Decomposing mental health inequities: an Oaxaca-Blinder analysis of ethnic and gender disparities in the UK
Year: 2026
Type: article
Abstract: Background Ethnic minority women in the United Kingdom experience worse mental health than the general population, yet the mechanisms driving this gap remain unclear. This study examines how much of the gap is explained by differences in social determinants and how much reflects differential returns to those determinants across groups. Methods We used pooled data from 14 waves of the UK Household Longitudinal Study (2010–2024), comprising 291,711 person-wave observations from 50,336 unique individuals. We compared ethnic minority women with the rest of the UK adult population. Mental health was measured using the SF-12 Mental Component Summary and the GHQ-12 Likert scale. Oaxaca-Blinder decomposition with pooled coefficients separated the observed gap into an explained component, mapping to differential exposure in the Diderichsen framework, and an unexplained component, which contains both differential vulnerability and unmeasured factors. A within-women contrast was estimated as a co-equal main analysis, comparing ethnic minority women with white women only. Sensitivity analyses tested the robustness of results to carry-forward imputation, income specification, the inclusion of limiting illness, and within-person clustering. Secondary analyses examined ethnicity without gender and disaggregated ethnic groups. Results Ethnic minority women scored 1.83 points lower on the SF-12 ( p < 0.001) and 0.81 points higher on the GHQ-12 ( p < 0.001) than the rest of the population. A substantial share of the SF-12 gap was associated with differences in group characteristics, primarily age composition, home ownership, marital status, and neighbourhood cohesion, although the explained share varied across specifications (38% to 91% across the sensitivity analyses). The overall unexplained component was non-significant but masked substantial opposing effects: education was less protective of functional mental health for ethnic minority women, while home ownership was more protective. These differential vulnerability effects reversed between the SF-12 and the GHQ-12. The within-women contrast yielded a non-significant raw gap (0.60 points, p = 0.13) but a similar pattern of compositional disadvantage offset by differential returns. The mental health gap was not visible when ethnicity was examined without gender. Disaggregated analyses revealed distinct patterns: for Asian women, the GHQ gap was driven almost entirely by differential vulnerability, while for Black women, substantial compositional disadvantage was offset by protective differential returns. Conclusions The mental health gap between ethnic minority women and the rest of the UK population is substantial, and a large share is associated with differences in observed characteristics, notably age composition, home ownership, marital status, and neighbourhood cohesion. The unexplained component is sensitive to specification and should not be read as a clean estimate of differential vulnerability. Significant differential returns operate in opposing directions beneath the surface. The findings are consistent with two complementary policy directions: redistributing access to the social determinants associated with much of the observed gap, and addressing the structural conditions under which those determinants translate into mental health returns.
Authors: Facundo Herrera, Giuseppe Migali, Céu Mateus
Institution: Lancaster University
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,690
OpenAlex ID: W7203647601
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