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> Mary De Silva
Context
and composition?
Social capital and maternal mental health in low income countries
Mary
De Silva
Thesis submitted for the degree of
Doctor of Philosophy
Faculty of Medicine, University of London
Department of Epidemiology and Population Health
London School of Hygiene and Tropical Medicine
November 2005
Abstract
Background and rationale
Women and the poor are disproportionately affected by common mental
disorders (CMD), yet few studies have explored their aetiology in
low income countries. Social capital may explain some of the geographical
variation in CMD. A systematic review shows that only one study
has examined the association between individual social capital and
CMD in low income countries. No study has explored the effect of
ecological social capital on CMD in this setting. The objective
of this thesis is to explore the relationship between individual
and ecological measures of social capital and maternal CMD in four
low income countries.
Methods
Cross-sectional data from the Young Lives (YL) project with information
across 234 communities in Peru, Ethiopia, Vietnam and Andhra Pradesh
(India) were used. The mental health of caregivers of one-year-old
children, and the individual social capital of all caregivers was
assessed. Ecological social capital was calculated by aggregating
individual responses to the community level. Mothers of one year
old children were selected for analysis (n=6909). Multi-level modelling
was used to explore the association between individual and ecological
social capital in each of the four countries, adjusting for a wide
range of individual and community level confounders. Psychometric
techniques and qualitative interviews were used in Peru to validate
the tool used by YL to measure social capital. Results of these
interviews were supplemented with a literature review to explore
the nature of social capital in Peru, and analyses were conducted
to explore the determinants of social capital. The results of these
analyses were used to help interpret the results of a further analysis
of the Peruvian data.
Results
The comparative analysis of social capital and CMD across the four
countries shows that combined measures of individual cognitive social
capital are associated with reduced odds of CMD. The results for
structural social capital are more mixed and culturally specific,
with some aspects associated with increased odds of CMD. The validation
of the tool to measure social capital in Peru emphasises the difficulties
of measuring complex concepts in different cultural settings, and
illustrates the culturally specific nature of social capital. The
description and analysis of social capital in Peru show it to be
multi-dimensional and complex and suggest that social capital may
have different effects on CMD in different sub-groups.
Conclusions and implications
Contextual and compositional factors are inter-related and are both
associated with CMD. Structural social capital has context-specific
effects and cognitive social capital more universal effects on CMD.
Social capital may have different effects in different sub-groups,
with potentially damaging effects in some disadvantaged groups.
While social capital is important for mental health, its complex
and context-specific nature means that it is impractical to use
it as an intervention to prevent or treat CMD. Instead, its value
is as a tool for understanding the social context in which the complex
relationship between an individual’s own characteristics and
those of their environment is played out.
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Information
on the author
Mary De Silva is MRC/ESRC Interdisciplinary Research Fellow at the
London School of Hygiene and Tropical Medicine
Contact details
Dr. Mary De Silva
Nutrition and Public Health Intervention Research Unit
London School of Hygiene and Tropical Medicine
Keppel Street
London
WC1E 7HT
Email: mary.desilva@lshtm.ac.uk
Download the
thesis
Social
capital and maternal mental health in low income countries
(Pdf file, 1.07 Mb)
Additional information
This thesis is listed also in sections Other
Social Disciplines, English,
and in the Chronological
archive
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