RESEARCH ARTICLE Community-Level Social Capital and Psychological Distress among the Elderly in Japan: A Population-Based Study

Despite accumulating evidence, previous studies have not clearly separated the contribu-tion of community-level social capital on mental health from that of individual-level social support. We examined the association between community-level social capital and psycho-logical distress in a sample of older Japanese individuals, taking into account the effects of individual-level social capital and social support. We collected data via a cross-sectional survey among all residents aged65 in three rural municipalities in Okayama Prefecture. We measured two components of social capital in the questionnaire: perceptions of trust and reciprocity in the community. Community-level social capital was obtained by aggregat-ing individual responses and calculating the proportion of subjects reporting mistrust and lack of reciprocity. Psychological distress was assessed by the Kessler Psychological Dis-tress scale. We calculated risk ratios (RRs) and 95 % confidence intervals (CIs) for psycho-logical distress using two-level Poisson regression models (9,761 individuals nested within 35 communities). The prevalence of psychological distress was 39.8%. Low community-level social capital was associated with psychological distress, even after controlling fo