Mental health outcome inequalities in IAPT services: An investigation of the minority stress hypothesis

Research has shown ethnic minority communities have poorer access and recovery rates in Improving Access to Psychological Therapies (IAPT), now known as NHS Talking Therapy Services when compared with the White British ethnic group. Previous research has shown that these differences are still evident even after controlling for socioeconomic status. The first chapter, a systematic literature review, explored the association between individualistic and collectivist core values and symptoms of depression and anxiety. A total of 28 papers were included in the review following a comprehensive search in databases and grey literature. The results from these studies were heterogeneous, however, it appeared that collectivism reduced depression and increased social anxiety. There were differences in trauma memories in post-traumatic stress disorder as those more individualistic values had more appraisals of mental defeat. The review also found that core values of individualism/ collectivism and depression/ anxiety can act as mediators or moderators. Again, these findings were not conclusive. Overall, this review highlighted the need for therapists to explore cultural core values with patients to help deliver culturally sensitive care and the need for further research. The second chapter aimed to investigate minority stress and ethnic density effects as possible predictors of treatment response for patients who access IAPT services. Healthcare records of 130,857 patients were analysed using multilevel modelling. Outcome measures for depression, anxiety and functioning were linked to neighbourhood ethnic density data. The results found some support for the minority stress effect (after controlling for socioeconomic deprivation and employment status), but only relevant to patients from Black Caribbean, Black- other and White – other backgrounds. This study highlighted a need for further research to explore ethnic health inequalities.