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Fitzsimon N, Shiely F, Corradino D, Friel S and Kelleher CC
Journal of Epidemiology & Community Health
Predictors of Poor Mental Health at Area Level in Ireland: A Multilevel Analysis of Deprivation and Social Capital Indictors
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Objective: To examine the variability in self-reported mental health problems at area level in Ireland and to assess the relative influence, if any, of sociodemographic and social capital indicators. Design: Multilevel cross sectional analysis of the 2002 National Survey of Lifestyle Attitudes and Nutrition (SLAN). Setting: 328 district electoral divisions (DEDs) across the Republic of Ireland. Participants: 5992 adults over 18 years selected at random within DEDs from the electoral register were asked to complete a standardised previously validated postal questionnaire. Main Outcome Measures: Self-reported mental ill health in the previous month. Results: 25% of respondents reported problems with mental health in the previous month. There was significant variability in the risk of reporting problems with mental health at DED level (variance 0.123, SE 0.034). Controlling for individual level social and demographic variables, which all had a significant effect on the risk of reporting poor mental health (age, sex, income level, education, means tested general medical services eligibility, employment status, level of social support, membership of clubs and organisations, smoking status, and interactions between these variables) did not affect the variability at DED level (variance 0.131, SE 0.050). People living in rural areas were less likely to report mental illness and were more likely to report high levels of trust, which independently reduced the risk of reporting poor mental health. Inclusion of individual level trust, and the DED level variable indicating urban or rural location, significantly reduced the variability at DED level (variance 0.046, SE 0.043). The cross level interaction between DED location and trust was not significant, indicating their effects are additive. Conclusions: Although there is area level variation in self-reported mental ill health not accounted for by individual level characteristics, this is largely explained by differences in urban and rural areas and patterns of trust in particular appear to be related to location. These findings provide further support for previous evidence that indicators of social capital may reflect well preserved community networks and support but are not necessarily related to material or social disadvantage. These findings have relevance for the international debate on the directionality of the relation between social capital and disadvantage.
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