Can mental health interventions change social networks? A systematic review

Abstract

BackgroundSocial networks of patients with psychosis can provide social support, and improve health and social outcomes, including quality of life. However, patients with psychosis often live rather isolated with very limited social networks. Evidence for interventions targeting symptoms or social skills, are largely unsuccessful at improving social networks indirectly. As an alternative, interventions may directly focus on expanding networks. In this systematic review, we assessed what interventions have previously been tested for this and to what extent they have been effective.MethodsA systematic review was conducted of randomised controlled trials, testing psychosocial interventions designed to directly increase the social networks of patients with psychosis. Searches of five online databases (PsycINFO, CINAHL, Cochrane Database, MEDLINE, Embase), hand searching of grey literature, and both forward and backward snowballing of key papers were conducted and completed on 12 December 2014. Trial reports were included if they were written in English, the social network size was the primary outcome, participants were ≥ 18 years old and diagnosed with a psychotic disorder.ResultsFive studies (n = 631 patients) met the complete inclusion criteria. Studies were from different countries and published since 2008. Four trials had significant positive results, i.e. an observable increase in patients’ social network size at the end of the intervention. The interventions included: guided peer support, a volunteer partner scheme, supported engagement in social activity, dog-assisted integrative psychological therapy and psychosocial skills training. Other important elements featured were the presence of a professional, and a focus on friendships and peers outside of services and the immediate family.ConclusionsDespite the small number and heterogeneity of included studies, the results suggest that interventions directly targeting social isolation can be effective and achieve a meaningful increase in patients’ networks. Thus, although limited, the existing evidence is encouraging, and the range of interventions used in the reported trials leave various options for future research and further improvements. Future research is needed to test the findings in different settings, identify which components are particularly effective, and determine to what extent the increased networks, over time, impact on patients’ symptoms and quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0684-6) contains supplementary material, which is available to authorized users.

A review of social participation interventions for people with mental health problems

“…Reasons for this are related both to negative symptoms of the disorder: anhedonia, emotional dullness and low energy, which impairs the motivation and ability to establish and maintain social relationships [8]; low confidence and poor self-esteem [9, 10]; as well as marked social disadvantages such as unemployment [10] and a higher likelihood of living alone [11] with fewer opportunities to utilise social skills. It is unclear whether these are a consequence of the illness or whether they predate it [12].…”

“…Systematic reviews [8, 24] have identified that one potential way of addressing this gap is by utilising social interventions which link people beyond mental health services to community-based sources of support. Social interventions aim to balance service users’ needs, assets and the ability of mental health services to deliver appropriate, holistic support by engaging with the voluntary and community sector, where many services such as interest-based classes and support groups are provided.…”

“…However, there is a paucity of evidence on social participation interventions, possibly because of the complexity of developing and evaluating them. A systematic review of trials of interventions to enhance the social networks of people with psychosis found only five trials [8], and a broader review of social participation intervention evaluations for people with mental health problems found only 14 intervention studies [24]. Many of the studies included in these reviews were susceptible to bias.…”

Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders

“…Integrating the group sessions has been shown to be critically important for CET to generalize to real-life accomplishments in social and occupational roles [18], although a recent study suggests that combining elements of computer-based cognitive training and social skills groups did not induce greater benefits than cognitive training alone [20]. Finally, group-based interventions are known to sustain engagement and to reduce stigma and isolation [21-23]. …”

Co-production of community mental health services: Organising the interplay between public services and civil society in Denmark

“…The existing literature examines primarily the effects of the involvement of civil society on people with mental health problems. Several studies have shown that initiatives to support and enlarge social networks have a positive effect (Anderson, Laxhman, & Priebe, 2015;Davidson et al, 2004;Slay & Stephens, 2013). However, we were unable to identify research on how public services and their staff handle working both in formal mental healthcare settings and with civil society participants/volunteers.…”