Social capital and the course of depression: six-month prospective cohort study

A Multi- Mediation Analysis on the Impact of Social Media and Internet Addiction on University and High School Students' Mental Health Through Social Capital and Mindfulness

INTRODUCTION

Social media addiction (SMA) and internet addiction (IA) are increasingly prevalent, impacting mental health (MH) globally. This study investigates the mediating roles of mindfulness and social capital (SC) in the relationship between SMA, IA, and MH among Ethiopian high school and university students, contributing to the Sustainable Development Goal (SDG) 3 of good health and well-being.

METHODS

A cross-sectional study was conducted with 1160 university and 1473 high school students in Dessie, Ethiopia. Participants completed validated questionnaires assessing SMA, IA, mindfulness, SC, and MH. Structural Equation Modeling (SEM) with a multi- mediation Model (SMM) was used to examine the hypothesized relationships.

RESULTS

SEM revealed that both SMA and IA had a direct negative effect on mindfulness, SC, and MH in in both high school and university students. Notably, mindfulness and SC significantly and positively predicted MH, indicating their protective role against the negative effects of SMA and IA. Furthermore, both mindfulness or SC fully or partially mediated the relationship between SMA, IA, and MH, highlighting their crucial role in explaining the association.

CONCLUSIONS

This study provides evidence for the crucial roles of mindfulness and SC in buffering the negative effects of SMA and IA on MH among Ethiopian students. The findings highlight the need for educational and health interventions that foster mindfulness and SC to enhance student mental health and promote a healthy digital environment. These results offer valuable insights for educators, health professionals, and policymakers in Ethiopia and other developing countries facing similar challenges.

The neuroanatomy of social trust predicts depression vulnerability

Trust attitude is a social personality trait linked with the estimation of others’ trustworthiness. Trusting others, however, can have substantial negative effects on mental health, such as the development of depression. Despite significant progress in understanding the neurobiology of trust, whether the neuroanatomy of trust is linked with depression vulnerability remains unknown. To investigate a link between the neuroanatomy of trust and depression vulnerability, we assessed trust and depressive symptoms and employed neuroimaging to acquire brain structure data of healthy participants. A high depressive symptom score was used as an indicator of depression vulnerability. The neuroanatomical results observed with the healthy sample were validated in a sample of clinically diagnosed depressive patients. We found significantly higher depressive symptoms among low trusters than among high trusters. Neuroanatomically, low trusters and depressive patients showed similar volume reduction in brain regions implicated in social cognition, including the dorsolateral prefrontal cortex (DLPFC), dorsomedial PFC, posterior cingulate, precuneus, and angular gyrus. Furthermore, the reduced volume of the DLPFC and precuneus mediated the relationship between trust and depressive symptoms. These findings contribute to understanding social- and neural-markers of depression vulnerability and may inform the development of social interventions to prevent pathological depression.

A Nationwide Evaluation of the Prevalence of Human Papillomavirus in Brazil (POP-Brazil Study): Protocol for Data Quality Assurance and Control

BACKGROUND

The credibility of a study and its internal and external validity depend crucially on the quality of the data produced. An in-depth knowledge of quality control processes is essential as large and integrative epidemiological studies are increasingly prioritized.

OBJECTIVE

This study aimed to describe the stages of quality control in the POP-Brazil study and to present an analysis of the quality indicators.

METHODS

Quality assurance and control were initiated with the planning of this nationwide, multicentric study and continued through the development of the project. All quality control protocol strategies, such as training, protocol implementation, audits, and inspection, were discussed one by one. We highlight the importance of conducting a pilot study that provides the researcher the opportunity to refine or modify the research methodology and validating the results through double data entry, test-retest, and analysis of nonresponse rates.

RESULTS

This cross-sectional, nationwide, multicentric study recruited 8628 sexually active young adults (16-25 years old) in 119 public health units between September 2016 and November 2017. The Human Research Ethics Committee of the Moinhos de Vento Hospital approved this project.

CONCLUSIONS

Quality control processes are a continuum, not restricted to a single event, and are fundamental to the success of data integrity and the minimization of bias in epidemiological studies. The quality control steps described can be used as a guide to implement evidence-based, valid, reliable, and useful procedures in most observational studies to ensure data integrity.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/31365.

Social Capital as a Mediator through the Effect of Education on Depression and Obesity among the Elderly in China

Objectives: Global aging is an increasingly serious problem. The health problems faced by the elderly, such as depression and obesity, require serious consideration. Education, depression and obesity are inextricably linked; for the elderly, education is constant, and the factors which can mediate the relationship between education, depression and obesity are still being discussed by scholars. The mediating effect of social capital is rarely studied. The objective of this study was to assess the mediating role of cognitive social capital and structural social capital, as well as the effect of education on depression and obesity among the elderly using China Family Panel Studies (CFPS) data. Methods: In total, 4919 respondents were included in the final analysis. Education was measured by years of schooling. Trust and participation were used as measures of cognitive social capital and structural social capital. Depression symptoms and BMI were used as outcomes. Structural equation models were developed to examine the direct and indirect effect of social capital and education on health outcomes. Results: Education was negatively correlated with depression symptom (r = −0.15, p < 0.001), while education was positively correlated with BMI (r = 0.08, p < 0.001). Older adults with a higher education level have higher cognitive social capital (r = 0.11, p < 0.001) and structural social capital (r = 0.20, p < 0.001). Social capital plays a mediatory role. Older adults with higher social capital have a lower risk of depression (cognitive: r = −0.23, p < 0.001; structural: r = −0.03, p < 0.01) but a higher risk of obesity (cognitive: r = 0.06, p < 0.01; structural: r = 0.03, p < 0.01). For depression, the mediating function of cognitive social capital (a1b1= −0.025) is stronger than that of structural social capital (a2b2 = −0.006). While, for obesity, the effects of both cognitive and structural social capital are the same (a1c1 = a2c2 = 0.005). Conclusions: Social capital as a mediator through the effect of education on depression and obesity among the elderly in China. Meanwhile, using the positive effects of social capital to avoid negative effects should also be seriously considered.

Self-stigma as a mediator between social capital and empowerment among people with major depressive disorder in Europe: The ASPEN study

Introduction:

Individual social capital has been recognized as having an important role for health and well-being. We tested the hypothesis that poor social capital increases internalized stigma and, in turn, can reduce empowerment among people with major depressive disorder (MDD).

Materials and methods:

This is a cross-sectional multisite study conducted on a sample of 516 people with MDD in 19 European countries. Structural Equation Models were developed to examine the direct and indirect effects of self-stigma and social capital on empowerment.

Results:

Social capital and self-stigma accounted for 56% of the variability in empowerment. Higher social capital was related to lower self-stigma (r = –0.72, P < 0.001) which, in turn, partially mediated the relationship between social capital and empowerment (r = 0.38, P < 0.001).

Conclusions:

Social capital plays a key role in the appraisal of empowerment, both directly and through the indirect effect mediated by self-stigma. In order to improve empowerment of people with MDD, we identify strategies to foster individual social capital, and to overcome the negative consequences related to self-stigma for attainment of life goals.

A cohort longitudinal study of individual level social capital and depressive symptoms in the Wisconsin Longitudinal Study

This study examined the association between two dimensions of social capital, structural and cognitive, and depression, as well as investigating their within- and between-effects. Using the Wisconsin Longitudinal Study, I applied a multi-level 2-wave longitudinal analysis, over a 7-year period, to examine these two dimensions of social capital influence on individual's depressive symptoms at both the between- and within-person levels. Results suggest both dimensions of social capital are negatively related with levels of depressive symptoms. The within-person changes for both self-efficacy and sense of belonging were larger than the estimates of between-effects, while trust and structural social capital effects were equal. These findings add to the growing body of literature examining depressive symptoms in late life, while also providing evidence for policymakers to hone in on key areas that can address depressive symptoms with social capital interventions.

The Relationship Between Social Capital and Depressive Symptoms Among the Elderly in China: The Mediating Role of Life Satisfaction

Background and Aim

Depression has become a serious health and social issue in recent years in China. This study aims to explore the relationship between social capital and depressive symptoms among the elderly in China, with a particular focus on the mediating role of life satisfaction.

Methods

The data of this study were sourced from the 2016 wave of China Family Panel Studies (CFPS), involving 1243 older adults aged 60 and above. A multiple linear regression model was used to explore the impact of social capital on depressive symptoms. Moreover, the add-on PROCESS macro for SPSS was employed to measure the mediating effect of life satisfaction on the relationship between social capital and depressive symptoms.

Results

The regression results suggest that CES-D score was associated with trust (coefficient = −0.1013, p < 0.01). In addition, the protective role of trust was significantly stronger for older adults aged 70–79, women, the poorest 1/3, and the elderly who live in rural areas. Moreover, the mediation analysis results suggest that the effect of trust on depressive symptoms was fully mediated by life satisfaction.

Conclusion

This study reveals that social capital has a positive effect on depressive symptoms among the elderly, and the positive health effect shows significant age, gender, income, and location inequalities. Furthermore, this study also provides new evidence indicating that life satisfaction fully mediates the relationship between social capital and depressive symptoms. Improving social capital could be a promising way for China to promote healthy aging in the future.

Cultural adaptation framework of social interventions in mental health: Evidence-based case studies from low- and middle-income countries

BACKGROUND

Evidence-based strategies for treating mental health conditions need to be scaled up to address the mental health treatment gap in low- and middle-income countries. Most medical and psychological interventions for the treatment of mental health conditions have been developed and evaluated in high-income countries. However, the imperative of scaling up such interventions potentially ignores local realities, and may also discredit or replace local frameworks for responding to distress.

AIMS

This article aims to develop a framework for the cultural adaptation of social interventions which are developed within, and draw upon, local contexts, to ensure they are acceptable, feasible and effective.

METHOD

A case study approach is used to discuss the feasibility of developing and adapting psychosocial interventions which are embedded in local knowledge, values and practices.

RESULTS

The first case study introduces yoga as an alternative and/or complementary, and culturally relevant, approach for people experiencing mental health conditions in India. The second case study is a cross-cultural adaptation of a psychosocial intervention from the United Kingdom to fit the local idioms of distress and service context in Sierra Leone, as the country battled with the Ebola outbreak. We use these case studies to develop a Cultural Adaptation Framework, which recognises that people and their mental health are products of their culture and society, to inform the future development, adaptation and evaluation of sociocultural interventions for people experiencing mental health conditions in low- and middle-income countries.

CONCLUSION

The Cultural Adaptation Framework can be used to ensure interventions are culturally relevant and responsive to local conditions prior to evaluating in experimental studies.

Ontario Brain Injury Association Peer Support Program: a mixed methods protocol for a pilot randomised controlled trial

INTRODUCTION

The objective of this study is to conduct a pilot randomised controlled trial (RCT) of the Ontario Brain Injury Association (OBIA) Peer Support Program. The RCT is designed to evaluate the effectiveness and dose-response of the Peer Support Program in improving participation and mood for people with moderate-to-severe traumatic brain injury compared with a wait-list control group.

METHODS AND ANALYSIS

The proposed research is a three-phase, mixed methods pilot RCT. Consistent with an integrated knowledge translation approach, the study design has been informed in consultation with the knowledge user (ie, OBIA). It will include an initial qualitative examination of barriers and enablers to the trial implementation (phase 1), a pilot RCT (phase 2) and conclude with a qualitative component (phase 3). A qualitative descriptive approach will be adopted for both qualitative phases of the study (n=20-25) and thematic analysis will be used. The 6 months phase-2 trial will be conducted with 60 participants. These participants will be randomised to one of three groups: a twice a week programme (n=20), a once a week programme (n=20) or the wait-list control group (n=20). The feasibility of participant recruitment and retention, data collection, as well as participant adherence to the OBIA Peer Support Program will be evaluated. The primary outcome measure will be participation, as measured by the Participation Assessment with Recombined Tools-Objective. Other proposed outcomes of interest will include mood, health-related quality of life and self-efficacy.

ETHICS AND DISSEMINATION

Ethics approval will be obtained from the principal author's institution (University Health Network Research Ethics Board). The results of this study will inform the development of a larger scale RCT and will inform future iterations of the OBIA Peer Support Program including a revised programme curriculum.

TRIAL REGISTRATION NUMBER

NCT03450460; Pre-results.

Network-based and cohesion-based social capital and variations in depressive symptoms among Taiwanese adults

BACKGROUND

Network- and cohesion-based social capital may play an important role in improving mental health. However, there is limited understanding about these relationships among adults in Taiwan.

AIM

The aim of this study was to examine the association between individual-level network and cohesion-based social capital and depressive symptoms among a population-based sample of Taiwanese adults.

METHODS

Data were obtained from the 1997 Taiwan Social Change Survey (n = 2,598). The 20-item Center for Epidemiological Studies Depression Scale was used to measure depressive symptom scores; ⩾16 represented high depressive symptoms. Network-based social capital was measured using a position generator. Two dimensions of cohesion-based social capital were assessed: cognitive (perceived neighborhood trust and reciprocity) and structural (local community participation and organizational participation). Multivariable log-binomial regression models, weighted to account for the complex sampling design and adjusted for confounders, estimated prevalence ratios and 95% confidence intervals (CIs) to examine the association between each social capital measure and depressive symptoms.

RESULTS

In this study, 29.6% of respondents were classified as having high depressive symptom scores. Higher scores of composite cognitive social capital (adjusted Prevalence Ratios (aPR)  = 0.92, 95% CI = [0.90, 0.95]) and structural social capital (aPR = 0.80, 95% CI = [0.65, 0.99]) were associated with a lower likelihood of high depressive symptom scores after controlling for confounders. However, there was no association between network social capital and depressive symptoms.

CONCLUSION

The findings suggest that the relationship between social capital and depressive symptoms in Taiwan differs according to the specific dimension of social capital assessed. Differentiating between network- and cohesion-based social capital merits greater attention to inform our understanding of building social capital to promote and improve mental health outcomes.

Social network analysis of psychological morbidity in an urban slum of Bangladesh: a cross-sectional study based on a community census

OBJECTIVES

To test whether social ties play any roles in mitigating depression and anxiety, as well as in fostering mental health among young men living in a poor urban community.

SETTING

A cohort of all young men living in an urban slum in Dhaka, the capital of Bangladesh.

PARTICIPANTS

All men aged 18-29 years (n=824) living in a low-income urban community at the time of the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Unspecified psychological morbidity measured using the General Health Questionnaire, 12-item (GHQ-12), where lower scores suggest better mental status.

RESULTS

The GHQ scores (mean=9.2, SD=4.9) suggest a significant psychological morbidity among the respondents. However, each additional friend is associated with a 0.063 SD lower GHQ score (95% CI -0.106 to -0.021). Between centrality measuring the relative importance of the respondent within his social network is also associated with a 0.103 SD lower GHQ score (95% CI -0.155 to -0.051), as are other measures of social network ties. Among other factors, married respondents and recent migrants also report a better mental health status.

CONCLUSIONS

Our results underscore the importance of social connection in providing a buffer against stress and anxiety through psychosocial support from one's peers in a resource-constraint urban setting. Our findings also suggest incorporating a social network and community ties in designing mental health policies and interventions.

Stigma Towards Depression in Rural Ireland: A Qualitative Exploration

The configuration of one's social environment influences the course and experience of depression. Research suggests that experiencing depression is associated with stigmatisation and the concomitant experiencing of discrimination across many facets of social life. This is identified as a particularly important factor in rural communities. Contemporary work is absent in relation to understanding the stigma towards depression in Ireland, and its manifestation in rural Ireland specifically. Evidence is presented which suggests that depression is a significant source of stigmatisation in this setting, and that entrenched views centring upon disability and fear are prevalent.

The dark side of social capital: A systematic review of the negative health effects of social capital

There is a growing literature demonstrating the health benefits of social capital (defined as the resources accessed through social connections). However, social capital is also acknowledged to be a "double-edged" phenomenon, whose effects on health are not always positive. We sought to systematically review studies that have found a negative (i.e. harmful) association between social capital and health outcomes. Our objective was to classify the different types of negative effects, following a framework originally proposed by Portes (1998). We conducted a literature search in Pubmed, Embase and PsychInfo. We identified 3530 manuscripts. After detailed review, we included 44 articles in our systematic review. There are at least two negative consequences of social capital besides the classification proposed by Portes: behavioral contagion and cross-level interactions between social cohesion and individual characteristics. When leveraging the concept of social capital for health promotion interventions, researchers need to take account of these potential "downsides" for health outcomes.

A review of social participation interventions for people with mental health problems

PURPOSE

The association between social networks and improved mental and physical health is well documented in the literature, but mental health services rarely routinely intervene to improve an individual's social network. This review summarises social participation intervention models to illustrate different approaches which practitioners use, highlight gaps in the evidence base and suggest future directions for research.

METHODS

A systematic search of electronic databases was conducted, and social participation interventions were grouped into six categories using a modified narrative synthesis approach.

RESULTS

Nineteen interventions from 14 countries were identified, six of which were evaluated using a randomised controlled trial. They were grouped together as: individual social skills training; group skills training; supported community engagement; group-based community activities; employment interventions; and peer support interventions. Social network gains appear strongest for supported community engagement interventions, but overall, evidence was limited.

CONCLUSIONS

The small number of heterogeneous studies included in this review, which were not quality appraised, tentatively suggests that social participation interventions may increase individuals' social networks. Future research needs to use experimental designs with sufficient samples and follow-up periods longer than 12 months to enable us to make firm recommendations for mental health policy or practice.

Viewpoint survey of mental health service users' experiences of discrimination in England 2008-2014

OBJECTIVE

Discrimination reported by mental health service users in England is high. The study aims to determine changes in mental health-related discrimination from 2008 to 2014.

METHODS

Samples of mental health service users were interviewed from 2008 to 2014 using the Discrimination and Stigma Scale version 12. Social capital in terms of access to social resources is a marker of discrimination in terms of effects on social connections, and so from 2011, social capital also measured using the Resource Generator-UK.

RESULTS

Fewer participants reported discrimination in one or more life areas in 2014 compared to 2008 (OR: 0.58, 95% CI 0.36 to 0.94 P = 0.03). A weighted multiple regression model found a decrease in overall discrimination in 2014 compared to 2008 (mean difference: -13.55, 95% CI: -17.32 to -9.78, P < 0.001). There was not a consistent in discrimination decline between each year. No differences in access to social resources were found.

CONCLUSIONS

Discrimination has fallen significantly over 2008-2014, although there was not a consistent decline between years. There is no evidence that social capital has increased.

Community-Based Study of the Relationship Between Social Capital and Cognitive Function in Wuhan, China

The present study aimed to detect the association between social capital and cognitive function in elderly residents with/without mild cognitive impairment (MCI) in Wuhan, China. A cross-sectional study was conducted for data collection in 2014. A sample of 1156 participants entered the study. Cognitive function was assessed using the Chinese version of the Montreal Cognitive Assessment. A modified instrument scale was used to measure bonding and bridging social capital. The results indicated that participants without MCI had higher social capital scores (45.2 ± 8.3) than those with MCI (37.0 ± 6.3; P < .001). With adjustments for relevant confounders, the multiple logistic regression model showed that participants with a bonding social capital score that ranged from 17 to 24 had an odds ratio (OR) for MCI of 0.38 (95% CI = 0.04-0.79); those with a score that ranged from 25 to 32 had an OR for MCI of 0.36 (95% CI = 0.04-0.70); and those with scores ≥33 had an OR for MCI of 0.25 (95% CI = 0.03-0.53). In conclusion, we found a statistically significant inverse association between bonding social capital and MCI, which suggests that shortage of social resource from homogeneous social networks might be associated with cognitive decline.

Individual social capital and health-related quality of life among older rural Chinese

No study based on the Resource Generator has explored the association between individual social capital and health-related quality of life among older adults. This study aims to evaluate the validity and reliability of the adapted Resource Generator-China, and examine the association between individual social capital measured by the Resource Generator-China and health-related quality of life of older rural-dwelling Chinese people. A field survey including 975 rural-dwelling people aged between 60 and 75 years was conducted in three counties of the Shandong Province of China in 2013. Quality of life was measured by the Chinese version of the 36-Item Short Form Health Survey (SF-36): scores of Physical Component Summary and Mental Component Summary. Cumulative scale analyses were performed to analyse the homogeneity and reliability of the Resource Generator-China. We constructed generalised linear models by gender to examine the associations of social capital with health-related quality of life. Our findings suggest that the adapted instrument for older rural-dwelling Chinese people can be a reliable and valid measure of access to individual social capital. There were positive associations between individual social capital (total scores and sub-scale scores) and health-related quality of life. Individual social capital had a stronger association with mental health among women than men. Future studies should be improved through a longitudinal design with a larger and randomised sample covering large geographical rural areas in China.

Enhancing social networks: a qualitative study of health and social care practice in UK mental health services

People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over-arching themes - worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub-themes which were identified included worker attitudes; person-centred approach; equality of worker-individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals' access to social capital within networks.

Improving community health networks for people with severe mental illness: a case study investigation

Introduction

Policy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.

Methods

A five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.

Results

Three personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey.

Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.

Conclusion

While our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Measuring Social Capital Investment: Scale Development and Examination of Links to Social Capital and Perceived Stress

Individuals with greater social capital have better health outcomes. Investment in social capital likely increases one's own social capital, bearing great implications for disease prevention and health promotion. In this study, the authors developed and validated the Social Capital Investment Inventory (SCII). Direct effects of social capital investment on perceived stress, and indirect effects through social capital were examined. 397 Participants from Beijing and Wuhan, China completed surveys. Analyses demonstrated that the SCII has a single factor structure and strong internal consistency. Structural equation modeling showed that individuals who invested more in social capital had greater bonding social capital, and subsequently less perceived stress. Results suggest that disease prevention and health promotion programs should consider approaches to encourage social capital investment; individuals may be able to reduce stress by increasing their investment in social capital. Future research is needed to provide additional empirical support for the SCII and observed structural relationships.

Viewpoint survey of mental health service users' experiences of discrimination in England 2008-2012

PURPOSE

Research suggests levels of discrimination among mental health service users in England are high, but fell over the course of the first phase of the Time to Change programme to reduce stigma and discrimination (2008-2011). The aim of this study was to determine changes in discrimination levels, both overall and by the area of life in which discrimination is experienced, since Time to Change began and over the first year of its second phase (2011-2012).

METHOD

Separate samples of mental health service users were interviewed annually from 2008 to 2012 using the Discrimination and Stigma Scale. In 2011 and 2012, social capital was also measured using the Resource Generator-UK.

RESULTS

Sample percentages of participants reporting the experience of discrimination in one or more life areas for years 2008-2012 were 91.4, 86.5, 86.2, 87.9 and 91.0 %, respectively. A multivariable logistic regression model was performed to test for significant differences by study year, weighted to match the study population and adjusted for employment status and diagnosis as potential confounding factors. The odds of reporting discrimination in one or more life areas were significantly lower as compared to 2008 for all subsequent years except for 2012 (0.76, 95 % CI 0.49-1.19). However, a weighted multiple regression model provided evidence of decreased mean overall discrimination in 2012 as compared to 2008 (mean decrease -7.57, 95 % CI -11.1 to -4.0, p < 0.001). The weighted mean number of social resources was 13.5 in 2012 as compared to 14.0 in 2011 (mean difference -0.60, 95 % CI -1.25 to 0.06).

CONCLUSIONS

While the overall level of discrimination across the life areas studied has fallen over 2008-2012, there is no evidence that more people using mental health services experience no discrimination. We suggest that the pattern suggesting a recent rise in discrimination following an earlier reduction may be linked to economic austerity. Further, the welfare benefits system has become an increasing source of discriminatory experience.

Social capital and reported discrimination among people with depression in 15 European countries

PURPOSE

Social capital is a protective factor for mental health. People with depression are vulnerable to discrimination and its damaging impact. No previous studies have explored the link between social capital and experienced or anticipated discrimination in people with depression. This study aims to test the hypothesis that levels of self-reported discrimination in people with depression are inversely associated with social capital levels.

METHOD

A total of 434 people with major depression recruited in outpatient settings across 15 European countries participated in the study. Multivariable regression was used to analyse relationships between discrimination and interpersonal and institutional trust, social support and social network.

RESULTS

Significant inverse association was found between discrimination and social capital in people with major depression. Specifically, people with higher levels of social capital were less likely to have elevated or substantially elevated levels of experienced discrimination.

CONCLUSIONS

Higher level of social capital may be closely associated with lower level of experienced discrimination among patients with major depression. It is important to explore these associations more deeply and to establish possible directions of causality in order to identify interventions that may promote social capital and reduce discrimination. This may permit greater integration in society and more access to important life opportunities for people with depression.

[Social capital in ELSA-Brasil: test-retest reliability of the Resource Generator scale]

OBJECTIVE

To estimate the test-retest reliability of items of the Resource Generator scale for assessing social capital in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil).

METHODS

The social capital was applied in a subsample of 281 participants from six ELSA investigation centers, on two occasions with an interval of seven to 14 days. The instrument consists of 31 items that represent concrete situations to evaluate the access to different types of resources. In addition, it evaluates the strength of ties (family, friends or acquaintances) for the available resources. Statistical analyses were performed through use of the kappa statistic (k) and prevalence-adjusted kappa (ka).

RESULTS

A high frequency was found for social resources (above 50%). Regarding the presence or absence of resources, prevalence-adjusted reliability (ka) varied from 0.54 to 0.97. With regard to the source for the resource, the reliability estimates ranged from ka = 0.45 ("someone who has good contacts with the media") to ka = 0.86 ("someone who completed secondary education").

CONCLUSIONS

The scale presented adequate levels of reliability, which varied according to the type of resource.

Corporate social responsibility and mental health: the Premier League football Imagine Your Goals programme

Football is increasingly used to facilitate recovery in mental health services, often in partnership with football clubs. However, few clubs have made mental health part of their corporate social responsibility programmes until recently. We report the impact on participants of the 'Imagine Your Goals' programme, run by 16 Premier League football clubs in conjunction with England's Time to Change programme to reduce mental health-related stigma and discrimination. Mixed methods evaluation used pre/post measures of well-being, access to social capital, focus groups held early on and towards the end of the two-year programmes, and questionnaires for coaching staff. There were no significant changes to participants' mental well-being scores between baseline and follow-up, nor to the total number of social resources accessible through their networks. However, there was a statistically significant increase at follow-up in the mean score of the personal skills subscale of the Resource Generator-UK. Participants' individual skills were also higher at follow-up. Qualitative data showed programmes had largely met participants' expectations in terms of socializing, providing structure and improving fitness levels, exceeded expectations in relationships with coaching staff and additional activities, but did not always meet them in improving football skills. Participants varied in their knowledge of exit opportunities, depending on which club's programme they attended. A minority of clubs reported difficulties in recruitment and concerns about planning for the future of the projects. Football clubs and the charitable foundations they set up can successfully deliver programmes to people with mental health problems which improve access to personal skills social capital and have other potential benefits.

Discrimination against people with severe mental illness and their access to social capital: findings from the Viewpoint survey

Aims. Discrimination against people with severe mental illness is an international problem. It is associated with reduced social contact and hinders recovery. This paper aims to evaluate if experienced or anticipated discrimination is associated with social capital, a known correlate of mental health. Methods. Data from the annual viewpoint cross-sectional survey of people with severe mental illness (n = 1016) were analysed. Exploratory univariate analysis was used to identify correlates of social capital in the sample, which were then evaluated in linear regression models. Additional hypotheses were tested using t tests. Results. Experienced discrimination made a modest contribution to the explained variance of social capital. Experienced discrimination from friends and immediate family was associated with reduced access to social capital from these groups, but this was not found for wider family, neighbours or mental health staff. Experience of discrimination in finding or keeping a job was also associated with reduced access to social capital. Conclusions. Further longitudinal research is needed to determine how resources within people's networks can help to build resilience, which reduces the harmful effect of discrimination on mental health.

From ethnography to randomized controlled trial: an innovative approach to developing complex social interventions

The evidence base for mental health social work is vastly under-developed in contrast to medicine and psychology. Without randomized controlled trial evidence of effectiveness, social work interventions are largely absent from UK clinical guidelines and are increasingly difficult to defend in multidisciplinary teams. This article will discuss an innovative and thorough approach to developing a social intervention which will be amenable to evaluation in a randomized controlled trial. Using ethnography to capture practice wisdom, underpinned by social capital theory with its own rich evidence base, the intervention will help people recovering from an episode of psychosis to connect, or reconnect, with other people. It is envisaged that by ensuring the intervention is grounded in the lived experience of workers and service users it will be more amenable to implementation in routine practice, and produce better outcomes.

Gender differences in the social pathways linking neighborhood disadvantage to depressive symptoms in adults

Depression debilitates the lives of millions and is projected to be the second leading disease burden worldwide by 2020. At the population level, the causes of depression are found in the everyday social and physical environments in which people live. Research has shown that men and women often experience neighbourhood environments differently and that these variations are often reflected in health outcomes. The current study examines whether social and environmental correlates of depression are similar in men and women. This study examines whether (i) there are gender differences in the association between neighbourhood disadvantage and depressive symptoms, and (ii) dimensions of social capital and cohesion mediate these associations. Data come from the Montreal Neighbourhood Networks and Healthy Aging Study, which consists of a cluster stratified sample of Montreal census tracts (n_ct = 300) and individuals within those tracts (n_i = 2707). Depressive symptoms and social capital were measured with a questionnaire. Neighbourhood disadvantage was measured at the census tract level using data from the 2006 Canada Census. Multilevel logistic regression stratified by gender and a three-step mediation analysis procedure were used. Final sample size for these analyses was 2574 adults. Depressive symptoms had a prevalence of 17.3% in the overall sample. Disadvantage was associated with depressive symptoms in women only (OR = 1.25, 95% CI = 1.01–1.55). Perceived neighbourhood cohesion was shown to mediate the association of disadvantage and depressive symptoms in women (ab = 0.02; 95% CI = 0.003–0.04, p<0.05). Other socio-relational variables, specifically generalized trust and trust in neighbours were associated with depression in women but did not act as mediating variables. Health promotion initiatives meant to combat depression may wish to consider gender differences in the design and implementation of neighbourhood or peer-based programs.

Individual-level social capital and self-rated health in Japan: an application of the Resource Generator

Despite accumulating evidence of associations between social capital and health in public health research, a criticism of the field has been that researchers have exclusively focused on concepts of social cohesion to the exclusion of individual-level approaches. In the present study, we evaluated the association between social capital measured by the Resource Generator (an individual-level assessment of access to social capital) and self-rated health among Japanese population in a cross-sectional study. A postal survey of 4000 randomly selected residents in Okayama City (western Japan) was conducted in February 2009. We divided the overall scores from the Resource Generator Japan scale into quartiles. Odds ratios (ORs) and 95% confidence intervals (CIs) for self-rated health were calculated separately by sex. Individuals with the highest quartile of scores had significantly lower odds of poor health compared to the lowest group after covariate adjustment among both men and women (men; OR: 0.45, 95% CI: 0.24-0.86, women; OR: 0.44, 95% CI: 0.25-0.79, respectively) and there were also significant dose-response relationships. In the sub-domains of Resource Generator Japan scale, a differential pattern was observed by sex. Women showed a clear dose-response relationship with health across all four sub-scales (domestic resources, expert advice, personal skills, and problem solving resources). In contrast, only the domain of expert advice exhibited a strong association with men's health. Among both men and women individual-level social capital measured by the Resource Generator was related to reduced odds of poor health even after taking into account individual confounders. Although we cannot exclude reverse causation due to the cross-sectional design, our study adds to the accumulating evidence of the potential utility of the Resource Generator for evaluating the relationship between individual-level access to social capital and health.

Social capital in pregnancy and postpartum depressive symptoms: a prospective mother-child cohort study (the Rhea study)

BACKGROUND

Depression, and to a lesser extent postpartum depressive symptoms, have been associated with characteristics of the social environment and social capital. Up to the present, mostly cross-sectional studies have explored such an association without providing a clear temporal relationship between social capital and depression.

OBJECTIVES

To estimate prospectively the effect of individual-level self-reported maternal social capital during pregnancy on postpartum depressive symptoms.

DESIGN

Prospective mother-child cohort (Rhea study).

SETTINGS

4 prenatal clinics in Heraklion, Crete, Greece.

PARTICIPANTS

All women for one year beginning in February 2007. From the 1388 participants, complete data were available for 356 women.

METHODS

Women self-completed two questionnaires: The Social Capital Questionnaire at about the 24th week of gestation and the Edinburgh Postnatal Depression Scale (range 0-30) at about the 8-10th week postpartum. Maternal social capital scores were categorized into three groups: the upper 10% was the high social capital group, the middle 80% was the medium and the lowest 10% was the low social capital group that served as the reference category. Multivariable log-binomial and linear regression models were performed for: the whole available sample; for participants with a history of depression and/or prenatal EPDS≥13; for participants without any previous or current depression and prenatal EPDS score<13. Potential confounders included demographic, socio-economic, lifestyle and pregnancy characteristics that have an established or potential association with maternal social capital in pregnancy or postpartum depressive symptoms or both.

RESULTS

Higher maternal social capital was associated with lower EPDS scores (highest vs lowest group: β-coefficient=-3.95, 95% CI -7.75, -0.14). Similar effects were noted for the subscale value of life/social agency (highest vs lowest group: β-coefficient=-5.96, 95% CI -9.52, -2.37). This association remained significant for women with and without past and/or present depression only for the subscale value of life/social agency although with a more imprecise estimate. No effect was found for participation, a structural dimension of social capital.

CONCLUSIONS

Women with higher individual-level social capital in mid-pregnancy reported less depressive symptoms 6-8 weeks postpartum. Given the proposed association of perceptions of the social environment with postpartum depressive symptoms, health professionals should consider evidence-based interventions to address depression in a social framework.

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.