O-43 Racism, immigration background, and adolescent mental health: an intersectional analysis of the London based DASH multi-ethnic cohort
Author(s):
S Harding, A Karamanos, C Nosarti, M Molokhia, S Ayis
Year of Presentation:
2026
Objective: Adolescent mental health inequalities are shaped by intersecting social positions. Quantitative evidence rarely examines how immigration background, racism, socioeconomic disadvantage, and gender jointly influence mental health. This study investigated intersectional patterns in adolescent mental health in the United Kingdom.
Methods: We analysed data from the Determinants of Adolescent Social Well-being and Health (DASH) longitudinal study, including 3,527 adolescents aged 11–16 years (7,054 pooled observations) from 51 secondary schools in London. Mental health outcomes were assessed using the Strengths and Difficulties Questionnaire (emotional symptoms, peer relationship problems, conduct problems, and hyperactivity/inattention). Intersectional strata were defined by gender, immigration background (UK-born vs. foreignborn), experiences of racism, and family socioeconomic circumstances. Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) models were fitted, adjusting for age and ethnicity, to estimate regression coefficients, variance partitioning, and predicted outcomes.
Results: Experiences of racism were consistently associated with worse mental health across all outcomes, including higher peer relationship problems (β=0.32, 95% CI 0.22– 0.42), emotional symptoms (β=0.59, 95% CI 0.46–0.71), conduct problems (β=0.45, 95% CI 0.32–0.59), and hyperactivity/inattention (β=0.50, 95% CI 0.36–0.63). Foreignborn adolescents reported higher peer relationship problems (β=0.33, 95% CI 0.21–0.44), but lower conduct (β=−0.15, 95% CI−0.30 to −0.00) and hyperactivity/inattention symptoms s (β=−0.29, 95% CI −0.46 to −0.13). Female adolescents had substantially higher emotional symptom scores (β=1.24, 95% CI 1.12–1.36) and lower conduct problems (β=−0.25, 95% CI −0.38 to −0.11). Intersectional analyses showed residual between-stratum variance, particularly for externalising symptoms, indicating nonadditive effects of intersecting social positions.
Conclusion: Adolescent mental health inequalities in the UK are fundamentally intersectional, with racism exerting a strong and pervasive effect across internalising and externalising outcomes. These findings highlight the limitations of single-axis analyses. Policies and interventions should address structural racism and socioeconomic disadvantage across intersecting social identities.