The Role of Social Network and Support in Mental Health Service Use: Findings From the Baltimore ECA Study

Department of Mental Health, Johns Hopkins School of Public Health, 624 N. Broadway St., Baltimore, MD 21205, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 09/2009; 60(9):1222-9. DOI: 10.1176/
Source: PubMed


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.

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Available from: Catherine Bradshaw, Aug 16, 2014
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    • "Social support within social networks may be protective , by reducing the propensity to develop mental illness, and for people who have developed mental illness, social networks may act as a substitute for services (Gourash 1978). Certainly, research in the US, Netherlands and Puerto Rico has shown that people were less likely to use mental health services if high levels of support were being provided within networks (Pescosolido et al. 1998, Ten Have et al. 2002, Maulik et al. 2009). However, in the UK, very little attention has been paid to the influence (either positive or negative) of the content and function of social networks on the usage of mental health services . "
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    ABSTRACT: Pakistani women in the UK are an at-risk group with high levels of mental health problems, but low levels of mental health service use. However, the rates of service use for Pakistani women are unclear, partly because research with South Asian women has been incorrectly generalised to Pakistani women. Further, this research has been largely undertaken within an individualistic paradigm, with little consideration of patients' social networks, and how these may drive decisions to seek help. This systematic review aimed to clarify usage rates, and describe the nature of Pakistani women's social networks and how they may influence mental health service use. Ten journal databases (ASSIA, CINAHL Plus, EMBASE, HMIC, IBSS, MEDLINE, PsycINFO, Social Sciences Abstracts, Social Science Citation Index and Sociological Abstracts) and six sources of grey literature were searched for studies published between 1960 and the end of March 2014. Twenty-one studies met inclusion criteria. Ten studies (quantitative) reported on inpatient or outpatient service use between ethnic groups. Seven studies (four quantitative, three qualitative) investigated the nature of social networks, and four studies (qualitative) commented on how social networks were involved in accessing mental health services. Pakistani women were less likely than white (British) women to use most specialist mental health services. No difference was found between Pakistani and white women for the consultation of general practitioners for mental health problems. Pakistani women's networks displayed high levels of stigmatising attitudes towards mental health problems and mental health services, which acted as a deterrent to seeking help. No studies were found which compared stigma in networks between Pakistani women and women of other ethnic groups. Pakistani women are at a considerable disadvantage in gaining access to and using statutory mental health services, compared with white women; this, in part, is due to negative attitudes to mental health problems evident in social support networks.
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    • "There is evidence that social support and social ties benefit an individual's mental health and psychological well-being (Turner and Marino, 1994; Kawachi and Berkman, 2001). Several studies have emphasized the effect of social support on reducing the symptoms of depression, anxiety, social phobia, and Common Mental Disorders (CMD) (Costa and Ludemir, 2005; Maulik et al., 2009; Moak and Agrawal, 2009; Kim, 2010). The positive effects of social support on mental health may be observed at any age, independent of the source that provides it, as long as the individual perceives him/herself to be socially integrated and supported (Cornwell and Waite, 2009a). "
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    • "Several studies have failed to find a relationship between network size and service utilization (Allen et al. 1999; Bussing et al. 2003; Davey et al. 2007). Perceived support from others is associated with utilization for several conditions (Gulliver, Griffiths, and Christensen 2010; Maulik et al. 2009; Sheppard et al. 2008; Wolters et al. 2002), but other studies have found no relationship between social support and health services utilization (Allen et al. 1999; King and Meyer 1997; Mendoza-Sassi, Béria, and Barros 2003). It is important to consider the influence of network norms, however, in addition to network structure (Carpentier et al. 2008; Deri 2005; Pescosolido 2006). "
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