Modelling mental health inequalities within an intersectional framework

By Kieran Balloo and Anesa Hosein

One of the unique angles of the #StudentWellLives Project is that we are using an intersectional approach to investigate mental health inequalities. Lawyer and scholar, Kimberlé Crenshaw, was the first person to come up with the term intersectionality. She wanted to show how discrimination in employment occurred for Black women – and that the discrimination did not occur because they were Black or because that they were women, but because they were Black women.

We, therefore, expect that when it comes to mental health, the inequalities may be occurring because of what Leslie McCall calls intercategorical complexity – i.e. depending on the multiple social categories that a young person may hold because of, for example, their sex, ethnicity, sexuality, socio-economic class (SEC), and education background. We aim to look at interactions between multiple social categories (e.g. comparing Black male student experiences with white female non-student experiences).

However, in doing this we face a challenge; a large part of the literature on intersectionality is based on qualitative research, much of which subscribes to the anticategorical approach in which McCall explains that social life is seen as being too complicated to be boxed into discrete categories. Whilst we broadly agree with this argument, and that everyone is an individual, in large-scale quantitative datasets such as the Next Steps Study that we are using, patterns are sought about the population to inform policy. Thus, an intercategorical approach is the methodological compromise we need to make. We are also considering these categories in a similar way to Rita Dhamoon and Olena Hankivsky, who contend that these the social categories are really just proxies for systemic privilege and oppression, such as sexism, racism, homophobia, and classism. Hence, through the intercategorical approach we aim to show that social inequalities are a result of structural power hierarchies that shape individuals’ experiences, and intersectionality captures the “numerous interlocking systems of privilege and oppression”, as suggested by Clare Evans and colleagues.

Traditionally, the intercategorical approach would involve an examination of the main effects (i.e. the social categories) and their interactions (i.e. the intersectionalities). We do, however, face some challenges if we use this approach. Firstly, we need to make sure that there are reasonable sample sizes in all of the combinations of social categories. Secondly, this can create some difficulties with interpretation because of the large number of interactions.

However, we may have found an alternative that can get around these challenges. Evans and colleagues recently published a very influential methodological paper about the use of the intercategorical approach in quantitative analyses. In their paper, they propose using multilevel modelling (also known as hierarchical linear modelling) to reflect the power hierarchies embedded in the social categories. The advantages of this approach are that the sample size becomes less of an issue, and the interpretation of the data across social categories can be more easily understood through the use of graphs.

We are still exploring this approach by Evans and colleagues, but we would be interested to hear from other researchers who have adopted a quantitative approach to intersectionality analyses, or those who might be interested in using this novel multilevel approach. Please leave a comment below or connect with us on Twitter: @uniwelllives #StudentWellLives.

Relevant Readings:

• Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1, 139-167.
• Dhamoon, R. K., & Hankivsky, O. (2011). Why the theory and practice of intersectionality matter to health research and policy. In O. Hankivsky (Ed.), Health inequities in Canada: Intersectional frameworks and practices (pp. 16–50). UBC Press.
• Evans, C. R., Williams, D. R., Onnela, J. P., & Subramanian, S. V. (2018). A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Social Science & Medicine, 203, 64-73.
• McCall, L. (2005). The complexity of intersectionality. Signs: Journal of women in culture and society, 30(3), 1771-1800.