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Background
People in lower socio-economic circumstances, as defined both by
deprivation indicators and labour market marginality, experience
higher rates of common mental health disorders.
Much of the evidence on mental health and socio-economic circumstances
is cross-sectional and the direction of the relationship is not
always self-evident. Existing health data sets are used to explain
differences between individuals and do not provide the best guide
to the causes of variations in health or to the policies which would
improve standards. Whether and how changes in the socio-economic
circumstances of a community affect the mental health and quality
of life of those who live there is much less well understood.
The launch of
a major urban regeneration programme in Wythenshawe, a highly disadvantaged
area of Manchester, provides an opportunity to investigate the impact
of changes in socio-economic circumstances on the mental health
of different groups and individuals within the local population
and to compare this to a control area where no such initiative exists.
Aims and
Objectives
It is the aim of this study to achieve a better understanding of:
- the role
played by urban regeneration in altering the degree and distribution
of socio-economic variations in mental health;
- the impact
of socio-economic changes on people with differential vulnerability
to the development of common mental illnesses;
- the measurement
of subjective well-being in urban settings and what factors contribute
to its improvement or maintenance during socio-economic change.
Study Design
Information will be collected about mental health status, quality
of life (QOL), personal circumstances and consulting behaviour using
a postal survey of some 8000 people. The survey will be repeated
in the year 2000 to provide the basis for the change data. Individuals
will be drawn randomly from electoral registers. Data will be analysed
using multi-level modelling.
Two groups of
about 200 people will be selected from the survey data. The first
group will consist of those more 'vulnerable' to common mental heath
problems (e.g. widowed, separated or divorced people, not working).
A second group will consist of less 'vulnerable' people (e.g. married
people, in work). The two groups represent variants across the socio-economic
spectrum, from the generally included at one end to the more excluded
at the other.
A series of qualitative interviews with these individuals will then
be undertaken. They will be assessed using clinical and QOL measures
and re-assessed after 12 months. The aim of this work will be to
explore the linkages between socio-economic change and changes in
mental health, well-being, and primary care consultation rates in
greater detail and accuracy than the survey can obtain.
In addition,
consultation rates in local primary care practices will be monitored,
and systematic methods for capturing the changes brought about by
the regeneration process will be developed.
Policy Implications
The study will contribute to our understanding of the aetiology
of ill-health and of the most effective policy instruments which
might be developed to improve well-being. It will directly address
issues raised in the national policy debate about the targeting
of interventions, especially in relation to regeneration policy.
The study will
shed light on the question of how far resources should be targeted
on the basis of need and on the feasibility of using health-related
indicators as part of that targeting process. The results of the
study will be particularly relevant to policy concerning social
variations in mental health, especially as improving quality of
life and the individual well-being of people with mental health
problems is a primary objective of local health improvement programmes.
Project Summary
Many of the interventions introduced to reduce health inequalities
and social exclusion in the UK are area-based, including Health
Action Zones and initiatives funded under the Single Regeneration
Budget and New Deal for Communities programmes. Among the objectives
of these interventions are improvements in the material and social
environment of areas of concentrated disadvantage and in the quality
of life of those who live there.
This project
examined the links between poor conditions and mental health and,
through a case-control study, investigated the role of urban regeneration
programmes in improving mental health. It was based on the regeneration
programme in Wythenshawe, a large council housing estate in Manchester,
and a neighbouring council estate, where no such initiative was
underway.
A baseline survey
was conducted in 1999, prior to the major regeneration process.
Information about mental health status, personal circumstances,
quality of life and consulting behaviour was collected from 2600
people. Quality of life was seen as a multidimensional construct,
which assesses well-being at the global level ('how do you feel
about your life as a whole') and through the investigation of specific
domains like work, housing and personal relationships. A second
survey was conducted two years later, in 2001, to assess the nature
and extent of changes in these items.
Key findings
- The baseline
survey provided a detailed picture of area disadvantage and mental
health in one of Britain's largest cities. Rates of material and
social deprivation were high: over 60% were not in paid work and
a similar proportion lacked the money to enjoy life. A substantial
minority were experiencing life events and personal vulnerability
factors known to increase the risk of mental distress, like bereavement
(30%) and longstanding illness/disability (28%). In responses
to the General Health Questionnaire (GHQ12), about a third of
the respondents reported 'feeling constantly under strain' (36%)
and 'feeling unhappy or depressed' (32%). 35% of the sample scored
above the threshold for probable psychiatric morbidity, a prevalence
rate in line with those recorded in other studies.
- Analyses
failed to identify strong relationships between socio-economic
circumstances, precipitating factors and measures of psychiatric
distress. Instead, the key explanatory variable for the Wythenshawe
sample was the subjective quality of life (QoL) rating which,
for individuals with many positive perceptions, was associated
with lower levels of distress. It is possible that, in a residential
population, associations between socio-economic circumstances
and mental distress are diluted by the lower frequency of psychiatric
morbidity in the sample. This association may be weakened still
further by the choice of a study area characterised by consistently
high levels of socio-economic deprivation. Nonetheless, the key
role played by the QoL rating points to the importance of people's
responses to similar social and community conditions in the production
of distress.
- The study
provides insight into how residents felt about their area. High
levels of dissatisfaction were reported in both the case and control
areas. Dissatisfaction with area was double the national average
(22% compared with 11%) and was higher in the case area (29%).
Only a minority of the residents in the case area were happy to
stay: 11% very strongly wanted to move, 18% preferred to move,
31% had mixed feelings about the area and 40% were happy to stay.
- A measure
of community experience was developed (Community Experience Scale),
consisting of 11 items tapping such dimensions of community life
as a sense of belonging, co-operation, safety and community identity,
leisure facilities and local leadership. Higher quality of life
ratings were associated with a greater sense of belonging, less
isolation, more neighbourliness/security, more leisure opportunities,
better leadership, and the absence of the sense that the area
is in decline. Higher symptom scores on the GHQ12 were associated
with perceptions of less neighbourliness/security, fewer leisure
facilities and the feeling that the area is in decline.
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