A multilevel analysis of association between neighborhood social capital and depression: evidence from the first South African National Income Dynamics Study

Heterogeneous gender gaps in mental wellbeing: Do women with low economic status face the biggest gender gaps?

Gender differences in depression are globally documented across a wide range of studies that analyse self-reports of depressive symptoms or clinical diagnoses. Extensive research fails to identify any single reason for this finding but given systematic variation in depressive symptomatology across social groups, gender differences must derive at least partly from environmental or social factors. Among the social factors that are considered most important are those relating to gender differences in socio-economic status and the underlying gender division of labor. In this study, we add to existing research by interrogating heterogeneity in gender differences in mental health. Studies that investigate environmental factors typically consider these only in relation to the average gender gap in depression. We use a novel sorting and classification method (Chernozhukov et al., 2018) that makes it possible to map the full distribution of gender differences in depressive symptomatology among comparable women and men. Although we cannot attribute causality, the method allows us to isolate those social factors that are distinctive to women who experience the largest gender gap in depressive symptoms compared to those who exhibit the smallest. The study analyses detailed nationally representative micro-data from South Africa, a country with high rates of poverty, which are higher still among women. As is common elsewhere, women report significantly more depressive symptoms than men, and low socio-economic status is correlated with poor mental health. However, women with low socio-economic status are not relatively more concentrated among women who face the largest gender gap in depressive symptomatology. These findings would not be consistent with the hypothesis that women have a greater tendency than men to ruminate over economic hardship and could rather point to resilience and a "steeling effect" among poor women.

Mental distress, COVID19 vaccine distrust and vaccine hesitancy in South Africa: A causal mediation regression analysis

AIM

Within the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa.

SUBJECT AND METHODS

The study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias.

RESULTS

The results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust.

CONCLUSION

The study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust.

Understanding the complex relationship between multidimensional poverty and depressive symptoms among young South Africans: A cross-sectional study

BACKGROUND

We use the Global Multidimensional Poverty Index (MPI) to explore how different dimensions of poverty more directly linked to young people are associated with depressive symptoms among South African youth.

METHODS

Data came from the 2017 wave of the nationally-representative National Income Dynamics Study (NIDS) in South Africa. We focused on a sample of 15-24-year-olds whose depressive symptoms were assessed using an adapted version of the 10-item Centre for Epidemiological Studies Depression Scale. We examine how individual dimensions and indicators of the MPI relate to depression, in comparison to more conventional measures, including household income, subjective social standing, overcrowding and personal assets. Cross-sectional analyses were adjusted for clustering to account for sampling design.

RESULTS

The MPI index was not associated with probable depression (OR = 1.02, 95 % CI 0.81-1.29). Only lack of access to the labour market emerged as a key individual dimension associated with probable depression (OR = 5.29, 95 % CI 1.70-16.47), a relationship driven by an increased odds for those not in employment, education or training. Lack of household assets, living in an informal dwelling and lower perceived social standing were also associated with increased odds for depression. No gender differences were noted.

LIMITATIONS

The study is cross-sectional and not suitable to examine the causal nature of the association between multidimensional poverty and depression.

CONCLUSIONS

Poverty dimensions that measure youth's access to employment or training have a strong association with depression. Further research is needed to assess whether improved access to employment or training contributes to improving mental health among young South Africans.

Individual-level social capital is associated with depressive symptoms among middle-aged community dwellers in rural Vietnam: a cross-sectional study

OBJECTIVES

There has been comparatively little research on the association between social capital and depressive symptoms in low- and middle-income countries. To address this deficit this study examined the association among middle-aged adults in rural Vietnam.

DESIGN

A cross-sectional study.

SETTING

Data came from the baseline survey of the Khánh Hòa Cardiovascular Study, which is an ongoing prospective cohort study aiming to elucidate the determinants of cardiovascular diseases.

PARTICIPANTS

A total of 3000 people aged 40-60 years old residing in rural communes in Khánh Hòa province, Vietnam.

EXPOSURE OF INTEREST

Cognitive social capital (ie, low, middle and high) and structural social capital (in terms of social participation; yes or no) were assessed via a questionnaire.

PRIMARY OUTCOME MEASURE

Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies Depression Scale.

RESULTS

A robust Poisson regression model revealed that adults in the highest versus lowest cognitive social capital tertile had a 61% lower prevalence of depressive symptoms (prevalence ratio (PR)=0.39, 95% CI=0.31 to 0.49). Individuals with higher structural social capital were also significantly less likely to experience depressive symptoms (PR=0.74, 95% CI=0.61 to 0.90).

CONCLUSION

In a cohort of 3000 middle-aged rural residents in Vietnam, both cognitive and structural social capital assessed at the individual level were inversely associated with the prevalence of depressive symptoms.

Income Disparity and Mental Wellbeing among Adults in Semi-Urban and Rural Areas in Malaysia: The Mediating Role of Social Capital

Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.

Does Socioeconomic status mediate the relationship between income loss and depression scores? Evidence from South Africa

This paper examines the role of socioeconomic status (SES) in mediating the effect of job and household income loss on mental health during the COVID-19 pandemic. We note that even though job loss will invariably reduce household income, the relationship between these factors and mental health may be mediated by SES. Specifically, in the context of COVID-19 induced shock, job loss may not be a threat to survival for an individual with relatively high SES, while this is not the case for individuals with low SES. Our empirical analysis uses threshold regression under the assumption that the relationship between depressive symptoms and pandemic induced job/ income loss has a threshold effect. We find that job loss (but not the decline in household income) is a stronger predictor of poor mental health for individuals that live in households above a certain SES threshold. This suggests that the psychological trauma of job loss due to loss of identity and purpose outweighs the financial loss for individuals with higher SES. On the other hand, a decrease in household income (as against the loss of individual income) is a stronger predictor of poor mental health for individuals with lower SES. We argue that these findings are related to high-income inequality in South Africa. The results highlight the different implications of job loss and income loss for depressive symptoms in the context of high socioeconomic inequality.

The role of neighborhood social capital on health and health inequality in rural and urban China

Given the "community lost" vs. "community saved" debate on how neighborhood solidarity changes with urbanization, we compared the rural-urban difference in the association of individuals' neighborhood social capital with health and the interaction effect between neighborhood social capital and income-poverty on health in China, where huge rural-urban disparities existed. Participants were 5014 Chinese adults (≥ 18 years) (rural: 2034; urban: 2980) from the 2012 cross-sectional Chinese General Social Survey. Health outcome was a factor score constructed by three items. Neighborhood social capital was divided into structural (neighborhood network size, frequency of socializing with neighbors, voting in neighborhood committee election, and participation in neighborhood voluntary activities) and cognitive (perceived neighborhood social cohesion) dimensions. Multivariable linear regression models showed positive associations between perceived neighborhood social cohesion and health in rural (β = 0.08, 95% CI: 0.03,0.14) and urban (β = 0.09, 95% CI: 0.05,0.12) areas. Only in rural but not urban areas was a neighborhood network of 10 or more persons (ref.: none) associated with better health (β = 0.25, 95% CI: 0.05,0.46). Interaction analysis showed that only in rural but not urban areas, with the increase of neighborhood network size, the health gap between the income-poor and the non-income-poor decreased generally. Our study suggested that cohesive neighborhoods benefit both rural and urban residents' health. Health interventions to improve neighborhood social cohesion should be designed to cope with the challenge of urbanization. Policymakers should avoid damaging neighborhood social capital when implementing other public policies, especially in rural areas where neighborhood network seems to matter more for health.

Continuance Intention of Online Healthcare Communities- The Mediation Mechanism of Social Interaction Ties

The purpose of this research is to evaluate the continuance usage intention on online healthcare community (OHC) platform for patients and examine the "doctor-OHC-patient" relationship. The proposed model attempted to integrate social interaction ties, shared value, trust with the indirect effects on the relationship between the determinants and continuous usage intention of the OHC platform. The empirical results showed that perceived critical mass, social identity, and para-social interaction would strengthen continuance intention via the social interaction ties. In addition, this study found that the shared values and trust increase users' willingness to continue usage of OHC. This study provides OHC platform managers with an in-depth understanding of the "doctor-OHC-patient" online social interaction. The results of this study may also help hospitals, health policy makers, and related healthcare practitioners to improve the way they use the web for advocacy and guidance, and provide insight into the intent of promoting the ongoing use of OHC platforms.

Neighborhood-Based Social Capital and Depressive Symptoms among Adults: Evidence from Guangzhou, China

This study examined the association between neighborhood-based social capital (NSC) and depressive symptoms in the context of urban neighborhoods in China, with special attention given to the association heterogeneity across socioeconomic groups. Drawing on cross-sectional data collected from 39 neighborhoods in Guangzhou, this research demonstrated that adults’ depressive symptoms were higher among those with lower cognitive (trustworthiness, reciprocity, and cohesion within a neighborhood) and structural (social network and participation) dimensions of NSC. Further analysis showed that the negative association between NSC and depressive symptoms was significantly heterogeneous across socioeconomic groups. Specifically, this negative relationship was more prominent in the lower socioeconomic classes than in the upper socioeconomic classes, indicating that the lower accumulation of NSC among disadvantaged groups may aggravate depression unequally across social classes. In addition, the negative association between social participation and depressive symptoms was stronger for people who are older or unemployed. The findings of this study not only provide new evidence concerning the significance of the beneficial effects of NSC in the Chinese context, but also, more importantly, highlight that NSC plays a crucial role in creating mental health inequality across social classes. Thus, the relevant social interventions including fostering neighborhood relationships and social activities should be carefully tailored against the backdrop of community building during the urbanization process. The implications of our study for urban governance to promote healthy cities are discussed.

Social Capital as a Mediator in the Link between Women's Participation in Team Sports and Health-Related Outcomes

The role of social capital in the association between team sports and health-related outcomes has not been well established in the literature. The purpose of this study was to explore whether social capital components (social support, trust, and social involvement) mediate the association between team sports and health-related outcomes (self-reported health, psychosomatic symptoms, and depressive symptoms). In a cross-sectional research design, we obtained data from 759 participants in the Mamanet Cachibol League, a community team sports model for women in Israel, as well as a comparison group of 308 women who did not participate in any team sports. Team captains were sent a link with an online questionnaire, which were then delivered to team members via text message. Using three parallel mediation models, we found that social support mediated the association between team sports and self-reported health, psychosomatic symptoms, and depressive symptoms. Trust mediated the association between team sports and both psychosomatic symptoms and depressive symptoms. Social involvement was not found to be a mediator in the association between team sports and any of the health-related outcomes. Our findings reveal the important role of social capital, specifically social support and trust, in promoting the health of women who participate in team sports.

Living alone and depression in a developing country context: Longitudinal evidence from South Africa

In South Africa, single-person households were a household type enforced by apartheid legislation, designed to restrict the “influx” of Africans into “white” and typically urban areas of the country. Yet the increase in living alone has been one of the most marked demographic trends of the post-apartheid period. The trend, which has occurred alongside the persistence in individual labor migration patterns and a decline in rates of union formation, has been driven by changes among working-age adults, rather than among older adults. This is the first empirical study to investigate the mental health implications of living alone among all adults in South Africa using national longitudinal data. The data come from five waves of the panel household survey, the National Income Dynamics Study (NIDS), conducted from 2008 to 2017. Information on depressive symptoms was collected from all adults (15 years and older), who were asked the ten questions which make up the Center for Epidemiologic Studies Short Depression Scale (CES-D 10). Adults who lived alone reported significantly higher depression scores than other adults, in the pooled ordinary least squares models, and in the fixed effects model, which controlled for any unobservable, time-invariant differences between the two groups of adults. Vulnerability to depression was moderated by adults’ preferences to continue living in their area of residence (as a measure of their social integration), but the positive relationship remained sizeable and significant across all models. The findings shed light on a further dimension of the migrant labor system in South Africa, which has not received adequate attention in the empirical literature, viz. the mental health implications for adults of solo migration, and they provide further motivation for the provision of affordable and safe family housing in local areas of employment.

•

The rise in solo living is a marked demographic trend in post-apartheid South Africa.

•

Working-age adults are more likely than older adults to live alone.

•

Solo-dwellers recorded significantly higher depression scores than other adults.

•

Social integration moderated but did not eliminate this relationship.

Job loss and mental health during the COVID-19 lockdown: Evidence from South Africa

OBJECTIVES

Existing literature on how employment loss affects depression has struggled to address potential endogeneity bias caused by reverse causality. The COVID-19 pandemic offers a unique natural experiment because the source of unemployment is very likely to be exogenous to the individual. This study assessed the effect of job loss and job furlough on the mental health of individuals in South Africa during the COVID-19 pandemic.

DATA AND METHODS

The data for the study came from the first and second waves of the national survey, the National Income Dynamics-Coronavirus Rapid Mobile Survey (NIDS-CRAM), conducted during May-June and July-August 2020, respectively. The sample for NIDS-CRAM was drawn from an earlier national survey, conducted in 2017, which had collected data on mental health. Questions on depressive symptoms during the lockdown were asked in Wave 2 of NIDS-CRAM, using a 2-question version of the Patient Health Questionnaire (PHQ-2). The PHQ-2 responses (0-6 on the discrete scale) were regrouped into four categories making the ordered logit regression model the most suited for assessing the impact of employment status on depressive symptoms.

RESULTS

The study revealed that adults who retained paid employment during the COVID-19 lockdown had significantly lower depression scores than adults who lost employment. The benefits of employment also accumulated over time, underscoring the effect of unemployment duration on mental health. The analysis revealed no mental health benefits to being furloughed (on unpaid leave), but paid leave had a strong and significant positive effect on the mental health of adults.

CONCLUSIONS

The economic fallout of the COVID-19 pandemic resulted in unprecedented job losses, which impaired mental wellbeing significantly. Health policy responses to the crisis therefore need to focus on both physical and mental health interventions.

Social Estrangement and Psychological Distress before and during the COVID-19 Pandemic: Patterns of Change in Canadian Workers

This article argues that the COVID-19 pandemic and associated social distancing measures intended to slow the rate of transmission of the virus resulted in greater subjective isolation and community distrust, in turn adversely impacting psychological distress. To support this argument, we examine data from the Canadian Quality of Work and Economic Life Study, two national surveys of Canadian workers-one from late September 2019 (N = 2,477) and the second from mid-March 2020 (N = 2,446). Analyses show that subjective isolation and community distrust increased between the two surveys, which led to a substantial rise in psychological distress. Increases in subjective isolation were stronger in older respondents, resulting in a greater escalation in psychological distress. These findings support a Durkheimian perspective on the harm to social integration and mental health caused by periods of rapid social change but also illustrate how a life course context can differentiate individual vulnerability to disintegrative social forces.

Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem

Despite the fact that universal inclusion is a basic principle of the Sustainable Development Goals, the inclusion of persons with disabilities in humanitarian interventions and development policies remains elusive. Persons with disabilities face high risks of poverty, poor nutrition, limited inclusion in labor markets and poor mental health as a result. Stigma is likely to play a negative role in this regard and yet, no study has investigated the impact of stigma on depression and self-esteem of persons with disabilities. To address this gap in the literature, we conducted in June 2017 a random sample disability case control household study in Soweto, a township in Johannesburg, South Africa. Using propensity score analysis and structural equation modeling, we investigated the relationship between disability, stigma, depression and self-esteem controlling for socioeconomic covariates. Our main empirical results showed that stigma significantly mediates the association between disability and higher depression on the one hand and between disability and lower self-esteem on the other. This mediating effect exists even after controlling for age, gender, marital status, education, employment and wealth. We also found strong direct associations between disability and depressive mood, somatic indicators and negative feelings such as unhappiness and low self-esteem. Unemployment aggravates depression and low self-esteem while low education worsens self-esteem only. In addition, depression exacerbates low self-esteem. Both unemployment and low education are more common among persons with disabilities aggravating the disability, depression, poor self-esteem nexus. Similarly, persons with disabilities who are more likely to be depressed are also at higher risk of low self-esteem. These results point to a vicious reinforcing circle of exclusion from society, despair and self-deprecation, which could prove difficult to break. Substantial psycho-social support and anti-stigma policies anchored in local cultural values, engaging persons with disabilities and their communities, are required to break this vicious circle.

Evidence on the Association Between Cigarette Smoking and Incident Depression From the South African National Income Dynamics Study 2008-2015: Mental Health Implications for a Resource-Limited Setting

INTRODUCTION

As a leading global disease risk factor, cigarette smoking has declined in some developed countries, but its health consequences are not well established in sub-Saharan Africa. This is particularly evident in South Africa, where few investigations have quantified the dually neglected challenges of cigarette smoking and depression, despite decades of research from developed countries. We investigated the association between cigarette smoking and incident depression, with the hypothesis that adolescents are particularly vulnerable.

METHODS

Panel data from the South African National Income Dynamics Study, a nationally representative sample of households at follow-up periods (years 2008-2015), were used. Our incident cohort consists of 14 118 adult participants who were depression free at baseline. The generalized estimating equation models were fitted to assess the association between current cigarette smoking and incident depression.

RESULTS

Current cigarette smoking among individuals aged at least 15 was significantly associated with incidents of depression among men (adjusted relative risk [aRR] = 1.16, 95% CI = 1.01 to 1.34), but not women. When the analyses were restricted to a sample population of older adolescents (ages 15-19), current cigarettes smoking was significantly associated with incident depression in both men (aRR = 1.84, 95% CI = 1.18 to 2.88) and women (aRR = 2.47, 95% CI = 1.15 to 5.29).

CONCLUSION

The results suggest an important relationship between cigarette smoking and incident depression, particularly among older adolescents, who are developmentally vulnerable and socioeconomically disadvantaged to experiencing depression. There is a considerable need to implement and prioritize culturally and developmentally appropriate prevention and cessation measures to reduce cigarette smoking and depression directed at adolescent populations.

IMPLICATIONS

There has been little population level research into the role of smoking on depression in sub-Saharan Africa, a region classified as a tobacco epidemic in the making. Our results have major implications for the often neglected crosscutting issues of tobacco control (Sustainable Development Goal 3.9) and mental health (Sustainable Development Goal 3.4). They indicate the role of smoking on depression, with the association being particularly pronounced among adolescent who are developmentally vulnerable and socioeconomically disadvantaged, and emphasize the need to implement and prioritize prevention and cessation measures directed at this population.

Benefits of Grandparental Caregiving in Chinese Older Adults: Reduced Lonely Dissatisfaction as a Mediator

Objective

The purpose of the present study is twofold: (1) to investigate the differences in terms of physical and mental health between those who provide grandparental care and those who do not and (2) to explore the mechanism that connects grandparental caregiving and health-related outcomes.

Methods

Two studies (a cross-sectional and a short-term longitudinal follow-up) were conducted. The cross-sectional study (Study 1) examined 148 older adults who provided grandparental care and another 150 older adults who did not. A small longitudinal follow-up study (Study 2) was conducted among 102 older adults randomly selected from Study 1, of which 52 were older adults who provided grandparental care, and another 50 older adults were those who did not. Health status (measured by SF-36), lonely dissatisfaction (measured by Lonely Dissatisfaction Subscale of PGC-MS), and cognitive functions (measured by subscales of WAIS) as well as demographics were measured in both studies.

Results

Results of both the cross-sectional and longitudinal studies showed that, compared with older adults who did not provide grandparental care, those providing grandparental care had significantly better physical and mental health as well as reduced lonely dissatisfaction. Further path analysis showed that lonely dissatisfaction mediated the association between providing grandparental care and enhancement in functions such that providing grandparental care could reduce lonely dissatisfaction, which, in turn, could improve their physical and mental health even after controlling for their cognitive functions.

Discussion

These results suggest that providing grandparental care can improve older adults’ physical and mental health through reduced lonely dissatisfaction.

Social capital and self-rated health of residents of Gauteng province: Does area-level deprivation influence the relationship?

Although social capital has been linked to population health, there is a dearth of studies on the phenomenon especially in sub-Saharan Africa. We investigated the individual and contextual effects of social capital indicators (group membership, registered to vote, perception towards safety in community and generalised trust) on the self-rated health (SRH) of the residents of Gauteng province. We used data from the 2015 Quality of Life (QoL) survey, which included a random representative sample of 27476 residents (level 1) in 508 administrative wards (level 2). We employed a multilevel logistic regression to examine the association of social capital and SRH (good vs poor). After adjusting for individual and area-level factors, no main effect of group membership (Adjusted OR: 0.93: 95% CI: 0.85-1.02), generalised trust (Adjusted OR: 1.01: 95% CI: 0.89-1.49) and registered to vote (Adjusted OR: 0.95; 95% CI: 0.82-1.10) was observed. However, if respondents were positive in their perception towards safety in community, there was a positive association with good SRH (Adjusted OR: 1.15; 95% CI: 1.01-1.31); while if residents reported a negative perception towards safety in community, a strong negative association with good SRH (Adjusted OR: 0.70; 95% CI: 0.62-0.79) was observed. Both ward variance and median odds ratio (MOR) indicate significant differences in good SRH by wards. A strong positive joint effect on the multiplicative scale was observed between satisfied with safety and the ward-level South African Multiple Deprivation Poverty Index (SAMPI), while a strong negative joint effect was also observed on a multiplicative scale between dissatisfied with safety and the SAMPI. Perception of safety in community is the core domain of social capital that significantly impacts the SRH of residents of Gauteng. Although the effect of perception towards safety in community on good SRH is influenced by ward deprivation,the effect is not dependent on the level of deprivation. Contextual factors as evidenced by the persistent MOR, in addition to individual factors, explain variation in reporting good SRH in the study area.

Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors

The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.

Does your neighborhood protect you from being depressed? A study on social trust and depression in Indonesia

BACKGROUND

Prevalence of depression in Indonesia is estimated at about 3.7% of the total population, although the actual may be higher. Studies worldwide have linked the environment where people live to their mental health status. However, little research is found in Indonesia regarding this link. We examined the association between individuals' perception towards their neighborhood and their depression symptoms.

METHODS

Social trust was measured at the individual (level 1) and community (level 2) levels based on the Indonesian Family Life Survey 5 (IFLS5) in 2014. Depression was measured using the 10-item Center for Epidemiologic Studies-Depression Scale Revised (CESD-R-10) and the scores were transformed into logit form using the Rasch model. Multilevel regression was used to determine correlations.

RESULTS

Of the total sample of 14,227 respondents in this study, about 19.4% had experienced severe depression symptoms in the past week. Social trust was found to be significantly associated with severe depression symptoms. The weaker the individuals' social trust towards their neighbourhood, the higher the probability of experiencing severe depression symptoms would be.

CONCLUSIONS

This study shows that social trust is associated with the severity of depression symptoms: the higher the social trust, the lower the probability of having severe depression symptoms is. Depression symptoms may also be attributed to significant differences between communities.

Depressive symptoms among Chinese residents: how are the natural, built, and social environments correlated?

Background

Depression has become a severe societal problem in China. Although many studies have analyzed how environmental characteristics within neighborhoods affect depression, only a few have dealt with developing countries, and even fewer have considered built, natural, and social environments concurrently.

Methods

Based on a sample of 20,533 Chinese residents assessed in 2016, the present study examined associations between depressive symptoms and respondents’ built, natural, and social environments. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and multilevel regression models were fitted accounting for potential covariates.

Results

Results indicated that living in neighborhoods with more green spaces and a higher population density were negatively associated with CES-D scores. Living in neighborhoods with more social capital was protective against depression. Furthermore, results showed that the social environment moderated the association between the built environment and depression.

Conclusions

Social environments moderate the relationship between the built environment and depression. As environments seem to interact with each other, we advise against relying on a single environment when examining associations with depressive symptoms.

Mental health, interpersonal trust and subjective well-being in a high violence context

This paper assesses whether two factors of wellbeing, social capital (interpersonal trust and social networks) and subjective well-being are associated with frequent mental distress and if there are any mediating effects by gender in a city of high urban violence. This paper relies on data that comes from a sample of over 1300 people representative by gender, race/ethnicity, and socioeconomic breakdown of the city of Cali in Colombia, which was collected in 2017 through face-to-face surveys. Our study uses logistic regression with fixed-effects at the district level to control for unobserved time-invariant factors. At the individual level, our analyses account for social and demographic context variables. The dependent variable is mental distress, defined as having 14 or more days feeling mentally ill in the previous 30-day period. Independent variables of interest are "interpersonal trust in unknown people" measured in a scale 0-10 and, social networks measured using the number of family members and close friends and subjective well-being through a question about life satisfaction in a scale 0-10. We find risk factors for mental health distress were low trust in unknown people, low life satisfaction, high levels of depression, living in cohabitation, being female, not having children, and living in middle socio-economic status. The odds of feeling mentally ill decreased as trust in unknown people increased by each unit in the trust scale (OR: 0.92). There were gender differences, with women's mental health being less likely to be affected by lack of interpersonal trust (OR: 0.94) than men (OR: 0.76). Our study suggests that actions aimed at fostering interpersonal trust in unknown people could positively affect mental health distress for both males and females. In the context of high urban violence, our study shows that men are more likely to benefit from such actions.

Assessing urban-rural differences in the relationship between social capital and depression among Ghanaian and South African older adults

Introduction

Research has demonstrated benefits of social capital on depression, but variations in this relationship by geographic characteristics such as urbanicity have rarely been investigated.

Methods

Using survey data on 4,209 Ghanaian and 3,148 South African adults aged 50 and above from the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE), exploratory and confirmatory factor analyses were conducted to extract dimensions of social capital from survey items. Structural equation models with the extracted factors were then used to estimate the associations between social capital and depression in each sample and assess differences between urban and rural settings with measurement and structural invariance tests.

Results

Factor analyses suggested three dimensions of social capital representing community engagement, sociability, and trust. Urbanicity did not substantially modify the effects of social capital on depression in either setting, but urban-rural differences in the measurement and level of social capital were observed. Urban Ghanaian older adults were less socially integrated and trusting than older rural residents (standardized mean difference: -0.28, -0.24, and -0.38 for community engagement, sociability, and trust, respectively) while urban South African older adults appeared less engaged in community activities but significantly more trusting and socially active informally than older rural residents (standardized mean difference: -0.33, 0.30, and 0.17 for community engagement, sociability, and trust, respectively). Moreover, while trust was associated with a lower risk of depression in South Africa overall, sociability and trust were associated with an increased risk of depression in Ghana.

Conclusions

Results indicate that the composition and average levels of social capital differ between urban and rural older adult residents in Ghana and South Africa although urban-rural differences in the strength of the association between social capital and depression were not substantial. Furthermore, the associations between social capital and depression are context-specific and are not uniformly beneficial.

Spatial structure of depression in South Africa: A longitudinal panel survey of a nationally representative sample of households

Wider recognition of the mental health burden of disease has increased its importance as a global public health concern. However, the spatial heterogeneity of mental disorders at large geographical scales is still not well understood. Herein, we investigate the spatial distribution of incident depression in South Africa. We assess depressive symptomatology from a large longitudinal panel survey of a nationally representative sample of households, the South African National Income Dynamics Study. We identified spatial clusters of incident depression using spatial scan statistical analysis. Logistic regression was fitted to establish the relationship between clustering of depression and socio-economic, behavioral and disease risk factors, such as tuberculosis. There was substantial geographical clustering of depression in South Africa, with the excessive numbers of new cases concentrated in the eastern part of the country. These clusters overlapped with those of self-reported tuberculosis in the same region, as well as with poorer, less educated people living in traditional rural communities. Herein, we demonstrate, for the first time, spatial structuring of depression at a national scale, with clear geographical ‘hotspots’ of concentration of individuals reporting new depressive symptoms. Such geographical clustering could reflect differences in exposure to various risk factors, including socio-economic and epidemiological factors, driving or reinforcing the spatial structure of depression. Identification of the geographical location of clusters of depression should inform policy decisions.

Neighborhood Environment and Disparities in Health Care Access Among Urban Medicare Beneficiaries With Diabetes: A Retrospective Cohort Study

Older adults' health is sensitive to variations in neighborhood environment, yet few studies have examined how neighborhood factors influence their health care access. This study examined whether neighborhood environmental factors help to explain racial and socioeconomic disparities in health care access and outcomes among urban older adults with diabetes. Data from 123 233 diabetic Medicare beneficiaries aged 65 years and older in New York City were geocoded to measures of neighborhood walkability, public transit access, and primary care supply. In 2008, 6.4% had no office-based "evaluation and management" (E&M) visits. Multilevel logistic regression indicated that this group had greater odds of preventable hospitalization in 2009 (odds ratio = 1.31; 95% confidence interval: 1.22-1.40). Nonwhites and low-income individuals had greater odds of a lapse in E&M visits and of preventable hospitalization. Neighborhood factors did not help to explain these disparities. Further research is needed on the mechanisms underlying these disparities and older adults' ability to navigate health care. Even in an insured population living in a provider-dense city, targeted interventions may be needed to overcome barriers to chronic illness care for older adults in the community.

A Nationwide Panel Study on Religious Involvement and Depression in South Africa: Evidence from the South African National Income Dynamics Study

Panel data from the South African National Income Dynamics Study, a nationally representative sample of households (years 2008, 2010 and 2012), were used to examine the longitudinal association between religious involvement and depression risk. Approximately 89.6-91.8% identified themselves as religiously affiliated, while 88.0-90.3% perceived religion to be important in South Africa during the observed study periods. A short-term association between religious involvement and significant depressive symptomatology was not detected, but logistic regression models that accounted for the clustering of repeated observations within participants indicated that, over time, those with religious affiliations (aOR 0.85, 95% CI 0.76-0.96) were at a lower risk than those not affiliated. Furthermore, individuals who reported religious activity as being important (aOR 0.81; 95% CI 0.73-0.91) were at less risk of significant depressive symptomatology over time than those rating religious activity as not important. Our study points to the potentially important role of religious involvement as an emerging area of investigation toward improving mental health at a population level in resource-limited settings.

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.

Associations between personal social capital and depressive symptoms: Evidence from a probability sample of urban residents in China

BACKGROUND:

Rapid socioeconomic changes in China present a mental health challenge and also an opportunity to investigate the relationship between social capital and depression.

MATERIALS AND METHODS:

Participants (18-45 years old, N = 1,250) were selected using a probability sampling method. The relationship between social capital (measured using the Personal Social Capital Scale) and depression (measured using the Brief Symptom Inventory Depression Subscale) was examined using bivariate analysis, followed by multiple regression to control for covariates.

RESULTS:

Of the total sample, 54.64% were female with mean age = 35.1 (standard deviation ( SD) = 7.5) years old. Depression score was 10.40 ( SD = 3.62) for males and 10.36 ( SD) = 3.30) for females. The social capital measures (including the total, bonding and bridging) were all negatively associated with depression scores, while the negative social capital was positively associated, after controlling for covariates. Subgroup analysis revealed some differences in the social capital-depression associations.

CONCLUSION:

The protective effect of social capital for mental health reported in other countries is also evident in this study. In addition, we found a positive association between negative social capital and depression. In addition to adding new knowledge, findings of this study, if verified with longitudinal design, can be used to support social and behavioral interventions in China to promote mental health by social capital enhancement.

Analyzing Multilevel Factors Underlying Adolescent Smoking Behaviors: The Roles of Friendship Network, Family Relations, and School Environment

BACKGROUND

This study investigates the extent to which friendship network, family relations, and school context are related to adolescent cigarette smoking. Friendship network is measured in terms of delinquent peers; family relations in terms of parental supervision; and school environment in terms of objective (eg, antismoking policy) and subjective (eg, school attachment) characteristics.

METHODS

Findings are based on the secondary analysis of the health behavior in school-aged children, 2009-2010. Two-level hierarchical generalized linear models are estimated using hierarchical linear modeling 7.

RESULTS

At the student level, ties to delinquent friends is significantly related to higher odds of smoking, while greater parental supervision is associated with lower odds. At the school level, antismoking policy and curriculum independently lower smoking behavior. Better within-class peer relations, greater school attachment, and higher academic performance are also negatively related to smoking. Last, the positive association between delinquent friends and smoking is weaker in schools with a formally enacted antismoking policy. However, this association is stronger in schools with better peer relations.

CONCLUSIONS

Adolescent smoking behavior is embedded in a broader ecological setting. This research reveals that a proper understanding of it requires comprehensive analysis that incorporates factors measured at individual (student) and contextual (school) levels.

The association between neighbourhood-level deprivation and depression: evidence from the south african national income dynamics study

BACKGROUND

Depression contributes substantially to the burden of disease in South Africa. Little is known about how neighbourhoods affect the mental health of the people living in them.

METHODS

Using nationally representative data (N=11,955) from the South African National Income Dynamics Study and the South African Indices of Multiple Deprivation (SAIMD) modelled at small-area level, this study tested associations between neighbourhood-level deprivation and depression, after controlling for individual-level covariates.

RESULTS

Results showed a significant positive association between neighbourhood-level deprivation and depression using the composite SAIMD (β = 0.31 (0.15); p=0.04) as well as the separate deprivation domains. Living environment deprivation (β =0.53 (0.16); p=0.001) and employment deprivation (β = 0.38 (0.13); p=0.004), respectively, were the two most salient domains in predicting this relationship.

CONCLUSIONS

Findings supported the hypothesis that there is a positive association between living in a more deprived neighbourhood and depression, even after controlling for individual-level covariates. This study suggests that alleviating structural poverty could reduce the burden of depression in South Africa.

High social trust associated with increased depressive symptoms in a longitudinal South African sample

Several studies have documented a protective association between social trust and mental and physical health, but gaps in knowledge remain. Debates regarding the contextual versus individual nature of social trust are ongoing; research from low- and middle-income countries is lacking, and study designs have been limited for causal inference. To address these gaps, we examined the association between social trust and depressive symptoms using three waves of the National Income Dynamics Study, a longitudinal South African survey. We used individual fixed-effects models to assess the association between changes in scores on the Center for Epidemiological Studies Depression Scale Short Form (CES-D-10) and in individual-level and district-level personalized and generalized trust among 15,670 individuals completing at least two waves of the NIDS adult questionnaire. High individual-level generalized trust was unexpectedly associated with increased depressive symptoms scores while district generalized trust did not show an association. We also found a cross-level interaction between individual and district-level personalized trust. High individual trust was associated with increased depressive symptoms scores when district trust was low; however, as district-level trust increased, higher individual trust was associated with reduced depressive symptoms. Our unexpected results suggest that trust may not always be beneficial for depressive symptoms, but rather, that its effects may depend on context. In the South African setting where social trust is low, being very likely to trust may be associated with worse depressive symptoms in some circumstances.

Association between disability and social capital among community-dwelling elderly

Objective

To assess the prevalence of disability and its association with social capital among community-dwelling elderly.

Methods

The study was based on 2nd Health Survey of Belo Horizonte Metropolitan Region - 2010, that included 1,995 community-dwelling elderly, randomly sampled. The exposure of interest was social capital, measured by confidence in neighborhood, perception of the physical environment, sense of cohesion in housing, and neighborhood perception of help. Socio-demographic variables, health conditions and use of health services were considered in the analysis with the purpose of adjustment.

Results

Approximately one third of participants (32.6%) were unable to at least one instrumental activity of daily living (IADL) and/or basic activity of daily living (ADL); the prevalence of disability in ADL/IADL was 18.1%, and only in IADL was 14.6%. Elderly with functional disabilities had higher odds of poor social capital, but only the sense of cohesion in housing neighborhood showed to be independently associated with functional disability (OR = 1.80; 95%CI 1.12 - 2.88).

Conclusions

Our results show the importance of social capital in research on associated factors of functional disability and indicate the need to implement public policies for social and environmental areas, since the needs of the elderly require measures beyond those typical of the health sector.

A Conceptual Framework for Examining Healthcare Access and Navigation: A Behavioral-Ecological Perspective

This paper introduces a conceptual framework for investigating individual ability to navigate healthcare in the contexts of the built environment, social environment, and healthcare infrastructure in which a person is embedded. Given the complexity of healthcare delivery in the United States, consumers are expected to have an increasingly sophisticated set of skills in order to effectively navigate and benefit from the healthcare resources available to them. Addressing barriers to navigation in vulnerable populations may be essential to reducing health disparities. This paper builds on previous conceptual developments in the areas of healthcare use, navigation, and ecological perspectives on health in order to present a behavioral-ecological framework for examining healthcare navigation and access. The model posits that healthcare navigation is an ecologically informed process not only because of the spatial distribution of health services, but because of the spatial distribution of individual and environmental factors that influence decision-making and behavior with respect to service use. The paper discusses areas for further research on healthcare navigation, challenges for research, and implications for reducing health disparities.

The relationship between negative household events and depressive symptoms: Evidence from South African longitudinal data

BACKGROUND

The relationship between negative life events and vulnerability to depression is not well-documented in developing countries, particularly using large-scale, longitudinal data. This study seeks to add to this literature by examining the relationship between negative household events and vulnerability to depression amongst a representative sample of South African adults for the period 2008-2012.

METHODS

Data from three waves of the longitudinal South African National Income Dynamics Study (NIDS) were analysed to estimate the association between negative household events and adult depressive symptoms using ordinary least squares (OLS) and fixed-effects regression models.

RESULTS

One in four South Africans reported that they lived in a household where at least one household member had been seriously ill or injured, or where a household member, relative or friend had died within the previous two years. There was a significant association between the serious illness of a household member, or the death of a family member who provided financial assistance, and adult depression scores.

LIMITATIONS

The study used data collected in a large-scale household survey by field work teams. It is reliant on self-reported depressive symptoms that have not been validated by formal clinical diagnosis.

CONCLUSIONS

There are high rates of morbidity and mortality in South Africa, and adults living in households where family members are ill or have died are significantly more vulnerable to depression. These findings highlight the importance of providing counselling and psychiatric support not only to those directly affected by negative health events, but also to their family or household members.

Trajectories of Neighborhood Cohesion in Childhood, and Psychotic and Depressive Symptoms at Age 13 and 18 Years

OBJECTIVE

Exposure to adverse social environments has been associated with psychotic and depressive symptoms in adolescence in cross-sectional studies, but the longitudinal relation is unclear. This study examined whether longitudinal trajectories of exposure to adverse social environments across childhood are associated with psychotic experiences and depressive symptoms in adolescence.

METHOD

Data on participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) were used to estimate longitudinal trajectories of childhood exposure to neighborhood cohesion (NC), discord (ND), and stress (NS) using latent class growth modeling. Logistic regression was used to examine the association between these trajectories and psychotic experiences and depressive symptoms at 13 and 18 years of age, adjusting for maternal psychopathology, participant sociodemographic and socioeconomic characteristics, and area-level deprivation.

RESULTS

A dose-response association was observed between higher NS and the odds of psychotic experiences at 13 years (medium NS, adjusted odds ratio [aOR] 1.25, 95% CI 1.05-1.49; high NS, aOR 1.77, 95% CI 1.30-2.40), whereas high levels of ND predicted psychotic experiences at 18 years (aOR 1.50, 95% CI 1.10-2.07). High levels of NC (aOR 1.43, 95% CI 1.02-1.71) and NS (aOR 1.55, 95% CI 1.07-2.26) were associated with increased odds of high depressive symptoms at 18 years in a dose-response fashion.

CONCLUSION

Prolonged and more severe exposure to adverse social environments is associated with greater odds of developing psychotic and depressive symptoms in late adolescence.

Parenting and youth sexual risk in context: The role of community factors

Black South African youth are disproportionately affected by HIV, and risky sexual behaviors increase youths' vulnerability to infection. U.S.-based research has highlighted several contextual influences on sexual risk, but these processes have not been examined in a South African context. In a convenience sample of Black South African caregivers and their 10-14-year-old youth (Mage = 11.7, SD = 1.4; 52.5% female), we examined the relation between parenting and youth sexual risk within the context of community-level processes, including neighborhood quality and maternal social support. Hypotheses were evaluated using structural equation modeling. Results revealed that better neighborhood quality and more social support predicted positive parenting, which in turn predicted less youth sexual risk. There was a significant indirect effect from neighborhood quality to youth sexual risk via parenting. Results highlight the importance of the community context in parenting and youth sexual risk in this understudied sample. HIV prevention-interventions should be informed by these contextual factors.

Income inequality widens the existing income-related disparity in depression risk in post-apartheid South Africa: Evidence from a nationally representative panel study

AIM

Income inequality (II) and poverty are major challenges in South Africa (SA) yet little is known about their interaction on population mental health. We explored relationships between district II, household income (HHI) and depressive symptoms in national panel data.

METHOD

We used 3 waves (2008, 2010, 2012) of the SA National Income Dynamics Study (n=25936) in adjusted mixed effects logistic regression to assess if the relationship between HHI and depressive symptoms is dependent on level of II. Depressive symptoms were assessed with Centre for Epidemiologic Studies Depression scale, and District inequality ratios (P10P90) derived from HHI distributions in 53 districts.

RESULTS

Lower HHI and increasing II were associated with depressive symptoms. The interaction term between HHI and II on depressive symptoms was significant (β=0.01, 95% CI: <0.01-0.01); with increasing II and decreasing HHI, depression risk increased.

CONCLUSION

II widens income-related disparities in depression risk in SA, with policy implications for understanding socioeconomic determinants of mental health and informing global efforts to reduce disparities in high poverty and inequality contexts.

Validation of the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) in Zulu, Xhosa and Afrikaans populations in South Africa

BACKGROUND

The 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) is a depression screening tool that has been used in the South African National Income Dynamics Study (NIDS), a national household panel study. This screening tool has not yet been validated in South Africa. This study aimed to establish the reliability and validity of the CES-D-10 in Zulu, Xhosa and Afrikaans. The CES-D-10's psychometric properties were also compared to the Patient Health Questionnaire (PHQ-9), a depression screening tool already validated in South Africa.

METHODS

Stratified random samples of Xhosa, Afrikaans and Zulu-speaking participants aged 15 years or older (N = 944) were recruited from Cape Town Metro and Ethekwini districts. Face-to-face interviews included socio-demographic questions, the CES-D-10, Patient Health Questionnaire (PHQ-9), and WHO Disability Assessment Schedule 2.0 (WHODAS). Major depression was determined using the Mini International Neuropsychiatric Interview. All instruments were translated and back-translated to English. Construct validity was examined using exploratory factor analysis with varimax rotation. Receiver Operating Characteristics (ROC) curves were used to investigate the CES-D-10 and PHQ-9's criterion validity, and compared using the DeLong method.

RESULTS

Overall, 6.6, 18.0 and 6.9% of the Zulu, Afrikaans and Xhosa samples were diagnosed with depression, respectively. The CES-D-10 had acceptable internal consistency across samples (α = 0.69-0.89), and adequate concurrent validity, when compared to the PHQ-9 and WHODAS. The CES-D-10 area under the Receiver Operator Characteristic curve was good to excellent: 0.81 (95% CI 0.71-0.90) for Zulu, 0.93 (95% CI 0.90-0.96) for Afrikaans, and 0.94 (95% CI 0.89-0.99) for Xhosa. A cut-off of 12, 11 and 13 for Zulu, Afrikaans and Xhosa, respectively, generated the most balanced sensitivity, specificity and positive predictive value (Zulu: 71.4, 72.6% and 16.1%; Afrikaans: 84.6%, 84.0%, 53.7%; Xhosa: 81.0%, 95.0%, 54.8%). These were slightly higher than those generated for the PHQ-9. The CES-D-10 and PHQ-9 otherwise performed similarly across samples.

CONCLUSIONS

The CES-D-10 is a valid, reliable screening tool for depression in Zulu, Xhosa and coloured Afrikaans populations.

Nedley Depression Hit Hypothesis: Identifying Depression and Its Causes

Depression is often diagnosed using the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. We propose how certain lifestyle choices and non-modifiable factors can predict the development of depression. We identified 10 cause categories (hits or “blows” to the brain) and theorize that four or more active hits could trigger a depression episode. Methods. A sample of 4271 participants from our community-based program (70% female; ages 17-94 years) was assessed at baseline and at the eighth week of the program using a custom test. Ten cause categories were examined as predictors of depression are (1) Genetic, (2)Developmental, (3)Lifestyle, (4)Circadian Rhythm, (5)Addiction, (6)Nutrition, (7)Toxic, (8)Social/Complicated Grief, (9)Medical Condition, and (10)Frontal Lobe. Results. The relationship between the DSM-5 score and a person having four hits categories in the first program week showed a sensitivity of 89.98 % (95% CI: 89.20 % - 90.73%), specificity 48.84% (CI 45.94-51.75) and Matthew Correlation Coefficient (MCC) .41 . For the eight-week test, the results showed a sensitivity 83.6% (CI 81.9-85.5), specificity 53.7% (CI 51.7-55.6) and MCC .38. Overall, the hits that improved the most from baseline after the eighth week were: Nutrition (47%), Frontal lobe (36%), Addiction (24%), Circadian rhythm (24%), Lifestyle (20%), Social (12%) and Medical (10%). Conclusions. The Nedley four-hit hypothesis seems to predict a depressive episode and correlates well with the DSM-5 criteria with good sensitivity and MCC but less specificity. Identifying these factors and applying lifestyle therapies could play an important role in the treatment of depressed individuals.

Income inequality and depressive symptoms in South Africa: A longitudinal analysis of the National Income Dynamics Study

Research suggests that income inequality may detrimentally affect mental health. We examined the relationship between district-level income inequality and depressive symptoms among individuals in South Africa-one of the most unequal countries in the world-using longitudinal data from Wave 1 (2008) and Wave 3 (2012) of the National Income Dynamics Study. Depressive symptoms were measured using the Center for Epidemiological Studies of Depression Short Form while district Gini coefficients were estimated from census and survey sources. Age, African population group, being single, being female, and having lower household income were independently associated with higher depressive symptoms. However, in longitudinal, fixed-effects regression models controlling for several factors, district-level Gini coefficients were not significantly associated with depressive symptoms scores. Our results do not support the hypothesis of a causal link between income inequality and depressive symptoms in the short-run. Possible explanations include the high underlying levels of inequality in all districts, or potential lags in the effect of inequality on depression.

Urban Planning and Health Inequities: Looking in a Small-Scale in a City of Cape Verde

BACKGROUND

The lack of high-quality data to support evidence-based policies continues to be a concern in African cities, which present marked social, economic and cultural disparities that may differently impact the health of the groups living in different urban contexts. This study explores three urban units--formal, transition and informal--of the capital of Cape Verde, in terms of overweight/obesity, cardiometabolic risk, physical activity and other aspects related to the urban environment.

METHODS

Quantitative and qualitative research methods were used in this intra-urban study. A proportional stratified random sample (n = 1912 adults), based on geographical coordinates of private households, was selected to apply the UPHI-STAT questionnaire. In a second stage (n = 599), local nutritionists collected anthropometric measurements (e.g., height, waist circumference) and body composition by bioelectric impedance (e.g., body weight, body fat, muscle mass). In a third stage, pedometers were used to count study participants' steps on working and non-working days for one week (n = 118). After a preliminary statistical analysis, a qualitative study was developed to complement the quantitative approach. Generalized linear models, among others, were used in the multivariate analysis.

RESULTS

Insecurity was the main concern among survey respondents in the three units, notwithstanding with significant differences (p < 0.001) among units. About three-quarters (76.6%) of the participants of the informal unit emphasised the need for more security. The formal unit presents an older age structure (61.3% above 40 years old) and the transition unit a younger age structure (only 30.5% above 40 years old). Some health-related variables were analysed in each unit, revealing an excess of chronic conditions reported by inhabitants of informal unit, compared with the formal unit despite the informal unit's younger age profile. The self-reported hypertension varied significantly among urban units (p < 0.001), with 19.3% in the formal unit, 11.4% in the transition unit and 22.5% in the informal unit. Women of the urban units present significant differences (5% level) for body mass index calculated from self-reported measures (p < 0.001), fat mass (p = 0.005), waist circumference (p = 0.046) and waist-to-height ratio (p = 0.017). For women, overall physical activity was 67.4% (95%CI [64.8,70.0]), with differences among urban units (p = 0.025). For men it was of 85.2% (95%CI [82.3,87.6]), without significant differences among urban units (p = 0.266). The percentage of women and men who reported physical activity in leisure time was discrepant, with 95%CI [22.6, 27.4] and [53.2, 60.2], respectively. The results of pedometers also indicated that men walk significantly more than women (p < 0.001), with a difference of approximately 2000 steps/day.

CONCLUSIONS

The data collection process itself also gave us some clues on the involvement of local communities, exploring the potential of social capital of these settings and the role of the woman in family and society in Cape Verde. The higher participation of women and residents of informal unit (the most disadvantaged groups) suggests these as the priority target groups for health promotion campaigns. The link between health planning, urban planning and security of the city needs to be reinforced to minimize health, social and gender inequalities.

Determinants of Obesity and Associated Population Attributability, South Africa: Empirical Evidence from a National Panel Survey, 2008-2012

Background

Obesity is a major risk factor for emerging non-communicable diseases (NCDS) in middle income countries including South Africa (SA). Understanding the multiple and complex determinants of obesity and their true population attributable impact is critical for informing and developing effective prevention efforts using scientific based evidence. This study identified contextualised high impact factors associated with obesity in South Africa.

Methods

Analysis of three national cross sectional (repeated panel) surveys, using a multilevel logistic regression and population attributable fraction estimation allowed for identification of contextualised high impact factors associated with obesity (BMI>30 kg/m²) among adults (15years+).

Results

Obesity prevalence increased significantly from 23.5% in 2008 to 27.2% in 2012, with a significantly (p-value<0.001) higher prevalence among females (37.9% in 2012) compared to males (13.3% in 2012). Living in formal urban areas, white ethnicity, being married, not exercising and/or in higher socio-economic category were significantly associated with male obesity. Females living in formal or informal urban areas, higher crime areas, African/White ethnicity, married, not exercising, in a higher socio-economic category and/or living in households with proportionate higher spending on food (and unhealthy food options) were significantly more likely to be obese. The identified determinants appeared to account for 75% and 43% of male and female obesity respectively. White males had the highest relative gain in obesity from 2008 to 2012.

Conclusions

The rising prevalence of obesity in South Africa is significant and over the past 5 years the rising prevalence of Type-2 diabetes has mirrored this pattern, especially among females. Targeting young adolescent girls should be a priority. Addressing determinants of obesity will involve a multifaceted strategy and requires at individual and population levels. With rising costs in the private and public sector to combat obesity related NCDS, this analysis can inform culturally sensitive mass communications and wellness campaigns. Knowledge of social determinants is critical to develop “best buys”.

Poverty, inequality and a political economy of mental health

The relationship between poverty and mental health is indisputable. However, to have an influence on the next set of sustainable global development goals, we need to understand the causal relationships between social determinants such as poverty, inequality, lack of education and unemployment; thereby clarifying which aspects of poverty are the key drivers of mental illness. Some of the major challenges identified by Lund (2014) in understanding the poverty-mental health relationship are discussed including: the need for appropriate poverty indicators; extending this research agenda to a broader range of mental health outcomes; the need to engage with theoretical concepts such as Amartya Sen's capability framework; and the need to integrate the concept of income/economic inequality into studies of poverty and mental health. Although income inequality is a powerful driver of poor physical and mental health outcomes, it features rarely in research and discourse on social determinants of mental health. This paper interrogates in detail the relationships between poverty, income inequality and mental health, specifically: the role of income inequality as a mediator of the poverty-mental health relationship; the relative utility of commonly used income inequality metrics; and the likely mechanisms underlying the impact of inequality on mental health, including direct stress due to the setting up of social comparisons as well as the erosion of social capital leading to social fragmentation. Finally, we need to interrogate the upstream political, social and economic causes of inequality itself, since these should also become potential targets in efforts to promote sustainable development goals and improve population (mental) health. In particular, neoliberal (market-oriented) political doctrines lead to both increased income inequality and reduced social cohesion. In conclusion, understanding the relationships between politics, poverty, inequality and mental health outcomes requires us to develop a robust, evidence-based 'political economy of mental health.'

Investigating the relationship between self-rated health and social capital in South Africa: a multilevel panel data analysis

Background

The relationship between social capital and self-rated health has been documented in many developed compared to developing countries. Because social capital and health play important roles in development, it may be valuable to study their relationship in the context of a developing country with poorer health status. Further, the role of social capital research for health policy has not received much attention. This paper therefore examines the relationship between social capital and health in South Africa, a country with the history of colonialism and apartheid that has contributed to the social disintegration and destruction of social capital.

Methods

This study uses data from the National Income Dynamics Study (NIDS), the first nationally representative panel study in South Africa. Two waves of the NIDS were used in this paper – Wave 1 (2008) and Wave 2 (2010). Self-rated health, social capital (individual- and contextual-level), and other covariates related to the social determinants of health (SDH) were obtained from the NIDS. Individual-level social capital included group participation, personalised trust and generalised trust while contextual-level or neighbourhood-level social capital was obtained by aggregating from the individual-level and household-level social capital variables to the neighbourhood. Mixed effects models were fitted to predict self-rated health in Wave 2, using lagged covariates (from Wave 1).

Results

Individual personalised trust, individual community service group membership and neighbourhood personalised trust were beneficial to self-rated health. Reciprocity, associational activity and other types of group memberships were not found to be significantly associated with self-rated health in South Africa. Results indicate that both individual- and contextual-level social capital are associated with self-rated health.

Conclusion

Policy makers may want to consider policies that impact socioeconomic conditions as well as social capital. Some of these policies are linked to the SDH. We contend that the significant social capital including community service membership can be encouraged through policy in a way that is in line with the values of the people. This is likely to impact on health and quality of life generally and lead to a reduction in the burden of disease in South Africa considering the historic context of the country.

A multilevel analysis of the relationship between neighborhood social disorder and depressive symptoms: evidence from the South African National Income Dynamics Study

The apartheid regime that governed South Africa from 1948-1994 established spatial segregation that is understood to have contributed to the magnitude of neighborhood social disorder in the postapartheid era. Although a number of neighborhood social disorder characteristics, such as perceived violence and crime in the community, are prominent issues in South Africa, the extent to which these perceived spatial attributes are linked to depression is unknown at the population level. Multilevel modeling of data from the second wave of the South African National Income Dynamics Study (SA-NIDS) was utilized to examine the relationship between depressive symptomatology and neighborhood social disorder as indicated by the perceived frequency of violent, criminal and illicit activities in the community. Depressive symptomatology was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale. A cut-off score of 10 or higher was used to indicate the presence of significant depressive symptomatology. Results showed that perception of neighborhood social disorder was independently associated with significant levels of depressive symptomatology. Gender, race or ethnicity, perceived health status, and education were significant for individual-level covariates of depression. Community intervention strategies that reduce the risk of neighborhood disorganization and emphasize positive social norms in the neighborhood are warranted. Taking into account the residential deracialization of a country transitioning from apartheid to nonracial democracy, a longitudinal spatial study design assessing the dynamics between depression and the aforementioned perceptions of neighborhood attributes may also be warranted.

Types of social capital and mental disorder in deprived urban areas: a multilevel study of 40 disadvantaged London neighbourhoods

OBJECTIVES

To examine the extent to which individual and ecological-level cognitive and structural social capital are associated with common mental disorder (CMD), the role played by physical characteristics of the neighbourhood in moderating this association, and the longitudinal change of the association between ecological level cognitive and structural social capital and CMD.

DESIGN

Cross-sectional and longitudinal study of 40 disadvantaged London neighbourhoods. We used a contextual measure of the physical characteristics of each neighbourhood to examine how the neighbourhood moderates the association between types of social capital and mental disorder. We analysed the association between ecological-level measures of social capital and CMD longitudinally.

PARTICIPANTS

4,214 adults aged 16-97 (44.4% men) were randomly selected from 40 disadvantaged London neighbourhoods.

MAIN OUTCOME MEASURES

General Health Questionnaire (GHQ-12).

RESULTS

Structural rather than cognitive social capital was significantly associated with CMD after controlling for socio-demographic variables. However, the two measures of structural social capital used, social networks and civic participation, were negatively and positively associated with CMD respectively. 'Social networks' was negatively associated with CMD at both the individual and ecological levels. This result was maintained when contextual aspects of the physical environment (neighbourhood incivilities) were introduced into the model, suggesting that 'social networks' was independent from characteristics of the physical environment. When ecological-level longitudinal analysis was conducted, 'social networks' was not statistically significant after controlling for individual-level social capital at follow up.

CONCLUSIONS

If we conceptually distinguish between cognitive and structural components as the quality and quantity of social capital respectively, the conclusion of this study is that the quantity rather than quality of social capital is important in relation to CMD at both the individual and ecological levels in disadvantaged urban areas. Thus, policy should support interventions that create and sustain social networks. One of these is explored in this article.

TRIAL REGISTRATION

Controlled-Trials.com ISRCTN68175121 http://www.controlled-trials.com/ISRCTN68175121.

The social determinants of multimorbidity in South Africa

Introduction

Multimorbidity is a growing concern worldwide, with approximately 1 in 4 adults affected. Most of the evidence on multimorbidity, its prevalence and effects, comes from high income countries. Not much is known about multimorbidity in low income countries, particularly in sub-Saharan Africa. The aim of this study was to determine the prevalence of multimorbidity and examine its association with various social determinants of health in South Africa.

Method

The data used in this study are taken from the South Africa National Income Dynamic Survey (SA-NIDS) of 2008. Multimorbidity was defined as the coexistence of two or more chronic diseases in an individual. Multinomial logistic regression models were constructed to analyse the relationship between multimorbidity and several indicators including socioeconomic status, area of residence and obesity.

Results

The prevalence of multimorbidity in South Africa was 4% in the adult population. Over 70% of adults with multimorbidity were females. Factors associated with multimorbidity were social assistance (Odds ratio (OR) 2.35; Confidence Interval (CI) 1.59-3.49), residence (0.65; 0.46-0.93), smoking (0.61; 0.38-0.96); obesity (2.33; 1.60-3.39), depression (1.07; 1.02-1.11) and health facility visits (5.14; 3.75-7.05). Additionally, income was strongly positively associated with multimorbidity. The findings are similar to observations made in studies conducted in developed countries.

Conclusion

The findings point to a potential difference in the factors associated with single chronic disease and multimorbidity. Income was consistently significantly associated with multimorbidity, but not single chronic diseases. This should be investigated further in future research on the factors affecting multimorbidity.