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

Abstract Background 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. Methods Data were analysed from 147,037 individuals referred to psychological treatment services in London, England. Moderated network analysis was used to examine the expression and co-occurrence of symptoms of depression, anxiety, and social functioning. Age and gender were included as covariates, and ethnicity (11 categories) was entered as the moderating variable. Symptom-level differences and differences in symptom-to-symptom relationships were estimated across all ethnic group comparisons. Results There was substantial variation in symptom networks between ethnic groups. White British individuals showed the most differences compared to other ethnic groups, particularly with higher endorsement of anxiety-related symptoms (e.g. nervousness and excessive worry) and greater reported functional impairment in work and social domains. Differences in symptom co-occurrence (the relationships between symptoms) were less frequent than differences in individual symptom levels. Across groups, several symptoms showed consistent relationships, suggesting shared aspects of distress alongside culturally patterned variation in symptom expression. Conclusions The influence of ethnicity on both symptom levels and symptom co-occurrence underscores the importance of culturally informed assessment. These findings highlight the need for services to consider culturally relevant symptom presentations to promote more equitable and appropriate mental health care.