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While several studies have found a positive relationship between constructs of social cohesion such as the sense of trust and belonging, and psychological distress [ 13 — 18 ], other studies have observed a negative relationship [ 11 , 13 , 14 ]. Social cohesion is a broad concept spanning community sense of belonging, trust in the community, reciprocity which is a sense of obligation to help others and confidence in return of assistance , equality with community members and community networks. Researchers, such as Korayi and Rothermund demonstrate how trust acts as a resource that is activated in times of need.

Others have suggested that the construct of cohesion can infer negative effects on people including, but not limited to, their psychological well-being [ 19 — 21 ]. For instance, we can infer that, while relationships with community members could potentially be beneficial in terms of receiving help, they could at the same time impose a burden on community members who are expected to provide continuous help. Evidence of community level factors and their impact on mental health remains scarce.

A set of extensive reviews of the literature shows that trust is the material from which community safety nets are woven [ 9 , 10 , 30 — 34 ]. Our study focused on three urban poor communities in Accra, where community level factors such as crime, insecurity, and poor environmental conditions predispose people to poor individual level psychological outcomes such as anxiety and depression [ 11 ]. Using data available from the Urban Health and Poverty Project EDULINK —situated in these three communities—we investigate the relationships between community and personal trust and psychological wellbeing, allowing us to test for associations and pathways through which these associations operate.

This study addresses three questions: 1 do community level of trust and individual level sense of trust have an influence on the mental well-being of the urban poor? Researchers observe that neighbourhood disorder is a function of both mistrust and powerlessness [ 32 , 33 , 35 ]. Powerlessness results from an inability to control negative community conditions such as a high crime rate and danger.

Powerlessness is associated with anxiety, depression and other negative mental health outcomes [ 11 , 30 — 32 , 36 , 37 ]. Mistrust, on the other hand, focuses on the relationship between place and people. Mistrust develops amongst people who have limited social and economic resources and live in contexts where resources are scarce.

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Places with very high levels of neighbourhood disorder are also associated with high levels of threat. The perceived threat in the community undermines the health [ 21 , 38 ] of community members. Individuals in disadvantaged neighbourhoods are challenged by material deprivation which influences their mental health status. Ross thus argues that people who live in disadvantaged communities lose their sense of control to neighbourhood disorder which makes them more vulnerable to adverse mental health problems such as psychological distress.

There is evidence that community disorder, anxiety and disadvantage are associated with powerlessness and mental health outcomes [ 26 — 28 ].


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Positive social cohesion has been associated with positive community outcomes such as care, reciprocity and affection from community members [ 10 ]. The effect of mistrust and powerlessness therefore is that people isolate themselves from the broader community and therefore do not receive the benefits of positive social cohesion. Besides isolation from the broader community, mistrust has also been associated with suspicion within the community [ 39 — 41 ].

Communities with high neighbourhood disorder have also been associated with a high sense of suspicion. Suspicion makes people believe that their neighbours will harm them if they had the opportunity. The tendency to be suspicious in neighbourhoods with high levels of perceived social threat makes people protect their vulnerabilities from their neighbours. For instance, people may not disclose their disease status, fearing that in a moment of crises disclosure might be used against them.

Psychological distress may be compounded in a situation where people do not talk about important personal issues that concern them. In addition, when people live in a constant state of suspicion it has the potential to affect their mental health in the long term. Trust enables people to build positive relationships with each other and amongst community members.

Trust enables people to share and receive from each other within a given community [ 42 ]. Trust may therefore have the potential to mitigate the effect of psychological distress in disadvantaged or urban poor communities. However, very few studies have been conducted to assess the influence sense of trust has on psychological distress in an urban poor context in SSA. Community trust as applied in this study relates to the extent to which people can rely on each in the community.

It measures a community level attribute of reciprocity and dependability. The sites for this study were three indigenous communities in central Accra. James Town and Ussher Town are a twin community commonly known as Ga-Mashie, dominated by an indigenous Ga ethnic group. The third site, Agbobloshie, is a heterogeneous migrant slum settlement adjoining Ga Mashie. The prevailing language spoken in the three communities is Ga. However, due to the high influx of internal migrants from other ethnic representations, other languages including Twi, Hausa and Ewe, are spoken in the communities.

The urban poor study area is populated largely by traders and fishermen. This densely populated area is characterized by restricted access to public amenities. For example, the communities have shared public facilities, such as toilets and baths.

Building therapeutic cities to tackle mental health problems

Characteristic of urban poverty, unemployment and underemployment rates are high in these communities and educational attainment is low [ 43 ]. Many community members are engaged in the informal sector sales and services trading , and manual labour. Other urban poor community dynamics include poor sanitation, a double burden of infectious and chronic diseases and high levels of crime, sex work and drug peddling.

These characteristics of urban poverty, as has been shown in several studies in the sub-region have negative implications on security, sense of community and consequently, the health of inhabitants. This population-based cross-sectional survey, carried out from September to November , was set in the three urban poor communities -Agbogbloshie, James Town and Ussher Town -as part of the Population Training and Research Capacity for Development PopTRCD project that aimed to improve training in the population sciences, as well as study the demography of urban poor communities in Accra, Ghana.

Data were collected from women and men aged 15—49 years and 15—59 years respectively, based on a sampling frame designed by the Ghana Statistical Service for the Ghana Demographic and Health Surveys. The sample was drawn from 29 enumeration areas EAs , each with 40 households systematically chosen to make up a total of households distributed over the three localities. The number of EAs and, therefore, households in each locality was proportionate to the population size of that locality. Six hundred and seventy-five households were selected for the EDULINK survey, yielding a sample size of respondents who were eligible for the individual questionnaire.

The data were collected using an interviewer-administered questionnaire in English and mostly Ga and Twi, these being languages indigenous to the study area. Forward and backward translation of the questionnaire was done to validate for appropriateness of wording and potential misinterpretation. Interviewers were trained, and the questionnaire was pre-tested prior to the survey. Written informed consent was obtained from all respondents prior to conducting the interview.

Respondents who could not append their signatures were provided ink pads to thumb print in the relevant sections of the informed consent forms. In addition to parental consent, they were required to provide written consent before interviews were conducted. Further, study participants had the option of withdrawing from the study at any point without consequences. Evidence on community as well as individual level factors in the extant literature suggests how community sense of trust and individual level background characteristics influence mental health [ 44 ].

Incorporating variables from this perspective, the study operationalizes both community and interpersonal level predictors. For the dependent variable, the survey incorporated the Kessler Psychological Distress Scale. For each question Table 1 , they were asked to give the one answer that came closest to the way they had been feeling, on a 5-point scale ranging from 1 none of the time to 5 all of the time.

The conceptualisation of sense of trust is measured from a multilevel perspective; at the community, interpersonal and intrapersonal levels. According to Ross , loss in community sense of trust develops in places where resources are scarce. Alluding to the urban poor context of the study, people may likely develop mistrust in community safety nets in adverse situations, that may result in poor mental well-being.

A high score indicates a higher level of trust [ 13 ]. Personal trust response was reverse coded. A high score indicates a higher level of personal sense of trust. Demographic variables controlled for included age, sex, level of educational attainment primary, JHS, SHS, higher , religiosity operationalised as the number of times a person attended religious services in the past month, locality of residence James Town, Ussher Town, Agbogbloshie , marital status in union or not , employment status employed or not , ethnicity Ga, Akan, other.

The data are analyzed using descriptive statistics frequency distributions, means and standard deviation , bivariate tests of associations cross-tabulations, oneway ANOVA , and multivariate regressions. The background characteristics of respondents, including age, sex, marital status, ethnicity, highest level of educational attainment, religious affiliation, locality of residence, type of occupation engaged in, are described using frequency distributions.

Bivariate tests of associations between community sense of trust and the other variables, are carried out, using one-way ANOVA. Multilevel regression analysis explores community level and personal sense of trust effects on psychological distress outcomes. Here, multiple linear regression is employed due to the continuous nature of the dependent variable. The demographic and socio-economic characteristics of the participants are presented in Table 2.

The mean score for psychological distress was Overall, the mean score for individual-level sense of trust was 8. Table 3 describes the bivariate relationship between demographic characteristics and psychological distress. The bivariate table shows that among the demographic characteristics, sex, education and perceived relative economic standing were significantly associated with psychological distress at the bivariate level. The mean psychological distress score was lower for males than for females.

In terms of education, as the level of education attainment increased, psychological distress decreased. A similar negative relationship was observed for perceived relative economic standing.

Urban health reading pack A: data and evidence - HEART

Locality, marital status, employment status, religiosity and ethnicity were not significantly associated with psychological distress. Table 4 features results from the multivariate regression model. In all, 3 models were used in assessing the relationship between psychological distress and both community and personal levels of trust, controlling for other explanatory factors. The first model expressed the relationship between only community level trust and psychological distress.

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The second model focused on the relationship between community level trust only and psychological distress. The third model expressed the relationship between the psychological distress and both community and personal trust while controlling for demographic factors. In model 1 see Table 4 , the results show that personal trust had a significant association with psychological distress.

Personal trust was inversely related to psychological distress, meaning an increase in personal trust was associated with a significant decrease in psychological distress. Specifically, every unit increase in personal sense of trust, a 0. In model 3, other factors associated with psychological distress in this model were perceived economic standing, sex, education and locality of residence. Permissions Icon Permissions. Abstract Rapid urbanization globally threatens to increase the risk to mental health and requires a rethinking of the relationship between urban poverty and mental health.

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Stack, Daniel J. Dickson, Jane E. Ledingham, Alex E. Predicting psychosis-spectrum diagnoses in adulthood from social behaviors and neighborhood contexts in childhood. Development and Psychopathology , ; 1 DOI: ScienceDaily, 24 April University of California - Davis. Growing up in poverty increases diagnoses of psychosis-spectrum mental illnesses: Study followed families for three decades.


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