The recent comprehensive estimates available reveal that the mental health pertaining to the children in United Kingdom (UK) has deteriorated over the past half century evident through 10% disorder prevalence. The prevalence of three main categories of mental disorders encompassing emotional disorders, conduct disorders and hyperkinetic disorders are rampant in Britain. The behavioral patterns in case of the children afflicted by various forms of mental disorders apart from other multiple disorders as well as Autism spectrum disorder alongside other less common disorders are found to occur in the children aged 5-16 years dwelling in the domicile of Britain.
The factors that are commonly found to influence such mental disorders in children are generally explored by taking into consideration the demographic and socio-economic characteristics, general physical and mental health status of the child, utilization of the available service alongside scholastic ability and attendance at school. Social functioning of the family and self in conjunction with the aspects of self harm and practice of smoking, drinking and drug use are taken into account as well (Green et al. 2005).
Rationale for the Project
Efforts are in progress to address the issue of debilitating mental health disorders among the youth population in Britain, but the variations in mental health pattern observed among the concerned group have limited the scope of suitable interventions. Empirical findings have lead to the generation of the fact that depressive symptoms emanating from the mental health disorder exert a significant independent risk for coronary artery disease in the vulnerable population. The effects of severity and duration of depressive symptoms in the population that is susceptible to sufferings due to mental health disorders need to be studied in depth and thoroughly investigated (Wulsin and Singal 2003).
The literatures exploring the correlation between ethnicity and mental health issues relevant to children are not scanty, however their focus is found to be diverse such as discussing topics related to child mental health and ethnic migrant (Lien et al. 2007), mental health service usage and ethnicity (Howell and McFeeters 2008), ethnic minorities and quality of care (Fernando 2010; Sewell 2009). Hence, it is imperative to probe into the matter relevant to the associations between the ethnicity variations and mental health illness among the children in UK and study the factors that contribute to the ethnic diversity in the relevant population. Effective interventions might resolve the prevalent situation through suitable combative strategies upon identification of the confounding factors.
Aims of the Study
The proposed study will have the following aims and objectives:
The Research Question
The chief research question for the prospective study is as follows:
Apart from the central research question, the projected study will try to find out answers to other questions that are as follows:
The Scoping Study
Enough evidences exist relating to the chosen topic to carry out a literature review to further probe into the matter and offer a deeper insight. The descriptive research study will be performed in this respect to undertake the research corroborating with the research objectives and research problems as defined by the researcher to develop better understanding and comprehension on matters relevant to the topic. The predefined aims and objectives will facilitate the researcher to undertake this type of research among all the other alternatives available.
The other two primary research designs namely the exploratory design and the hypothesis design do not fit into the objectives of the research that will be conducted (Bordens and Abbott 2002). The issue related to the ethnic influences on the mental health disorders prevalent among the children in UK may thus be answered to an extent based on the information available from reliable sources. Therefore it is possible to convert the ideas obtained in an acceptable structure for a literature review. The literature review will essentially explore the following:
Research has shown that variation exists in terms of voluntary and compulsory admissions to specialist mental health services operational in UK attributed to ethnic diversity. Variations are also evident in terms of pathways to specialist care in case of the concerned population because of ethnic group variation. In matter concerning access to primary care assessments, black patients encounter more complex pathways to specialist care compared to the white patients (Bhui et al. 2003). The findings corroborated with other works as well (Edbrooke-Childs et al. 2016).
The issue related to cross cultural psychiatry carried out in case of children aged 0-19 years comprising of all ethnic groups revealed the existence of interethnic differences that may be largely unexplained. On matters relevant to common mental disorders prevalence, the children belonging to the major minority groups showed similar or better mental health in contrast to the White British children. The reasons for such differences although remain obscure, but unfulfilled needs of services pertinent to the Pakistani and Bangladeshi children has been contemplated as a probable reason (Goodman, Patel and Leon 2008). A relevant study highlighted on the diagnosis and treatment of childhood psychiatric disorders among the preadolescent children in Great Britain.
Findings of the study showed that during the first decade of the 21st century, a sharp decline in the emotional and behavioural problems are noted. However, threshold for mental health issues to exert an influence over the mental distress in the children along with the classroom teaching has underwent significant change over time thereby necessitating and prioritizing the continued monitoring of the child mental health (Sellers et al. 2015).
Assessment carried out with respect to health and wellbeing of the children dwelling in Great Britain in recent years showed that they are maintaining a middle position in terms of issues related to infant mortality, immunisation rates and low birth weights. Poor picture is depicted through children’s self assessment of health. Execution of health behaviours in the concerned population has also been found to be bad on matter concerning diet, health and drugs. Early sexual activity as well as teenage pregnancy is also among the niggling issues in UK that contribute towards the development of mental health disorders (Bradshaw 2016; Rees and Main 2016). Thus ethnicity has been reported to affect the mental health condition.
Methodology
In order to successfully respond to the research question that has been raised in the study, utilization of proper methodology is required. The issue that has been highlighted in the study will aim to address the vital link present between the ethnic variation and the prevalence of mental health disorder among the chosen population of children in UK. The systematic literature review will be conducted in course of the study to find out appropriate articles that suit the research question. A systematic literature review will aid in minimizing the chances of occurrence of bias and ensure the procurement of comprehensive knowledge pertaining to the given topic.
Assessment of the relevance of the studies is crucial to the retrieval of suitable evidence that help in defining the possibilities of the research. In this context the screening of the appropriate data sources is vital to harbor positive outcomes (Booth, Sutton and Papaioannou 2016). The systematic review process in course of the study must conform to the critical appraisal of articles to generate evidences that are congruent to the topic of research. Synthesis and interpretation of evidences through systematic reviews are carried out by virtue of conducting critical appraisal of journal articles. In a particular practice setting, the efficiency and success of the study is dependent upon factors that contribute towards the effective performance and execution of systemic review in compliance with the critical appraisal of articles (Katikireddi, Egan and Petticrew 2014).
Careful and analytical evaluation of the articles constitutes the critical appraisal by means of assessing or estimating the worth, value and quality of the research article. Particularly in case of the disciplines that comprise of social, health, behavioral and human sciences studies follow the mixed method approach through combining qualitative and quantitative evidences in a skillful manner. Primary mixed method research articles are followed to bring out the critical appraisal of articles to deduce suitable conclusions regarding the primary mixed methods research articles (Heyvaert et al. 2013). The three pivotal issues that need to be considered while undertaking critical appraisal include validity, professional importance and applicability.
The main purpose of critical appraisal of articles is to engage in a balanced consideration of the study. Transparency concerning all aspects of research through provision of clear and demarcated standards for reporting is essential. Thus the way is paved for the author to prepare the manuscript. Further it aids the editors and reviewers to assess the merit of a manuscript for potential publication. Moreover the strengths, weaknesses and validity of the research findings are carried out by means of evaluation of the journal articles that is relevant to a particular context through systematic reviews. The assessment can be made with respect to the usefulness and validity of the research articles through evaluation of the appropriateness of the study design.
Other key considerations in course of a critical appraisal emphasize on the suitability of the statistical methods used along with their subsequent interpretation in addition to knowledge regarding the potential conflicts of interest as well as relevance to the domain of one’s own practice (O’Brien et al. 2014). Therefore it is of paramount importance to carry out the methodology accurately attending to the performance of critical appraisal of articles through conducting systematic literature review on the chosen topic. Finding of research articles from suitable sources and congruent to the topic of discussion is another crucial task that determines the validity and reliability of the study that has been conducted and therefore requires more attention, prudence and pragmatism on the part of the researcher to undertake the study. Efficient exhibition of appraisal skills will thus further increase the validity of the research.
In the pursuit of research in a satisfactory manner and in compliance with the ethical and legal guidelines, certain approaches have been followed throughout the course of the study. Five databases are being used for the search – ProQuest, B-on, EBSCO, Emerald, and Google Scholar. Six keywords are used – ethnicity, mental health, child mental health, ethnic variation, ethnic disparity, and ethnic minority to retrieve pertinent data suiting the topic of research. The inclusive criteria will be articles that have been published in peer reviewed journals within the timeline extending from 2003 to 2016 and studies conducted in UK relating to the relevant information on the topic.
The exclusion criteria are researches carried out outside of the UK. About 18,000 results were obtained by means of inserting the key words like ethnicity and mental health of children in UK. Fifteen pertinent research papers on the topic available so far are selected that met the inclusion criteria and most are available in Google scholar. Emphasis is placed on qualitative studies because most literature on the topic uses qualitative method for procuring information in line with the chosen topic. References to all articles extracted from databases will be cited for acknowledging the original work of the authors.
A comparative study depicting the mental health status of the refugee children who have infiltrated Britain was done in contrast to the children belonging to ethnic minority and the indigenous white children. The refugee children in turn belonged to diverse ethnic communities who constituted a bulk proportion of the asylum seekers who are predisposed to be affected by certain risk factors for psychological disturbance pertaining to exposure to forced displacement, violence and multiple losses. The strengths and difficulties questionnaire (SDQ) was resorted to evaluate the mental health conditions in the study groups.
The results showed that the refugee children compared to the control groups considering the ethnic groups and indigenous groups have significant psychological disturbances with particular problems in the emotional symptoms. In contrast to the ethnic group children, the refugee children expressed high concerning total and emotional scores while high values occurred in terms of peer, hyperactivity and emotional scores compared to the indigenous group as well. Therefore the unmet mental health needs of the refugee children must be addressed holistically through proper access to the mental health clinical services. Effective service provision may be settled through collaborative efforts of the schools, primary healthcare services and community child mental health teams. Thus the comparative study provided valid and convincing information regarding the mental health status in the children belonging to the refugee, ethnic minority and indigenous population through proper evidences and research with future implications (Fazel and Stein 2003).
Another study highlighted on the mental health differences prevalent among the migrant and native children. Multiple reasons have been attributed to these differences that range from the ethnic minority position of the migrants, process of migration, specific cultural background of the migrants besides the selection of migrants. The study essentially followed the literature review format whereby researches across international publications were considered for evaluation. The prevalence of mental health disorders among the migrant population were identified to be high in contrast to the ethnic minority population as well as those who are native to the place.
Behavioral problems in case of the migrant youth population was found to be reflected through the responses received from the informant in the study. However, the stark differences in responses and feedback largely emanated from the type of informant used that accounted for large differences both in school as well as at home apart from the variations in cultural standards in addition to biases expressed through self, teacher or parent reports. The issue relevant to ethnic minority effect in relation to social mechanisms such as prejudice, racism, oppression and discrimination calls for greater attention and insight to explain the differences in mental health to address their health appropriately and holistically (Stevens and Vollebergh 2008).
A recent study investigated the barriers occurring at the interface between child and adult mental health services that are required for seamless transition to the next level of service for the affected patients. The outcomes of poor transition have also been found to impact upon the healthcare service user. The services available across physical health have been found to be explored more compared to the mental health status. Disruption in continuity to care along with disengagement from services have been found to severely impact the mental health state of the vulnerable population of youth and children. Facilitators and barriers to mental health care service are required to account for effective treatment intervention thereby rendering a proper cure in the transition phase.
The predictors and outcomes specific to the transition are desirable to understand how the process of transition is influencing the service recipients. The young who belong to ethnic minority group have been found to refrain from consulting with the physicians for receiving suggestions and recommendation allied to the mental health status. Ongoing support and psychiatric interventions are solicited in case of persons affected by neurodevelopmental disorders. In the context of UK this study holds much significance in terms of providing adequate information and data to the healthcare practitioners, clinicians, service users and caregivers on matter pertinent to mental health status and transition to care from adolescent to adult mental health services (Singh 2009).
Epidemiological study conducted across the UK to assess the rates of psychiatric disorder among the population belonging to the age group of 5-15 years particularly that of the obsessive compulsive disorder (OCD). The study was carried out in the form of a nationwide survey where with the increase in age, the prevalence of OCD was identified to be greater compared to the young ones. In comparison to the normal controls the children affected by OCD condition were found to belong to lower socio-economic class expressing lower level of intelligence. Moreover, the findings suggest that because of associated psychosocial disadvantages, co-morbidities and chronic nature of OCD lead to other psychiatric disorder in the concerned population (Heyman et al. 2003).
A study was conducted to evaluate the discrepancy in internalizing mechanisms and the problems related to children who belonged to the ethnic minority (Indians) and the ethnic majority (English) group living in Britain. Reports were derived from the parents of the participant children on matter pertinent to their internalizing issues in addition to information about the access to social support and parenting style. Findings of the study suggested that the connection between ethnicity and the ensuing internalizing problems prevalent more among the Indian children were found to be mediated by the actions related to maternal positivity, paternal negativity and access to social support as reported by the parents.
An important insight and revelation of the study depicted that as per the best fitting structural equation model ethnicity did not exert any direct impact upon the internalizing problems in children nor influenced the parental style. Moreover ethnicity was identified to be a reliable predictor of social support based on parental reports. Children’s internalizing problems were found to be majorly impacted by the direct influence of social support while parenting style affected the issue relevant to children’s internalizing problems in an indirect way. The final implication of the study brought to the forefront, the major role related to the social support that contributed to the generation of internalizing problems. The relative effects of the parental style were found to be much less in comparison to the social support in influencing the outcomes relate to internalizing problems.
Thus elevated levels of internalizing behaviors were found to be much more prominent in case of the children having Indian origin and following Hindu religion hold promise in terms of strategizing and implementing suitable interventions to tackle the condition. The essential role of the social support in mitigating the issues of internalizing need have been recognized in the study to safeguard the rights of the children and individuals belonging to ethnic minority group especially that of the immigrants (Atzaba-Poria and Pike 2005). Another study investigated the issue related to health disparity among the Muslim patients in the UK as well as US.
The findings of the study are based on evidences procured from suitable sources that underpin the social and political contexts in shaping the identity of the Muslims in the chosen countries. Both the physical and mental health status of the affected members of the Muslim community have been reported of encountering similar situation with respect to the consequences occurring due to the emerging trend of ‘Islamophobia’.
Health disparities that are in vogue among the Muslim community members need to be performed for cultural and institutional adjustments within the health care setting. Emotional distress has been reported in the concerned population that severely threat their mental health and wellbeing. Discrimination and marginalization are the prime reasons that lead to the emanation of health discrepancy among the Muslim patients in UK. Ethnic sensitivity need to be dealt in an appropriate manner to resolve the issue and that has been particularly in the study (Laird et al. 2007).
The variations due to ethnicities among the minority groups related to obsessive compulsive disorder (OCD) have been studied in investigations done in clinical trials. Findings from relevant literature reviews show that OCD has similar prevalence rates across various ethnic groups in countries across the globe. The children belonging to the ethnic minorities group exhibited higher prevalence of OCD compared to other native groups. However information regarding the vulnerable population across the ethnic minority community of children is found to be significantly underrepresented. The observation occurred to be more pronounced for inequalities occurring in case of depression. Type of service or age of the affected community however did not held any significant implication for the observed inequalities.
Accurate diagnosis post referral to tertiary and secondary mental health services is found to be hampered due to certain obstacles that need to be addressed holistically for the ethnic minority children. Thus facilitation of the strategies and policies to mitigate the inequalities has been suggested in the study (de la Cruz et al. 2015). An evidence and research based study highlighted the issue of racial disparities in health in addition to discrimination. The burden of perceived discrimination in health is fund to affect the vulnerable population of people belonging to ethnic minority community. An inverse relationship between discrimination and health has been documented in the study that calls for greater attention to assess the stressful dimensions for the discrimination of health.
The study concerning the black, white and Bangladeshi adults settled in UK was found to be significantly associated with generating psychological distress. The findings revealed that UK ethnic minorities suffer from anxiety, psychosis or depressive disorders much more compared to the native population in UK that in turn may be attributed to differential access to societal goods and resources and residential segregation. Comprehensive approaches are required to combat such health inequities in the ethnic community members in UK (Williams and Mohammed 2009). Another study highlighted on the issue of the contribution of depression to the onset of coronary artery disease in conjunction with the evaluation o the magnitude of risk presented by depression for the onset of coronary artery disease.
The result of the study suggests that depressive symptoms pose significant heart for the onset of coronary artery disease when compared against other vital risk factors. The severity and duration of depressive symptoms are crucial to the understanding of the perceived risk for developing coronary artery disease. Other confounding factors that affect the onset of coronary artery diseases included smoking and other lifestyle habits. However, the relative weightage of depression towards development of coronary artery disease was found to be higher (Wulsin and Singal 2003). Thus the ethnic influence on mental health disorder among the susceptible population needs to be explored in more details to identify the possible reasons that might lead to such condition.
Studies have suggested that adolescence is the most vulnerable phase in a person’s life to confront the issue of mental illness. Thus for the sake of probing deeper into this matter, the views of the young people in connection to the mental health services available in UK has been explored. Recommendations for developing services meant to cater to the specific needs of the young people have been suggested. Positive views that governed the efficacy of the service included quality of mental health workers along with the encouragement provided for self reliance. Negative views attached to the provision of mental health service as perceived by the young people included stigma, medicalization of problems along with lack of information. The young people of the ethnic minority group are less likely to seek the mental health services according to the findings of the study.
Lack of trust and less accessibility to mental health services for the young population of ethnic minority have been fund to be particularly vital in this respect. Young people having ethnic minority background in the study reported stigmatized views concerning mental health services. Asylum seekers or refuges mostly constituted the ethnic minority population in UK who were under the threat of encountering mental illness (Plaistow et al. 2014). Another study evaluated the risk factors for health disparities in children having ethnic backgrounds. Social environment posed a significant impact upon the health discrimination in the concerned population. Perceptions inclusive of personal and family experiences regarding racial discrimination have been indicated to affect the onset of mental illness among the concerned population. Disparities were noted in terms of biological functioning, psychological functioning was observed as a consequence of racial discrimination in the ethnic community (Sanders-Phillips et al. 2009).
Strength and difficulties questionnaire for the parent and teacher was utilized for the purpose of comparing the rates of conduct related, emotional and hyperactivity problems relevant to 7 years old children for the span of 1999-2008. Data retrieved during this timeframe suggested that the perceived levels of emotional and behavioral problems in the pre-adolescent children in Great Britain declined suggesting the changing patterns of the impact of mental health on the children’s distress and classroom learning outcomes.
The diminished effect was more pronounced in case of boys rather than the girls while the impact scores varied widely across the cohorts of girls (Sellers et al. 2015). An insightful investigation carried out on the children in UK highlighted on the school level variations to indicate a range of health indicators. One of the major health indicators referred to the mental and emotional health in the affected population. On close introspection, the study suggested that consistency remained in the school level variation of health in the adolescents. Variations were found to be higher in case of the risky behaviors thereby suggestive of the implementation of suitable strategies to resolve the issue (Hale et al. 2014).
Discussion
Measures to mitigate the issue relevant to the ethnic impacts on the prevalence of mental health disorder among the young in UK are scanty. Studies need to be conducted in this respect carefully considering the implications that might result out of the negative influences of ethnic variation on the mental health status of the children in UK. Appropriate studies carried in the context of Great Britain investigated the service related public sector costs. The findings of the study showed that there exist marked interindividual variations in utilization and costs.
The associations among the utilizations or costs were found to be related to impairment, attainment of reading, child age, maternal age, gender and ethnicity, parental anxiety and depression, family size, social class and functioning. The remaining unexplained variations in costs has been attributed to poor targeting, ineffective and inappropriate ways in which the mental health and social service care respond to the problems related to behavioral and emotional problems (Knapp et al. 2015).
Researches across diverse sources have highlighted the efficacy of suitable interventions to tackle the problems related to mental health illness among the children belonging to ethnic backgrounds. The most remarkable interventions to cater to the needs of the concerned population have been affixed to the non-therapeutic and counseling interventions. Participation to Sports and physical activities is the most widely accepted and legitimate form of non-clinical intervention that has the potential of harboring optimist outcomes. Positive effects in terms of cognitive and health benefits are noted through physical activity participation (Holt 2016).
Ethical Issues
The researcher will resort to handling the content of existing researchers in an accurate and fair manner. In order to maintain the legal abidance and ethical considerations the researcher must adhere to the ethical issues while utilizing secondary resources, the researcher will acknowledge the ownership of the original data by means of citing the author of the original literature works. The investigator must take care of the cognizance of ethical questions that need to be addressed in the existing literature. The proposed study must strictly follow the dictums laid down in terms of ethical and legal issues. The research work must be undertaken in compliance with the propositions made in the Data Protection Act, 1956 (Riege 2003). Prior to the onset of the research, the researcher must be aware and thorough regarding the purpose and aim of the research.
The proposed study will not cater to any commercial interest other than just fulfilling the academic purpose. In order to procure data reliable, valid and authentic sources will be utilized in order to prevent any ambiguity or doubts related to the research. The secondary data collection will abide all the set standards that define a proper research work without scope for any prosecution. The privacy and confidentiality of the data will be of utmost priority throughout the research to ethically carry out the study safeguarding the reliability of the information procured. Under no circumstances, the information retrieved will be misused for other purposes or for catering to commercial interests other than for research work.
Users and Beneficiaries
The children residing in the United Kingdom and belonging to diverse ethnic backgrounds are under the threat to suffer from mental health disorders and are likely to encounter conditions that might challenge their health and well being to a large extent. The proposed study is likely to probe deeper into their issues by means of imparting important knowledge that relate to the ethnic disparities that might influence the mental health condition of the children in UK. The children with diverse ethnic lineage and residing in UK are the most vulnerable to fall victim to the differential ethnic influences impacting the mental health status of them.
Thus in keeping with the trends in mental health patterns that gravely challenge the existence of the children, the vulnerable population consisting of the children in UK are likely to be greatly benefitted as a result of this study. The reasons behind the emanation of mental health issues among the ethnic minority children in UK will be elaborated and discussed in details through undertaking the study. Moreover it is speculated that the associated members comprising of the policymakers, social workers and private organizations that are intimately or indirectly related to the provision of mental health services will be the major beneficiaries of this study. The proposed study will help them to devise appropriate policies and strategies thereby helping in combating the issue.
Conclusion
The issue related to the influence of the ethnicity on the mental health of children in UK has been a topic of research since quite a while. The reasons for the differential responses in case of the children belonging to the ethnic minority groups have been attributed to various factors including the access to health and social care services, discrimination, stigmatization and the lack of equitable facilities that in turn accounted for health disparities. The discrepancies in emotional and behavioral responses in these children are found to vary significantly in comparison to the native British counterparts. Majority of the asylum seekers and refugees are found to be afflicted by the mental health disorders and they mostly constitute the ethnic minority community in the UK domicile.
Moreover, these children have been speculated to be under the threat of encountering major developmental and mental health disorders that might be detrimental to their growth and hinder their progress. Therefore, several suggestions and recommendations have been made to mitigate the problems in an effort to enhance the quality of living for the affected children. In this regard, non therapeutic and counseling interventions, appropriate social and health care services in addition to participation to games and physical activities in a group has been identified to harbor positive benefits. Hence, more research and deeper investigations are desirable to highlight on the issues that underpin the onset of mental health disorders because of the ethnic influence on the children in UK.
References
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