Social Support and Social Adjustment: Implications for Mental Health Professionals

The general importance of an individual's support network has been recognized in the field of community mental health; yet a more detailed understanding of how a client's available social ties may contribute to his or her adjustment is presently lacking. This study used network analysis to examine differences in the social networks of mental health clients to identify factors associated with positive social adjustment. Subjects were selected from three different types of mental health programs as well as from the general population of Marion County, Oregon. Results generally revealed that subjects from the community sample more often would look to immediate family members for support. Better functioning chronic clients emphasized professional contacts, whereas more poorly adjusted chronic clients would look to friends for support. The results have implications both for understanding the nature of the support available to a client and mobilizing the support resources of the existing network of relationships to aid adjustment to community living.     

Preferences for Smoking Cessation Support from Family and Friends Among Adults with Serious Mental Illness

Engaging natural supports may be a promising strategy to promote the use of evidence-based smoking cessation treatment for individuals with serious mental illness (SMI) who smoke. This qualitative study explored preferences for support for quitting from family and friends among individuals with SMI who participated in cessation treatment. Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. Open-ended questions asked during a social network interview explored participants’ preferences for more support for quitting smoking from family and friends. The qualitative data was coded and common themes were identified across the dataset. Three primary preferences emerged for smoking cessation support from family members and friends: 1) more practical support for quitting (e.g., financial help with purchasing cessation medications); 2) more emotional support for quitting (e.g., encouraging progress toward quitting); and 3) changing their own smoking behaviors in the presence of participants (e.g., don’t smoke around them or offer them cigarettes). Individuals with SMI who participated in smoking cessation treatment at community mental health centers indicated several ways that family members and friends could support their efforts to quit smoking. Understanding how people with SMI want support from family and friends to quit smoking will inform strategies to leverage these natural resources to promote the use of evidence-based smoking cessation treatment and support smoking abstinence for this population.     

Qualitative research in aphasia: A review of the literature

Background: Stroke and aphasia can negatively affect a person’s ability to maintain healthy social relationships, both within the family and also with friends and the wider network. To date, this has been explored predominantly through qualitative interviews and questionnaires. Blogs written by people with aphasia constitute a novel source of data, comprised of people’s own voices on issues that are of concern to them.

Aims: To explore the impact of stroke and aphasia on a person’s relationships with family, friends and the wider network through analysing blogs written by people with aphasia.

Methods &; Procedures: Blog search engines were used to identify blogs sustained by a sole author who had aphasia following a stroke, and which reflected on their social network. The data were analysed qualitatively using framework analysis.

Outcomes &; Results: The systematic search resulted in 10 relevant blogs. Participants were aged between 26 and 69 years old, lived in the community, were at least 1 year post stroke and included six women and four men. Aphasia was a consistent thread running through the blogs affecting conversations with all parts of a person’s network and impacting on participants’ sense of self. They found it more difficult to take part in family activities and described higher degrees of dependence and changed family dynamics. Contact with friends was reduced, partly due to communication and physical difficulties. While some participants became motivated to become members of groups post stroke, contact with the wider network sometimes diminished, in part because of loss of work and community activities. An additional factor impacting on social relationships was other people’s positive or negative reaction towards the person with aphasia. Finally, the blogs reflected on the importance of support they had received, both from close family and also from the wider community.

Conclusions: This study found that social relationships played a crucial role in people’s lives following a stroke and aphasia. Nonetheless, family relationships, friendships and social exchanges within the wider social network were all substantially affected. Exploring this area through online narratives offered a rich and highly authentic source of data. The findings suggest that clinicians should incorporate social approaches in rehabilitation and consider ways to foster the maintenance of social networks. The use of social media by people with aphasia should be further explored, both as a therapeutic outlet and also as a way for people with aphasia to feel connected to a wider community.     

Revealing a hidden problem. An evaluation of a community dementia case-finding program from the Indian 10/66 dementia research network

BACKGROUND: Dementia in India is largely a hidden problem with no community awareness and little help seeking from affected families, despite high levels of strain. Cases must therefore be identified before practical help can be offered. METHOD: After two and a half hours of formal training, local community health workers in rural Kerala were asked to identify possible cases of dementia from the community they served. Diagnoses were then verified by a senior local psychiatrist with clinical and research interests in old age psychiatry. RESULTS: The community health workers identified 51 out of 1979 over 60 year old residents (a prevalence of 2.6%) as suspected cases of dementia. Following the psychiatrist's assessment, 33 met DSM-IV criteria for dementia. The majority of confirmed cases were of the Alzheimer's Disease sub-type. Most "non-cases" were found to be suffering from other major psychiatric disorders, with substantial unmet need. The positive predictive value of the community health workers informal screening was 64.7%. CONCLUSIONS: This simple cost-effective case-finding method can be of practical use in the development of community based dementia care services in India and other developing countries with similar health care systems.     

Associations of a social network typology with physical and mental health risks among older adults in South Korea

Objectives: The objectives of this study were to (1) develop an empirical typology of social networks in older Koreans; and (2) examine its effect on physical and mental health.

Method: A sample of 6900 community-dwelling older adults in South Korea was drawn from the 2014 Korean National Elderly Survey. Latent profile analysis (LPA) was conducted to derive social network types using eight common social network characteristics (marital status, living arrangement, the number and frequency of contact with close family/relatives, the number and frequency of contact with close friends, frequency of participation in social activities, and frequency of having visitors at home). The identified typologies were then regressed on self-rated health and depressive symptoms to explore the health risks posed by the group membership.

Results: The LPA identified a model with five types of social network as being most optimal (BIC = 153,848.34, entropy = .90). The groups were named diverse/family (enriched networks with more engagement with family), diverse/friend (enriched networks with more engagement with friends), friend-focused (high engagement with friends), distant (structurally disengaged), and restricted (structurally engaged but disengaged in family/friends networks). A series of regression analyses showed that membership in the restricted type was associated with more health and mental health risks than all types of social networks except the distant type.

Conclusion: Findings demonstrate the importance of family and friends as a source of social network and call attention to not only structural but also non-structural aspects of social isolation. Findings and implications are discussed in cultural contexts.     

Caregiver burden and psychotic patients' perception of social support in a Nigerian setting

  Background: In Nigeria, there are no national social welfare and community rehabilitation programmes for the mentally ill. Families have to bear the major burden of care. The present study aimed to assess the severity of indices of burden among relatives of 75 schizophrenics and 20 major affective disorder cases, to identify the factors associated with burden, to assess the relationship between caregiver burden and patients' perception of social support, and to compare these with equivalent data for cancer patients' relatives. Method: Caregivers were assessed, using a burden questionnaire and Goldberg's General Health Questionnaire (GHQ-12). Patients were assessed for perception of social support from the extended family. Results: Clinical severity and burden indices were similar for the psychiatric illness groups. However, relatives of patients with psychotic symptoms, unco-operative behaviour, marital instability and unemployment had significantly higher GHQ scores; while patients from such families perceived a wider social support network. Financial burden was greater than effect on family routines. Disruption of family routines, GHQ scores and (inversely) size of family network patient expected support from, predicted global rating of burden. Although clinical severity and disruption of family routines for cancer patients were higher; relatives of psychiatric patients had higher GHQ scores, more family disharmony and greater social stigma. Conclusions: Disturbed behaviour is a greater determinant of severity of burden than psychiatric diagnosis; hence adequacy of treatment is a first step in reducing caregiver burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care. Research and policy should consider measures to strengthen extended family network ties in developing countries. Accepted: 13 November 2000     

Emotional support providers and psychological distress among Anglo- and Mexican Americans

Accumulating evidence from studies investigating the role naturally-occurring emotional support networks play in remediating psychological distress strongly suggests that such networks buffer personal distress and lessen the need for formal mental health care. Research findings also suggest that reliance on emotional support networks varies across ethnic groups. The present study compared emotional support network characteristics of Anglo-Americans to those of Mexican Americans, in addition to examining the relationship between the reliance on specific support providers and psychopathological symptoms for Anglo- and Mexican Americans. Randomly selected adult Anglo- and Mexican Americans (n=515) living in one of three suburban communities in Southern California provided responses to a standardized measure of psychological impairment and named those persons on whom they depended in time of personal problems. Both Anglo- and English speaking Mexican American (ES MA) respondents reported significantly larger networks and more cumulative contact and reciprocity with network members than did Spanish-speaking Mexican Americans (SS MA) respondents. Anglos and ES MAs named significantly more friends and neighbors as emotional support providers than did SS MAs. SS MAs. on the other hand, more often depended on extended kin and spouses than did the other two subgroups. Professional caregivers accounted for a very small proportion of responses across the subgroups. The number of friends and neighbors as support providers was significantly and positively correlated with problems of social relations in only the SS MA subgroup. Implications of results for community mental health direct and indirect service components are discussed.     

Clients' community and social contacts: results of a 5-year longitudinal study

Clients’ contacts with a range of community amenities and with their friends and relatives were examined to assess the impact of a new community-based service. Results over a 5-year period were compared for clients in different residential settings: supported ordinary housing, mental handicap hospital and private family homes. Findings indicated increased use of community amenities for those in supported housing and in their family homes. Little change was noted in clients’ contact with relatives, and the paucity of social contact with friends was highlighted. Use of community amenities in relation to the development of social networks is dicussed.     

Online support to facilitate the reintegration of students with brain injury: trials and errors

The reintegration of students after acquired/traumatic brain injury (ABI/TBI) continues to be fraught with difficulties. Presented are (1) case studies exploring the potential of online support for teachers of students with ABI after returning from a paediatric rehabilitation centre; (2) results of Internet-based courses about reintegrating students with ABI; (3) outcomes of videoconferencing-based and Internet email-based support; (4) development of an online support process that uses Questions and Answers as a quick and immediate resource for teachers. The authors recommend that a collaborative process be instituted, in order to generate a relatively small number of high quality online resources about re-integrating students into their school and community. A second recommendation focuses on the development of online support network which may be text or email based or which may use videoconferencing over the Internet. Such networks allow students with ABI to maintain contact with their family and friends in the home community and facilitate their reintegration. An Internet-based support structure also allows professionals to provide consultation, collaboration and continuing input.     

The relationship between social support networks and depression in the 2007 National Survey of Mental Health and Well-being

Purpose

Social isolation and low levels of social support are associated with depression. The purpose of the current study was to investigate the relationship between depression and social connectivity factors (frequency of contact and quality of social connections) in the 2007 Australian National Survey of Mental Health and Well-being.

Methods

A national survey of 8841 participants aged 16–85 years was conducted. Logistic regression was used to investigate the relationship between social connectivity factors and 12-month prevalence of Major Depressive Disorder in the whole sample, as well as across three age groups: younger adults (16–34 years), middle-aged adults (35–54 years), and older adults (55+ years). Respondents indicated how often they were in contact with family members and friends (frequency of contact), and how many family and friends they could rely on and confide in (quality of support), and were assessed for Major Depressive Disorder using the World Mental Health Composite International Diagnostics Interview.

Results

Overall, higher social connection quality was more closely and consistently associated with lower odds of the past year depression, relative to frequency of social interaction. The exception to this was for the older group in which fewer than a single friendship interaction each month was associated with a two-fold increased likelihood of the past year depression (OR 2.19, 95% CI 1.14–4.25). Friendship networks were important throughout life, although in middle adulthood, family support was also critically important—those who did not have any family support had more than a three-fold increased odds of the past year depression (OR 3.47, 95% CI 2.07–5.85).

Conclusions

High-quality social connection with friends and family members is associated with reduced likelihood of the past year depression. Intervention studies that target the quality of social support for depression, particularly support from friends, are warranted.

     

Dementia sufferers living at home

Based on a subsample of 61 cases of dementia in an intensive interview study conducted in Liverpool, this article looks at the availability of family care, the characteristics of carers, the problems they face and the service support they receive. The findings confirm those of earlier studies: only two-thirds of dementia sufferers living in the community have identifiable carers; the average age of carers was 65; dementia cases demonstrated a high level of dependency and need for supervision; and the level of input of domiciliary services was low. It was also found that a substantial proportion of sufferers live alone but most are not without supporters. GPs are identified as the key professionals who act as gatekeepers to other services. It is suggested that presently available services are inappropriate for some carers and that packages of care and support need to be flexible and better tailored to carers' needs.     

Mothers with learning difficulties and their support networks

Mothers with learning difficulties ^{1 1}The present authors use the term ‘learning difficulties' in deference to parents’ preferences, particularly those in the UK. Other terms in the literature include parents with intellectual disability, developmental disability and/or mental retardation.
are thought to be among the most socially isolated parents in the community. A great deal of attention has been directed to assessing their parenting abilities and teaching parenting skills, but less has been given to the support that mothers may (or may not) receive from family, friends and the service system. The present paper investigates mothers' views about the types of support which they receive and from whom they receive it. Data were derived from 70 mothers who participated in interviews using a support interview guide designed to accommodate the mothers' cognitive difficulties. The primary purpose of the interview was to explore the quantity and composition of the mothers' support networks, the frequency of contact and geographical proximity of support people, and the type of support provided. Key findings include: the central place that family members have in these mothers' lives; the importance of service providers as sources of information and advice; and the relative absence of friends and neighbours. Briefly, mothers living alone have service‐centred networks, mothers living with a partner have family‐centred networks with relatively dispersed family ties, and mothers living in a parent/parent‐figure household have local, family‐centred networks. The overall conclusion to be drawn from the present results is that these mothers do not live in a social vacuum, but many are socially isolated. The finding that so few mothers could identify supportive ties with friends and neighbours suggests that these mothers are isolated from their local communities and are potentially vulnerable if a breakdown occurs in the support provided by their families. The need for service providers to be more actively involved in linking mothers to their communities is discussed.     

Social networks of residents in supportive housing

One goal of supportive housing is to enlarge and improve the functioning of the social support networks of residents. The networks of a convenience sample of 42 residents were assessed using scales developed by Barrera. The size of the networks (11.5) was no larger than that reported for similar clients living in other types of community settings but the composition differed. Staff and co-residents appear to partially replace rather than add to family and friends. This is of concern because friends are uniquely important determinants of satisfaction. An association between perceived need for support and network size was also found. These findings suggest some positive influences but also raise questions about unintended negative consequences of living in artificially constructed social environments.When this project was undertaken, Dr. Goering, Janet Durbin, Bill Lancee and Taras Babiak were all members of the Social and Community Psychiatry Section, Clarke Institute. Robert Foster was Executive Director of Regeneration House, Inc., where Susan Boyles is Assistant Executive Director.     

Loneliness in Older Chilean People: Importance of Family Dysfunction and Depression

Loneliness is considered a public health problem that negatively affects wellbeing, especially in the older population. In Latin-American countries, most of the older population live with their family. Although this is thought to diminish feelings of loneliness, there is scarce data to support this. The objective of this study is to determine the prevalence of loneliness and evaluate its association with objective social networks, family functioning and perception of social support, in a sample of older people from Santiago, Chile. A survey was conducted of a representative sample of community older people (60–97 years) from Santiago, Chile, using the UCLA abbreviated scale of loneliness. Logistic regression was performed to test the variables related to the loneliness of older people. A total of 1,217 older people were interviewed. 88% were living with at least one person at home and 92% had living children. Using the UCLA abbreviated scale, 45% were found to perceive feelings of loneliness at least some of the time. Logistic regression showed significant association between loneliness and family dysfunction; depressive symptoms; living alone; not having a partner (widowed, separated or single); having little contact with relatives and friends; feeling a lack of social support; and sensation of poor self-efficacy. Loneliness is a prevalent public health problem in this older Latin-American community. Living accompanied does not protect against loneliness, particularly in vulnerable groups such as those with depression, or when there are family conflicts. The high prevalence of loneliness strongly conveys the need for public health policies to address loneliness in older people.     

Reciprocal relationship between social support and depressive symptoms among Chinese elderly

For many Hong Kong Chinese elderly, depression is a quite common occurrence. This study examines the reciprocal relationship between social support and depressive symptoms. The data came from a longitudinal study of a representative community sample of the elderly population in Hong Kong. Using multiple regression models, the authors found that elderly persons who reported depressive symptoms more frequently were likely to receive higher levels of social support from family members living with elders, but lower levels of social support from friends three years later, even after controlling for socio-demographic and physical health status variables. In addition, elderly people who received more social support from family members not living with elders reported fewer depressive symptoms three years later.     

Caregivers of relatives with dementia: Experiences encompassing social support and bereavement

In this study, 30 caregivers were interviewed less than 6 months after the death of a family member with dementia. The study describes the caregivers' experiences of bereavement and social support in two stages: during the caregiving period and following the death. Furthermore, a link between the two stages is described. In fact, a central dynamic in caregiver bereavement seems to be the support experienced, as well as the possibility of having continued support from family and/or friends. Caregivers who reported more positive appraisals during the caregiving period were likely to feel relieved after the death of a relative. They also tended to be more satisfied with their social support.     

Health care triads and dementia care: integrative framework and future directions

Physicians are usually the first contact in the health care system for persons with dementia and their family caregivers. This paper provides a synopsis of research findings and knowledge gaps regarding interactions among these participants in the health care triad--primary care physicians, family caregivers, and persons with dementia. Research traditions that inform knowledge about health care triads and dementia care include: older patient-physician relationships; the stress-coping social-support health model that dominates family caregiver research; the social learning-self-efficacy model; and literature on the quality of medical care. An integrative framework is presented to illustrate how the quality of interaction in dementia care encounters may be influenced by specific characteristics of members of the health care triad. Domains of dementia care interaction include symptom diagnosis, symptom management, medication management, support service linkage, and emotional support. The integrative framework also links the quality of interaction in these domains with health-related outcomes relevant to each of the health care triad members. Most empirical research in this area has found that family caregivers are dissatisfied with many aspects of physicians' dementia care, but measurement techniques vary widely and little is known about how the quality of physician care is associated with health-related outcomes. Physician surveys have shown that they are least certain about the quality of support service linkage advice they provide. Virtually no research has examined how the person with dementia experiences medical care encounters with physicians and their family members. Much remains to be learned about the longitudinal experience of each member of the health care triad, and how the quality of dementia care encounters changes over the course of the disease process. In this era of rapidly expanding educational and support service interventions for persons with dementia and their family caregivers, as well as computer-based information about dementia care, the influence of these external factors on health care triad interactions and outcomes also remains to be studied.     

Association between lifestyle activity and depressed mood among home-dwelling older people: a community-based study in Japan

In the community-based cross-sectional study, we investigated patterns of lifestyle activities among older people and examined the association between specific types of lifestyle activity and depressed mood status. The participants were 656 men and women aged 65 or older in 2004 who lived in a rural town in Japan, neither institutionalized nor hospitalized and who did not have symptoms of dementia. We found that less interaction with neighbors, society and friends was highly associated with depressed mood for men. Additionally, although they were physically active in gardening/farming, it did not necessarily mean that they were mentally healthy if they did not have close ties with friends, family and children/grandchildren. For women, it seemed important to engage in several types of activities relating to society, leisure and children/grandchildren to be in less depressed mood. Even if they were socially inactive, if they had frequent contact with family and children/grandchildren or going out for pleasure they were less likely to be depressed. Distinguishing gender differences in lifestyle activity patterns and the association of activities with depressed mood will help to guide the development of depression intervention programs.     

Understanding family, community, immigration, and acculturation issues in psychodynamic psychotherapy with Asian Americans

The authors discuss the importance of issues related to family, community, immigration, and acculturation in providing psychodynamic psychotherapy for Asian Americans. Despite differences between specific sub-ethnic groups of Asian Americans, many of these groups share an emphasis on group connectedness and family unity that can have important implications for individual development and can influence the course of psychotherapy with these patients. The authors first review the effects of immigration and dislocation (e.g., culture shock, mourning for the loss of family, friends, and familiar cultural environment) on Asian Americans, and then describe the types of changes and stresses the acculturation process can produce. These include guilt at leaving family behind in the country of origin and intergenerational conflict between parents and their more Westernized children, especially concerning social life, dating, and marriage. The authors then use Asian Indian family structure and community life to illustrate the types of effects family organization and roles and community context have on Asian American individuals. In the second half of the article, the authors discuss how these cultural factors can influence the process of psychotherapy and describe techniques that may improve the chances of successful therapy (e.g., being sensitive to patients' reluctance to discuss personal issues outside the family, being more willing to involve family members in the therapy process).     

强迫症患者与正常对照的家庭功能和社会支持的对照研究(英文)

背景在强迫症的发生与病情演变中家庭功能起着重要的作用,因而理解强迫症患者的家庭问题类型有助于制定针对性的家庭干预。目的比较强迫症患者及其同住的父母与正常对照及其同住父母的家庭功能和社会支持。方法在同济大学东方医院门诊的32例符合DSM-IV强迫症诊断标准的患者和其同住的父母中的一位以及通过附近居委会招募的31位社区对照者(年龄、受教育程度相匹配)及其同住的父母之一参加了本研究。所有受试者独立填写2个中文版自评量表,即用于评估家庭功能7个维度的McMaster家庭功能评定量表(Family Assessment Device,FAD)以及用于评估主观感受到的来自于家庭成员、朋友以及其他社会支持的领悟社会支持量表(Multidimensional Scale of Perceived Social Support,MSPSS)。结果根据原版量表划分正常与否的分界值,强迫症患者及其父母的FAD所有维度的得分均处于异常范围。除了FAD的情感卷入这一维度,强迫症患者及其父母报告的家庭功能和社会支持都分别低于社区对照及其父母报告的程度。患者与父母在问题解决、沟通和情感介入等3个FAD因子的得分一致性高于社区对照与父母的一致性(p均小于0.001),但行为控制的得分一致性低于对照(p=0.009)。除个别相关系数未达统计学意义外,所有研究对象的MSPSS的4个得分均与FAD的7个得分呈正相关。结论在中国,强迫症类似于其他精神障碍,也是一种广泛影响家庭功能的疾病。治疗强迫症时,需要整合基于家庭的心理社会干预(如家庭治疗)以及基于个体的生物学干预和心理干预。本研究结果发现所有研究对象主观感受到的社会支持与家庭功能密切相关,这凸显了在中国,家庭功能在个体的身份认同与社交网络中的中心地位作用。