Urban/Non-Urban Differences In Community
Participation, Sense of Community, and
Perceptions of the Environment among
Individuals with Psychiatric Disabilities
Greg Townley, PhD
Eugene Brusilovskiy, M.U.S.A
Mark S. Salzer, PhD
For more information about this study or our center, please go to
www.tucollaborative.org or send an email to eugeneby@temple.edu
Acknowledgment
The contents of this presentation were developed under a grant from the
National Institute on Disability, Independent Living and Rehabilitation
Research (NIDILRR; Grant # 90RT5021-02-00; Salzer, PI). However, the
contents do not necessarily represent the policy of the U.S. Department of
Health and Human Services, and endorsement by the Federal government
should not be assumed.
Background
There is a paucity of research on the impact of urbanicity on community living
and participation experiences of adults with psychiatric disabilities (PD).
 Community participation (CP) and civic engagement
 Levasseur et al. (2015) found that CP of older adults did not differ across in
metropolitan, urban and rural areas, but after controlling for potential
confounders some differences were found.




In more urban areas, higher CP was associated with greater proximity to neighborhood
resources, while in rural areas, participation was associated with more years at residence
CP may be more difficult for individuals with PD living in rural settings
due to transportation barriers, greater stigma, and fewer community
resources (McDonel et al., 1997).
Greiner et al. (2004) found civic engagement (i.e., being active in a
coalition or civic group) to be higher in rural areas compared to urban
areas
Background (Cont’d)
 Sense of community
• Rural and non-urban areas have traditionally been seen as offering higher levels of
•
social capital, expressed through greater sense of community and social
involvement (Hofferth & Iceland, 1998; Ziersch et al., 2009).
Lower population density encourages connections between residents. Isolation and
lower levels of public services in rural areas facilitate network cooperation,
exchange, and voluntary activity (Ziersch et al., 2009).
 Stigma
•
•
Older adults with untreated PD living in isolated rural counties had higher levels of
perceived and internalized stigma than those in urban areas (Stewart et al., 2015).
Cohesive social relations in rural settings can foster negative reactions to people
with mental health problems due to fears of anything “out of the ordinary” (Wainer
& Chesters, 2000)
Background (Cont’d)
 Perceptions of the built and social environment
•
•
Very limited research comparing aspects of the built environment between
urban and non-urban dwellers, particular among individuals with PD.
–
However, it is likely that individuals in urban settings will have more
positive perceptions of their physical environments compared to nonurban dwellers due to greater proximity to resources and enhanced
access/ walkability.
Individuals in non-urban settings typically report stronger perceptions of
safety and lower levels of crime compared to urban dwellers (Pain, 2000).
Defining Urbanicity
•
Here, we are utilizing two frequently used approaches to measure urbanicity:
– U.S. Bureau of the Census provides block group (BG) level population
density.
•
In this study, urban census BGs have population density of 1000
people/mile2 or more, and all surrounding BGs have a population
density of 500 people/mile2 or more
•
Otherwise, BGs are non-urban
– U.S. Department of Agriculture (USDA) uses Rural-Urban Continuum
Codes (RUCCs), ranging from 1 (most urban) to 9 (most rural). County
RUCCs are determined by population size and proximity to metropolitan
areas.
•
In this study, urban counties have RUCCs of 1 or 2
•
Non-urban counties have RUCCs of 3-9
Research Hypotheses
•
•
We examine the relationships between urbanicity and a variety of community
living and participation experiences.
Because some community living experiences, such as CP and perceptions of
the environment likely operate at an ecological level that is more proximal to
individuals’ residences, we use U.S. Census (block group level) definition of
urbanicity to test the following hypotheses:
–
H1: Individuals in urban settings will report higher rates of community
participation than individuals in non-urban settings
–
H2: Individuals in urban settings will report more positive perceptions of
the built environment than individuals in non-urban settings
–
H3: Individuals in urban settings will report lower perceptions of
neighborhood safety compared to individuals in non-urban settings
Research Hypotheses (Cont’d)
•
As some community living experiences, such as sense of community, civic
participation, and perceptions of stigma, likely operate at an ecological level
that is more distal to participants’ homes, we use the USDA (county level)
definition of urbanicity to test the following hypotheses:
–
H4: Individuals in urban settings will report higher rates of civic
engagement than individuals in non-urban settings
–
H5: Individuals in non-urban settings will report higher levels of sense of
community than individuals in urban settings
–
H6: Individuals in non-urban settings will report higher levels of
perceived mental health stigma than individuals in urban settings
Participants
•
Participants were 300 individuals with psychiatric disabilities receiving mental
health services at 21 mental health agencies throughout the US
–
Average age: 46 (SD = 11.23)
–
195 (65%) participants were white, while 105 (35%) were persons of color
–
179 (60%) participants identified as female
–
230 (77%) of participants reported a diagnosed mood disorder (e.g., major
depression and bipolar disorder)
–
128 (43%) of participants reported a diagnosed schizophrenia-spectrum
disorder
Measures
•
•
•
•
•
•
Community Participation: Modified, 22-item version of the Temple
University Community Participation (TUCP) scale (Salzer, Brusilovkiy, PrvuBettger, & Kottsieper, 2014).
Built Environment: 7-item version of the HES-Neighborhood Quality Scale
(Kloos & Shah, 2009).
Neighborhood Safety: 3-item version of the HES-Safety Scale (Kloos & Shah,
2009).
Civic Engagement: Sum total of participation in three civic activities:
donating money to charitable causes, voting, and protesting/ demonstrating.
Sense of Community: Modified, 12-item version of the Sense of Community
Index-2 (Chavis, Lee & Acosta, 2008).
Stigma: 12-item Devaluation and Discrimination Scale (Link et al., 1989).
Procedures
•
After providing informed consent, individuals completed a paid phone survey
including a series of questions about community participation, loneliness,
perceptions of their neighborhoods, mental health symptoms, stigma, sense of
community, and quality of life.
Levels of Urbanicity for Study Participants
Urban
Non-Urban
Census Definition
Our Study
USA†
71% (n=213)
80%
29% (n=87)
20%
USDA (RUCC) Definition
Our Study
USA ‡
69% (n=207)
76%
31% (n=93)
24%
Notes:
† http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/defined.html
‡ http://www.ers.usda.gov/data-products/rural-urban-continuum-codes/documentation.aspx
Participant Map
Research Hypotheses
•
•
We examine the relationships between urbanicity and a variety of community
living and participation experiences.
Because some community living experiences, such as CP and perceptions of
the environment likely operate at an ecological level that is more proximal to
individuals’ residences, we use U.S. Census (block group level) definition of
urbanicity to test the following hypotheses:
–
H1: Individuals in urban settings will report higher rates of community
participation than individuals in non-urban settings
–
H2: Individuals in urban settings will report more positive perceptions of
the built environment than individuals in non-urban settings
–
H3: Individuals in urban settings will report lower perceptions of
neighborhood safety compared to individuals in non-urban settings
Results: Hypotheses 1-3
• Block Group Level Definition of Urbanicity from the U.S. Census is used here.
Urban
Non-urban
(n = 213)
(n = 87)
Mean S.D. Mean S.D.
H1: Community Participation
TUCP- total # of participation days
TUCP- total #of participation areas
H2: Built Environment (Neighborhood
Quality)
H3: Social Environment
(Neighborhood Safety)
53.97 42.8 42.98 32.2
7.82 3.41 6.92 3.34
T-Test
t
2.57 < .05
2.07 < .05
3.55
0.74
3.36 0.68 2.09
3.29
0.93
3.51
0.8
P
Cohen’s
d
0.31
0.27
<.05
0.26
-1.98 <.05
0.25
Results: Hypotheses 4-6
 County Level (RUCC) Definition of Urbanicity from the USDA is used here.
H4: Civic Engagement
H5: Sense of Community
H6: Perceived Stigma
Urban
Non-urban
T-Test
(n = 213)
(n = 87)
Cohen’s d
Mean S.D. Mean S.D.
t
P
0.79 0.79 0.56 0.65 2.42 <.05
0.32
2.52 0.75 2.22 0.69 3.29 <.01
0.42
3.56 0.98 3.88 0.98 -2.56 <.05
0.33
Discussion
•
•
•
•
This study represents one of the first attempts to assess the impact of
urbanicity on important community inclusion experiences for adults with
psychiatric disabilities
We found that participants in urban settings reported higher levels of
community participation compared to individuals in non-urban settings.
–
This is in line with our expectations and is likely a result of individuals in
urban settings having greater access to stores, services, and other activity
locations; as well as greater access to resources such as transportation and
walkable roadways.
We also found that participants in urban settings reported more positive
perceptions of the built environment but lower perceptions of neighborhood
safety. This is consistent with our hypotheses as well as findings in the
literature.
As expected, civic engagement was higher among participants living in urban
counties, while perceptions of mental health stigma were stronger among
individuals in non-urban counties.
Discussion (Cont’d)
•
•
•
Contrary to our hypothesis and suggestions in the literature, we found that
individuals living in urban counties had higher rates of sense of community
than individuals in non-urban counties.
–
It is likely that sense of community and social capital operate differently
for individuals with psychiatric disabilities compared to members of the
general population due to factors such as increased isolation,
marginalization and societal stigma of mental illness.
Future studies should include more objective indicators of the environment,
including population demographics from the Census, neighborhood
walkability, access to transportation, and distance from participant residences
to various community resources.
Environmental influences on community living and participation experiences
of individuals with PD is an understudied area. This study illuminates
important differences between individuals residing in urban and non-urban
areas and informs targets for interventions aimed at increasing community
participation, sense of community, and aspects of the built and social
environment.
References
1. Chavis, D.M., Lee, K.S., & Acosta J.D. (2008). The Sense of Community (SCI) Revised: The Reliability
and Validity of the SCI-2. Paper presented at the 2nd International Community Psychology
Conference, Lisboa, Portugal.
2. Greiner, K. A., Li, C., Kawachi, I., Hunt, D. C., & Ahluwalia, J. S. (2004). The relationships of social
participation and community ratings to health and health behaviors in areas with high and low
population density. Social science & medicine, 59(11), 2303-2312.
3. Hofferth S.L. & Iceland J. (1998). Social Capital in Rural and Urban Communities. Rural Sociology,
63(4): 574-598.
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Housing and Adaptive Functioning for Persons with Serious Mental Illness. American Journal of
Community Psychology, 44(3-4): 316-326.
5. Levasseur M., Cohen, A.A., Dubois, M.F., Genereux M., Richard L., Therrien F.H., & Payette H.
(2015). Environmental Factors Associated with Social Participation of Older Adults Living in
Metropolitan, Urban and Rural Areas: The NuAge Study. American Journal of Public Health, 105(8):
1718-1725.
6. Link B.G. (1982). Mental Patient Status, Work, and Income: An Examination of the Effects of a
Psychiatric Label. American Sociological Review. 47:202–215.
References (Cont’d)
1. McDonel, E. C., Bond, G. R., Salyers, M., Fekete, D., Chen, A., McGrew, J. H., & Miller, L. (1997).
Implementing assertive community treatment programs in rural settings. Administration and Policy
in Mental Health and Mental Health Services Research, 25(2), 153-173.
2. Pain R. (2000). Place, Social Relations and the Fear of Crime: A Review. Progress in Human
Geography, 24(3): 365-387.
3. Salzer M.S., Brusilovskiy E., Kottsieper P., and Prvu-Bettger J. (2014). Measuring Community
Participation of Adults with Psychiatric Disabilities: Reliability of Two Modes of Data Collection.
Rehabilitation Psychology, 59(2): 211-219.
4. Stewart H., Jameson J.P., Curtin L. (2015). The Relationship between Stigma and Self-Reported
Willingness to Use Mental Health Services among Rural and Urban Older Adults. Psychological
Services, 12(2): 141-148.
5. Wainer J., & Chesters J. (2000). Rural Mental Health: Neither Romanticism nor Despair. Australian
Journal of Rural Health, 8(3): 141-7.
6. Ziersch A.M., Baum F., Gusti I., Darmawan N., Kavanagh A.M., & Bentley R.J. (2009). Social Captial
and Health in Rural and Urban Communities in South Australia. Australian and New Zealand
Journal of Publica Health, 33(1): 7-16.