Abstract
IntroductionLevels of mental distress in the United States are a health policy concern. The association between social capital and mental distress is well documented, but evidence comes primarily from individual-level studies. Our objective was to examine this association at the county level with advanced spatial econometric methods and to explore the importance of between-county effects.MethodsWe used County Health Rankings and Roadmaps data for 3,106 counties of the contiguous United States. We used spatial Durbin modeling to assess the direct (within a county) and indirect (between neighboring counties) effects of social capital on mental distress. We also examined the spatial spillover effects from neighboring counties based on higher-order spatial weights matrices.ResultsCounties with the highest prevalence of mental distress were found in regional clusters where levels of social capital were low, including the Black Belt, central/southern Appalachia, on the Mississippi River, and around some Indian Reservations. Most of the association between social capital and mental distress was indirect, from the neighboring counties, although significant direct effects showed the within-county association. Models also confirmed the importance of county-level socioeconomic status.ConclusionWe found that county social capital is negatively related to mental distress. Counties are not isolated places and are often part of wider labor and housing markets, so understanding spatial dependencies is important in addressing population-level mental distress.
Highlights
Levels of mental distress in the United States are a health policy concern
Counties with the highest prevalence of mental distress were found in regional clusters where levels of social capital were low, including the Black Belt, central/southern Appalachia, on the Mississippi River, and around some Indian Reservations
We found that county social capital is negatively related to mental distress
Summary
The association between social capital and mental distress is well documented, but evidence comes primarily from individual-level studies. Social capital can be measured at both individual and ecological levels [3], and its association with mental distress has been well documented [4,5,6]. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. We identified 2 major gaps in our understanding of how social capital is associated with mental distress at the ecological level. Whether mental distress of a focal area is affected by the social capital of neighboring areas remains underexplored, and little is known about the importance of distance — as measured by spatial order (ie, nth spatial lags) — in explaining spillover effects of social capital on mental distress
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