Social Tie Characteristics and Psychiatric Rehabilitation Outcomes Among Adults With Serious Mental Illness

Abstract

Social support has achieved national attention as a key component of the mental health recovery paradigm for persons with serious mental illness (SMI). The aim of this study was to investigate the amount of variance accounted for by four social tie characteristics (social network orientation, emotional support, tangible support, and negative exchange) in three outcomes (mental health recovery, loneliness, and quality of life [QOL]). This study also investigated whether social tie characteristics mediated the link between symptom distress and rehabilitation outcomes. Participants were 101 adults with SMI, living in New York City and Boston. Eight measures were used to assess the above constructs. Bivariate correlations and hierarchical regression were conducted. Social tie characteristics contribute significantly to loneliness and recovery, with the amount of variance accounted for by symptom distress in loneliness and mental health recovery increasing significantly when social tie characteristics were added to the model. Mediator analyses revealed that emotional support and negative social exchange mediate the relationship between symptom distress and loneliness. Tangible support mediates the relationship between symptom distress and recovery. Rehabilitation counselors need to assess and inquire about social tie characteristics. Future researchers should investigate the types of support/nonsupport specific to people with SMI.

Keywords

psychiatric rehabilitation social support coping rehabilitation counseling severe mental illness

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References

Albert

Becker

McCrone

Thornicroft

(1998). Social networks and mental health service utilisation: A literature review. International Journal of Social Psychiatry, 44, 248–266. doi:10.1177/002076409804400402.10.1177/002076409804400402.

Anthony

W. A.

(1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11–23.

Baron

R. M.

Kenny

D. A.

(1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182. doi:10.1037/0022-3514.51.6.117310.1037/0022-3514.51.6.1173

Barrera

Jr. (2000). Social support research in community psychology. In Seidman

(Ed.), Handbook of community psychology (pp. 215–245). Dordrecht, Netherlands: Kluwer Academic.

Brady

S. J.

Koch

L. C.

Griffith

P. L.

(2003). Family involvement in rehabilitation planning: Learning objectives and activities for rehabilitation counseling students. Rehabilitation Education, 17, 155–170.

Brissette

Scheier

M. F.

Carver

C. S.

(2002). The role of optimism in social network development, coping, and psychological adjustment during a life transition. Journal of Personality and Social Psychology, 82, 102–111. doi:10.1037/0022-3514.82.1.10210.1037/0022-3514.82.1.102

Brookings

J. B.

Bolton

(1988). Confirmatory factor analysis of the interpersonal support evaluation list. American Journal of Community Psychology, 16, 137–147.

Calsyn

R. J.

Winter

J. P.

(2002). Social support, psychiatric symptoms, and housing: A causal analysis. Journal of Community Psychology, 30, 247–259. doi:10.1002/jcop.1000410.1002/jcop.10004

Cano

Douglas

J. S.

Sprafkin

R. P.

Lantinga

L. J.

Fiese

B. H.

Brand

(2003). Family support, self-rated health, and psychological distress. Primary Care Companion Journal of Clinical Psychiatry, 5, 111–117.

10.

Chronister

(2009). Social support and rehabilitation: Theory, research and measurement. In Chronister

J. A.

(Ed.), Understanding psychosocial adjustment to chronic illness and disability: A handbook for evidence-based practitioners in rehabilitation (pp. 149–183). New York, NY: Springer.

11.

Chronister

Chou

C. C.

Frain

Cardoso

S. C.

(2008). The relationship between social support and rehabilitation related outcomes: A meta-analysis. Journal of Rehabilitation, 74, 16–32.

12.

Cohen

(1988). Psychosocial models of the role of social support in the etiology of physical disease. Health Psychology, 7, 269–297. doi:10.1037/0278-6133.7.3.26910.1037/0278-6133.7.3.269

13.

Cohen

Hoberman

H. M.

(1983). Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology, 13, 99–125.

14.

Cohen

McKay

(1984). Interpersonal relationships as buffers of the impact of psychological stress on health. In Baum

Singer

J. E.

Taylor

(Eds.), Handbook of psychology and health. Hillsdale, NJ: Erlbaum.

15.

Cohen

Mermelstein

Kamarck

Hoberman

H. M.

(1983). Measuring the functional components of social support. In Sarason

I. G.

Sarason

B. R.

(Eds.), Social support: Theory, research and applications (pp. 73–94). Boston, MA: Martinus Nijhoff.

16.

Corrigan

P. W.

Phelan

S. M.

(2004). Social support and recovery in people with serious mental illnesses. Community Mental Health Journal, 40, 513–523.

17.

Crewe

N. M.

(1980). Quality of life: The ultimate goal in rehabilitation. Minnesota Medicine, 63, 586–589.

18.

Cutrona

C. E.

Russell

D. W.

(1990). Type of social support and specific stress: Toward a theory of optimal matching. In Sarason

I. G.

Sarason

B. R.

Pierce

G. R.

(Eds.), Social support: An interactional view (pp. 267–296). New York, NY: John Wiley.

19.

Derogatis

L. R.

Cleary

P. A.

(1977). Confirmation of the dimensional structure of the SCL-90: A study in construct validation. Journal of Clinical Psychology, 33, 981–989.

20.

Derogatis

L. R.

Lipman

R. S.

Covi

(1973). SCL-90: An outpatient psychiatric rating scale—Preliminary report. Psychopharmacology Bulletin, 9, 13–28.

21.

Dijker

A. J.

Koomen

Kok

(1997). Interpersonal determinants of fear of people with AIDS: The moderating role of predictable behavior. Basic and Applied Social Psychology, 19, 61–79. doi:10.1207/s15324834basp1901_510.1207/s15324834basp1901_5

22.

Evers

A. W. M.

Kraaimaat

F. W.

Geenen

Jacobs

J. W. G.

Bijlsma

J. W. J.

(2003). Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behaviour Research and Therapy, 41, 1295–1310. doi:10.1016/S0005-7967(03)00036-610.1016/S0005-7967(03)00036-6

23.

Falvo

(1999). Medical and psychosocial aspects of chronic illness and disability (2nd ed.). Gaithersburg, MD: Aspen.

24.

Goldberg

R. W.

Rollins

A. L.

Lehman

A. F.

(2003). Social network correlates among people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 26, 393–402. doi:10.2975/26.2003.393.40210.2975/26.2003.393.402

25.

Heller

Rook

K. S.

(2001). Distinguishing the theoretical functions of social ties: Implications for support interventions. In Duck

(Ed.), Personal relationships, implications for clinical and community psychology (pp. 119–139). New York, NY: John Wiley.

26.

Hogan

M. F.

(2003). New freedom commission report: The president’s new freedom commission: Recommendations to transform mental health care in America. Psychiatric Services, 54, 1467–1474. doi:10.1176/appi.ps.54.11.146710.1176/appi.ps.54.11.1467

27.

Holahan

C. J.

Moos

R. H.

Bonin

(1997). Social support, coping, and psychological adjustment: A resource model. In Pierce

G. R.

Lakey

(Eds.), Sourcebook of social support and personality: The Plenum series in social/clinical psychology (pp. 169–186). New York, NY: Plenum.

28.

Hoyt

W. T.

Imel

Z. E.

Chan

(2008). Multiple regression and correlation techniques: Recent controversies and best practices. Rehabilitation Psychology, 53, 321–339. doi:10.1037/a001302110.1037/a0013021

29.

Johnson

R. A.

Rose

J. A.

Russell

(1992). Loneliness and interpersonal relationships across the school years. In Medway

F. P.

Cafferty

T. P.

(Eds.), School psychology: A social psychological perspective (pp. 377–396). Hillsdale, NJ: Erlbaum.

30.

Johnson

S. L.

Meyer

Winett

Small

(2000). Social support and self-esteem predict changes in bipolar depression but not mania. Journal of Affective Disorders, 58, 79–86. doi:10.1016/S0165-0327(99)00133-010.1016/S0165-0327(99)00133-0

31.

Kahn

R. L.

Antonucci

T. C.

(1980). Convoys over the life course. Attachment, roles, and social support. In Baltes

P. B.

Brim

O. G.

(Eds.), Life-span development and behavior (pp. 254–283). New York, NY: Academic Press.

32.

Kelley

S. D. M.

Lambert

S. S.

(1992). Family support in rehabilitation: A review of research, 1980-1990. Rehabilitation Counseling Bulletin, 36, 98–119.

33.

Kessler

R. C.

Berglund

P. A.

Glantz

M. D.

Koretz

D. S.

Merikangas

K. R.

Walters

E. E.

(2010, July 25). Estimating the prevalence and correlates of serious mental illness in Community Epidemiological Surveys (United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, National Mental Health Information Center, Section III: Population Dynamics, Chapter 12). Retrieved from http://mentalhealth.samhsa.gov/publications/allpubs/SMA04-3938/Chapter12.asp

34.

Lakey

Cohen

(2000). Social support theory and measurement. In Cohen

Underwood

L. G.

Gottlieb

B. H.

(Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 29–52). Oxford, UK: Oxford University Press.

35.

Lam

J. A.

Rosenheck

(1999). Social support and service use among homeless persons with serious mental illness. International Journal of Social Psychiatry, 45, 13–28. doi:10.1177/00207640990450010310.1177/002076409904500103

36.

Madianos

(2010, June 15). Deinstitutionalization. In Stone

J. H.

Blouin

(Eds.), International Encyclopedia of Rehabilitation. Retrieved from http://cirrie.buffalo.edu/encyclopedia/article.php?id=33&language=en

37.

Maisel

N. C.

Gable

S. L.

(2009). The paradox of received social support: The importance of responsiveness. Psychological Science, 20, 928–932. doi:10.1111/j.1467-9280.2009.02388.x10.1111/j.1467-9280.2009.02388.x

38.

McKenna

M. A.

Power

P. W.

(2000). Engaging the African American family in the rehabilitation process: An intervention model for rehabilitation counselors. Journal of Applied Rehabilitation Counseling, 31, 12–18.

39.

Narrow

W. E.

Regier

D. A.

Norquist

Rae

D. S.

Kennedy

Arons

(2000). Mental health service use by Americans with severe mental illnesses. Social Psychiatry and Psychiatric Epidemiology, 35, 147–155. doi:10.1007/s00127005019710.1007/s001270050197

40.

Newsom

J. T.

Morgan

D. L.

Nishishibi

Rook

(2000). Development of new comparable measures of negative and positive social exchanges. Presented at the 53rd Annual Scientific Meeting of the Gerontological Society of America, Washington, DC.

41.

Nguyen

T. D.

Attkisson

C. C.

Stegner

B. L.

(1983). Assessment of patient satisfaction: Development and refinement of a Service Evaluation Questionnaire. Evaluation and Program Planning, 6, 299–313.

42.

Roessler

R. T.

(1990). A quality of life perspective on rehabilitation counseling. Rehabilitation Counseling Bulletin, 34, 82–90.

43.

Rogers

E. S.

Anthony

Lyass

(2004). The nature and dimensions of social support among individuals with severe mental illnesses. Community Mental Health Journal, 40, 437–450. doi:10.1023/B:COMH.0000040657.48759.0e10.1023/B:COMH.0000040657.48759.0e

44.

Rogers

E. S.

Chamberlin

Ellison

M. L.

Crean

(1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48, 1042–1047.

45.

Rook

K. S.

(1984). The negative side of social interaction: Impact on psychological well-being. Journal of Personality and Social Psychology, 46, 1097–1108. doi:10.1037/0022-3514.46.5.109710.1037/0022-3514.46.5.1097

46.

Russell

D. W.

(1996). The UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66, 20–40.

47.

Russell

D. W.

Cutrona

C. E.

de la Mora

Wallace

R. B.

(1997). Loneliness and nursing home admission among rural older adults. Psychology and Aging, 12, 574–589.

48.

Russell

D. W.

Peplau

L. A.

Cutrona

C. E.

(1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472–480.

49.

Schonfeld

I. S.

(1991). Dimensions of functional social support and psychological symptoms. Psychological Medicine, 21, 1051–1060.

50.

Schulz

Newsom

Mittelmark

Burton

Hirsch

Jackson

(1997). Health effects of caregiving: The caregiver health effects study: An ancillary study of the cardiovascular health study. Annals of Behavioral Medicine, 19, 110–116. doi:10.1007/BF0288332710.1007/BF02883327

51.

Storey

Certo

N. J.

(1996). Natural supports for increasing integration in the workplace for people with disabilities. Rehabilitation Counseling Bulletin, 40, 62.

52.

Sutton

(1985). The need for family involvement in client rehabilitation. Journal of Applied Rehabilitation Counseling, 16, 42–45.

53.

Symister

Friend

(2003). The influence of social support and problematic support on optimism and depression in chronic illness: A prospective study evaluating self-esteem as a mediator. Health Psychology, 22, 123–129. doi:10.1037/0278-6133.22.2.12310.1037/0278-6133.22.2.123

54.

Tolsdorf

C.C.

(1975). Social Network and the Coping Process, University of Massachusetts, Amherst.

55.

Trobst

K. K.

(2000). An interpersonal conceptualization and quantification of social support transactions. Personality and Social Psychology Bulletin, 26, 971–986. doi:10.1177/0146167200261000710.1177/01461672002610007

56.

U.S. Department of Health and Human Services. (1999). Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Estimation Methodology for Adults With Serious Mental Illness (SMI). Federal Register, 64, 33890–33897. Retrieved from http://www.wais.access.gpo.gov

57.

Vaux

(1988). Social support: Theory, research, and intervention. New York, NY: Praeger.

58.

Vaux

A. C.

Burda

P. C.

Stewart

(1986). Orientation toward utilization of support resources. Journal of Community Psychology, 14, 159–170. doi:10.1002/1520-6629(198604)14:2<159::AID-JCOP2290140207>3.0.CO;2-H10.1002/1520-6629(198604)14:2<159::AID-JCOP2290140207>3.0.CO;2-H

59.

Whitley

Harris

Fallot

R. D.

Berley

R. W.

(2008). The active ingredients of intentional recovery communities: Focus group evaluation. Journal of Mental Health, 17, 173–182. doi:10.1080/0963823070149842410.1080/09638230701498424

60.

World Health Organization Quality of Life Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.

61.

Young

Bullock

(2003). Illness Management and Recovery and the Role of the Mental Health Recovery Measure (MHRM) in Outcomes Research. Ohio Department of Mental Health, Ohio Coordinating Center for Excellence for Illness and Recovery.

62.

Young

S. L.

Ensing

D. S.

(1999). Exploring recovery from the perspective of people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 22, 219–231.