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Mental health and “the Troubles” in Northern Ireland: implications of civil unrest for health and wellbeing
  1. C C Kelleher
  1. Department of Public Health Medicine and Epidemiology, Faculty of Medicine, Earlsfort Terrace, University College, Dublin 2, Eire
  1. Correspondence to:
 Professor C C Kelleher; 

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Mental health and social capital

Mental ill health is the new global epidemic and its wider determinants of great social significance.1 In this issue O’Reilly and Stevenson present findings from Northern Ireland indicating that the prolonged civil conflict there seems to have had an adverse effect on the mental health and wellbeing of citizens.2 The study is of interest for several reasons. Firstly, Northern Ireland is an internationally famous example of a longstanding violent political conflict apparently resolved by a major peace initiative over the past five years.3 As there are many such political trouble spots globally, the immediate and longer term public health implications are always of interest. Secondly, the specific independent measure reported in this study, the GHQ-12, is a well validated indicator of mental health status and the interpretation of its significance is important.1 Thirdly, internationally both the social variations and health promotion literature have focused increasingly on concepts of social capital and cohesion in interpreting how macrosocial processes might affect individual and community wellbeing.4,5 In this context the breakdown of community relations to the point of outright conflict, particularly in circumstances of material disadvantage, is highly pertinent to our interpretation of this paper.

The data O’Reilly and Stevenson present are based on the Northern Ireland Health and Wellbeing survey of 1997. In assessing the impact at area and personal level of “the Troubles”, careful account is taken of religious affiliation, socioeconomic status, long term illness or disability, major life event stressors, and available social support. Their findings show an independent effect on GHQ-12 caseness score of personal and area based exposures to the Troubles, even when these various socioeconomic indicators are taken into account. Notwithstanding this, it is also true that those living in disadvantaged circumstances were much more likely …

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