Depression is a common mental disorder that is characterised by “sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration” [1]. According to the World Health Organisation (WHO) [2], depression is the third leading contributor to the global burden of disease and is anticipated to become the highest contributing factor by 2030. Nevertheless, for women, depression is already the leading cause of disease worldwide [2]. Significant gender differences have been found in many countries, with depression being about twice as common among women than among men [3, 4].
In low- and middle-income countries, among which most Eastern European countries are included, depression is also the leading cause of the global disease burden [2]. In their study of 23 countries, Van de Velde et al. [4] found that the prevalence of depression was highest in the Eastern and Central European countries. In Russia, however, relatively little is known about depression [5]. Nonetheless, some studies have shown that levels of depression are high in Russia [6], and especially among women [7]. For example, in a study in Novosibirsk in 1999–2000, depression was reported by 23 % of men and 44 % of women [8]. During the same years, in Arkhangelsk, depression, anxiety and/or sleeping disorders affected 33 % of men and 69 % of women [9]. Consequently, there is a significant gender difference in depression in Russia.
Depression has been related to a number of factors, such as alcohol consumption [10], economic situation [8] and social capital [11]. However, as recently stated by Levecque and Van Rossem: “Although depression is widespread, the complex mechanisms causing depression are still not clearly understood” ([12], p. 50). Among the causes of depression, social capital may be of particular importance [13]. The association between social capital and depression is often traced back to the work of Emile Durkheim, who found a link between social integration and suicide rates in different societies [14]. In the WHO report Promoting Mental Health, social capital is suggested as one of the factors that might promote better mental health [15]. Unfortunately, despite the potential importance of the social capital-mental health relationship, relatively few studies have been conducted on this topic in Eastern Europe [16]. Although there have been reports on the prevalence of depression in Russia, few studies have examined how this disorder affects each gender [5, 17]. Women have generally been overlooked in health studies in Russia, as men have suffered the heaviest burden of mortality [18]. The aim of this article therefore is to fill these research gaps by studying the association between different forms of social capital and self-rated depression in Moscow. Women and men will be analysed separately, with a special focus on women.
Social capital
Social capital is often described as a valuable resource accessed through social relations. Bourdieu defines it as “the actual or potential resources which are linked to possession of a durable network of more or less institutionalised relationships of mutual acquaintances and recognition – or in other words, to membership of a group” ([19], p. 248). Putnam writes that “the core idea of social capital is that social networks have a value” ([20], p. 18). Coleman also views social capital as a valuable resource, but acknowledges that “a given form of social capital that is valuable in facilitating certain actions may be useless or even harmful for others” ([21], p. 98). This argument supports the view that there can be a negative side to social capital [22].
Different forms of social capital
Although social capital has been defined in various ways, most definitions include two aspects: one structural and the other cognitive, i.e. the social relations themselves and their more qualitative aspects, such as trust and reciprocity. Structural social capital is often divided into informal and formal forms [21, 23]. The former comprises casual relations with family and friends, whereas the latter involves more rule-bound networks, such as voluntary associations. Among informal contacts, a further distinction can be made between relations within and outside of one’s family. Family is often viewed as the main form of social capital [24, 25], i.e. family-based social capital. Family has been defined as both immediate family and extended family (the latter e.g. relatives) [26]. As put by Astone et al.: “Family behaviours, including marriage and childrearing, remain the classic examples of investment in social capital” ([27], p. 18). More recent sociological research has also stressed the importance of family as social capital [28]. In contemporary society, however, social relations often extend beyond family. People have access to a variety of relationships: a few family relations and perhaps hundreds of peripheral ones [29].
Whereas Bourdieu and Coleman focused on strong familial ties, Putnam, especially in his early work, focused on the weaker, more formal ties outside the family that, for instance, can be accessed via voluntary associations [23]. Weak ties refer to relations among people who are distant from each other, such as acquaintances [30]. A more recent distinction is the one between bonding and bridging social capital [31]. Bonding relations are homogenous in terms of certain social characteristics, such as age or educational level, whereas bridging relations are heterogeneous and link people across different groups, such as intergenerational relations. Although these distinctions are related, they are not synonymous. Strong ties exist between people who are emotionally close, bonding ties between people who are similar. Weak ties unite emotionally distant people, whereas bridging ties connect people who are different from each other. For a more detailed discussion of the different forms of social capital, see Ferlander [32].
Social capital and mental health
There is consistent evidence linking social capital to physical health, but fewer studies have linked social capital with mental health [33]. Though they may not have used the term social capital, many earlier studies found a positive link between strong family ties and mental health [34, 35]. It has been shown, for example, that married individuals exhibit fewer depressive symptoms than non-married individuals [36]. Marriage generally has a positive effect on well-being through the exchange of emotional support and increased economic well-being [37]. More extended family, i.e. relatives, play an important role in terms of social support [38]. Marriage and other family relations are vital buffers against stress [39]. Strong and bonding relations, however, can also be a source of strain, leading to feelings of obligation and poor health [22, 40].
In a study in a low-income area of the US, Mitchell and LaGory found that bonding social capital increased mental distress, whereas bridging contacts decreased it [41]. The authors concluded that the obligations of bonding social capital might be a burden and a source of stress for people living in economically deprived areas. Similarly Caughy and colleagues [42] found that higher levels of social capital among parents were related to higher levels of depression among children in poor areas. In wealthy areas, however, higher parental social capital was associated with better mental health in children. Thus, the social capital-mental health link varies not only between different forms of social capital, but also between different groups. In relation to this, many scholars have stressed the importance of comparing different groups when studying the association between social capital and health [43]. Vyncke et al. ([44], p. 960), for instance, recently wrote that: “Future studies should seek to identify subgroups for whom social capital might be particularly influential, by transcending ‘simple’ dyads such as ‘men versus women’”.
Social capital, gender and mental health
Gender differences have received relatively little attention in social capital research [44]. It has been found, though, that women tend to be more family-oriented, often occupying the role of “kin-keeper” in the family [45]. Spending more time performing this role, women might socialise less outside the family, as shown by the observation that women belong to fewer voluntary associations than men [46]. However, women tend to bear the cost of creating social capital, while deriving fewer benefits from it than men [45]. Although generally ignoring gender issues in relation to social capital, Bourdieu argues that women enable men to accumulate social capital through social activities, such as the exchange of gifts and telephone calls [47]. A recent study in Russia gives an example of this by showing that women spend more time providing unpaid assistance than men, even though they face a greater risk of nonreciprocation [48].
It has also been claimed that women do not receive the same health benefits from their contacts as their male counterparts. A number of studies have found a positive link between social capital and self-rated health among men, but not among women [e.g. 49, 50]. Pertaining to depression, nevertheless, social relations seem to have a stronger effect on women [33, 51]. In their classic work, Brown and Harris found that women with a close confidant were less likely to become depressed during traumatic life events [52]. There is also some evidence that the effect of divorce in terms of depression is greater for women than for men [53]. Similar findings have also been reported for Eastern Europe, for instance in Ukraine where it was recently shown that divorce and widowhood are associated with female depression [54].
In contrast, social relations may also increase levels of mental illness among women with fewer economic resources. Kawachi and Berkman argue that differences in gender support may partly account for the higher prevalence of psychological distress among women compared to men, particularly if social relations involve strain associated with obligations to provide support for others [55]. In two different studies of mothers in low-income settings, social capital was associated with a higher risk of mental health problems [56, 57]. The authors hypothesised that participating in many social activities may have placed an additional burden on already overextended mothers. Similar effects have been found among mothers in Russia [58, 59].
Social capital in Russia
Russia is often described as being characterised by a weak civil society and low levels of institutional trust [60, 61]. As a large number of the social safety nets that were available in the Soviet period, such as childcare and maternity benefits, either weakened or disappeared after the collapse of communism [62, 63], many Russians, particularly women, have turned to their informal contacts for social and emotional support [64]. Family and friends are argued to be vital forms of social capital in Eastern Europe [65], and in Russia, it has been suggested that the “family may be the only island of stability in the boundless ocean of uncertainty” ([66], p. 367).
In most Russian families, the link between generations is strong. For instance, studies have shown that relations between daughters and mothers in Russia are very amicable [67]. Women’s family relations often involve exchanges of emotional support across generations, but they can also be fraught with hierarchical and internal power relations, particularly between women of different ages [58, 59]. This ambivalence towards intergenerational relations is also shown by Minnigaleeva and her colleagues, who found that the general view of the elderly outside one’s family in Russia is negative—they are often described as poor, passive and unable to adapt to modern life [68]. However, when people speak about the elderly within their family, the image is more positive, with the elderly being described as “active, kind, wise and caring” ([68], p. 64–65).
In Russia, family may be even more important for women than for men, as women tend to be more economically dependent than men [69]. Although the high levels of female employment present during the Soviet period have persisted, women’s position in the labour market has deteriorated as a result of gender discrimination [70]. For example, a recent national report showed that the ratio of female to male earnings was 65 % [71]. Single women are thus at risk of living in poverty [17]. Moreover, conservative attitudes suggesting that women should return to their ‘traditional’ role in the home have re-emerged [58]. Gender roles are highly traditional in Russia, with women undertaking most of the domestic and child-caring duties [63, 72]. In trying to balance home with work, the ‘double burden’ is heavy for many Russian women [17].
There has been a trend towards smaller families in Russia with decreasing rates of marriage and increasing divorce rates [59, 66]. Attitudes are also beginning to change in Russia, especially among the young and highly educated, who have more liberal attitudes towards gender roles [73]. It has also been argued that there has been an increase in detached relations, i.e. relations with low levels of emotional closeness, among Russian women [67]. Among divorced Muscovites, there is a high prevalence of loneliness, and more women than men report that they often feel lonely [74]. This might have negative health effects, as in a society with weak social safety nets, the most exposed groups are probably those without strong ties. Indeed, it has been hypothesised that social capital might be particularly strongly related to mental health in these types of societies [33]. The need for more studies on the social capital-depression link in low- and middle-income countries, such as Russia, has also recently been emphasised [13].