Ethnic and income-related inequalities in mental health among adolescents: a cross-sectional study in Bradford, UK.

Introduction: Poverty is a well-established determinant of adolescent mental health, but associations between ethnicity and mental health are less clear. We quantified inequalities in mental health and well-being among adolescents in Bradford, UK. Methods: We conducted a cross-sectional analysis of the Born in Bradford birth cohort, using surveys from 2023/2024 (ages 12-15). Participants completed validated measures of anxiety and depression (Revised Child Anxiety and Depression Scale 25), well-being (Short Warwick-Edinburgh Mental Well-being Scale), emotional and behavioural problems (Strengths and Difficulties Questionnaire), loneliness (UCLA Loneliness Scale 4), eating-related problems (Eating Disorders Examination Questionnaire-Short) and psychosis-like experiences (Psychosis-Like Symptoms Scale 8). We used linear regression to estimate associations with ethnicity and family income (measured by free school meals eligibility). Results: We included 9496 participants (median age 13.9 years; 52.1% female; 40.9% Pakistani ethnicity; 34.4% white British ethnicity; 24.6% other ethnicities; and 62.0% living in the most deprived quintile of neighbourhoods in England). Compared with adolescents of white British ethnicity, those of Pakistani ethnicity had fewer anxiety and depression symptoms (Cohen's d=-0.31, 95% CI -0.37 to -0.24); higher well-being (d=0.15, 95% CI 0.10 to 0.20), fewer emotional and behavioural problems (d=-0.40; 95% CI -0.48 to -0.32); less loneliness (d=-0.22, 95% CI -0.26 to -0.17), fewer eating-related problems (d=-0.07; 95% CI -0.11 to -0.02) and no evidence of a difference in psychosis-like experiences (d=-0.07; 95% CI -0.17 to 0.02). Estimates for other minority ethnic groups were less precise but generally suggested better mental health than white British adolescents. Adolescents eligible for free school meals had poorer outcomes across all measures: anxiety and depression (d=0.13; 95% CI 0.07 to 0.18); well-being (d=-0.17; 95% CI -0.22 to -0.12); loneliness (d=0.09; 95% CI 0.04 to 0.14); emotional and behavioural problems (d=0.14; 95% CI 0.06 to 0.22); eating-related problems (d=0.06; 95% CI 0.01 to 0.11); and psychosis-like experiences (d=0.10; 95% CI 0.01 to 0.20). In exploratory sex-stratified analyses, girls reported poorer mental health and ethnic differences were wider among girls than boys. Conclusions: Poverty was consistently associated with poorer adolescent mental health. Despite higher deprivation, Pakistani adolescents reported substantially better outcomes than white British adolescents, particularly for emotional and behavioural problems.