Addi van Bergen

Chapter 2 32 Mental health in the general population Figure 4 shows evidence in favour of our hypothesis that high SE/low SI is associated with adverse health outcomes for MH in the general population. Our hypothesis is supported by 92% of the combined sample (27,881 persons, 6 instances, 5 studies) [37, 38, 46-48] and partly supported by 8% of the sample (2,493 persons; 1 instance) [34]. All but one study were cross-sectional in design. A retrospective cohort study showed an association between high psychological distress in elderly persons and later SE. High levels of SE, in turn, were found to be predictive of high psychological distress[46]. Three cross-sectional studies found positive associations between a large number of SE indicators and self-reported anxiety and anguish [47], common mental illness and severe mental illness [48]; depressive symptoms and psychotic experiences [38]. Figuur 4 v2 5-Nov-16 0 10,000 20,000 30,000 40,000 High risk groups (2) General population (6) High risk groups (1) General population (6) High risk groups (13) General population (7) General Health Physical health Mental health persons Hypothesis supported Hypothesis partly supported No associaton Inverse association Figure 4. Significance and direction of the relationship between SE/SI and health: total sample size (X-axis) and number of instances (between brackets). Another supportive study [37] found that the relationship between disability and MH was moderated by the social and economic dimensions of SE (operationalised as low social support and financial hardship respectively); and that the combination of the two dimensions strengthened the effect. The study with partial evidence [34] found a significant relation between low MH and the social dimension of SE but not with the cultural and economic dimension. Within the political dimension one indicator (adequate housing and safe neighbourhood) showed a concordant relation with MH whereas the other did not (access to institutions). Mental health in high-risk groups Figure 4 shows that the association between SE/SI and MH was tested in 13 high- risk study populations. Due to the typically small samples, the total sample size is modest compared to the general population sample (Figure 4; Tables S1a-b). This does not indicate less evidence per se. Our hypothesis was supported by 80% of the combined sample (4,646 persons; 8 out of 13 instances) and partly supported by 12% of the sample (692 persons; 3 instances). Supporting evidence was derived from two