Feeling connected again: interventions that increase social identification reduce depression symptoms in community and clinical settings

Relations between plasma oxytocin, depressive symptoms and coping strategies in response to a stressor: the impact of social support

BACKGROUND

Social support can serve as a protective factor against the negative impacts of stressors and may thereby promote well-being. As well, exogenous administration of oxytocin has been tied to diminished stress responses and might also enhance the effects of social support.

METHODS/RESULTS

In the current study, conducted among female undergraduate students (N = 67), higher depressive symptoms were related to lower endorsements of problem-focused coping in response to a psychosocial stressor comprising the Trier Social Stress test (TSST). However, the relation between depressive symptoms and problem-focused coping was absent among participants who had a close female friend present serving as social support prior to the stressor experience. Additionally, endogenous plasma oxytocin levels were related to certain coping strategies being favored (e.g., problem-solving, humor, cognitive distraction, self-blame and support seeking) in response to the psychosocial stressor. However, the strength of these relations varied as a function of whether individuals had social support present or not.

CONCLUSION

These findings confirm the positive impact of social support in attenuating the relation between depressive symptoms and specific coping methods. The results of this study are consistent with view that oxytocin levels are accompanied by particular stress responses, possibly through the promotion of coping methods endorsed.

Providing Undergraduate Nursing Students and the Community With an Opportunity to SMILE: Student Managed Initiatives in Lifestyle Education

BACKGROUND

The SMILE: Student Managed Initiative in Lifestyle Education program is an arts and health workshop that runs for 2 hours per day for 8 weeks. Health care students and community members are invited to participate. SMILE was developed to provide undergraduate nursing and health care students with an opportunity to practice and improve on their communication, group facilitation, and leadership skills. SMILE also provides community participants access to an arts and health education workshop.

METHOD

The SMILE project was evaluated using a qualitative approach to identify effects to student and community participant learning.

RESULTS

The SMILE evaluation highlighted a key theme: Helping to Learn, Learning to Help. Students identified SMILE as an opportunity to learn how to help and community members recognized and valued their role in helping students learn.

CONCLUSION

This article provides an overview of the SMILE program and report on the evaluation findings. [J Nurs Educ. 2017;56(5):309-313.].

Stigma-related stress, shame and avoidant coping reactions among members of the general population with elevated symptom levels

BACKGROUND

It is unclear whether mental illness stigma affects individuals with subthreshold syndromes outside clinical settings. We therefore investigated the role of different stigma variables, including stigma-related stress and shame reactions, for avoidant stigma coping among members of the general population with elevated symptom levels.

METHODS

Based on a representative population survey, general stress resilience, stigma variables, shame about having a mental illness as well as avoidant stigma coping (secrecy and social withdrawal) were assessed by self-report among 676 participants with elevated symptom levels. Stigma variables and resilience were examined as predictors of avoidant stigma coping in a path model.

RESULTS

Increased stigma stress was predicted by lower general stress resilience as well as by higher levels of perceived stigma, group identification and perceived legitimacy of discrimination. More shame was associated with higher perceived legitimacy. Lower resilience as well as more perceived stigma, group identification and perceived legitimacy predicted avoidant coping. Stigma stress partly mediated effects of resilience, perceived stigma and group identification on avoidant coping; shame partly mediated effects of perceived legitimacy on coping. Stigma stress and shame were also directly and positively related to avoidant stigma coping. Analyses were adjusted for symptoms, neuroticism and sociodemographic variables.

CONCLUSIONS

Stigma may affect a larger proportion of the population than previously thought because stigma variables predicted secrecy and withdrawal among members of the general population with elevated, but overall mild symptom levels. Avoidant stigma coping likely has harmful effects, potentially exacerbating pre-existing psychological distress and undermining social networks. This highlights the need to reduce public stigma as well as to support individuals with subthreshold syndromes in their coping with stigma stress and shame reactions.

Associations of participation in community assets with health-related quality of life and healthcare usage: a cross-sectional study of older people in the community

BACKGROUND

Community assets are promoted as a way to improve quality of life and reduce healthcare usage. However, the quantitative impact of participation in community assets on these outcomes is not known.

METHODS

We examined the association between participation in community assets and health-related quality of life (HRQoL) (EuroQol-5D-5L) and healthcare usage in 3686 individuals aged ≥65 years. We estimated the unadjusted differences in EuroQol-5D-5L scores and healthcare usage between participants and non-participants in community assets and then used multivariate regression to examine scores adjusted for sociodemographic and limiting long-term health conditions. We derived the net benefits of participation using a range of threshold values for a quality-adjusted life year (QALY).

RESULTS

50% of individuals reported participation in community assets. Their EuroQol-5D-5L scores were 0.094 (95% CI 0.077 to 0.111) points higher than non-participants. Controlling for sociodemographic characteristics reduced this differential to 0.081 (95% CI 0.064 to 0.098). Further controlling for limiting long-term conditions reduced this effect to 0.039 (95% CI 0.025 to 0.052). Once we adjusted for sociodemographic and limiting long-term conditions, the reductions in healthcare usage and costs associated with community asset participation were not statistically significant. Based on a threshold value of £20 000 per QALY, the net benefits of participation in community assets were £763 (95% CI £478 to £1048) per participant per year.

CONCLUSIONS

Participation in community assets is associated with substantially higher HRQoL but is not associated with lower healthcare costs. The social value of developing community assets is potentially substantial.

Loss of group memberships predicts depression in postpartum mothers

PURPOSE

The postpartum period presents the highest risk for women's mental health throughout the lifespan. We aimed to examine the Social Identity Model of Identity Change in this context. More specifically, we investigated changes in social identity during this life transition and their consequences for women's postpartum mental health.

METHODS

Women who had given birth within the last 12 months (N = 387) reported on measures of depression, social group memberships, and motherhood identification.

RESULTS

Analyses indicated that a decrease in group memberships after having a baby, controlling for group memberships prior to birth, was associated with an increase in depressive symptomology. However, maintaining pre-existing group memberships was predictive of better mental health. New group memberships were not associated with depressive symptomology. Identification as a mother was a strong positive predictor of mental health in the postpartum period.

CONCLUSIONS

The social identity model of identity change provides a useful framework for understanding postpartum depression. Interventions to prevent and treat postpartum depression might aim to support women in maintaining important social group networks throughout pregnancy and the postpartum period.

Like a bridge over troubled water? A longitudinal study of general social support, colleague support, and leader support as recovery factors after a traumatic event

Background: Whereas the association between social support and psychological distress has been well-established through both cross-sectional and longitudinal studies, less is known about whether social support influences rate of change in psychological distress over time. Nor is it clear whether social support predicts baseline psychological distress, or, more importantly, whether social support may contribute to more rapid recovery following trauma exposure. Objective: This study aimed to determine the extent to which social support contributed to the recovery process among individuals with psychological distress after being exposed to trauma. Methods: Prospective survey data from ministry employees were collected 10, 22, and 34 months after the 2011 Oslo bombing that targeted the governmental quarters. We explored recovery in a clinical subsample (N = 238) of individuals with elevated levels of psychological distress (defined as mean 10-item Hopkins symptom checklist score > 1.85) one year after the event. A linear latent growth curve of psychological distress with general social support from friends and family, colleague support, and leader support as predictors was examined. Results: High levels of general social support and leader support were independently associated with a more rapid decline in psychological distress over time. Conclusions: General social support, as well as support from a leader in one's working life, may facilitate recovery from psychological distress after exposure to a traumatic event. Enhancing social support from family and friends, as well as in work settings, may benefit those with psychological distress following a traumatic workplace event.

Stressful life transitions and wellbeing: A comparison of the stress buffering hypothesis and the social identity model of identity change

The relationship between stressful life transitions and wellbeing is well established, however, the protective role of social connectedness has received mixed support. We test two theoretical models, the Stress Buffering Hypothesis and the Social Identity Model of Identity Change, to determine which best explains the relationship between social connectedness, stress, and wellbeing. Study 1 (N=165) was an experiment in which participants considered the impact of moving cities versus receiving a serious health diagnosis. Study 2 (N=79) was a longitudinal study that examined the adjustment of international students to university over the course of their first semester. Both studies found limited evidence for the buffering role of social support as predicted by the Stress Buffering Hypothesis; instead people who experienced a loss of social identities as a result of a stressor had a subsequent decline in wellbeing, consistent with the Social Identity Model of Identity Change. We conclude that stressful life events are best conceptualised as identity transitions. Such events are more likely to be perceived as stressful and compromise wellbeing when they entail identity loss.

'Everyone here wants everyone else to get better': The role of social identity in eating disorder recovery

Retention of a positively valued illness identity contributes to poor outcomes for individuals with eating disorders (EDs). Consequently, dis-identification from the illness identity and the adoption of a recovery identity are vital for successful recovery. While social identity processes have been shown to influence ED maintenance, their role in recovery is rarely considered. This study explores how a sense of shared identity helps individuals with EDs manage their condition and promotes recovery. Transcripts from 18 online support sessions involving 75 participants were thematically analysed. Our findings suggest that the illness identity initially operates as a social identity that forms the basis for connections with similar others. For those wishing to recover, identity-based support is then perceived to be more effective than that found outside the group. Online interactions also facilitate construction of a new shared recovery identity which promotes a shift from the illness identity as a primary source of definition and endorses group norms of illness disclosure and treatment engagement. While in the clinical literature, ED identity is seen as problematic and interventions are targeted at challenging an individual's self-concept, we suggest that interventions could instead harness identity resources to support a transition to a recovery identity.

Flourishing after depression: Factors associated with achieving complete mental health among those with a history of depression

This study investigated factors associated with complete mental health among a nationally representative sample of Canadians with a history of depression by conducting secondary analysis of the 2012 Canadian Community Health Survey- Mental Health (n=20,955). Complete mental health was defined as 1) the absence of mental illness, substance abuse, or suicidal ideation in the past year; 2) happiness or life satisfaction almost every day/past month, and 3) social and psychological well-being. The prevalence of complete mental health among those with and without a history of depression was determined. In a sample of formerly depressed respondents (n=2528), a series of logistic regressions were completed controlling for demographics, socioeconomic status, health and lifetime mental health conditions, health behaviours, social support, adverse childhood experiences, and religiosity. Two in five individuals (39%) with a history of depression had achieved complete mental health in comparison to 78% of those without a history of depression. In comparison to the formally depressed adults who were not in complete mental health, those in complete mental health were more likely to be female, White, older, affluent, married, with a confidant, free of disabling pain, insomnia, and childhood adversities and without a history of substance abuse. They were also more likely to exercise regularly and use spirituality to cope.

A qualitative study exploring the effects of attending a community pain service choir on wellbeing in people who experience chronic pain

In line with growing evidence of the health benefits of singing, this study aimed to explore participants' perceptions of the impact of a service-user-led community pain choir on their psychological wellbeing, self-efficacy and relationships with their chronic pain. The choir has links to a multidisciplinary pain management service, which is informed by the ethos of solution-focused (SF) principles, specifically in identifying and drawing upon patients' resources. Seven choir members participated in semi-structured interviews, grounded in lines of enquiry commonly used in SF practice. Thematic analysis of the data uncovered seven themes: Physical Improvements, Emotional Impact, Personal Growth, Interpersonal Processes, Relationship with the 'Self', Living Well with Pain and Sharing the Music and Spreading the Word. Participants' narratives provided support for participation in the choir in enhancing positive affect, self-worth, interpersonal relationships and overall wellbeing. The choir enabled continued progress towards accomplishing key pain management programme aims: self-management, coping and living well with pain. Findings expanded upon existing evidence relating to singing and wellbeing by highlighting the choir's role in promoting resilience and acceptance of pain. Clinical implications are explored in relation to psychosocial dimensions of pain.

Somewhere I belong: Long-term increases in adolescents' resilience are predicted by perceived belonging to the in-group

This study sought to examine the role of belonging in the increases in resilience observed following an adventure education programme (AEP). First, we demonstrate that group belonging makes a significant contribution to the improvement in resilience participants' experienced over the course of the AEP. Second, we demonstrate that this increase in resilience is maintained 9 months following the AEP and that group belonging maintained a significant contribution when controlling for participants' initial resilience level and other psychosocial variables (i.e., centrality of identity and social support). Our findings accord well with recent research on the Social Cure or Social Identity Approach to Health and add to a growing body of work identifying the mechanisms underlying this phenomenon.

Is group singing special? Health, well-being and social bonds in community-based adult education classes

Evidence demonstrates that group singing improves health and well-being, but the precise mechanisms remain unknown. Given that cohesive social networks also positively influence health, we focus on the social aspects of singing, exploring whether improvements in health and well-being are mediated by stronger social bonds, both to the group as a whole (collective-bonding) and to individual classmates (relational-bonding). To do so, seven newly-formed community-based adult education classes (four singing, N=84, and three comparison classes studying creative writing or crafts, N=51) were followed over seven months. Self-report questionnaire data on mental and physical health, well-being, and social bonding were collected at Months 1, 3 and 7. We demonstrate that physical and mental health and satisfaction with life significantly improved over time in both conditions. Path analysis did not show any indirect effects via social bonding of Condition on health and well-being. However, higher collective-bonding at timepoint 3 significantly predicted increased flourishing, reduced anxiety and improved physical health independently of baseline levels. In contrast, relational-bonding showed no such effects, suggesting that it is feeling part of a group that particularly yields health and well-being benefits. Moreover, these results indicate that singing may not improve health and well-being more than other types of activities. Nonetheless, these findings encourage further work to refine our understanding of the social aspects of community-based adult education classes in promoting health, well-being and community cohesion.

The desire to belong: Social identification as a predictor of treatment outcome in social anxiety disorder

OBJECTIVE

Perception of personal identity cannot be separated from the perception of the social context and one's social identity. Full involvement in group psychotherapy may require not only the awareness of personal impairment, but also social identification. The aim of the current study was to examine the association between social identification and symptom improvement in group-based psychotherapy.

METHOD

169 participants received 12 sessions of group-based cognitive behavioral therapy for social anxiety disorder. Social identification, the extent to which a person identifies with those who suffer from the same psychological problem as themselves and/or with those lacking psychopathology (non-sufferers), and clinical outcome were assessed at baseline, mid-and posttreatment, and 1, 3, and 6-months follow-up.

RESULTS

At baseline, patients aspired for closeness with non-sufferers, and viewed themselves as distant from fellow sufferers and non-sufferers. After treatment, participants viewed not only themselves, but also other individuals with social anxiety, as closer to both non-sufferers and fellow sufferers. These ratings were related to clinical outcomes.

CONCLUSIONS

The increase in closeness to both sufferers and non-sufferers across treatment may reflect a movement towards a more tolerant, less dichotomous and rigid, separation of ill and healthy that occurs with successful social anxiety treatment.

Walking groups in socioeconomically deprived communities: A qualitative study using photo elicitation

Walking groups can benefit health but uptake is more likely amongst those who are socially well-situated and need them least. This study worked with a new walking group in a community in England with poor health and socio-economic indicators to understand non-participation and barriers to involvement. It used a qualitative approach. Participant generated photographs captured the physical and social environments in which they walked and these were used with semi-structured interviews to inductively explore walking group participation and the wider social context of walking. We found that prior to joining there were low expectations of any health benefit and walking groups were not viewed as ‘proper’ activity. The group format and social expectations presented a barrier to joining. Having joined participants described a developing awareness of the health benefits of walking. The shared sense of achieving health goals with others sustained the group rather than socialising, per se. We suggest that walking group participation is a complex social practice. Promoting walking groups as a social activity for this group of people may well have been counter-productive.

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Photo-elicited interviews explored physical and social environments for walking.

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Group walking was not viewed as effective exercise with health benefits.

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Group format and social expectations represented a barrier to these participants.

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The walking group was sustained by achievement of goals rather than sociability.

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Promoting walking groups as a social activity can be counter-productive.

Creating psychological connections between intervention recipients: development and focus group evaluation of a group singing session for people with aphasia

OBJECTIVES

The study sought to identify key design features that could be used to create a new framework for group-based health interventions. We designed and tested the first session of a group intervention for stroke survivors with aphasia which was aimed at nurturing new psychological connections between group members.

SETTING

The intervention session, a participant focus group and interviews with intervention facilitators were held in a local community music centre in the South West of England.

PARTICIPANTS

A convenience sample of 10 community-dwelling people with poststroke aphasia participated in the session. Severity of aphasia was not considered for inclusion.

INTERVENTION

Participants took part in a 90-min group singing session which involved singing songs from a specially prepared song book. Musical accompaniment was provided by the facilitators.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants and group facilitators reported their experiences of participating in the session, with a focus on activities within the session related to the intervention aims. Researcher observations of the session were also made.

RESULTS

Two themes emerged from the analysis, concerning experiences of the session ('developing a sense of group belonging') and perceptions of its design and delivery ('creating the conditions for engagement'). Participants described an emerging sense of shared social identity as a member of the intervention group and identified fixed (eg, group size, session breaks) and flexible (eg, facilitator responsiveness) features of the session which contributed to this emergence. Facilitator interviews and researcher observations corroborated and expanded participant reports.

CONCLUSIONS

Engagement with health intervention content may be enhanced in group settings when intervention participants begin to establish positive and meaningful psychological connections with other group members. Understanding and actively nurturing these connections should be a core feature of a general framework for the design and delivery of group interventions.

"Depression is who I am": Mental illness identity, stigma and wellbeing

BACKGROUND

Previous research has found that in the face of discrimination, people tend to identify more strongly with stigmatized groups. Social identification can, in turn, buffer wellbeing against the negative consequences of discrimination. However, this rejection identification model has never been tested in the context of mental illness identity.

METHODS

A survey was conducted with 250 people with diagnosed depression or current symptoms of at least moderate clinical severity.

RESULTS

Experiencing mental illness stigma was associated with poorer wellbeing. Furthermore, people who had experienced such stigma were more likely to identify as a depressed person. Social identification as depressed magnified, rather than buffered, the relationship between stigma and reduced wellbeing. This relationship was moderated by perceived social norms of the depressed group for engaging in depressive thoughts and behaviors.

CONCLUSIONS

These findings suggest that mental illness stigma is a double-edged sword: as well as the direct harms for wellbeing, by increasing identification with other mental illness sufferers, stigma might expose sufferers to harmful social influence processes.

Social Identities as Pathways into and out of Addiction

There exists a predominant identity loss and "redemption" narrative in the addiction literature describing how individuals move from a "substance user" identity to a "recovery" identity. However, other identity related pathways influencing onset, treatment seeking and recovery may exist, and the process through which social identities unrelated to substance use change over time is not well understood. This study was designed to provide a richer understanding of such social identities processes. Semi-structured interviews were conducted with 21 adults residing in a drug and alcohol therapeutic community (TC) and thematic analysis revealed two distinct identity-related pathways leading into and out of addiction. Some individuals experienced a loss of valued identities during addiction onset that were later renewed during recovery (consistent with the existing redemption narrative). However, a distinct identity gain pathway emerged for socially isolated individuals, who described the onset of their addiction in terms of a new valued social identity. Almost all participants described their TC experience in terms of belonging to a recovery community. Participants on the identity loss pathway aimed to renew their pre-addiction identities after treatment while those on the identity gain pathway aimed to build aspirational new identities involving study, work, or family roles. These findings help to explain how social factors are implicated in the course of addiction, and may act as either motivations for or barriers to recovery. The qualitative analysis yielded a testable model for future research in other samples and settings.

Religious Identity, Religious Participation, and Psychological Well-Being in Asian American Adolescents

Religiosity plays a prominent spiritual and social role in adolescents' lives. Yet, despite its developmental salience, few studies have examined normative changes in religiosity or the implications of these changes for psychological well-being. We explored longitudinal variation in and associations between religiosity, as defined by private regard, centrality, and participation in religious activities, and diverse indicators of well-being including self-esteem, depressive symptoms, positive and negative affect, and both the presence of and search for meaning in life. The participants were two cohorts of Asian American high school students (N = 180; 60 % female) followed for 4 years and living in the southeastern US. Using hierarchical linear modelling and controlling for gender and generational status, results revealed that religious identity (i.e., regard, centrality) did not normatively increase or decrease over time, but participation increased. Religious identity was significantly associated with higher self-esteem, greater positive affect, the presence of meaning in life, and reduced depressive symptoms (for females), and participation was positively associated with positive affect and the presence of meaning. Our results and discussion emphasize the utility of further examining how religion plays a role in health and well-being, particularly among immigrant youth.

The moderating role of an oxytocin receptor gene polymorphism in the relation between unsupportive social interactions and coping profiles: implications for depression

Oxytocin is a hormone that is thought to influence prosocial behaviors and may be important in modulating responses to both positive and negative social interactions. Indeed, a single nucleotide polymorphism, rs53576, of the oxytocin receptor gene (OXTR) has been associated with decreased trust, empathy, optimism, and social support seeking, which are important components of coping with stressors. In the current study, conducted among undergraduate students (N = 225), it was shown that parental and peer social support was related to fewer depressive symptoms through elevated problem-focused coping and lower emotion-focused coping, and these effects were independent of the OXTR polymorphism. Unsupportive social interactions from parents were associated with more severe depressive symptoms through the greater use of emotion-focused coping, and this relation was moderated by the OXTR genotype. Specifically, individuals who carried the polymorphism on one or both of their alleles demonstrated increased emotion-focused coping following unsupportive responses compared to those without the polymorphism. Likewise, lower problem-focused coping mediated the relation between parental and peer unsupportive responses to depressive symptoms, but this mediated relation was only evident among carriers of the polymorphism. These findings suggest that carrying this OXTR polymorphism might favor disadvantageous coping styles in the face of negative social interactions, which in turn are linked to poor mood. Regardless of genotype, parental, and peer social support are fundamental in determining stress-related coping and well-being.

Shared identity predicts enhanced health at a mass gathering

Identifying with a group can impact (positively) upon group members’ health. This can be explained (in part) through the social relations that a shared identity allows. We investigated the relationship between a shared identity and health in a longitudinal study of a month-long pilgrimage in north India. Questionnaire data ( N = 416) showed that self-reported health (measured before, during, and after the event) was better at the event than before, and although it reduced on returning home, it remained higher than before the event. This trajectory was predicted by data concerning pilgrims’ perceptions of a shared identity with other pilgrims at the event. We also found evidence that a shared identity amongst pilgrims had an indirect effect on changes in self-assessed health via the belief one had closer relations with one’s fellow pilgrims. We discuss the implications of these data for our understandings of the role of shared identity in social relations and health.

"The we's have it": evidence for the distinctive benefits of group engagement in enhancing cognitive health in aging

Aligned with research in the social capital and general health literature, a large body of evidence shows that older people who are more socially active have better cognitive integrity and are less vulnerable to cognitive decline. The present research addresses the question of whether the type of social engagement (group-based vs. individual) has differential effects on these cognitive health outcomes. Drawing on population data (N=3413) from three waves (i.e., Waves 3, 4 and 5) of the English Longitudinal Study of Ageing, we investigated the independent contribution of group and individual engagement in predicting cognitive functioning four years later. Hierarchical linear regression was used entering age, gender, socioeconomic status, ethnicity, and physical health as covariates. The final model, controlling for initial cognitive function and social engagement (both group and individual) showed that only group engagement made a significant, sustained, and unique contribution to subsequent cognitive function. Furthermore, the effects of group engagement were stronger with increasing age. These findings extend previous work on the social determinants of health by pinpointing the types of relationships that are particularly beneficial in protecting cognitive health. The fact that group engagement optimized health outcomes, and that this was especially the case with increasing age, has important implications for directing community resources to keep older adults mentally active and independent for longer.

Social Identity Reduces Depression by Fostering Positive Attributions

Social identities are generally associated with better health and in particular lower levels of depression. However, there has been limited investigation of why social identities protect against depression. The current research suggests that social identities reduce depression in part because they attenuate the depressive attribution style (internal, stable, and global; e.g., “I failed because I’m stupid”). These relationships are first investigated in a survey (Study 1, N = 139) and then followed up in an experiment that manipulates social identity salience (Study 2, N = 88). In both cases, people with stronger social identities were less likely to attribute negative events to internal, stable, or global causes and subsequently reported lower levels of depression. These studies thus indicate that social identities can protect and enhance mental health by facilitating positive interpretations of stress and failure. Implications for clinical theory and practice are discussed.

Leader Behavior as a Determinant of Health at Work: Specification and Evidence of Five Key Pathways

The extent to which leadership influences employee health and the processes that underlie its effects are not well understood at present. With the aim of filling this gap, we review four distinct forms of leader behavior (task-oriented, relationship-oriented, change-oriented, and passive/destructive) and clarify the different ways in which these can be expected to have a bearing on employee health. Next, we present a model that integrates and extends these insights. This model describes five pathways through which leader behavior can influence the health of organizational members and summarizes what we know about the most important determinants, processes (mediators) and moderators of these relationships. These involve leaders engaging in person-focused action, system- or team-focused action, action to moderate the impact of contextual factors, climate control and identity management, and modelling. Finally, we identify important gaps and opportunities in the literature that need to be addressed in future research. A key conclusion is that while much has been done to explore some key pathways between leadership and health, others remain underexplored. We also outline how future research might address these in the context of a more expansive theoretical, empirical and practical approach to this emerging field of research.