Social Inclusion as a Determinant of Mental Health and Wellbeing

The link between social inclusion and mental health & wellbeing

A study of 2000 people in Finland found that social support strengthened mental health in all respondents (Sohlman 2004).

Young people reporting poor social connectedness (that is, having no-one to talk to, no-one to trust, no-one to depend on, and no-one who knows them well) are between two and three times more likely to experience depressive symptoms compared with peers who reported the availability of more confiding relationships (Glover et al, 1998).

A large meta-analysis of routinely collected data from 1952-1993 found a significant increase in mean levels of anxiety among US college students and school children which was correlated with reduced social connectedness (Twenge, 2000).

Evidence of significant and persistent correlations has been found between poor social networks (weak social ties, social connectedness, social integration, social activity, and social embeddedness) and mortality from almost every cause of death (Seeman 2000; Berkman & Glass 2000; Eng et. al 2002).

Studies have consistently demonstrated people who are socially isolated or disconnected from others have between two and five times the risk of dying from all causes compared to those who maintain strong ties with family, friends & community (Berkman & Glass 2000).

Belonging to a social network of communication and mutual obligation makes people feel cared for, loved, esteemed and valued. This has a powerful protective effect on health. Supportive relationships may also encourage healthier behaviour patterns (Wilkinson & Marmot 2003).

Two different but potentially complimentary mechanisms have been proposed to explain how social networks influence mental health. Social networks may have a beneficial effect on mental health regardless of whether or not the individuals are under stress, social networks may also improve the wellbeing of those under stress by acting as a buffer or moderator of that stress (Kawachi & Berkman, 2001).

By providing emotional support, companionship and opportunities for meaningful social engagement, social networks have an influence on self-esteem, coping effectiveness, depression, distress and sense of wellbeing (Berkman & Glass, 2000).

Social networks and social ties have a beneficial effect on mental health outcomes, including stress reactions, psychological wellbeing, and symptoms of psychological distress including depression and anxiety (Kawachi & Berkman 2001).

Whiteford, Cullen and Baingana (in press) indicate that :

• The benchmark Whitehall study demonstrated the link between social exclusion and ill health, and social isolation has been linked to unhappiness, illness, and shortened life.
• Socialising with colleagues from work, attending religious services and participation in clubs is related to positive health status.
• Vulnerability for depression includes the lack of confiding relationships, unemployment and low social status all of which can derive from a breakdown in social cohesion. Even in conditions where psychosocial factors are generally not considered to be pathological, this relationship has been reported. For example, socially isolated elderly people have a relatively greater risk of developing Alzheimer’s disease.

Social relationships have potentially health promoting and health damaging effects. Positive mental and physical health effects are associated with social interactions among older adults, including better recovery after disease onset. Critical and/or overly demanding social ties have however been correlated with increased stress and risk of depression among the elderly (Seeman, 2000).

The amount of emotional and practical social support people get varies by social and economic status. Poverty can contribute to social exclusion and isolation. People who get less social and emotional support are more likely to experience more depression (Wilkinson & Marmot 2003).

The Victorian Population Health Survey (VPHS) 2002 found that people with few social networks were more likely to report fair to poor health and to be experiencing some level of psychological distress. The study identifies higher network scores were associated with those who lived in rural areas, older age groups, those who were Australian born and those who were employed. Higher network scores were also associated with a range of benefits including an increased ability to get help in an emergency, feeling valued by society, accepting diversity and better health outcomes (DHS 2003).

An analysis of VPHS community strength indicator data undertaken by the Department of Victorian Communities shows that people who participate and those who can get help when needed are healthier and feel more positive about the communities in which they live. It also shows inequalities between population groups, most notably between socio-economic and ethnic groups (DVC 2004).

Baum et al. (2000) found mental health status was more strongly correlated with levels of participation in social and community life than physical health.

A national survey conducted by the Australian Bureau of Statistics in 2001 found rates of mental and behavioural problems and 'a very high level of psychological distress' were higher amongst adults who lived alone compared with adults living in a household with at least one other person (ABS 2003).

People are increasingly more likely to live alone and spend much more time by themselves according to an Australian Bureau of Statistics study which found that between 1992 and 1997, the percentage of our waking time spent alone increased by 14% to 3 hours a day (ABS 2000). The link between social capital and mental health & wellbeing.

There is growing evidence of correlations between various dimensions of social capital and aspects of mental health such as: common mental illnesses (Pevalin, 2002; Pevalin & Rose, 2002); happiness and wellbeing (Saguaro Seminar, 2001; Putnam, 2001); self-assessed mental health status (Baum et al, 2000); depressive symptoms (Ostir et al, 2003); feelings of insecurity related to crime (Lindstrom et al, 2003); general psychological distress (Berry & Rickwood, 2000; Berry & Rogers, 2003); emotional health (Rose, 2000); and binge drinking (Weitzman & Kawachi, 2000).

Although low levels of social capital have been correlated with poorer health, including mental health, a large UK study has found that social capital does not moderate or buffer the negative impact of structural socio-economic factors on health or common mental illness (Pevalin and Rose, 2002).

Greater levels of community participation, social support and trust in others in the community have been associated with reduced experience of psychological distress (Berry & Rickwood, 2000). 

Lower levels of social trust have been associated with higher rates of most causes of death, including heart attacks, cancer, stroke, unintentional injury and infant mortality (Kawachi & Berkman 2000).

Variations in anti-social behaviour and suicidal behaviour have been traced to strengths or absences of social cohesion (OECD 2001). Whiteford, Cullen and Bangana (in press) indicate that :
• There is a correlation between poor health and lower levels of social capital as evidenced by levels of interpersonal trust and norms of reciprocity (both of which can serve as indicators for social capital).
• There is evidence for an inverse relationship between social capital and the presence of mental disorders in populations.
• Social scientists have demonstrated higher social capital may protect individuals from social isolation, create social safety, lower crime levels, improve schooling and education, enhance community life and improve work outcomes.
• The same strong ties that are needed for people to act together can also exclude non-members, such as the poor or minority groups. Strong ties within the group may lead to less trust and reciprocity to those outside the group.
• Analysis of ecological factors indicates societies with low trust levels exhibit higher rates of violent and property crime, such as homicide, assault, robbery and burglary.

This article originally appeared on www.vichealth.vic.gov.au

What Does Arthritis Mean For Younger People?

Think arthritis only affects the elderly? Think again. By 2030, an estimated 580 million people worldwide, ages 18 and older, will have been diagnosed with the disease. Pretty eye-opening, right?

Conventional medicine tends to treat arthritis with strong, immune-suppressing medications that temporarily relieve the symptoms of the disease. Unfortunately, I've seen how these medications can also damage your gut and how they fail to truly address the root cause of the issue. This World Arthritis Day, it’s time to make a change. I’m here to tell you that there’s another way—a way that’s designed to address the underlying causes—in order to reduce inflammation without medication. Here’s how:

1. You can treat all kinds of arthritis with one approach.

There are more than a dozen different kinds of arthritis, and while there are certainly differences in conventional understanding and treatment for each one, they all have common root causes and triggers for inflammation and pain. For example, the two most common diagnoses are rheumatoid arthritis (RA) and osteoarthritis (OA). While RA is considered an inflammatory (autoimmune) disease and OA is typically thought of as the result of "wear and tear" and injury to the joint, both of these conditions are influenced by lifestyle choices such as diet and exercise. No matter what kind of arthritis you have, it’s important to know that it can be made worse by inflammation that starts elsewhere in the body, including the gut. Which brings me to my next point…

2. Heal the gut, and you heal the joints.

You may have heard some talk about gut health—and the gut-brain connection or the gut-pain connection—and you’ve probably heard the word "microbiome," or the friendly bacteria in your body. Fascinating studies have confirmed that the root cause of your arthritis is most likely lurking in your digestive system, so to heal your joints, you must first heal your gut. But where do you start? The best first step is to take a probiotic daily to help remove the harmful microbes that might be causing your symptoms, but some require a more intensive plan.

3. Treat your terrain with inflammation-fighting foods.

A fresh start for your microbiome means a new chance to influence your "terrain," or what I think of as the body’s deepest soil, where cells either thrive or wither. There’s a strong connection between your diet, your gut microbiome, and your pain level, so I recommend choosing foods that fight inflammation like organic plants and foods high in fiber and healthy fats, while avoiding refined sugars, dairy products, and red meats. Here are some of my guiding principles:

• Increase fiber, micronutrients, and phytonutrients, or, in less-scary terms, eat more vegetables and fruits, and choose organic whenever possible.
• Reduce refined sugar, high-fructose corn syrup, and refined grains.
• Improve the quality of fat by removing refined oils and hydrogenated fats.
• Improve the quality of the animal protein you eat by choosing 100 percent grass-fed and finished beef, free-range chicken, and sustainably farmed, low-mercury fish.
• Limit salt, food dyes, and preservatives (which happens naturally when you limit processed foods).

4. Carve out time for daily stress-reduction activities.

Traumatic events and ongoing stress are very real triggers for inflammatory diseases. In our go-go-go world, we’re always rushing; we can’t miss this deadline or that meeting, and we very rarely take the time to sit back, relax, and let our minds reset. Diet and stress are two root causes of a damaged gut, inflammation, and chronic disease, so it’s no surprise that in order to heal your arthritis naturally, you must take time to practice your favorite stress reduction activities daily. I recommend meditation, yoga, long walks through nature, and journaling to ease the mind.

This article originally appeared on mindbodygreen.com and was written by Susan Blum, M.D., MPH

Are You Overwhelmed — Why Won’t You Ask For Help?

Leading by doing — we could write the book. We see the big picture, organize the details, meet the deadlines, and never let them see us sweat.

Yep, we’re on top of it all the time…except when a task veers beyond our arsenal of expertise. But that rarely happens. And since we’re so good at figuring things out, we soldier on, on our own. Until we can’t.

Sometimes the task is too foreign, the time too short, the energy too finite to pull it off. And then we’re stuck acting like a Lone Leader, trying to operate without the necessary support.

There are at least three reasons a Lone Leader prefers to operate solo, even when overwhelmed. Knowing which one you’re prone to is the first step toward being able to issue an SOS. Take our mini-quiz to find out your tendency.

Lone Leader mini-quiz
First, think of a time when you were in over your head but didn’t ask for help. Then quickly answer the following three questions:

How did you Feel when you had more than you could handle?
A. Vulnerable
B. Overworked
C. Isolated

What did you Think when you had more than you could handle?
A. I hope no one checks on this until I figure it out.
B. I wish I could clone myself.
C. If I had more clout, maybe I wouldn’t have to do this by myself.

What did you Do when you had more than you could handle?
A. Googled, tried something, Googled, tried something else, Googled…
B. Made a superhuman effort to get things as right as possible.
C. Did your best, knowing it wasn’t what it could be.

If you chose mostly A answers, read about Opaque Leaders, below. Mostly Bs, you’re likely an Uneasy Leader. Cs are Hesitant Leaders. If you had a mix of letters, you’re a hybrid, which means you’ll find parts of yourself in all three types.

After you learn about your Lone Leader tendency — and maybe spend a few minutes reflecting on past examples of it — go to our Help Yourself printable worksheet for an exercise to help shift your perspective on getting help when you truly need it.

When you act like an Opaque Leader
You’ve got it covered — literally. Your veneer of competence is more than skin deep, and everyone knows it. But those tiny fissures of inexperience worry you. What if someone notices that you’re not 100% all that? Would you still be respected? Would you lose your position? Rather than chance it, you draw the shades around your weak spot and carry on like the impenetrable expert you believe you should be.

You need to see how asking for help is a sign of confidence. Never saying you’re sorry. Never admitting you’re wrong. All that tough-guy stuff is hooey. The courage to request assistance lets people see your human side, the one that says, “I know what I don’t know, and I know you can help me change that.”

Get the exercise: What confidence really looks like

When you act like an Uneasy Leader
You’re happiest when things are on a steady simmer and within reach. That way you can adjust as needed to ensure a good result. It’s when you can’t fully control the situation that misgivings arise. Will someone else make the same decision you would? Will quality suffer? Better to triple your own efforts, you reason, than risk compromise at the hand of another.

You need to think about accepting help as a way to make things better.The beauty of collaboration (a.k.a. help) is you get a whole new set of ideas to play with in addition to your own. That’s not compromise, that’s creativity in one of its best forms. Hey, did ever see what happened when a fine artist let her four-year-old finish some of her sketches?

Get the exercise: Discover the upsides of collaboration 

When you act like a Hesitant Leader
No one would accuse you of being high maintenance. You keep the wheels turning almost single-handedly without much need for applause. Thing is, when you could use some assistance you’re reluctant to sound the alarm. Will they think you’re a pest? Will they have bigger fish to fry? Will no one answer at all? The imagined consequence of rejection is enough to keep you from raising your hand.

You need to believe that others want to help. Ask someone to help you and they are instantly flattered. Beyond the initial ego-boost, your potential helper experiences a sense of validity and purpose. It’s almost like you’re doing them a favor.

Get the exercise: Find out why people want to help

DOWNLOAD THE PRINTABLE WORKSHEET: Help Yourself: How to get the assistance you need but won’t ask for
 

This article originally appeared on unstuck.com and was written by Unstuck

5 Steps to Bounce Back From a Bad Day

A bad day starts when you spill coffee everywhere on your way to work. Then you space out about the important tasks you had to get done. The icing on the cake? Your boss cancels a presentation you spent all yesterday preparing for. Bottom line: Today sucked.

Even if you love your job, an occasional bad day is par for the course. It can be hard to shake grouchiness when you wake up on the wrong side of the bed, are annoyed by at work, or distracted by world events or relationship drama.

The secret to recovering from a bad day is learning how to move forward despite it. How you respond can mean the difference between a quick recovery and a full-blown funk.

Here are 5 steps to help get you back on track so you can come back stronger tomorrow:

The only constant is change.

That’s why we created the Making a Change course and guide. Whether you’re starting a new job, moving across the country, or changing a habit, Making a Change will prepare you to get Unstuck. 
Learn more here >

Step 1: Embrace your bad day

You’re human, and like the rest of us, you’re bound to make mistakes or have moments where you’re not performing at 100 percent. As much as your inner perfectionist may be freaking out, forgive yourself. Give yourself permission to feel bad (for a little while at least).

Release any anger, guilt, or self-blame so that you can move on. Take a breather and walk around the block. Scribble out your frustrations in a journal. Call your mom or best friend. There’s no shame in crying in the bathroom, either!  

Step 2: Change your mindset

Once you’ve moved through the sorrow, shift your mood by asking yourself, “How do I want to feel right now instead?” Calm? Joyful? Strong? Consciously generate positive emotion so that you can get back to work with a fresh perspective.

Watch for ways you may also be blowing things out of proportion (“I’m not good enough. I always screw up” or “Nothing ever goes according to plan”). Unhelpful thinking is common, but you can unhook from it by reframing your perspective. To do so, first identify those automatic negative thoughts, then tweak your self-talk to be more balanced and realistic.

Step 3: Recalibrate mentally and physically

As you may know, bad days affect both the body and mind. Stress shuts down many normal functions, which is why you may feel anxious or rushed and experience symptoms like tunnel vision or shallow breathing when things are going badly.

Try bringing blood, oxygen, and calm back into your system with a grounding practice, stretching, or a few jumping jacks.

Step 4: Treat yourself — the healthy way

Don’t confuse self-care with self-sabotage. Skip drinking the day away at happy hour. Steer clear of numbing out through food, TV, or another substance or bad tendency. Focus on what restores you and makes you genuinely feel good, even in the tiniest way. That may be giving a calling a friend, going to bed an hour earlier, or saying “no” to a networking event so you don’t overextend yourself.

Step 5: Leave it behind

Emotions are contagious (including negative ones) and when work sucks, unhappiness can follow us home. Draw a boundary with an evening routine to signal the shift and bring closure to a bad workday.

At home, speak up and let your family, roommates, or maybe your pets know you’re having a rough day. Request space to decompress if you do need it, but resist the urge to isolate. Connection with others, even virtually, is an important component of happiness. It helps us realize that bad days are universal and also serves as a much-needed source of support and advice.

No one is perfect. Life rarely works out exactly as planned. Instead of beating yourself up when a crummy day happens, expect them. And remember, you get to decide how you respond when bad days happen. Will you let it derail you? Or will you choose to see it as a tiny bump in the road on the way to achieving your goals?

Ironically, a bad day can be a hidden gift — it’s an opportunity to show to yourself exactly how resilient you are. You have the capacity to do hard things, so go show today who’s boss.

This article originally appeared on unstuck.com and was written By Melody Wilding.