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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?
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”
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.
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.