1 MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens Glasgow G12 8RZ, UK
2 Department of Urban Studies, University of Glasgow, UK
3 Department of Family Medicine, Karolinska Institutet, Sweden
Correspondence: Anne Ellaway, MRC Social & Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow G12 8RZ, UK. E-mail: Anne{at}msoc.mrc.gla.ac.uk
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Abstract |
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Methods A postal questionnaire was sent to a random sample of adults in the West of Scotland (sampling from the 1997 electoral roll, response rate was 50%, achieved sample 2838).
Results Having adjusted for socio-demographic variables, rating one's house/flat as worth less than others was associated with lower self-esteem (P < 0.001) and mastery (P < 0.001) and higher depression (P < 0.007) and anxiety (P < 0.012). Rating one's car as worth less than others was not significantly associated with these psychosocial variables.
Conclusions Our findings lend some support, but only in relation to the home, to the hypothesis that perceiving oneself to be worse off in relation to those around is related to poorer psychosocial health.
Accepted 12 March 2004
Recent debates on the determinants of health inequalities have included the idea that socio-economic differences affect health through perceptions of one's place in the social hierarchy.1 It has been argued that perceiving oneself to be inferior in relation to others around us is a psychosocial risk factor2 associated with ill health.3 Although there has been much discussion of the extent to which social comparisons and health outcomes might be related,47 there have not been many empirical studies of associations between social comparisons and health. One study in Sweden explored the relationship between relative deprivation and self-rated health and found that effects were less pronounced on women and those at the lower end of the income distribution.8 This study used the mean income of reference groups (formed by combining indicators of social class, age, and living region, resulting in 40 reference groups) and defined relative deprivation as having an income below 70% of the mean income in the reference group. The formation of the reference groups was not based on any known actual contact by individuals with others in their same hypothetical reference group. A study in the US found that a more restricted range and skew of the income distribution in a community was associated with greater individual happiness, although the magnitude of the social comparison effect was smaller than the main effect of income.9 Another study (based on data from Hungary and Poland) found that markers of higher status and higher standing in the social hierarchy (ownership of luxury household items) was associated with improved self-rated health after controlling for individual socio-demographic characteristics.10
Research in experimental settings has shown that downward social contrasts produce positive affect and upward social comparisons produce negative affect.11,12 Psychological costs may be incurred when a comparison other is clearly superior to the self and hence poses a threat to self-esteem; conversely, self-esteem may be enhanced when a comparison other is inferior to the self.13
There is growing recognition of the association that assets such as houses and cars can have with health, even after taking other well-known indicators of socioeconomic status into account.1418 Richard Wilkinson2 has noted Karl Marx's comment on the role of housing in social comparisons:
A house may be large or small; as long as the surrounding houses are equally small it satisfies all social demands for a dwelling. But if a palace arises beside the little house, the little house shrinks to a hovel ... [and] ... the dweller will feel more and more uncomfortable, dissatisfied and cramped within its four walls.19Cars are seen to confer status,20,21 and to display symbolic capital,22 and the psychosocial benefits associated with private transport have been shown to vary by socio-demographic characteristics such as gender.23
In this paper we examine whether social comparisons of the worth of two common assets (homes and cars) are related to four psychosocial health measures (anxiety, depression, self-esteem, and mastery). In particular, we wanted to know whether individual perceptions of the value of these assets as being lower in comparison to those in the vicinity were associated with disadvantageous psychosocial health.
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Methods |
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We included questions designed to elicit how people see themselves in relation to others around them. All respondents (both home owners and renters) were asked the following question: Compared with other houses or flats in your street is your home worth more, worth about the same or worth less? (99% of owner-occupiers and 97% of renters responded to this question). Respondents who reported access to a car were also asked: Compared with other cars/vans in your neighbourhood is your car/van worth more, worth about the same or worth less? We varied the geographical scale for these two questions as cars are mobile and social comparisons may be made whilst driving around the local area rather than simply in the street where one lives. We also asked respondents what type of car they had access to, and we subsequently grouped this into the categories: A/B Mini/Supermini, Lower medium, Upper medium, Executive/Luxury, using the 1998 Motor Vehicle Registration Information System Market Segments, obtained from the Society of Motor Manufacturers and Traders Ltd.
Psychosocial health measures included in the survey were the Hospital Anxiety and Depression Scale (HADS),27 self-esteem, measured by the Rosenberg 10-item scale,28 and mastery, using the 7-item Pearlin Mastery scale.29 Scores can range from 0 to 21 on anxiety and depression subscales of the HADS, 030 on the Rosenberg scale, and 021 on the Pearlin Mastery scale.
The Hospital Anxiety and Depression Scale (HADS) was originally developed for use in general hospital settings and was designed to assess inpatients' anxiety and depression according to two sub-scales. The instrument has been validated in other non-hospital settings and in a range of studies,3034 and was selected for use in our postal survey because of its brevity and capability of being self-administered. The scale has 14 items and includes statements such as: I still enjoy the things I used to, I get sudden feelings of panic, I can laugh and see the funny side of things. Respondents are asked to respond to each item in the scale (according to how they have been feeling in the last 7 days) by circling their choice of four answers: most of the time, a lot of the time, only occasionally and never. Responses were scored 03 so that higher scores always indicate higher anxiety and depression, and then summed (among our respondents the anxiety subscale score ranged from 0 to 21 with a mean of 7.1 [SD = 4.0]; depression subscale scores ranged from 0 to 20 with a mean of 4.8 [SD = 3.6]).
Self-esteem has been shown to be related to health outcomes.28,35,36 Rosenberg's self-esteem scale is of a unidimensional nature which, it has been suggested, strengthens its power37 and it has been found to have reliability coefficients (Cronbach's alphas) of 0.8635 and 0.91.38 The 10-item measure of self-esteem28 which we used measures feelings about self worth and includes items such as: I feel I am a person of worth, at least equal to others, I feel I do not have much to be proud of, all in all I'm inclined to think I'm a failure. The Pearlin Mastery scale has frequently been used in North American and European settings and has been shown to be related to health.35,39 The seven-item measure of mastery29 was used. This measures an individual's self-perceived capacity to control events, and includes items such as: there is really no way I can solve some of the problems I have, I often feel helpless in dealing with the problems of my life, I can do just about any thing I really set my mind to do. Respondents are asked to respond to each item in both scales by ticking whether they strongly agree, agree, disagree, or strongly disagree. Responses were scored 14 so that higher scores always indicate higher mastery or self-esteem, and then summed (among our respondents the mastery score ranged from 7 to 28 with a mean of 19.7 [SD = 3.4]; self-esteem scores ranged from 11 to 40 with a mean of 30.4 [SD = 5.2]).
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Results |
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The mean scores of the four psychosocial health measures (self-esteem, mastery, depression, and anxiety) by respondents' perception of the value of their home are shown in the first section of Table 2 (unadjusted and adjusted mean scores are shown in this Table).
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To examine whether the significant associations found between social comparisons of home and the four psychosocial health measures remained after controlling for respondents' socio-demographic characteristics, we carried out multivariate analysis (using General Linear modelling within SPSS version 9.0).
The mean scores of the four psychosocial health measures in relation to comparisons of home after adjustment for sociodemographic variables (sex, age, social class, employment status, housing tenure, and ACORN group) are shown in the second section of Table 2.
Self-esteem and mastery scores were linearly patterned (P < 0.001 for both self-esteem and mastery on trend test)those who reported that their home was worth more than others in the same street had the highest mean self-esteem and mastery scores and those who reported that their home was worth less had the lowest mean self-esteem and mastery scores. Respondents who thought their home was worth less than others around them had significantly higher HADS anxiety and depression mean scores than those who thought their home was worth about the same or worth more. Those who thought their home was worth more than others around them had slightly higher anxiety and depression mean scores compared with those who thought their home was worth about the same; however, this difference was not statistically significant.
Social comparisons of car
Among those with car access (n = 1325 cases with no missing values), 59.9% of all respondents perceived their car/van to be worth about the same as others in the neighbourhood, 12.3% perceived it to be worth more, and 27.8% worth less (Table 3). Those in younger age groups were significantly more likely than older respondents to report their car as being worth more than others in the neighbourhood. Marked differences were observed by car type in perceptions of one's car as being worth more, with a much higher proportion of respondents (28.3%) with expensive cars than respondents with cars at the bottom end of the market (7%) reporting this.
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Discussion |
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Our finding that perceiving one's car to be worth more rather than of similar value to others nearby was associated with slightly elevated levels of anxiety may be a reflection of the perceived vulnerability of one's car, and of the fact that most cars depreciate in value very quickly.
There are several caveats to our findings. Our data are cross-sectional and based on self-reports of psychosocial well-being and perceptions of relative values and it may be that respondents' perceptions are coloured by negative response set44 or that people with higher psychosocial resources rate their homes and cars more positively. However, given the slightly elevated anxiety and depression scores amongst those with the most positive view of the value of their homes and cars, this raises interesting questions about the direction of response sets. More research is required which is able to explore these issues using longitudinal data sets.
These results are from the West of Scotland and it may be that social comparisons are more important in other regions in the UK or in other parts of the world. For example, national identity in Scotland is the most important form of self-identity after parenthood,45 and the pursuit of a meritocratic society, as advanced by the Conservative and New Labour Governments, has less support in Scotland.46 In places where social comparisons are more important, there could be stronger associations with well-being given the context of a more class-conscious and/or meritocratic society. The study of psychosocial correlates of social comparisons therefore has to be sensitive to regional and national particularities.
In conclusion, our findings lend some support, but only in relation to the home, that perceiving oneself to be worse off in relation to others in one's street is associated with poorer psychosocial health.
KEY MESSAGES
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Acknowledgments |
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References |
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