1. Introduction
With the development of society, people have paid more and more attention to mental health. As a substantial body of evidence has documented, mental health is affected by factors such as the environment [
1], living habits [
2], medical resources [
3], and experience [
4]. It relies on economic development and community policies to improve mental health by increasing individual income and providing a better living environment, advocating healthy lifestyles, and promoting the rational flow of medical resources [
5,
6,
7,
8,
9]. However, even though the state and society promote mental health through a variety of ways, mental illness is still severe [
10]. As the China Mental Health Survey indicated, the number of Chinese people who suffer from depression reached 95 million by 2015 [
11]. Thus, it is necessary to expand research on the factors influencing mental health, with a focus on social capital [
12].
Originating from the field of sociology, social capital has been a great concern in public health since the 1990’s [
13]; however, there is still a lack of consensus on the definition of social capital [
14]. Social capital may be the resources mobilized by individuals or collectives to realize their interests [
15,
16]. Social capital can be also viewed as the features of family, peers, the community, school, and work [
17,
18,
19,
20]. According to the functional perspective, social capital is divided into outreach and cohesion [
21]. In addition, the standard content of social capital can be divided into cognitive social capital and structural social capital [
22,
23,
24]. Although there is no consensus on the concept and classification of social capital, there are common elements, such as formal and informal relationships, mutual assistance, trust, and social participation [
17,
25].
Although a lot of research has been carried out, the impact of social capital on mental health is a controversial topic. A meta-analysis showed a very small impact of social capital on mental health [
26]; some studies also support these findings [
22,
27]. However, there is also a lot of work indicating that social capital has a significant impact on mental health [
28,
29,
30]. Some of the literature has demonstrated the impact of social capital on the mental health of special groups, such as adolescents [
31,
32,
33], ethnic minorities [
34,
35], immigrants [
36,
37], the aged [
38,
39], and the diseased population [
14,
40]. In addition, as the research on the specific sub dimensions of social capital has documented, cognitive social capital, cohesive social capital, and community social capital have significant impacts on residents’ mental health [
21,
41,
42]. However, overall, most of the literature does not address the causal inference. Minority literature on the paths has indicated that social capital leads to health inequality through the social and economic inequality of individuals and families, health investment, and the interaction between individuals and their environment [
43,
44]. In addition, social capital may affect an individual’s mental health by influencing their attitude to life and habits [
24].
There are many studies accumulated so far on the impact of social capital on mental health, but most of them do not address causal inference. This study explores the causal inference on the impact of social capital on mental health in China. The remainder of this paper is structured as follows.
Section 2 contains the data, definitions, and a summary of the variables.
Section 3 outlines the empirical approach.
Section 4 presents the results of the two-stage least square (TSLS) regression, a robustness check, and a heterogeneity analysis.
Section 5 provides a discussion.
Section 6 concludes.
2. Data and Variables
The data used in this study come from the China Family Panel Studies (CFPS) conducted by the China Social Science Investigation Center at Peking University. CFPS is an ongoing longitudinal survey which started in 2010. The data are collected in interviews once every 2 years. The study is based on a permanent sample of 14,960 households and 42,590 individuals who entered information in the 2010 baseline survey. It conducts a detailed and comprehensive investigation of family income, social security participation, education, health, and individual characteristics, which makes these data suitable for the research and analysis presented here. Additionally, it has a large sample size, wide coverage, a reasonable questionnaire design, scientific survey methods, and timely data updates, effectively reflecting the development of our society.
In this study, we focused on the relationship between social capital and the mental health of adult individuals. We started with 32,669 respondents from the CFPS samples in 2018 and applied some sample restrictions. First, we deleted the respondents who were still in school at the time of the survey (4075). Secondly, in the CFPS, individuals over 17 years old are defined as adults, so we deleted samples aged 16 and under (189). Thirdly, samples with missing information for any item were also deleted (10,572). Fourthly, to obtain the instrumental variable, samples from districts with a small population size were excluded (767). After this data-screening process, we finally obtained 17066 valid samples.
The key variables are defined in the following subsections.
2.1. Mental Health
This study used the simplified Center for Epidemiological Studies—Depression (CES-D) scale to measure mental health, which has shown good reliability and validity in the previous literature [
45,
46,
47]. Respondents were asked about the frequency of the following behaviors or feelings in the past week: (1) “I didn’t feel depressed”, (2) “I found it easy to do anything”, (3) “I slept well”, (4) “I felt happy”, (5) “I didn’t feel lonely”, (6) “I live happily”, (7) “I didn’t feel sad”, (8) “I believe life can continue”. Each question is scored from 0 (5–7 days) to 3 (less than 1 day), and we added the scores to measure mental health. Thus, the variable of mental health ranged from 0 to 24, and the higher the value, the better the individual mental health.
2.2. Social Capital
This study measures individual social capital in terms of cognitive and structural social capital. Based on existing definitions and social capital questionnaires, we selected social help and social trust as the indicators of cognitive social capital. We measured social help by asking the question “Do you think most people are willing to help others?” [
14], and measured social trust by asking “Do you think most people are trustworthy?” [
48,
49]; both questions took 1 if the respondents thought so, and 0 otherwise. We selected social networks and social participation as the indicators of structural social capital. We measured social networks by the logarithm of gift expenditure, since, in Chinese culture, social communication is often accompanied by mutual gifting; thus, gifting expenditure can reflect the depth and breadth of individual social networks [
24,
50,
51]. We measured social participation by the question “How many memberships do you hold in the Communist Party of China, the Communist Youth League, the Trade Union, or the Workers’ Association?”, for which the responses ranged from 0 (none of them) to 4 (all of them) [
14]. The higher the value, the greater the degree of social participation.
2.3. Control Variables
Other factors, such as individual characteristics and behavior, were included. Individual characteristics included age, gender, education, income, urbanicity, marital status, medical expenditure, and job type. Individual behaviors included smoking, reading, alcoholism, taking a noon break, and exercising. In addition, family characteristics included fuel and water for cooking, per capita income, and size.
Table 1 presents the summary statistics for all those variables.
3. Empirical Approach
Following the previous literature, mental health is a continuous variable, so we used the following OLS model:
where
MHi is the mental health of individual
i,
(
j = 1,2,3,4) is social trust (
), social help (
), social participation (
), and gifting expenditure (
) of individual
i, respectively.
(
k = 1,2,...,17) is gender, age, marital status, education, job type, income, medical expenditure, noon break, smoking, alcoholism, reading, exercise, family size, family income, cooking fuel, and water of individual
i, respectively,
are the corresponding coefficients, and
is the error term.
In this model, in order to reduce the errors caused by endogeneity, we also consider the social and economic characteristics of individuals and families, including gender, age, education, income, medical expenditure, family size, family income, etc., because these variables have been addressed to have significant impacts on mental health in existing studies. In addition, some studies have also found a significant relationship between living behaviors and residents’ health, so we also take it as a part of the control variable.
For this model, there may be endogeneity, mainly arising from reverse causality. Social capital may affect mental health through individual feelings and available resources. On the other hand, individuals with higher mental health are likely to participate in social interactions and overestimate their social position, and thus obtain higher social capital [
52]. To solve this problem, we used an instrumental variable (IV) and two-stage least square (TSLS) regression. In particular, this study considered the average social capital level of the 223 districts as the instrumental variable. We would like to discuss the following assumptions for valid IVs [
53].
Exclusion Restriction Assumption: Individual mental health is not affected by the average level of social capital of the district once individual social capital is taken into account. On the one hand, the instrumental variables in this paper, i.e., the average level of social capital of a district, is different from the community social capital in the previous literature. The existing studies have addressed the association between community social capital and individual mental health, which may lead to the violation of exclusion restriction [
20,
54]. The previous literature mostly measures community social capital from community belongingness, infrastructure construction, participation, support, and community-based occupations, and analyzes its impact on residents’ mental health [
55,
56]; little literature addressed the significant impact of individual social capital at the cluster level on mental health. On the other hand, social capital measured at the cluster level has also been used as an instrumental variable in the existing literature; for example, the research on the impact of social capital on women empowerment [
57], and the impact of social security polices [
58], which also supports the validity of IV at the cluster lever. Moreover, since the number of IVs is equal to the number of endogenous variables, i.e., the model is exactly identical, the instrumental variables can be considered as exogenous from the perspective of statistical methods.
Relevance Assumption: The average social capital at the cluster level of a district has a strong correlation with individual social capital. This is fulfilled since the generation shows the direct relationship between individual social capital and the instrumental variables. In order to make the IV estimation more reliable, we carried out a weak instrumental variable test in the two-stage least square regression, and as the result shown in
Section 4.1, the assumption is fulfilled.
No Instrument–Outcome Confounder Assumption: There are no other confounding factors between the average level of individual social capital and mental health. As the previous literature addressed, personal and family characteristics have impacts on individual mental health, such as age, physical health, family population, income, etc. Some of these characteristics also have impacts on personal social capital, which may result in the violation. Those variables are observed, and we put them into the regression model to separate the confounding effects.
Monotonicity Assumption: There is no one who would have lower social capital if living in a district with high average social capital, but have higher social capital if living in a district with low average social capital. On the one hand, the average social capital level is generated based on individual social capital. Therefore, individuals living in a district with a higher/lower average social capital level have a greater probability of higher/lower individual social capital. On the other hand, a district with higher average social capital is more likely to have better cultural, economic, and social foundation conditions to promote the accumulation of individual social capital, and vice versa. Therefore, the IV fulfills the assumption.
We used the following TSLS model to carry out an analysis that included the endogenous variables for social capital [
59,
60]:
where
(l = 1,2,3,4) is the average level of social trust (
), social help (
), social participation (
), and gifting expenditure (
) of the district.
(
j = 1,2,3,4) and
(
k = 1,2,...,17) have the same meanings as in Equation (1). Equation (2) estimates the relationships among the instrumental variables, the control variables, and social capital. Equation (3) estimates the impacts of social capital and other variables on mental health, considering the instrumental variables to obtain more accurate results.
In order to check the robustness of the results that we obtained through the two-step least squares (2SLS) model, we carried out two robustness checks. Firstly, we added two new variables, i.e., faith and entertainment expenditure, which may have impacts on mental health, to the basic model to observe the change in the relationship between social capital and mental health. Second, we analyzed the sample that only included individuals in the labor market to check the robustness of the impact of social capital on mental health in the alternative sample.
In addition, in order to study the heterogeneity of the impact of social capital on mental health, we also carried out heterogeneity analysis. Specifically, we conducted subgroup regression based on urbanicity, gender, age, and geographical area, and carried out permutation tests for the coefficients between groups [
61].
5. Discussion
To our knowledge, this study has expanded the research on the impact of social capital on mental health in a large representative sample covering the whole of China, in particular the causal inference for the impact of social capital on mental health. Our results support the important impact of social capital on mental health, which will help to formulate social policies to promote residents’ mental health.
To solve the problem of endogeneity in the model, we established the average level of social capital of a district as the instrumental variable and applied the two-stage least squares (2SLS) method. We found that social capital significantly improved residents’ mental health. Specifically, cognitive social capital, measured as social trust and social help, had a significant positive impact on individuals’ mental health. However, the impact of structural social capital on mental health varied across different dimensions. Social networks, measured by gifting expenditure, had a significant impact on individuals’ mental health, but social participation had no significant impact. We checked that these results were robust by using additional variables and alternative samples. These findings have policy and intervention implications. Social capital can be used as one of the tools to improve residents’ mental health. Specifically, community health policies should pay more attention to improving cognitive social capital, and encourage residents to establish mutual aid organizations, such as women’s federations, elderly associations, volunteer associations, etc. In addition, it is necessary to enhance the interaction between community residents, families, residents and village (neighborhood) committee cadres, for example, family fellowship activities, and meetings between civil servants and residents, to improve residents’ sense of trust and mutual help. For structural social capital, community policies should be biased towards family cultural guidance and community infrastructure construction to encourage individuals to expand social networks reasonably.
Another main contribution of this study is that we found heterogeneity in the impact of social capital on individual mental health by urbanicity, gender, age, and geographic location, which indicates that different health promotion policies should be implemented for different groups. For almost all groups, mental health is significantly and positively affected by social capital, which indicates that social capital can be used as an effective tool to improve the mental health of different groups based on subdimensions of social capital and group characteristics.
In addition, we also found that gender, age, education, marital status, alcoholism, exercise, family size, family per capita income, and cooking fuel had significantly positive effects on individuals’ mental health, while medical expenditure, smoking, and reading had opposite significant impacts. These findings suggest that individual and family-based mental health promotion policies are still necessary. Mental health monitoring and guarantee policies for women, young people, unmarried people, people with a low education level, and people with physical limitations need to be strengthened. Meanwhile, through the promotion of culture and a community environment, policies can guide residents to form good living habits, gradually transferring the functions of mutual assistance and belonging from the family to the community.
There are some open problems following this study. First, following Arezzo et al. [
62], Fiorillo [
25], Phyllis [
57], Fang [
38], Sun and Lu [
14], and Kilian et al. [
30], we used cross-sectional data for causal inference. See, for example, Reichenheim et al. [
63], for the conditions for causal inference with cross-sectional data. Indeed, at least one theoretical analysis for causal inference with cross-sectional data is important in future research. Second, this research mainly studied the existence of the impact of social capital on mental health, and introducing intermediary variables and regulatory variables to analyze the paths will be an important direction in future research.