Division of Psychiatry, University College London, London, UK.
Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
Lancet Psychiatry. 2024 Mar;11(3):183-192. doi: 10.1016/S2215-0366(23)00412-1.
In 2012, the UK Government announced a series of immigration policy reforms known as the hostile environment policy, culminating in the Windrush scandal. We aimed to investigate the effect of the hostile environment policy on mental health for people from minoritised ethnic backgrounds. We hypothesised that people from Black Caribbean backgrounds would have worse mental health relative to people from White ethnic backgrounds after the Immigration Act 2014 and the Windrush scandal media coverage in 2017, since they were particularly targeted.
Using data from the UK Household Longitudinal Study, we performed a Bayesian interrupted time series analysis, accounting for fixed effects of confounders (sex, age, urbanicity, relationship status, number of children, education, physical or mental health impairment, housing, deprivation, employment, place of birth, income, and time), and random effects for residual temporal and spatial variation. We measured mental ill health using a widely used, self-administered questionnaire on psychological distress, the 12-item General Health Questionnaire (GHQ-12). We compared mean differences (MDs) and 95% credible intervals (CrIs) in mental ill health among people from minoritised ethnic groups (Black Caribbean, Black African, Indian, Bangladeshi, and Pakistani) relative to people of White ethnicity during three time periods: before the Immigration Act 2014, after the Immigration Act 2014, and after the start of the Windrush scandal media coverage in 2017.
We included 58 087 participants with a mean age of 45·0 years (SD 34·6; range 16-106), including 31 168 (53·6%) female and 26 919 (46·3%) male participants. The cohort consisted of individuals from the following ethnic backgrounds: 2519 (4·3%) Black African, 2197 (3·8%) Black Caribbean, 3153 (5·4%) Indian, 1584 (2·7%) Bangladeshi, 2801 (4·8%) Pakistani, and 45 833 (78·9%) White. People from Black Caribbean backgrounds had worse mental health than people of White ethnicity after the Immigration Act 2014 (MD in GHQ-12 score 0·67 [95% CrI 0·06-1·28]) and after the 2017 media coverage (1·28 [0·34-2·21]). For Black Caribbean participants born outside of the UK, mental health worsened after the Immigration Act 2014 (1·25 [0·11-2·38]), and for those born in the UK, mental health worsened after the 2017 media coverage (2·00 [0·84-3·15]). We did not observe effects in other minoritised ethnic groups.
Our finding that the hostile environment policy worsened the mental health of people from Black Caribbean backgrounds in the UK suggests that sufficient, appropriate mental health and social welfare support should be provided to those affected. Impact assessments of new policies on minority mental health should be embedded in all policy making.
Wellcome Trust.
2012 年，英国政府宣布了一系列被称为“敌对环境”政策的移民政策改革，最终导致了“温德拉什丑闻”。我们旨在调查敌对环境政策对少数族裔背景人群心理健康的影响。我们假设，在 2014 年移民法案和 2017 年温德拉什丑闻媒体报道之后，来自加勒比黑人背景的人相对于白人背景的人会有更差的心理健康状况，因为他们是特别针对的目标。
使用来自英国家庭纵向研究的数据，我们进行了贝叶斯中断时间序列分析，考虑了混杂因素（性别、年龄、城市、关系状况、子女数量、教育、身体或精神健康障碍、住房、贫困、就业、出生地、收入和时间）的固定效应，以及剩余时间和空间变异的随机效应。我们使用广泛使用的自我管理问卷，即心理困扰 12 项一般健康问卷（GHQ-12）来衡量心理健康不良。我们比较了少数族裔（加勒比黑人、黑人、印度人、孟加拉人和巴基斯坦人）和白人在三个时间段内心理健康不良的平均差异（MD）和 95%可信区间（CrI）：在 2014 年移民法案之前、在 2014 年移民法案之后和在 2017 年温德拉什丑闻媒体报道开始之后。
我们纳入了 58087 名平均年龄为 45.0 岁（SD 34.6；范围 16-106）的参与者，其中包括 31168 名（53.6%）女性和 26919 名（46.3%）男性参与者。该队列由以下族裔背景的个体组成：2519 名（4.3%）黑人、2197 名（3.8%）加勒比黑人、3153 名（5.4%）印度人、1584 名（2.7%）孟加拉人、2801 名（4.8%）巴基斯坦人和 45083 名（78.9%）白人。在 2014 年移民法案之后和 2017 年媒体报道之后，来自加勒比黑人背景的人心理健康状况比白人更差（GHQ-12 评分中的 MD 为 0.67[95%CrI 0.06-1.28]）。对于在英国境外出生的加勒比黑人参与者，心理健康状况在 2014 年移民法案之后恶化（1.25[0.11-2.38]），而对于在英国出生的参与者，心理健康状况在 2017 年媒体报道之后恶化（2.00[0.84-3.15]）。我们在其他少数族裔群体中没有观察到影响。
我们发现敌对环境政策使英国的加勒比黑人背景人群的心理健康状况恶化，这表明应该向受影响的人群提供足够、适当的心理健康和社会福利支持。新政策对少数族裔心理健康的影响评估应该嵌入所有政策制定中。
惠康信托基金会。
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