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Objective
To investigate the causes of the lower rate of mental disorders diagnosed in British Indian children compared to White children.
Design
Secondary analysis of two population-based, cross-sectional surveys of child mental health (the British Child and Adolescent Mental Health Surveys of 1999 and 2004).
Setting
Great Britain (nationally-representative sample). Mental health outcome measures: Parent Strengths and Difficulties Questionnaire (SDQ); teacher SDQ; child SDQ; multi-informant clinical diagnosis.
Participants
16 449 White and 419 Indian children aged 5–16. The detailed multivariable models focused on the 13 868 White and 361 Indian children from England whose parents had completed an SDQ in English.
Results
There was a substantially lower prevalence (p<0.001) of any mental disorder in Indians (3.4%, 95% CI 1.9 to 5.9) compared to Whites was (9.6%, 95% CI 9.1 to 10.2). Strong evidence (p<0.002) of an Indian advantage for externalising problems/disorders was consistently observed for the parent, teacher, child SDQs and for clinical diagnosis. Detailed psychometric analyses of the SDQ and clinical interview measures provided no evidence that this Indian mental health advantage could be explained by a measurement bias in the assessment of mental health. In multivariable analyses the unexplained difference between Indians and Whites decreased somewhat after adjusting for the fact that Indian children were more likely to live in two-parent families (92.2% vs. 65.4%) and less likely to have academic difficulties (e.g. 2.9% vs. 8.6% for parent-reported learning difficulties). In models adjusting for a larger number of child, family, school and area variables the difference reduced only by about a quarter (e.g. from 1.08 to 0.75 SDQ points on the parent SDQ) and remained highly significant (p<0.001). There was little or no evidence of an ethnic difference for internalising problems/disorders in unadjusted or adjusted models.
Conclusions
The mental health difference between Indian and White children is specific to a substantial advantage for externalising disorders, and this advantage appears to be real rather than due to a reporting bias. This advantage is largely unexplained by major risk factors for child mental health problems available in this dataset. Further qualitative and quantitative research into the causes of this advantage has the potential to yield insights which could improve the mental health of children of all ethnic groups.