Personal well-being networks, social capital and severe mental illness: exploratory study

The impact of social support on university students living with mental illness: a systematic review and narrative synthesis

BACKGROUND

Limited reviews address the role of social support for university students with mental health issues, despite its proven significance for other vulnerable groups.

AIMS

The current review aims to examine the current evidence on the nature and impact of social support for students with self-reported and diagnosed mental health problems, along with the availability and effectiveness of social support interventions.

METHODS

Electronic databases (CENTRAL, CINAHL, Embase, HMIC, MEDLINE, PsycINFO, SCOPUS, Web of Science) and grey literature databases (EThOS, SSRN) were systematically searched from inception to March 2024 Articles were eligible for inclusion if they reported on the nature and role of social support for university students with mental health problems. Data from included articles were extracted and narratively synthesised. Quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Ten studies, involving 3669 participants, were included. Findings indicated high social support significantly mitigated against suicide, depression, anxiety, and psychological distress. Barriers to support access and both positive and negative impacts on mental health were identified.

CONCLUSIONS

Results underscore the need to consider the distinct support requirements of students with mental health problems, who often face insufficient access to high social support. This emphasises the potential for effective interventions in this population.

The Meaning of Social Support for Mental Health Service-Users: The Case Managers' Perspective

This study sought to understand the unique types of social support salient to mental health service-users from the perspective of case managers. The sample consisted of case managers working in county mental health agencies in the southwest and west coast. Data was gathered from three focus groups and analyzed using NVivo 10 and Consensual Qualitative Research. Six themes were described including relational support, consistency support, validation and affirmation support, social connection support, day-to-day living support and vocational support. While the social support domains described in this study share conceptual underpinnings with traditional conceptualizations of support, our findings reveal unique types of support from the perspective of case managers. Findings from this study offer an important perspective-case managers-to the extant body of research investigating the meaning of social support for people with lived mental health experiences. Of particular interest is the finding that relational support, affirmative and validation support, and consistency support are salient case manager functions.

Association between social capital, mental health, and digital health literacy among the university students in China: a multigroup analysis based on major difference

BACKGROUND

This study aimed to clarify medical-nonmedical difference on the relationship between social capital, mental health and digital health literacy of university students in China, and furtherly provide evidence-based suggestions on the improvement of the digital health literacy for the university students.

METHODS

The snowball sampling method was used to collect data from the university students (including medical students and nonmedical students) through online questionnaires, and finally 1472 university students were included for the data analysis, of whom, 665 (45.18%) were medical students, 807 (54.82%) were nonmedical students; 462 (31.39%) were male, 1010 (68.61%) were female. Mean value of the age was 21.34 ± 2.33 for medical students vs. 20.96 ± 2.16 for nonmedical students. Descriptive analysis, chi-square test analysis, one-way Analysis of Variance (conducted by SPSS) and structural equation modeling (conducted by AMOS) were employed to explore the difference on the relationship between social capital, mental health and digital health literacy between the medical students and nonmedical students.

RESULTS

The mean value of the digital health literacy was 36.27 (37.33 for medical students vs. 35.39 for nonmedical students). The SEM analysis showed that there was a statistically positive correlation between social capital and digital health literacy (stronger among the nonmedical students (0.317) than medical students (0.184)). Mental health had a statistically positive impact on the digital health literacy among medical students (0.242), but statistically significant correlation was not observed in nonmedical students (0.017). Social capital was negatively correlated with the mental health for both medical students and NMS (stronger among the nonmedical students (0.366) than medical students (0.255)). And the fitness indices of SEM were same between medical students and nonmedical students (GFI = 0.911, AGFI = 0.859, CFI = 0.922, RMSEA = 0.074).

CONCLUSION

The digital health literacy of the university student was relatively high. Both social capital and mental health could exert a positive effect on digital health literacy, while social capital was found to be positively associated with mental health. Statistical difference was found between medical students and nonmedical students on the above correlations. Implications were given on the improvement of the digital health literacy among university students in China.

Using the Recovery Capital Model to Explore Barriers to and Facilitators of Recovery in Individuals with Substance Use Disorder, Psychiatric Comorbidity and Mild-to-Borderline Intellectual Disability: A Case Series

Recovery capital (RC) encompasses the wide range of resources individuals can employ to recover from Substance Use Disorder (SUD). It consists of five subdomains: human, social, cultural, financial, and community RC. Negative recovery capital (NRC) represents the obstacles to recovery. Research on (N)RC in complex multimorbid populations is scarce. This study offers an initial exploration of the viability of (N)RC in three individuals with SUD, psychiatric comorbidities, and an intellectual disability (a triple diagnosis) in inpatient addiction treatment. We collected case file data, ranked recovery goals, and conducted follow-up interviews. The data were subjected to template analysis, using (N)RC domains as codes. All domains were prevalent and relevant, showing dynamic and reciprocal effects, influenced by critical life events acting as catalysts. Notably, during treatment, patients prioritized individual skill development despite challenges in other domains. RC emerges as a valuable concept for mapping recovery barriers and facilitators in individuals with a triple diagnosis, serving as an alternative to the medical model and complementing the biopsychosocial model. It provides a systematic framework to assess critical factors for recovery in complex cases and accordingly align interventions. Future studies should explore the intersections of NRC domains and the dynamic nature of (N)RC to enhance the understanding of the challenges faced by individuals with a triple diagnosis.

Exploring the use of social network interventions for adults with mental health difficulties: a systematic review and narrative synthesis

BACKGROUND

People with mental health difficulties often experience social isolation. The importance of interventions to enhance social networks and reduce this isolation is increasingly being recognised. However, the literature has not yet been systematically reviewed with regards to how these are best used. This narrative synthesis aimed to investigate the role of social network interventions for people with mental health difficulties and identify barriers and facilitators to effective delivery. This was undertaken with a view to understanding how social network interventions might work best in the mental health field.

METHODS

Systematic searches using combinations of synonyms for mental health difficulties and social network interventions were undertaken across 7 databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science) and 2 grey literature databases (EThoS and OpenGrey) from their inception to October 2021. We included studies reporting primary qualitative and quantitative data from all study types relating to the use of social network interventions for people with mental health difficulties. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data were extracted and synthesised narratively.

RESULTS

The review included 54 studies, reporting data from 6,249 participants. Social network interventions were generally beneficial for people with mental health difficulties but heterogeneity in intervention type, implementation and evaluation made it difficult to draw definitive conclusions. Interventions worked best when they (1) were personalised to individual needs, interests and health, (2) were delivered outside formal health services and (3) provided the opportunity to engage in authentic valued activities. Several barriers to access were identified which, without careful consideration could exacerbate existing health inequalities. Further research is required to fully understand condition-specific barriers which may limit access to, and efficacy of, interventions.

CONCLUSIONS

Strategies for improving social networks for people with mental health difficulties should focus on supporting engagement with personalised and supported social activities outside of formal mental health services. To optimise access and uptake, accessibility barriers should be carefully considered within implementation contexts and equality, diversity and inclusion should be prioritised in intervention design, delivery and evaluation and in future research.

Mental Health Service Users and Their Caregivers Perspectives on Personal Recovery from Severe Mental Health Conditions in Cape Town, South Africa: A Qualitative Study

Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.

Social network characteristics of Black African and Caribbean people with psychosis in the UK

Poorer social networks predict more coercive pathways to care and other adverse outcomes in people with psychosis. People from Black African and Caribbean backgrounds have more negative experiences within UK mental health care systems and family relationships often breakdown. This study aimed to examine the social network characteristics of Black African and Caribbean people experiencing psychosis and associations between network characteristics and severity of psychosis, negative symptoms, and general psychopathology. Fifty-one participants completed social network mapping interviews (a gold standard approach to assessing social network composition) and the Positive and Negative Syndrome Scale. This is the first study to explicitly measure social network size amongst Black people with psychosis living within the UK and results showed that participants' social network size (mean = 12) was comparable to that of other psychosis samples. Networks were of moderate density and comprised disproportionately more relatives than other relationship types. Poor network quality was related to more severe psychosis symptoms suggesting that social network quality may be an important factor in influencing the severity of psychosis. Findings highlight the need for community-based interventions and family therapies to mobilise sources of social support for Black people with psychosis within the UK.

Living with cystic fibrosis during the COVID-19 pandemic: a social connectedness perspective

Purpose

This study explores the concept of social connectedness for adults with Cystic Fibrosis (CF), generally and during the onset of the COVID-19 pandemic, to help inform contemporary CF healthcare. Social connectedness is an essential component of belonging and refers to an individual’s sense of closeness with the social world. Unique disease factors make exploration of social connectedness pertinent, added to by COVID-19, with the CF population potentially facing increased risk for severe illness.

Methods

Seventeen adults with CF in Western Australia undertook interviews, with findings categorized as overarching themes.

Results

In a general sense, participants described social connectedness challenges caused by CF, despite which they reported meaningful connections that benefits their mental and physical health. Within a COVID-19 specific context, participants demonstrated resilience in the face of adversity, highlighted the importance of empathy in relation to the pandemic, and described how social support is both an outcome and enhancer of social connectedness.

Conclusions

This study contributes to limited social connectedness literature within CF and chronic illness in general, highlighting the importance of social connectedness awareness raising, assessments and interventions in CF healthcare inside and outside the COVID-19 pandemic.

Construing journeys to recovery from psychosis: A qualitative analysis of first-person accounts

PURPOSE

To perform a qualitative analysis of the factors that were construed as salient in facilitating the process of recovery in the narratives of people with psychosis who had their first-person accounts (FPAs) published in an academic journal.

METHODS

Computerized textual analysis was undertaken of 156 FPAs written by persons who had experienced psychosis and published in the Schizophrenia Bulletin between 1979 and 2020. Constructs were extracted from the FPAs and coded in terms of Mental health treatment and therapy, Self-management and Multiple factors; recovery processes (Connectedness, Hope, Identity, Meaning and Empowerment), Struggles and Turning points.

RESULTS

Psychosis impacted on individuals in profound and diverse ways. This was reflected in the different pathways to recovery included in the FPAs. Underlying the different pathways was the salience of re-engagement in the shared reality of others; development of a cohesive and positive self; empowerment through the use of self-management strategies, and making sense of experience through reconstruing what was meaningful. Personal constructs identified in the FPAs provided insight into both challenges faced and alternative avenues of movement that were perceived as available.

CONCLUSIONS

Processes that support individuals re-engaging with the shared reality of others are central to recovery. Supportive relationships and fostering open dialogue were consistent themes across the different pathways that recovery journeys took. Establishing a meaningful lifestyle and recovering a positive sense of identity were a key challenge following psychosis onset. Appreciation of experiences contained in FPAs has the potential to enhance the effectiveness and humanity of mental health care.

Engagement with services in Black African and Caribbean people with psychosis: The role of social networks, illness perceptions, internalized stigma, and perceived discrimination

OBJECTIVES

Research and policies in the United Kingdom have repeatedly highlighted the need to reduce ethnic disparities and improve engagement with mental health services among Black African and Caribbean people with psychosis. The aim of this study was to examine the role of social network characteristics and psychological factors in engagement with services in Black people with psychosis.

METHODS

A cross-sectional study was conducted with 51 Black African and Caribbean adults with non-affective psychosis and currently receiving care from mental health services in England. Measures were completed to examine relationships between social networks, illness perceptions, perceived racial or ethnic discrimination in services, internalized stigma, and current engagement with services from service user and staff perspectives.

RESULTS

Social network composition (ethnic homogeneity) moderately correlated with better service user and staff reported engagement. Greater perceived personal control over problems was associated with better staff reported engagement. Lower perceived ethnic or racial discrimination in services, and specific illness perceptions (higher perceived treatment control, greater self-identification with psychosis symptoms, more concern and greater emotional response related to problems) were associated with better service user reported engagement. Internalized stigma was not associated with service engagement. Multivariate regression analyses suggested that a more ethnically homogenous social network was the strongest predictor of better service user and staff reported engagement.

CONCLUSIONS

Psychosocial interventions that target social networks, perceived ethnic and racial discrimination in services, and illness perceptions may facilitate better engagement and improve outcomes. Further longitudinal studies are required to examine causal mechanisms.

Adapting a social network intervention for use in secondary mental health services using a collaborative approach with service users, carers/supporters and health professionals in the United Kingdom

Background

Social integration, shared decision-making and personalised care are key elements of mental health and social care policy. Although these elements have been shown to improve service user and service-level outcomes, their translation into practice has been inconsistent and social isolation amongst service users persists.

Aim

To co-adapt, with service users, carers/supporters and health professionals, a web-based social network intervention, GENIE™, for use in secondary mental health services. The intervention is designed to support social activity and preference discussions between mental healthcare professionals and service users as a means of connecting individuals to local resources.

Methods

In Phase 1 (LEARN), we completed two systematic reviews to synthesise the existing evidence relating to the i) effectiveness and ii) the implementation of social network interventions for people with mental health difficulties. We undertook semi-structured interviews with a convenience sample of 15 stakeholders previously involved in the implementation of the intervention in physical healthcare settings. Interviews were also conducted with 5 national key stakeholders in mental health (e.g., policy makers, commissioners, third sector leads) to explore wider implementation issues.

In Phase 2 (ADAPT), we worked iteratively with eight service users, nine carers, six professionals/volunteers and our patient and public advisory group. We drew on a framework for experience-based co-design, consisting of a series of stakeholder consultation events, to discuss the use of the social network intervention, in mental health services. Participants also considered factors that could serve as enablers, barriers, and challenges to local implementation.

Results

Across the stakeholder groups there was broad agreement that the social network intervention had potential to be useful within mental health services. In terms of appropriate and effective implementation, such an intervention was predicted to work best within the care planning process, on discharge from hospital and within early intervention services. There were indications that the social connection mapping and needs assessment components were of most value and feasible to implement which points to the potential utility of a simplified version compared to the one used in this study. The training provided to facilitators was considered to be more important than their profession and there were indications that service users should be offered the opportunity to invite a carer, friend, or family member to join them in the intervention.

Conclusion

The GENIE™ intervention has been co-adapted for use in mental health services and a plan for optimal implementation has been co-produced. The next phase of the programme of work is to design and implement a randomised controlled trial to evaluate clinical and cost effectiveness of a simplified version of the intervention.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08521-1.

Use of generic social services and social integration of patients with a severe mental illness in Belgium: Individual and services network determinants

BACKGROUND

Patients with severe mental illnesses (SMI) have low levels of social integration, which could be improved if they used social services. To our knowledge, however, the extent to which they use generic social services remains unknown.

AIMS

We assessed the extent to which patients with SMI use generic social services and the factors that may drive that usage.

METHOD

In 2014, we carried out a multi-setting clustered survey of patients with severe mental disorders (n = 1,019, participation rate = 71%) and of services (n = 517, participation rate = 53%) in 19 networks of services, covering most of Belgium. On the one hand, we asked patients, amongst other, about their health condition, their social integration in the community, and their use of social services of different types. On the other hand, we asked each service to report on its relationships with other services in the services networks.

RESULTS

On average, patients' use of generic social services within the previous 6 months was low (6%-16%), with the exception of administrative services. There were few differences in usage according to the severity of patients' symptoms, but some differences according to gender and age were observed. Social integration was improved when generic social services were more central in the networks.

CONCLUSIONS

We suggest that generic social services should be more central in mental health services networks.

A Study From a Psychological Perspective of High Performance to Explore the Relationship Among Resource Bricolage, Social Capital, Entrepreneurial Attitude, and Intention

COVID-19 caused a serious increase in competition due to limited resources. Obviously, it influenced the entrepreneurs' motivation. The entrepreneurial intention, social capital, and resource bricolage ability of individuals were important issues. Thus, exploring an individual's mindset from a psychological perspective of high performance was the advanced issue to deal with social capital promotion. This study developed an instrument adapted from related scales that consisted of 27 items and four factors: social capital, entrepreneurial attitude, resource bricolage, and entrepreneurial intention. The data was collected through an online survey in China and Taiwan by purposive sampling. A total of 692 valid samples provided data for the statistical process. A multiple regression technique was employed in the data process. The instrument passed the validity and reliability test. Data analysis results showed that social capital can positively predict entrepreneurial attitude and entrepreneurial intention. Furthermore, entrepreneurial attitude will affect entrepreneurial intention dramatically. Yet, resource bricolage ability has no moderating effect on social capital and entrepreneurial intention. In addition, resource bricolage ability plays a moderating role between entrepreneurial attitude and entrepreneurial intention. Moreover, it was found that participants demonstrated a high entrepreneurial intention when there was a high entrepreneurial attitude with high resource bricolage ability when the moderating effect was examined. In this study, some practical suggestions are provided for researchers, educators, and entrepreneurs.

Picturing healthcare: a photovoice study of how healthcare is experienced by service users in a mental-health low threshold service

Background

A recent policy change dictates that all mental healthcare in Norway must be referred and documented in the medical record of the service users. This has not been the case within low threshold mental health services, which is services without referrals, social arenas where healthcare professionals are available and where service users themselves can choose to attend based on their self-reported needs. This challenges the idea of “healthcare” being a medical term as opposed to experienced and expressed by the service user.

A new healthcare understanding that includes the service users’ voices are thus needed, and the aim of this study is to explore how service users within low threshold services, understand, describe, and experience healthcare.

Methods

The present study has used the photovoice approach to explore how four service users perceive and experience healthcare in a low threshold context. The chosen photovoice method enabled service users to reflect upon and communicate their experiences first visually by individual pictures and thereafter reflective texts emerged through seven workshops. A qualitative thematic analysis was performed based on the pictures, notes and audiotaped material from the workshops.

Results

The analysis found three main themes showing how healthcare is experienced: availability of people, availability of places and availability of activities. This is illustrated through the following sub-themes: First, common community, good relations and fellowship, second, flexible and easily accessible support, which includes the opportunity to spend time and to try things out in a safe environment, and third, facilitation and motivation for participation and activity, given the opportunity to have a meaningful role and be seen as a resourceful human being.

Conclusions

A new understanding of healthcare is needed in the context of recovery-oriented low threshold services, as today`s largely medical understanding of healthcare is challenging to connect to a relational, recovery-oriented understanding of healthcare. As healthcare are to be documented in service users medical record, further research should explore how to document healthcare based on a new or extended, relational understanding of healthcare.

Employment related barriers and facilitators for people with psychiatric disabilities in Spain

BACKGROUND: People with mental health-related disabilities still experience difficulties in obtaining and maintaining a job. Previous international studies inform about employment barriers and facilitators but there is insufficient research in Spain. OBJECTIVE: To explore what type of employment barriers and facilitators were important for people with psychiatric disabilities with past work experiences in competitive and protected work settings. METHODS: In-depth, semi-structured qualitative interviews with 24 participants selected through purposive sampling. RESULTS: The personal sphere was the content most closely related to barriers, followed by the social environment. Facilitators were more closely related to the interviewees’ social network, followed by elements in their personal sphere and job environment. CONCLUSIONS: The findings suggest the need to implement supported employment services in Spain to promote hiring people with psychiatric disabilities in competitive companies. The results also indicate the need to implement new services aimed at supporting the management of disability information during the process of obtaining and maintaining a job, while there is still a need to conduct anti-stigma and anti-discrimination campaigns.

'Modelling social exclusion in a diagnostically-mixed sample of people with severe mental illness'

BACKGROUND

Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion.

AIMS

(1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness.

METHOD

Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations.

RESULTS

About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age (p = .008), lack of higher education (p < .001), more previous admissions (p = .005), severity of current symptoms and greater experienced stigma (p = .006) and anticipated stigma (p = .035). Greater social inclusion was associated with better quality of life (p < .001) and less loneliness (p < .001).

CONCLUSIONS

Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people's social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.

Person-Centered Care Considerations for End-of-Life Care to Persons With Severe and Persistent Mental Illness

Various factors impact end-of-life (EOL) for older adults. This period is more complex for older adults with severe and persistent mental illness (SPMI). The current article aims to explore a non-exhaustive list of person-level and environmental factors that may impact EOL for older adults with SPMI. [Journal of Gerontological Nursing, 48(3), 11-16.].

Assessing the effectiveness of social network interventions for adults with a diagnosis of mental health problems: a systematic review and narrative synthesis of impact

BACKGROUND

Social connections have been linked to the genesis and amelioration of mental health problems and thus have potential therapeutic value.

PURPOSE

To identify the current evidence base, assess risk of bias and synthesise findings on the effectiveness of social network interventions for people with mental health problems.

METHODS

Electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science, Scopus) and grey literature databases were systematically searched from inception to October 2021 using free text syntax combining synonyms for 'mental health problems' and 'social network interventions'. Articles were eligible for inclusion if they reported data from randomised controlled trials on the effectiveness of interventions designed to improve social networks for adults (18+) with mental health problems. Papers were independently reviewed for inclusion with conflicts resolved through consensus. Included papers were quality assessed and data extracted and synthesized narratively. Risk of bias was assessed using the Cochrane Risk of Bias Tool.

RESULTS

Nine studies randomising 2226 participants were included. Four focused on those with a diagnosis of schizophrenia or psychosis, one on major depressive disorder and four included all types of mental health diagnoses. The current evidence base is of unclear quality. However, interventions which focused on supporting social activities appear to hold the most promise for enhancing social networks. Data on cost-effectiveness and research acceptability were limited, but suggest the potential economic feasibility of and acceptability for evaluating these interventions.

CONCLUSION

There is emerging evidence that social network interventions can be effective in improving social connections for people with mental health problems. However, further evaluations with robust methodological approaches are required to inform evidence-based recommendations for health services.

Wellbeing and Social Network Characteristics in Rural Communities: Findings from a Cohort in Social Housing in Cornwall, United Kingdom

The mental wellbeing of those living in resource poor and rural localities is a public health priority. Despite evidence of a link between social networks and mental wellbeing, little is known about this relationship in the context of rural and resource poor environments. The current study uses novel social network methodology to investigate the extent to which social network size and composition is related to mental wellbeing in a social housing community in rural England. Data come from 88 individuals living in social housing in Cornwall. These participants are part of a larger study of 329 social housing households surveyed in 2017 and 2018. Mental wellbeing was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). A series of multivariable linear regression models were used to test associations between social network characteristics and mental wellbeing. Social network size was significantly associated with the SWEMWBS (b = 0.39, p < 0.01), such that individuals with larger networks reported better mental wellbeing, but after controlling for community social cohesion, this effect dissipated. Neither gender composition or talking with network members about health and wellbeing were significantly associated with the SWEMWBS. Findings suggest that both the quantity of social connections and perceptions of community cohesion are moderately associated with mental wellbeing in rural and resource poor localities. As such, efforts to improve mental wellbeing would benefit from targeting multiple aspects of social relationships, rather than focusing solely on increasing the size of individuals' social networks.

A cross-sectional study addressing the importance of work and other everyday activities for well-being among people with mental illness: does additional vulnerability matter?

BACKGROUND

Work and other everyday activities are beneficial for well-being among people with mental illness, but poor circumstances can create detrimental effects, possibly aggravated by additional vulnerabilities linked with their mental illness. This study aimed to investigate how activity factors were related to well-being and functioning among three vulnerable groups using outpatient mental health care - young people with psychosis, people with a history of substance use disorder (SUD), and immigrants with post-traumatic stress disorder (PTSD) - while controlling for vulnerability group, age and gender.

METHODS

Participants represented the three types of vulnerability (n = 46/57/39). Data collection, using self-report and interviewer-rated questionnaires, concerned aspects of everyday activity (work experiences; views of the worker role; satisfaction with everyday occupations; activity level), well-being (quality of life: life and health; quality of life: environmental aspects; recovery) and functioning (psychosocial functioning; symptom severity). Spearman correlations and General Linear Modelling were used.

RESULTS

Activity satisfaction was positive (p < 0.001) but recent work experience negative (p = 0.015) for the life and health aspect of quality of life. Activity satisfaction was positive for the environmental aspects of quality of life (p < 0.001). Resources for having a worker role (p < 0.001) and belief in having a future worker role (p = 0.007) were positively associated with better recovery. Activity level (p = 0.001) and resources for having a worker role (p = 0.004) showed positive associations with psychosocial functioning. Belief in a future worker role (p = 0.011) was related with symptom level. Women had less severe symptoms in the young group with psychosis. Regarding vulnerability group, young people with psychosis perceived better quality of life; those with a history of SUD had less severe psychiatric symptoms; and the recent immigrants with PTSD had the highest level of psychosocial functioning.

CONCLUSION

Work experience may not be conducive to well-being in itself; it is satisfaction with work and other activities that matters, and worker and employer expectations need alignment. No vulnerability group seemed consistently more disadvantaged regarding well-being and functioning, but the fact that differences existed is vital to acknowledge in activity-based rehabilitation. Inquiring about meaningful activities and providing opportunities for executing them would be a fruitful way of support.

Influences on participation in a programme addressing loneliness among people with depression and anxiety: findings from the Community Navigator Study

BACKGROUND

Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions.

METHODS

Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study's working group, which included experts by experience, clinicians and researchers.

RESULTS

The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant's relationship with the Community Navigator.

CONCLUSIONS

We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual's participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.

The personal social network of psychiatric service users

BACKGROUND

For psychiatric service users, the personal social network offers resources such as behavioural guidance, social support, and coherence of care delivery. So far, most research on the subject has assessed the availability of these resources using size and composition measures. However, the availability of network resources also depends on the cohesion of the relationships between network members, a topic that is rarely addressed in the literature.

AIMS

In this article, we aim to describe the cohesion of psychiatric service users' networks.

METHOD

We carried out a personal network survey and collected data on the social networks of 380 service users recruited in outpatient and inpatient services in Belgium. We used an ego-network mapping technique. The data were analysed using several structural metrics describing size, composition, and cohesion. We carried out analysis of variance (ANOVA) in relation to residential status, level of education, psychiatric history, and psychosocial functioning and analysed three cohesion indicators (density, fragmentation, and centralisation) with regression analyses.

RESULTS

Personal social networks were small and not very cohesive. Most were composed of a dense subgroup as well as several isolated network members. The analyses revealed that highly educated psychiatric service users had more fragmented networks, while users living in independent accommodation had less dense networks. Density and fragmentation were not associated with the severity of psychosocial functioning, whereas centralisation was.

CONCLUSIONS

The low level of cohesion may indicate that service users aim to access multiple and diverse social resources and that better-off service users are more successful at doing so. On the whole, however, these personal social networks were fragile, because they contained a high number of isolated network members. Finally, it could be beneficial for professionals to pay special attention to the central persons within the networks of psychiatric service users.

Opportunities, Enablers, and Barriers to the Use of Recorded Recovery Narratives in Clinical Settings

Background: Recorded Recovery Narratives (RRNs) describing first-person lived experience accounts of recovery from mental health problems are becoming more available. Little is known about how RRNs can be used in clinical practice and clinical education. Aims: The aim of this paper is to enable implementation planning for RRN interventions by identifying determinants of uptake. The objective was to identify opportunities, barriers, and enablers to the uptake of RRN interventions in clinical practice and education. Method: Three phases of focus groups were conducted with multi-professional mental health clinicians. Phase 1 (4 groups, n = 25) investigated current and possible uses of RRNs, Phase 2 (2 groups, n = 15) investigated a specific intervention delivering recovery narratives. Phase 3 (2 groups, n = 12) investigated clinical education uses. Thematic analysis was conducted. Results: RRNs can reinforce the effectiveness of existing clinical practices, by reducing communication barriers and normalizing mental health problems. They can also extend clinical practice (increase hope and connection, help when stuck). Clinical considerations are the relationship with care pathways, choice of staff and stage of recovery. In educational use there were opportunities to access lived experience perspectives, train non-clinical staff and facilitate attitudinal change. Barriers and enablers related to design (ability to use online resources, accessibility of language, ability to individualize choice of narrative), risk (triggering content, staff skills to respond to negative effects), trust in online resource (evidence base, maintenance), and technology (cost of use, technology requirements). Conclusions: RRNs can both improve and extend existing clinical practice and be an important educational resource. RRNs can improve engagement and hope, and address internalized stigma. Beneficially incorporating RRNs into clinical practice and education may require new staff skills and improved technological resources in healthcare settings. Future work could focus on the use of peer support workers views on RRN use and how to avoid unnecessary and unhelpful distress. Trial Registration Number: Work in this paper has informed three clinical trials: ISRCTN11152837; ISRCTN63197153; ISRCTN76355273.

The influence of personal communities in understanding avoidable emergency department attendance: qualitative study

BACKGROUND

Use of emergency department (ED) care globally seems to be increasing at a faster rate than population growth (Baker, House of Commons Library. Accident and Emergency Statistics, Demand, Performance, 2017). In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment (NHS Digital, Hospital Accident and Emergency Activity 2016-17, 2019) is cited as evidence that these patients did not require this level of care. The solution to not using the most appropriate point in the system has traditionally been seen as a knowledge problem, requiring, improved sign-posting and information to enable people to self-manage or use health care management for minor ailments. However research about help-seeking behaviour suggests that the problem may not be an informational one. A considerable literature points to help seeking as a social process influenced by a range of contingencies and contextual factors including the way in which lay people influence health care utilisation (Giebel et al. BMJ Open 9:1, 2019). Personal communities comprise a variety of active and significant social ties which have potential to influence individual capacity to seek help. Here we extend and unpack further influencing decisions about seeking formal health care with reference to how they are shaped and informed by and within personal social networks.

METHODS

We undertook a personal network mapping and qualitative interview-based study to look at, problematize and understand attendance for non-urgent problems. We used network analysis and methods to map and characterise the personal communities of people seeking help from ED for minor ailments and semi-structured interviews with 40 people attending a single ED and associated GP hub providing equivalent care. Interviews were built around an ego network mapping activity and a topic guide structured to explore attender's narratives about why they had visited the ED. This ego network activity uses a diagram consisting of three concentric circles (Fiori et al. J Gerontol B-Psychol 62: 322-30, 2007), representing closest social network members (in the centre) and those at further distance. Participants were initially presented with one of these diagrams and asked to write names of people or resources that had played a role in their attendance and the interviewer probed the interviewee to discuss the actions, input and value of the people and services that supported the visit to the ED.

RESULTS

We analysed number and type of network connections and undertook a thematic analysis to identify how imagined and actual network members and influences were implicated in ED attendance. The network maps created during the interviews were examined and a typology of networks was developed and used to distinguish different types of networks informed by our reading of the data, and a Network Typology Scoring Tool, a measure of frequency of contact and relationship type in networks.

CONCLUSIONS

Our study suggests that faced with acute minor illness or injury people's networks narrow: they do not (and perhaps cannot) mobilise their imagined care network because the resources or connections may not be there or are difficult to engage. In addition we identified important system drivers of behaviour, notably that these patients are often directed to the ED by 'professional influencers' including health services staff.

Schizophrenia Psychosis in Women

A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women’s reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status.

The Community Navigator Study: Results from a feasibility randomised controlled trial of a programme to reduce loneliness for people with complex anxiety or depression

Background

Loneliness is common among people with mental health problems and predicts poorer recovery from depression and anxiety. Needs for support with loneliness and social relationships are often under-addressed in mental health services.

The Community Navigator programme was designed to reduce loneliness for adults (aged 18 and above) with complex depression or anxiety who were using secondary mental health services. Acceptability and feasibility of the programme and a trial evaluation were tested in a feasibility randomised controlled trial with qualitative evaluation.

Methods

Forty participants with depression or anxiety using secondary mental health services were recruited from mental health services in two London sites and randomised to receive: the Community Navigator programme over six months in addition to routine care (n = 30); or routine care (n = 10). Measures of loneliness, depression, other clinical and social outcomes and service use were collected at baseline and six-months follow-up. Levels of engagement in the programme and rates of trial recruitment and retention were assessed. Programme delivery was assessed through session logs completed by Community Navigators. The acceptability of the programme was explored through qualitative interviews (n = 32) with intervention group participants, their family and friends, programme providers and other involved staff.

Results

Forty participants were recruited in four months from 65 eligible potential participants asked. No one withdrew from the trial. Follow-up interviews were completed with 35 participants (88%). Process records indicated the programme was delivered as intended: there was a median of seven meetings with their Community Navigator (of a maximum ten) per treatment group participant. Qualitative interviews indicated good acceptability of the programme to stakeholders, and potential utility in reducing loneliness and depression and anxiety.

Conclusions

A definitive, multi-site randomised controlled trial is recommended to evaluate the effectiveness and cost-effectiveness of the Community Navigator programme for people with complex anxiety and depression in secondary mental health services.

Negotiating support from relationships and resources: a longitudinal study examining the role of personal support networks in the management of severe and enduring mental health problems

BACKGROUND

Personal communities or personal support networks comprise a variety of social ties considered important to individuals in their everyday lives. This set of active and significant ties influence the capacity to manage mental health problems because of the potential to access social support. However, little is known in the context of people's everyday management of mental health about how relationships with people, places, objects and activities are navigated and negotiated. This study aimed to explore the nature and negotiation of support from personal communities in the everyday management of severe and enduring mental health problems.

METHODS

A longitudinal qualitative study undertaken in the UK incorporating 79 interviews with 29 participants based on personal network mapping. 29 users of mental health services with a diagnosis of severe and enduring mental illness were interviewed at three time points. Data was analysed using an inductive thematic approach underpinned by the Network Episode Model.

RESULTS

The presence and maintenance of interpersonal trust was a fundamental condition of the relational work required to develop, undertake and sustain relationships with others. Whilst relationships with spouses, family members and friends were generally viewed positively, the work required to engage human others was contingent, vicarious and overlain with felt and enacted stigma. Developing relationships with others was hindered by a lack of confidence fuelled by the experience of mental illness and a fear of rejection or failure. By contrast, weaker ties and inanimate objects and places offered and provided a sense of reliability and security. Strategies employed by participants in order to garner sufficient support for condition management in the light of these particular challenges are illuminated by the discussion of who and what is relevant and valued in personal support networks.

CONCLUSIONS

Access to valued activities, hobbies and things should be considered alongside human relationships in providing a means of ongoing support and resource for the everyday management of life for those experiencing severe and enduring mental health problems.

Repeated Police Mental Health Act Detentions in England and Wales: Trauma and Recurrent Suicidality

Most police Mental Health Act (Section 136) detentions in England and Wales relate to suicide prevention. Despite attempts to reduce detention rates, numbers have risen almost continually. Although Section 136 has been subject to much academic and public policy scrutiny, the topic of individuals being detained on multiple occasions remains under-researched and thus poorly understood. A mixed methods study combined six in-depth interviews with people who had experienced numerous suicidal crises and police intervention, with detailed police and mental health records. A national police survey provided wider context. Consultants with lived experience of complex mental health problems jointly analysed interviews. Repeated detention is a nationally recognised issue. In South East England, it almost exclusively relates to suicide or self-harm and accounts for a third of all detentions. Females are detained with the highest frequencies. The qualitative accounts revealed complex histories of unresolved trauma that had catastrophically damaged interviewee’s relational foundations, rendering them disenfranchised from services and consigned to relying on police intervention in repeated suicidal crises. A model is proposed that offers a way to conceptualise the phenomenon of repeated detention, highlighting that long-term solutions to sustain change are imperative, as reactive-only responses can perpetuate crisis cycles.

Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study

INTRODUCTION

Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs.

METHODS AND ANALYSIS

Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping.

ETHICS AND DISSEMINATION

This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences.

Development and Evaluation of a Recovery College Fidelity Measure

OBJECTIVE

Recovery Colleges are widespread, with little empirical research on their key components. This study aimed to characterize key components of Recovery Colleges and to develop and evaluate a developmental checklist and a quantitative fidelity measure.

METHODS

Key components were identified through a systematized literature review, international expert consultation (n = 77), and semistructured interviews with Recovery College managers across England (n = 10). A checklist was developed and refined through semistructured interviews with Recovery College students, trainers, and managers (n = 44) in 3 sites. A fidelity measure was adapted from the checklist and evaluated with Recovery College managers (n = 39, 52%), clinicians providing psychoeducational courses (n = 11), and adult education lecturers (n = 10).

RESULTS

Twelve components were identified, comprising 7 nonmodifiable components (Valuing Equality, Learning, Tailored to the Student, Coproduction of the Recovery College, Social Connectedness, Community Focus, and Commitment to Recovery) and 5 modifiable components (Available to All, Location, Distinctiveness of Course Content, Strengths Based, and Progressive). The checklist has service user student, peer trainer, and manager versions. The fidelity measure meets scaling assumptions and demonstrates adequate internal consistency (0.72), test-retest reliability (0.60), content validity, and discriminant validity.

CONCLUSIONS

Coproduction and an orientation to adult learning should be the highest priority in developing Recovery Colleges. The creation of the first theory-based empirically evaluated developmental checklist and fidelity measure (both downloadable at researchintorecovery.com/recollect ) for Recovery Colleges will help service users understand what Recovery Colleges offer, will inform decision making by clinicians and commissioners about Recovery Colleges, and will enable formal evaluation of their impact on students.

Social networks and symptomatic and functional outcomes in schizophrenia: a systematic review and meta-analysis

PURPOSE

To conduct a systematic review and meta-analysis to examine the strength of associations between social network size and clinical and functional outcomes in schizophrenia.

METHOD

Studies were identified from a systematic search of electronic databases (EMBASE, Medline, PsycINFO, and Web of Science) from January 1970 to June 2016. Eligible studies included peer-reviewed English language articles that examined associations between a quantitative measure of network size and symptomatic and/or functional outcome in schizophrenia-spectrum diagnoses.

RESULTS

Our search yielded 16 studies with 1,929 participants. Meta-analyses using random effects models to calculate pooled effect sizes (Hedge's g) found that smaller social network size was moderately associated with more severe overall psychiatric symptoms (N = 5, n = 467, g = - 0.53, 95% confidence interval (CI) = - 0.875, - 0.184, p = 0.003) and negative symptoms (N = 8, n = 577, g = - 0.75, 95% CI = - 0.997, - 0.512, p = 0.000). Statistical heterogeneity was observed I² = 63.04%; I² = 35.75%,) which could not be explained by low-quality network measures or sample heterogeneity in sensitivity analyses. There was no effect for positive symptoms (N = 7, n = 405, g = - 0.19, 95% CI = 0.494, 0.110, p = 0.213) or social functioning (N = 3, n = 209, g = 0.36, 95% CI = - 0.078, 0.801, p = 0.107). Narrative synthesis suggested that larger network size was associated with improved global functioning, but findings for affective symptoms and quality of life were mixed.

CONCLUSION

Psychosocial interventions which support individuals to build and maintain social networks may improve outcomes in schizophrenia. The review findings are cross-sectional and thus causal direction cannot be inferred. Further research is required to examine temporal associations between network characteristics and outcomes in schizophrenia and to test theoretical models relating to explanatory or mediating mechanisms.