Background A growing body of literature explores the effects of ethnic density on various mental health outcomes. However, the results have been mixed and there is a need for a better understanding of the pathways involved. This systematic review aims to synthesise theoretical and empirical evidence on the pathways between ethnic density and mental health that have been conceptualised and tested in UK based research.
Methods A theory-based systematic review of UK evidence was conducted. 15 literature databases were searched without date restriction until June 2019. The main eligibility criteria were as follows: an individual level mental health or well-being measure and ethnic density measured at a defined geographical unit. The population of interest was any ethnic group, both minority and majority. Reviewer NB conducted all stages of the review, with random 10% samples double reviewed by a second reviewer (SS) at each stage. All studies were assessed on quality using a refined version of the CASP checklist. The results of the review were synthesised in a thematic format, grouped by study context, mental health outcome, and the pathways tested or discussed. Following this, a visual representation of the hypothesised and tested pathways was developed.
Results An initial search returned 3,664 documents after removing duplicates. 286 documents were included after title and abstract screening, and a final 36 papers identified after full text screening. In general, evidence for an ethnic density effect was found in papers which had larger sample sizes and employed smaller areal units. Hypothesised causal pathways were inconsistently tested in statistical analysis. The main pathways analysed were: racism and victimisation, migration and residency, social capital and support and English language proficiency. 11 papers did not test any pathways.
Conclusion The hypothesised pathways operating between ethnic density and mental health have been tested inconsistently. However, several plausible pathways have been identified, particularly those relating to racism and social capital and support. A more consistent focus on pathways and the application of more specific analysis techniques is required in order to advance our understanding of the pathways behind the ethnic density effect. It is arguable that a considerable body of US research is missed due to the UK focus of this study. However, this focus was deemed necessary in order to gain a better understanding of the potential causal pathways involved.
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