Conceptual framework for social connectedness in mental disorders: Systematic review and narrative synthesis

Development and Preliminary Validation of the Divine Connectedness Scale in the USA

This research conceptualized and offered preliminary evidence on the psychometric properties of the 10-item Divine Connectedness Scale-a measure that assesses individuals' perceptions of feeling supported by (divine guidance) and working with (divine collaboration) God or a Supreme Being. Results of exploratory factor analysis and confirmatory factor analysis with 434 undergraduate students in the United States showed that scores from a single-factor model of divine connectedness were valid and reliable. Divine connectedness was positively associated with religiosity, forgiveness, and well-being variables. Divine connectedness showed incremental validity over demographic covariates, social desirability, and religiosity in predicting later meaning in life and flourishing.

Phubbing and its impact on the individual's psychological well-being

Increasingly, smartphones have become a part of people's everyday lives, and are now considered by many to be an indispensable social accessory. Since attachment to a smartphone could have negative psychological consequences, a burgeoning new area of research has emerged which examines the effects of smartphones on individuals' well-being. Hence, this study focuses on phubbing - one's engagement with the smartphone during a face-to-face conversation with another person or group of people - and its association with psychological well-being. For this investigation, a quantitative descriptive approach has been adopted involving a sample of 370 women and men from Spain between 25 and 60 years old. The survey was distributed during late 2019 and the first quarter of 2020. The Phubbing Behaviors Survey was conducted, comprising five dimensions (cultural, technological, social, communicational, and psychological), and a total of 33 items requiring responses on a 5-point Likert scale. This survey was used in conjunction with the General Health Questionnaire (GHQ-28), consisting of four categories (somatic symptoms, social dysfunction, anxiety and insomnia, and severe depression), and 7 items per category. The findings reveal a positive correlation between phubbing and severe depression and, young women under 25 years old show higher levels of somatic symptoms than men in the same age group. This study demonstrates the need to raise awareness via health education and to promote healthy use of the Internet to prevent psychological distress resulting from phubbing.

Social connectedness and supported self-management of early medication abortion in the UK: experiences from the COVID-19 pandemic and learning for the future

Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care.

Application of an egocentric social network approach to examine changes in social connections following treatment for anxiety and depression: A novel measurement tool for clinical trials research?

The epidemic of loneliness and social isolation has been recognized as a public health crisis warranting the same prioritization as other public health issues today, such as obesity, substance use disorders, and tobacco use. Social disconnection is particularly prevalent and disabling among individuals with anxiety and depression, yet it is inadequately evaluated and addressed in most clinical psychology treatment research. Studies generally employ global measures of perceived connectedness, loneliness, or relationship satisfaction, limiting understanding about elements of one's social network that may change with treatment. This study examined changes in the degree (number of people nominated) and quality of one's social network from pre-to post-treatment using an egocentric social network approach in 59 adults (mean age = 30.8 years, range = 18 to 54) with clinically elevated anxiety or depression who were randomized to a cognitive and behavioral positive valence treatment versus waitlist. Participants (egos) named people in their lives (alters) with whom they discussed important issues or spent free time. For each alter, participants rated how close they felt, how close they thought the alter felt to them, and how frequently they communicated. Linear regressions, which included treatment group as a predictor, revealed no group differences in changes in network degree, perceived alter feelings of closeness, or communication frequency, despite prior findings from this sample indicating larger increases in perceived global connectedness in the treatment group. Unexpectedly, the control group reported a greater increase in perceived closeness to alters. Post-hoc analyses revealed this was explained by the treatment group identifying more distal social ties (e.g., extended family, colleagues, roommates) as alters following treatment - an outcome positively associated with global improvements in connectedness. This proof-of-concept study suggests egocentric social network surveys may provide unique information on treatment-related changes in social functioning. Suggestions are provided for adaptations to facilitate application of social network surveys to mental health treatment research.

Understanding the Effect of External and Internal Assets on Hazardous/Harmful Drinking Among Chinese College Students: A Serial Mediation Model

Hazardous/harmful drinking among college students is increasingly becoming a global health concern. Previous studies have mostly paid more attention to the prevalence and risk factors of alcohol use disorder based on the public health approach, and less is understood about psychological mechanisms and protective factors of problem drinking behavior. Grounded in the framework of developmental assets, this study explored the predictive effect of external assets (i.e., social connectedness) and internal assets (i.e., self-concept clarity and drinking refusal self-efficacy) on hazardous/harmful drinking among Chinese college students. Participants were 598 college students with a mean age of 19.41 (SD = 1.21) years. The results of structural equation modeling showed that social connectedness negatively predicted college students' hazardous/harmful drinking. Moreover, our path analyses revealed a serial mediation among these variables: students with high social connectedness tended to report high self-concept clarity, which in turn increased drinking refusal self-efficacy, and consequently decreased the level of hazardous/harmful drinking. This study revealed the mechanisms underlying how external and internal assets predict risky drinking among college students. These findings made significant contributions to prevention and precision interventions for college-aged youth with drinking problems.

The impact of COVID-19 on young people's mental health, wellbeing and routine from a European perspective: A co-produced qualitative systematic review

BACKGROUND

The impact of the Covid-19 pandemic on young people's (YP) mental health has been mixed. Systematic reviews to date have focused predominantly on quantitative studies and lacked involvement from YP with lived experience of mental health difficulties. Therefore, our primary aim was to conduct a qualitative systematic review to examine the perceived impact of the Covid-19 pandemic on YP's (aged 10-24) mental health and wellbeing across Europe.

METHODS AND FINDINGS

We searched MEDLINE, PsycINFO, Embase, Web of Science, MEDRXIV, OSF preprints, Google, and voluntary sector websites for studies published from 1st January 2020 to 15th November 2022. European studies were included if they reported qualitative data that could be extracted on YP's (aged 10-24) own perspectives of their experiences of Covid-19 and related disruptions to their mental health and wellbeing. Screening, data extraction and appraisal was conducted independently in duplicate by researchers and YP with lived experience of mental health difficulties (co-researchers). Confidence was assessed using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) approach. We co-produced an adapted narrative thematic synthesis with co-researchers. This study is registered with PROSPERO, CRD42021251578. We found 82 publications and included 77 unique studies in our narrative synthesis. Most studies were from the UK (n = 50; 65%); and generated data during the first Covid-19 wave (March-May 2020; n = 33; 43%). Across the 79,491 participants, views, and experiences of YP minoritised by ethnicity and sexual orientation, and from marginalised or vulnerable YP were limited. Five synthesised themes were identified: negative impact of pandemic information and restrictions on wellbeing; education and learning on wellbeing; social connection to prevent loneliness and disconnection; emotional, lifestyle and behavioural changes; and mental health support. YP's mental health and wellbeing across Europe were reported to have fluctuated during the pandemic. Challenges were similar but coping strategies to manage the impact of these challenges on mental health varied across person, study, and country. Short-term impacts were related to the consequences of changing restrictions on social connection, day-to-day lifestyle, and education set-up. However, YP identified potential issues in these areas going forward, and therefore stressed the importance of ongoing long-term support in education, learning and mental health post-Covid-19.

CONCLUSIONS

Our findings map onto the complex picture seen from quantitative systematic reviews regarding the impact of Covid-19 on YP's mental health. The comparatively little qualitative data found in our review means there is an urgent need for more high-quality qualitative research outside of the UK and/or about the experiences of minoritised groups to ensure all voices are heard and everyone is getting the support they need following the pandemic. YP's voices need to be prioritised in decision-making processes on education, self-care strategies, and mental health and wellbeing, to drive impactful, meaningful policy changes in anticipation of a future systemic crisis.

Social Connectedness Between Family Caregivers and Older Adults Living in Long-Term Care Homes in the Context of COVID-19

The coronavirus disease (COVID-19) pandemic and resulting restrictions on physical access to long-term care homes culminated in health declines for older adults living there and their families. Knowledge gaps exist regarding maintaining social connectedness when physically separated. The study aimed to explore family members' perceptions of the impact that restrictions on physical access to long-term care homes had on the experience of social connectedness between family members and older adults living in long-term care. The method used was a qualitative description, using in-depth semi-structured interviews. Themes arising from inductive qualitative content analysis of 21 interviews with family members included: (a) lack of connection threatening mental, emotional health, and physical health; (b) navigating trust in the unknown; (c) feelings of stress and anxiety for family members; and (d) technology - an asset, but not for everyone. Study findings suggest more emphasis should be placed on supporting social connections between older adults and their families in the context of long-term care beyond COVID-19.

Social connectedness and the role of virtual reality: experiences and perceptions of people living with dementia and their caregivers

PURPOSE

People living with dementia are often at increased risk of becoming socially disconnected due to dementia-related challenges. In recent years, digital technology has been designed to help address the social health of people living with dementia and provide opportunities to promote or maintain their social connectedness. This paper presents the findings from phase two of a participatory action research project, which explored people living with dementia and their caregiver's experiences and perceptions of social connectedness and the potential role of Virtual Reality (VR) in promoting or maintaining same.

MATERIALS AND METHODS

People living with dementia (n = 8) and their informal caregivers (n = 8) participated in an individual, 1:1 online interview. Data analysis was guided by reflexive thematic analysis.

RESULTS

The findings presented four themes: social connectedness: lived experiences and insights, facilitating social connectedness, barriers to social connectedness and the potential of multi-user VR for social connectedness. People living with dementia experienced a range of personal, community and societal connectedness. Facilitators of social connectedness included supportive, non-judgemental, and reciprocal relationships, technology adoption, and personal and contextual facilitators. Dementia-related difficulties and periods of disruption or change were considered barriers to social connectedness. Multi-user VR was perceived as useful for promoting and maintaining social connectedness.

CONCLUSIONS

The perceived usefulness of multi-user VR for social connectedness indicates its potential for use with this population. Understanding the lived experiences, barriers, and facilitators of social connectedness will assist researchers and the human-computer interaction community to inform the design of future multi-user VR for social connectedness outcomes with people living with dementia and their caregivers.

Unravelling the link between physical activity and peer social connectedness in young people with intellectual disabilities: a systematic review of quantitative studies

BACKGROUND

There is limited understanding of the context surrounding physical activity (PA) of young people with intellectual disabilities (ID), which has an impact on the development of PA promotion programmes. Peer social connectedness seems to be a vital correlate to focus on, but has not been included in current studies examining the correlates and determinants of PA levels of young people with ID. This study aims to synthesise the evidence on (1) the social constructs researchers have used to conceptualise peer social connectedness in a PA context among young people with ID, (2) the measurement tools that have been used and (3) the relationship between PA and peer social connectedness in young people with ID.

METHODS

The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ovid MEDLINE, Ovid Embase, Web of Science, ERIC, CINAHL and PsycINFO were searched from 1 January 1996 up to, and including, July 2023 to identify English-language studies, which examined associations between PA and peer social connectedness in adolescents and young adults (13-24 years) with ID. Study quality was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields.

RESULTS

Thirteen studies met the inclusion criteria and were included in the review. Ten peer social connectedness constructs and 18 measurement instruments were identified. Studies were predominantly focused on Special Olympics participants and unified activity formats. Participation in PA can increase social connectedness, but there is a lack of studies examining whether PA can also be increased by focusing on peer social connectedness in young people with ID.

CONCLUSIONS

Results show that peer social connectedness is recognised as relevant to researchers developing and testing PA programmes for young people with ID.

Stigma and its impact on disclosure and mental health secrecy in young people with clinical depression symptoms: A qualitative analysis

BACKGROUND

Clinical depression ranks as a leading cause of disease and disability in young people worldwide, but it is widely stigmatized. The aim of this qualitative research was to gather young people's experiences of depression stigma and its impact on loneliness, social isolation, and mental health disclosure and secrecy. This novel information can then be used to guide psychosocial interventions for young people with depression.

METHODS

This qualitative study included N = 28 young people aged 18-25 years (Mage = 21.30). Participants were recruited from the community who had high symptoms of depression (assessed through a pre-screen using the Mood and Feelings Questionnaire (MFQ) with a benchmark score > 27) or had been recently diagnosed with depression by a medical professional. Semi-structured interviews were based on conceptual model drawings created by participants and analyzed using thematic analysis.

RESULTS

Four main themes emerged: 1) Depression secrecy: positive and negative aspects; 2) Depression disclosure: positive and negative aspects; 3) The solution is selective disclosure; and 4) Participants' recommendations do not align with personal preferences. In particular, the young people described non-disclosure as a way to be in control, but that secrecy prevented authentic engagement with others. Young people also described disclosure as eliciting more stigma but as necessary to gain help. Finally, the young people described struggling with knowing how much to disclose in relation to their mental health and with whom they could disclose.

CONCLUSIONS

This study provides new evidence of how young people with depression experience stigma and its effects on disclosure and mental health secrecy. Knowing how young people struggle with these issues can allow us to develop interventions to encourage them to come forward and discuss their mental health in order to receive appropriate support and treatment. We recommend young people be signposted and have access to mental health champions or nominated teachers in their schools or universities.

Health Provider Experiences in Supporting Social Connectedness Between Families and Older Adults Living in Long-Term Care Homes

Introduction

Many people, often older adults, living in long-term care homes (OA-LTCH) became socially isolated during the COVID-19 pandemic due to variable restrictions on in-person visits and challenges associated with using technology for social connectivity. Health providers were key to supporting these OA by providing additional care and facilitating their connections with family using technology such as smartphones and iPads. It is important to learn from these experiences to move forwards from the COVID-19 pandemic with evidence-informed strategies that will better position health providers to foster social engagement for OA-LTCH across a range of contextual situations.

Objective

This exploratory qualitative description study sought to explore health provider experiences in supporting social connectedness between family members and OA-LTCH within the COVID-19 context.

Methods

Qualitative, in-depth semistructured interviews were conducted with 11 health providers.

Results

Using inductive qualitative content analysis study findings were represented by the following themes: (a) changes in provider roles and responsibilities while challenging for health providers did not impact their commitment to supporting OA-LTCH social and emotional health, (b) a predominant focus on OA-LTCH physical well-being with resultant neglect for emotional well-being resulted in collective trauma, and (c) health providers faced multiple challenges in using technology to support social connectivity.

Conclusion

Study findings suggest the need for increased funding for LTC to support activities and initiatives that promote the well-being of health providers and OA living in LTC, the need to prioritize social well-being during outbreak contexts, and more formalized approaches to guide the appropriate use of technology within LTC.

Characterizing Social Connectedness and Associated Mental Health Symptoms among Sexual Minority Men Enrolled in a Substance Use Recovery Support Program

BACKGROUND

Sexual minority men (SMM; gay, bisexual, and other men who have sex with men) report higher rates of substance use compared to other populations. Social connectedness is a critical component for promoting and maintaining recovery from substance use disorders. However, the degree of social connectedness among SMM who report substance use is largely unknown.

OBJECTIVES

We examined substance use, social connectedness (past 30-d participation in formal recovery support, past 30-d interaction with supportive family/friends, relationship satisfaction, and types of support) and mental health among SMM at the time of their enrollment in a behavioral substance use program from September 2019 to October 2021.

RESULTS

Of the107 SMM, 80% of the sample reported past 30-d illicit substance use, with methamphetamine representing the most commonly reported drug used (53%). Participants used a variety of social connections for support, including self-help groups (44% voluntary; 5% religious-affiliated; 20% other) and family/friends (81%). Importantly, 15% reported they had no one to turn to when having trouble and 36% were either dissatisfied or very dissatisfied with their relationships. Participants who endorsed significant depressive (58%) and anxiety (70%) symptoms were more likely to endorse relationship dissatisfaction than participants who did not endorse symptoms (p < 0.01).

CONCLUSIONS

One-third of SMM enrolled in a substance use recovery program expressed relationship dissatisfaction, particularly those struggling with depression or anxiety. Future research and programming should examine ways of leveraging existing social connectedness or forging new social supports to enhance mental health and substance use recovery for SMM using substances.

A systematic review of how social connectedness influences associations between racism and discrimination on health outcomes

Racial discrimination is a well-known risk factor of racial disparities in health. Although progress has been made in identifying multiple levels through which racism and racial discrimination influences health, less is known about social factors that may buffer racism's associations with health. We conducted a systematic review of the literature with a specific focus on social connectedness, racism, and health, retrieving studies conducted in the United States and published between January 1, 2012, and July 30, 2022, in peer-reviewed journals. Of the 787 articles screened, 32 were selected for full-text synthesis. Most studies (72%) were at the individual level, cross-sectional, and among community/neighborhood, school, or university samples. Studies had good methodological rigor and low risk of bias. Measures of racism and racial discrimination varied. Discrimination scales included unfair treatment because of race, schedule of racist events, experiences of lifetime discrimination, and everyday discrimination. Measures of social connectedness (or disconnectedness) varied. Social-connectedness constructs included social isolation, loneliness, and social support. Mental health was the most frequently examined outcome (75%). Effect modification was used in 56% of studies and mediation in 34% of studies. In 81% of studies, at least 1 aspect of social connectedness significantly buffered or mediated the associations between racism and health. Negative health associations were often weaker among people with higher social connectedness. Social connectedness is an important buffering mechanism to mitigate the associations between racial discrimination and health. In future studies, harmonizing metrics of social connectedness and racial discrimination can strengthen causal claims to inform interventions.

Pilot randomized controlled trial of a brief strategy to prevent suicide after discharge from residential addiction treatment

INTRODUCTION

Veterans are at greater risk for suicide and veterans with substance use disorder (SUD) have an even greater risk. Little research has looked into brief interventions to prevent suicide in this population in residential substance use treatment programs.

METHOD

We conducted a pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients participating in the Residential Recovery Center (RRC) SUD 28-day program and deemed at risk for suicide. We measured changes in symptoms at 1-, 3-, and 6-months. We looked at social connectedness, suicidal ideation, hopelessness, thwarted belongingness, perceived burdensomeness, and treatment engagement.

RESULTS

The study enrolled twenty patients. One participant withdrew immediately after baseline. We found that adherence to VA BIC components was high, as 100 % of patients (N = 10) completed 70 % or more of the VA BIC visits. Furthermore, 80 % of intervention group patients (N = 8) completed all VA BIC components. During the six-month follow-up, suicidal ideation improved in patients assigned to VA BIC, while it worsened in the standard care arm. Similarly, patients assigned to VA BIC reported a reduction in perceived burdensomeness over the six-month follow-up period while it worsened in the standard care arm. Additionally, VA BIC may modestly improve treatment engagement in the first month postdischarge.

CONCLUSION

We were able to recruit and enroll patients from a residential SUD treatment program into a clinical trial of the VA BIC intervention. Our preliminary results suggest that VA BIC may be useful in reducing suicidal ideation and perceived burdensomeness in patients who are discharged from residential SUD treatment programs and increasing treatment engagement. Future trials of VA BIC should determine whether VA BIC can reduce the risk of suicide in patients who are discharged from residential SUD treatment programs.

Social connectedness and mental health before and during the COVID-19 pandemic in a community sample in Korea

This study compared social connectedness patterns and examined the relationships between objective or subjective social connectedness and mental health before and during the COVID-19 pandemic among community dwelling adults in South Korea. An identical online survey was administered at two time points, in 2019 prior to the onset and again in 2021. Objective (network diversity and network size) and subjective (thwarted belongingness and perceived burdensomeness) social connectedness were measured along with positive and negative indices of mental health (depression, suicidal behavior, happiness, and life satisfaction). The results indicated that among social connectedness indices perceived burdensomeness were significantly higher during the COVID-19 pandemic compared to the prior period, while network size was smaller. Subjective social connectedness was associated with all aspects of mental health consequences, either positive or negative. Among objective social connectedness, only network diversity was significantly associated with increased happiness and life satisfaction, and objective social connectedness was not associated with depression and suicidal behavior. These associations did not differ across the two time periods. The findings, both before and during the pandemic, indicated that network diversity is an important factor for positive indices of mental health and that efforts to increase subjective social connectedness are needed to decrease the risk of depression and suicidal behavior.

Online songwriting reduces loneliness and postnatal depression and enhances social connectedness in women with young babies: randomised controlled trial

OBJECTIVE

Loneliness is a public health challenge associated with postnatal depression (PND). This study developed and tested an online songwriting intervention, with the aim of reducing loneliness and symptoms of PND and enhancing social connectedness among women with young babies.

STUDY DESIGN

This was a two-armed non-blinded randomised controlled trial (RCT, ISRCTN17647261).

METHODS

Randomisation was conducted in Excel using a 1:1 allocation, with participants (N = 89) allocated to an online 6-week songwriting intervention (Songs from Home) or to waitlist control. Inclusion criteria were women aged ≥18 years, with a baby ≤9 months old, reporting loneliness (4+ on UCLA 3-Item Loneliness Scale) and symptoms of PND (10+ on Edinburgh Postnatal Depression Scale [EPDS]). Loneliness (UCLA-3) was measured at baseline, after each intervention session and at 4-week follow-up. The secondary measures of PND (EPDS) and social connectedness (Social Connectedness Revised 15-item Scale [SC-15]) were measured at baseline, postintervention and at 4-week follow-up (Week 10). Factorial mixed analyses of variance with planned custom contrasts were conducted for each outcome variable comparing the intervention and control groups over time and across baseline, Weeks 1-6 and the follow-up at Week 10 for each outcome variable.

RESULTS

Compared with waitlist control, the intervention group reported significantly lower scores postintervention and at follow-up for loneliness (P < 0.001, η2P = 0.098) and PND (P < 0.001, η2P = 0.174) and significantly higher scores at follow-up for social connectedness (P < 0.001, η2P = 0.173).

CONCLUSIONS

A 6-week online songwriting intervention for women with young babies can reduce loneliness and symptoms of PND and increase social connectedness.

'... You feel like the one that got left behind': a narrative inquiry into the friendships of people who have endured mental health difficulties

AIMS

To explore insights between friendship and mental health through a critical narrative inquiry. To conceptualise friendship and inform public health approaches to loneliness and mental health.

METHOD

Seventeen interviews were conducted with middle-age people who had experienced mental health difficulties. Stories were subjected to a narrative analysis and interrogated further using critical theory.

RESULTS

Compassion in friendship reduces alterity and loneliness, and results in mutual discovery of dignity in relation to distress and stage of life. This is not achievable in all friendship.

CONCLUSION

The temporary encounter of friendship can provide new bases for authentically relating. Through dignity and authenticity, friendship can contribute to mental health and reduce loneliness. Suggestions are made to inform public health approaches to friendship.

The Effects of COVID-19 Lockdown on Social Connectedness and Psychological Distress in U.S. Adults with Chronic Diseases

Lockdown measures enacted in 2020 to control the spread of COVID-19 led to increases in the prevalence of mental health problems. Due to their high-risk status, individuals with chronic diseases may be at increased risk and disproportionately adversely affected by the COVID-19 pandemic. The investigators examined associations between having a high-risk chronic condition, social connectedness, and general distress and COVID-19-specific distress among U.S. adults during the COVID-19 lockdown. Baseline measures of a longitudinal survey collected at the beginning of the pandemic (April to June 2020) were analyzed to identify factors associated with loss of social connectedness from pre- to post-lockdown. The associations between social connectedness and both general and COVID-19-specific psychological distress were adjusted for certain high-risk chronic illnesses and interaction effects. The sample available for analysis included 1354 subjects (262 high-risk chronic diseases and 1092 without chronic illness). Those reporting the loss of social connectedness were younger (median = 39 vs. 42) and more likely to be unemployed because of the pandemic (19.4% vs. 11.0%). Adjustment for interaction demonstrated a stronger negative association between social connectedness change and the psychosocial impact of COVID-19 for those with high-risk illness(es) (change in connectedness*chronic illness OR = 0.88, 95%CI: 0.79-0.98, p = 0.020). These findings inform our understanding of the distribution and intersection of responses to public health lockdown orders in the U.S. and build further evidence of the importance of social connectedness on psychological distress.

Social network typologies moderate the association of loneliness with depressive symptomatology in middle-aged and older adults

Background

Depression remains among the most prevalent mental disorders, and it severely affects daily functioning and quality of life. There has been extensive research reporting on the impact of social relationships on depression, but much of this research has only considered isolated aspects of relationships. This study derived social network types based on the multiple components of social relationships, and then investigated their effects on depressive symptoms.

Methods

Using samples of 620 adults (M_age = 53.52), Latent Profile Analysis (LPA) was conducted to uncover network types based on the structural (network size, contact frequency, marital status, and social engagement), functional (levels of support and conflict), and qualitative (satisfaction with relationships) aspects of social relationships. Multiple regressions were used to test if distinct network types directly impact on depressive symptoms and whether network types moderate the association of loneliness (perceived social isolation) with depressive symptoms.

Results

LPA identified four distinct network types (diverse, family-focused, friend-focused, and restricted) and there were significant differences in depressive symptoms among four network types. Analysis using the BCH method showed that individuals in the restricted network type had the highest depressive symptoms, followed in order by individuals in the friend-focused, family-focused, and diverse network types. Regression results further indicated that an individual's network network type membership was significantly associated with depressive symptoms, and being in the diverse and family-focused network types alleviated the negative effect of loneliness on depressive symptoms.

Conclusion

The results suggest that both quantitative and qualitative aspects of social relationships are important in buffering against the adverse effect of loneliness on depressive symptoms. These findings underscore the utility of taking a multi-dimensional approach to uncover heterogeneity in the social networks of adults and their implications on depression.

A psychosocial pathway to paranoia: The interplay between social connectedness and self-esteem

The quantity and quality of social contacts have been related to self-esteem, and both social relationships and self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizotypy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness to perceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings underscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional outcomes of psychosis.

Stress and Depression in Ohio Social Workers during the COVID-19 Pandemic: The Buffering Role of Social Connectedness

Although social workers have an elevated risk of infection with COVID-19, no previous studies have investigated the virus's impact on practitioners. Using survey data (N = 441), this study identified associations between stress, depression, and COVID-related factors and explored the role of social connectedness as a moderator for mental health among Ohio social workers. The results of the study showed that among social workers with a positive COVID-19 diagnosis, 70 percent experienced moderate/high levels of stress, and 37 percent met the criteria for clinical depressive symptoms. Results from the multiple regression analyses showed that perceived stress was positively associated with a positive COVID-19 diagnosis for social workers, and depression was positively associated with working with a client with a positive COVID-19 diagnosis. An interaction effect was also identified between social connectedness and social workers' mental health. These findings suggest that the provision of individual or organizational interventions that emphasize social connectedness can help to protect social workers' mental health.

Social Connectedness, Physical Distancing, and Anxiety in Complying with Shelter-In-Place Orders and Advisories during the Once-In-A-Century COVID-19 Pandemic in the US: A Study of Social Media and Internet Users

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was first identified in Wuhan, China, in December 2019. As of 20 October 2020, the virus had infected 8,202,552 people, with 220,061 deaths in US, and in countries around the world, over 38 million people have become infected and over one million have died. The virus usually spreads via respiratory droplets from an infected person. At the time of compiling this paper, while countries around the world are still striving to find a "pharmaceutical intervention (PI)", including treatments and vaccines, they are left with only "non-pharmaceutical interventions (NPIs)", such as physical distancing, wearing masks, and maintaining personal hygiene. In the US, all 50 states, the District of Columbia, and five US territories issued mandatory stay-at-home orders between March 1 and 31 May 2020 to lower the risk of virus transmission. This study empirically examined how social connectedness and anxiety interact with shelter-in-place compliance and advisories during the pandemic. The study collected information from 494 adults using an online survey during April and July 2020.

Using Veterans Socials to Build a Community: Feasibility of the VOICES Intervention

Increasing social connection and access to care has been found to decrease the rate of suicide in U.S. veterans. The Veteran Outreach Into the Community to Expand Social Support (VOICES) is an intervention developed by Department Veteran Affairs (VA) staff to improve social connection and provide information about services by implementing community-based Veterans Socials. Seventy veterans at eight locations completed an anonymous cross-sectional survey. This evaluation examined three domains, acceptability (i.e., perceived value), demand (i.e., estimated or actual use), and expansion (i.e., sustainability and increase of Veterans Socials across time and locations). Findings indicated considerable levels of acceptability, demand for, and expansion of this intervention. Additionally, data suggested this intervention may increase social connection and utilization of VA services among attendees.

Loneliness, Belonging, and Mental Health in Australian University Students Pre- and Post-COVID-19

The move to online learning during COVID-19 deprived first-year students of friendships and other sources of social support that could buffer against stress during their transition to university. These effects may have been worse for international students than domestic students as many were subjected to travel restrictions or quarantine in addition to the usual stressors. This study examined the impact of COVID-19 on social connectedness and mental health of first-year students enrolled in a metropolitan university in Australia. The study involved 1239 students (30.4% international) and used a 3 (cohorts: 2019, 2020, 2021) × 2 (enrolment status: domestic and international) between-group design. Results showed that both loneliness and university belonging were significantly worse during the first year of COVID-19 compared to the year before or after. Contrary to expectation, domestic students were lonelier than international students across all cohorts. Multiple-group memberships did not change. As predicted, loneliness was moderately to highly correlated with the number of stressors, psychological distress, and (lower) well-being, whereas university belonging and multiple-group memberships were related to positive mental health outcomes. These findings highlight the need for initiatives that promote student connectedness and mental health as the university sector recovers from COVID-19.

Interventions to improve social connections: a systematic review and meta-analysis

PURPOSE

The importance of both frequent and high-quality social connections is widely recognised. Previous reviews of interventions for promoting social connections found mixed results due to the inclusion of uncontrolled studies and merging of objective and subjective dimensions of social connections. This study aimed to compare the effectiveness of interventions designed to promote 'objective social contact' and the 'quality of social connections'; and compare the effectiveness of interventions from different theoretical orientations on these social dimensions through a systematic review and meta-analysis of controlled trials.

METHODS

A systematic search of electronic databases Medline, Embase, PsycINFO and PubMed was conducted to identify randomised controlled trials of interventions for social isolation, loneliness, social participation and/or social connectedness in adults. Data were analysed using Stata V.16.0.

RESULTS

Fifty-eight studies met inclusion criteria (mean age = 62 years). Overall, interventions led to significant improvements in objective social contact (Hedges' g = 0.43) and perceived quality of social connections (Hedges' g = - 0.33). Increasing access to other people was the most effective strategy for promoting objective social contact (Hedges' g = 0.67). Providing adults with skills to manage maladaptive attributional biases, fear-related avoidance of social situations, and barriers to social contact, was the most effective strategy for addressing deficits in perceived quality of social connections (Hedges' g = - 0.53).

CONCLUSION

In summary, different interventions had differential effects on the frequency and quality of social relationships and associated emotional distress. Psychological interventions hold the most promise for increasing meaningful social connections and reducing distress.

'The threat is in all of us': Perceptions of loneliness and divided communities in urban and rural areas during COVID-19

Loneliness is becoming recognised as an important social issue with health and well-being consequences. The recent and ongoing COVID-19 pandemic has likely impacted loneliness through increased social isolation, though the effects may vary across urban and rural locations, where the dynamics of social capital, community cohesion and community divide are likely to differ. This paper consequently examines the different and compounding impacts of isolating disasters, such as bushfires and pandemics, on social capital and loneliness in urban and rural areas of Australia. This article compares experiences of loneliness in rural/regional and urban areas of Australia moving from the aftermath of the 2019-2020 bushfires into the COVID-19 pandemic. Semi-structured interviews provide a complex insight into how loneliness is experienced across different locations. The key findings included a higher sense of social divide exacerbating loneliness in rural communities, higher levels of loneliness among participants who lived alone in either area. It was concluded that loneliness was experienced extensively among those who were single and/or lived alone, regardless of their geographical location.

How arts engagement supported social connectedness during the first year of the COVID-19 pandemic in the UK: findings from the HEartS Survey

Objectives

This study investigated how adults in the United Kingdom perceived their arts and cultural engagement to facilitate social connectedness over two phases in the first year of the COVID-19 pandemic.

Study design

The study used the HEartS Survey, a newly designed online survey tool to capture arts engagement in the United Kingdom and its associations with social and mental well-being, over two phases in 2020: March to May (Phase 1) and October (Phase 2).

Methods

Qualitative data were provided at both phases by 581 respondents, who identified which arts and cultural activity they felt most connected them to others and how during the last month.

Results

Thematic analysis revealed that, at both phases, arts and cultural engagement was perceived to facilitate social connectedness through four pathways that were also identified prepandemic: social opportunities, sharing, feelings of commonality and belonging and collective understanding. The subthemes shed light on specific ways that respondents used the arts during the pandemic to connect with others, including using the arts: as a catalyst for conversations, to maintain, reinstate or strengthen relationships during social distancing and to facilitate social interactions (Theme 1); to bring people together through shared experiences and sharing of art (Theme 2); to elicit feelings of direct and indirect proximity to others, to connect people with common interests, to feel a sense of belonging to something and to feel part of a collective ‘COVID-19 experience’ or to feel collectively distracted from the pandemic (Theme 3); and to learn from and about other people and to relate to others (Theme 4). The activity most frequently cited as connecting was watching a film or drama, followed by listening to recorded music.

Conclusions

Engagement in arts and cultural activities supported feelings of social connection among adults in the United Kingdom over two phases in the first year of the COVID-19 pandemic, highlighting the importance of access to the arts and culture to support social connectedness.

Outdoor public recreation spaces and social connectedness among adolescents

Background

Outdoor public recreation spaces are important settings for leisure and physical activity. Adolescents’ use of these spaces may contribute to social connectedness via social interaction with peers and the community in these settings. However, research on this topic is limited. This exploratory study examined associations of frequency of visitation and physical activity in outdoor public recreation spaces with social connectedness among adolescents in Melbourne, Australia.

Methods

Adolescents self-reported their frequency of visitation to parks, trails, beach/lake, and sports facilities; frequency of physical activity in a park, local street or path, and their street; and social connectedness. Separate analyses were conducted for visitation (n = 349, 15.4 ± 1.6 years, 58% female) and physical activity (n = 441, 15.4 ± 1.6 years, 59% female) using multilevel linear regression models.

Results

No significant associations were observed for frequency of visitation to a park (B = 0.86, 95% CI = − 0.26, 1.99), trails (B = 0.41, 95% CI = − 0.61, 1.44), beach/lake (B = − 0.44, 95% CI = − 1.46, 0.57), or sports facilities (B = 0.64, 95% CI = − 0.43, 1.70), nor for frequency of physical activity in their street (B = − 0.07, 95% CI = − 0.46, 0.31), local street/path (B = − 0.05, 95% CI = − 0.43, 0.33) or in a park (B = 0.23, 95% CI = − 0.14, 0.60) with adolescents’ social connectedness.

Conclusions

The findings did not support the hypothesis that visiting and being active in outdoor public recreation spaces are associated with adolescents’ social connectedness. Future research should consider the duration and context of outdoor public recreation space use (e.g., sports, socialising, relaxing alone) and whether different types and/or a combination of public spaces are more/less conducive to social connectedness.

Secularism, family ties and loneliness: A multilevel longitudinal study of ten European societies

OBJECTIVES

Mass media suggest rising political and religious concern about secularism-induced decline of the family. Implications for loneliness remain unexamined. The current study filled this gap.

METHODS

Data were from 10 national probability samples in the Survey of Health, Ageing and Retirement in Europe. Multilevel longitudinal models tested linkages of societal secularism with loneliness, their mediation by specific family relationships, and the role of this cultural dimension in weakening associations of family ties with loneliness. Both weighted Maximum Likelihood and unweighted Bayesian analyses were conducted, separately for each gender.

RESULTS

Societal secularism was not positively linked to either gender's loneliness. Associations with family ties were inconsistent, with only men's average partnered status lower in more secular settings. Nor did any positive indirect effects emerge. Moderation results were also inconsistent, with secularism only weakening linkages of some family dimensions with loneliness. Bayesian estimates were generally nonsignificant.

DISCUSSION

Societal secularism may not be a risk factor for loneliness or for weak family ties. Results stand at odds with religious and political rhetoric on secularism-induced decline of the family, and its individual and societal consequences.

Associations between COVID-19 mobility restrictions and economic, mental health, and suicide-related concerns in the US using cellular phone GPS and Google search volume data

During the COVID-19 pandemic, US populations have experienced elevated rates of financial and psychological distress that could lead to increases in suicide rates. Rapid ongoing mental health monitoring is critical for early intervention, especially in regions most affected by the pandemic, yet traditional surveillance data are available only after long lags. Novel information on real-time population isolation and concerns stemming from the pandemic's social and economic impacts, via cellular mobility tracking and online search data, are potentially important interim surveillance resources. Using these measures, we employed transfer function model time-series analyses to estimate associations between daily mobility indicators (proportion of cellular devices completely at home and time spent at home) and Google Health Trends search volumes for terms pertaining to economic stress, mental health, and suicide during 2020 and 2021 both nationally and in New York City. During the first pandemic wave in early-spring 2020, over 50% of devices remained completely at home and searches for economic stressors exceeded 60,000 per 10 million. We found large concurrent associations across analyses between declining mobility and increasing searches for economic stressor terms (national proportion of devices at home: cross-correlation coefficient (CC) = 0.6 (p-value <0.001)). Nationally, we also found strong associations between declining mobility and increasing mental health and suicide-related searches (time at home: mood/anxiety CC = 0.53 (<0.001), social stressor CC = 0.51 (<0.001), suicide seeking CC = 0.37 (0.006)). Our findings suggest that pandemic-related isolation coincided with acute economic distress and may be a risk factor for poor mental health and suicidal behavior. These emergent relationships warrant ongoing attention and causal assessment given the potential for long-term psychological impact and suicide death. As US populations continue to face stress, Google search data can be used to identify possible warning signs from real-time changes in distributions of population thought patterns.

Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis

BACKGROUND

Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited.

OBJECTIVE

The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years.

METHODS

A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework.

RESULTS

Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (-25.6%, 95% CI -0.352 to -0.160; P<.001) and anxiety (-15.1%, 95% CI -0.251 to -0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted.

CONCLUSIONS

D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

Sequential multiple assignment randomised trial of a brief contact intervention for suicide risk management among discharged psychiatric patients: an implementation study protocol

INTRODUCTION

The postdischarge suicide risk among psychiatric patients is significantly higher than it is among patients with other diseases and general population. The brief contact interventions (BCIs) are recommended to decrease suicide risk in areas with limited mental health service resources like China. This study aims to develop a postdischarge suicide intervention strategy based on BCIs and evaluate its implementability under the implementation outcome framework.

METHODS AND ANALYSIS

This study will invite psychiatric patients and family members, clinical and community mental health service providers as the community team to develop a postdischarge suicide intervention strategy. The study will recruit 312 patients with psychotic symptoms and 312 patients with major depressive disorder discharged from Shenzhen Kangning Hospital (SKH) in a Sequential Multiple Assignment Randomised Trial. Participants will be initially randomised into two intervention groups to receive BCIs monthly and weekly, and they will be rerandomised into three intervention groups to receive BCIs monthly, biweekly and weekly at 3 months after discharge according to the change of their suicide risk. Follow-ups are scheduled at 1, 3, 6 and 12 months after discharge. With the intention-to-treat approach, generalised estimating equation and survival analysis will be applied. This study will also collect qualitative and quantitative information on implementation and service outcomes from the community team.

ETHICS/DISSEMINATION

This study has received ethical approval from the Ethics Committee Review Board of SKH. All participants will provide written informed consent prior to enrolment. The findings of the study will be disseminated through peer-reviewed scientific journals, conference presentations. A project report will be submitted to the National Natural Science Foundation of China as the concluding report of this funded project, and to the mental health authorities in the Shenzhen to refine and apply evidence-based and pragmatic interventions into health systems for postdischarge suicide prevention.

TRIAL REGISTRATION NUMBER

NCT04907669.

Inpatient Institutional Care: The Forced Social Environment

The landscape of mental health recovery is changing; there have been calls for a shift from the clinical expertise being the dominant voice within mental healthcare towards a more personalised and collaborative service that supports those in need of mental healthcare to define what recovery is for the individual. Within this new recovery movement, there has been a recognition of the importance of the social environment in which individuals are situated and the relationship of this to mental health and wellbeing. Included in this is the importance of an individual’s role within society and the ways in which knowledge, such as experts by experience, can hold an important value. The argument then, is that social connectedness forms part of the recovery journey and that relationships can help us develop or re-connect with who we are in powerful ways. Such a view has only been strengthened by the recent and ongoing global COVID-19 pandemic. Within the UK, discussions of the importance of our wellbeing have become commonplace within the context of restricted social contact. With this heightened awareness of how the social contributes to wellbeing, it is important to consider the environments in which those in receipt of mental healthcare are situated. One of which is institutionalised care, where it is commonplace to restrict social contact. For example, by virtue of being within a locked environment, individuals’ freedom of movement is often non-existent and thus contacts with those not residing or working within the institution is restricted. While such restrictions may be deemed necessary to protect the individual’s mental health, such environments can be unintentionally toxic. Data are presented from an ethnography that was conducted within an inpatient forensic mental health hospital in the UK to highlight the problematic social environment which some individuals experience. Key interpersonal issues are presented, such as, trust, racism, the threat of physical violence and bullying that was experienced by staff and residents at the hospital. Consideration is given to the coping strategies enacted by residents and the pathologising of such behaviour. The consequences on interpersonal wellbeing are explored.

Social connectedness among parents raising children in low-income communities: An integrative review

Social isolation has been linked to numerous health risks, including depression and mortality. Parents raising children in low‐income and under‐resourced communities are at an increased risk for experiencing social isolation and its negative effects. Social connectedness (SC), one's sense of belongingness and connection to other people, or a community, has been linked to reduced social isolation and improved health outcomes in the general population, yet little is known about the impact SC has on parents with low incomes. This integrative review aims to describe the current state of the science surrounding SC in parents with low incomes, summarize how SC is being defined and measured, evaluate the quality of the science, and identify gaps in the literature to guide future research. Five electronic databases were searched, yielding 15 articles for inclusion. Empirical studies meeting the following criteria were included: population focused on parents who have low incomes or live in low‐income communities and have dependent children, outcomes were parent‐centered, SC was a study variable or a qualitative finding, and publication date was before March 2021. Findings emphasize SC as a promising construct that may be protective in the health and well‐being of parents and children living in low‐income communities. However, a lack of consensus on definitions and measures of SC makes it difficult to build a strong science base for understanding these potential benefits. Future research should focus on understanding the mechanisms by which SC works to benefit parents and their children.

Arts engagement supports social connectedness in adulthood: findings from the HEartS Survey

Background

Loneliness is a public health challenge, associated with premature mortality and poorer health outcomes. Social connections can mitigate against loneliness, and there is evidence that the arts can support social connectedness. However, existing research on the arts and social connectedness is limited by focus on particular age groups and arts activities, as well as a reliance on typically small-scale studies.

Methods

This study reports survey data from 5892 adults in the United Kingdom, closely matched to the national profile in terms of sociodemographic and economic characteristics. It investigates the extent to which arts engagement is perceived to be linked with feelings of social connectedness, which forms of arts engagement are reported as most connecting, and how. Data were collected via the HEartS Survey, a newly designed tool to capture arts engagement in the United Kingdom and its associations with social and mental health outcomes. Demographic and quantitative data, pertaining to the extent to which arts engagement is perceived to be linked with social connectedness, were analysed descriptively. Qualitative data pertaining to respondents’ perceptions of how arts engagement is linked with feelings of social connectedness were analysed using inductive thematic analysis.

Results

Results demonstrated that the majority of respondents (82%) perceive their arts engagement to be linked with feelings of social connectedness at least some of the time. The forms of arts engagement most linked with feelings of social connectedness were attending a live music performance, watching a live theatre performance, and watching a film or drama at the cinema or other venue. Four overarching themes characterise how arts engagement is perceived to facilitate feelings of social connectedness: social opportunities, sharing, commonality and belonging, and collective understanding.

Conclusions

The findings suggest that arts engagement can support social connectedness among adults in the UK through multiple pathways, providing large-scale evidence of the important role that the arts can play in supporting social public health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11233-6.

Recorded Mental Health Recovery Narratives as a Resource for People Affected by Mental Health Problems: Development of the Narrative Experiences Online (NEON) Intervention

BACKGROUND

The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs).

OBJECTIVE

This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs.

METHODS

Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made.

RESULTS

KI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8% (105/330) of narrative accesses.

CONCLUSIONS

RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health.

The effects of social group interventions for depression: Systematic review

BACKGROUND

There is a growing prevalence of prolonged antidepressant use globally. Social group interventions may be an effective way to manage mild to moderate depression, especially with patients seeking to discontinue antidepressant use. This systematic review evaluates studies that used social group interventions to manage depression.

METHODS

Studies published up to June 2019 in nine bibliographic databases were identified using search terms related to depression, social interventions, and social participation. Formal therapies for depression (cognitive behaviour therapy, music therapy) were excluded as they have been reviewed elsewhere.

RESULTS

24 studies met inclusion criteria; 14 RCTs, 6 non-randomised controlled trials and 4 pre-post evaluations. In total, 28 social group programs were evaluated, 10 arts-based groups, 13 exercise groups and 5 others. Programs ranged in 'dose' from 5 to 150 hours (M = 31 hours) across 4 to 75 weeks (M = 15 weeks) and produced effect sizes on depression in the small to very large range (Hedge's g = .18 to 3.19, M = 1.14). A regression analysis revealed no participant variables, study variables or intervention variables were related to effect size on depression.

LIMITATIONS

Risks of bias were found, primarily in the non-randomised studies, which means the findings must be regarded as preliminary until replicated.

CONCLUSION

These findings indicate that social group interventions are an effective way to manage mild to moderate depression symptoms in a variety of populations. This approach may also help to prevent relapse among patients tapering off antidepressant medication.

Social connectedness in adults with mental disorders: ecological validation of a conceptual framework for novel complex interventions

BACKGROUND

Social connectedness interventions may improve the clinical outcomes and personal recovery of adults with mental disorders but many interventions lack a clear theory-base and show limited effectiveness.

AIM

To evaluate the validity of a newly developed conceptual framework (the CIVIC framework: Closeness, Identity, Valued relationships, Involvement and Cared for and accepted) to function as the theory-base for novel social connectedness-based mental health interventions.

METHOD

Semi-structured interviews with adults with diagnostically heterogeneous mental disorders (n = 13) and mental health professionals (n = 9). Participants reported their social connectedness experiences, their views on the CIVIC framework and potential targets for new interventions. Sequential inductive and deductive thematic analyses were used. Data quality was assessed through respondent validation.

RESULTS

Both inductive and deductive analyses provided validation of the CIVIC framework. Additional themes of Stigma and Connectedness beyond social relationships were identified in the inductive analysis. Candidate interventions to target each CIVIC domain were identified.

CONCLUSIONS

The CIVIC framework demonstrates ecological validity and can therefore serve as the theory-base for the development of novel social connectedness-based interventions. This study indicates that interventions would be most effective when they incorporate evidence-based approaches which target each of the categories described by the CIVIC framework.

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

BACKGROUND

Young people have a higher prevalence of loneliness than other age groups, and they are also at risk of depression. Quantitative studies describe a bidirectional association between loneliness and depression, but there is limited understanding of how these influence each other. Little is known about the experience of loneliness among young people with depression. Qualitative approaches may help understand the relationship between loneliness and depression among young people, and how to intervene to improve outcomes. We aimed to conduct a meta-synthesis to understand the complex inter-relationship between loneliness and depression among young depressed people by synthesising evidence from a systematic review of qualitative studies.

METHODS

We conducted a meta-synthesis of qualitative studies capturing experiences of loneliness among young people with depression. We systematically searched six electronic databases for selected search terms, critically appraised eligible studies, and analysed the data from included studies using the approach of thematic synthesis. We used feedback from an inter-disciplinary research workshop to improve reflexivity.

RESULTS

Our inclusion criteria identified fourteen studies. Our analysis identified four themes: (1) social withdrawal due to poor mental health, (2) non-disclosure of depression contributing to social distance, (3) the desire to connect, and (4) paradoxes of loneliness and depression. These themes illustrated a range of pathways between depression and loneliness, and a sense of how these might be mutually reinforcing. Our findings suggest that where depressed individuals engage in certain behaviours (withdrawing; not confiding) for a range of reasons, this can lead to feelings of loneliness, an awareness of which worsens their mood, thus perpetuating their depression.

CONCLUSIONS

Young people with depression experience loneliness as an insurmountable distance between themselves and others. Our findings identified non-disclosure of depression, and the debilitating nature of the depressive symptomatology, as factors perpetuating a vicious cycle of loneliness and depression. They suggest that approaches to tackling the problem might include helping young people communicate about their depression to trusted friends and educating their social networks in how to support them. The wider research literature suggests that cognitive interventions may have a role in shifting maladaptive cognitions about their social world.

"It's a lifeline": Generating a sense of social connectedness through befriending parents of disabled children or children with additional need

OBJECTIVES

This study explored the influence of a parent-to-parent peer support scheme on the wellbeing of parents of disabled children or children with additional need who joined a befriending scheme.

METHODS

A longitudinal concurrent mixed methods (qualitative and quantitative) research design collected data (telephone interviews, Footsteps Tool, Resilience Scale-14) with 33 befriendees (1:1 or group support) and 33 befrienders at time-point 1 (TP1). TP2 data were collected from 20 befriendees and 16 befrienders 6-9 months after recruitment.

RESULTS

There was some improvement on average scores between TP1 and TP2 on both tools. The strongest evidence of change - 'a sense of positivity and hope' and 'connection, belonging and sharing' - was in the parents' reports of how the scheme helped them to build secure and valued social connections within a community of other parents who understood their lives.

CONCLUSION

Both the befriendees and befrienders reported the sense of hope and a feeling of belonging as key benefits that resulted from the social connections they gained from the scheme.

PRACTICE IMPLICATIONS

Social connectedness is likely to be a more useful concept than resilience in examining change.