Intersectional Inequalities

Mental health research has long documented inequalities; between men and women, between ethnic groups, between those who grew up in poverty and those who did not. What it has done less well is capture what happens at the intersections. A young person who is a sexual minority, assigned female at birth, and grew up in poverty does not simply accumulate three separate disadvantages: their experience may be qualitatively different from the sum of its parts. Making the Margins Visible is a five-year Wellcome-funded research programme (April 2025–2030), led by Darío Moreno-Agostino (Principal Research Fellow in Population Mental Health, UCL Centre for Longitudinal Studies), using quantitative methods, intersectional theory, and large UK cohort data to map these patterns in detail, and to make the findings actionable for policy and practice. Co-investigators include Professor Jayati Das-Munshi, Professor Laia Bécares, and Professor Helen L. Fisher at King's College London, and Professor Praveetha Patalay, Professor George Ploubidis, and Professor Ann Phoenix at UCL.

The Research

The programme applies an intersectional framework, rooted in Crenshaw's (1989) foundational work and the Combahee River Collective's political tradition, to the quantitative study of youth mental health inequalities. Rather than treating sex, ethnicity, sexual identity, and socioeconomic position as separate predictors to be controlled for, the approach treats their combinations as units of analysis in themselves.

Study 1

Study 1 is a cross-sectional analysis of a UK birth cohort of 9,675 young people born between 2000 and 2002, at a key transitional life stage. Four mental health outcomes were examined: psychological distress (Kessler-6), psychological wellbeing (SWEMWBS), any self-harm in the past 12 months, and lifetime attempted suicide. Social positions were defined across four axes: sex assigned at birth, ethnic identity, sexual identity, and childhood poverty — producing up to 48 intersectional combinations. The study was pre-registered on OSF.

Key findings included large inequalities across almost all outcomes, with the largest gaps by sexual identity and sex assigned at birth. Sexual minority young people and those assigned female at birth consistently showed worse mental health outcomes. The gap in lifetime suicide attempts by childhood poverty was particularly stark: a 41.3 percentage point difference between the highest and lowest risk intersectional positions. Findings by ethnic identity were more mixed, a result that generated substantial discussion in YPAG and Policy and Impact Advisory Board sessions, with members raising questions about sample size, help-seeking behaviour, and the limitations of ethnicity categories in existing datasets.

The study also found that some intersectional positions showed outcomes that went beyond the sum of their parts, better or worse than would be predicted by adding up the individual effects of each identity. These non-additive effects point to possible buffering or amplifying dynamics at specific intersections that deserve further investigation. A further methodological contribution was demonstrating that standard mental health questionnaires may not measure the same constructs equivalently across all intersectional groups, a finding with direct implications for how inequalities are quantified and reported.

Study 2

Study 2 uses an Integrative Data Analysis approach, pooling data from five longitudinal UK studies (the Millennium Cohort Study, Next Steps, LSYPE-2, COSMO, and Understanding Society) to achieve a combined sample of up to 40,000 adolescents. The larger sample enables analysis of a broader range of social identities and reduces the sample size limitations that constrained inference in Study 1. The study examines psychological distress at ages 17–18 and extends the analytic approach to include additional predictors such as housing tenure, religion, region, school type, and parental employment. The protocol was pre-registered on OSF.

Study 3 and Beyond

Study 3 moves from self-reported mental health scales to administrative data: electronic health records linked to cohort survey data, allowing examination of intersectional inequalities in mental health service use, a complementary perspective that is less susceptible to the measurement differences identified in Study 1, and potentially more compelling for policymakers. A preliminary study examines how consent to data linkage itself varies across intersectional positions. Work Package 2 of the broader programme will extend the analyses longitudinally, asking whether specific intersectional groups are experiencing a greater share of the mental health declines documented in recent generations.

An early output from the team Moreno-Agostino et al. (2025) in Social Science & Medicine, examines COVID-19 impacts on population mental health trajectories by gender and socioeconomic status, illustrating the broader methodological approach the programme applies to intersectional questions.

My Involvement

I hold two roles on this project, as a member of the Young People's Advisory Group (YPAG) and as a member of the Policy and Impact Advisory Board (PIAB), a distinct group focused specifically on the policy and practice implications of the research.

In the YPAG, my involvement has included interpreting Study 1 findings, discussing how the results should be framed and communicated (including sensitivities around the childhood poverty and suicide attempt data), and co-developing the pre-registration protocol for Study 2. Sessions have focused on what the findings mean, what might explain them, and what the research team should do next.

In the PIAB, the focus shifts to actionability: which findings have the strongest policy implications, which audiences should be prioritised, and what formats would be most effective for reaching them. Discussions have covered potential engagement with the National Child Poverty Strategy, LGBTQI+ mental health charities, All-Party Parliamentary Groups, Ofsted, WHO, and local authorities — as well as more creative dissemination formats including poetry and infographics. The PIAB also considers how the political climate shapes what is feasible to communicate and when.