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.The authors, affiliated with the Oregon Mental Health Division, would like to acknowledge the help of the following people: Dr. Al Sheff, Clinical Director, Oregon State Hospital (OSH); Donna Clark, R. N., B. S. N., Nursing Day Supervisor, Oregon State Hospital; the ward staff at OSH: Ruth Shirley, Ph.D., R.N., Director of Marion County Community Mental Health Program; Luce LeFleur, M.P.S., Supervisor of Screening Crisis Marion County Community Mental Health Program; Dave Drummond, Ph.D., Clinical Supervisor Marion County Day Treatment Program; Corinne Nygaard, Program Secretary; Jess Armas, MSW, Director of the Community Counseling Center in Salem, Oregon, and his staff; and Barry Kast, MSW, Program Manager for Day Treatment, Benton County Mental Health, and his staff. Without their generous help, this study would not have been possible. Special thanks if given to Jeanne Robinson, our efficient and tireless interviewer.     

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.     

The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders

Summary It has been suggested that deficits or impairments in social functioning may explain the depleted support networks of the mentally ill. With this in mind, 145 long-term users of day care psychiatric facilities, 57% of whom had a life-time diagnosis of schizophrenia, were examined to determine whether deficits in social and survival skills explained deficits in their social networks. Compared with patients with acute depression, long-term patients had smaller social networks. There was a very small but statistically significant association between observer ratings of deficits in social functioning (daily social and living skills) and self-reported family social networks size. Behavioural problems were also associated with smaller family networks. Among the long-term patients, duration of service contact and type of disorder (affective vs nonaffective psychosis) were not related to network size. These preliminary findings are discussed.     

Social support as a predictor of response to group therapy for complicated grief

This study investigated the effect of perceived social support on the outcome of group therapy for patients who experienced complicated grief following a variety of death losses. One hundred and seven psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from three sources (family, friends, and a special person) prior to treatment onset. For patients in both forms of therapy, perceived social support from friends was directly associated with favorable treatment outcome. In contrast, perceived social support from family was inversely related to outcome for patients in both forms of therapy. Perceived social support from a special person was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but unrelated for those in supportive therapy. The results highlight the importance of assessing the level of support patients perceive from their social networks. The findings also suggest that the effect of perceived social support may also depend on the source of the support. Possible explanations and clinical implications of these findings are discussed.     

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.     

Troubles de santé mentale, recours aux soins et au soutien social chez une population vulnérable : l’exemple des centres maternels de Paris

Introduction

The negative effect of social deprivation and poverty on mental health has been the subject of numerous publications since the 1960s, with studies generally showing a higher prevalence of mental health disorders in homeless, unemployed or low income populations. Women in perinatal contexts are also at greater risk for psychopathology: the relative risk for being hospitalised is up to 60% higher in the perinatal period than during the two years preceding pregnancy. Access to social care and informal support is therefore particularly important for pregnant women in vulnerable social conditions. In France, socially excluded mothers access shelter and accommodation in maternal centres. Over the last few years, staff in these centers report what they perceive to be as an increase in the prevalence of mental health problems in the mothers using these services. The current study, CEMAT, set out to examine this question.

Methodology

Based on a participatory research method, a qualitative and epidemiological study was carried out in order to evaluate the reality and needs in terms of mental health care in this population, as well as to evaluate available care and support networks. The study took place in 2005. All stakeholder groups in six maternal centres agreed to participate in focus groups and, in addition, residents were invited to respond to epidemiological and qualitative questionnaires, including the Mini International Neuropsychiatric Interview (MINI 5.0.0) and its qualitative questions aimed at evaluating use of medical and social network resources. Overall, 95 women took part in this study, representing 61% of all residents. Subjects were young (64% under 26) and 57% had been living in their centre for over 12 months.

Results

A percentage of 68% (N = 65) of the participants were identified as having a mental health disorder, according to the MINI. Of these 65 women, 55 (85%) had consulted a physician (mainly general practitioners and gynecologists) during the preceding two months. Ninety seven per cent of women validating one or more MINI diagnoses had specifically looked for help for these disorders, 17% seeking only professional help (GP, psychiatrist, psychologist, social worker, expert in non conventional medicine or traditional care), 23%looking for an informal source of support (partner, family, friends) and 57% using both professional care and informal support. High rates of satisfaction (69% for professional services, 81% for informal support) showed the capacity of this population to request relevant social and medico-social support.

Discussion

Results tend to confirm the links between psychosocial vulnerability and mental health disorders. On the other hand, the women's ability to ask for and to access specific psychological care, whether it be from professionals or informally from friends and family is to be underlined. The high satisfaction rates tend to prove that, though psychologically vulnerable, this population has coping capacities that should be recognized and valorized. Options open to such structures do not necessarily involve the sole development of internal mental health resources, but need to acknowledge and strengthen existing support networks.     

Social networks and health of older people living in sheltered housing

Eighty-seven residents from three sheltered accommodation schemes for people over 60 years, were interviewed about: their physical and mental health, social networks, social support, decision to move in, and how they found living in sheltered housing. Twenty-four percent had a diagnosis of depression and 8% dementia, but few had ever seen a mental health professional. Over half (55%) had clinically significant levels of activity limitation and 37% had significant somatic symptoms. Despite provision of glasses or aids 31% could not see satisfactorily and 23% could not hear adequately. Locally integrated social networks were most common (41%). Residents with a private network (16%) were more likely than those with a locally integrated network to have significant activity limitation and to report often being lonely. There were no differences between network types in levels of depression or dementia. Poor health of a person or their spouse was the most commonly reported reason for moving to sheltered housing, followed by the possibly related reasons of problems with their old home no longer being suitable e.g. stairs, and because they wanted to have a warden or alarm system available should the need arise. Most residents were happy living in sheltered accommodation. Many made use of 'sheltered' features such as the common room, the communal laundry, the warden and the alarm. A minority of residents were lonely and a few were unhappy with sheltered accommodation.     

Social network size in adolescents at clinical high risk for psychosis

Aims

Adolescents and young adults at clinical high risk (CHR) for psychosis report few close friends. Social support has been linked to conversion to psychosis and psychosis relapse in CHR individuals. Expanding earlier research on loneliness and friendships at a single timepoint, this study described composition and changes in social network and its association with clinical and cognitive symptoms among CHR adolescents.

Methods

Ninety five individuals (46 CHR individuals, 49 healthy volunteers) completed baseline and 1-year follow-up Social Network Index (SNI) evaluations and clinical interviews. Analyses first examined SNI size and composition across 10 categories (e.g., family, close friends, coworkers, classmates) between groups. Then, the relationship between SNI size and baseline social symptoms (i.e., paranoia, social anhedonia, social anxiety, social cognition), social function, and changes in symptoms and social networks over 1-year were examined within the CHR group.

Results

CHR individuals showed smaller social networks overall, driven by fewer friendships and family relationships. Social cognition and social anxiety significantly related to SNI size at baseline, but social anhedonia and paranoia did not. SNI size related to social function, but with a modest effect size (r's = .45 and .56). Surprisingly, an increase in positive symptom severity related to an increase in familial but a decrease in coworker social network size.

Conclusions

The social support deficits in the CHR group were specific to relatives and friendships, with social anxiety and social cognition as implicated symptoms. Social relationships may serve as a promising early intervention target in individuals at CHR for psychosis.     

Dynamics and perceptions of social support and their impact on well-being: a qualitative study of adolescents in Northern Ghana

Although perceived social support has been studied in various contexts, there is still scant research on qualitative accounts of how perceptions of support for adolescents living in impoverished contexts are formed and relate to psychological well-being. We explored the dynamics and perceptions of social support among 18 purposefully selected school-going adolescents in the northern region of Ghana. Emerging thematic areas comprised: the dynamics of familial networks that included quality familial relationships; valued support from friends; and the negative aspects of various social relations. With family – and peer social relations perceived as beneficial for practical advice and – support, the mere existence of social ties was not the adolescents’ most important consideration for well-being. Instead, the quality of interactions across different social networks emerged as more instrumental for relational and overall well-being. Understanding the sources of problematic social interactions, such as the consideration of ‘face-saving’ when seeking instrumental support, could provide useful suggestions for interventions aimed at creating social environments that enhance positive mental health.     

Maternal social support patterns and child maltreatment: comparison of maltreating and nonmaltreating mothers

Compared to demographically matched mothers, maltreating mothers listed fewer friends in their social support networks, reported less contact with friends, and gave lower ratings of quality of support received from friends. Maternal depressive symptoms, quality of current relationships, and social support from friends were each independently associated with maltreatment status in logistic regression analysis. Implications for intervention and research are offered.     

A cognitive intervention to enhance institutionalized older adults' social support networks and decrease loneliness

Nearly all older adults experience social losses, which can disrupt their social support networks and impair their quality of life. Events such as retirement, an inability to drive, death of a spouse and/or close life-long friends, or moving to an elder care facility may negatively affect the quality of older adults' social support networks. Low levels of perceived social support are associated with increased depression, impaired immune functioning and reduced life expectancy. Moreover, social interactions can be cognitively stimulating and may help older adults preserve their cognitive abilities. In the present study, institutionalized older adults were exposed to either a cognitive enhancement programme designed to enhance social networks or a control group. Measures of perceived social support and loneliness were administered before and after a 3-month, group-based intervention. There was a significant interaction between group and time. Those who did not participate in the intervention experienced a decrease in perceived social support and an increase in perceived loneliness. Participants in the intervention group stayed the same on the above measures. Helping older adults increase or maintain the quality of their social networks may lead to enhanced cognitive functioning, decreased depression and improved quality of life. Recommendations to help assisted living facilities, nursing homes, retirement communities and senior centres develop social and cognitive interventions are provided.     

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.     

The effect of social networks and social support on common mental disorders following specific life events

Maulik PK, Eaton WW, Bradshaw CP. The effect of social networks and social support on common mental disorders following specific life events. Objective: This study examined the association between life events and common mental disorders while accounting for social networks and social supports. Method: Participants included 1920 adults in the Baltimore Epidemiologic Catchment Area Cohort who were interviewed in 1993–1996, of whom 1071 were re‐interviewed in 2004–2005. Generalized estimating equations were used to analyze the data. Results: Social support from friends, spouse or relatives was associated with significantly reduced odds of panic disorder and psychological distress, after experiencing specific life events. Social networks or social support had no significant stress‐buffering effect. Social networks and social support had almost no direct or buffering effect on major depressive disorder, and no effect on generalized anxiety disorder and alcohol abuse or dependence disorder. Conclusion: The significant association between social support and psychological distress, rather than diagnosable mental disorders, highlights the importance of social support, especially when the severity of a mental health related problem is low.     

Changes in social network diversity and perceived social support after psychiatric hospitalization: results from a longitudinal study

BACKGROUND: There is a large empirical basis for the importance of social networks and support for people with a mental illness. However, only a few studies have examined the predictors, changes and correlations of these constructs within a longitudinal framework. AIM: To analyze changes in social network diversity as measured by the number of social roles and perceived social support over the course of three years after a psychiatric hospitalization while controlling for sociodemographic and clinical variables. A further aim was to inquire whether some social roles are perceived as being more supportive than others. METHOD: Random coefficient models were applied to the data of a longitudinal study on the life circumstances of people with affective disorders or schizophrenia (N = 183). RESULTS: The majority of participants had relatives, friends and co-workers, while a markedly smaller proportion had a spouse/partner or children. Social network diversity increased during the time period observed while the perception of social support did not change. Being male, without a job (competitive or sheltered), or having a low income predicted less diverse networks. Partners and friends were perceived as most supportive. Persons without a close friendship perceived less overall support, but only at baseline (hospitalization), while persons with a job on the competitive labor market felt better supported. CONCLUSIONS: Social disintegration in the course of mental illness that is found in some studies has no equivalent in our study in what concerns network diversity and perceived support. According to our results, characteristics of vocational and economic integration are of much greater relevance, as they enhance or hinder access to social participation.     

The relationship between social networks and occupational and self-care functioning in people with psychosis

BACKGROUND: Relatively few studies have examined relationships between the social networks of people with psychotic disorder and other aspects of their functioning. The aim of this paper is to describe the social networks of people with psychosis and to investigate relationships between social networks and personal and occupational functioning, taking account of illness course. METHODS: A two-phase epidemiological survey of persons with psychosis was conducted in four predominantly urban areas of Australia. A census and screen for psychosis was followed by a semi-structured interview of a stratified random sample of participants to assess their functioning. Data relating to functioning and social networks from 908 individuals (most with a diagnosis of schizophrenia) were analysed using structural equation modelling (SEM). RESULTS: The majority of people with psychosis (67 %) had a network comprising of family and friends, 15 % were defined as having a family-dominated network, 11 % a friends-dominated network and 7 % of participants were defined as socially isolated (no family or friends). Participants who had friends and family in their network (12 %) or who had a family-dominated network (7 %) were more likely to be in full-time employment compared with those with a friends-dominated network (4 %) or those who were socially isolated (5 %). Dysfunction in self-care was more frequently reported among socially isolated people (50 %) and those with family-dominated networks (47 %) than among those with friends-dominated networks (35 %) and those who had friends and family in their social network (23 %). SEM revealed a strong association between social integration and functioning (r = 0.71), even after controlling for illness course. Social integration was defined as having contact with family and/or friends and functioning was defined as having employment and no difficulties in self-care. Male gender was associated with poorer self-care, and female gender was slightly, but significantly, associated with a greater likelihood of having friends. CONCLUSION: There is a strong relationship between social networks and functioning after taking account of course of illness. That is, the presence of family and friends is generally associated with better self-care and employment. Interventions that are targeted at improving social relationships are likely to have a positive impact on self-care and occupational functioning (and vice versa).     

The aging HIV/AIDS population: fragile social networks

Social support becomes an increasingly critical resource for people as they age. In New York City, 25% of all people living with HIV/AIDS are over age 50, and 64% are over age 40. This study sample (n=160) reflects current HIV/AIDS epidemiology, with 34% females and 89% people of color. This study provides a detailed profile of this growing, aging cohort and their social networks. Our study finds this growing group of aging adults is isolated from informal networks due to the stigma of HIV/AIDS and ageism. Typically, partners and family members are key sources of informal support, but only 1/3 of respondents had a partner and 71% lived alone. This group relies heavily on friends, many of whom are also HIV-positive. Participants were in primary care and many (86%) utilized Medicaid. The fragile networks of these older adults will be challenged by age-related comorbidities. Without traditional caregivers, these aging adults with HIV/AIDS will have an immense impact on healthcare delivery and community-based programs.     

Community integration of elderly mentally ill persons in psychiatric hospitals and two types of residences

OBJECTIVE: Deinstitutionalization policy in the Netherlands has given rise to two new living arrangements for elderly long-term psychiatric patients. Both involve accommodation in mainstream residential homes for elderly persons, either concentrated in a specialized care unit or dispersed throughout the facility. The authors studied the effectiveness of these two housing models for the community integration of such residents compared with accommodation in a psychiatric hospital. METHODS: Three subsamples were selected: 49 residents in six units of concentrated housing, 47 residents in 12 units of dispersed housing, and 78 patients in 24 psychiatric hospital units, for a total sample of 174 participants. These samples were compared in a quasi-experimental, posttest-only design that used four measures of community integration: amount of perceived influence over one's daily life, involvement in social activities, social network size, and frequency of visits received from members of the network. To adjust for differences in the populations, the hospital patients were matched to the residential home residents, and confounding factors were controlled for. RESULTS: Residential homes afforded more privacy, were closer to public services, and had a more diversified population than psychiatric hospitals. Participants in dispersed housing experienced more personal influence over their lives than did hospital patients. Concentrated-housing participants were less enterprising and had smaller social networks. The three groups did not differ in the frequency of visits received from network members. CONCLUSIONS: Community-integrated facilities do not necessarily imply community-integrated residents. Only dispersed-housing residences were an improvement over hospitals, and then solely in terms of residents' influence over their own daily lives. The advantage of the dispersed-housing model is that it resembles independent living while its institutional nature offers structure and protection.     

Hospitalization and the composition of mental patients' social networks

Social networks of 310 chronically mentally ill patients in Chicago-area State mental hospitals were examined to assess the relationship between the number of hospitalizations and network size and composition. As the number and length of admissions increases, although network size remains stable, there are fewer relatives and friends in the network. The networks of patients with frequent admissions are composed primarily of people met through the mental health system and those known for a short time. These differences are neither related to diagnosis nor to severity of mental illness. The results suggest that the process of hospitalization is related to patients' sources of social support. Implications for readmissions are discussed.     

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.     

Social networks, support, and psychosocial functioning among American Indian women in treatment

The relationship of social networks and social support to the psychosocial functioning (self-efficacy, self-esteem, anxiety, depression, and hostility) of 159 American Indian women undergoing residential substance abuse treatment at Native American Connections was assessed. Social support and active participation by clients' families during treatment were found to be significantly related to improved psychosocial functioning. No relationship was found between positive social networks and psychosocial improvement. Interventions for substance abuse should aim to include family and friends in clients' treatment.