Title: The role of sociocultural distance in explaining higher rates of psychotic disorders in ethnic and other minorities.
Funder: Economic and Social Research Council

Abstract: Psychotic disorders are a group of mental health disorders characterised by hallucinations, delusions and disorders of thought, as well as negative symptoms such as anhedonia. They affect up to 3.5% of people in their lifetime (1-3) and are associated with massive lifelong individual and societal burdens (4-6), including an average reduced life expectancy of 15 years (7,8). A better understanding of the distribution and determinants of these disorders is critical to identify and prevent the aetiological drivers of these health inequalities in society. Although we do not yet know the definitive causes of psychosis, we do know that risk is inequitably distributed through society. For instance, in my PhD I have demonstrated that there is an eight-fold variation in psychosis risk between geographical settings in Europe, most parsimoniously explained by differences in levels of socioeconomic stability (9). Risk is also known to be higher in urban areas (10), in young men (11), and for several ethnic minority groups (12). We have known since the 1930s that psychosis is more common in some migrants and their descendants (13,14), and although research points towards a role for social stress (15,16), we are yet to fully understand the causes of this. In my PhD, I developed a theoretical sociocultural distance model to explain this excess psychosis risk in ethnic minority groups, which holds that culturally and socially distant minorities are particularly at risk of social exclusion. This outsider status leads to increased psychosocial disempowerment (a lack of control over one's life), which increased psychosis risk. When I empirically tested this model in my thesis, I demonstrated that excess risk of psychotic disorders in ethnic minority groups was largely attributed to sociocultural distance, revealing for the first time a potentially modifiable public health target to tackle these inequalities by ethnicity. Nonetheless, 'ethnic minorities' is a very heterogeneous term: what might explain excess risk in Moroccan groups in the Netherlands, might not be very meaningful to the Black Caribbean or Pakistani groups in Great Britain. I believe we need to investigate not only how this model operates, but also for which minorities this model works, and those for whom it doesn't. This fellowship will enable me to position myself as a leading early career researcher working at the interface of epidemiology, sociology and mental health to tackle the gross social injustices experienced by certain parts of society with respect to psychosis risk, by allowing me to: 1. Write up my PhD findings for publication in peer-reviewed journals and dissemination to key stakeholders to maximise their impact; 2. Receive the necessary interdisciplinary training to be able to address the above questions appropriately, both via structured courses and through mentoring and a research visit; 3. Meaningfully engage with charities focussing on mental health and ethnic minorities, such as the McPin Foundation, Black Thrive or the South Asian Mental Health Alliance to inform future research questions through ongoing contact and a structured networking event and a resulting co-produced review paper. 5. Identify gaps in evidence and research priorities in this field by generating a co-produced review. 6. Apply for a full early career researcher fellowship to tackle disparities in severe mental illness across ethnic and other minority groups using an interdisciplinary approach.


Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: MENTAL HEALTH