Skip to main content
×
Home
    • Aa
    • Aa

Effect of neighbourhood deprivation and social cohesion on mental health inequality: a multilevel population-based longitudinal study

  • D. Fone (a1), J. White (a2), D. Farewell (a1), M. Kelly (a3), G. John (a4), K. Lloyd (a5), G. Williams (a6) and F. Dunstan (a1)...
Abstract
Background

The common mental disorders (CMDs) of anxiety and depression are the most common form of poor mental health in the general population. Evidence from the small number of previous cohort studies on the role of neighbourhood factors in mental health is inconclusive. We tested the hypothesis that high levels of neighbourhood social cohesion modify an adverse association between change in individual mental health and neighbourhood deprivation.

Method

We carried out a longitudinal multilevel analysis using data from the Caerphilly Health and Social Needs Cohort Study with a 7-year follow-up (n = 4426; age range 18–74 years at baseline). Neighbourhood deprivation and neighbourhood social cohesion were assessed at baseline and change in mental health between follow-up and baseline was assessed using the five-item Mental Health Inventory (MHI-5).

Results

Residence in the most deprived neighbourhoods was negatively associated with change in mental health, after adjusting for baseline individual socio-economic risk factors and transitions in life events. This negative effect was significantly reduced in high social cohesion neighbourhoods. The predicted change in mental health score was calculated for the 10th and 90th centiles of the household low-income distribution. The difference between them was −2.8 in the low social cohesion group and 1.1 in the high cohesion group. The difference between the groups was 3.9 [95% confidence interval (CI) 0.2–7.6].

Conclusions

The public health burden of poor mental health and mental health inequality could potentially be reduced by strengthening social cohesion in deprived neighbourhoods. This offers a mechanism to address the adverse effect of neighbourhood deprivation on population mental health.

Copyright
Corresponding author
* Address for correspondence: D. Fone, Professor of Health Sciences Research, Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4YS, Wales, UK. (Email: foned@cf.ac.uk)
References
Hide All
AlmedomA (2005). Social capital and mental health: an interdisciplinary review of primary evidence. Social Science and Medicine 61, 943964.
BerwickDM, MurphyJM, GoldmanPA, WareJEJr, BarskyAJ, WeinsteinMC (1991). Performance of a five-item mental health screening test. Medical Care 29, 169176.
BlakelyTA, WoodwardAJ (2000). Ecological effects in multi-level studies. Journal of Epidemiology and Community Health 54, 367374.
BucknerJC (1988). The development of an instrument to measure neighbourhood cohesion. American Journal of Community Psychology 16, 771791.
CattellV (2001). Poor people, poor places, and poor health: the mediating role of social cohesions and social capital. Social Science and Medicine 52, 15011516.
ConnollyS, O'ReillyD, RosatoM (2007). Increasing inequalities in health: is it an artefact caused by the selective movement of people? Social Science and Medicine 64, 20082015.
CrockettA, AfkhamiR, RaffertyA, HigginsV, MarshallA (2011). Weighting the Social Surveys. ESDS Government. UK Data Archive and Institute for Social and Economic Research.
Croft-JefferysC, WilkinsonG (1989). Estimated costs of neurotic disorder in UK general practice. Psychological Medicine 19, 549558.
CuijpersP, SmitsN, DonkerT, ten HaveM, de GraafR (2009). Screening for mood and anxiety disorders with the five-item, the three-item, and the two-item Mental Health Inventory. Psychiatry Research 168, 250255.
De SilvaMJ, McKenzieK, HarphamT, HuttlySRA (2005). Social capital and mental illness: a systematic review. Journal of Epidemiology and Community Health 59, 619627.
DewaCS, ThompsonAH, JacobsP (2011). The association of treatment of depressive episodes and work productivity. Canadian Journal of Psychiatry 56, 743750.
DWP (2012). Households Below Average Income (HBAI): An Analysis of the Income Distribution 1994/95 – 2009/10. National Statistics. Department for Work and Pensions: London (www.gov.uk/government/publications/households-below-average-income-hbai-199495-to-200910). Accessed 2 December 2013.
FineB (2001). Social Capital Versus Social Theory. Political Economy and Social Science at the Turn of the Millennium, pp. 189190. Routledge: London.
FoneDL, DunstanFD, ChristieS, JonesA, WestJ, WebberM, LesterN, WatkinsJ (2006 a). Council tax valuation bands, socio-economic status and health outcome: a cross-sectional analysis from the Caerphilly Health and Social Needs Study. BMC Public Health 6, 115.
FoneDL, DunstanFD, JohnA, LloydK (2007 a). Associations between the common mental disorders and the Mental Illness Needs Index in community settings: a multilevel analysis. British Journal of Psychiatry 191, 158163.
FoneDL, DunstanFD, LloydK, WilliamsGH, WatkinsJ, PalmerSR (2007 b). Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis. International Journal of Epidemiology 36, 338345.
FoneDL, DunstanFD, WhiteJ, KellyM, FarewellD, JohnG, LyonsRA, LloydK (2012). Cohort profile: the Caerphilly Health and Social Needs Electronic Cohort Study (E-CATALYsT). International Journal of Epidemiology. Published online: 5 November 2012 . doi: 10.1093/ije/dys175.
FoneDL, FarewellDM, DunstanFD (2006 b). An ecometric analysis of neighbourhood cohesion. Population Health Metrics 4, 17.
FordE, ClarkC, McManusS, HarrisJ, JenkinsR, BebbingtonP, BrughaT, MeltzerH, StansfeldSA (2010). Common mental disorders, unemployment and welfare benefits in England. Public Health 124, 675681.
FryersT, MelzerD, JenkinsR (2003). Social inequalities and the common mental disorders. Social Psychiatry and Psychiatric Epidemiology 38, 229237.
HarphamT, GrantE, ThomasE (2002). Measuring social capital within health surveys: key issues. Health Policy and Planning 17, 106111.
HemingwayH, StaffordM, StansfeldS, ShipleyM, MarmotM (1997). Is the SF-36 a valid measure of change in population health? Results from the Whitehall II study. British Medical Journal 15, 12731279.
KawachiI, BerkmanLF (2000). Social cohesion, social capital, and health. In Social Epidemiology (ed. Berkman L. F. and Kawachi I.), Ch. 8, pp. 174190. Oxford University Press: New York.
KawachiI, KennedyBP, GlassR (1999). Social capital and self-rated health: a contextual analysis. American Journal of Public Health 89, 11871193.
KellyM, DunstanF, LloydK, FoneD (2008). Evaluating cutpoints for the MHI-5 and MCS using the GHQ-12: a comparison of five different methods. BMC Psychiatry 8, 10.
LaPierreTA (2012). The enduring effects of marital status on subsequent depressive symptoms among women: investigating the roles of psychological, social and financial resources. Journal of Epidemiology and Community Health 66, 10561062.
LloydKR, JenkinsR, MannA (1996). Long term outcome of patients with neurotic illness in general practice. British Medical Journal 313, 2628.
MacintyreS, EllawayA, CumminsS (2002). Place effects on health: how can we conceptualise, operationalise and measure them? Social Science and Medicine 55, 125139.
MacintyreS, McKayL, DerG, HiscockR (2003). Socio-economic position and health: what you observe depends on how you measure it. Journal of Public Health Medicine 25, 288294.
MairC, Diez RouxAV, GaleaS (2008). Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. Journal of Epidemiology and Community Health 62, 940946.
MairC, Diez RouxAV, ShenM, SheaS, SeemanT, EcheverriaS, O'MearaES (2009). Cross-sectional and longitudinal associations of neighborhood cohesion and stressors with depressive symptoms in the multiethnic study of atherosclerosis. Annals of Epidemiology 19, 4957.
McCabeCJ, ThomasKJ, BrazierJE, ColemanP (1996). Measuring the mental health status of a population: a comparison of the GHQ-12 and the SF-36 (MHI-5). British Journal of Psychiatry 169, 517521.
McKenzieK, WhitleyR, WeichS (2002). Social capital and mental health. British Journal of Psychiatry 181, 280283.
McManusS, MeltzerH, BrughaT, BebbingtonP, JenkinsR (2009). Adult Psychiatric Morbidity in England, 2007. Results of a Household Survey. The NHS Information Centre for Health and Social Care: London.
MerloJ (2003). Multilevel analytical approaches in social epidemiology: measures of health variation compared with traditional measures of association. Journal of Epidemiology and Community Health 57, 550552.
MuntanerC, LynchJ, Davy SmithG (2000). Social capital and the third way in public health. Critical Public Health 10, 107124.
MurayamaH, FujiwaraY, KawachiI (2012). Social capital and health: a review of prospective multilevel studies. Journal of Epidemiology 22, 179187.
NormanP, BoyleP, ReesP (2005). Selective migration, health and deprivation: a longitudinal analysis. Social Science and Medicine 60, 27552771.
PevalinDJ, GoldbergDP (2003). Social precursors to onset and recovery from episodes of common mental illness. Psychological Medicine 33, 299306.
PropperC, JonesK, BolsterA, BurgessS, JohnstonR, SarkerR (2005). Local neighbourhood and mental health: evidence from the UK. Social Science and Medicine 61, 20652083.
PutnamRD (1993). Making Democracy Work: Civic Traditions in Modern Italy. Princeton University Press: Princeton, NJ.
RaiD, KosidouK, LundbergM, ArayaR, LewisG, MagnussonC (2012). Psychological distress and risk of long-term disability: population-based longitudinal study. Journal of Epidemiology and Community Health 66, 586592.
RasbashJ, SteeleF, BrowneW, GoldsteinH (2009). A User's Guide to MlwiN version 2.10. Centre for Multilevel Modelling: University of Bristol.
RumpfH-J, MeyerC, HapkeU, JohnU (2001). Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Research 105, 243253.
RussTC, StamatakisE, HamerM, StarrJM, KivimäkiM, BattyGD (2012). Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. British Medical Journal 345, e4933.
SackerA, WigginsRD (2002). Age-period-cohort effects on inequalities in psychological distress, 1981-2000. Psychological Medicine 32, 977990.
SampsonRJ, MorenoffJD, Gannon-RowleyT (2002). Assessing ‘neighbourhood effects’: social processes and new directions in research. Annual Review of Sociology 28, 443478.
SingerJD, WillettJB (2003). A framework for investigating change over time. In Applied Longitudinal Data Analysis. Modelling Change and Event Occurrence, pp. 910. Oxford University Press: New York.
SkapinakisP (2007). Commentary: Socioeconomic position and common mental disorders: what do we need to know? International Journal of Epidemiology 36, 786788.
StaffordM, BartleyM, SackerA, MarmotM (2003). Measuring the social environment: social cohesion and material deprivation in English and Scottish neighbourhoods. Environment and Planning A 35, 14591475.
StaffordM, De SilvaM, StansfeldS, MarmotM (2008 a). Neighbourhood social capital and common mental disorder: testing the link in a general population sample. Health and Place 14, 394405.
StaffordM, Duke-WilliamsO, SheltonN (2008 b). Small area inequalities in health: are we underestimating them? Social Science and Medicine 67, 891899.
StaffordM, GimenoD, MarmotMG (2008 c). Neighbourhood characteristics and trajectories of health functioning: a multilevel prospective analysis. European Journal of Public Health 18, 604610.
SubramanianSV, KimDJ, KawachiI (2002). Social trust and self-rated health in US communities: a multilevel analysis. Journal of Urban Health 79, 521534.
SubramanianSV, LochnerKA, KawachiI (2003). Neighborhood differences in social capital: a compositional artifact or a contextual construct? Health and Place 9, 3344.
ThomasC, BenzevalM, StansfeldSA (2005). Employment transitions and mental health: an analysis from the British household panel survey. Journal of Epidemiology and Community Health 59, 243249.
ThomasC, BenzevalM, StansfeldS (2007). Psychological distress after employment transitions: the role of subjective financial position as a mediator. Journal of Epidemiology and Community Health 61, 4852.
WadeTJ, PevalinDJ (2004). Marital transitions and mental health. Journal of Health and Social Behaviour 45, 155170.
WareJEJr., GandekB (1998). Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. Journal of Clinical Epidemiology 51, 903912.
WareJEJr., KosinskiM, DeweyJE (2000). How to Score Version 2 of the SF-36® Health Survey. QualityMetric Incorporated: Lincoln, RI.
WareJEJr., KosinskiM, GandekB (1993). SF-36® Health Survey: Manual and Interpretation Guide. QualityMetric Incorporated: Lincoln, RI.
WeichS (1997). Prevention of the common mental disorders: a public health perspective. Psychological Medicine 27, 757764.
WeichS, TwiggL, LewisG, JonesK (2005). Geographical variation in rates of common mental disorders in Britain: prospective cohort study. British Journal of Psychiatry 187, 2934.
WhiteIR, RoystonP, WoodAM (2010). Multiple imputation using chained equations: issues and guidance for practice. Statistics in Medicine 30, 377399.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Fone supplementary material
Fone supplementary material

 Word (118 KB)
118 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 18
Total number of PDF views: 158 *
Loading metrics...

Abstract views

Total abstract views: 700 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th October 2017. This data will be updated every 24 hours.