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Morozumi R, Matsumura K, Hamazaki K, Tsuchida A, Takamori A, Inadera H. Impact of individual and neighborhood social capital on the physical and mental health of pregnant women: the Japan Environment and Children's Study (JECS). BMC Pregnancy Childbirth 2020; 20:450. [PMID: 32762739 PMCID: PMC7409696 DOI: 10.1186/s12884-020-03131-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies revealed positive, negative, and no influence of social capital on the health outcomes of pregnant women. It was considered that such differences were caused by the disparities of outcome measures and sample sizes between studies. Our chief aim was to verify the positive influence of social capital on the health condition of pregnant women using established health outcome measures and large-scale nationwide survey data. Methods We employed questionnaire survey data from 79,210 respondents to the Japan Environment and Children’s Study, and physical and mental component summary scores from the 8-Item Short-Form Health Survey as outcome measures. We estimated the effect of individual and neighborhood social capitals on physical and mental component summary scores. To consider the property that the richness of social capital would be generally determined by individual characteristics, and to estimate the causal influence of social capital on health without bias caused by said property, we adopted average treatment effect estimation with inverse probability weighting. Generally, average treatment effects are based on the difference of average outcomes between treated and untreated groups in an intervention. In this research, we reckoned individuals’ different levels of social capital as a kind of non-randomized treatment for respective individuals, and we applied average treatment effect estimation. The analysis regarded pregnant women with the lowest level of social capital as untreated samples and women with other levels of social capitals as treated samples. Results For mental component summary score, the maximum average treatment effects in the comparison between the lowest and highest levels of social capital were approximately 4.4 and 1.6 for individual and neighborhood social capital, respectively. The average treatment effects for the physical component summary score were negligible for both social capital types. Conclusions Social capital particularly contributes to improving mental component summary score in pregnant women. The likelihood of a mentally healthy pregnancy may be increased by enhancing social capital.
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Affiliation(s)
- Ryoko Morozumi
- Faculty of Social Sciences, University of Toyama, 3190 Gofuku, Toyama-shi, Toyama, 930-8555, Japan.
| | - Kenta Matsumura
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Kei Hamazaki
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan.,Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Akiko Tsuchida
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan.,Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Ayako Takamori
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan
| | - Hidekuni Inadera
- Toyama Regional Center for JECS, University of Toyama, Toyama, Japan.,Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
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Lee HY, Oh J, Perkins JM, Heo J, Subramanian SV. Associations between maternal social capital and infant birth weight in three developing countries: a cross-sectional multilevel analysis of Young Lives data. BMJ Open 2019; 9:e024769. [PMID: 31601580 PMCID: PMC6797356 DOI: 10.1136/bmjopen-2018-024769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore how three indicators of social capital (ie, group membership, social support and cognitive social capital and specific types within each type) are associated with infant birth weight. STUDY DESIGN AND SETTINGS Cross-sectional analyses of the first wave of Young Lives Survey data collected in 2002 from India (Andhra Pradesh state), Peru and Vietnam. PARTICIPANTS 807 mothers in India, 1528 mothers in Peru and 1706 mothers in Vietnam. OUTCOMES MEASURE Infant birth weight was measured in grams. Participation in specific groups, receipt of social support from specific groups or individuals and perceptions of their community were measured for social capital indicators. Two-level random intercept linear regression models were fit separately by country (first level: individual and second level: community). RESULTS Maternal group membership displayed a consistent positive association with infant birth weight across the three countries. There was no relationship with maternal cognitive social capital. Membership in a women's group was associated with infant birth weight consistently in all three countries (b=119.6, 95% CI 21.7 to 217.4 in India, b=133.4, 95% CI 40.9 to 225.9 in Peru, b=60.6, 95% CI 0.5 to 120.6 in Vietnam). However, membership in a political group in Peru was inversely associated with infant birth weight (b=-276.1, 95% CI -465.7 to -86.5). CONCLUSION Although a higher level of social capital is associated with higher infant birth weight, specific types of social capital may have different associations with infant birth weight depending on the social, political or cultural specificity of the country. These results pave the way for additional research on the mechanisms through which social capital influences birth weight outcomes in each country.
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Affiliation(s)
- Hwa-Young Lee
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Takemi Program in International Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Juhwan Oh
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jessica M Perkins
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- National Assembly Futures Institute, Seoul, Republic of Korea
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Higher child-raising costs due to maternal social isolation: Large population-based study in Japan. Soc Sci Med 2019; 233:71-77. [PMID: 31185444 DOI: 10.1016/j.socscimed.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND To assess the association between maternal social isolation and the child-rearing costs among mothers with 6-month-old infants. METHODS Data was analyzed from a population-based birth-cohort study in Japan, the Longitudinal Survey of Babies in the 21st Century (n = 40,643). Maternal isolation was defined by lack of social support among mothers expressing difficulties with child rearing. Child-rearing costs for one month (when the infant was 6-months-old) were self-reported in units of JPY 10,000 (approximately 80 USD). The association between maternal social isolation and child-rearing cost was assessed using generalized linear models adjusted for child, maternal, and family level characteristics. RESULTS Of the sample, 258 (0.6%) women were classified as socially isolated. In the crude model, isolated mothers paid JPY 6980 (95% confidence interval [CI]: 4753-9207), approximately USD$87, more per month on child-rearing expenses compared to non-isolated mothers. This finding was similar in the multivariable adjusted model (marginal effect: JPY 4,186, 95% CI, 2235-6136). Stratified analysis comparing low income vs. non-low income mothers showed that, among the former group, socially isolated mothers spend more on child rearing than mothers who are not isolated (marginal effect: JPY 13,218, 95% CI:784 to 2565), while among the non-low income group, a significant association was not observed. CONCLUSIONS Socially isolated mothers spent JPY4,186 (approximately USD 35) more per month on child-rearing costs compared to non-isolated mothers when the infant was aged 6 months old. In nationwide terms, this cost could be roughly calculated as JPY 350 million (approximately USD 2.9 million) in 2001. Provision of social network connections and support for socially isolated mothers is suggested to be an efficient public health policy.
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Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study. PLoS One 2017; 12:e0180857. [PMID: 28854236 PMCID: PMC5576674 DOI: 10.1371/journal.pone.0180857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 06/22/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To generate and evaluate an indicator of the health system’s performance in the area of maternal and reproductive health in Colombia. Materials and methods An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator’s score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. Results The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator’s behavior was found to have an association with the unsatisfied basic needs index and women’s education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. Discussion The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.
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Hetherington E, Doktorchik C, Premji SS, McDonald SW, Tough SC, Sauve RS. Preterm Birth and Social Support during Pregnancy: a Systematic Review and Meta-Analysis. Paediatr Perinat Epidemiol 2015; 29:523-35. [PMID: 26332279 DOI: 10.1111/ppe.12225] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Additional social support is often recommended for women during the prenatal period to optimise birth outcomes, specifically to avoid preterm birth. Social support is thought to act in one of two ways: by reducing stress and anxiety, or by providing coping mechanisms for women with high stress. However, evidence in this area is mixed. The purpose of this meta-analysis is to determine if low levels of social support are associated with an increased risk for preterm birth. METHODS Six databases were searched for randomised control trials and cohort studies regarding social support and preterm birth with no limits set on date or language. Inclusion criteria included the use of a validated instrument to measure social support, and studies conducted in high-income or high-middle-income countries. RESULTS There were 3467 records retrieved, 16 of which met the inclusion criteria. Eight studies (n = 14 630 subjects) demonstrated a pooled odds ratio (OR) of 1.22 (95% CI 0.84, 1.76) for preterm birth in women with low social support compared with high social support. Among women with high stress levels, two studies (n = 6374 subjects) yielded a pooled OR of 1.52 (95% CI 1.18, 1.97). The results of six studies could not be pooled due to incompatibility of outcome measures. CONCLUSIONS There is no evidence for a direct association between social support and preterm birth. Social support, however, may provide a buffering mechanism between stress and preterm birth.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Chelsea Doktorchik
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shahirose S Premji
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Sheila W McDonald
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Reg S Sauve
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Semali IA, Leyna GH, Mmbaga EJ, Tengia-Kessy A. Social Capital as a Determinant of Pregnant Mother's Place of Delivery: Experience from Kongwa District in Central Tanzania. PLoS One 2015; 10:e0138887. [PMID: 26426538 PMCID: PMC4591118 DOI: 10.1371/journal.pone.0138887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 08/07/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery. METHODS We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12. RESULTS Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4-6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3-13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9-11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4-13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001). CONCLUSION Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.
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Affiliation(s)
- Innocent Antony Semali
- Department of Epidemiology and Biostatistics, School of public Health and Social sciences, Dar es Salaam, Tanzania
| | - Germana Henry Leyna
- Department of Epidemiology and Biostatistics, School of public Health and Social sciences, Dar es Salaam, Tanzania
| | - Elia John Mmbaga
- Department of Epidemiology and Biostatistics, School of public Health and Social sciences, Dar es Salaam, Tanzania
| | - Anna Tengia-Kessy
- Department of Community Health, School of public Health and Social sciences, Dar es Salaam, Tanzania
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Tofani AA, Lamarca GDA, Sheiham A, Vettore MV. The different effects of neighbourhood and individual social capital on health-compromising behaviours in women during pregnancy: a multi-level analysis. BMC Public Health 2015; 15:890. [PMID: 26369830 PMCID: PMC4570677 DOI: 10.1186/s12889-015-2213-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 09/02/2015] [Indexed: 11/21/2022] Open
Abstract
Background This study assessed clustering of three health-compromising behaviours and explored the association of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of pregnancy (follow-up). Methods A longitudinal study was conducted on a representative sample of women recruited in antenatal care units grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status), individual social capital (social support and social networks) and socio-demographic variables were collected at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering was assessed using an observed to expected ratio method. The association of contextual and individual social capital with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models. Results Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely associated with low levels of individual social capital. Low individual social capital predicted smoking during whole pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood social capital. Conclusions Three health-compromising behaviours are relatively common and cluster in Brazilian women throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social resources should be considered when planning the interventions.
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Affiliation(s)
- Andrea Almeida Tofani
- National Institute of Cancer, Ministry of Health of Brazil, Praça Cruz Vermelha, 23, Centro - Rio de Janeiro, RJ, CEP: 20230-130, Brazil. .,Institute of Studies in Public Health, Federal University of Rio de Janeiro, Avenida Horácio Macedo, S/N - Próximo a Prefeitura Universitária da UFRJ, Ilha do Fundão - Cidade Universitária, Rio de Janeiro, RJ, CEP 21941-598, Brazil.
| | - Gabriela de Almeida Lamarca
- Centre of Studies, Policies and Information on Social Determinants of Health, National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, RJ, CEP: 21041-210, Brazil.
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK.
| | - Mario Vianna Vettore
- Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK.
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Social capital, tolerance of diversity and adherence to Mediterranean diet: the Rhea Mother-Child Cohort in Crete, Greece. Public Health Nutr 2014; 18:1300-7. [PMID: 25089536 DOI: 10.1017/s136898001400144x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy. DESIGN This is a cross-sectional analysis of data from a prospective mother-child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal-maximal adherence). 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. Multivariable log-binomial and linear regression models adjusted for confounders were performed. SETTING Heraklion, Crete, Greece. SUBJECTS A total of 377 women with singleton pregnancies. RESULTS High maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest v. lowest group: β coefficient=0·95, 95 % CI 0·23, 1·68), after adjustment for confounders. Similar dose-response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted β coefficient=1·08, 95 % CI 0·39, 1·77). CONCLUSIONS Individual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet.
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Moudatsou MM, Kritsotakis G, Alegakis AK, Koutis A, Philalithis AE. Social capital and adherence to cervical and breast cancer screening guidelines: a cross-sectional study in rural Crete. HEALTH & SOCIAL CARE IN THE COMMUNITY 2014; 22:395-404. [PMID: 24450830 DOI: 10.1111/hsc.12096] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 06/03/2023]
Abstract
Breast and cervical cancers are among the leading causes of female mortality. The reasons that make women adhere, or not, to screening guidelines are not only related to individual and health characteristics but are also placed in a wider social and cultural context. Social capital might facilitate the dissemination of relevant knowledge of and the adherence to cancer screening guidelines. This cross-sectional study explored the associations of individual-level social capital with breast and cervical cancer screening and the knowledge for the existence of relevant screening tests (Pap test and mammography) in the municipality of Gorgolaini, a rural area in Crete, Greece. A random sample of 131 of the 592 women of the 2001 electoral register were invited to participate in the study and 125 completed the Social Capital Questionnaire and two questions on self-reported health knowledge and behaviour (participation rate 95.4%). Women were eligible to participate if they were aged 35-75, had lived in the area for the last 10 years and were of Greek origin. Multiple logistic regressions were performed to establish associations among each social capital factor (total, participation in the community, value of life, tolerance for diversity, feelings of safety, family/friends connections) and knowledge of and adherence to breast and cervical cancer screening guidelines after adjustment for confounders. Our results suggest that early detection of breast and cervical cancers may be facilitated when taking into account the social context of the population.
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Affiliation(s)
- Maria M Moudatsou
- Department of Medicine, Faculty of Social Medicine, University of Crete, Heraklion, Greece
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Lamarca GA, Leal MDC, Leao ATT, Sheiham A, Vettore MV. The different roles of neighbourhood and individual social capital on oral health-related quality of life during pregnancy and postpartum: a multilevel analysis. Community Dent Oral Epidemiol 2013; 42:139-50. [DOI: 10.1111/cdoe.12062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Gabriela A. Lamarca
- Escola Nacional de Saúde Pública FIOCRUZ; Rio de Janeiro RJ Brazil
- Department of Epidemiology and Public Health; University College London; London UK
| | - Maria do C. Leal
- Escola Nacional de Saúde Pública FIOCRUZ; Rio de Janeiro RJ Brazil
| | - Anna T. T. Leao
- Faculdade de Odontologia; Universidade Federal do Rio de Janeiro; Rio de Janeiro RJ Brazil
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health; University College London; London UK
| | - Mario V. Vettore
- Unit of Dental Public Health; School of Clinical Dentistry; University of Sheffield; Sheffield UK
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The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women. BMC Pregnancy Childbirth 2013; 13:1. [PMID: 23324161 PMCID: PMC3556498 DOI: 10.1186/1471-2393-13-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum. METHODS A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH--good SRH at baseline and follow-up, and, 2. Poor SRH--poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates. RESULTS The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house. CONCLUSIONS Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women's SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.
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Social capital in pregnancy and postpartum depressive symptoms: a prospective mother-child cohort study (the Rhea study). Int J Nurs Stud 2012; 50:63-72. [PMID: 22980484 DOI: 10.1016/j.ijnurstu.2012.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 08/08/2012] [Accepted: 08/17/2012] [Indexed: 11/22/2022]
Abstract
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.
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