Research Findings: Ethnic background: South Asian health Summary Papers
Do measures of mental stress among UK South Asians under-estimate their association with poor health?
Traditionally used clinical measures of stress find contrasting patterns among ethnic migrants in the UK - high rates of mental health problems among Irish and Afro-Caribbean contrast with low rates of mental stress found among South Asians. These findings, in addition to their significance for the mental health of migrants have led public health researchers to rule out stress as contributing to the high rates of heart disease in South Asians overseas. However, some argue that stress is being under-reported by South Asians in the UK.
There are many ways of measuring mental stress and in this study we compared three commonly used methods of measuring mental stress among South Asians from the 1970s cohort living in Glasgow. Responses to a 12-item General Health Questionnaire (clinically valid measure) were compared to self-report and psychosomatic measures and found to potentially under-estimate mental stress in several South Asian groups. Using psychosomatic and self-assessment measures, we found that the greater stress among women, Muslims and limited English speakers may be explained by the types of stressful situations they experience and that the GHQ under-estimates distress related to situations experienced, particularly by ethnic minorities and women.
Williams, R. G. A., S. Eley, et al. (1997). "Has psychological distress among British Asians been underestimated? A comparison of three measures in the West of Scotland population." Ethnicity and Health 2(1/2): 21-29.
Stressful experiences affecting the mental health of South Asians living in Glasgow
Some earlier studies have found higher rates of mental stress among some South Asian groups living in Glasgow compared with the general population. High rates were found using psychosomatic and self-assessment measures but not with the General Health Questionnaire (clinically validated measure).
We therefore compared the cohort of South Asians with the general 1970s cohort in Glasgow to investigate whether South Asians are subject to certain types of stressful situations that are not picked up in responses to the General Health Questionnaire but are picked up using the other two measures. Participants were asked about stressful situations such as experiences of assault, stress or dissatisfaction with work, overcrowding, low standard of living, being away from family or from someone they could confide in.
The higher rates of stress found among women, Muslims and limited English speakers could be explained by the types of stressful situations they experience. Furthermore, the General Health Questionnaire was found to under-estimate the stress related to situations experienced, particularly by ethnic minorities and by women. Mental health issues reported among ethnic minorities have led to public health interest in policies for reducing violence, especially racist violence, and increasing the help available to women in the South Asian community.
Williams, R. G. A. and K. Hunt (1997). "Psychological distress among British South Asians: the contribution of stressful situations and subcultural differences in the West of Scotland Twenty-07 Study." Psychological Medicine 27(5): 1173-1181.
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Diet, stress and heart disease risk among British South Asians
Migrants from the Indian subcontinent and their South Asian descendents, regardless of where they settle, appear to have a high risk of death from heart disease. Traditional lifestyles of South Asians which are based on a healthy diet of vegetables and pulses (among Hindus and Sikhs), and few smokers (particularly among women and Sikhs) tend to be adopted by relatively new migrants but to a lesser extent among settled communities in the UK. Moreover, heart disease is not the main cause of death in rural India, but it would appear to be an increasing problem in urban areas. The excess of heart disease among South Asians in Scotland (as shown in Figure 1) is not fully understood but is thought to relate to dietary factors, insulin-resistance, stress and genetic factors.
This project compared data from a sub-sample from the South Asian community living in the West of Scotland (mainly Punjabis, both Muslim and non-Muslim) to that of the general 1970s cohort of the Twenty-07 Study. We wanted to find out if the South Asian community was more or less ‘at risk’ of heart disease than the general population by measuring established risk factors relating to dietary, smoking, and exercise behaviours and determine whether the high death rates from heart disease among South Asians is related to stress, socioeconomic deprivation, lack of social support and racial discrimination.
Among the established risk factors studied the only one which South Asians were less exposed to was smoking. In men or women (or both) there was an excess of other risk factors such as eating too few fruit and vegetables, eating too much dietary fat from meat and dairy, and not taking enough exercise. We found evidence in support of the three other factors relating to high levels of heart disease, namely insulin-resistance, stress and socioeconomic deprivation. The socioeconomic circumstances of South Asians were worse than the general population. Factors relating to stress and mental health such as length of working day, low income, crowded housing, fear of assault, and perceive lack of social support (in women) was greater in South Asians, than the general population. Self-reported diabetes was more common in Asian men than the general population, and symptoms of angina more common in South Asian women. This study adds further evidence to support the belief that high rates of heart disease in South Asians are likely to result from a complex interaction of multiple risk factors and a better understanding of these will help develop better health promotion strategies to target vulnerable ethnic groups.
Williams, R. G. A., R. Bhopal, et al. (1994). "Coronary risk in a British Punjabi population: comparative profile of non-biochemical factors." International Journal of Epidemiology 23(1): 28-37.
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How does the health of the South Asian community in Glasgow compare with that of the Glasgow population in general?
Previous population studies have highlighted important differences in the disease experience of South Asians, and between males and females. Much work has focused on specific diseases such as heart disease, diabetes and mental health which have identified poor health and greater healthcare needs among ethnic migrants. However, few studies have looked at broader measures of health such as symptoms, perceptions of health, communication, lifestyle and patterns of illness among ethnic minorities compared to the general population. This study aimed to compare common health experiences of a South Asian community with that of the general population, by sex and by patterns of hospital admissions and death rates.
Comparing the 1970s cohort from the Twenty-07 study with a similarly aged sample of South Asian men and women, we found both South Asian men and women to be shorter and broader than the general population, and South Asian women to be more overweight. South Asians had faster pulse rates, women had poorer lung function (asthma, respiratory symptoms) and men had higher diastolic blood pressure, than the general population. Fewer male South Asians were accident prone or had experienced digestive problems and more female South Asians experienced mental health problems and total symptoms overall, compared with the general population sample. Fewer South Asians had problems with their eyesight, teeth and long standing illness. South Asians appeared to be disadvantaged only in terms of their body size, otherwise many health differences were balanced between South Asians and the general population. However, South Asian women appeared to have poorer health and be more disadvantaged than male South Asians compared to sex differences in the general population. Patterns of poor health were consistent with patterns of hospital admissions and death rates. Our findings will help develop more effective health promotion programmes targeting the most disadvantage ethnic groups.
Williams, R. G. A., R. Bhopal, et al. (1993). "Health of a Punjabi ethnic minority in Glasgow: a comparison with the general population." Journal of Epidemiology and Community Health 47(2): 96-102.
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