Social capital and mental illness: a systematic review

STUDY OBJECTIVE: The concept of social capital has influenced mental health policies of nations and international organisations despite its limited evidence base. This papers aims to systematically review quantitative studies examining the association between social capital and mental illness. DESIGN AND SETTING: Twenty electronic databases and the reference sections of papers were searched to identify published studies. Authors of papers were contacted for unpublished work. Anonymised papers were reviewed by the authors of this paper. Papers with a validated mental illness outcome and an exposure variable agreed as measuring social capital were included. No limitations were put on date or language of publication. MAIN RESULTS: Twenty one studies met the inclusion criteria for the review. Fourteen measured social capital at the individual level and seven at an ecological level. The former offered evidence for an inverse relation between cognitive social capital and common mental disorders. There was moderate evidence for an inverse relation between cognitive social capital and child mental illness, and combined measures of social capital and common mental disorders. The seven ecological studies were diverse in methodology, populations investigated, and mental illness outcomes, making them difficult to summarise. CONCLUSIONS: Individual and ecological social capital may measure different aspects of the social environment. Current evidence is inadequate to inform the development of specific social capital interventions to combat mental illness.     

Social capital and health promotion: a review

Interest in social capital and health has emerged at an exciting time. In public health, there is a renewed interest in mechanisms that link social inequalities and health. In epidemiology, there has been a critical interrogation of methods and a call for a more explicit use of theory. In health promotion over the last 20-30 years, social health interventions have been somewhat marginalised in an era dominated by interest in traditional cardiovascular disease risk factors. Now that social hypotheses are being reborn in health, there is a risk that the sophistication that has developed in social health promotion and the literatures that have informed it could be overlooked. In this paper, we present a brief history of social capital and how it has come into recent prominence through the debate linking income inequality and health. We present the background to this, the earlier literatures on social environmental influences on health and the possible processes thought to underlie this relationship. Social capital has relational, material and political aspects. We suggest that, although the relational properties of social capital are important (eg, trust, networks), the political aspects of social capital are perhaps under recognised. The paper also reviews how complex social processes at the community level have come to be operationalised by social theorists and intervention agents in other fields. We suggest that social capital research so far has inadequately captured the underlying constructs, in particular the qualitative difference between the macro/context level and the micro/individual level. While being cautious about the science, we conclude that social capital's power as rhetoric and as a metaphor may be of value. We conclude by suggesting that the coalescence of interests in context-level influences on health now invites a revitalisation of theories and interventions inspired by diverse fields, such as geography and ecological community psychology.     

Social capital and health: a review of prospective multilevel studies

Background

This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention strategies that enhance social capital.

Methods

We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome.

Results

We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia.

Conclusions

Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health.Key words: health, literature review, multilevel analysis, prospective study, social capital     

Social capital, SES and health: an individual-level analysis

Stimulated by the finding (Kawachi et al., 1997) that social capital in communities may mediate the relationship between income inequality and health status, this article describes relationships between individual-level elements of social capital--trust, commitment and identity in the social-psychological dimension; participation in clubs and associations and civic participation in the action dimension--and self-rated health status, before and after controlling for human capital (socioeconomic status measured by income and education), using survey data collected in Saskatchewan, Canada (n = 534, 40% response rate). Income (P = 0.001) and education (P < 0.001) were related to health in the expected directions. Both income (P = 0.002) and education (P = 0.004) were related to health among the elderly; education (P = 0.035) to health among the middle-aged; and neither among the youthful respondents. Frequency of socialization with work-mates (P = 0.019) and attendance at religious services (P = 0.034) had the strongest (and positive) relationships with health of the social engagement questions, even after controlling for human capital, and participation in clubs and associations was positively related to health among the elderly (P = 0.009). But for commitment to one's own personal happiness (P = 0.039), trust, commitment and identification of various kinds were not significantly related to health. Civic participation was also unrelated to health. The main conclusion is that little evidence was found for compositional effects of social capital on health. Secondary findings are that the relationship between SES and health was the same for men and women and strongest among the elderly; that socialization with colleagues from work is relevant and that attendance at religious services and participation in clubs are related to health for the elderly.     

Social capital and mental health: a comparative analysis of four low income countries

Women and the poor are disproportionately affected by common mental disorders (CMD), and women in low income countries are particularly at risk. Social capital may explain some of the geographical variation in CMD, but the association between social capital and CMD in low income countries has rarely been studied. This paper aims to explore the relationship between individual and ecological measures of social capital and maternal CMD in four low income countries. Cross-sectional data from the Young Lives (YL) study with information across 234 communities in Peru, Ethiopia, Vietnam and Andhra Pradesh (India) were used. The mental health of mothers of one-year-old children (n=6909), and the individual cognitive and structural social capital of all respondents was assessed. Ecological social capital was calculated by aggregating individual responses to the community level. Multi-level modelling was used to explore the association between individual and ecological (community level) social capital and maternal CMD in each of the four countries, adjusting for a wide range of individual and community level confounders. The analysis shows that individual cognitive social capital is associated with reduced odds of CMD across all four countries. The results for structural social capital are more mixed and culturally specific, with some aspects associated with increased odds of CMD. This suggests that structural social capital has context-specific effects and cognitive social capital more universal effects on maternal CMD.     

Social capital and health: Does egalitarianism matter? A literature review

The aim of the paper is to critically review the notion of social capital and review empirical literature on the association between social capital and health across countries. The methodology used for the review includes a systematic search on electronic databases for peer-reviewed published literature. We categorize studies according to level of analysis (single and multilevel) and examine whether studies reveal a significant health impact of individual and area level social capital. We compare the study conclusions according to the country's degrees of economic egalitarianism. Regardless of study design, our findings indicate that a positive association (fixed effect) exists between social capital and better health irrespective of countries degree of egalitarianism. However, we find that the between-area variance (random effect) in health tends to be lower in more egalitarian countries than in less egalitarian countries. Our tentative conclusion is that an association between social capital and health at the individual level is robust with respect to the degree of egalitarianism within a country. Area level or contextual social capital may be less salient in egalitarian countries in explaining health differences across places.     

Social capital and health: a meta-analysis

The relationship between social capital and health has received extensive attention in fields such as public health, medicine, epidemiology, gerontology and other health-related disciplines. In contrast, the economics literature on this subject is relatively small. To address this research gap, we investigate the cross-disciplinary empirical literature using meta-analysis. We analyze 12,778 estimates from 470 studies. Our analysis finds that social capital is significantly related to a variety of positive health outcomes. However, the effect sizes are consistently very small. This finding is robust across different types of social capital (e.g., cognitive, structural, bonding, bridging, linking), and for many different measures of health outcomes (e.g., mortality, disease/illnesses, depression). The small effects that we estimate cast doubt on recent initiatives to promote health through social capital such as those by the WHO, the OECD, and US Healthy People 2020.     

Abortion and long-term mental health outcomes: a systematic review of the evidence

Claims that women who have elective abortions will experience psychological distress have fueled much of the recent debate on abortion. It has been argued that the emotional sequelae of abortion may not occur until months or years after the event. Despite unclear evidence on such a phenomenon, adverse mental health outcomes of abortion have been used as a rationale for policy-making. We systematically searched for articles focused on the potential association between abortion and long-term mental health outcomes published between January 1, 1989 and August 1, 2008 and reviewed 21 studies that met the inclusion criteria. We rated the study quality based on methodological factors necessary to appropriately explore the research question. Studies were rated as Excellent (no studies), Very Good (4 studies), Fair (8 studies), Poor (8 studies), or Very Poor (1 study). A clear trend emerges from this systematic review: the highest quality studies had findings that were mostly neutral, suggesting few, if any, differences between women who had abortions and their respective comparison groups in terms of mental health sequelae. Conversely, studies with the most flawed methodology found negative mental health sequelae of abortion.     

Social work and primary health care: an integrative approach

An interinstitutional, interagency Consortium has been formed in Houston to develop an innovative service model and provide interdisciplinary primary care/mental health training. The Houston Consortium Program integrates mental health professionals and trainees into the primary care framework of a neighborhood center serving a low-income, predominatly Mexican-American population. The introduction of mental health, psychosocial, and cross-cultural perspectives to complement the long-standing physiological concerns of health professionals fosters an holistic approach to patient care. The social workers' full participation as members of primary care teams builds upon their traditional training to provide them the experience and skills required to function effectively in the expanded coordinative capacity of health/mental health manager as defined by the President's Commission on Mental Health. It is anticipated that Consortium Program can serve as a heuristic model in the development of a nationwide pattern of comprehensive care.     

我国社会资本与老年心理健康研究的系统评价

目的对我国现有的社会资本与老年心理健康的定量研究进行系统评价,以明确社会资本与我国老年人心理健康的之间的关系。方法系统检索我国现有的社会资本与老年心理健康的研究文献,并按照一定的条件筛选,对纳入分析的研究提取数据,进行系统评价。用半定量的方法对纳入研究的文献进行系统分析。结果筛选后纳入文献25篇,合计样本量32580例。其中有18篇文献对认知型社会资本与老年心理健康的关系进行了研究,均显示认知型社会资本对老年心理健康具有促进作用;有13篇文献对结构型社会资本与老年人心理健康的关系进行了研究,11篇表明结构型社会资本也是老年心理健康的保护因素,另2篇则有相反的结果。结论认知型社会资本对老年心理健康具有促进作用,结构型社会资本与老年心理健康的关系尚存在争论,有待进一步探索。     

Social capital and access to primary health care in developing countries: Evidence from Sub-Saharan Africa

We test for a causal role of social capital, as measured by self-reported trust, in determining access to basic health facilities in Sub-Saharan Africa. To skirt the reverse-causality problems between social capital and basic health, we rely on instrumental-variable (IV) estimates. A one standard-deviation increase in trust is predicted to lead to a 0.22 standard-deviation fall in doctor absenteeism, a 0.31 standard-deviation fall in waiting time and a 0.30 standard-deviation fall in bribes. As a robustness check, we also use a different database regarding a different health issue, access to clean water. We find that a one standard-deviation rise in trust leads to a 0.33 standard-deviation rise in access to clean water. The variety of public goods considered provides insights about the possible channels through which social capital is converted into health improvements.     

Social ties and mental health

It is generally agreed that social ties play a beneficial role in the maintenance of psychological well-being. In this targeted review, we highlight four sets of insights that emerge from the literature on social ties and mental health outcomes (defined as stress reactions, psychological well-being, and psychological distress, including depressive symptoms and anxiety). First, the pathways by which social networks and social supports influence mental health can be described by two alternative (although not mutually exclusive) causal models—the main effect model and the stress-buffering model. Second, the protective effects of social ties on mental health are not uniform across groups in society. Gender differences in support derived from social network participation may partly account for the higher prevalence of psychological distress among women compared to men. Social connections may paradoxically increase levels of mental illness symptoms among women with low resources, especially if such connections entail role strain associated with obligations to provide social support to others. Third, egocentric networks are nested within a broader structure of social relationships. The notion of social capital embraces the embeddedness of individual social ties within the broader social structure. Fourth, despite some successes reported in social support interventions to enhance mental health, further work is needed to deepen our understanding of the design, timing, and dose of interventions that work, as well as the characteristics of individuals who benefit the most.     

Social inequality and health: the role of social capital

The aim of the article is to examine whether and to what degree the unequal distribution of social capital in the population explains the relationship between socioeconomic position and health in Norway. Theoretical insight and empirical evidence seem to suggest that social capital mediates the effect of socioeconomic position on health outcomes. However, only a few studies have addressed this question and those that have done so have used few and simple indicators of social capital. This study is based on a nationwide cross-sectional survey (N = 3190) commissioned by Statistics Norway. The survey was designed to cover a comprehensive set of variables measuring different aspects of the theoretical construct of social capital. Two health outcomes, self-perceived health and longstanding illness, were analysed. The results showed that the mediating role of social capital between socioeconomic position and health was negligible for both health outcomes. After controlling for socio-demographic variables and socioeconomic position, only neighbourhood satisfaction and generalised trust showed a significant association with self-perceived health, whereas none of the social capital variables had any significant association with longstanding illness. Some theoretical and methodological implications of the results are discussed.     

Social capital and health of older Europeans: causal pathways and health inequalities

This study uses a time-based approach to examine the causal relationship (Granger-like) between health and social capital for older people in Europe. We use panel data from waves 1 and 2 of SHARE (the Survey of Health, Ageing, and Retirement in Europe) for the analysis. Additional wave 3 data on retrospective life histories (SHARELIFE) are used to model the initial conditions in the model. For each of the first 2 waves, a dummy variable for involvement in social activities (voluntary associations, church, social clubs, etc.) is used as a proxy for social capital as involvement in Putnamesque associations; and seven health dichotomous variables are retained, covering a wide range of physical and mental health measures. A bivariate recursive Probit model is used to simultaneously investigate (i) the influence of baseline social capital on current health - controlling for baseline health and other current covariates, and (ii) the impact of baseline health on current participation in social activities - controlling for baseline social capital and other current covariates. As expected, we account for a reversed causal effect: individual social capital has a causal beneficial impact on health and vice-versa. However, the effect of health on social capital appears to be significantly higher than the social capital effect on health. These results indicate that the sub-population reaching 50 years old in good health has a higher propensity to take part in social activities and to benefit from it. Conversely, the other part of the population in poor health at 50, may see their health worsening faster because of the missing beneficial effect of social capital. Social capital may therefore be a potential vector of health inequalities for the older population.     

Community mental health: A review

Community mental health is the public health aspect of the mental health field. It is inhabited by a variety of mental health professionals in addition to psychiatrists; but it is inhabited also by social scientists, economists, politicians, social reformers, ex-patients and their families, and ordinary citizens. It needs to be differentiated from community psychiatry (which is the kind of psychiatry practiced by social system-oriented psychiatrists) and social psychiatry (which is really an interdiscipline in academia, comprising social scientists and psychiatrists who are concerned with understanding the ways in which behavioral science data illuminate human behavior, ordered and disordered). Community mental health has developed in full form largely in the past two decades, although its roots go far back in history beyond our own era. The particular themes which are intertwined in the matrix of community mental health are: (1) moral treatment, the focus on humane and humanistic approaches to the mentally disordered, and protection of their rights as citizens; (2) prevention of illness or of its consequences, the preventive medicine of psychiatry; (3) new developments and improvements in the techniques of clinical services in mental health care; and (4) The social concept of the right to health care, as it pertains to mental health programs and needs. The process by which these themes have been interwoven is one which has gone on at both federal and state-local levels, but the more enduring and significant process is that at the state-local level, as most extensively exemplified in the California system.