Intersectional inequalities in youth mental health measurement and outcomes: population-representative evidence from the UK Millennium Cohort Study
- 1UCL Centre for Longitudinal Studies, University College London, UK
Abstract
BackgroundPopulation-representative evidence on social inequalities in youth mental health from an intersectional perspective is limited. We investigated inequalities across multiple mental health outcomes among young adults and examined whether measures operated equivalently across social and intersectional groups.
MethodsCross-sectional analyses were conducted with 9,675 participants aged 23 years from the nationally representative UK Millennium Cohort Study (born 2000-2002). Self-reported outcomes included psychological distress (Kessler-6), probable serious psychological distress/ caseness (Kessler-6 score [≥]13), psychological wellbeing (Short Warwick-Edinburgh Mental Well-Being Scale; SWEMWBS), past-year self-harm, and lifetime suicide attempts. Measurement invariance analyses assessed comparability of the Kessler-6 and SWEMWBS across groups. Intersectional MAIHDA examined inequalities by sex assigned at birth, ethnic identity/background, sexual identity, and childhood poverty. Young people with lived experience of mental ill-health and/or social discrimination contributed to study design, interpretation, and reporting.
FindingsLarge inequalities were observed across all outcomes, with the largest disparities by sexual identity, followed by sex assigned at birth, childhood poverty history, and ethnic identity/background. Across intersectional strata, predicted psychological distress ranged from-0.27 to 1.32 SDs, and psychological wellbeing from-0.54 to 0.11 SDs. Predicted prevalence varied 6.99-fold (9.81% to 68.55%) for psychological distress caseness, 6.84-fold (8.60% to 58.79%) for self-harm, and 22.10-fold (1.96% to 43.32%) for suicide attempts. Young people at the intersection of sexual minority status, female birth sex, childhood poverty, and some ethnic minority identities/backgrounds experienced particularly poor outcomes. Most inequalities showed cumulative patterns consistent with additive expectations, although some intersectional groups experienced better or worse outcomes than expected. Accounting for measurement differences revealed inequalities that were otherwise undetected.
InterpretationFindings highlight the large extent of mental health inequalities when multiple dimensions of social (dis)advantage are considered, and the need to address both the social conditions generating these inequalities and the methodological assumptions shaping how they are measured and understood.
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BibTeX
@misc{morenoagostino2026intersectional,
title = {{Intersectional inequalities in youth mental health measurement and outcomes: population-representative evidence from the UK Millennium Cohort Study}},
author = {D. Moreno-Agostino and T. Steare and C. R. Evans and E. Fitzsimons and A. Phoenix and G. B. Ploubidis and U. Abid and Y. Nawaz and H. Pant and H. L. Fisher and P. Patalay},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.19.26365893},
url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365893v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Intersectional inequalities in youth mental health measurement and outcomes: population-representative evidence from the UK Millennium Cohort Study
AU - D. Moreno-Agostino
AU - T. Steare
AU - C. R. Evans
AU - E. Fitzsimons
AU - A. Phoenix
AU - G. B. Ploubidis
AU - U. Abid
AU - Y. Nawaz
AU - H. Pant
AU - H. L. Fisher
AU - P. Patalay
PY - 2026
DA - 2026/10/19
PB - medRxiv
DO - 10.64898/2026.10.19.26365893
UR - https://www.medrxiv.org/content/10.64898/2026.10.19.26365893v1
AB - BackgroundPopulation-representative evidence on social inequalities in youth mental health from an intersectional perspective is limited. We investigated inequalities across multiple mental health outcomes among young adults and examined whether measures operated equivalently across social and intersectional groups. MethodsCross-sectional analyses were conducted with 9,675 participants aged 23 years from the nationally representative UK Millennium Cohort Study (born 2000-2002). Self-reported outcomes included psychological distress (Kessler-6), probable serious psychological distress/ caseness (Kessler-6 score [≥]13), psychological wellbeing (Short Warwick-Edinburgh Mental Well-Being Scale; SWEMWBS), past-year self-harm, and lifetime suicide attempts. Measurement invariance analyses assessed comparability of the Kessler-6 and SWEMWBS across groups. Intersectional MAIHDA examined inequalities by sex assigned at birth, ethnic identity/background, sexual identity, and childhood poverty. Young people with lived experience of mental ill-health and/or social discrimination contributed to study design, interpretation, and reporting. FindingsLarge inequalities were observed across all outcomes, with the largest disparities by sexual identity, followed by sex assigned at birth, childhood poverty history, and ethnic identity/background. Across intersectional strata, predicted psychological distress ranged from-0.27 to 1.32 SDs, and psychological wellbeing from-0.54 to 0.11 SDs. Predicted prevalence varied 6.99-fold (9.81% to 68.55%) for psychological distress caseness, 6.84-fold (8.60% to 58.79%) for self-harm, and 22.10-fold (1.96% to 43.32%) for suicide attempts. Young people at the intersection of sexual minority status, female birth sex, childhood poverty, and some ethnic minority identities/backgrounds experienced particularly poor outcomes. Most inequalities showed cumulative patterns consistent with additive expectations, although some intersectional groups experienced better or worse outcomes than expected. Accounting for measurement differences revealed inequalities that were otherwise undetected. InterpretationFindings highlight the large extent of mental health inequalities when multiple dimensions of social (dis)advantage are considered, and the need to address both the social conditions generating these inequalities and the methodological assumptions shaping how they are measured and understood.
ER -