CHAPTER 6: DISCUSSION
6.2 SOCIAL CAPITAL AND MENTAL WELLBEING
6.2.1 Mental wellbeing
The respondents’ states of mental wellbeing and psychosocial distress were measured using three well validated and reliable instruments: the WHO-5 for mental wellbeing, the Kessler-6 for psychosocial distress, and for loneliness the 6-item de Jong Gierveld Loneliness scale. All three instruments showed good reliability in this residential setting and there was a medium-strength correlation with the WHO-5 and the Kessler-6 with consistent scoring across the two instruments.
Overall, the respondents reported high levels of wellness, with 74% - 82.7%
reporting a sense of wellbeing or a lack of psychosocial distress. Men showed higher levels of psychological distress than women (p=.014), perhaps because relocation to a residential facility has more severe financial, physical and instrumental implications for men than for women – worsened in the face of their higher levels of self-efficacy (Biddle, 2012), thus eroding men’s sense of independence and self-efficacy more drastically than women’s, and so leading to higher levels of psychological distress (Drageset et al., 2011). This is a possibility that merits further investigation.
Of particular interest was the finding that the generally high levels of subjective mental wellbeing reported by the respondents paradoxically went hand in hand with fairly high levels of reported loneliness: more than half of the respondents (54.7%) reported being emotionally lonely and just under half (48.0%) declared that they were socially lonely. The level of emotional loneliness in nine respondents was of an intense nature. The percentage of respondents with overall loneliness (72%) was higher than in other comparable studies, where the rates ranged from 25% - 54%
(Drageset et al., 2011; Golden et al., 2009).
In addition, no association was found between age, marital status (never married and widowed) and loneliness, and this too is not in accordance with other comparable studies (Drageset, 2004; Drageset et al., 2011; Golden et al., 2009).
Also of particular interest in this study was the significant association (p=.007) between emotional loneliness and being of Indian descent (persons of Indian descent accounted for 19.4% of the sample). While this is certainly an area that requires further investigation, it is worth floating a hypothesis to account for this exceptionally high level of emotional loneliness that can also be generically applied to other residents. Luanaigh and Lawlor (2008) state that the development of new contacts can act as a buffer against the feelings of loneliness that so often follow in the wake of an older person’s relocation to a residential facility; but their submission has to be appraised against the backdrop of the Canadian PRI’s emphasis (2005) on the significance of homogeneity in the formation of bonding capital. Now, in the residential facility where the enquiry was conducted, homogeneity could well have been equated with age, being without a partner, being English speaking and being
“white”. On that basis, persons of Indian descent could have encountered exclusion on the part of the dominant racial group in the residence, the “whites”. Alternatively the strong bonding capital in the light of South Africa’s historical context might have discouraged integration (PRI, 2005). Whether such exclusion would have been motivated more by racial factors or more by the Indian residents’ cultural dissimilarities from the majority remains undetermined - and should be enquired into.
The ABS (2004) has found cultural differences to be significant barriers to social
Australia, Biddle (2012) concluded that the highest level of subjective wellbeing is associated with diversity in a person’s social network; that is, the presence within it of some people from minority groups. And here it is worth noting that the ABS’s definition (2004) of acceptance of diversity includes the values of respect, understanding and appreciation. Further studies need to be run to establish whether diversity has been embraced in this facility in Durban. (Emotional loneliness is further discussed later in this chapter.)
Another concern, brought to light by the Kessler-6, was that five respondents were identified as having a recognized mental disorder. There has been some criticism of the use of the Kessler-6 in the South African context where it is claimed to show a moderate discriminatory bias against the Black population group (Andersen et al., 2011). Accordingly, Andersen and colleagues (2011) suggested that this tool is better suited to the Australian and Canadian studies where its reliability has not been questioned. However given that the demographic profile of the Durban residence differs little from those overseas, the Kessler-6 proved in the event to have high reliability (Cronbach α=.862).
It is recommended by the Psychiatric Research Unit in Hillerod, a WHO Collaborating Centre for Mental Health, that any WHO-5 item in the negative category suggests a need for further screening (http://www.cure4you.dk). Using this scoring, nearly half of the residents reported at least one negative item that may raise doubts about their mental wellbeing. Considering that most of the negative reporting was linked to respondents’ not always feeling active and vigorous, and considering further that these responses originated with the older old where the connection between ageing and physical deterioration is most marked (Bisschop et al., 2004), the high level of reporting becomes understandable. It should be noted that this finding of poor sense of mental wellbeing is slightly higher than that of the Jongenelis and colleagues’ (2011) study involving residents (333) from 14 nursing homes in the North West Netherlands (where 42.2% of the residents exhibited some form of depression), but is lower than other reports based on the Kessler-6 and the standard form of WHO-5 scoring. It is suggested nonetheless that more attention be
paid to exercise programmes for the residents of the Durban facility and that further studies monitor the link between their exercise levels and their mental wellbeing.
If one excludes from the data analysis residents’ complaints about low energy levels, the picture that emerges is a firmly positive one: overall mood scored well (84%), so did feeling cheerful and in good spirits (81.3%) and being interested in activities (74.7%). Significantly, there was a reported high sense of hope (88%); thus, despite the number of widows/widowers (45, 60%) in the sample, with the attendant possibility of grief overshadowing more optimistic feelings (Bergin & Waite, 2005), hope remained – and remained strong. These findings are significant for the building and preservation of the respondents’ social capital as hopefulness is a shield against psychological distress (Omer and Rosenbaum, 1997). And it may be that the high level of reported hopefulness, operating as a counterweight to loneliness, accounts for the paradox, noted above, of generally high levels of reported mental wellness going hand in hand with rather high levels of reported loneliness. Further, the high level of hopefulness may also account for the absence of a link between demographic association and a sense of general mental wellbeing; this is a finding that mirrors those of Jongenelis and colleagues (2004) save for their finding of a negative association between older old age and depression in 350 Nursing Home patients.