Community participation & psychological distress

1. Community participation & psychological distress Helen L Berry National Centre for Epidemiology & Population Health ANU College of Medicine & Health Sciences

2. 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

3. 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

4. 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

5. 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

6. 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)

7. 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

8. 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?

9. Hypothetical structureof volitional community participation

10. 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.

11. Unfitted & fitted one factor congeneric modelsof Community Activism Fitted model Unfitted model

12. Frequency of community participationordered most to least common

13. 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”

14. “Big 7” types of community participation

15. 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

16. 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

17. 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.

18. 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

19. Breadth, perceptions & distress Note: Pearson Product Moment correlations, significant at *p<.05, ** p<.01, ***p<.001.

20. 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.

21. Hypothetical model:Personal social capital and distress

22. 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

23. Participation, cohesion & distress Note: Pearson Product Moment correlations, significant at ** p<.01, ***p<.001.

24. 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)

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

26. Building one-factor congeneric models:Community participation

27. Building one-factor congeneric models:Personal social cohesion

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

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

30. Stripped structural model ofpersonal social capital & distress

31. 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)

32. 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

33. 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.