Are people with sudden health change more reliant on neighbourhood social structures?

Background

There is a large body of literature attesting the relationship between health and neighbourhood social characteristics (NSC) like social cohesion and how this relationship may vary between social groups. However, there is limited research looking into how this relationship may be moderated by health status, probably due to methodological complexity of assessing this question.

Methods

We used a longitudinal event-based design approach and two survey data (SOEP for Germany and Understanding society for the UK) in which we identified participants with a sudden change in health (MCS and PCS of the SF12) of at least one standard deviation, matched to similar study participants without health changes. Using multilevel models to account for repeated measures and matching, adjusted for pre-shock MCS and PCS, age, and sex, we investigated how having a health shock modified the association between MCS and PCS with a measure of NSC.

Results

For both survey data the longitudinal association post health shocks between health and neighbourhood social characteristics showed a differential between negative health shocks and controls for mental health: for Understanding society (2334 controls for 2334 shocks) MCS increased by 1.17 (SE: 0.55) per unit of NSC for controls, for those with negative shocks, this association was significantly increased by 2.70 MSC points per unit of NSC (SE: 0.72). For SOEP (2056 controls for 2056 shocks), the pattern was similar: MCS increased by 1.85 (SE: 0.49) per unit of NSC for controls, for those with negative shocks, this association was significantly increased by 1.46 MSC points per unit of NSC (SE: 0.65).

Conclusions

We were able to confirm that the association between NSC and mental health may depend on the health status. Our analysis shows that better NSC may bring a higher health benefit to those with sudden drop in health than those without, confirming the hypotheses of being more reliant on neighbourhood social support.

Key messages

• Good neighbourhood social characteristics have stronger positive association with mental health for those having experienced a sudden drop in physical or mental health.

• A higher reliance on social support for those experiencing a health shock might explain this differential in association.