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Mental health service users in the UK have become increasingly involved in research over the last 2 decades partly as a consequence of research governance. Ethnic minority service users, however, point to power imbalances stemming from marginalisation and discrimination creating barriers to knowledge co-production (Kalathil, J. (2013). Hard to reach? Racialised groups and mental health service user involvement.). Heavily influenced by Freire’s liberatory education, participatory action research (PAR) repoliticises participation where those most affected by injustice are central in both producing knowledge about injustice and implementing solutions. Ethnic minority people with lived experience of ‘severe mental illness’ (‘the racialised mad’) were appointed as coresearchers to work with academic researchers on a qualitative study exploring ethnic inequalities in ‘severe mental illness’. Drawing on Foucault’s notion of power as relational, we focus on three key aspects of productive power: (1) relational engagement and reciprocity, (2) positioning coresearchers as authentic researchers and (3) adopting an ethic of care, to explore complicity and resistance in reproducing hierarchies of knowledge and power when attempting to create and sustain a PAR process for collective analysis, action and solidarity. We utilise retrospective and recorded reflections over the course of the project. Finally, we discuss the ethical and methodological implications for contemporary sociological research into health and illness.

There has been increasing recognition in the literature that migration and marriage events are interdependent. However, previous studies on migration and gendered health outcomes focus on isolated migration events and rarely embed the migration process in the context of family life course. This study aims to narrow the research gap by examining the impacts of combined internal migration and marriage histories on health and how these vary by gender from a life course perspective. We utilized the rich life history data from the China Health and Retirement Longitudinal Study and the analytical sample is composed of people of age 50 years and above with rural origin, who have migrated and married (N = 3096). By employing sequence analysis, we identified eight typical patterns of marriage–migration histories for older Chinese people. Thereafter, linear regression and Poisson regression were used to examine the relationship between these patterns and four later-life health outcomes (depressive symptoms, self-rated health, physical functioning and cognitive impairment). To address the selectivity into different marriage–migration trajectories, we further employed inverse-probability-weighted regression adjustment estimators for robustness checks. Results show that migrating in early adulthood before marriage leads to better health outcomes than migrating after marriage or migrating and getting married simultaneously. Moreover, health differences among these three groups are larger among women than men. Further analysis suggests that the relative health advantages of those, in particular for women, who migrate before marriage compared with those who migrate and marry simultaneously can be partly explained by their higher chances of gaining urban citizenship (converting to a nonagricultural Hukou) and marrying highly educated spouses. We conclude with a discussion of the implications of these findings for both internal migration in China and international migration.

Background frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. Objective to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. Design population-based cohort study. Setting communities in England. Subjects in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. Methods multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. Results the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0–34.6%] and 11.7 (11.1–12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2–1.3) and 2.2 (95% CI = 2.1–2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. Conclusions in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

Although rural-to-urban migration has been well researched, how gender shapes processes and outcomes, including later-life health outcomes, has not been thoroughly investigated. Guided by a life course perspective, this study explores gender differences in rural-urban migration patterns and its association with depression in later life among Chinese older adults. Exploiting rich life history data from the China Health and Retirement Longitudinal Study, we employ sequence analysis to identify the typical migration trajectories of Chinese older adults. Moderated mediation analysis is then used to examine gender-specific health pathways linking migration trajectories and later-life depression. The results indicate that: rural migrants who settled in urban regions have lower level of depression in later life than ‘return migrants' who moved back to rural areas or those who were rural non-migrants; the gender gap in depression is marginally smaller among early urban settlers than rural non-migrants; and household income in later life has stronger mediation effects for migrant men than for migrant women. The study therefore highlights the importance of considering the role of gender when designing policies aiming to improve the health and wellbeing of migrants in later life.

Later life relationships and in particular the role of sex within them, have often been neglected in research due to assumptions of decline and sexlessness. We contribute to a growing body of work which counters these stereotypes by examining sexual scripts within the socio-cultural context of later life relationships. We analyzed open-text comments from the English Longitudinal Study of Aging (ELSA) collected as part of a self-completion questionnaire. In Wave 6, 1065 participants (M age 67.5, SD 9.6 years) and in Wave 8, 922 participants (M age 69.1, SD 9.01 years) responded to an open-text box question. Across both waves, 38% of respondents were men and 62% were women. The analysis used a coding template developed from existing literature and adjusted to accommodate emerging topics. A gendered analysis of the interrelated topics of relationships, sex and sexuality resulted in themes which illustrate similarities and differences in how men and women negotiate sex in later life relationships. The findings confirm that sex remains integral to intimacy in later life relationships for many men and women. However, they also demonstrate that norms of age and gender interact to shape sex and relationship practices in later life. These norms limit some people's experiences, for example, preventing them from seeking new relationships, as well as creating challenges for intimacy in partnerships. These findings extend the theoretical understanding of relationships and sex in later life.

Although rural-to-urban migration has been well researched, how gender shapes processes and outcomes, including later life health outcomes, has not been thoroughly investigated. Guided by a life course perspective, this study explores gender differences in rural-urban migration patterns and its association with mental health in later life among Chinese older adults. Exploiting rich life history data from the China Health and Retirement Longitudinal Study, we employ sequence analysis to identify the typical migration trajectories of Chinese older adults. Moderated mediation analysis is then used to examine gender-specific health pathways linking migration trajectories and later-life mental health. The results indicate that: men and women follow different migration trajectories across the life course. Men are more likely to migrate between rural and urban areas, and to migrate multiple times. Rural migrants who settled in urban regions have better mental health in later life than return migrants or rural non-migrants; the gender gap in mental health is marginally smaller among early urban settlers than rural non-migrants. Household income and Hukou conversion mediate the relationship between migration trajectories and later-life mental health among older people of rural origin. Household income in later life has stronger mediation effects for migrant men than for migrant women. The study suggests that a life course perspective and awareness of gender dynamics should be incorporated in policymaking to reduce the rural-urban divide and gender-based inequality in mental health.

In this article we use the example of race/ethnic inequalities in severe mental illness to demonstrate the utility of a novel integrative approach to theorising the role of racism in generating inequality. Ethnic minority people in the UK are at much greater risk than White British people of being diagnosed with a severe – psychosis related – mental illness, and this is particularly the case for those with Black Caribbean or Black African origins. There is entrenched dispute about how we might understand the drivers of this inequality. To address this dispute we build on, and to a certain extent refine, established approaches to theorising structural and institutional racism, and integrate this within a theoretical framework that also incorporates racist/discriminatory interactions (interpersonal racism). We argue that this provides a conceptually robust and thorough analysis of the role of inter‐related dimensions of racism in shaping risks of severe mental illness, access to care, and policy and practice responses. This analysis carries implications for a broader, but integrated, understanding of the fundamental drives of race/ethnic inequalities in health and for an anti‐racism public health agenda.

Purpose Although excess risks particularly for a diagnosis of schizophrenia have been identified for ethnic minority people in England and other contexts, we sought to identify and synthesise up-to-date evidence (2018) for affective in addition to non-affective psychoses by specific ethnic groups in England. Methods Systematic review and meta-analysis of ethnic differences in diagnosed incidence of psychoses in England, searching nine databases for reviews (citing relevant studies up to 2009) and an updated search in three databases for studies between 2010 and 2018. Studies from both searches were combined in meta-analyses allowing coverage of more specific ethnic groups than previously. Results We included 28 primary studies. Relative to the majority population, significantly higher risks of diagnosed schizophrenia were found in Black African (Relative risk, RR 5.72, 95% CI 3.87–8.46, n = 9); Black Caribbean (RR 5.20, 95% CI 4.33–6.24, n = 21); South Asian (RR 2.27, 95% CI 1.63–3.16, n = 14); White Other (RR 2.24, 95% CI 1.59–3.14, n = 9); and Mixed Ethnicity people (RR 2.24, 95% CI 1.32–3.80, n = 4). Significantly higher risks for diagnosed affective psychoses were also revealed: Black African (RR 4.07, 95% CI 2.27–7.28, n = 5); Black Caribbean (RR 2.91, 95% CI 1.78–4.74, n = 16); South Asian (RR 1.71, 95% CI 1.07–2.72, n = 8); White Other (RR 1.55, 95% CI 1.32–1.83, n = 5); Mixed Ethnicity (RR 6.16, 95% CI 3.99–9.52, n = 4). Conclusions The risk for a diagnosis of non-affective and affective psychoses is particularly elevated for Black ethnic groups, but is higher for all ethnic minority groups including those previously not assessed through meta-analyses (White Other, Mixed Ethnicity). This calls for further research on broader disadvantages affecting ethnic minority people.

Background: Migrating between rural and urban areas over the life course profoundly shapes the conditions of later life. In the Chinese context, living in urban areas with an urban Hukou is associated with socioeconomic advantage. This study attempts to investigate how migration into urban areas in China is related to these processes and the association with risk of depression in later life by focusing on the timing and the type of migration (rural-urban residential mobility and/or institutional transition of Hukou status). Methods: We use sequence analysis to identify migration trajectories in the China Health and Retirement Longitudinal Study. Then we estimate how and why these trajectories are associated with risk of depression at older ages using a random intercept hierarchical linear model, distinguishing between three levels: city, household and individual. Results: The type of migration path taken over the life course is differentially associated with mental wellbeing in later life in China. Urban migration with rural-urban Hukou conversion during young adulthood is associated with lower levels of depression in later life. Urban migration at older ages regardless of Hukou transitions is protective against depression in old age. Formal social protection, particularly having a private pension, contributes substantially to the mental health advantage of social groups with an urban Hukou. Informal social mechanisms such as familial support are relevant, but only explain a small part of the differences in mental health. Conclusion: Having an urban Hukou has an independent protective role in shaping mental wellbeing in later life in China, potentially in part due to the entitlement to a private pension attached to this status. With weakening informal support in contemporary China, enhanced formal social protections in the form of adequate pensions should be put in place to mitigate structural inequalities associated with migration in old age., SCOPUS: ar.j, info:eu-repo/semantics/published

ObjectivesIn the absence of robust direct data on ethnic inequalities in COVID-19-related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.DesignEcological analysis of COVID-19-related mortality rates occurring by 24 April 2020 and ethnic composition of the population. Account is taken of age, population density, area deprivation and pollution.SettingLocal authorities in England.ResultsFor every 1% rise in proportion of the population who are ethnic minority, COVID-19-related deaths increased by 5·12, 95% CI (4·00 to 6·24), per million. This rise is present for each ethnic minority category examined, including the white minority group. The size of this increase is a little reduced in an adjusted model to 4·42, 95% CI (2·24 to 6·60), suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas.This estimate suggests that the average England COVID-19-related death rate would rise by 25% in a local authority with two times the average number of ethnic minority people.ConclusionsWe find clear evidence that rates of COVID-19-related mortality within a local authority increases as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.

Collecting biological data in representative surveys is becoming more common due to their potential to inform research and policy. Nevertheless, using nurses to collect these data can lead to unintended effects. In this paper, we investigate how nurses influence the non-response process by looking at five waves of data coming from two surveys in the UK: Understanding Society and the English Longitudinal Study of Ageing. We find that nurses explain between 5 and 14 percent of the variance in non-response to biological data collection. We also find that older nurses are more successful in obtaining cooperation and consent to biological data collection and nurses with more survey experience are more likely to successfully collect blood samples. Finally, we show that including nurse characteristics in non-response weighting models leads to modest changes in population estimates of biological markers.

This study uses data from consecutive England and Wales censuses to examine the intragenerational economic mobility of individuals with different ethnicities, religions and genders between 1971 and 2011, over time and across cohorts. The findings suggest more downward and less upward mobility among Black Caribbean, Indian Sikh and Muslim people with Bangladeshi, Indian and Pakistani ethnicities, relative to white British groups, and more positive relative progress among Indian Hindu people, but also some variation in the experiences of social mobility between individuals even in the same ethnic groups. For some groups, those becoming adults or migrating to the UK since 1971 occupy an improved position compared with older or longer resident people, but this is not universal. Findings suggest that these persistent inequalities will only be effectively addressed with attention to the structural factors which disadvantage particular ethnic and religious groups, and the specific ways in which these affect women.

BackgroundIn the absence of direct data on ethnic inequalities in COVID-19 related mortality in the UK, we examine the relationship between ethnic composition of an area and rate of mortality in the area.MethodsEcological analysis using COVID-19 related mortality rates occurring by 24thApril 2020, and ethnic composition of the population, across local authorities in England and Wales. Account is taken of age, population density, area deprivation and pollution.ResultsFor every 1% rise in proportion of the population who are ethnic minority, COVID-19 related deaths increased by 5·10 (3·99 to 6·21) per million. This rise is present for each ethnic minority category examined. The size of this increase is a little reduced in a fully adjusted model, suggesting that some of the association results from ethnic minority people living in more densely populated, more polluted and more deprived areas.This estimate suggests that the average England and Wales COVID-19 related death rate would rise by 25% in a local authority with twice the average number of ethnic minority people.DiscussionWe find clear evidence that rates of COVID-19 related mortality within a local authority increase as the proportion of the population who are ethnic minority increases. We suggest that this is a consequence of social and economic inequalities, including among key workers, driven by entrenched structural and institutional racism and racial discrimination. We argue that these factors should be central to any investigation of ethnic inequalities in COVID-19 outcomes.

Objectives Volunteering after retirement age is beneficial to well-being. This study furthers previous research by presenting a longitudinal analysis of the well-being of volunteers, compared to non-volunteers, based on characteristics of the voluntary work in which they participate. Method Participants were 3,740 people aged State Pension Age and over from the English Longitudinal Study of Ageing. Longitudinal regression models were used to determine whether frequent volunteers saw beneficial changes in well-being (depression, satisfaction with life, CASP-19, and social isolation) compared to non-volunteers. The initial model used a hierarchical approach so that we could also examine the impact of social and health factors. Models were then run to determine whether well-being in relation to volunteering was influenced by its continuity, the number of activities engaged in, whether the volunteering was formal or informal in nature, and whether or not the respondent reported feeling appreciated for their efforts. Results Although sociodemographic and health circumstances reduce the magnitude of the effects of volunteering on well-being, the effect of volunteering remained significant in almost all analyses. The beneficial effect of volunteering appeared to stop among respondents who stopped volunteering between waves. The best outcomes were observed among those participating in higher numbers of activities, regardless of whether or not these were classed as formal or informal, and who felt appreciated for their work. Discussion Certain aspects of volunteering might be especially beneficial to the well-being of older people. That these effects stop when volunteering stops suggest a causal element to this relationship.

The UK health system must take urgent action to better understand and meet the health needs of migrants and ethnic minority people, say Sarah Salway and colleagues

SummaryIn this paper, we explore ethnic inequalities in severe mental illness and care experiences. We consider the barriers to progressive and cohesive action and propose ways of overcoming these. Clinical and policy leadership must bring together hidden patient voices, divergent professional narratives and quality research.Declaration of interestK.B. is Editor of the British Journal of Psychiatry, but has not played any role in the decision-making for this paper. K.B. leads and J.N. is a partner and K.H. a researcher in the Synergi Collaborative Centre.

China’s unprecedented population aging and social and economic change raise important issues concerning life course determinants of advantage or disadvantage into later life. Data from the China Health and Retirement Longitudinal Study (CHARLS) 2013 were analysed to identify the influence of childhood health on later life health as indicated by self-rated health and how this influence could be mediated by social and economic positions (SEP) and resources later in the life span. CHARLS provides nationally representative data on 18, 000 individuals aged 45 years and above in approximately 150 districts and 450 villages. Both multivariate logit regression model and KHB method (Karlson/Holm/Breen method) were applied to examine and decompose the life span influences on later life health. The results show that the childhood health, accounts for approximately half of the effect directly and another half of the effect indirectly through social and economic variations during adulthood. Relative living standard, marital status and urban residence are the most significant and important social and economic mediators for men; For women, living standard and secondary schooling are most influential while marital status is not significant. Implications for social and economic policies to improve later life health are discussed., Highlights • Early life health influences later life health • Early life health enables better education, adulthood SEP and resources • Lifelong disadvantage existed in health for women, minorities and rural residents • Impact of childhood health can be partially mediated by adulthood socio-economic positions and resources • Socio-economic positions and resources have larger influence on health for men than women

It is still unclear what the optimal structure of mental health care networks should be. We examine whether certain types of network structure have been associated with improved continuity of care and greater social integration. A social network survey was carried out, covering 954 patients across 19 mental health networks in Belgium in 2014. We found continuity of care to be associated with large, centralized, and homophilous networks, whereas social integration was associated with smaller, centralized, and heterophilous networks. Two important goals of mental health service provision, continuity of care and social integration, are associated with different types of network. Further research is needed to ascertain the direction of this association. Electronic supplementary material The online version of this article (doi:10.1007/s10488-017-0800-7) contains supplementary material, which is available to authorized users.

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults’ experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults’ sexual rights.\ud \ud