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IJE Advance Access originally published online on February 28, 2007
International Journal of Epidemiology 2007 36(2):338-345; doi:10.1093/ije/dym004
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Does social cohesion modify the association between area income deprivation and mental health? A multilevel analysis

David Fone1,2,*, Frank Dunstan1, Keith Lloyd3, Gareth Williams4, John Watkins1,2 and Stephen Palmer1

1 Department of Epidemiology, Statistics & Public Health, Centre for Health Sciences Research, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
2 National Public Health Service for Wales, Mamhilad Park Estate, Pontypool, Gwent, NP4 0YP, UK.
3 School of Medicine, Swansea University, Swansea, SA2 8PP, UK.
4 School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, UK.

* Corresponding author. Centre for Health Sciences Research, School of Medicine, Cardiff University, Heath Park Cardiff, CF14 4YS, UK. E-mail: foned{at}cf.ac.uk


  Abstract

Background Despite the increasing belief that the places where people live influence their health, there is surprisingly little consistent evidence for their associations with mental health. We investigated the joint effect of community and individual-level socio-economic deprivation and social cohesion on individual mental health status.

Methods Multilevel analysis of population survey data on 10 653 adults aged 18–74 years nested within the 325 census enumeration districts in Caerphilly county borough, Wales, UK. The outcome measure was the Mental Health Inventory (MHI-5) subscale of the SF-36 instrument. A social cohesion subscale was derived from a factor analysis of responses to the Neighbourhood Cohesion scale and was modelled at individual and area level. Area income deprivation was measured by the percentage of low income households.

Results Poor mental health was significantly associated with area-level income deprivation and low social cohesion after adjusting for individual risk factors. High social cohesion significantly modified the association between income deprivation and mental health: the difference between the predicted mean area mental health scores at the 10th and 90th centiles of the low income distribution was 3.7 in the low cohesion group and 0.9 in the high cohesion group (difference of the difference in means = 2.8, 95% CI: 0.2, 5.4).

Conclusions Income deprivation and social cohesion measured at community level are potentially important joint determinants of mental health. Further research on the impact of the social environment on mental health should investigate causal pathways in a longitudinal study.

Keywords Mental health, social medicine, social environment, epidemiology, models, statistical

Accepted 4 January 2007


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