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Modeling the Importance of Within- and Between-County Effects in an Ecological Study of the Association Between Social Capital and Mental Distress


Map A depicts the spatial distribution of mental distress in contiguous US and Map B shows the spatial distribution of social capital. We use quintiles to present different levels of mental distress and social capital. Both maps indicate strong spatial clustering for these two variables. Specifically, in Map A, counties with high prevalence of mental distress cluster in the Southern states (such as Louisiana and Alabama), the central and southern Appalachia regions, and the Mississippi River Valley through Oklahoma. Indian Reservations are also found to have a high prevalence of mental distress. In Map B, counties with high levels of social capital cluster in the Great Plains (such as Iowa, South Dakota, and Nebraska) and the Midwest. By contrast, counties with low social capital are clustered in the South and the Mountain West (eg, Nevada and Utah). The opposite patterns in Maps A and B provide auxiliary evidence for the negative association between mental distress and social capital.

Spatial distribution of mental distress and social capital in the United States, County Health Rankings and Roadmaps, United States, 2018. Map A depicts county-level prevalence of mental distress, and Map B depicts the social capital index of counties.

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Page last reviewed: June 13, 2019