Perceptions of social capital and the built environment and mental health

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  • Social Science & Medicine 62 (

    Perceptions of social capital and the built environment and

    we had previously envisaged. We also found that approximately one-third of the variance for neighbourhood quality and

    10% for social control was explained at postcode (neighbourhood) level after adjusting for individual variables, thus

    There has been an ongoing debate on the


    E-mail addresses: (R. Araya), (F. Dunstan),

    (R. Playle), (H. Thomas),

    importance of people and places for health. Thisinterest has been stimulated by the debate on social

    0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved.

    doi:10.1016/j.socscimed.2005.11.037 (S. Palmer), (G. Lewis).suggesting that some of our compositional measures capture contextual characteristics of the built and social environment.

    After adjusting for individual variables, trust and social cohesion, two key social capital components were the only factors

    to show statistically signicant associations with GHQ-12 scores. However, these factors also showed little variation at

    postcode levels, suggesting a stronger individual determination. We conclude that our results provide some evidence in

    support of an association between mental health (GHQ-12 scores) and perceptions of social capital, but less support for the

    contextual nature of social capital.

    r 2005 Elsevier Ltd. All rights reserved.

    Keywords: Social capital; Mental health; Contextual effects; Wales

    IntroductionCorresponding author. Tel.: +44 117 9546702.mental health

    Ricardo Arayaa,, Frank Dunstanb, Rebecca Playleb, Hollie Thomasc,Stephen Palmerb, Glyn Lewisa

    aUniversity of Bristol, Bristol, UKbDepartment of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Cardiff, UK

    cDepartment of Psychological Medicine, University of Wales College of Medicine, Cardiff, UK

    Available online 24 January 2006


    There has been much speculation about a possible association between the social and built environment and health, but

    the empirical evidence is still elusive. The social and built environments are best seen as contextual concepts but they are

    usually estimated as an aggregation of individual compositional measures, such as perceptions on trust or the desirability

    to live in an area. If these aggregated compositional measures were valid measures, one would expect that they would

    evince correlations at higher levels of data collection (e.g., neighbourhood). The aims of this paper are: (1) to investigate

    the factor structure of a self-administered questionnaire measuring individual perceptions of trust, social participation,

    social cohesion, social control, and the built environment; (2) to investigate variation in these factors at higher than the

    individual level (households and postcodes) in order to assess if these constructs reect some contextual effect; and (3) to

    study the association between mental health, as measured by the General Health Questionnaire-12 (GHQ-12), and these

    derived factors. A cross-sectional household survey was undertaken during MayAugust 2001 in a district of South Wales

    with a population of 140,000. We found that factor analysis grouped our questions in factors similar to the theoretical ones2006) 30723083

  • ARTICLE IN PRESSR. Araya et al. / Social Science & Medicine 62 (2006) 30723083 3073capital and health (Kawachi & Berkman, 2000;Muntaner & Lynch, 2002; OBrien Caughy, OCam-po, & Muntaner, 2003; Pearce & Davey-Smith,2003; Sampson, 2003; Tunstall, Shaw, & Dorling,2004) and studies examining health variationsacross geographical areas (Ellaway, Macintyre, &Kearns, 2001; Macintyre, Ellaway, & Cummins,2002; Macintyre, Maciver, & Sooman, 1993; Ska-pinakis, Lewis, Araya, Jones, & Williams, 2005).Interest in nding better ways of measuring and

    capturing the contextual nature of places, neigh-bourhoods, and communities has also grown. Someof the difculties in the measurement of contextualvariables can be appreciated when examining howsocial capital has been measured so far.Although there is no consensually agreed deni-

    tion of social capital, one commonly used one isthat it refers to how social relations and networksinuence collective action for mutual benet(Kawachi, Kennedy, Lochner, & Prothrow-Stith,1997; Putnam, 1993). The concept of social capitalcan be disaggregated into at least two importantcomponents, structural and cognitive (Bain &Hicks, 1998). Whilst the former refers to the extentand intensity of associational links, the latter hasmore to do with qualitative aspects of these links,such as levels of trust or reciprocity.Much of the research in social capital and health

    has used these so-called cognitive features assessedat an individual level to estimate indirectly theamount of social capital in an area (Kawachi,Kennedy, & Glass, 1999; Kawachi et al., 1997;Lochner, Kawachi, Brennan, & Buka, 2003; Loch-ner, Kawachi, & Kennedy, 1999; McCulloch, 2003;Subramanian, Lochner, & Kawachi, 2003). This isproblematic because these cognitive aspects of socialcapital are meant to represent a contextual con-struct, rather than a compositional one obtainedthrough aggregating individual data. Two different,but not mutually exclusive, approaches to pursuingthis challenge have been used. Firstly, these featurescan be measured through direct observation ofcertain collective behaviours in an area; e.g., peoplenot respecting zebra crossings or arguing in publicspaces might indicate lower levels of social capital.Although this approach might be more contextuallyvalid, it can be resource intensive, some features arenot directly observable, and some observationsrequire subjective inferences, such as deciding iftwo people engaged in a discussion can be regardedas arguing. Secondly, some of these cognitive

    components can also be measured indirectly byinvestigating individuals perceptions of, e.g., howmuch people trust each other in the neighbourhood.These individual perceptions are then aggregated oranalysed at higher levels of aggregation usingmultilevel models to obtain an estimate of the levelof trust in the area. Several self-reported question-naires have been developed to assess these percep-tions on various aspects of social capital withdifferences depending on the specic aims for whichthey were designed (Lochner et al., 1999; Sampson,Raudenbush, & Earls, 1997; The World Bank SocialCapital Thematic Group, 2002).Although this methodology is simple and feasible,

    it is still questionable if these perceptions are validcontextual measures or just simply the sum ofindividuals perceptions (compositional). Further-more, even if these perceptions reected a trulycontextual characteristic it is still possible that thisestimate could be somehow confounded by thecharacteristics of the individuals living in that place.One way of indirectly attempting to clarify if theseperceptions represent some contextual construct isby trying to ascertain what proportion of thevariance on any of these constructs (e.g., percep-tions on trust or reciprocity) is explained at higherlevels, such as neighbourhoods, after accounting forindividual factors. In a recent study, Subramanianet al. (2003) used individual data on the perceptionof trust by individuals in Chicago, USA, to examinewhether there were true differences in trust betweenneighbourhoods after accounting for individualvariation. Their results suggested that, even afteraccounting for individual socio-demographic vari-ables, signicant neighbourhood variation remainedin the individual perception of trust (Subramanianet al., 2003).The built environment can be assessed using

    direct observations of the characteristics of geogra-phical areas (Perkins, Meeks, & Taylor, 1992;Weich, Holt, Twigg, Jones, & Lewis, 2003) orthrough perceptions of residents on the quality oftheir built environment (Dalgard & Tambs, 1997).Perceptions on the built environment, such asgrafti on walls or dirtiness, are hypotheticallysubject to similar respondent bias as perceptions onsocial capital, e.g., trust or social cohesion.It could be argued that the quality of the built

    environment is a consequence of different levels ofsocial capital or vice versa. For instance, a highproportion of houses with broken windows isprobably the consequence of low levels of social

    capital in the area. However, it is also plausible that

  • ARTICLE IN PRESSR. Araya et al. / Social Science & Medicine 62 (2006) 307230833074unfavourable changes in the physical environmentmight lead to deterioration in trust or socialcohesion.A few studies have been published in peer-

    reviewed journals reporting on the associationbetween social capital and common mental dis-orders among adults. Most of these studies haveonly measured and analysed social capital data atthe individual level (Ellaway et al., 2001; Harpham,Grant, & Rodriguez, 2004; Ross, 2000; Silver,Mulvey, & Swanson, 2002; Steptoe & Feldman,2001). Others have either aggregated individual datato create compositional variables representing high-er levels (e.g., neighbourhood) or analysed indivi-dual data using hierarchical multilevel models toestimate the level of variation at different levels(Cutrona, Russell, & Hessling, 2000; Skapinakiset al., 2005).The underlying, but yet unproven, assumption

    has been that social capital is good for mentalhealth. Although some studies analysing data atindividual level have found inverse associationsbetween mental illness and social capital, moststudies using aggregated data or multilevel modelshave failed to nd statistically signicant associa-tions between social capital and common mentalillness at higher levels, such as neighbourhoods. It isworth emphasising that most of these studies haveused different sampling designs, measures ofsocial capital and mental health, and differenthierarchical data structures, making comparisonsrather problematic.Studies on the built environment and mental

    health have focused on residents perceptions oftheir environment (Dalgard & Tambs, 1997; Ross,2000) and geographical area variations or contex-tual assessments of the quality of the built environ-ment (Duncan, Jones, & Moon, 1995; Pickett &Pearl, 2001; Reijneveld & Schene, 1998; Wainwright& Surtes, 2003; Weich, Blanchard, & Prince, 2002;Weich et al., 2003). Most of these studies have alsofailed to nd statistically signicant area effects onmental health after accounting for individualfactors. Amongst studies that have used multilevelmodelling with positive ndings, Skapinakis et al.(2005) found a small but signicant associationbetween mental health and geographical areas in anationally representative sample in Wales but nospecic factor explained these ndings (Skapinakiset al., 2005). Ross (2000) found that neighbourhooddisorder and residential instability were associated

    with depression (Ross, 2000). Other studies usingmultivariate analysis of individual data have shownthat characteristics of the built environment canbe associated with psychiatric symptomatology(Dalgard & Tambs, 1997; Sampson, 2003; Weichet al., 2002).The complex way in which the social and built

    environment might interact to affect mental healthis unknown but there is no shortage of speculationon the potential mechanisms. It is possible that thesocial and built environment can effect changes ineach other and eventually impact on mental health.For instance, a poorly maintained built environ-ment with derelict buildings and covered in rubbishmight affect the sense of social cohesion in theneighbourhood, the combination of both leading topoorer mental health among its residents. But it isalso possible that poor social cohesion might lead toa poorer built environment as residents might havelittle interest to look after their common areas.Poorer mental health among residents might alsolead to less interest to keep the neighbourhood tidyand to engage in social interactions. All thesecombinations are possible and thus it is importantto conduct studies in which both the perceptions ofthe social and built environment are simultaneouslyassessed and analysed at different levels of dataaggregation. Different aspects of the built environ-ment may affect residents perceptions of theirneighbourhood and lead to behaviours congruentwith these beliefs. For instance, empty and boardedhouses may facilitate criminal activity and lead toperceptions of lack of safety and unwillingness tointeract with other people. Social withdrawal,isolation, and fear are likely to lead to theemergence of psychiatric symptoms among vulner-able people. However, there is as yet no empiricalevidence showing unequivocally these or manyother potential associations between the social andbuilt environment and mental health.This study was part of a comprehensive research

    programme [housing and neighbourhood andhealth (HANAH)] investigating the relationshipsbetween the built and social environment andhealth. In this paper, we present the results of theself-administered questionnaire developed to mea-sure the residents perceptions of aspects of thesocial and built environment. The aims of this paperwere: (1) to look for common factors grouping itemsof a self-administered questionnaire to measureperceptions of the social and built environment; (2)to investigate variation in factors derived from the

    questionnaire at area level, after accounting for

  • ARTICLE IN PRESSR. Araya et al. / Social Science & Medicine 62 (2006) 30723083 3075individual variables, in order to estimate if thesecompositional constructs might reect some con-textual effect; and (3) to study the associationbetween mental health and these factors.


    Sampling strategy

    A cross-sectional household survey was under-taken during MayAugust 2001 in a district of SouthWales with a population of 140,000. The areaseconomy used to be dominated by heavy industry,including coal, steel, and petrochemicals, but thesehave seen a signicant decline since the 1970s. Thishas left a legacy of environmental pollution fromheavy industry, poor standards of housing andamenities, high levels of poverty and economicinactivity. Some large-scale post-war housing devel-opments are now places of social isolation and lackof social and economic investment. Standards ofhealth in the former steel and coal communities,including the area in this study, are typical of similardeprived areas throughout the UK.As it has been argued that ecological associations

    are best explored using data from small areas (Curtis& Rees Jones, 1998; Perkins et al., 1992), our primarysampling unit was the postcode, often a single streetof houses, with a mean of 16.5 domestic householdsper postcode. This small scale relates to Barton,Grant, and Guises (2003) home patch that isincreasingly seen as a useful unit for urban design(Barton et al., 2003). A stratied random sample of51 postcodes was chosen with probabili...


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