Informal Sources Of Support Research Articles

Rural dementia carers: formal and informal sources of support

Primary carers provide much of the day-to-day care for community-dwelling people living with dementia (PWD). Maintaining that contribution will require a more in-depth understanding of the primary carer role and the support needs that flow from that role. This study explored patterns of formal and informal support utilisation by people caring for a PWD in a rural-regional context. In-depth semi-structured interviews were conducted with 18 rural primary carers of a PWD and thematically analysed. Participant primary carers' almost total commitment to, and absorption in their role and their assumption of ultimate responsibility for the PWD's wellbeing meant that external social context, such as rurality, became less relevant. Carer networks effectively contracted to those key individuals who were central to supporting them in their caring task. External sources of support were tightly managed with strong boundaries around the provision of direct care to the PWD largely excluding all but professional providers. Primary carers are generally categorised along with other family and friends as informal care. However, in assuming primary responsible for the care and wellbeing for the PWD they effectively become the key care provider, suggesting that it would be productive in both research and practice to treat primary carers as key members of a care partnership alongside professional carers, rather than as adjuncts to formal care and/or another client.

Characteristics of Suicide Attempts in Young People Undergoing Treatment for First Episode Psychosis

Understanding the characteristics of suicide attempts in people undergoing treatment for first episode psychosis (FEP) may have implications for risk management at a service level and local suicide prevention strategies. Although studies have focused on identifying individual-level risk factors for suicide attempts in this patient group, none have yet conducted an in-depth profile of suicide attempts. The aim of the present study was to examine the characteristics of suicide attempts in young people during the initial 18 months of treatment for FEP. A retrospective medical record audit study of a cohort of patients accepted for treatment at a specialist FEP service between 1/12/2002 and 30/11/2005. Of 607 patients, 73 (12%) attempted suicide during treatment. Of these 73, most (72.6%) attempted suicide on one occasion. The majority of attempts (85.3%) occurred when patients were treated as outpatients and were in regular contact with the service. Suicide attempts tended to be impulsive (77.6%), triggered by interpersonal conflict or distress due to psychotic symptoms. Two thirds involved self-poisoning, usually by overdose of prescribed medications. All inpatient suicide attempts were by hanging or strangulation. Individuals infrequently sought help immediately before or after the attempt; if help-seeking occurred, informal sources of support were contacted. To reduce the number of suicide attempts among individuals treated for FEP, psychiatric services could consider: restricting the amount of medication prescribed per purchase; individualised suicide risk management plans for all newly admitted patients, including those who do not appear to be at risk; stringent reviews of inpatient psychiatric units for potential ligature points; providing information and psycho-education for significant others in recognition and response to suicide risk; fostering patients' problem solving and conflict resolution skills; and regular risk assessment and close monitoring of patients, particularly during the high risk period of 3 months after a suicide attempt.

Informal Support Networks of Low-Income Senior Women Living Alone: Evidence from Fort St. John, BC

Within the context of an aging Canadian rural and small-town landscape, there is a growing trend of low-income senior women living alone. While there is a perception that rural seniors have well-developed social networks to meet their daily needs, some research suggests that economic and social restructuring processes have impacted the stability of seniors' support networks in small places. While much of the research on seniors' informal networks focuses upon small towns in decline, booming resource economies can also produce challenges for low-income senior women living alone due to both a higher cost of living and the retrenchment of government and service supports. Under such circumstances, an absence of informal supports can impact seniors' health and quality of life and may lead to premature institutionalization. Drawing upon a household survey in Fort St. John, British Columbia, we explore informal supports used by low-income senior women living alone in this different context of the Canadian landscape. Our findings indicate that these women not only have a support network that is comparable to other groups, but that they are also more likely to draw upon such supports to meet their independent-living needs. These women rely heavily on family support, however, and greater efforts are needed to diversify both their formal and informal sources of support as small family networks can quickly become overwhelmed.

Intersections, Immigration, and Partner Violence: A View From a New Gateway—Baltimore, Maryland

This article reports on the results of exploratory surveys with immigrant women regarding their observations of intimate partner violence and criminal justice practices in their communities in the emerging immigrant gateway of Baltimore, Maryland. Using an intersectional/interlocking theoretical framework, it asks how nativity interacts with other social locations in the experiences of partner violence through surveys of women representing 5 language groups. The study found high levels of awareness of the problem of partner violence in immigrant communities and strong awareness of many U.S. criminal justice approaches to the problem. Although the women preferred informal sources of support in a situation of abuse, they strongly supported government intervention. We found low levels of awareness of the Violence Against Women Act as well as little support for the higher levels of prosecution for batterers, even though arrest was sometimes approved. The article calls for sensitive policies and practices that take into account the particular vulnerabilities of the foreign-born, especially in localities where national diversity is relatively novel.

Mental Health Burden Among Impoverished HIV-Positive Patients in Peru

HIV and poor mental health are intricately related. In settings of poverty, both are often rooted in structural factors related to material and social deprivation. We performed a qualitative analysis to understand factors contributing to poor emotional health and its impact among impoverished Peruvian HIV-infected individuals. We conducted focus group discussions with patients and providers consisting of semistructured, open-ended questions. Qualitative analysis provided insight into the profound impact of depression, isolation, stigma, and lack of social support among these patients. Living with HIV contributed significantly to mental health problems experienced by HIV-positive individuals; furthermore, long-standing stressors-such as economic hardship, fragmented family relationships, and substance use-shaped patients' outlooks, and may have contributed not only to current emotional hardship but to risk factors for contracting HIV as well. Once diagnosed with HIV/AIDS, many patients experienced hopelessness, stigma, and socioeconomic marginalization. Patients tended to rely on informal sources of support, including peers and community health workers, and rarely used formal mental health services. In resource-poor settings, the context of mental health problems among HIV-positive individuals must be framed within the larger structural context of poverty and social exclusion. Optimal strategies to address the mental health problems of these individuals should include integrating mental health services into HIV care, task shifting to utilize community health workers where human resources are scarce, and interventions aimed at poverty alleviation.

Human infrastructure in health: a commentary on networks of supports

The move towards community health settings and health partnership initiatives in managing chronic disease have inadvertently created a renewed focus on the social economy in Australia, particularly the informal human structures of support and significance (people, professionals and partnerships) that can contribute to health. Although these initiatives have also pointed to the need for greater flexibility of service delivery and trans-disciplinarity of health professionals, their ultimate success rests on the quality of the underlying human infrastructure to support these changes. Over the past two decades, a confluence of observations and research studies have confirmed the existence of, and need for, a social construction of health and chronic disease management (see e.g. Gallant,1 Israel2 and Norris et al.3). Undoubtedly, chronic conditions may precipitate a process of deep introspection, identity change, and extreme modification of day-today activities for the individual or 'self' (see Charmaz4 and Muenchberger et al.5). However, the role and significance that others play in lessening the impact of chronic disease on the individual although often mentioned, remains vastly underestimated and even less well understood. In the absence of a comprehensive understanding of the human infrastructure that is expected to support the shift towards prevention and coordination in the community, the burden of disease will continue to damage social networks, maintaining inappropriate, unsustainable and costly dependencies on health services.The social construction of health and wellbeing can be best understood when considering the concept of self-management. The idea that self-management in chronic disease is solely an individual's responsibility is a tempting, but fundamental error of understanding. Self-management courses are often delivered to individuals (within a group context) by a trained peer or health professional, and the goals and outcomes specified are largely individually focussed (e.g. individual gains in knowledge, skills and health utilisation).3 The information on 'managing self' in chronic disease is usually disseminated by way of an individual workbook, and goals are documented in response to individual priorities, needs and capacities. There is also a component focussed on locating effective support and linking with healthcare providers.6 Even though there is an implied assumption, if not expectation, that including family members or significant others will somehow facilitate self-management goals over time, what is not often clear is the nature or quality of the role that family members or significant others must assume in order to facilitate this change in health behaviour.A comprehensive review conducted by Gallant1 explicated the particular importance of emotional support in self-management (especially perceived support). Gallant argued that effective selfmanagement relies on the facilitated relationships between family, peers and healthcare professionals (see also Kendall et al.7). Although there is increasing focus and resources dedicated to optimising the patient-health professional partnership in chronic disease, the same cannot be said for family and friendship networks where the impost may be much greater. Without in-depth studies documenting the quantity and quality of the social infrastructure andhowit is used by people with chronic conditions, it is difficult to determine actual social and financial implications. For instance, in Australia between 1998 and 2003, 93 900 people with severe (including chronic) conditions required daily assistance with core activities.8 Presumably, most of this daily assistance came from family or friends. Indeed, almost half of disability services delivered to people with chronic conditions have been found to be provided through informal support sources.9 A major question, therefore, becomes how the health service system can support, maintain and partner with this significant social network to improve the health of people with chronic conditions. …

Childlessness at the end of life: evidence from rural Wales

ABSTRACTAfter the spouse, children are the most likely source of informal support for an older person when the frailties of advanced old age create the need for help. Childlessness may thus be seen as particularly a problem for older people. In general, to compensate for the lack of children, childless people develop closer relationships with available next-of-kin and non-kin. Despite this, in times of need they are likely to find themselves with inadequate informal support. Using data from the Bangor Longitudinal Study of Ageing, this article explores the consequences of childlessness among persons aged 85 years or more living in rural Wales. The results indicate that by the time they reach old age, childless people have adapted to their situation and developed expectations consistent with being childfree. They have closer relationships with collateral kin, friendships are important and a high value is placed on independence. Nevertheless, unless they die suddenly or after a short acute illness, almost all of them enter residential care or a long-stay hospital at the end of their lives. It is also shown that the situation of childless people varies greatly and depends on several factors, particularly marital status, gender, social and financial capital, and on the person's earlier investment in the strengthening of next-of-kin and non-kin networks.

Help-Seeking Behaviors and Reasons for Help Seeking Reported by a Representative Sample of Women Victims of Intimate Partner Violence in New Zealand

Efforts to understand and support the process of help seeking by victims of intimate partner violence are of considerable urgency if we are to design systems and responses that are capable of actively and appropriately meeting the needs of victims. Using data from the New Zealand Violence Against Women Study, which drew from a representative general population sample of women aged 18 to 64 years, the authors report on the help-seeking behaviors of the women who had ever in their lifetime experienced physical and/or sexual violence by an intimate partner (n = 956). More than 75% of respondents reported that they had told someone about the violence, indicating that it is not necessarily a "secret and private" problem. However, more than 40% of women indicated that no one had helped them. Informal sources of support (family and friends) were most frequently told about the violence but not all provided helpful responses. Fewer women told formal sources of help such as police, health care providers, and not all provided helpful responses. Women's reasons for seeking help and for leaving violent relationships were similar and included "could not endure more," being badly injured, fear or threat of death, and concern for children. Women's reasons for staying in or returning to violent relationships included perception of the violence as "normal/not serious," her emotional investment in the relationship, or staying for the sake of the children. The findings suggest that broader community outreach is required to ensure that family and friends are able to provide appropriate support for women in abusive relationships who are seeking help. Continued improvement in institutional responses is also required.

Proximity to death and participation in the long-term care market.

The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.

What do Suicide Survivors Tell Us They Need? Results of a Pilot Study

Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.

Sources of support for pre‐service teachers during school experience

The purpose of the study was to report on the changing sources of support structures utilised by pre‐service teachers during a series of school experiences (SEs). A sample of pre‐service teachers was interviewed after their final SE. These students were in their last year of a four‐year Bachelor of Education degree at a college in southern England. The interviews were semi‐structured and focused on categories that originated from previous research. Sources of support were both formal (college tutors and teacher tutors) and informal (other pre‐service teachers, host families and other teachers). It appeared that the respondents moved from formal to informal sources of support as they progressed through the series of SEs. They particularly valued immediate professional support and advice from their teacher tutors and also the social support of their pre‐service and teacher colleagues. This supports the view that learning to teach is a constructivist activity where novitiates move from peripheral participation on SE into a full community of practice (the world of teachers) as suggested by situated learning theory. A further theme that emerged was that of the split responsibility for assessment between college tutors and teacher tutors.

What factors predict women's disclosure of sexual assault to mental health professionals?

AbstractAlthough many sexual assault survivors seek support from mental health sources for adverse psychological symptoms due to sexual assault, many do not. A diverse sample of adult sexual assault survivors was surveyed about their sexual assault experiences, social reactions received when disclosing assault, attributions of blame, coping strategies, and psychological symptomatology. Statistical analyses were run to identify demographic, assault, and postassault factors differentiating women who disclosed from those who did not disclose sexual assault to mental health sources. Both demographic (race, sexual orientation, and age) and postassault factors (posttraumatic stress disorder [PTSD] symptom severity, number of informal support sources told, receipt of tangible aid/information support) significantly predicted assault disclosure. Implications of the results are discussed. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 619–638, 2007.

Latino Teens Talk About Help Seeking and Help Giving in Relation to Dating Violence

The authors examine attitudes about help seeking and help giving related to dating violence among Latino ninth graders, including survey and focus group data. Latino teens are more likely to seek help for a dating violence situation from informal sources of support (e.g., friends) than from formal sources (e.g., health professionals). Students are most likely to turn to other teens for help and do not confide or trust the adults in their social network. Teens are reluctant to intervene in dating violence situations. The quality of help offered by teens related to dating violence is perceived as being limited.

Correlates of Women's Sexual Assault Disclosure to Informal and Formal Support Sources

Deciding which people to tell about sexual assault is an important and potentially consequential decision for sexual assault survivors. Women typically receive many different positive and negative reactions when they disclose sexual assault to social support sources. A diverse sample of adult sexual assault survivors in the Chicago area was surveyed about sexual assault experiences, social reactions received when disclosing assault to others, attributions of blame, coping strategies, and PTSD. Analyses were run to identify demographic, assault, and postassault factors differentiating women disclosing to informal support sources only from those disclosing to both informal and formal support sources. Women disclosing to both formal and informal support sources experienced more stereotypical assaults, had more PTSD symptoms, engaged in less behavioral self-blame, and received more negative social reactions than those disclosing to informal support sources only. Implications for future research and intervention are discussed.

Correlates of Women’s Sexual Assault Disclosure to Informal and Formal Support Sources

Deciding which people to tell about sexual assault is an important and potentially consequential decision for sexual assault survivors. Women typically receive many different positive and negative reactions when they disclose sexual assault to social support sources. A diverse sample of adult sexual assault survivors in the Chicago area was surveyed about sexual assault experiences, social reactions received when disclosing assault to others, attributions of blame, coping strategies, and PTSD. Analyses were run to identify demographic, assault, and postassault factors differentiating women disclosing to informal support sources only from those disclosing to both informal and formal support sources. Women disclosing to both formal and informal support sources experienced more stereotypical assaults, had more PTSD symptoms, engaged in less behavioral self-blame, and received more negative social reactions than those disclosing to informal support sources only. Implications for future research and intervention are discussed.

The aging HIV/AIDS population: Fragile social networks

Social support becomes an increasingly critical resource for people as they age. In New York City, 25% of all people living with HIV/AIDS are over age 50, and 64% are over age 40. This study sample (n = 160) reflects current HIV/AIDS epidemiology, with 34% females and 89% people of color. This study provides a detailed profile of this growing, aging cohort and their social networks. Our study finds this growing group of aging adults is isolated from informal networks due to the stigma of HIV/AIDS and ageism. Typically, partners and family members are key sources of informal support, but only 1/3 of respondents had a partner and 71% lived alone. This group relies heavily on friends, many of whom are also HIV-positive. Participants were in primary care and many (86%) utilized Medicaid. The fragile networks of these older adults will be challenged by age-related comorbidities. Without traditional caregivers, these aging adults with HIV/AIDS will have an immense impact on healthcare delivery and community-based programs.

Describing the Social Environment of Elderly Persons at the Time of Death

To describe the social environment of elderly persons at the time of their death and its correlates. Telephone interviews with the next-of-kin of deceased elderly persons. Potential participants were the next-of-kin of all Jewish elderly individuals who died during the course of one year in a major city in the northern part of Israel. The final sample included 139 participants (58% response rate; 70% cooperation rate). Information was collected regarding the decedents' social environment three days before their death and at the time of death. Eight types of informal sources of support and four sources of formal support were examined. The correlates examined included the decedents' demographic, health, social, and death characteristics. The majority of the decedents died while surrounded by at least one family member. Having a larger social network was associated with a larger number of persons present at the time of death. Being informed about the impending death was associated with a larger number of persons from the formal and informal networks present at the time of death. The common fear of dying alone and isolated was not confirmed by this study. Increased efforts should be invested in helping professionals to deal with the difficulties inherent to the process of diagnosing an upcoming death.

Social networks, ethnicity and public home-care utilisation

This article examines the relationships between support networks, ethnicity and the utilisation of formal care services, taking into account background characteristics and functional health status among 3,403 older people in Israel. Data were drawn from a national survey in 1997 of people aged 60 or more years. The outcome variable was the use of publicly-financed personal care or homemaking services. About 15 per cent of the study population made use of such home care. Six informal support network constellations were identified by applying cluster analysis to key criterion variables that reflect the inter-personal milieu. The resultant network types were: community-clan, family-focused, diverse, friend-focused, neighbour-focused, and restricted networks. Binary logistic regression revealed that the use of formal home-care services was significantly associated with a respondent's age, gender, functional level and informal support network type (Nagelkerke R2=0.39). No association was found between home-care utilisation and a respondent's ethnicity (Arab, Jew, and new Russian immigrant), income or education. The results show that publicly-financed formal care services were utilised more frequently by older-old persons, women, functionally impaired individuals and people embedded in the neighbour-focused and restricted networks (and to a lesser degree, in the diverse and friend-focused networks). Neighbour-focused and restricted network types were characterised by fewer informal support resources at their disposal than the other types. Thus, formal home care was sought more often in cases in which the informal sources of support had less capacity to provide ongoing informal care.

The housing and support needs of teenage mothers

The Government has expressed a wish to see more supported accommodation made available to teenage parents, and has identified a number of possible models that might be employed. However, focus group discussions with young parents indicated a strong preference for self‐contained accommodation and a number of concerns associated with shared forms of housing. It was particularly important to the young people to be housed close to sources of informal support. Those forms of professional support that were most appreciated were the ones that closely replicated the help provided by family and friends.

Social and Professional Support for Parents of Adolescents with Severe Intellectual Disabilities

Background Previous research has identified various dimensions of social support that are positively associated with parental well‐being. However, most research does not include multiple measures of social support and uses heterogeneous samples in terms of child characteristics such as age and severity of intellectual disability.Methods Thirty‐three parents of adolescent children with moderate–profound intellectual disabilities completed measures of parental well‐being (stress, anxiety and depression, and caregiving satisfaction), social support (informal and formal sources, and practical and emotional support), and child characteristics (adaptive and problem behaviours).Results Correlation analyses showed that parental well‐being was associated with the child's adaptive and problem behaviours and with the child's autism diagnosis. Parents’ ratings of the helpfulness of informal sources of support (spouse, extended family, friends, etc.) was most reliably associated with parental well‐being, and remained so after controlling for child characteristics. Parents’ access of service and professional support was not associated with parental well‐being, but there was some evidence that it was related to their child's needs.Conclusions The research emphasizes the significance of including multiple measures of social support in research with families of children with an intellectual disability. Furthermore, the possibility that parents, during their child's adolescence, may be especially vulnerable to the disruption of their informal support networks is an important practical consideration.