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Community participation & psychological distress. Helen L Berry National Centre for Epidemiology & Population Health ANU College of Medicine & Health Sciences. Acknowledgements. Eurobodalla Shire Council, Eurobodalla Shire, New South Wales, Australia

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Community participation & psychological distress

Helen L Berry

National Centre for Epidemiology & Population Health

ANU College of Medicine & Health Sciences


Acknowledgements

  • Eurobodalla Shire Council, Eurobodalla Shire, New South Wales, Australia

    • Sponsored Eurobodalla Study (data collection)

  • Australian Government Department of Families, Communities and Indigenous Affairs

    • Social Policy Research Grant FCH 2006/02 (for this study)

  • Megan Shipley, NCEPH, ANU CMHS

    • Research assistance


Background: Community participationReferences: Berry et al. 2007; last slide

Community participation important for health

  • including mental health (X-sectional, prospective, onset, course, recovery)

  • depression, anxiety, psychosis, schizophrenia, distress, cognitive decline

  • thru’ life, sex, ethnicity, worldwide, rich & poor nations, rural & urban

  • But no theory of participation, no systematic investigation

  • Don’t know

    • what participation is

    • which kinds matter for MH

    • why related to MH – some studies find it is not, or very weak

    • if appropriate health promotion strategy


  • Background (ii):Perceptions about community participation

    • Media talk of longing for community, of not connecting enough – emotional topic

    • No systematic investigation of thoughts & feelings

    • Perceptions highly predictive of MH

      • eg., close concept – social support

    • How perceptions about participation are related to MH


    Aims

    • Report on relationship between:

      • Frequency of participation

      • Perceptions about participation

    • Investigate relationship between frequency of and perceptions about participation, and distress

      • Type or breadth?

    • Investigate an explanatory hypothesis about why participation may be related to distress


    The Eurobodalla Study

    • Self-report mail survey 2001-02

    • Funded by Eurobodalla Shire Council

    • N = 963 adults 18-97

      • Random sample from electoral rolls Eden-Monaro

      • Stratified by sex and age

    • Eurobodalla Shire, southern NSW

    • Coastal region, 40,000, 80% in three towns, tourism

    • Low employment, low income, low education, retirement destination, so ageing (among oldest)


    Are mental health and participationreally linked?

    • No – background factors cause both

      • intrinsic(eg, personality, disability)

      • extrinsic(eg, poverty, rural & remote vs metropolitan)

    • Yes – mental health problems are a barrier to participation

      • social drift

      • stigma

    • Yes – community causation

      • social capital theory

        Evidence for all – reciprocal causation, mediation & moderation


    Babysitting clubs

    Voting (formally)

    Eating together

    Chatting with neighbours

    Reading newspapers

    Tea breaks with colleagues

    Collecting for charity

    Organising an activist group

    Playing sport

    Discussing current affairs

    Being on a school board

    Being in a choir

    Visiting extended family

    Signing petitions

    Emailing friends

    Writing to a newspaper editor

    Living with others

    Volunteering

    Going on talk-back radio

    Standing for election

    What sorts of activities make up volitional community participation?


    Hypothetical structureof volitional community participation


    Measuring frequency of participation

    • Australian Community Participation Questionnaire1

    • Theory-based self-report instrument

      • 67 items

      • 14 different types of participation (EFA & OFCM)

      • response format 1 (never) – 7 (very often)

      • multi-item weighted sub-scales – means, Sx

    1. Berry, H.L., Rodgers, B. & Dear, K.B.G. (2007). Preliminary development and validation of the Australian Community Participation Questionnaire: Types of participation and associations with distress in a coastal region. Social Science & Medicine, 64(8), 1719-1737.


    Unfitted & fitted one factor congeneric modelsof Community Activism

    Fitted model

    Unfitted model


    Frequency of community participationordered most to least common


    Frequency of participation and MH

    • Relationship between each type of participation and MH

      • K10 general psychological distress; general indicator of mental health

      • Multiple regression analysis

      • controlling for wide array of socio-demographic factors

        • Not in paid work, financial disadvantage (health care card), live alone, Indigenous Australian, high school or less

    • 9 (of 14) types of participation independently related to distress

      • All small relationships (r = .11 to -.20)

      • 5 n.s. at p<.05

      • 2 worse distress (political)

      • 7 less distress – “Big 7”


    “Big 7” types of community participation


    Breadth of participation

    • Breadth of community participation

      • more important than any one type?

      • small correlations

    • Big 7 or all 14?

      • all 14 types of participation dichotomised by mean split

      • score of 1 (at or above M) or 0 (below)

      • count how many above mean; ANOVA, index grouping variable

        Index 1

    • based on Big 7

    • 8-pt index, range 0-7

    • Index M=3.60, Sx=1.61

    • Index 2

    • based on all 14

    • 15-pt index, range 0-14

    • Index M=6.14, Sx=2.89


    Breadth# of community participation& general psychological distress

    Big 7 Index

    • Breadth strongly & linearly related to distress

    • But only Big 7

    • Use Big 7 index of breadth of participation

    # Estimated marginal means controlling for socio-demographic factors


    Perceptions about participation

    Perceptions about participation2

    • Too much or too little

      • for each type of participation

      • 5-point response format, 1 (much too much) – 5 (much too little)

      • irrespective of frequency

    • Enjoyable or not enjoyable

      • for each type of participation

      • 5-point response format, 1 (very enjoyable) – 5 (very unenjoyable)

      • N/a category allowed

    2. Berry, H.L. & Shipley, M. (forthcoming). Longing to belong: Social capital and mental health in a coastal Australian region.


    Indices of perceptions about participation

    • Four more indices for perceptions about participation

      • also based on Big 7

        • same relationship to distress as breadth

      • procedure as for breadth index

      • range 0-7

    • Too much or too little?

      • too much M=.24, Sx=.54

      • too little M=2.31, Sx=1.50

  • Enjoyable or not enjoyable?

    • not enjoyable M=.15, Sx=.48

    • enjoyable M=2.41, Sx=1.80


  • Breadth, perceptions & distress

    Note: Pearson Product Moment correlations, significant at *p<.05, ** p<.01, ***p<.001.


    Explanatory hypothesis:Personal social capital

    Personal social capital3

    • Community participation (breadth, perceptions)

    • Personal social cohesion

      • Universalism (Schwarz, 1992)

      • Sense of belonging (Cohen et al. 1985)

      • Generalised reciprocity (Inglehart et al. 1997)

      • Social trust (Cummins & Bromiley 1996; Berry et al. 2000; 2003; 2005; Inglehart et al. 1997)

      • Optimism (Scheier 1994)

        Implied causality: structural equations modelling

    3. Berry, H.L., & Rickwood, D.J. (2000). Measuring social capital at the individual level: Personal Social Capital, values and psychological distress. International Journal of Mental Health Promotion, 2(3), 35-44.


    Hypothetical model:Personal social capital and distress


    Structural equations modelling

    • Confirmatory, hypothesis-driven technique

    • Combines factor analysis, MH regression, ANOVA & path

    • Basic units are measurement models:

      • One-factor congeneric models (OFCMs) – concept factor models

      • Build them first

      • SEM may include observed variables, OFCMs and CFMs

    • Modify models:

      • Delete n.s. paths or items

      • Modification indices

      • Fit indices (absolute & relative fit, overfit)

    • All concepts in model must be significantly associated according to hypothetical model


    Participation, cohesion & distress

    Note: Pearson Product Moment correlations, significant at ** p<.01, ***p<.001.


    Building the structural model: Procedure

    Complete all OFCMs, then assemble – theory, confirmatory

    • Socio-demographic disadvantage controls (as OFCM)

    • Community participation (as OFCM)

      • breadth (one index)

      • perceptions (four indices)

    • Personal social cohesion (OFCM)

      • universalism

      • sense of belonging

      • reciprocity

      • social trust (weighted composite from OFCM)

      • optimism

    • Psychological distress (observed variable)


    Building the one-factor congeneric models:Socio-demographic disadvantage


    Building one-factor congeneric models:Community participation


    Building one-factor congeneric models:Personal social cohesion


    Building the structural model with distress:Assemble OFCMs into hypothesised model


    Until eventually ……..Full structural model of personal social capital & distress


    Stripped structural model ofpersonal social capital & distress


    Study limitations: Untangling required

    • Need to address causality & pathways

      • X-sectional can’t do this, but can:

        • Summarise factors & how related, especially SEM

        • Confirm/ disconfirm plausibility of hypotheses

    • Possible explanations other than social capital

      • Community level selection (untested)

        • social types move to high participation neighbourhoods

      • People with MH problems less responsive to stress-buffering effects of participation (some evidence)

    • Relationship community and individual level factors

      • Measure individual participation & MH (good)

      • Need to measure ecological level participation & MH (not aggregate)

      • Relationship between community & individual (ML models)


    Conclusions & implications

    • Participation strongly related to distress

      • breadth & perceptions (enjoyment, too little)

      • Community causation (personal social capital) plausible

      • media sense about longing for connectedness

    • Conceptualisation & measurement vital

      • no relationship between participation & MH?

      • yes? no? confounded? Direction of association?

      • never properly measured; perceptions never studied

      • Some types matter, some don’t, some dangerous

    • Participation as a MH promotion strategy?

      • specificity: Big 7, not just any type

      • breadth: across specific types


    References

    • Baum, F. (1999). The role of social capital in health promotion: Australian perspectives, 11th National Health Promotion Conference. Perth, Western Australia.

    • Baum, F.E., Bush, R.A., Modra, C.C., Murray, C.J., Cox, E.M., Alexander, K.M., & Potter, R.C. (2000). Epidemiology of participation: an Australian community study. Journal of Epidemiology & Community Health, 54(6), 414-423.

    • Berry, H.L., & Rickwood, D.J. (2000). Measuring social capital at the individual level: Personal Social Capital, values and psychological distress. International Journal of Mental Health Promotion, 2(3), 35-44.

    • Berry, H.L., & Rodgers, B. (2003). Trust and distress in three generations of rural Australians. Australasian Psychiatry, 11(S), S131-137.

    • Berry, H.L., Rodgers, B., & Dear, K.B.G. (2007). Preliminary development and validation of the Australian Community Participation Questionnaire: Types of participation and associations with distress in a coastal region. Social Science & Medicine.

    • Bosma, H., van Boxtel, M.P.J., Ponds, R., Jelicic, M., Houx, P., Metsemakers, J., & Jolles, J. (2002). Engaged lifestyle and cognitive function in middle and old-aged, non-demented persons: a reciprocal association? Zeitschrift Fur Gerontologie Und Geriatrie, 35(6), 575-581.

    • Glei, D.A., Landau, D.A., Goldman, N., Chuang, Y.-L., Rodriguez, G., & Weinstein, M. (2005). Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. International Journal of Epidemiology, 34(4), 864-871.

    • Lindstrom, M. (2005). Ethnic differences in social participation and social capital in Malmo, Sweden: a population-based study. Social Science & Medicine, 60(7), 1527-1546.

    • McAllister, I. (1998). Civic Education and Political Knowledge in Australia. Australian Journal of Political Science, 33(1), 7-23.

    • Michael, Y.L., Berkman, L.F., Colditz, G.A., & Kawachi, I. (2001). Living arrangements, social integration, and change in functional health status. American Journal of Epidemiology, 153(2), 123-131.

    • Putnam, R.D. (2000). Bowling Alone: The Collapse and Revival of American Community New York: Simon & Schuster

    • Seeman, T.E., & Berkman, L.F. (1988). Structural characteristics of social networks and their relationship with social support in the elderly: Who provides support. Social Science & Medicine, 26(7), 737-749.

    • Uslaner, E.M. (1998). Social capital, television, and the mean world: Trust, optimism, and civic participation. Political Psychology [Special Issue: Psychological Approaches to Social Capital], 19(3), 441-467.

    • Wainer, J., & Chesters, J. (2000). Rural mental health: Neither romanticism nor despair. Australian Journal of Rural Health, 8(3), 141-147.

    • Ziersch, A.M. (2005). Health implications of access to social capital: findings from an Australian study. Social Science & Medicine, 61(10), 2119-2131.


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