State-event relations among indicators of susceptibility to mental distress in Wythenshawe in the UK

The effects of the London 2012 Olympics and related urban regeneration on physical and mental health: the ORiEL mixed-methods evaluation of a natural experiment

Background

There is limited evidence for public health policy-makers on the health impacts of urban regeneration programmes.

Objectives

To assess whether or not the London 2012 Olympic and Paralympic Games, and related urban regeneration, were associated with an increase in physical activity and mental health and well-being; to assess whether or not any benefits were sustained over time; and to capture the experiences of residents of the Olympic host boroughs.

Design

Quasi-experimental prospective cohort study of adolescents and their parents/carers, with a nested qualitative longitudinal study of families.

Setting

London boroughs of Newham, Barking and Dagenham, Tower Hamlets and Hackney.

Participants

A cohort of 2254 adolescents in 25 schools; a repeat cross-sectional study of parents/carers and a sample of 20 families for the qualitative study.

Intervention

The London 2012 Olympic and Paralympic Games, and urban regeneration primarily associated with the redevelopment of the Olympic Park for legacy use.

Primary outcome measures

Change in the proportion of respondents meeting physical activity recommendations (using self-reported physical activity); change in the proportion of respondents reporting depression and anxiety and change in well-being score.

Main results

At 6 months, adolescents who became inactive were less likely to come from the intervention borough (Newham) than from comparison boroughs [risk ratio (RR) = 0.69, 95% confidence interval (CI) 0.51 to 0.93]. At 18 months, there were no statistically significant differences between intervention and comparison boroughs for all adolescent physical activity and screen-time transitions. Those who visited the Olympic Park more than once a month were the least likely to remain inactive (RR 0.11, 95% CI 0.02 to 0.48) and the least likely to become inactive (RR 0.38, 95% CI 0.24 to 0.60) compared with those who were active at baseline and at the 18-month follow-up. No impacts on parental/carer physical activity were observed. Adolescents who were ‘no longer depressed’ (RR 1.53, 95% CI 1.07 to 2.20) or ‘remained depressed’ (RR 1.78, 95% CI 1.12 to 2.83) at 6 months were more likely to be from the intervention borough. For well-being, there was no association between boroughs and change in well-being between baseline and the 6-month follow-up. At 18 months’ follow-up, adolescents who ‘remained depressed’ (RR 1.93, 95% CI 1.01 to 3.70) were more likely to be from the intervention borough than from comparison boroughs. No associations were observed for well-being at 18 months. There was limited evidence of change for parental mental health and well-being. The qualitative study found that residents generally welcomed the unexpected chance to live in a cleaner, safer and more unified environment. The findings suggested that the Games temporarily alleviated certain stressors in the social and physical environment. Overall, the Games lessened participants’ sense of social exclusion and appeared to generate a sense of inclusion and respite, even if this was only temporary. Study limitations include the potential for adolescents to not be assigned the correct level of exposure to urban regeneration and the effect of reductions in central and local public budgets owing to the UK Government’s deficit reduction programme.

Conclusions

This study provided the highest quality data to date on the short- and medium-term social and health impacts of sporting mega-events. We found limited evidence that the London 2012 Olympic and Paralympic Games had a positive effect on adolescent or parental physical activity, mental health or well-being.

Funding

The National Institute for Health Research Public Health Research programme.

An Olympic Legacy? Did the Urban Regeneration Associated With the London 2012 Olympic Games Influence Adolescent Mental Health?

Public expenditure on large events such as the London 2012 Olympic Games is often justified by the potential legacy of urban regeneration and its associated health and well-being benefits for local communities. In the Olympic Regeneration in East London Study, we examined whether there was an association between urban regeneration related to the 2012 Games and improved mental health in young people. Adolescents aged 11-12 years attending schools in the Olympic host borough of Newham in London or in 3 adjacent comparison London boroughs completed a survey before the 2012 Games and 6 and 18 months after the Games (in 2013 and 2014, respectively). Changes in depressive symptoms and well-being between baseline and each follow-up were examined. A total of 2,254 adolescents from 25 randomly selected schools participated. Adolescents from Newham were more likely to have remained depressed between baseline and the 6- and 18-month follow-up surveys (for 6-month follow-up, relative risk = 1.78, 95% confidence interval: 1.12, 2.83; for 18-month follow-up, relative risk = 1.93, 95% confidence interval: 1.01, 3.70) than adolescents from the comparison boroughs. No differences in well-being were observed. There was little evidence that urban regeneration had any positive influence on adolescent mental health and some suggestion that regeneration may have been associated with maintenance of depressive symptoms. Such programs may have limited short-term impact on the mental health of adolescents.

More than jobs and houses: mental health, quality of life and the perceptions of locality in an area undergoing urban regeneration

BACKGROUND

Urban regeneration initiatives are considered to be one means of making a contribution to improving people's quality of life and mental health. This paper considers the relationship between lay perceptions of locality adversity, mental health and social capital in an area undergoing urban regeneration.

METHODS

Using qualitative methods as part of a larger multi-method study, perceptions of material, and non-material aspects of the locality and the way in which people vulnerable to mental health problems coped with living in adversity were identified as being more highly valued than intended or actual changes to structural elements such as the provision of housing or employment.

RESULTS

Themes derived from narrative accounts included concerns about the absence of social control in the locality, the reputation of the area, a lack of faith in local agencies to make changes considered important to local residents, a reliance on personal coping strategies to manage adversity and perceived threats to mental health which reinforced a sense of social isolation. We suggest these elements are implicated in restricting opportunities and enhancing feelings of 'entrapment' contributing to low levels of local collective efficacy. The gap between social capital capacity at an individual level and links with collective community resources may in part have accounted for the absence of improvements in mental health during the early life of the urban regeneration initiative.

IMPLICATIONS/CONCLUSIONS

In order to enhance quality of life or mental health, agencies involved in urban initiatives need as a basic minimum to promote security, increase leisure opportunities, and improve the image of the locality.

The impact of mental illness on quality of life: A comparison of severe mental illness, common mental disorder and healthy population samples

Patient-centred outcomes such as quality of life (QOL) are valued and used extensively in mental healthcare evaluations, but concerns remain about their practical application due to perceived measurement issues, including responsiveness and relationships with objective indicators and depression. Evidence from general population studies challenge some assumptions, suggesting that measurement difficulties might relate to the characteristics of mental health samples, rather than measurement itself. This paper assesses the impact of mental illness on QOL and its measurement, examining whether the life-conditions, opportunities and QOL of different mental health-status groups vary, and if explanatory models of domain-specific and global QOL differ. Objective life-conditions, access to life-opportunities and subjective QOL were assessed over 2 years, using the same methodology in severe mental illness (SMI; n = 149 (baseline)/n = 126 (follow-up)), common mental disorder (CMD; n = 794/354) and no disorder (n = 1119/583) groups. Objective life-conditions were worse in the SMI group than in mentally healthy population and CMD groups, but the opportunities available to the SMI group were no more restricted than the CMD group. Subjective QOL ratings reflected this; SMI group scores were lower than the healthy population and in some life-domains the CMD group. Models of QOL suggested that life-quality was explained differently in the three groups. QOL studies combining mental health samples should control for health-status group, and domain-specific and global indicators of lifestyle and opportunity.

The troubled relationship between psychiatry and sociology

The alienated relationship between psychiatry and sociology is explored. The two disciplines largely took divergent paths after 1970. On the one side, psychiatry manifested a pre-occupation with methodological questions and sought greater medical respectability, with a biomedical approach returning to the fore. Social psychiatry and its underpinning biopsychosocial model became increasingly marginalised and weakened. On the other side, many sociologists turned away from psychiatry and the epidemiological study of mental health problems and increasingly restricted their interest to social theory and qualitative research. An interdisciplinary void ensued, to the detriment of the investigation of social aspects of mental health.

Adaptation, response-shift and quality of life ratings in mentally well and unwell groups

In this paper, a novel decomposition of adaptation, focusing on aspirations and resignation, is presented. Adaptation, response-shift and quality of life were assessed over 2 years, using the same methodology in three different health-status groups: severe mental illness (n = 149); common mental disorder (n = 354); and no disorder (n = 583). Adaptation effects occurred in all life domains including health, but in only one third of each sample. As hypothesised, aspirations tended to be associated with lower quality of life (QOL) ratings and resignation was associated with higher QOL scores (although not significantly higher, necessarily). These two effects tended to cancel each other out, so that the overall impact of adaptation was minimal. Health-status, changes in objective situation (e.g. financial circumstances) and changes in depression were all associated with QOL at follow-up, but resignation and aspiration also made independent contributions. Resignation was more closely related to changes in global ratings than to domain-specific ratings, whereas aspirations appeared consistently and made a greater contribution. The results are consistent with other measurement approaches that indicate that adaptation effects in relation to QOL, are not large.

Individual and district scale determinants of users’ satisfaction with primary health care in developing countries

The paper has two aims: to explore possible determinants of user satisfaction based on a broad conception of the health care system involving both individual and district scale variables, and to add to the limited knowledge and empirical study about such determinants in developing countries. The study was carried out in one of Brazil's poorest states, Ceará, in the northeast of the country. Brazil has a policy of an increased role for the population in management together with decentralised management to the local administrative (municipio) scale. For user views on health care to be useful in management, understanding their determinants needs to explore not only individual scale factors but also influences from the local health system and wider society, here termed district scale factors. The study design took different angles on users' satisfaction to build three measures: the particular health event (termed perceived quality); a generalised perception (termed satisfaction); and, satisfaction with the Community Health Worker (termed CHW satisfaction). Potential determinants explored at the individual scale (17 variables) are grouped into: socio-demographic and economic characteristics; health outcome; health care provision; and, awareness of space for local voice in planning. Potential determinants explored at the district scale (50 variables) are grouped into: formal organisation and management (health system inputs, management capacity, outputs and outcomes); informal organisation (population awareness of health system activities, staff characteristics, district management style); and, local political culture (geographic and socio-economic population profile, commitment to the district of local leaders, norms and values of staff regarding practice). Three determinants were key for all three user evaluation measures: getting an appointment, getting better, and the type of district (rural-urban). Our primary conclusion from this study is that there are limitations to the extent that user satisfaction can fulfill the claims made for it. On a more positive note, with these limitations noted, user satisfaction can prove a useful management tool more modestly at a local, context-specific scale.

Housing improvement and self-reported mental distress among council estate residents

This paper is concerned with how housing improvements instigated either publicly or privately influence the degree of psychological stress reported by council estate residents in South Manchester. Stress is measured on the GHQ12 scale containing standard symptomatic items. Potential sources of variation in this indicator are analysed within a geographical setting where repeated samples of residents were drawn from two adjacent suburban council housing estates before and after the implementation of a single regeneration budget (SRB) housing initiative in late 1999. The residents of one of these estates (Wythenshawe) were targeted by this funding while those in the other (Mersey Bank) were not. The latter, therefore, serve as a control for the effects of the enhanced incidence of housing improvement activity promoted by this SRB. Regression analyses revealed that stress was raised significantly among the SRB residents perhaps on account of the additional environmental nuisance they encountered. The experience of stress among all residents, however, was dominated by measures of personal psychosocial risk and it is argued that future regeneration initiatives should address the manifestation of these risks in the effort to achieve better mental health.