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

Abstract

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.

Introduction

The supposition that changing socio-economic circumstances might affect the mental health of a community has been informed through the refinement of a number of psychological constructions (Weich & Lewis, 1998; Marmot & Bobak, 2000; Rogers et al., 2001; WHO, 2001). The initial ideas concerning this connection emphasised the importance of social structure evidenced by the positive association between psychiatric morbidity and social disadvantage and adversity (Holingshead & Redlich (1958)) and, later, with disparities in resources like income, occupation and years in education (Bartley, Blane & Davey-Smith, 1998). A second strand of this debate, often referred to as the psychosocial perspective, has noted the more immediate contribution to the onset of mental distress of precipitating personal factors like the experience of stressful life events or changed social circumstances (Dohrenwend & Dohrenwend, 1982; Brown & Harris, 1978). The evolution of this research has also witnessed a switch from a preoccupation with the psychiatric epidemiology elicited from individuals being treated for mental health problems to a more recent focus on the origins of symptomatic distress among the community as a whole (Aneshensel & Sucoff, 1996; Elliott, 2000). A corollary of all this effort is that initiatives aimed at improving the local environment might impact indirectly upon the mental health of the recipients of these actions.

More particularly, the research reported here is concerned with how housing improvements instigated either publicly or privately influence the degree of psychological stress reported by those most immediately affected. The measurement of stress is made quantitatively by recourse to the General Health Questionnaire 12 point scale (GHQ12) containing standard symptomatic items (Goldberg & Williams, 1988). 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 in South Manchester 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 improvement activity promoted by this SRB. This design facilitates the exploration of two general hypotheses. First, are the GHQ12 scores of residents altered either negatively or positively by the experience of housing improvement? Second, are such possible outcomes further affected by the more intense occurrence of regeneration activity in the targeted estate? The assessment of these essentially environmental stimuli also includes an examination of their leverage relative to known psychological risks factors for the susceptibility to mental distress.

The paper is organised as follows. Section 2 considers recent research concerning the relationship between environmental influences and the psychosocial risks for mental distress. Section 3 describes the survey methods together with the experimental design. The latter consists of a sequence of multiple regression models specified first to establish the leverage of the incidence of housing improvements on GHQ12 scores and then to include variation associated with the presence of known psychosocial risks. Section 4 describes the results of these statistical procedures. The discussion relates these findings to the debate about the influence of spatially tailored social policy interventions on community mental health.