The influence of social stigma and discriminatory experience on psychological distress and quality of life among rural-to-urban migrants in China

The global literature has revealed a potential negative impact of social stigma on both physical and mental health among stigmatized individuals; however, the mechanisms through which social stigma affects the individual’s quality of life and mental health are not well understood. This research simultaneously examines the relationships of several determinants and mediating factors of psychological distress and quality of life. Data were collected through a cross-sectional survey among 1006 adult (predominantly male) rural-to-urban migrants in 2004–2005 in Beijing, China. Participants reported on their perceived social stigma, discriminatory experiences in daily life, preparation for migration, discrepancy between expectation and reality, coping with stigma-related stress, psychological distress, and quality of life. Structural equation modeling was performed. We found that perceived social stigma and discriminatory experiences had direct negative effects on psychological distress and quality of life among rural-to-urban migrants. Expectation-reality discrepancy mediated the effects of perceived social stigma and discriminatory experiences on psychological distress and quality of life; coping mediated the effect of social stigma on quality of life. Psychological distress was associated with quality of life. Preparation prior to migration was positively related to coping skills, which were positively related to quality of life. We conclude that perceived social stigma and daily discriminatory experiences have a significant influence on psychological distress and quality of life among rural-to-urban migrants. Pre-migration training with a focus on establishment of effective coping skills and preparation of migration may be helpful to improve their quality of life and mental health.     

Psychological distress among Thai migrant workers in Israel

The purpose of this cross-sectional study was to examine the associations between migration stressors and psychological distress among Thai migrant agricultural workers in Israel, and to examine the direct and indirect contribution of socio-cultural variables to this relationship. Two hundred and twenty-one Thai male workers were interviewed using a structured questionnaire that included demographic variables and occupational exposures to organophosphate pesticides (as control variables), migration stressors, intervening variables (traditional health beliefs, social support, drinking behavior, and utilization of medical services), and a psychological distress scale. In multivariate analysis, migration stressors, the migrants' traditional health beliefs, quality of current social relationships, drinking behavior, as well as age and occupational exposure were significantly associated with psychological distress. Workers who reported higher migration stressors (perceived the migration to be difficult, and often felt homesick), those with higher levels of traditional health beliefs, those whose social relationships with other Thai co-workers were poor, those who consumed either no alcohol or large amounts of alcohol, and those who reported 'problem drinking' had significantly higher levels of psychological distress. A moderating effect of the quality of social relationships with co-workers on the association between homesickness and psychological distress was found. Additionally, migrants aged 28-34 and those who were experiencing eye irritation from chemicals at work had significantly increased levels of distress. The findings demonstrate the focal role of specific migration stressors and the current socio-cultural context on psychological distress of migrant workers.     

Migration Circumstances,Psychological Distress,and Self-Rated Physical Health for Latino Immigrants in the United States

Objectives. We determined the impact of premigration circumstances on postmigration psychological distress and self-rated physical health among Latino immigrants.Methods. We estimated ordinary least squares and logistic regression models for Latino immigrants in the 2002–2003 National Latino and Asian American Study (n = 1603).Results. Mean psychological distress scores (range = 10–50) were 14.8 for women and 12.7 for men; 35% of women and 27% of men reported fair or poor physical health. A third of the sample reported having to migrate; up to 46% reported unplanned migration. In multivariate analyses, immigration-related stress was significantly associated with psychological distress, but not with self-rated health, for both Latino men and women. Having to migrate was associated with increased psychological distress for Puerto Rican and Cuban women respondents and with poorer physical health for Puerto Rican migrant men. Unplanned migration was significantly associated with poorer physical health for all Latina women respondents.Conclusions. The context of both pre- and postmigration has an impact on immigrant health. Those involved in public health research, policy, and practice should consider variation in immigrant health by migration circumstances, including the context of exit and other immigration-related stressors.Theories of acculturation, defined as “the acquisition of the cultural elements of the dominant society,”1^(p369) dominate Latino immigrant health research.2–4 Acculturation studies highlight important aspects of how individuals make meaning of their life experiences, including health experiences, through language, cultural norms, and values.5 In addition, studies of Latino mental health have demonstrated the influence of cultural change within immigrant families; uneven levels of acculturation within families can lead to family cultural conflict, which may have adverse mental health impacts.6,7Nevertheless, the focus on cultural determinants of health (i.e., acculturation) often comes at the expense of other factors related to migration, including social, political, and economic adversity in both places of origin and the United States.8–12 A particularly understudied set of influences on Latino immigrant health relates to the circumstances of departure, including whether individuals had to migrate because of political conflict, dire economic conditions, or other pressures.13 Exposure to such conditions in one’s place of origin may have lingering affects on mental health.14,15 The degree to which migration is planned might also have a long-term impact on health; unplanned migration may lead to a more sudden rupture of the social networks that support both psychological and physical well-being.16–19 Acculturation-focused studies typically do not consider the influence of migration or country-of-origin context on immigrant health, given that the frame of reference for acculturation is US society.11Stressors related to the conditions of migration include a set of social and structural inequities that immigrants may experience upon arriving and settling in the United States. These include unfair treatment attributable to legal status, nativity status, and accent, as well as unequal access to social benefits, such as health care.20–24 These forms of discrimination are often subsumed in the immigrant health literature within the construct of “acculturative stress,”25 suggesting erroneously that they can be attributed to an individual’s level of acculturation. More accurately, however, these stressors relate to the diverse social, political, and economic climates in receiving communities and not necessarily to whether immigrants have “acculturated.”8 For example, immigrants who are proficient in English may continue to experience discrimination based on their legal status.26 We therefore prefer the more expansive term “immigration-related stress” instead of “acculturative stress,” which is conceptually limited to the challenges involved with cultural change, including language learning and retention.27 Immigration-related stressors may comprise discrimination, including legal status discrimination, and may also refer to the challenges of familial cross-border separation, which does not necessarily relate to level of acculturation.28 Immigration-related stress has been shown to be associated with adverse health outcomes for specific Latino subgroups,3,29 but it has received less attention in national studies.We tested the relationship of migration circumstances to both psychological distress and self-rated physical health for a national sample of Latino immigrants in the United States. We hypothesized that stressful conditions leading to migration, as well as adverse experiences of arrival and settlement, would be associated with higher levels of psychological distress and poorer overall physical health. We expected that the relationships between premigration circumstances and health outcomes would be moderated by Latino subgroup, given that migration experiences vary greatly among Latino groups, which include peoples from distinct social, cultural, political, and economic contexts.30,31 For example, Puerto Rican–born migrants are US citizens and therefore have different conditions of migration than those migrating without legal documents or who have to navigate the immigration system for legal entry.32 In addition, some Latin American immigrants have faced distinct migration circumstances because of the political context in both their countries of origin and the United States. For example, early waves of Cuban migrants received refugee status and resettlement assistance,18 whereas the majority of those fleeing civil wars in Central America were never granted refugee status, limiting their access to benefits.30,33,34 For some Latino subgroups, such as Cubans and many Central and South Americans, unplanned or involuntary migration might refer more to political reasons for migration, or a combination of political and economic motivations,18 whereas for other groups (e.g., Puerto Ricans or Mexicans), identifying migration as involuntary or unplanned might refer more to dire economic circumstances or family obligations that motivated migration.32 We therefore hypothesized that circumstances of migration would be more strongly associated with poor health outcomes for Cubans and many other Latinos, given that many of these groups were motivated to migrate, at least in part, by political circumstances such as civil war or political persecution.We also hypothesized that migration circumstances would be related to psychological distress and physical health above and beyond measures of individual- and family-level acculturation. This reflects our argument that structural contexts can cause stress for Latino immigrants in both places of origin and of settlement.Finally, we expected to find different patterns in the association between migration circumstances and health outcomes by gender. In part, we expected that women would report higher levels of psychological distress than men, although there may be fewer differences in physical health outcomes. Men and women experience different migration circumstances, with significant variation by ethno-national subgroup.32–35 For example, Mexican women have historically been more likely to join family members already settled in the United States, although they are increasingly initiating migration; many Mexican men established migration networks in the 20th century through labor projects directly targeting male workers.36,37 Puerto Rican men were similarly recruited in the early and mid-20th century to work on the US mainland. Women became increasingly incorporated into circular labor migration patterns over the second half of the 20th century, often fulfilling familial and economic obligations in both Puerto Rico and the mainland.32,38 Central American and Dominican women were historically more likely to initiate migration in their family networks, taking jobs in factories or as domestic workers and facilitating men’s migration later on.33,34 Political refugees, including Cubans and some South Americans, were more likely to migrate as families.38 Given these differences, the meaning of migration planning and decision-making might vary qualitatively for men and women. This suggests the need for an analysis stratified by gender, although we expected that reporting unplanned migration or having to migrate (vs wanting to migrate) would be associated with poorer health for both men and women.Researchers have also documented gendered experiences of settlement for immigrants, including lesser access to legal and occupation-related resources for women compared with men,38,39 and greater continued attachment of women to countries of origin,40,41 with women more likely to maintain family caregiving roles both in places of settlement and abroad. These additional disadvantages resulting from stressful migration circumstances may lead to poorer health outcomes for female migrants than for male migrants, and they provide additional rationale for stratified analyses by gender, although we expected that immigration-related stressors would be negatively associated with psychological and physical health for both men and women.     

Spaces for smoking in a psychiatric hospital: Social capital,resistance to control,and significance for ‘therapeutic landscapes’

This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatric hospital in the North of England we explore the perceived significance for wellbeing of ‘smoking spaces’ (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatric hospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatric hospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider the implications for hospital design and the model of care.     

The mental health of foreign students

Because of the psychological stress associated with university life and the physical and mental stress associated with migration, researchers have become interested in psychological problems of foreign students. In this study four groups of foreign students from different parts of the world were compared with two British groups on a self-report measure of mental health. No sex differences were found yet the overseas students, as a whole, showed significantly more disturbance than either British control or first-year subjects. However, despite many differences between their countries of origin there were no significant differences between any of the overseas groups on the total scale score or any sub-scores. Further, with the exception of Malaysian students, the British subjects were significantly more satisfied with their social lives than the other groups. These findings are discussed in terms of the literature on life events and illness, culture shock and migration and mental health.     

Domestic conditions, paid employment and women's experience of ill-health

Traditionally, research concerned with the relationship between paid employment and women's experience of ill-health has focused on one or other of two competing explanatory models: the role enhancement model which postulates a positive health effect of paid employment and the role overload model which postulates a negative effect. Though a synthesis of these two models is becoming apparent in the literature (Arber 1990, 1991) a number of important issues remain neglected. This paper focuses on three of these neglected issues: the extent to which the relationship between employment and health is mediated by the nature and/or extent of the workload associated with both formal and domestic work; whether the relationship differs for different types of ill-health; and the role of health related selection into different social roles. Using data from the Health and Lifestyles survey, an innovative approach is taken to the measurement of domestic conditions, and separate measures of long-term health status, and of short-term physical and psychological health state are used. Proportional odds models are used to assess the relationship between employment status, domestic conditions and type of employment (measured in terms of the socio-economic group of a woman's own occupation) independent of underlying long-term health status. Our findings suggest that the presence of long-term illness is the single most powerful influence on present health state, but that this does not explain away the positive relationship between employment and women's health. They also suggest that this relationship is different for different types of ill health and is not the same for women in different types of occupation. In particular, our findings suggest that the association between paid work and better health is rather less apparent for physical than psychological health, and in women working full time in professional or managerial occupations. Domestic conditions appear to have an effect on women's health equal to or greater than employment status, depending on the health measure used. However, there was no evidence of an interaction between employment status and domestic conditions. We conclude with a discussion of the ways in which our findings fit in with those of previous research. We argue in particular for more attention to be given to the nature of both the dependent (‘health’) and explanatory (‘work’) variables used in research on the relationship between employment and women's health.     

Socio-geographic mobility and health status: A longitudinal analysis using the National Population Health Survey of Canada

The paper reviews arguments that associations between small area socio-economic conditions and individual health are likely to vary according to the type of health condition considered. We comment on the importance of longitudinal research to examine how far area conditions predict later health outcomes, and also how far area variations in health may result from selective migration processes predicted by health status. Using data for 1996 and 2002, from the National Population Health Survey of Canada, linked to small area data on social and on material deprivation in the area of residence for 6950 survey respondents at the two time points, we report on analyses to address these questions. The area measures of material and social deprivation were previously developed by Pampalon and colleagues at the Institut National de Santé Publique de Québec and related to the dissemination area matching the informant's postal code. The health outcomes considered were restriction of activity due to chronic conditions and psychological distress. Our findings suggest that individuals living in materially deprived areas in 2002 were more likely to be affected by health conditions resulting in restriction of activity. Prevalence of psychological distress was higher in areas with greater social deprivation in 2002. Most of these area differences were attenuated when adjustment was made for individual socio-demographic characteristics. Measures recorded in 1996 of individual characteristics and measures of deprivation for area of residence were used to predict change in health outcomes by 2002. Several individual factors (sex, age group, income, household composition) in 1996 were predictive of later health outcomes. After controlling for these individual characteristics the only significant association between health change and area deprivation was with development of restricted activity, which was more common among people who, in 1996, had lived in areas that ranked moderately high on material deprivation. We also report some evidence for selective migration effects, though these mainly seem to operate indirectly via socio-economic characteristics that predict both health outcomes and differential migration patterns. The clearest evidence on this point is for those in with psychological distress in 1996, who were particularly likely to move to an area which was more socially or materially deprived by 2002. This supports the idea that area differences in psychological distress are partly the result of selective migration effects.     

Socio-geographic mobility and health status: A longitudinal analysis using the National Population Health Survey of Canada

The paper reviews arguments that associations between small area socio-economic conditions and individual health are likely to vary according to the type of health condition considered. We comment on the importance of longitudinal research to examine how far area conditions predict later health outcomes, and also how far area variations in health may result from selective migration processes predicted by health status. Using data for 1996 and 2002, from the National Population Health Survey of Canada, linked to small area data on social and on material deprivation in the area of residence for 6950 survey respondents at the two time points, we report on analyses to address these questions. The area measures of material and social deprivation were previously developed by Pampalon and colleagues at the Institut National de Santé Publique de Québec and related to the dissemination area matching the informant's postal code. The health outcomes considered were restriction of activity due to chronic conditions and psychological distress. Our findings suggest that individuals living in materially deprived areas in 2002 were more likely to be affected by health conditions resulting in restriction of activity. Prevalence of psychological distress was higher in areas with greater social deprivation in 2002. Most of these area differences were attenuated when adjustment was made for individual socio-demographic characteristics. Measures recorded in 1996 of individual characteristics and measures of deprivation for area of residence were used to predict change in health outcomes by 2002. Several individual factors (sex, age group, income, household composition) in 1996 were predictive of later health outcomes. After controlling for these individual characteristics the only significant association between health change and area deprivation was with development of restricted activity, which was more common among people who, in 1996, had lived in areas that ranked moderately high on material deprivation. We also report some evidence for selective migration effects, though these mainly seem to operate indirectly via socio-economic characteristics that predict both health outcomes and differential migration patterns. The clearest evidence on this point is for those in with psychological distress in 1996, who were particularly likely to move to an area which was more socially or materially deprived by 2002. This supports the idea that area differences in psychological distress are partly the result of selective migration effects.     

Zweigeschlechtlichkeit und hierarchische Geschlechterordnung

The aims of this article are to illustrate how the discussion on inclusion of the social category gender has changed, which theoretical concepts determine this discussion and to which extent an institutionalisation has taken place with the objective of reducing gender-specific discrimination in the areas of health care as well as health sciences. To show this, in the first section three theoretical concepts will be explained which allow the meaning of gender as a central social category to be understood. These three concepts are (1) approaches to analyse gender as a social structural category, (2) social-constructivist approaches and (3) approaches that deal with symbolic-discursive orders. The second section presents an historic outline of female and gender-specific health sciences over the last 30 years with its different phases of discussion, especially regarding the process of the inclusion of gender in research work on health. The final third section relates the methodological thoughts deducted from the theoretical concepts as well as the historic discussion, resulting in the concepts of "gender bias" to the action-orientated approach of "gender mainstreaming".     

Measurement in Veterans Affairs Health Services Research: Veterans as a Special Population

Objective. To introduce this supplemental issue on measurement within health services research by using the population of U.S. veterans as an illustrative example of population and system influences on measurement quality.
Principal Findings. Measurement quality may be affected by differences in demographic characteristics, illness burden, psychological health, cultural identity, or health care setting. The U.S. veteran population and the VA health system represent a microcosm in which a broad range of measurement issues can be assessed.
Conclusions. Measurement is the foundation on which health decisions are made. Poor measurement quality can affect both the quality of health care decisions and decisions about health care policy. The accompanying articles in this issue highlight a subset of measurement issues that have applicability to the broad community of health services research. It is our hope that they stimulate a broad discussion of the measurement challenges posed by conducting "state-of-the-art" health services research.     

Psychosocial oncology research

In recent years, increased attention has been paid to psychosocial aspects of cancer treatment, recovery and survivorship because oncology health professionals have observed that psychological and social variables can influence the medical outcomes and quality of life of cancer patients. A number of theoretical and conceptual frameworks which might guide research in this field are suggested. Next, several methodological issues of concern to psychosocial; oncology researchers are examined. This is followed by a discussion of recent important findings from psychosocial oncology research and of their implications for social work practice. Finally, recommendations for future research in the field are offered.     

Beyond the Page: A Process Review of Using Ethnodrama to Disseminate Research Findings

Public health researchers are charged with communicating study findings to appropriate audiences. Dissemination activities typically target the academic research community. However, as participatory research grows, researchers are increasingly exploring innovative dissemination techniques to reach broader audiences, particularly research participants and their communities. One technique is ethnodrama/ethnotheatre, a written or live performance based on study findings. Though used effectively in social change programs, dramas are seldom used to distribute research findings exclusively. Therefore, little information is available about planning and implementing an ethnodrama for this purpose. We present a case study describing the process of planning and implementing an ethnodrama in the context of the Durham Focus Group Study, which explored men’s health-seeking behaviors and experiences with health and healthcare services in Durham, North Carolina. Here, we highlight lessons learned throughout the production of the ethnodrama, and how we addressed challenges associated with transforming research data into educational entertainment. Additionally, we provide discussion of audience feedback, which indicated that our ethnodrama evoked an urgency to change health behaviors among lay persons (67%) and delivery of health services among those identifying as providers (84%), pointing to the success of the performance in both entertaining and educating the audience.     

Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men

Both subjective and objective measures of lower social position have been shown to be associated with poorer health. A psychosocial, as opposed to material, aetiology of health inequalities predicts that subjective social status should be a stronger determinant of health than objective social position. In a workplace based prospective study of 5232 Scottish men recruited in the early 1970s and followed up for 25 years we examined the association between objective and subjective indices of social position, perceived psychological stress, cardiovascular disease risk factors and subsequent health. Lower social position, whether indexed by more objective or more subjective measures, was consistently associated with an adverse profile of established disease risk factors. Perceived stress showed the opposite association. The main subjective social position measure used was based on individual perceptions of workplace status (as well as their actual occupation, men were asked whether they saw themselves as "employees", "foremen", or "managers"). Compared to foremen, employees had a small and imprecisely estimated increased risk of all cause mortality, whereas managers had a more marked decreased risk. The strongest predictors of increased mortality were father's manual as opposed to non-manual occupation; lack of car access and shorter stature, (an indicator of material deprivation in childhood). In the fully adjusted analyses, perceived work-place status was only weakly associated with mortality. In this population it appears that objective material circumstances, particularly in early life, are a more important determinant of health than perceptions of relative status. Conversely, higher perceived stress was not associated with poorer health, presumably because, in this population, higher stress was not associated with material disadvantage. Together these findings suggest that, rather than targeting perceptions of disadvantage and associated negative emotions, interventions to reduce health inequalities should aim to reduce objective material disadvantage, particularly that experienced in early life.     

Associations between migrancy, health and homelessness: a cross-sectional study

There is limited awareness of the link between differing health problems and migrancy of homeless people. The present cross-sectional study sought to quantify the extent of migrancy of homeless people from their place of birth (PLOB) and evaluate whether a history of problematic drug use, alcohol misuse or enduring mental health problems were associated with migrancy from their PLOB. The work was conducted at an inner-city health centre for the homeless in the north of England. Place of birth was created as an entry on the computerised registration records. The PLOB was collected and recorded for each homeless person registering with the service over the study period. Information was also extracted regarding diagnoses of problematic illicit drug use, problematic alcohol use and enduring mental health problems for each homeless person. The study identified statistically significant differences for the migration of homeless people from their PLOB for age, problematic drug use and problematic alcohol use. Problematic alcohol use is independently associated with an increased likelihood of migration from the PLOB. Conversely, a history of illicit drug use is associated with a reduced possibility of migration from the PLOB when accessing primary healthcare services. There was no significant difference for migration from the PLOB for mental health. Not all homeless people migrate from their PLOB and health problems of drug use, mental health or alcohol use are independently associated with different patterns of migration. Understanding the migrancy of homeless people is important when planning and targeting appropriate health and social services to address their varying health, social and psychological needs.     

Health care policy: qualitative evidence and health technology assessment

Since the late 1990s health technology assessment (HTA) has gained influence as a research and evaluation approach supporting health care policy. The focus on this methodology is congruent with the growing importance of evidence-based health care. Although HTA is a multidisciplinary discipline from a theoretical point of view, practice shows that social, ethical and psychological aspects are seldom truly integrated into the assessment of health technology. HTA is still very much biased by the medical and pharmaceutical research traditions. This contribution focuses on the question of how qualitative research findings could be useful as an additional source of information or as 'evidence' in HTA. Medical and health care scientists are seldom acquainted with qualitative research or judge it as a less (or un-)reliable form of research. 'Qualitative dimensions' of health care are not considered 'real' evidence. This contribution argues that qualitative findings could be put higher in the hierarchy of evidence generating research in health care. First it can be realized by improving the knowledge of the nature of qualitative research. Second qualitative findings can become more trustworthy information, if researchers themselves respect methodological prerequisites and clarify their theoretical perspective, research aims and use of research methods. Some methodological characteristics of qualitative research and 'evidence' are discussed for their contribution to HTA and evidence-based health care.     

Unemployment and ill health: understanding the relationship.

OBJECTIVE--To review research relevant to understanding the psychological, social, and biological pathways by which unemployment may affect health risk; to consider the importance of four specific mechanisms; and to indicate some directions for future research. CRITERIA FOR INCLUSION AND EXCLUSION OF PUBLISHED STUDIES--Studies were chosen to illustrate the development of four major hypotheses regarding the relationship between unemployment and ill health, as well as the present state of knowledge. The review therefore includes some much-cited "classics" drawn from a long time span. Where recent reviews already exist relevant to individual mechanisms, these are referred to. Recent (since 1987) reports were sought by searching the BIDS data base. Particular effort was made to locate studies which enabled alternative hypotheses to be evaluated, and to point out where existing evidence is inconsistent or incomplete, indicating the need for further research. CONCLUSIONS--To understand the relationship between unemployment and ill health and mortality, four mechanisms need to be considered: the role of relative poverty; social isolation and loss of self esteem; health related behaviour (including that associated with membership of certain types of "subculture"); and the effect that a spell of unemployment has on subsequent employment patterns.     

The social production of health: critical contributions from evolutionary, biological, and cultural anthropology

In 1946, the newly formed World Health Organization boldly sought to conceptualize "health" as wellbeing in the positive sense, "not merely the absence of disease or infirmity." Yet nearly six decades later, researchers are still principally concerned with pathology and its characteristics and consequences. This special issue is the result of an effort to broaden the focus. Anthropologists working from evolutionary, biological and sociocultural perspectives and in diverse geographic regions were asked to examine meanings associated with health and/or to identify social conditions and practices that have contributed to positive physiological and psychological states in particular cultures, times, or across time. Most notable, perhaps, was discovering how difficult it is for Western social scientists to move beyond pathology-based thinking; most authors represented here regard health primarily as the absence of disease. Still, these papers articulate and address questions key to understanding health in and of itself, including: How is health conceptualized? What kinds of social conditions lead to health? And, how do social inequalities affect health? This introduction critically discusses previous work on the subject to contextualize the original research papers offered here.     

A review of epidemiological studies on the relationship of social networks and support to depressive symptoms in the elderly

This paper reviews evidence concerning the relationship of social support and networks to psychological well-being in elderly people. Although few studies have used comparative concepts and featured measurements of social networks and social support, the overall findings are that depressive symptoms in elderly people are associated with (a) smaller size of social networks which are supportive, (b) lower emotional support which is anticipated or received, (c) lower instrumental support which is anticipated, and (d) not providing support to others, and that depressive symptoms are greater when the amount of received instrumental support is larger. There is evidence consistent with both direct effects of social networks and support on reducing depressive symptoms, and buffering effects to protect persons from adverse effects of stressful life events. In addition, physical health status, activities of daily living, income, and marital status are associated with depression among the elderly. A well-conducted longitudinal study is essential for research in this area in Japan.     

Does social isolation,social support or loneliness influence health or well-being after a cardiovascular disease event? A narrative thematic systematic review

Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well-being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full-text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12–96 years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender-disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well-being outcomes after a CVD event.     

Perceived neighborhood social cohesion and subsequent health and well-being in older adults: An outcome-wide longitudinal approach

BackgroundGrowing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion's “dark side” and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes.MethodsData were from 12,998 participants in the Health and Retirement Study—a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing.ResultsPerceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period.ConclusionsWith further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being.