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Project details

Deprivation, Psychological Factors and Health: Response and Recovery from Illness
Award No. L128251011

Contact:
Dr. Malcolm D MacLeod
School of Psychology
University of St Andrews
Fife KY16 9UJ
Tel: +44 (0)1334 476161
Click to email

Principal Researchers:
Dr. Malcolm D MacLeod
Dr. Elspeth Graham
Professor Marie Johnston

Duration of Research:
August 1997 - July 2000

Research areas: Area inequalities/influences; Psycho-social influences
Project Plan Project Summary

Background return to top
Whilst it is generally recognised that material aspects of living conditions such as income, wealth, quality of housing and diet are important for physical and mental health, there is evidence to suggest that health may also be affected by a person's socio-economic position relative to others. If this is so, general increases in absolute standards of living could not be expected to produce equivalent gains in health in circumstances where relative differences in standards of living are also increasing. Thus the question of how relative deprivation contributes to the socio-economic gradient in health is of considerable importance for the UK, where the economic gap between the worst and best off in society widened through the 1980s and early 1990s. The present study is designed to investigate this issue and asks, 'Why is it that people who are not as well off as others in society have poorer health?'

We are already aware that psychological factors such as depression, self-esteem, optimism and beliefs in personal control are associated with health-related behaviours, health and recovery from illness. The study will examine the role that such psychological factors play in the relationship between relative deprivation and health, and the extent to which these factors are triggered by feelings of relative deprivation.

A novel aspect of the study will be the use of a range of different measures of absolute and relative deprivation. This will allow us to link the deprivation characteristics of individuals to those of their home areas and to assess the association between various deprivation measures and recovery from illness.

Aims and Objectives
The aims of the study are:

  • to explore the role of and extent to which psychological factors influence the relationship between deprivation and health;
  • to establish those aspects of deprivation which are most clearly related to health and health changes;
  • to examine how people compare themselves with other people, and the relationship between these comparisons and psychological factors known to affect health.

Study Design
The study will involve the collection of data on the state of health, deprivation and beliefs of people who have had a heart attack. A sample of 200 patients will be interviewed within one month of their heart attack and again three months later. Data from the National Census Small Area Statistics will be used to map deprivation levels in their home areas and to examine changes in these areas over the 1980s.

We will explore the way in which individuals assess their own levels of deprivation and, in particular, whether they make comparisons with others who live near them. Our expectations are that people who perceive themselves as being less well-off will show poorer recovery. Should this be the case, we will examine the extent to which this is due to psychological factors.

Policy Implications
It is anticipated that this detailed analysis of the relationships between relative deprivation, absolute deprivation and health will lead to a better understanding of the role of psychological factors than is currently the case. The implications for interventions to enhance patient outcomes would be very different if perceptions, rather than objective deprivation, prove to be the key factor. Further, a greater understanding of how other psychological factors have an impact on recovery rates will provide a more sound basis from which to develop effective policies to promote comparability in health experiences between different socio-economic groups in society.

During the project we will work directly with an NHS Trust providing coronary care and cardiac rehabilitation services and will, therefore, establish lines of communication with those responsible for policy development in this area.

Project Summaryreturn to top
The project built on the growing research and policy interest in the psycho-social processes linking social deprivation and health. It examined the causal pathways which run between the socio-economic characteristics of individuals and areas, and one particular health outcome: recovery from first myocardial infarction (MI).

The team employed a prospective design. Patients were recruited across a two-year period (February 1998 to January 2000) from the Coronary Care Unit of a large hospital in Scotland following admission for their first (and acute) MI. They were interviewed in their own homes at 5 weeks post-MI (T1) and then again at 15 weeks post-MI (T2). 219 patients completed both interviews.

Key findings

  • The relationship between material deprivation and health. Four dimensions of material deprivation were found to have independent effects on recovery, with those on lower incomes, in poorer areas, surrounded by lower numbers of ill people and in socially homogeneous areas making a poorer recovery. Of these dimensions, area poverty contributed most to the prediction of physical recovery and individual income contributed least. As this suggests, for this sample of MI patients, the area you live in appears to be more important to health outcome than your individual wealth.
  • In addition, perceived deprivation was also related to physical recovery: those who saw themselves as less well-off relative to others showed a poorer recovery.
  • Psychological factors and health. Two psychological factors had main effects on recovery: those with lower self-esteem and with more misconceptions about the causes and consequences of MI recovered less well. Low self-esteem was, in turn, predicted by deprivation. Those in poorer neighbourhhoods and those who perceived themselves to be less well-off than others showed lower self-esteem.
  • Social comparisons. A new instrument was developed to gather data on people's comparison processes. It suggested that there is a neighbourhood effect and one independent of income, which influences the valence of comparison (whether comparisons are positive or negative). Social comparisons are also related to perceptions of relative wealth and to self-esteem.
  • Pathways from material deprivation to recovery from MI. The findings suggest a model in which the key pathways run from material deprivation (of the patient and the area in which they live) through a set of psychological factors (self-esteem, perceived relative wealth and misconceptions about the causes and consequences of MI) to physical recovery. Both the underlying material factors and the intermediary psychological factors are potentially amenable to change, suggesting points in the pathways which may offer opportunities for intervention.
return to top
Newsletter articles:
How does relative deprivation affect health? ;

A comparison a day keeps the doctor away...or does it?
Findings:
Relative deprivation and recovery from first acute myocardial infarction

 

 
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