more in this person?
j
…did talking to this person make things worse?
k
…did he/she talk about his/her personal worries with you?
…did you need practical help from this person with major things, for example looking after you when ill,
help with finances, children?
l
m …did this person give you practical help with major things?
n
o
…would you have liked more practical help with major things from this person?
…did this person give you practical help with small things when you needed it, for example, chores,
shopping, watering plants etc. ?

15. Data: Other variables
• Mental Illness measured by Clinical
Interview Schedule-Revised (CIS-R, Lewis et
al, 1992)
• Age
• Social class/ income (to be decided)

16. Results: Is there variation by ethnic
group in the use of services?
Ethnic Group
% used a mental health service
Irish
13.5
White
10.8
Black Caribbean
10.6
Indian
10.5
Pakistani
7.1
Bangladeshi
5.3
Total
9.8

17. Results: Differences in social networks
by mental health service use
Used a MH service
Mean (S.E)
Not used a MH service
Mean (S.E)
No of close people
5.72 (0.48)
6.06 (0.12)
No of relatives seen once
a month or more
4.45 (0.49)
5.60 (0.19)
No of friends seen once a
month or more
8.07 (1.16)
7.74 (0.32)
Confiding and emotional
support
15.1 (0.27)
15.0 (0.09)
Practical support
4.62 (0.20)
4.89 (0.06)
Negative aspects of
support
3.41 (0.19)
2.82 (0.05)

18. Results: Differences in social networks
by MH service use
% within categories of service use
Regular contact with relatives (Yes)
Contact relatives once a week or more
Face to face contact with relatives once a week or more
Regular contact with friends
Contact friends more than once a week
Face to face contact with friends once a week or more
First closest person
Spouse/ partner
Relative
Friend
Second closest person
Spouse/ partner
Relative
Friend
Used a MH
service
88.2%
79.5%
44.7%
Not used a MH
service
90.7%
81.0%
58.4%
86.1%
83.4%
65.9%
88.7%
83.6%
64.7%
38.0%
42.5%
19.5%
46.2%
42.7%
11.1%
10.8%
66.3%
22.9%
8.4%
74.0%
17.6%

19. .05
P (using a MH service)
.1
.15
.2
Mental health service use by negative aspects of support
0
1
2
3
4
5
6
7
8
Negative aspects of support
White
Black Caribbean
Indian
9
10
Irish
Bangladeshi
Pakistani
11
12

20. .05
P (using a MH service)
.1
.15
Mental health service use by no of friends seen
0
10
20
30
40
50
60
70
80
No of friends seen once a month or more
White
Black Caribbean
Indian
Irish
Bangladeshi
Pakistani
90
100

21. Thank you for listening!
Comments and Questions?
dharmi.kapadia@manchester.ac.uk
@DharmiKapadia