Family network support and mental health recovery

Depression risk and resilience in a diverse sample of older adults in the United States

Living in poor and physically deteriorating neighborhoods is associated with heightened likelihood of experiencing depression. At the same time, not all people experience their neighborhoods in the same way. We predicted and tested the possibility that variability in this association can be explained by the social support that people derive both from their personal networks and other people residing in the same neighborhood, and that this moderation varies by race/ethnicity. Health and Retirement Study data (2018/2020 waves) were used to evaluate the role of individual-level and contextual risk and resilience factors in association with depression among US older non-Hispanic white adults (n = 4,986, mean age 67 years), non-Hispanic black adults (n = 1,342, mean age 65 years), and Hispanic adults (n = 937, mean age 64 years). Four notable findings emerged. First, perceived neighborhood disorder was related to increased depression risk for non-Hispanic white and black participants, but not Hispanic participants. Second, participants residing in census tracts with higher poverty rates were more likely to report depression. Third, non-Hispanic white participants residing in census tracts with greater Hispanic resident density had reduced depression risk. This same pattern was not observed among non-Hispanic black participants. Finally, perceived support from family was associated with reduced depression risk among all participants. These data suggest both individual- and contextual-level sources of risk and resiliency for depression. The implications for theories that seek to explain the relative resilience to neighborhood disorder observed among US Hispanic residents are discussed.

How Young Adults with Serious Mental Health Diagnoses Navigate Poverty Post-emancipation: The Complex Roles of Community Mental Health Services & Informal Social Support

Serious mental health diagnoses are prevalent among youth who "age out" of foster care by reaching the maximum age for child welfare service eligibility. Post-emancipation, little is known about how youth engage in community mental health services, or leverage informal social networks, to navigate independence. Twenty emancipating youth completed three interviews over 16 months. All emancipated into poverty; most lived alone and initially connected to adult community mental health teams. Four service use and informal support profiles emerged from analysis: (1) Navigators (n = 2) actively used mental health services and provided limited informal support; Treaders (n = 9) passively used mental health services and heavily exchanged informal support; Survivors (n = 5) used mental health services when in crisis and heavily provided informal support; and Strugglers (n = 4) avoided mental health services and took resources from informal connections. Findings have implications for both child and adult mental health and social service providers.

The Mediating Effects of Perceived Family Support in the Relationship Between Anxiety and Problematic Smartphone Use: A Cross-Cultural Validation

ABSTRACT

Problematic smartphone use (PSU) is frequently considered a public health issue, especially in East Asia and Europe. Yet, there is a paucity of research focusing on cultural and familial determinants of PSU. This cross-cultural study aimed to investigate smartphone usage patterns and possible mediating effects of perceived family support (PFS) from a stress-coping perspective. Convenience samples of 790 Chinese and 439 Belgian undergraduates completed an online survey that focused on sociodemographics and psychological variables ( i.e. , anxiety, depression, PFS, and PSU). In both samples, PSU was positively associated with anxiety and depression, and negatively associated with PFS. However, after controlling for sex and age in structural equation models, the consistent mediating effects of PFS were only found between anxiety and PSU in both cultural settings. These findings suggest that psychological interventions that take into account familial factors could be helpful for young people presenting with anxiety and PSU.

Exploring the Impact of Family Separation on Refugee Mental Health: A Systematic Review and Meta-narrative Analysis

The refugee crisis is spreading rapidly, with the number of global refugees this decade doubling in comparison to the last, leading to further concern regarding asylum policies and their psychological impacts. The aim of this systematic review is to further emphasize the correlation between familial separation and the risk of mental health disorders in refugees. This particular review uses quantitative and qualitative data sourced from a variety of countries to comparatively view the mental health status of approximately 8,737 refugees ages 15 and older. This was done to determine if familial separation could potentially impact their overall quality of life. As a result, separation from one's family was found to be correlated with symptoms of posttraumatic stress disorder, depression, anxiety, adult separation anxiety disorder, intermittent explosive disorder, and more. Studies reported a high variance in the prevalence of mental health disorders when models were adjusted for family separation. Methods to improve asylum procedure and mental health services for refugees is taken into consideration.

Correlates of community rehabilitation service utilization among persons with psychiatric disabilities

BACKGROUND

The use community psychiatric rehabilitation (CPR) service could facilitate community tenure, autonomy, and recovery among persons with psychiatric disabilities. Nevertheless, based on existing scientific evidence, the conformance rate with the treatment recommendations was modest and the existing services are underutilized in Taiwan.

AIMS

This study examined the correlates of CPR service utilization based on the Behavioral Model of Health Service Utilization. Especially, the effects of enabling factors were explored.

METHODS

Five hundred and ninety-two participants from 32 community psychiatric rehabilitation centers in Taiwan completed the questionnaire. There were three groups of independent variables: predisposing, enabling, and need factors. Multiple regression analysis with a hierarchical method of entry was performed.

RESULTS

The hypothesized model was significant. Eight independent variables in the model explained 29.3% of the variances in the service utilization. Three enabling factors were significant after controlling for the effects of other factors. The most important correlate was professional relationships followed by family support and welfare subsidy.

CONCLUSIONS

The findings support that factors associated with CPR service utilization need to be examined separately from general mental health service. CPR program design and service delivery should consider the three most important enabling factors and the extent of service utilization could be enhanced.

Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning

Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in ‘recovery’; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as ‘return to baseline’, and we know less about patterns and predictors when recovery is situated as a ‘process’. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an ‘outcome’ and as a ‘process’ and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a ‘poor health’ state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised.

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There is no consensus on what recovery is and how it should be operationalised.

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Understanding of inequalities in recovery across health conditions remains scarce.

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We operationalised recovery both as an outcome and as a process.

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We found robust inequalities in recovery across the two approaches.

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Considering recovery as a process revealed more nuanced patterns in inequalities.

The Social Support Network of Adults with an Autism Spectrum Condition: An Exploration Using the Network in Action-Questionnaire

Actively involving the network during treatment, as recommended in Autism Spectrum Condition (ASC) guidelines, can be facilitated with the Network in Action-Questionnaire (NiA-Q), which identifies the current and potential sources of social support. The aims of this study were to (1) examine the factor structure of the NiA-Q and (2) to explore the self- and proxy-report on the social network. Before the start of treatment in a mental health institution, 193 adults with an ASC diagnosis and 84 proxies completed the NiA-Q. Factor analysis showed two factors: positive social support and interpersonal distress. Self- and proxy-report on the NiA-Q did not differ for most variables, except for social network wishes. The NiA-Q provides a basis for network involvement and strengthening.

Microdosing as a Response to the Meaning Crisis: A Qualitative Analysis

The use of psychedelic substances in both humanistic and mainstream clinical research has been increasing in the last decade. In particular, the practice of microdosing—ingesting sub-hallucinogenic doses of psychedelics—has been increasing in popularity, but large-scale qualitative analyses are still uncommon. This study attempted to recognize emergent themes in qualitative reports regarding the experience of microdosing to enrich the theoretical landscape in psychedelic research and propose future research directions for both basic and clinical research. Participants were people who reported microdosing at least once in the last year; they described their experiences using an online survey. Data from 118 informative responses suggested four main emergent themes: reasons for microdosing, the practice of microdosing itself, outcomes linked to microdosing, and meta-commentary about microdosing. We use meaning-making theory and propose that, even at low doses, psychedelic substances can provide a sense of meaning. Our results suggest that many of the reported benefits occur regardless of motivation to microdose and are likely due to the enhanced psychological flexibility and a sense of connectedness made possible due to the use of psychedelics. Double-blind, placebo-controlled experiments are required to substantiate these reports.

Whose responsibility? Part 2 of 2: views of patients, families, and clinicians about responsibilities for addressing the needs of persons with mental health problems in Chennai, India and Montreal, Canada

BACKGROUND

Individuals with mental health problems have many insufficiently met support needs. Across sociocultural contexts, various parties (e.g., governments, families, persons with mental health problems) assume responsibility for meeting these needs. However, key stakeholders' opinions of the relative responsibilities of these parties for meeting support needs remain largely unexplored. This is a critical knowledge gap, as these perceptions may influence policy and caregiving decisions.

METHODS

Patients with first-episode psychosis (n = 250), their family members (n = 228), and clinicians (n = 50) at two early intervention services in Chennai, India and Montreal, Canada were asked how much responsibility they thought the government versus persons with mental health problems; the government versus families; and families versus persons with mental health problems should bear for meeting seven support needs of persons with mental health problems (e.g., housing; help covering costs of substance use treatment; etc.). Two-way analyses of variance were conducted to examine differences in ratings of responsibility between sites (Chennai, Montreal); raters (patients, families, clinicians); and support needs.

RESULTS

Across sites and raters, governments were held most responsible for meeting each support need and all needs together. Montreal raters assigned more responsibility to the government than did Chennai raters. Compared to those in Montreal, Chennai raters assigned more responsibility to families versus persons with mental health problems, except for the costs of substance use treatment. Family raters across sites assigned more responsibility to governments than did patient raters, and more responsibility to families versus persons with mental health problems than did patient and clinician raters. At both sites, governments were assigned less responsibility for addressing housing- and school/work reintegration-related needs compared to other needs. In Chennai, the government was seen as most responsible for stigma reduction and least for covering substance use services.

CONCLUSIONS

All stakeholders thought that governments should have substantial responsibility for meeting the needs of individuals with mental health problems, reinforcing calls for greater government investment in mental healthcare across contexts. The greater perceived responsibility of the government in Montreal and of families in Chennai may both reflect and influence differences in cultural norms and healthcare systems in India and Canada.

Attachment as a framework to facilitate empowerment for people with severe mental illness

OBJECTIVES

Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact.

DESIGN

We used a cross-sectional design.

METHODS

In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed.

RESULTS

Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not.

CONCLUSIONS

Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI.

PRACTITIONER POINTS

Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of 'standing alongside' and offering support may be important requisites for empowerment.

A systematic review of measures assessing mental health professionals' perspectives of recovery

Recovery is internationally recognized as a concept to improve the well-being of consumers. Compared with the numerous measures assessing consumer perspectives of recovery, only a few measures have been developed to assess Mental Health Professionals' (MHPs) perspectives of recovery to inform practice. The present study aims to systematically review the literature to identify existing measures designed to assess MHPs' perspectives of recovery and evaluate their psychometric properties, and the methodological considerations of the design and use of these measures. We searched literature across eight electronic databases: MEDLINE, Web of Science, PsycINFO, PsyArticles, CINAHL, Scopus, EMBASE, and Google scholar. We identified 2631 articles across all databases. Of these, 40 articles met the inclusion criteria, which comprised 14 original measures assessing mental health recovery and 26 articles reassessing the psychometric properties of the original 14 measures. Our results suggested that while there are existing measures for assessing MHPs' perspectives of recovery, only a few of these measures met standard evaluation criteria for psychometric properties. Specifically, the validation of the identified measures is still in its infancy. For example, the easiness of applying the measures differs among the studies, and only a few of the measures fully involved consumers in the scale development phase. The implication of the findings for future use and development of recovery measures in mental health practice and research are discussed and recommended.

Do Living Arrangements and Social Network Influence the Mental Health Status of Older Adults in Malaysia?

Living arrangement has been reported to have a significant influence on several mental health statuses of older adults, but their social network may confound this association. This study is aimed at examining the interactive effect of living arrangements and social network on the mental health status among older adults in Malaysia. A total of 2,188 Malaysian older adults living nationwide were included in this cross-sectional study. Participants were classified into four groups according to their living arrangements (living alone or not living alone) and social network size (assessed using Lubben's Social Network Scale-6). Poor social network was defined as the lowest quartile (fourth quartile) of the score. Mental health statuses, which include flourishing in life, life satisfaction, cognitive functions, loneliness, depression, and perceived stress, were measured. Multiple linear regression models, adjusted for age, gender, education, and comorbidities, revealed that a good social network was significantly associated with an increase on the flourishing scale scores, regardless of living arrangements. Not living alone and having good social network was significantly associated with increased Montreal Cognitive Assessment scores and decreased loneliness scores. This study found that living arrangements are not always a risk factor for the mental health status of older adults. However, it may be confounded by the level of their social networks. The results suggested that the effects of social network may exceed the impact of living arrangements. It is recommended that health professionals pay more attention to the social networks of older Malaysians to harness its benefits in improving their mental health status.

Social support and strain and emotional distress among Latinos in the northeastern United States

Background

US Latinos report high levels of emotional distress. Having positive familial and friend social support buffers emotional distress among US Latinos, but thus far no research has been done on social support and ataque de nervios in that population, or on social strain and emotional distress.

Methods

This paper assesses social support and strain across three relationship types (partner, family, and friends) with three measures of emotional distress (depression, anxiety, and ataque de nervios). The sample for partner, family, and friend support included 508 Latino adults 21 and older. Multivariate logistic regression models were used to assess the association of social support and strain with each outcome.

Results

As all social support types increased, the odds of emotional distress symptoms decreased. Conversely, as each unit of partner and family strain increased, the odds of emotional distress symptoms increased. Increased friend strain was associated with greater odds of depressive and anxiety symptoms only.

Conclusion

Social support in all three network types (partner, family, and friend) was associated with a decrease in the odds of emotional distress, assessed as symptoms of depression, anxiety, and ataque de nervios.

Psychological impact of the COVID-19 pandemic within institutional quarantine and isolation centres and its sociodemographic correlates in Qatar: a cross-sectional study

SETTING

The State of Qatar has had one of the highest COVID-19 infection rates globally and has used state-managed quarantine and isolation centres to limit the spread of infection. Quarantine and isolation have been shown to negatively affect the mental health of individuals. Qatar has a unique population, with around 90% of the population being economic migrants and a majority being blue-collar workers and labourers.

OBJECTIVES

This study was carried out to evaluate the psychological impact of institutional isolation and quarantine during the COVID-19 pandemic outbreak in Qatar. The study also explored the sociodemographic correlates of this psychological impact.

DESIGN, PARTICIPANTS AND INTERVENTION

A cross-sectional study involving 748 consenting individuals in institutional quarantine and isolation in Qatar during the months of June and July 2020 was carried out. Relevant sociodemographic data along with depressive and anxiety symptomatology scores were collected from consenting adults at these facilities.

RESULTS

37.4% (n=270) of respondents reported depressive symptoms and 25.9% (n=189) reported anxiety symptoms. The scores were higher for individuals in isolation facilities and higher for migrants from poor socioeconomic group (p<0.001 for both). Within this group, although worries about infection were widely reported, lack of contact with the family was cited as one of the most important sources of distress. Respondents reported that contact with the family and reliable information were important factors that helped during the duration of isolation and quarantine.

CONCLUSIONS

Our study reported significantly elevated scores for depression and anxiety during institutional quarantine, which is in keeping with emerging evidence. However, in contrast to other studies reporting mostly from native populations, this study of a population with an overwhelming majority of immigrants highlights the special mental health needs of this specific group and can inform future healthcare policies.

It's Not a Race, It's a Marathon! Families Living with a Young Adult Suffering from Mental Illness

The aim of this study is to explore families' perceptions of everyday life when living with a young adult suffering from mental illness. Findings include: 1) Families balance between letting go and enabling the young adult to become independent while remaining close to help him/her complete education, work and have a social life. 2) Young adults try to deal with symptoms of mental illness by themselves and not be a burden, although longing for family members to understand them and the situation. 3) Healthcare professionals still hold back information although young adults have consented to giving family members insight.

Igniting and Maintaining Hope: The Voices of People Living with Mental Illness

The study objective was to identify the types of experiences that consumers identify as igniting and maintaining hope, and those most frequently reported. Data were collected through an anonymous online survey. Two open-ended questions elicited reflective personal accounts regarding hope-promoting experiences. Using an interpretive content analysis design, data were coded inductively using constant comparative analysis. Numbers of participants reporting each type of experience were calculated to identify patterns of hopeful experiences. Findings from 72 participants highlighted a diversity of hope-promoting experiences and sources. Fifteen experiences were identified, forming two broad categories: interactions and experiences involving others, and personal or internal experiences, insights and actions. Findings suggest that consumers play an active role in igniting and maintaining their own hope. Peer workers and health workers can support this by being cognizant of the quality of their interactions with consumers and by facilitating connections with others, particularly families, friends and peers.

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

PURPOSE

Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation.

METHODS

Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary.

RESULTS

In total, 30 RCTs met the review's inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants' characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies.

CONCLUSION

The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.

Qualitative analysis of social network influences on quitting smoking among individuals with serious mental illness

Objective: The prevalence of cigarette smoking among adults with serious mental illness (SMI) remains high in the United States despite the availability of effective smoking cessation treatment. Identifying social influences on smoking and smoking cessation may help enhance intervention strategies to help smokers with SMI quit. The objective of this qualitative study was to explore social network influences on efforts to quit smoking among adults with SMI enrolled in a cessation treatment program. Methods: Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. A convenience sampling strategy was used to recruit participants for social network interviews exploring the influence of family, friends, peers, and significant others on quitting smoking. A team-based analysis of qualitative data involved descriptive coding, grouping coded data into categories, and identifying themes across the data. Results: Social barriers to quitting smoking included pro-smoking social norms, attitudes, and behaviors of social network members, and negative interactions with network members, either specific to smoking or that triggered smoking. Social facilitators to quitting included quitting with network members, having cessation role models, and social support for quitting from network members. Conclusions: Similar to the general population, social factors appear to influence efforts to quit smoking among individuals with SMI enrolled in cessation treatment. Interventions that leverage positive social influences on smoking cessation have the potential to enhance strategies to help individuals with SMI quit smoking.

A Novel Adaptation of the HOME Inventory for Elders: The Importance of the Home Environment Across the Life Course

The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka. Whether the adapted domains correlated with indicators of health and well-being in ways consistent with the child development literature was then examined. Through mixed-methods research based on 248 household surveys, four focus groups, and 15 interviews, three domains emerged: Physical Environment, Variety of Stimulation, and Emotional and Verbal Responsiveness. Regression modeling revealed that a higher quality physical home environment correlated with two measures of cognitive function after adjusting for covariates, but no consistent association with two psychological well-being scales. In contrast, higher Variety of Stimulation scores correlated with better cognitive function and lower psychological distress. There was no consistent correlation between Responsiveness and selected health outcomes. Qualitative data indicate that elders are active household contributors who strive to achieve harmonious relations with coresident kin. These findings reveal notable synergies between early and late life efforts to improve cognitive and psychological health, and highlight household considerations for future healthy aging research.

Mental health presentations to the emergency department: A perspective on the involvement of social support networks

The involvement of families, carers and significant others (i.e. social support networks) has a positive corollary for a person experiencing mental health problems. Accordingly, in Australia involvement of social support networks within mental health services is endorsed in national health policy and service guidelines. Despite the endorsement, this is yet to be fully realised in all areas that provide mental health services, including emergency departments. Social support networks are integral in the provision of mental health consumers' care. Supporting the involvement of social support networks in the emergency department can provide healthcare services with opportunities for enhanced and cost-effective care, contributing to improved outcomes for consumers. An overview of some of the barriers and facilitators of social support network involvement is provided. The intention of this paper is to encourage reflection and dialogue on this important area of mental health service provision and support the evolution of a new paradigm of research into social support network involvement in the emergency department.

Modeling variables associated with personal recovery among service users with mental disorders using community-based services

BACKGROUND

Mental health research is evolving toward the identification of conceptual models and associated variables, which may provide a better understanding of personal recovery, given its importance for individuals affected by mental disorders (MDs).

AIMS

This article evaluated personal recovery in a sample of adults with MDs using an adapted conceptual framework based on the Andersen behavioral model, which evaluates predisposing, enabling and needs factors in service use.

METHODS

The study design was cross-sectional and included 327 mental health service users recruited across four local health service networks in Quebec (Canada). Data were collected using seven standardized instruments and participant medical records. Structural equation modeling was performed.

RESULTS

Quality of life (QOL), an enabling factor, was most strongly associated with personal recovery. Health behavior variables associated with recovery included the following: use of alcohol services, having a family physician, consulting a psychologist, use of food banks, consulting fewer professionals and not using drug services. Regarding needs factors, higher numbers of needs, lower severity of unmet health, social and basic needs and absence of mood disorders were also associated with personal recovery. No predisposing factors emerged as significant in the model.

CONCLUSION

Findings suggest that QOL, needs variables and comprehensive service delivery are important in personal recovery. Services should be individualized to the health, social and basic needs of service users, particularly those with mood disorders or co-occurring mental health/substance use disorders.

Family Inclusion in Mental Health Service Planning and Delivery: Consumers' Perspectives

Family inclusion in treatment planning and delivery for people living with mental illness is advocated in government policy but is yet to be widely translated into practice. While external barriers have been identified, including concerns about consumers' best interests, little is known about consumers' own views. This study explores consumers' experiences and perspectives of including family in treatment. Semi-structured interviews were conducted with 13 adult consumers who could identify supportive family members. Data were analysed using constant comparative analysis. The findings indicated that the outcomes reported from family inclusion depended on who, how, how much and when family were included, and the degree of choice consumers had regarding these features For consumers to have real choice around these features, family inclusion needed to be accessible, families needed to be willing, and all parties needed to agree upon a consumer-centred purpose. Findings can aid health professionals to facilitate consumer choice.

Supported housing for persons with serious mental illness and personal recovery: What do families think?

BACKGROUND AND AIMS

Previous research on supported housing for people with serious mental illness focuses primarily on tenant/client experiences. The aim of this article is to present families' perspectives on the role of supported housing in recovery, utilizing the CHIME framework of personal recovery.

METHOD

Qualitative interviews were conducted with 14 families of individuals with serious mental illness living in supported housing. Participants were across five supported housing sites in four Canadian provinces.

RESULTS

Families credited supported housing with helping tenants redefine a positive sense of identity, re-establish social relationships and regain control over their lives. Families were less confident about supported housing facilitating future employment or 'full' recovery, focusing on stability rather than continual improvement.

CONCLUSION

This is one of the first studies to report family perspectives on the role of supported housing in their loved one's recovery processes - both strengths and weaknesses.

Recovery without autonomy: Progress forward or more of the same for mental health service users?

In Western nations, the Recovery approach has become a widely accepted philosophy and treatment concept in mental health. Yet, community understanding of the Recovery approach remains largely unexplored. This study aimed to investigate (i) people's awareness of the principles underpinning the Recovery approach in mental health, and (ii) the treatment approaches people consider most important, and whether these align with the Recovery approach. To achieve these aims, a random sample of 1217 Australian adults participated in the National Social Survey (QSS) via telephone interview. People's experience with mental health services, the importance they place on various treatment approaches, and their awareness of principles underpinning the Recovery approach were assessed. Analyses were conducted using descriptive statistics. Most participants (94%) agreed that 'regardless of the severity of symptoms experienced and/or the mental illness diagnosis, being diagnosed with a mental illness means there is always hope for a meaningful life'. Moreover, most participants considered treatments in line with the Recovery approach as important. However, few participants (35%) agreed with the principle that 'after diagnosis, the person themselves should direct the long-term management of their mental illness, rather than a medical professional'. Australian people were to some extent aware of the principles underpinning the Recovery Approach, particularly with regard to hope, ability to live a meaningful life, and the importance of support from family, friends, and others living with mental illness. Nonetheless, autonomy was not highly prioritized, with the prevailing view that management of mental illness should be directed by the medical profession.

Social inclusion and relationship satisfaction of patients with a severe mental illness

BACKGROUND

Research suggests that patients with a severe mental illness (SMI) are among the most social excluded in society. However, comparisons of social network composition and relationship satisfaction between SMI patients and a control group are rare.

AIMS

Our aim was to compare differences in size, satisfaction and composition of the social network between patients with SMI and a control group. Potential sociodemographic and clinical risk factors in relation to social network size in SMI patients were explored.

METHODS

The sample consisted of a control group ( N = 949) and SMI patients ( N = 211) who were under treatment in Dutch mental health care institutions. In these groups, network size, relationship satisfaction, sociodemographic and clinical (patients only) characteristics were assessed.

RESULTS

Social network size was 2.5 times lower in SMI patients, which was also reflected in a lower relationship satisfaction. The composition of the social network of SMI patients differs from that of controls: patients' network seems to consist of a smaller part of friends. Different risk factors were associated with the impoverishment of the social network of family, friends and acquaintances of patients with SMI.

CONCLUSION

SMI patients have very small networks compared to controls. This may be a problem, given the ongoing emphasis on outpatient treatment of SMI patients and self-dependence. This outcome advocates for more attention to social isolation of SMI patients and involvement of family in the treatment and aftercare of SMI patients.

A one-year longitudinal qualitative study of peer support services in a non-Western context: The perspectives of peer support workers, service users, and co-workers

This study explored the changing views of key stakeholders (peer support workers, their co-workers, and service users) about peer support services in a non-Western community, using a longitudinal qualitative approach. Five trainee peer support workers (PSWs), 15 service users, and 14 co-workers were interviewed over a 12-month period, under the auspices of the Peer Support Workers Project (also known as the Mindset project) in Hong Kong. A total of 77 interviews were transcribed and thematic analyses were conducted across the participant groups at three different time points (training, work placements, and employment). During the initial implementation of the services, uncertainty about the role of the PSWs were reported. However, trusting and beneficial relationships with service users were gradually built, showing growing resilience and confidence over time. The participants realized that PSWs' experiences of mental illnesses were a unique asset that could help service users to alleviate their own somatic symptoms and improve their connections with others. Our findings highlight that the perceptions of peer support services changed from confusion to viewing PSWs as an asset, to an awareness of the importance of family support, and to the belief that implementing such a program will benefit both service users and PSWs.

Escala de funcionamiento familiar. Propiedades psicométricas modificadas en una muestra mexicana

El objetivo de este estudio fue validar las propiedades psicométricas de la versión modificada de la Escala de Funcionamiento Familiar (García Méndez, 2006). Colaboraron de manera voluntaria 1196 participantes de la Ciudad de México: 471 padres (39.4 % de la muestra) y 725 madres (60.6 % de la muestra), con un rango de edad de 25 a 43 años (M = 34, DT = 5.10). La muestra fue no probabilística y se dividió en dos grupos con igual número de integrantes cada uno. Con un grupo de 598 participantes, se realizó un análisis factorial exploratorio que agrupó 32 ítems distribuidos en cinco factores, los cuales evalúan el funcionamiento familiar. La varianza total explicada fue de 44.08% y la consistencia interna global de la escala fue de 0.79. Los factores fueron: ambiente familiar positivo (α = .885), conflicto (α = .848), diversión (α = .791), hostilidad (α = .721) y coaliciones (α = .660). Para probar la estructura de la escala se realizó un análisis factorial confirmatorio con esos 598 participantes. Los valores obtenidos en los ajustes NFI, CFI, NFI y RMSEA demostraron la estabilidad del modelo con los 5 factores. Se concluyó que la escala cumple con las propiedades psicométricas requeridas para evaluar el funcionamiento familiar en población mexicana.

Predictors of personal recovery for persons with psychiatric disabilities: An examination of the Unity Model of Recovery

This study examined a comprehensive set of potential correlates of recovery based on the Unity Model of Recovery. Thirty-two community psychiatric rehabilitation centers in Taiwan agreed to participate in this study. A sample of 592 participants were administered the questionnaires. Five groups of independent variables were included in the model: socio-demographic variables, illness variables, resilience, informal support, and formal support. The results of regression analysis provided support for the validity of the Unity Model of Recovery. The independent variables explained 53.5% of the variance in recovery for the full sample, and 55.5% for the subsample of the consumers who have been ever employed. The significance of the three cornerstones (resilience, family support, and symptoms) for recovery was confirmed. Other critical support variables, including the extent of rehabilitation service use, professional relationship, and professional support were also found to be significant factors. Among all the significant correlates, resilience, family support, and extent of rehabilitation service use ranked in the top three. The findings could shed light on paths to recovery. Implications for psychiatric services were discussed and suggested.

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

Research in the area of social networks and health has demonstrated that lay social network members play a critical role in the early stages of the illness career, influencing key decisions and pathways to formal care. Here, we revisit and extend this body of work, examining how the lay social network context can moderate the influence of treatment experiences on recovery outcomes as the illness career unfolds. To achieve this goal, we address two research questions, drawing on a longitudinal sample of people making their initial contact with the mental health treatment system: First, we explore how treatment experiences, lay social network characteristics, and recovery outcomes change over 2 years, beginning with the point of entry into treatment. Second, we examine whether the relationship between perceived treatment experiences and recovery outcomes is contingent on characteristics of the lay network context in which clients are socially embedded, focusing on the network's cultural orientation toward medical professionals. We find that positive treatment interactions facilitate improved self-esteem, mastery, role functioning, recovery optimism, and global functioning when the lay network culture is pro-medical, but largely have null effects on the recovery process when the lay network is more hostile to medical professionals.

Extent and pattern of burden of care and its associated factors among Eritrean families of persons living with schizophrenia: a cross-sectional study

PURPOSE

To assess the caregiving burden and its associated factors among Eritrean families of persons living with schizophrenia.

METHODS

A cross-sectional study was conducted for 146 caregivers with their respective known patients with schizophrenia of Saint Mary's Neuropsychiatric National Referral Hospital (SMNNRH). Data were collected using Pai and Kapur's Family Burden Interview Schedule (FBIS), the Positive and Negative Syndrome Scale (PANSS) and self-prepared sociodemographic sheet. Data were analysed using SPSS V.21. Descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA) and multiple regression analysis was employed to analyse the data.

RESULTS

In this study, 84 (57.5%) were males and 62 (42.5%) were females. The mean age was 33.96+10.37 (median=31) for the patients and 46.76+13.96 (median=48) for the caregivers. Total mean objective score was 29.47+6.67. Family caregivers who were single (F=3.224, p<0.005, effect size (ES)=0.064), had educational level at elementary (F=5.647 p=0.001, ES=0.11), had low monthly income (t=7.727, p<0.001, ES=0.01) and were dissatisfied with family support (t=2.889, p<0.01, ES=0.01) experienced greater burden relative to the counterparts. Caregiver's age (β=0.156; p<0.05), duration of caregiving (β=0.131; p<0.05), monthly household family income (β=-0.298; p<0.001), history of self-injury (β=0.151; p=0.05), positive scale (β=0.344; p<0.001), negative scale (β=0.278; p<0.001) and general psychopathological scale (β=0.146; p<0.01) emerged as significant predictors of objective burden.

CONCLUSIONS

Family caregivers of a person living with schizophrenia experience a significant burden of care. Our findings highlight that there is a need of strengthening social and psychological support to reduce the caregiving burden.

Autovideography: The Lived Experience of Recovery for Adults with Serious Mental Illness

Mental health services have been transforming toward a recovery orientation for more than a decade, yet a robust understanding of recovery eludes many providers, and consensus on a conceptual definition has yet to be reached. This article examines mental health consumers' lived experience of recovery and evaluates the usefulness and comprehensiveness of CHIME, a major framework conceptually defining recovery for adults with serious mental illness. Researchers partnered with a mental health association in a major US city to engage in research with graduates of a recovery and education class for adults diagnosed with serious mental illness. Twelve participants were loaned video cameras and invited to "Tell us about your recovery" through autovideography. Of the 12 participants, six produced videos directly responding to the overall research question and were subsequently included in the present analysis. Data were analyzed thematically, and CHIME adequately represented the major domains presented in consumer videos with two notable modifications: subdomains of "reciprocity" within relationships and "contributing to others" were added to comprehensively represent consumer perspectives about recovery. Adding two subdomains to CHIME more effectively represents consumer narratives about recovery, contributes to the social construction of the personhood of people with serious mental illness, and offers a more robust description of the process of recovery.

A Content Analysis of Quantitative Research in Journal of Marital and Family Therapy: A 10-Year Review

We examined the trends of quantitative research over the past 10 years in the Journal of Marital and Family Therapy (JMFT). Specifically, within the JMFT, we investigated the types and trends of research design and statistical analysis within the quantitative research that was published in JMFT from 2005 to 2014. We found that while the amount of peer-reviewed articles have increased over time, the percentage of quantitative research has remained constant. We discussed the types and trends of statistical analysis and the implications for clinical work and training programs in the field of marriage and family therapy.

Mimicking family like attributes to enable a state of personal recovery for persons with mental illness in institutional care settings

BACKGROUND

The convergence between mental ill health and homelessness is well documented, but critical events that precipitate the downward spiral into homelessness, and promote personal recovery remain only partially explored in India.

AIMS

To explore causative factors of the descent into homelessness, and gain insight into creative and innovative approaches that promote personal recovery, specifically in institutional care settings.

METHODS

This qualitative study used focus group discussions, detailed personal interviews and anonymised data drawn from patient files. The data were analysed using phenomenological approaches.

RESULTS

Findings suggest that besides poverty and deprivation, death of the primary caregiver is a critical event in precipitating distress and a breakdown in the family, leading to a loss of support systems and a sense of belongingness, and rendering persons with mental illness homeless. Social affiliations, kinship, congruence between the real and ideal self, and the drive to assume a more powerful identity and/or pursue self-actualisation emerged as key factors aiding personal recovery. In the absence of a family, mimicking its attributes appears to ground institutions and professionals in an ethos of responsiveness and user-centricity, thereby promoting personal recovery.

CONCLUSIONS

This study highlights the critical need to further explore and understand the nature of distress and descent into homelessness, and gain insight into caregiver strain and strategies that can be developed to reduce the same. It further emphasizes the need to shed light on individual strategies that help pursue wellbeing, and delve deeper into the application of value frameworks in institutions and their role in promoting personal recovery among persons with mental health issues.

Family influence in recovery from severe mental illness

The aim of this study was to investigate the perceived influence of family on recovery from severe mental illness. 54 semi-structured interviews were conducted with a diverse sample of people with severe mental illness living in Montreal. Results indicated that family both facilitated and impeded recovery processes. Specifically, family facilitated recovery through providing (a) moral support, (b) practical support and (c) motivation to recover. However family impeded recovery through (a) acting as a stressor, (b) displaying stigma and lack of understanding, and (c) forcing hospitalization. The study indicates the importance of family psychoeducation in promoting recovery.

The Lived Experience of Getting and Having a Home of One's Own: A Meta-Synthesis

This study aimed to synthesize findings from qualitative studies that explored the lived experiences of persons with serious mental illness with regard to getting and having a home. A systematic search strategy was used. Data from 24 articles were extracted and analyzed using a phenomenological-hermeneutic approach. The total number of informants was N = 769. Four main themes emerged: (1) The Turning Point: The Transition to a Home, (2) The Key to Stability and Thriving: Having and Estating a Home, (3) Home: The Mental Health Hub, and (4) Home: The Base Camp for Reconnecting and Relating.

Needs of siblings of persons with psychosis: a systematic descriptive review

Research on caregivers of psychosis has predominantly focused on parents and spouses. Issues related to siblings of persons with psychosis (SOPP) are yet to be evaluated comprehensively. Like parents and spouses, SOPP also share the caregiver burden and have their own issues and needs. This systematic descriptive review aims to identify the types of needs of SOPP in the published literature and gives implications for further practice and research. The primary data search was carried out with predefined protocol in PubMed database and an additional hand search was done in EBSCOhost, ProQuest, Scopus, and PsychINFO. All the searches yielded a total of 862 titles. After screening for necessary inclusion criteria, seven studies were included in the final review. The results are discussed under six major themes that emerged from this review. Six out of seven studies highlighted the need for information on siblings' illness and participation in caregiver support group. Other important needs were illness management or rehabilitation needs; help in managing their own psychosocial issues; treatment related informational needs; and inclusion in treatment process. The socio-demographic details of these studies showed that majority of the participants were female siblings of Caucasian or white British ethnicity and from developed countries. SOPP predominantly have specific needs such as informational and support group needs, which are different in the priority of other primary caregiver needs. Paucity of literature from developing countries and the limitations of the existing studies warrant further systematic research.

Risk and protective factors for relapse among individuals with schizophrenia: a qualitative study in Dar es Salaam, Tanzania

BACKGROUND

Relapse in people with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of people with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families, the mental health sector and the country's economy. So far no study has been done to address relapse in Tanzania. The purpose of the study was to explore perspectives on risk and protective factors influencing relapse of people with schizophrenia and their caregivers attending Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania.

METHODS

A qualitative study was conducted, involving in-depth interviews of seven people with schizophrenia who are out-patients and their seven family caregivers at MNH. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all study participants. The recorded information was transcribed and analyzed using NVivo 9 computer assisted qualitative data analysis software.

RESULTS

Personal risk and protective factors for relapse, environmental risk and protective factors for relapse and suggestions to reduce relapse were the main themes that emerged from this study. People with schizophrenia and their caregivers (all of whom were relatives) perceived non adherence to antipsychotic medication as a leading risk factor of relapse; other risks included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protective factors. Participants suggested strengthening mental health psycho-education sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening the nurse-patient therapeutic relationship in provision of mental health care.

CONCLUSIONS

This study calls for improvement in mental health care service delivery to individuals with schizophrenia. Establishing a curricular in mental health nursing that aims to produce competent mental health nurse force would improve nursing practice in mental health care service delivery.

Factors associated with the emotional distress of women family members of adults with serious mental illness

Women family members of adults with serious mental illness are at great risk for emotional distress. This study examined associations between characteristics of 60 women (age, race, and education), their relatives with mental illness (age, diagnosis, and years since diagnosis), and the family situation (relationship, living arrangements, and care provided) and symptoms of emotional distress. Depressive symptoms were greater among those with younger, non-sibling relatives. Anxiety was greater among Caucasians and those with a recently diagnosed family member, particularly bipolar disorder. Anger was associated with providing direct care. The findings are informative for tailoring interventions to minimize emotional distress in future family caregivers.

"Who believes most in me and in my recovery": the importance of families for persons with serious mental illness living in structured community housing

In this article, the authors report on qualitative findings on the role of family in supporting recovery for mental health consumers living in structured, community housing in a large Canadian city. Despite living separately from families and relying heavily on formal services, residents identified their families more often than mental health professionals, friends, and residential caregivers as those who most believe in them and their recovery. Families supported recovery by providing affection and belonging, offering emotional and instrumental support, and by staying actively involved with residents. Families are a vital, untapped resource for social workers in promoting independent living.

Social relationships and activities among married psychiatric inpatients with sexual difficulties

This study examined the social relationships and activities of married adults with sexual difficulties receiving inpatient psychiatric care in Ontario, Canada. The authors conducted secondary analysis of population-level data on 11,982 married inpatients who were assessed with the Resident Assessment Instrument Mental Health. The authors used descriptive statistics, chi-square analyses, and multivariate logistic regression techniques. Results indicated that 10.7% experienced sexual difficulties, which were related to higher likelihood of dysfunctional social relationships and to lower likelihood of social contact, especially among married women. These findings suggest that assessment of sexual function should be seen as part of comprehensive psychiatric care to support recovery.