Toshihide Iwase

Do bonding and bridging social capital have differential effects on self-rated health? A community based study in Japan

Background Few studies have examined the potential difference in the relationship between bonding versus bridging social capital and health outcomes. We sought to examine the association between these different types of social capital and self-rated health in a population-based study. Methods In February 2009, 4000 residents of Okayama City (aged 20–80 y) were randomly selected for a survey on social capital and health. The survey asked about participation in six different types of associations: Parents and Teachers Association, sports clubs, alumni associations, political campaign clubs, citizens groups and community associations. We distinguished between bonding and bridging social capital by asking participants about their perceived homogeneity (with respect to gender, age and occupation) of the groups they belonged to. ORs and 95% CIs for poor health were calculated. Results Bridging social capital (ie, participation in groups involving people from a diversity of backgrounds) was inversely associated with poor health in both sexes and women appeared to benefit more than men. Compared to those who reported zero participation, high bridging social capital was associated with a reduced odds of poor health (OR 0.25, 95% CI 0.11 to 0.55) in women after controlling for demographic variables, socioeconomic status, smoking habit and overweight. By contrast, bonding social capital was not consistently associated with better health in either gender. Conclusions The present study suggests that bonding and bridging social capital have differential associations with health and that the two forms of social capital need to be distinguished in considering interventions to promote health.

Does social capital promote physical activity? A population-based study in Japan.

BACKGROUND To examine the association between individual-level social capital and physical activity. METHODOLOGY/PRINCIPAL FINDINGS In February 2009, data were collected in a population-based cross-sectional survey in Okayama city, Japan. A cluster-sampling approach was used to randomly select 4,000 residents from 20 school districts. A total of 2260 questionnaires were returned (response rate: 57.4%). Individual-level social capital was assessed by an item inquiring about perceived trust of others in the community (cognitive dimension of social capital) categorized as low trust (43.0%), mid trust (38.6%), and high trust (17.3%), as well as participation in voluntary groups (structural dimension of social capital), which further distinguished between bonding (8.9%) and bridging (27.1%) social capital. Using logistic regression, we calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for physical inactivity associated with each domain of social capital. Multiple imputation method was employed for missing data. Among total participants, 68.8% were physically active and 28.9% were inactive. Higher trust was associated with a significantly lower odds of physical inactivity (OR = 0.58, 95% CI = 0.42-0.79) compared with low trust. Both bridging and bonding social capital were marginally significantly associated with lower odds of physical inactivity (bridging, OR = 0.79, 95% CI = 0.62-1.00; bonding, OR = 0.71, 95% CI = 0.48-1.03) compared with lack of structural social capital. CONCLUSIONS/SIGNIFICANCE Low individual-level social capital, especially lower trust of others in the community, was associated with physical inactivity among Japanese adults.

Individual-level social capital and self-rated health in Japan: An application of the Resource Generator

Despite accumulating evidence of associations between social capital and health in public health research, a criticism of the field has been that researchers have exclusively focused on concepts of social cohesion to the exclusion of individual-level approaches. In the present study, we evaluated the association between social capital measured by the Resource Generator (an individual-level assessment of access to social capital) and self-rated health among Japanese population in a cross-sectional study. A postal survey of 4000 randomly selected residents in Okayama City (western Japan) was conducted in February 2009. We divided the overall scores from the Resource Generator Japan scale into quartiles. Odds ratios (ORs) and 95% confidence intervals (CIs) for self-rated health were calculated separately by sex. Individuals with the highest quartile of scores had significantly lower odds of poor health compared to the lowest group after covariate adjustment among both men and women (men; OR: 0.45, 95% CI: 0.24-0.86, women; OR: 0.44, 95% CI: 0.25-0.79, respectively) and there were also significant dose-response relationships. In the sub-domains of Resource Generator Japan scale, a differential pattern was observed by sex. Women showed a clear dose-response relationship with health across all four sub-scales (domestic resources, expert advice, personal skills, and problem solving resources). In contrast, only the domain of expert advice exhibited a strong association with mens health. Among both men and women individual-level social capital measured by the Resource Generator was related to reduced odds of poor health even after taking into account individual confounders. Although we cannot exclude reverse causation due to the cross-sectional design, our study adds to the accumulating evidence of the potential utility of the Resource Generator for evaluating the relationship between individual-level access to social capital and health.

Type D Personality Is Associated with Psychological Distress and Poor Self-Rated Health among the Elderly: A Population-Based Study in Japan

We investigated the association between Type D personality, psychological distress, and self-ratings of poor health in elderly Japanese people. In August 2010, questionnaires were sent to all residents aged ≥65 in three municipalities (n = 21232) in Okayama Prefecture, Japan, and. 13929 questionnaires were returned (response rate: 65.6%). To assess mental and physical health outcomes, we used the Kessler Psychological Distress Scale and a single item question regarding perceived general health. We analyzed 9759 questionnaires to determine odds ratios (ORs) and 95% confidence intervals (CIs) for several health outcomes, adjusting for sex, age, smoking status, frequency of alcohol consumption, overweight status, educational attainment, socioeconomic status, and number of cohabiters. The multiple imputation method was employed for missing data regarding Type D personality. The prevalence of Type D personality in our sample was 46.2%. After adjusting for covariates, we found that participants with Type D personality were at 4–5 times the risk of psychological distress, and twice the risk of poor self-rated health. This association was stronger in participants aged 65–74 years (psychological distress; OR: 5.80, 95% CI: 4.96–6.78, poor self-rated health; OR: 2.84, 95% CI: 2.38–3.38) than in those aged over 75 years (psychological distress; OR: 4.54, 95% CI: 3.96–5.19, poor self-rated health; OR: 2.05, 95% CI: 1.79–2.34). Type D personality is associated with adverse health status among Japanese elderly people in terms of mental and physical risk; therefore, further research into the implications of this personality type is warranted.

Home visits by commissioned welfare volunteers and psychological distress: A population-based study of 11,312 community-dwelling older people in Japan

Novel countermeasures to increase healthcare expenditures should be explored in rapidly aging societies, including Japan. Social support is a resource for the older people that effectively reduces psychological distress, with or without specialized health service provision. This cross‐sectional study was conducted to determine whether home visits by commissioned welfare volunteers (organizations of community residents assigned by national or local governments) are associated with a lower risk of psychological distress among the older people.

Social Capital and Suicidal Ideation in Community-Dwelling Older Residents: A Multilevel Analysis of 10,094 Subjects in Japan

OBJECTIVE Social capital, the collective resources of groups including perceptions of trust and reciprocity, is recognized as an important contributor to suicide. We examined the association of individual- and community-level social capital with suicidal ideation after adjusting for social support among older adults living in the community. METHODS In August 2010 we sent questionnaires to all residents aged 65 years and older living in 3 rural municipalities (N = 21,232) in Okayama Prefecture, Japan; 13,919 questionnaires were returned (response rate: 65.6%). The final analysis included 10,094 participants. The outcome variable was suicidal ideation. Exposure variables were individual-level mistrust and lack of reciprocity (level 1), and the aggregated responses of these variables from 35 communities in the municipalities (level 2). Covariates included age, sex, educational attainment, marital status, the number of cohabitants, years of residence, self-rated socioeconomic status, disability, social support, and psychological distress. Multilevel logistic regression analysis was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS After adjusting for social support and psychological distress, we found that mistrust and lack of reciprocity were only associated with suicidal ideation at the individual level. Stratified analysis showed that among subjects with psychological distress, mistrust was associated with suicidal ideation at individual (OR: 1.88; 95% CI: 1.42-2.51) and community levels (OR: 1.98; 95% CI: 1.02-3.81). CONCLUSIONS Our findings show that individual- and community-level social capital is a possible protective factor for suicidal ideation, particularly for people with psychological distress.

Can communication skills training improve empathy? A six-year longitudinal study of medical students in Japan

Abstract Background: Empathy is an important component of overall clinical competence; thus, enhancing empathy in medical education is essential for quality patient care. Aim: This longitudinal study was designed to address the following questions: 1. Can a targeted educational program in communication skills training enhance empathy in medical students? and 2. Can such a program have a sustained effect? Methods: Study participants included 116 students who entered Okayama University Medical School in 2011. Students participated in a communication skills training program aimed to enhance their empathy, and completed the Jefferson Scale of Empathy (JSE) five times: at the beginning of medical school, prior to participation in the program, immediately after the program, and in last years of medical school. A total of 69 students, representing 59% of the cohort, completed the JSE in all five test administrations. Results: Students’ total scores on the JSE and its two factors (Perspective Taking and Compassionate Care) increased significantly (p < 0.001) after participation in the communication skills training program. However, the program did not have a sustained effect. Conclusions: Targeted educational programs to enhance empathy in medical students can have a significant effect; however, additional reinforcements may be needed for a sustained effect.

Erratum to: Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community? (Soc Psychiatry Psychiatr Epidemiol, (2014), 49, (619-627), 10.1007/s00127-013-0752-5)

In the original publication of the article, the following errors have occurred. In Table 1, the labels ‘‘No’’ and ‘‘Yes’’ of the first six variables to assess social support (SS1 to SS6), and ‘‘Not living together’’ and ‘‘Living together’’ of the characteristic ‘‘Marital status’’ have been reversed inadvertently. In Table 2, the mean of ‘‘Social support (SS1-7)’’ among men should be 5.80 instead of 5.79. In the fourth line from the bottom on page 624, the sentence ‘‘Third, they numbered about 28,000’’ should read, ‘‘Third, they numbered about 23,000’’. Also, in the third line from the bottom of page 624, ‘‘This is more than 30 times’’ should read, ‘‘This is more than 20 times’’.