It has been proposed that the onset of schizophrenia creates a social network crisis, resulting in a dramatic deterioration of social resources during the period immediately following a first hospitalization from essentially normal pre-hospitalization levels. To evaluate this proposal, recent onset patients (n = 89) completed comprehensive assessments that examined their social networks in the 12 months prior to first hospitalization and, in a subset of patients (n = 34), at a 15-month follow-up. Cross-sectional relationships to social functioning and symptoms were examined at both time points. Compared to existing research, at the initial assessment patients were characterized by several network disturbances, including small network size, a high proportion of family members, and highly dense interconnections among network members; these disturbances generally remained moderately to highly stable at follow-up. Smaller social networks were related to poor current and premorbid social functioning and aspects of clinical functioning, particularly at the 15-month follow-up assessment. Thus, this first repeated assessment of social network characteristics in the early course of schizophrenia does not support the social network crisis concept. Instead, results suggest that functionally relevant social network disturbances often exist by the time of first hospitalization in schizophrenia.
"From an offline clinical perspective, the reasons for deficits in the social support networks of people with a diagnosis of schizophrenia centre on the behavioural characteristics of the patients themselves . One purported thesis is that people with a diagnosis of schizophrenia experience a “social network crisis” at onset of symptoms  (although a longitudinal study found that gender, economic status and activity in the labour market were more important predictors of social network diversity ). One study found that individuals with a diagnosis of schizophrenia with greater 'social skills’ had larger social networks, although interestingly participants did not feel that they received greater support than did people with smaller social networks or more negative symptoms of schizophrenia . "
[Show abstract][Hide abstract] ABSTRACT: Digital technologies are increasingly directed at improved monitoring, management and treatment of mental health. However, their potential contribution to social networks and self-management support for people diagnosed with a serious mental illness has rarely been considered. This review and meta-synthesis aimed to examine the processes of engagement and perceived relevance and appropriateness of telehealth interventions for people with a diagnosis of schizophrenia. The review addresses three key questions. How is the use of digital communications technologies framed in the professional psychiatric literature? How might the recognised benefits of telehealth translate to people with a diagnosis of schizophrenia? What is the user perspective concerning Internet information and communication technologies?
A critical interpretive synthesis (CIS) of published findings from quantitative and qualitative studies of telehealth interventions for people with a diagnosis of schizophrenia.
Most studies were of an exploratory nature. The professional discourse about the use of different technologies was overlain by concerns with surveillance and control, focusing on the Internet as a potential site of risk and danger. The critical synthesis of findings showed that the key focus of the available studies was on the delivery of existing traditional approaches (e.g. improving medications adherence, provision of medical information about the condition, symptom monitoring and cognitive behavioural therapy). Even though it was clear that the internet has considerable potential in terms of accessing and utilising lay support the potential of communication technologies in mobilising of resources for personal self-management or peer support was a relatively absent or hidden a focus of the available studies.
Based on an interpretive synthesis of available studies, people with a diagnosis of schizophrenia or psychosis use the Internet primarily for the purposes of disclosure and information gathering. Empowerment, regulation and surveillance emerged as the key dimensions of engagement (or not) with telehealth interventions. The findings suggest that telehealth interventions are disproportionately used by particular patient groups (e.g.women, people who are employed). Further research needs to ascertain the mechanisms by which telehealth interventions may be potentially beneficial or harmful for engagement and management to people with a diagnosis of schizophrenia.
"While remission from positive symptoms is often rapidly achieved following the first episode (Lieberman et al. 2003; Schooler et al. 2005), social dysfunction is a significant issue from the very early phases (Addington et al. 2008). Service users tend to become isolated very quickly after onset and their social contacts may become restricted to paid mental health professionals and a few close family members (Macdonald, Hayes & Baglioni, 2000; Macdonald, Sauer, Howie & Albiston 2005; Horan et al. 2006; Berry, Wearden & Barrowclough, 2007; Stanghellini & Ballerini, 2007). "
[Show abstract][Hide abstract] ABSTRACT: The first episode of psychosis frequently occurs during adolescence and early adulthood, and is associated with high levels of trauma, affective disturbance and suicide. The social networks of service users often decrease significantly following the first onset, although many will remain in close contact with some family members particularly during the early phases. However, the negative impact of psychosis on families and their relationship with the identified service user are well documented. Family intervention is a recommended and evidence-based treatment in later psychosis. In this paper, we review the literature on family interventions in early psychosis in the context of new evidence for its efficacy and its routine incorporation in early intervention services for psychosis.
"For instance, parents invest many resources in their children with the expectation that the reward will come later in their lives (Antonucci and Akiyama 1987; Neufeld and Harrison 1995). Because of this, close kin relations are more likely to endure in the face of increased caregiver burden and the strains it puts on caregivers (Adams and Bleizsner 1995; see also Horan et al. 2006). Bound by normative obligations to provide care or by affection for the recipient, family members may be unable or reluctant to withdraw care or stop contact (Stoller and Pugliesi 1991). "
[Show abstract][Hide abstract] ABSTRACT: Bridges that span structural holes are often explained in terms of the entrepreneurial personalities or rational motivations of brokers, or structural processes that lead to the intersection of social foci. I argue that the existence and use of bridges in interpersonal networks also depends on individuals' health. Poor health may make it more difficult to withstand the pressures and to execute some of the common tasks associated with bridging (e.g., brokerage). I examine this possibility using egocentric network data on over 2,500 older adults drawn from the recent National Social Life, Health, and Aging Project (NSHAP). Multivariate regression analyses show that both cognitive and functional health are significantly positively associated with bridging, net of sociodemographic and life-course controls. The relationship between functional (kinesthetic) health and bridging appears to be partially mediated by network composition, as older adults who have poorer functional health also tend to have networks that are richer in strong ties. Several potential mediation mechanisms are discussed. Cognitive function remains significantly associated with bridging net of network composition, suggesting that the inherent challenges of maintaining bridging positions may be more difficult to cope with for those who have cognitive impairments than for those who have functional impairments such as limited mobility. An alternative explanation is that cognitively impaired individuals have more difficulty recognizing (and thus strategically using) bridges in their networks. Theoretical implications and possibilities for future research are discussed.
Social Networks 01/2009; 31(1):92-103. DOI:10.1016/j.socnet.2008.10.005 · 2.93 Impact Factor
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