Social Capital and Mental Health
Higher household income may help to reduce symptoms of depression by reducing financial stress and strengthening social support even within neighbourhoods with high concentrations of poverty, but it does not protect those residing in a high poverty community from distress associated with neighbourhood disorder or experiences of discrimination In an ecological study, the significant risk factors found for hospitalization included unemployment, poverty, physician supply, and hospital bed supply, and the significant protective factors were rurality, economic dependence, and housing stress Two cross-sectional studies included in this review , demonstrated that living in a neighbourhood with a higher percentage of residents of the same ethnicity was associated with depression.
Social Capital and Common Mental Disorder: A Systematic Review
Data from some prospective studies indicate socioeconomic status of neighbourhood of residence to be associated with incidence or worsening of depression independent of individual socioeconomic status and other individual covariates , while others did not support this association , In another study, living in a socially advantaged neighbourhood, with cultural services, near a park and having a local health service nearby were associated with lower risk of depression Some studies examined the impact of income inequality on mental health.
One cross-sectional study found significant associations between neighbourhood inequality and depression , and another found higher depressive symptoms in countries with greater income inequality and with less individualistic cultures 63 , independently of individual level effects. A longitudinal study found that income inequality did not correlate significantly with the presence of depressive symptoms Cross-sectional studies suggest that neighbourhood-level social capital , and its dimensions of availability and satisfaction with community services , , high collective efficacy and community participation reduce the likelihood of depressive symptoms.
One study found that major depression was not associated with social capital In an instance of the "dark side" of social capital, Takagi et al. Both neighbourhood disorder and community cohesion were related to PTSD symptoms after controlling for trauma exposure Life events mediate the relation between neighbourhood characteristics and depression Teychenne et al.
In the longitudinal studies reviewed, lower levels of social cohesion , of cognitive social capital , and of aesthetic quality , and higher levels of violence , were positively associated with incident depression. People who trusted their neighbours were less likely to develop major depression, but the association became non-significant after excluding participants with major depression at the baseline In another study, stronger perceived neighbourhood homogeneity was inversely associated with depressive mood, but, when participants who reported a depressive mood at baseline were excluded, stronger perceived heterogeneous network was inversely associated with depressive mood Both social support and neighbourhood collective efficacy moderated the effect of perceived discrimination on depressive symptoms Review of studies on the social determinants of suicide.
In this category we included 22 studies. The studies consisted of individual-level evidence case-control or cohort studies or aggregate ecological studies. Some studies have shown associations between suicide rates and indices of area deprivation , However, O'Reilly et al. Individual-level and population-based evidence suggested that low social capital , , low linking social capital , unemployment rate , the proportion of indigenous population , the proportion of population with low individual income and income inequality , particularly for those aged were significantly and positively associated with suicide.
Another study found no statistically significant independent association of a structural measure of neighbourhood social capital volunteerism with suicide In the studies reviewed on the geographical distribution, suicide rates were higher in rural areas ,, In a study in the US, rural decedents were less likely to be receiving mental health care and more likely to use firearms to commit suicide A study in England and Wales found higher rates of suicide in inner cities, but largely explained by the socioeconomic characteristics of these areas, and in coastal regions, particularly those in more remote regions.
The systematic reviews included in this study showed a mixed results on the associations between ethnic density and mental disorders, b limited research on the association between poverty and postnatal depression in low- and lower middle-income countries, with inconsistent results, and c support for the harmful effect of neighbourhood social disorder and, to a lesser extent, protective effect of neighbourhood socioeconomic status on depression.
Seventy-eight studies reported associations between individual-level factors and mental health. Given the large number of exposures considered in this review, some exposure-outcome pairs were examined by only a single study. Level of education, parenthood, rural-urban differences, low socioeconomic position and race were not associated with mental health outcomes in one study for each determinant.
Sixty-nine studies reported associations between area-level factors and mental health, 23 focusing on social capital, 36 on neighbourhood socioeconomic conditions, 15 on geographical distribution and built environment, 9 on exposure to neighbourhood problems, and 2 on ethnic composition. Ninety-two percent 12 of 13 of the studies assessing "cognitive" aspects of social capital found a statistically significant association between low social capital and poor mental health.
Statistically significant positive associations were found in 24 Income inequality was a risk factor for suicide in 2 studies, but results on the association with poor mental health and depression were conflicting. Unemployment rate emerged as a risk factor for poor mental health and suicide in 6 studies.
Being exposed to neighbourhood problems was associated with higher levels of psychological distress, depression and suicide in 11 studies, while the presence of stress-buffering mechanisms was statistically significantly and negatively associated with mental disorders. Urban neighbourhoods were associated with depression in 4 studies, but rural areas were associated with higher suicide rates than urban areas in other 4 studies. Poor quality built environment also emerged as a risk factor for depression in 3 studies, while neighbourhood walkability and living near a park were protective factors.
This review has some limitations, at review-level and at study- and outcome-level. Literature search was limited to articles focusing on individual and contextual determinants, and this search strategy may have contributed to an incomplete retrieval of studies. Several exclusion criteria were established in order to reduce the heterogeneity of studies and to make it possible to extract some conclusions, and this further narrowed the studies included.
We had no access to 31 of the articles assessed for eligibility, and that was a reason for exclusion. We included in the review the studies identified by the search strategy, but factors such as publication bias and selective reporting may contribute to a distorted perception of the results.
Social Capital and Mental Distress in an Impoverished Community
There was large heterogeneity between studies concerning study design and populations, determinants, outcome and instruments used. This heterogeneity only allows a few descriptive findings. Further empirical studies on social inequalities in health are needed to make sense of the mixed research findings, to understand the pathways through which they influence health, and to find out ways of reducing their magnitude. Two main mechanisms have been posited in understanding the link between mental illness and poor social circumstances: social causation and social selection.
According to the social causation hypothesis, socioeconomic standing has a causal role in determining health or emotional problems. Social selection hypothesis posits that genetically predisposed individuals with worse physical or emotional health may "drift down" the socioeconomic hierarchy or fail to rise in socioeconomic standing as would be expected on the basis of familial origins or changes in societal affluence.
Longitudinal studies, with multiple time point measures, are much needed in the future to clarify the causal direction between social determinants and mental health. The study of the associations between contextual SES and mental health also needs more powerful studies, using multilevel analyses and establishing mediating pathways and effect-modifying factors, in order to disentangle the individual effect from the neighbourhood effect on health.
The goal of this literature review was to identify the relevant published evidence on the associations between social determinants and mental health.
Social Capital Matters for the Mental Health of Children in Rural China - Chicago Policy Review
These disorders are highly prevalent, have severe consequences, and it is particularly important to improve our understanding of modifiable risk factors that may help to advance preventive efforts. For many decades, studies have shown that mental health is the complex outcome of numerous biological, psychological and social factors, involving contextual factors beyond the individual. Despite changes in concepts and methods used to define cases and measure socioeconomic status, the studies reviewed suggest that exposure to a wide range of social stressors continues to play an important role in the aetiology and the course of mental health problems and disorders.
Higher rates of mental disorders are associated with social disadvantage, especially with low income, limited education, occupational status and financial strain. Lack of social support, high-demand or low control over work, critical life events, unemployment, adverse neighbourhood characteristics, and income inequality were also identified as psychosocial risks that increase the chances of poor mental health.
Importantly, this review highlighted some important protective factors: having trust in people, feeling safe in the community, and having social reciprocity is associated with lower risk of mental health distress. Our results suggest that both individuals and neighbourhoods need to be targeted in order to enhance mental health. Saraceno argued that, in parallel to the classical biopsychosocial etiological hypothesis, an identical paradigm for mental health intervention is needed: "The social dimension of mental illness should be an intrinsic component of intervention and not just a concession in etiological modelling" In fact, the present review suggests that ameliorating the economic situation of individuals, enhancing community connectedness, and combating neighbourhood disadvantage and social isolation may improve population's mental health.
These results may be relevant to healthcare providers and to policy makers, and should be taken into account when designing policies and interventions aimed at improving treatment services, preventing mental disorders, and promoting mental health in different communities. The authors report no conflicts of interests. The authors alone are responsible for the content and writing of the paper. World Health Organization. The World Health Report: Mental health - new understanding, new hope. Geneva: World Health Organization; Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study Risks to Mental Health: an overview of vulnerabilities and risk factors.
Social characteristics of psychological distress in disadvantaged areas of Berlin. Int J Soc Psychiatry. The psychological well-being of the Chinese elderly living in old urban areas of Hong Kong: a social perspective. Aging Ment Health.
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