Supportive behaviors in natural support networks of people with serious mental illness.

OBJECTIVE: A significant number of people with mental illness do not use mental health services to receive treatment for their symptoms. This study examined the hypothesis that social network and social support affect mental health service use. METHODS: Data were from the Baltimore cohort of the Epidemiologic Catchment Area study, a prospective cohort study that gathered data over four time points. This study examined data gathered in 1993–1996 (N=1,920) and 2004–2005 (N=1,071). The study examined indicators of social network and social support in relation to four types of service use (general medical, mental health within general medical, specialty psychiatric, and other human services) with multivariate logistic regression. Examples of other human services include a self-help group or crisis center for help with any psychological problem. Weighted generalized estimating equations were used for the analyses. RESULTS: Among persons with major depressive disorder, generalized anxiety disorder, panic disorder, or alcohol use disorder in the past year or psychological distress in the past few weeks, general medical service use was reduced when the frequency of contact with relatives or friends occurred less than daily, but it was increased by about 40% when there was a higher than median level of spousal support. In contrast, receiving general medical services for mental health problems was reduced by about 50% when there was a higher than median level of social support from relatives. Specialty psychiatric service use was reduced when there was regular contact with six or more relatives and there was a higher than median level of social support from friends and relatives. None of the social network or social support measures were significantly (p≤.01) associated with use of other human services. CONCLUSIONS: Increased contact with the social network and higher levels of social support were associated with greater use of general medical services. However, more social support was associated with use of fewer services within the specialty psychiatric sector.

IntroductionWorking conditions and social support given from organization have a significant impact on employees for working for a long time. Confidence of employees to their jobs is related to the things that they live. Autonomy of employees in the organization affects the level of social suport perceived by employees (Eisenbergerand etc., 1999: 1026-1040).While the concept of social support had been a defined and measured concept until the 1980s, the concept of organizational support has been a topic of discussion for nearly 70 years (Zagenczyk, 2006: 8). Social support can be defined as a perception that is related to supporting level of behaviors of individuals provided by social networks like school, close-friend, classmates, teacher, father and mother for increasing functions of individuals and/or providing a buffer zone against negative consequences (House & Kahn, 1985: 83, 108; Malecki & Demaray, 2006: 375-395). It is also regarded as social and psyhchological support (Yildirim, 1997: 81-87) that an individual gets from his/her environment. Social support can be said to be indispensable because it helps people to dissolve their problems, helps people to reduce stress, helps people to adopt to environment and make people to feel better psychologically.Social support is the primary determinant of one's own characteristic. A family member can perceive all of other family members as a supporter or an obstacle. The second determinant of the perceived support is the person whom support taken from. The person who provides social support doesn't get as much attention as the person who perceives social support in the literature. However, perceptions of support may reflect the characteristic of the person whom support taken from. The third determinant of the perceived support is interaction between the person who perceives support and the person whom support taken from. This special interaction reflects the special situation between two people (Yalcin, 2004: 45). Perceived social support can be evaluated as perceptions and expectations that can be taken from reliable individulas around him/her when needed.The buffer effect model and the main effect model have been proposed as two basic models about in which situations social support is necessary. The buffer effect model based on idea of providing source from the individuals in the social support network in order to overcome problems when faced stressful events. According to the main affect model, social support sources are effective factors on the protection of individulas' psychological and physical health without considering whether the individual is under stress or not (Krespi, 1993; Cohen & Wills, 1985: 310-357).When evaluated in terms of teachers, social support offers facilities for professional dialogue and cooperation between colleagues and offers solutions to understanding and solving problems at schools. In this cooperation and support process, teachers help and support each other more (Kroger, 1995: 545-551). Teachers are able to cooperate and support each other inside and outside the classroom through formal and informal ways. Systems that provide support for teachers can be classified as group directed by outside consultant, teacher support team and teacher support groups for individual teachers. Informal approach between colleagues may take place during coffee and tea breaks, in the corridor or in any social environment. This informal support is also important in the formation of collaborative environment in the school. The formal approaches for cooperation of colleagues are coaching and mentoring applications (Creese and etc., 1998: 109-114; Berardi & Hall, 2007; Tastan, 2008: 114). Because teaching profession is a quite stressful profession, teachers' perception of professional social support is very important. When teachers face irrelevant and low-motivated students in classrooms and receive low supports for improving their working conditions they may feel lonely. …

Suicide is a devastating public health problem, and research indicates that people with prior attempts are at the greatest risk of completing suicide, followed by persons with depression and other major mental and substance use conditions. Because there has been little direct input from individuals with serious mental illness and a history of suicidal behavior concerning suicide prevention efforts, this study examined how this population copes with suicidal thoughts. Participants in 14 regional consumer-run Hope Dialogues in New York State (N=198) wrote up to five strategies they use to deal with suicidal thoughts. Strategies were classified according to grounded theory. First responses included spirituality, talking to someone, positive thinking, using the mental health system, considering consequences of suicide to family and friends, using peer supports, and doing something pleasurable. Although a majority reported that more formal therapeutic supports were available, only 12% indicated that they considered the mental health system a frontline strategy. Instead, respondents more frequently relied on family, friends, peers, and faith as sources of hope and support. Consumers' reliance on formal therapeutic supports and support from peers and family suggests that education and support for dealing with individuals in despair and crisis should be targeted to the social networks of this high-risk population. The disparity between availability of formal mental health services and reliance on them when consumers are suicidal suggests that suicide prevention efforts should evaluate whether they are effectively engaging high-risk populations as they struggle to cope with despair.

Opportunities in mental health services research.

Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder. A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients' clinical status varied widely, separate models were run for patients who were euthymic for at least three-fourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma. In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient. Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as "different" during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients' illness states.

Factors Associated With Stigma Among Caregivers of Patients With Bipolar Disorder in the STEP-BD Study

BackgroundDiabetes remains a major health problem in the United States, affecting an estimated 10.5% of the population. Diabetes self-management interventions improve diabetes knowledge, self-management behaviors, and clinical outcomes. Widespread internet connectivity facilitates the use of eHealth interventions, which positively impacts knowledge, social support, and clinical and behavioral outcomes. In particular, diabetes interventions based on virtual environments have the potential to improve diabetes self-efficacy and support, while being highly feasible and usable. However, little is known about the patterns of social interactions and support taking place within type 2 diabetes–specific virtual communities.ObjectiveThe objective of this study was to examine social support exchanges from a type 2 diabetes self-management education and support intervention that was delivered via a virtual environment.MethodsData comprised virtual environment–mediated synchronous interactions among participants and between participants and providers from an intervention for type 2 diabetes self-management education and support. Network data derived from such social interactions were used to create networks to analyze patterns of social support exchange with the lens of social network analysis. Additionally, network correlations were used to explore associations between social support networks.ResultsThe findings revealed structural differences between support networks, as well as key network characteristics of supportive interactions facilitated by the intervention. Emotional and appraisal support networks are the larger, most centralized, and most active networks, suggesting that virtual communities can be good sources for these types of support. In addition, appraisal and instrumental support networks are more connected, suggesting that members of virtual communities are more likely to engage in larger group interactions where these types of support can be exchanged. Lastly, network correlations suggest that participants who exchange emotional support are likely to exchange appraisal or instrumental support, and participants who exchange appraisal support are likely to exchange instrumental support.ConclusionsSocial interaction patterns from disease-specific virtual environments can be studied using a social network analysis approach to better understand the exchange of social support. Network data can provide valuable insights into the design of novel and effective eHealth interventions given the unique opportunity virtual environments have facilitating realistic environments that are effective and sustainable, where social interactions can be leveraged to achieve diverse health goals.

Fone and his colleagues ask us to consider the relationship between area-level social cohesion and individual mental health. At the outset readers should appreciate that population measures of mental health distress, similar to the one used by Fone et al. have been shown to be significantly related to measures of serious mental health disorders. While there are variations in the quality of these measures, with some providing greater efficiency than others, the emergent evidence suggests that brief, structured screening scales of mental health distress can reproduce classifications based on lengthier clinical interviews of mental disorders. Such measurement studies are important in ‘cross-walking’ the findings between routine community surveys of mental health distress with the less frequent and more intense efforts of clinical epidemiology to estimate the prevalence of specific mental health disorders in population surveys. These mental health measures provide an important indication of population well-being. In global burden of disease parlance, mental health disorders are prevalent and associated with a substantial personal, social and economic burden. In developed countries, their share of the global burden of disease is predicted to increase. When they occur they tend to be persistent across the lifecourse, are largely untreated, costly when they are treated, and associated with inequities in the delivery of health care that lead to significantly higher levels of physical health morbidity and mortality in individuals with mental health disorders. Of the many determinants of mental health status studied to date most have been estimated at the individual level with little attention or opportunity to demonstrate mesoand macrolevel influences. Fone et al. bring forward such evidence and show that income deprivation and social cohesion at the small-area level are significantly and independently associated with poor mental health status. Moreover, the effect of income deprivation on mental health status is reduced in areas of high social cohesion and is greater in areas of low social cohesion. In their multi-level analyses they show that this effect modification operates at the community level, not the individual level. In practical terms they suggest that in deprived areas, high levels of community social cohesion based on friendships, visiting, and borrowing and exchange of favours with neighbours is potentially of importance in protecting mental health. So, we add this observation to growing efforts to document how outcomes in physical health and (now) mental health at an individual level vary with characteristics defined and measured at the level of groups—be they families, neighbourhoods, or in this case, small areas. The value of the current contribution is provisional and the authors say this in several ways. Early in their presentation they call for greater clarity in concepts, definitions, measures and the operational procedures for studying causal links between the social environment and health. They later note that no inferences about cause can be made from their cross-sectional data and call for longitudinal methods to investigate causal pathways. The documented effects in their present contribution invite consideration of the next steps and the authors do this by way of calling for better science and theory. What might some of these improvements to future research in this area entail? Certainly advances are needed in both theory and measures. At present there is a plethora of proposed social capital measures in the absence of highly articulated and specified theoretical models that differentiate these measures and test how they mediate outcomes of interest. As one adds levels to a model, theoretical differentiation and measurement precision need to be applied within each level in order to attain theoretical clarity and fidelity about the links between, in this case, social support, social capital and the proposed mechanisms that operate to produce changes in the outcome of interest. For example, at the level of individuals, measures of social support are commonly used in community and clinical epidemiology. In his review of concepts, measures and models, Barrera noted that the term social support is ‘insufficiently specific to be useful as a research concept’ and instead argued for more specific terminology to distinguish social support concepts along with more molar measures to test their association with outcomes of interest. Since then, social support concepts and measures have been differentiated along three principal domains: the extent to which individuals are attached to significant others as measured by their social ties, participation in organizations, contact with friends and family and/or the complexity of their social network (e.g. social embeddedness); the individual’s cognitive appraisal Curtin University of Technology and the Telethon Institute for Child Health Research, PO Box 855, West Perth, 6872, Western Australia. E-mail: S.Zubrick@curtin.edu.au Published by Oxford University Press on behalf of the International Epidemiological Association The Author 2007; all rights reserved. International Journal of Epidemiology 2007;1–3 doi:10.1093/ije/dym040

10.1176/appi.ps.59.1.105

Objectives : This study aims to explore how social support and social network are related with health behavior. Methods : The target population was 12,449 people in Chungcheongbuk-do. The sample was accrued for the period of 3 months in 2008 by face to face interview of direct visiting from systematic sampling method. The instruments used in this study were social support, social network and health behavior. Results : There was significant difference in the level of social support and social network by sex, age, educational level, occupation, and monthly income(p<0.05). There was significant difference in the level of social support by alcohol drinking, physical exercise. There was significant difference in the level of social network by smoking, alcohol drinking, physical exercise, obesity(p<0.05). Multivarite analysis shows significant difference in the level of social instrumental support by smoking, physical exercise. It shows significant difference in the level of social emotional support by smoking. It also shows significant difference in the level of social network by smoking, physical exercise. Conclusion : These results suggest that social support and social network may be associated with health behavior. Because this study was cross sectional research, the order was not found between social support, social network and health behavior. Through a study on monitoring, we will obtain more information for relationship.

The COVID-19 Pandemic: Setting the Mental Health Research Agenda

The Differential Effects of Social Support on the Psychological Well-Being of Aging Mothers of Adults With Mental Illness or Mental Retardation* Jan S. Greenberg**, Marsha Mailick Seltzer, Marty Wyngaarden Krauss, and Hea-won Kim Aging mothers of adults with mental illness and aging mothers of adults with mental retardation were contrasted with respect to their levels of stress, social support resources and the extent to which social support was predictive of their level of caregiving burden and depressive symptoms. Although mothers of adults with mental illness had smaller social support networks than mothers of adults with mental retardation, they were more likely to be members of support groups and have at least one friend also caring for a relative with disabilities. In addition, social support was a more prominent predictor of changes in burden and depressive symptoms in mothers of adults with mental illness, suggesting the importance of the social context for their psychological well-being. Key Words: caregiver burden, caregiving, mental illness, mental retardation, social sup port, support groups. In recent years, research attention has focused increasingly on the well-being of aging parents caring for an adult son or daughter with lifelong disabilities, including mental illness and mental retardation (Cook, Lefley, Pickett, & Cohler, 1994; Greenberg, Seltzer, & Greenley, 1993; Lefley, 1987; Seltzer, Greenberg, & Krauss, 1995; Seltzer & Krauss, 1989). In our earlier work, we found that aging mothers caring for an adult child with mental illness experience higher levels of caregiver burden and lower levels of psychological well-being than aging mothers caring for an adult child with mental retardation (Greenberg et al., 1993; Seltzer et al., 1995). Research on the stress process (Ensel & Lin, 1991; Pearlin, 1989) has shown that coping and social support are two resources that influence the extent to which a stressful situation, such as lifelong caregiving responsibility, takes a toll on psychological well-being. Our past research has investigated the differential effects of coping by aging mothers of adults with mental illness as compared with aging mothers of adults with mental retardation. We found that although the two groups were similar in the coping strategies they employed in response to stressful situations, they differed in the effect of coping on their level of psychological well-being. When mothers of adults with mental retardation used problem focused coping strategies, they were able to reduce their risk of depression, but mothers of adults with mental illness experienced no such relief when they coped similarly (Seltzer et al., 1995). We interpreted this difference in the effectiveness of problem-focused coping as being related to differences in the caregiving context between the two groups. Folkman (1984) posited that problem-focused strategies are most effective in coping with stressors that are within the individual's control. We argued that families of persons with mental illness experience less control over the stresses associated with caregiving because of the cyclical nature of mental illness and the associated behavioral problems that disrupt family and social routines (Francell, Conn, & Gray, 1988; Wasow, 1994). In contrast, most adults with mental retardation show stability in their functional level and cognitive abilities (Eyman & Widaman, 1987), and thus parental caregivers are more likely to experience the caregiving context as predictable and controllable (Wikler, 1986). In this paper, we extend our past work by exploring the role of social support in mitigating caregiving stress among these two groups of parental caregivers of adults with disabilities. Parallel with our earlier work on coping, in this paper we examine two general research questions with respect to the extent to which social support is a resource that reduces the stress of long-term parental caregiving. …

A significant number of people with mental illness do not use mental health services to receive treatment for their symptoms. This study examined the hypothesis that social network and social support affect mental health service use. Data were from the Baltimore cohort of the Epidemiologic Catchment Area study, a prospective cohort study that gathered data over four time points. This study examined data gathered in 1993-1996 (N=1,920) and 2004-2005 (N=1,071). The study examined indicators of social network and social support in relation to four types of service use (general medical, mental health within general medical, specialty psychiatric, and other human services) with multivariate logistic regression. Examples of other human services include a self-help group or crisis center for help with any psychological problem. Weighted generalized estimating equations were used for the analyses. Among persons with major depressive disorder, generalized anxiety disorder, panic disorder, or alcohol use disorder in the past year or psychological distress in the past few weeks, general medical service use was reduced when the frequency of contact with relatives or friends occurred less than daily, but it was increased by about 40% when there was a higher than median level of spousal support. In contrast, receiving general medical services for mental health problems was reduced by about 50% when there was a higher than median level of social support from relatives. Specialty psychiatric service use was reduced when there was regular contact with six or more relatives and there was a higher than median level of social support from friends and relatives. None of the social network or social support measures were significantly (p</=.01) associated with use of other human services. Increased contact with the social network and higher levels of social support were associated with greater use of general medical services. However, more social support was associated with use of fewer services within the specialty psychiatric sector.

COVID-19 and mental health during pregnancy: The importance of cognitive appraisal and social support

Objective-This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nation's largest state prison system. Methods-The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006.An electronic database was used to identify inmates whose parole was revoked within 12 months of their release.The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis.Results-Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7,95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8,95% CI=1.7-4.5) in the 12 months after their release.However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk.Conclusions-These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.Over the past four decades the widespread deinstitutionalization of persons with serious mental illness (1-3), the increase in drug-related arrests (4,5), and the reduction of community-based mental health care (1,2) have resulted in a substantial overrepresentation of persons with serious mental illness in the U.S. correctional system (1,2,6).Approximately 10% to 20% of U.S. prison inmates are estimated to have an axis I major mental disorder of thought or mood, such as major depressive disorder, bipolar disorder, or schizophrenia (7-12).Moreover, a majority of inmates with serious mental illness have a comorbid substance use disorder (7,(12)(13)(14)(15).A number of investigations have examined predictors of recidivism among released inmates (16)(17)(18)(19).Although results of these studies-conducted throughout a variety of criminal justice