How do immigration background, racism, socioeconomic circumstances and gender intersect to influence adolescent mental well-being? A longitudinal MAIHDA analysis of the multiethnic DASH cohort in London, UK.

Introduction: Despite increasing awareness of ethnic inequalities in mental health, UK-based research on the mental health experiences of adolescent migrants remains limited. This gap is particularly notable given the backdrop of rising legal migration and increasingly politicised public narratives surrounding immigration. Drawing on intersectionality theory, this study examines adolescent mental well-being at the intersections of immigration background, racism, socioeconomic disadvantage and gender. Methods: The British Determinants of Adolescent Social Well-being and Health longitudinal study followed up an ethnically diverse sample of 11-13-year-olds in London, UK, between 2002-2003 and 2005-2006. Using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, we assessed the interplay between immigration background, racism, socioeconomic circumstances and gender using information on 4775 participants. Results: Notable intersectional inequalities involving immigration background, racism, socioeconomic disadvantage and gender were evident, regardless of age and ethnicity. These included UK-born males who reported racism and were least disadvantaged had higher predicted conduct symptom scores than foreign-born males who reported racism and were most disadvantaged. The lowest predicted conduct scores were among foreign-born females who did not report racism and were least disadvantaged (b=1.97, 95% CI 1.85 to 2.08). For hyperactivity, UK-born females who reported racism and were more disadvantaged had significantly higher scores than foreign-born males who did report racism and were more disadvantaged. The lowest hyperactivity scores were among foreign-born males who had not reported racism and were least disadvantaged (b=3.11, 95% CI 2.98 to 3.23). For internalising symptoms, foreign-born males who reported racism and were least disadvantaged had the highest peer relationship scores (b=2.46, 95% CI 2.35 to 2.58). Across all strata, females who reported racism had higher emotional symptom scores than those who did not, regardless of immigration status or socioeconomic circumstances. Conclusions: To fully understand inequalities in migrant adolescent mental well-being, the interplay between racism, socioeconomic disadvantage and gender must be explored.