Investigating differences in common mental health symptom expression and co-occurrence across ethnicities

Ethnic inequalities exist in the prevalence of mental disorders and their associated treatment outcomes. Cultural variation may influence psychological symptom expression; understanding this might inform care and ultimately reduce care disparities. Data were used from n=147,037 individuals referred to psychological treatment services in London, England. Moderated network analysis was used to estimate the expression and co-occurrence of symptoms of depression, anxiety, and social functioning, while controlling for age and gender, and moderating for ethnicity (11 categories). There was substantial variation in symptom networks between ethnic groups. White British individuals showed the most differences compared to other ethnic groups, particularly in anxiety-related symptoms and functional impairment. Fewer differences were observed in symptom co-occurrence across ethnicities (the relationship between symptoms) compared to individual symptom variations (the effect of ethnicity on individual symptoms). The influence of ethnicity on mental health symptoms highlights the need for culturally appropriate assessment and care.