Is there a link between rates of common mental disorder and deficits in social capital in Gospel Oak, London?: Results from a qualitative study

doi:10.1016/j.healthplace.2004.05.002

Health & Place

Volume 11, Issue 3, September 2005, Pages 237-248

https://doi.org/10.1016/j.healthplace.2004.05.002 Get rights and content

Abstract

Previous research in Gospel Oak indicates high-rates of common mental disorder. This paper explores how far deficits in social capital may be linked to these rates. Interviews, focus groups and participant observation were conducted to assess social capital in Gospel Oak from the phenomenological experience of residents. The data suggested that most residents perceived the neighbourhood to be rich in well-developed facilities, services and associational activity. Residents also generally expressed satisfaction with local trust and reciprocity. The results do not support the hypothesis that rates of common mental disorder in Gospel Oak are linked to deficits in social capital. Compositional factors may be more important in accounting for these rates.

Introduction

Common mental disorder (CMD) is a term used to describe a heterogeneous range of disorders characterised by anxiety and depressive symptoms “commonly encountered in community settings and whose occurrence signals a breakdown in normal functioning” (Goldberg and Huxley, 1992).

Prevalence of CMD in the United Kingdom (UK) has been reliably estimated through the UK National Psychiatric Morbidity Surveys (UK NPMS). The first occurred in 1993 (Meltzer et al., 1995), the second in 2000 (Singleton et al., 2001). Both sampled close to 10 000 randomly selected individuals screened for psychiatric morbidity using the Revised Version of the Clinical Interview Schedule (CIS-R; Lewis and Peloti, 1990).

The UK NPMS shows a clear excess of CMD in urban areas. In the 2000 UK NPMS the urban areas of London and North-West England had the highest prevalence rates of CIS-R scores above 12, an accepted cut-off point for ascertaining the presence of a CMD. This was a repetition of results found in the 1993 survey. The 1993 survey showed higher prevalence of CIS-R scores above 12 in urban areas with an adjusted odds ratio of 1.21 (95% CI 1.06–1.38). Two competing theories exist to explain elevated rates of CMD in urban areas-compositional theory and contextual theory.

Section snippets

Compositional theory

Compositional theory (also known as drift theory) focuses on the characteristics of individuals living in urban environments, rather than the urban environment per se. A fundamental proposition of compositional theory is that people currently experiencing (or with a life history of) mental health stress “drift” to large urban environments. These people are posited to bring their pre-existing mental illnesses or vulnerability factors with them, thus inflating rates in these urban areas.

Another

Contextual theory

Contextual theory (also known as “breeder” theory) accounts for elevated rates of CMD in urban areas by focusing on collectively experienced characteristics of the environment rather than risk factors experienced solely at the individual level. They rely on a belief that certain common supra-individual exposures in urban areas have a deleterious affect on mental health, thus creating a generic increase in risk for residents. These factors include pollution, noise, lack of open space, urban

Social capital and mental health

Most studies of social capital and health have focused on physical health outcomes. However it has been suggested that social capital may play a positive role in determining mental health outcomes (McKenzie et al., 2002). Putnam himself marshals evidence supporting this link quoting Seligman's observation that “the rate of depression over the last two generations has increased roughly tenfold” (Putnam, 2000, p. 261). Putnam ascribes this “increase” to a widespread decrease in social capital

Site of study

Gospel Oak is an electoral ward in the London Borough of Camden with approximately 6 200 residents. It is a mixed tenure area, streets of privately owned Georgian housing mark the North whereas the South is occupied overwhelmingly by Camden Council's Gospel Oak Housing Estate. This estate consists of a series of discreet sub-estates built in the early nineteen-seventies. The Ward is generally typical of inner-London in terms of demographic characteristics; 62% of dwellings are local authority

Sampling strategy and participants

The epidemiological study of Gospel Oak described in the introduction is ongoing. In 1999 a quantitative cross-sectional survey was carried out of nearly 1000 residents. Individual participants were selected using random probability sampling methods (see Weich et al., 2002 for further details). Participants’ mental health status was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Data was also collected on participants’ demographic and socio-economic

Processes and questions

Twenty-six residents participated in in-depth interviews (two of these unavoidably became family interviews). Six attended one of two focus groups. Almost all interviews occurred in resident's homes, lasting on average one hour. All were conducted by the first author and recorded onto audiocassette using a small dictaphone. They were then transcribed verbatim into a word-processing package for later analysis. We gave participants the choice of whether they would rather participate in interviews

Participant observation

Participant observation was also conducted on a regular basis over a 24-month period by the first author to compliment the data gathered from other sources. Two related strategies guided the participant observation, both aiming to ensure the maximum data possible was gathered relevant to the research question.

Firstly the researcher attempted to cultivate a trusted relationship with approximately a dozen key informants who lived and/or worked in the area. These included shopkeepers, activists,

Data analysis

All this data was used to assist us in our attempt to assess the phenomenological meaning and influence of local social capital on aspects related to mental health of residents. As suggested by Geertz (1973) we attempted to build an overall thick-description throughout the analysis, maintaining complexity and links between the data. Simultaneously, we proceeded to sort the data according to the method proposed by Miles and Huberman (1994) of reducing data through thematic grouping, with ongoing

Results

The results are divided into two principal components. Firstly we examine data collected with regards to what could be understood as structural aspects of social capital in Gospel Oak such as organisations, networks, facilities and services. Secondly we examine data related to more inter-personal aspects of social capital in the neighbourhood such as trust and reciprocity. This division is theoretically driven in that these two components have been consistently and most commonly identified as

Structural aspects of social capital in Gospel Oak

We examined aspects of facilities, services and organisations in Gospel Oak. These have been identified as variables that are crucial for the formation and development of social capital (Cattell, 2001; Baum and Palmer, 2002). They also indicate some of the principal characteristics of social capital as defined by Putnam for example density of community networks, civic engagement and civic identity/sense of belonging.

Reciprocity and trust in Gospel Oak

In this second principal section of the results we explore the more relational aspects of social capital in Gospel Oak, most notably trust and reciprocity. We found that most residents stated that they felt the area was one with satisfactory levels of trust and that this made them feel good about themselves and Gospel Oak. Brian is a senior citizen with a mental illness. He remarks, like many others, how he looks after other residents’ keys:

We have hanging on our nail on our dining room four

Social capital and common mental disorder

In overall terms, most residents we encountered reported qualitative satisfaction with components deemed to define social capital such as trust and community networks. This married well with ethnographic evidence gathered through participant observation. Thus the data does not support the hypothesis, suggested by prior research and speculation, that gross rates of CMD in Gospel Oak are linked to deficits in social capital. If there is any affect on mental health the data suggests social capital

Conclusion

The principal research question in this study did not demand a very finely nuanced description and analysis. This question arose from real speculation that deficits in social capital may be linked to gross rates of CMD. In overall terms the results suggest that the residents we encountered generally seemed satisfied with social capital in the neighbourhood, and they interpreted this as having a positive influence on their mental well-being. This married well with our own ethnographic analysis

Acknowledgements

The study was funded by the UK Medical Research Council in the form of a research studentship to RW, who was also assisted financially by a Macrae bursary of the King's College Theological Trust. We are eternally grateful. The research took place while RW was a research student at the Institute of Psychiatry, King's College London. The fieldwork was facilitated by the kindness of Prof. Michael King and the Academic Dept. of Psychiatry, Royal Free and University College Medical Schools-Royal

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Is there a link between rates of common mental disorder and deficits in social capital in Gospel Oak, London?: Results from a qualitative study

Abstract

Introduction

Section snippets

Compositional theory

Contextual theory

Social capital and mental health

Site of study

Sampling strategy and participants

Processes and questions

Participant observation

Data analysis

Results

Structural aspects of social capital in Gospel Oak

Reciprocity and trust in Gospel Oak

Social capital and common mental disorder

Conclusion

Acknowledgements

Social Science & Medicine

Health and Place

Social Science Medicine

Health and Place

Social Science Medicine

Opportunity structuresurban landscape, social capital and health promotion in Australia

Health Promotion International

Community Studies

On the analysis of observational dataa discussion of the worth and uses of inductive techniques and respondent validation

Sociology

The forms of social capital

Qualitative interviews in medical research

British Medical Journal

The social origins of depression

Ward comparisons, London Borough of Camden

Social Capital and Health

The Influence of Social Support and Social Capital on Health

Depression in Europe

British Journal of Psychiatry

Is there a place for geography in the analysis of health inequality?

Sociology of health and illness

Healthy Cities

Handbook of Qualitative Research

Psychiatric morbiditya multi-level approach to regional variations in the UK

Journal of Epidemiology and Community Health

Mental Health and the Environment

The Future for Queen's Crescent Library

The Urban Villagers

The Interpretation of Cultures

The Discovery of Grounded Theory

Common Mental Disorders

Whats Wrong with Ethnography?

Justice, Nature and the Geography of Difference