Affect of Social Capital on Mental Health Outcomes

Dr. Shoeb Ahmed Hospital and Health Care Management Consultant.
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Affect of Social Capital on Mental
Health Outcomes
Dr. Shoeb Ahmed
B.S, BDS, PGDHM, PGDMLE, PGDHA, EMSRHS, MPH, M.Sc. (Psy), MHRM,
M.Sc. (Biotech), F.H.T.A, MS (Global Health), M.Phil (HHSM), FRHS, FMSPI,
DEM & ISO 14000/ 14001, Cert. in Health Economics (World Bank), CPHQ, (PhD).
Hospital and Health systems Management Consultant.
Health Technology Assessment Consultant.
Health Care Quality Management Consultant.
Ruby Med Plus
M: +919666148506
Email: shoebilyas@gmail.com / support@rubymedplus.com.
Begumpet
Hyderabad-500016

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Introduction
Understanding, social capital may provide an explanation of how the social
environment affects mental health. Social capital is the interaction between
people and the types of ‘resources’ that can arise from social connections. The
foundation idea of social capital theory is that social networks have value and social
capital refers to connections among individuals, social networks and the norms of
reciprocity and trustworthiness that arise from them. In that sagacity, social capital is
closely related to what some have called “civic virtue”. The difference is that “social
capital” calls attention to the fact that civic virtue is most powerful when embedded
in a dense network of reciprocal social relations.
The most accessible definition of social capital used in the health sciences originates
from Putnam. He states that social capital consists of five principal characteristics,
namely: (1) community networks, voluntary, state, personal networks, and density;
(2) civic engagement, participation, and use of civic networks; (3) local civic identity
sense of belonging, solidarity, and equality with other members; (4) reciprocity and
norms of cooperation, a sense of obligation to help others, and confidence in return
of assistance; (5) trust in the community.
Emerging evidence shows that, the places where people live are an important factor
in determining and sustaining inequalities in health outcome between individuals in a
given community. Although there is substantial geographical variation and inequality
in mental health status there is no consistent evidence from studies of places, people
and mental health that the socio-economic characteristics of places are independently
associated with individual mental health, after accounting for individual level socio-
economic status.
A society of isolated individuals is not necessarily rich in social capital. (Putnam,
2000, pp. 18-19). Putnam (2000), views ‘civic engagement’ such as participation in a
range of voluntary associations, clubs and societies, as a crucial means to bring
people together, in order to develop the shared norms of cohesion and trust from
which social capital is developed. He described the value of cohesive, trusting social
connections between people, as important for facilitating reciprocal activities and
mutual cooperation.

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Mental health can be conceptualized as a state of well-being in which the individual
realizes his or her own abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to his or her
community (World Health Organization, 2007). Mental health is the embodiment of
social, emotional and spiritual wellbeing. Mental health provides individuals with
the vitality necessary for active living, to achieve goals and to interact with one
another in ways that are respectful and just (Victorian Health Promotion
Foundation, 1999).
The espousal of social capital in mental health research
Putnam (1995) defines social capital as “coordination and cooperation for mutual
benefit” and Coleman (1990) as “relations among actors …that are useful for the
cognitive or social development of a child or young person”. Hence it is a
way of describing social relationships within societies or groups of people and
adds a social dimension to traditional structural explanations of disease by
viewing communities not just as contextual environments, but as connected
groups of individuals. (Cullen and White ford 2001). Medline cites well over 150
studies examining the association between social capital and health (Kawachi et al.
2004).
In the field of mental health, social capital is starting to influence mental health
policy development. (Henderson and Whiteford 2003). Building or sustaining
healthy communities is now considered an important weapon in a state’s strategy
to prevent mental illness like for instance, the UK Government has written the
building of social capital into its mental health policy. The Department of Health has
explicitly cited developing social capital as an important feature of mental health
promotion (Department of Health 2001), WHO and in particular the World Bank
have adopted social capital as an important tool in poverty reduction and
community development (Henderson and Whiteford 2003).

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Social capital has two components i.e. bonding and bridging. It is very important to
understand these two components of social capital. Bonding refers to cohesive ties
between people in similar circumstances who have access to similar amounts of
resources, and ‘bonding’ social capital is thought to promote the development of
strong ‘in-group’ identities (Kawachi, Subramanian & Kim, 2007). In comparison,
bridging connections refer to ‘weaker’ ties between diverse individuals who may be
dissimilar in relation to their social and cultural circumstances, ethnic background,
and levels of access to economic resources (Kawachi et al., 2007). Bridging ties’ are
seen as having the most potential for generating positive community outcomes and
for promoting population health, whereas ‘bonding’ social ties, even though they
may offer social support, are also thought to have the potential to be exclusionary
and lead to negative health outcomes (Baum & Ziersch, 2003).
An understanding of the concept of ‘bonding’ and ‘bridging’ ties, and how they have
been included within the social capital literature, is relevant because, in considering
the nature of individuals involvement in community groups, this research paper will
examine the types of social connections that an individual establish within groups,
and the mental health outcomes.
Understanding the role of the social environment in the etiology of poor mental
health status is important for prevention of this important disease burden in the
community. Mental illness is a broad concept which encompasses many different
conditions with differing etiologies, ranging from schizophrenia to depression and
substance misuse. There is good evidence in the literature, that health behavior and
health care delivery are influenced by a broad range of systemic and social factors,
like social capital, but not only biomedical factors, hence we need to understand how
social capital may translate into better mental health outcomes and health equity.
The theory of social capital emphasizes multiple dimensions inside the concept. For
example, social capital can be divided into a behavioral /activity component (for
example, participation) and a cognitive/perceptual component (for example, trust).
These are referred to as structural and cognitive social capital respectively. (Bain K,
Hicks N, 1998).
Structural and cognitive social capital can refer to linkages and
perceptions in relation to people who are akin to each other such as others in one’s

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own community or people of the alike socioeconomic status (called bonding social
capital), or to people who are poles apart such as people outside one’s community or
with a different social identity (called bridging social capital). Social capital can also
occur through ceremonial institutions such as between a community and local
government structures, and this is termed linking social capital. (Szreter S, Woolcock
M, 2004)
Psychosocial Processes and Social Capital
Social capital has been viewed as principally relevant for mental health, because it is
argued that psychological mechanisms provide the pathways by which social capital
affects health more largely (McKenzie & Harpham, 2006). Social capital has been
used as an overarching device to explain the relationships between social ties and
positive mental health, and social support and related concepts (such as social
integration and cohesion) which have been viewed as components of social capital
(Lin, 1999; Kawachi & Berkman, 2001).
High levels of social capital are encouraging for the development of an individual’s
psychosocial processes that are needed to cope with life’s stressors and protective
against ill-health. These psychosocial processes relate to an individual’s cognitive
social capital but arise from social interaction within an individual’s community.
Interaction with others is improved if it is based on trust and reciprocity, which
provide protective factors against the instigation of any psychosocial processes that
are known to be pre-determinants of mental health.
Social environments with higher levels of trust create reliable citizens. The
developmental processes by which the moral values of trust and reciprocity become
instilled in children occur more quickly in communities with higher social capital.
Community members have some sense of public responsibility for each other, even if
they have no related ties. This example is gained by experience by having strangers
showing degrees of public responsibility to you. These norms of reciprocity or
mutual respect can translate into easier child rearing, improved self-government, and
the maintenance of the public life courteousness (Berkman and Kawachi 2000).
In addition, “social capital could influence health of individuals via psychosocial

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processes by providing effective support and acting as the source of self-esteem and
mutual respect” (Wilkinson 1996). Variations in the availability of psychosocial
resources at the community level may help to explain the jarring finding that socially
isolated individuals residing in more cohesive communities do not appear to suffer
the same ill health consequences as those living in less cohesive communities”
(Berkman and Kawachi 2000: 185).
The association between mental disorders and poor social circumstances in which the
individuals are in socially disadvantaged situations are exposed to more psychosocial
stressors (adverse life events) than those in more advantaged environments, hence
these stressors act as triggers for the onset of symptoms and the loss of the
individual psychological abilities necessary for social functioning (Bebbington et al.
1993). The psychosocial pathways to the development of mental disorders which
include higher levels of life events, anomie, learned helplessness, thwarted
aspirations, low self-esteem, and less security (Social Capital and Mental Health
Workshop, McKenzie, July 2000).
Individual social capital is a measure of appraisal of surrounding social environment,
social networks, and level of participation in given community. Usually depression
and anxiety produce characteristic ways of thinking, with more negative appraisal
associated with anxiety and depression disorders. It is also seen that individual
suffering with depression are less likely to play an active part in the community than
those who are noti
and also lead to a breakdown in marital stability (Kessler et al.
1998)ii
, increased teenage parenthood (Kessler et al. 1997), more distant social
relationships (Mickelson et al. 1997) and other factors associated with social
deterioration.
Even mental disorders, such as schizophrenia, can result in dramatic social decline
as a result of impaired psychological and social functioning. The positive and
negative symptoms of the disorder interfere with the person’s capacity to cope with
the usual demands of interpersonal interaction and the decoding of social
communication (Murphy 1972). Early identification of, and intervention to remove,
target symptoms associated with the social and vocational decline in mental disorders
is now possible (Hafner et al. 1999).
There is also evidence to link violent societies with poor mental health contributing

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to a downward spiral, and for the poor health of household members impacting on
the mental health of care givers and their withdrawal from participation in
community activities. (Pridmore P et al, 2006). There is good evidence that inequity
caused by disparities in communities with income distribution can erode trust and
diminish social capital. (Kawachi et al 1997) which suggest that, the more macro
level social and economic processes influence mental health. Other studies have
found that social capital variables account for a significant amount of physical and
emotional health at the individual level and that those reporting high levels of trust
have better self-rated health status and greater life satisfaction.( Rose R, 2000).
A case study from India demonstrated that advocacy of federations can lead to
mobilization of large groups of people across a city and increase cohesion of
informal community networks in slum areas. (Pridore P et al 2006) But other cross-
national studies indicate that individual-level analysis of social capital along with
macro level determinants is important for understanding elderly mental health
(pollack C et al 2006) and cognitive social capital is positively associated with child
mental health. (Thomas E, 2006).
Prilleltensky & Prilleltensky (2007) argue that wellbeing is dependent upon
relationships, practices and policies which promote equitable power relations. The
findings of this study suggest that social capital cannot be expected to promote
mental health and well-being if no attention is paid to addressing issues of power,
and unequal power dynamics. Such attention needs to be directed both at the ‘micro’
level of power struggles between people in social settings (such as community
groups), and more broadly at wider structural inequalities which organize the ways in
which people experience their everyday lives, and how this impacts upon the type of
social capital available to them.
The mechanisms underlying the association between workplace social capital and
depression may be largely similar to those in the neighborhood context. Although
low social capital can be distinguished from the concept of social support, there may
be a relation between the two, with lower workplace social capital decreasing the
likelihood of accessing various forms of support. Low social capital could also
reflect poorer access to local services and amenities, and it could be an obstacle for
an effective dissemination of mental health information and knowledge at the

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workplace. A low level of integration within a social network may produce negative
psychological states, which decrease motivation for self care and it could increase
vulnerability to the adverse health effects of chronic stress.
Communities with low levels of social capital have been suggested to be less
effective at exercising social control over health-risk behaviors members of these
communities may not obtain normative guidance about healthy behaviors, which can
in turn affect mental health. However, the association between workplace social
capital and depression was little affected by adjustment for health behaviors.
Psychiatric disorders are among the most common causes of disability retirement in
workers. According to estimates of the World Health Organization, approximately
121 million people suffer from depression, and it will account for 15 percent of the
disease burden throughout the world by 2020. In addition to individual suffering,
depression leads to substantial loss of productivity. Building or sustaining healthy
communities has been seen as an important weapon in a country strategy to prevent
mental ill health.
Empowerment and Social Capital
Empowerment is viewed as a central strategy to promote health and mental well-
being (WHO, 1986), and community participation is seen as an important strategy to
‘empower’ people. Ellaway and Macintyre (2007) found that participation in some
types of groups was associated with lower levels of psychological distress, and this
relationship was particularly strong for men to prevent mental illness.
Participation in community groups has been identified as producing ‘costs’ for the
individual; such as potentially stressful demands on personal resources, time and
energy, and discordant and negative social interaction (Chinman, Wandersman &
Goodman, 2005) and linked with stress and can have a unconstructive impact on
psychological well-being. The above statement is also supported by Mitchell and
LaGory (2002) study in the context of a disadvantaged urban community in the U.S.,
they found that higher levels of participation in community relations was associated
with increased levels of mental distress. These two studies suggest the possibility
that, in conditions of socioeconomic disadvantage, participation in community
groups could potentially exacerbate mental health problems.

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Leisure and recreation aspects of group involvement have also been identified as
positive for the well-being of older (Hutchinson & Wexler, 2007). The community
involvement of rural, low-income women in religious organizations has been found
to be linked with lower levels of depressive symptoms (Garrison, Marks, Laurence &
Braun, 2004).
Social Networks and Social Capital
A number of potential mechanisms through which social capital may affect mental
health have been proposed, largely drawing on the associations that individual social
networks and support are related with mental health (Kawachi and Berkman,
2001).which include: (a) more rapid diffusion of health information; (b) social
control over deviant health-related behaviour (collective efficacy); (c) increased
access to local services and amenities; and (d) psychosocial processes such as self-
esteem and mutual respect (Kawachi et al. 1999a). Building or sustaining healthy
communities is an important weapon to prevent mental illness. In the Opinion of
social scientists, policy makers, and international institutions like World Health
Organization and the World Bank, social capital contributes to health inequalities
within and between populations.
Social Capital may lead to better mental health through influencing health-related
behaviors by the adoption of health promoting activity and healthy norms, and
exerting social control over abnormal behaviour. Another pathway is that privileged
levels of community cohesion result in higher degrees of social organization that
enhances access to services that influence health. Individual functioning and well-
being is affected by diverse social experience and conditions, which includes an
individual’s social capital environment. Psychological strength (self-esteem,
individual identity) and vulnerability, which factor into functioning and well-being,
are also affected by the social context of an individual (National Institute for Mental
Health 1995). The association of workplace social capital with self-rated health has
only recently been demonstrated but its association with mental health is unknown.
Numerous studies have shown, however, that other psychosocial work factors, such
as social support and organizational justice may contribute to mental health.

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Measurement of social capital
Exploring social capital as a community characteristic is exciting as it moves beyond
determinants of health to the way that society can reduce the risk of illness
(McKenzie 2003). There is consensus that social capital consists of social networks
(quantity of relationships) characterized by norms of trust and reciprocity (quality
of relationships) (Lochner et al. 1999), but these must be broken down into their
component parts and measured separately (Stone 2001). Social capital can be divided
into a behavioral /activity component of what people do (for example participation in
groups) and a cognitive/perceptual component of what people think (for example
whether they trust other people). These are referred to as structural and cognitive
social capital respectively (Bain and Hicks 1998).
Social capital can also occur through formal institutions such as between a
community and local government structures, or through people with different power
relations, termed linking social capital (Szreter and Woolcock 2004). Thus while
structural and cognitive social capital explains the nature of networks (i.e. their
quality or quantity), bonding, bridging and linking social capital explain where
these relationships take place.
Individual social capital is most commonly measured by asking individuals about
their participation in social relationships and their perceptions of the quality of those
relationships. For example it may measure whether a person participates in local
social groups not related to work or whether they trust their neighbors. Since social
capital is characteristic of an area, not an individual, researcher examining mental
health and social capital may want to attempt to measure the mental health of an
area. One possible conceptual model that has been employed in New York, NY
(Siegel et al. 1997) includes indicators from several different domains socio-
economic, needs, supports, and outcomes. Within these four domains, indicators
differed by measure according to either the “well-being” of persons with mental
illness or a more general measure of the “social and mental well-being” of people in
New York City. Weich et al (2002) did report that some independently rated
household and neighborhood characteristics were associated with the prevalence of
common mental disorder, although multilevel models were not used to analyze their

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data. After adjustment, deck access properties, age of property and private gardens
were associated with common mental disorder.
The Mental Health Index indicators integrated
• Socio-economic – poverty and employment
• Needs – prevalence of serious, and of severe and persistent mental illness (SMI
and SPMI, respectively)
• Supports – availability of mental health and residential services for those with
mental illness in general, and the SPMI population in particular
• Outcomes – undesirable conditions specific to persons with mental illness that
require careful monitoring including service system problems, substance abuse
co-morbidity, criminal justice system involvement, homelessness, and avoidable
mortality.
The Social and Mental Well Being Index integrated
• Socio-economic – poverty and unemployment
• Needs – the population size of the whole community
• Supports – availability of a broad range of community services that address
poverty, homelessness, education, drug and alcohol abuse, and medical treatment
Outcomes – quality of life, social welfare, substance abuse, public health
avoidable mortality and others.
In order to measure the indirect effects of Economic Social capital (ESC) on an
individual’s mental health, the direct effects of that individual’s own social capital
must also be taken into account. Multi-level modeling can be used to assess the
direct effect of ISC and the indirect effect of ESC on an individual’s risk of suffering
from Mental Disorder. A recent review has shown that many studies have
investigated associations between mental health and social cohesion measured at the
individual level, but none have investigated the joint effect of community and
individual level measures. It has also been suggested that the social cohesion of
communities could influence associations between potentially adverse factors such as
area income deprivation on the mental health of individuals.

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Discussion
There is currently a growing body of research exploring the impact of
neighborhood social characteristics ranging from socio-economic deprivation to
neighborhood disorder on a wide range of health outcomes including mental health
(Subramanian 2004). Contextual and compositional factors are inter-related and are
both associated with mental Health. Structural social capital has context-specific
effects and cognitive social capital more universal effects on mental health. While
social capital is important for mental health, its complex and context-specific nature
means that it is unfeasible to use it as an intervention to prevent or treat mental
disorders. 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. It is accepted that improved health status
contributes to enhancing human capital (Bhargava et al. 2001). For those with mental
illness, action to remove psychosocial stressors, provide social and psychological
support, and provide clinical treatments to reduce symptoms and disability, can all
lead to an enhancement of the individual attributes necessary for constructive social
interaction and assuming a productive social role. Psychiatric illnesses are the most
important cause of disability in low income countries. (Abas and Broadhead 1994).
Usually measures should have a payoff in terms of building social capital as good
mental as well as physical health enhances the resilience and competencies necessary
for more constructive participation in civil society. In this context mental health,
while clearly part of health, it may have specific importance in contributing to the
cognitive and psychological attributes necessary for the interactions which underpin
social capital.
Women are believed to be more vulnerable to mental illness due to their multiple
roles as caregivers and economic producers, exposure to domestic violence, and
unequal power relations with men (Patel 2001). Severe life events such as the death
of a loved one, domestic abuse or family breakdown are all associated with an
increased risk of Mental disorders (WHO 2001b), contributing to the vicious cycle
between poverty and mental illness as the poor are disproportionately affected by
such events. (Patel et al. 2002), therefore severe life events which trigger an episode
may instigate a downward spiral of mental illness.

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Health-related Behaviors and Social Capital
Social capital may influence community members’ health behavior by promoting a
more rapid diffusion of health information or increasing the likelihood that healthy
behavior norms are adopted (like physical activity) and by exerting social control
over deviant health-related behavior (such as smoking). The theory of the diffusion
of innovations suggests that the innovative behaviors (e.g. use of preventive services)
diffuse much more rapidly in communities that are cohesive and that have higher
levels of trust (Rogers 1983). Criminology studies (Sampson et al. 1997) have
suggested that the higher the degree of “collective efficacy or degree that community
members are willing to exert to socially control deviant behavior, the more likely the
community is to prevent delinquency and crime. This process may be applied
similarly to prevent deviant behavior, such as adolescent smoking, drinking, and
drug abuse (Berkman and Kawachi 2000).
Access to Mental Health Services and Amenities
Community social capital may affect health also in terms of access to services and
amenities. Criminology studies have found that socially cohesive communities are
more successful at bonding together to fight potential budget cuts of local services
(Sampson et al. 1997). Cohesive communities are more able to unite to form
appropriable social organizations, which could be formed to ensure access to services
that are directly related to health such as transportation, community health clinics,
and recreational facilities. The differences in access to amenities and resources
between poor and affluent communities have been documented (Macintyre et al.
1993). “Given such geographically based inequalities, the existence of local pressure
groups to lobby for the provision of services could make all the difference”
(Berkman and Kawachi 2000: 185).
Decreased access to services and amenities is often a result of poverty or crisis.
Social capital links in this case become even more important, for they can serve as a
coping mechanism that helps for day-to-day survival. This can be critical for short-
term survival, providing needs such as food, security, or basic infrastructure
maintenance (Cuny 1994). Long-term solutions to the problems of inadequate
resources and social exclusion require connecting the marginalized to mainstream
resources and services through mechanisms of bridging social capital, which unites

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these excluded groups with the majority (Putnam 1995). Bridging social capital is
most likely to help improve the standard of living for these excluded and
marginalized groups. Social capital for impoverished groups stems from family and
neighbors helps ensure their daily survival; while social capital for wealthier groups
helps them further their interests (World Bank Social Capital Website).
Encouraging community participation is an important aspect of health promotion and
community development. It is viewed as an important part of developing health
policies and programs in ways which are democratic and accountable, and is seen as
a strategy to empower individuals and communities to gain control over their social
and economic circumstances, which in turn, can be beneficial for health and well-
being (Commission for the Social Determinants of Health, 2008).
Encouraging participation by community members in relation to health programs and
services is viewed as a way to include disadvantaged groups and address social
exclusion and health inequalities (McLean, Campbell & Cornish, 2003). In relation
to social and health policy, a focus on community participation is an important aspect
of government policies in countries such as the UK and Australia, which aim to
reduce social ‘exclusion’ (Popay et al., 2008)
Social capital can contribute towards health promotion, in the extent to which it can
be used for its strategic value, and that the concept can be carefully employed within
wider health promotion practices which explicitly draw upon social justice, equity
and empowerment principles.(Wakefield & Poland, 2005)voluntary community
participation can be a compulsory activity imposed upon some groups, as individuals
who receive unemployment benefits are compelled to volunteer and be involved in
community activities (Warburton & Smith, 2003) which decreases mental stress.
Stressed Problems in Communities affecting social capital and
mental health
Communities under stress are more likely to experience certain conditions that are
symptoms of, or catalysts to, lower levels of social capital. These low levels of social
capital may then amplify and buttress these conditions, further eroding levels of

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social capital. Conditions experienced by communities in stress include
disorganization, unpredictability, low trust, high anxiety, high vigilance, low
efficacy, low social control (e.g. work and social environment), and high migration
(impacts familiarity / identity / threat) (Social Capital and Mental Health Workshop,
McKenzie, July 2000). Desjarlais et al. (1995) identify three clusters of problems
social pathologies, exacerbating social and economic circumstances and poor health
– which are found in communities under stress.
Model of Overlapping Clusters of Problems (Desjarlais et al.
1995: 7).
Social Pathologies Health Problems
• Substance Abuse • Heart Disease
• Violence • Depression
• Abuse of Women • Stress-related Conditions
• Child Abuse • Behaviors Contributing to
Chronic Illness
Exacerbating Conditions
• High Unemployment
• Poverty
• Limited Education
• Stressful Work Conditions
• Gender Discrimination
“In general, mental, social and behavioral health problems represent overlapping
clusters of problems that, connected to the modern wave of global changes and new
morbidities, interact so as to intensify each other’s effects on behavior and well-
being” (Desjarlais et al. 1995: 6-7). The social pathologies and health problem

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clusters are more difficult to cope with when the surrounding social environment is
bad – such as being plagued by high unemployment, low income, limited education,
stressful work conditions, gender discrimination, unhealthy lifestyle, and human
rights violations Examining the factors that produce differences in health or social
capital between communities, or fundamental social causes, may be useful in
fleshing out their interrelations. A lack of attention to these fundamental causes will
ensure that differentials persist. Fundamental causes are linked to resources like
money, power, prestige and social connections (or exacerbating conditions on the
above chart) that strongly influence a community’s ability to avoid risks and to
minimize the consequences of any emerging disease. Fundamental causes are
particularly important in periods of change. New diseases, new environmental
hazards, new knowledge of risks and new treatments are all the prevalence of
fundamental causes. In a dynamic system, fundamental causes are always important.
Those who have more access and power will be less afflicted by disease (Desjarlais
et al. 1995).
The relationships between social capital and health and social capital and mental
health are clear in terms of the presence of social capital (or lack thereof) having
effects on both health and mental health. However, few studies have tried to
investigate the reverse, the impact health and mental health status may have on social
capital, or the interrelations of the three variables. For example, psychological health
is an outcome but could also be a conduit through which social capital has its effects
on physical illness (e.g., there is significantly increased risk of death from a
cardiovascular illness in those with common mental disorders).
Some still feel however that the links between social capital, mental health, and
health are unclear. The notion of social capital supports the ideals of cohesive and
thriving communities, yet it is still difficult to trace how this then relates to better
health actions and status, including well-being and quality of life. A well-knit
community is not one that is necessarily healthy. To further elucidate these links,
public health and social science researchers need to focus on building better
epidemiological and theoretical understandings of the relationship between social
capital, health, and mental health (personal communication, Wood, March 2000
referencing Baum 1999).

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Suicide, Anti-social Behavior and Social Capital
Variations in anti-social and suicidal behavior have been traced to strengths or
absences of social cohesion (OECD 2001). Weak social controls and the disruption
of local community organization have been hypothesized to be the underlying factor
producing increased rates of suicide (Durkheim 1897) and crime (Shaw and McKay
1942). Social disorganization, defined as the “inability of a community structure to
realize the common values of its residents and maintain effective social controls,”
correlates to rates of suicide and crime (Sampson and Groves 1989). The social
organizational approach views local communities and neighborhoods as complex
systems of friendship, kinship, and acquaintanceship networks, as well as formal and
informal associational ties rooted in family life and ongoing socialization processes
(Sampson 1996). From the perspective of crime control, a major dimension of social
disorganization is the ability of a community to supervise and control teenage peer
groups, especially gangs. Shaw and McKay argued that residents of cohesive
communities were better able to control the youth behaviors that set the context for
gang violence (Berkman and Kawachi 2000)
Conclusion
The common mental disorders like that of depression and anxiety can lead to
substantial disability. The possibility of neighborhoods, in addition to characteristics
of residents, can affect mental health which, is of increasing interest to social
researchers and epidemiologist. Income deprivation and social capital measured
at community level are potentially important joint determinants of mental
health. Poor mental health can be significantly associated with area-level
income deprivation and low social capital. State-society relations in which they are
inherently embedded. It relies on the distinction between bonding, bridging and
linking forms of social capital. A “healthy society”, capable of consistently
promoting the population health of all its citizens, will be characterized by a
balanced distribution of a relatively rich endowment of all three of these forms of
social capital. Whether or not the resources of social capital which exist in any
society will take on health-promoting or health-degrading net effects is still not clear
with diversified view of pioneers in social capital.

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Social capital is not a magic pill for improving society mental health but, It is a
useful concept which focuses our attention on an important set of resources, inhering
in relationships, networks and associations, which have previously been given
insufficient attention in the social sciences, Psychiatric and health sciences literature.
This is probably partly because they are not easy to categories, study and measure
their effects quickly. The social capital perspective therefore broadcast us that if we
normatively approve of the goal of enhancing population mental health, we cannot
achieve this through substance inputs, alone, or simply through “technological fixes”,
whether “forced” or magnanimously “approved” by those with superior resources.
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