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Technology and Opportunity: People with Serious Mental Illness and Social Connection
Abstract
Objective
Little information exists regarding how individuals with serious mental illness use technology and whether this usage facilitates social connections. This study contributes to filling this knowledge gap by examining ways in which a sample of persons with serious mental illness use cell phones and the Internet.
Methods
Interviews with 50 consumers living in supported housing were asked about their use of cell phones and computers and their perceptions of social connections.
Results
Cell phones and computers allowed greater linkage with social, medical, mental health, and employment resources. Nearly all obtained phones through publicly funded programs. “Running out of minutes” was common and associated with disrupted communication and safety concerns. Few people owned computers, resulting in restricted access.
Conclusion
Policy makers should consider providing free or discounted hardware, subsidizing unlimited plans, and promoting computer literacy.
... Technology-related factors refer to factors related to the technology through which the intervention was offered. The primary barrier to engagement noted in 25 studies was users' experience of technical issues [44,50,80,92,100,103,118,129,138,155,172,179,185,195,205,208,[212][213][214][215][216][217][218][219][220], such as a mobile app crashing and shutting down unexpectedly; in 3 studies, participants did not have the resources required to use an intervention [171,221,222]. In 7 studies, participants expressed concerns over the eventual costs associated with using an intervention [85,93,104,123,165,223,224]. ...
... An important facilitator was whether a DMHI facilitated social connectedness and enabled the user to interact with other people. Previous work has shown that social support through social networks not only increases engagement but may also have a positive effect on depression symptoms [221,222]. However, in some studies in this review, mental health service users and providers were concerned that technology would facilitate social avoidance if people were to use a digital intervention in lieu of engaging in face-to-face individual or group therapy. ...
https://www.jmir.org/2021/3/e24387
Background
Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions.
Objective
This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs.
Methods
A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included.
Results
A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health.
Conclusions
Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
... Technology-related factors refer to factors related to the technology through which the intervention was offered. The primary barrier to engagement noted in 25 studies was users' experience of technical issues [44,50,80,92,100,103,118,129,138,155,172,179,185,195,205,208,[212][213][214][215][216][217][218][219][220], such as a mobile app crashing and shutting down unexpectedly; in 3 studies, participants did not have the resources required to use an intervention [171,221,222]. In 7 studies, participants expressed concerns over the eventual costs associated with using an intervention [85,93,104,123,165,223,224]. ...
... An important facilitator was whether a DMHI facilitated social connectedness and enabled the user to interact with other people. Previous work has shown that social support through social networks not only increases engagement but may also have a positive effect on depression symptoms [221,222]. However, in some studies in this review, mental health service users and providers were concerned that technology would facilitate social avoidance if people were to use a digital intervention in lieu of engaging in face-to-face individual or group therapy. ...
BACKGROUND
Digital mental health interventions, that deliver mental health support via technologies such as a mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement, referring to a user’s uptake and sustained interactions with these interventions, varies.
OBJECTIVE
The aim of this systematic review is to identify common barriers and facilitators influencing user engagement with digital mental health interventions.
METHODS
A systematic search was conducted of the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies reporting qualitative and/or quantitative data were included.
RESULTS
208 articles met the inclusion criteria. Included articles used a variety of methodologies including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program/content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health.
CONCLUSIONS
While previous research suggests that digital mental health interventions can be useful in supporting mental health, contextual factors are important determinants as to whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating digital mental health interventions to help explain and understand user engagement, and can inform the design and development of new digital interventions.
... Some individuals who experience severe mental health problems such as psychosis and bipolar disorder report already using the Internet and mobile phones to self-manage their mental health. For example, some use the Internet to search for health-related information such as medication, diagnoses, and symptoms and to discuss their mental health on the Internet with others [5][6][7][8][9][10]. Additionally, staff working in mental health care services have reported largely neutral or positive attitudes toward the use of digital health interventions for the management of mental health problems [11][12][13][14][15][16][17] but are cautious about using digital health interventions for severe and complex cases [15][16][17]. ...
... Web-based information-seeking was viewed positively and staff welcomed the incorporation of psychoeducation material into digital health interventions, suggesting that this could be well received by staff and service users alike. Concerns surrounding the abundance of unregulated Web-based material echo previous qualitative work, where individuals experiencing severe mental health problems also queried the trustworthiness of information from Internet sources and preferred information from organizational and charitable websites, rather than private companies or chat rooms [5,9]. Such skepticism surrounding the reliability of information found on the Internet may be warranted. ...
Background:
Researchers are currently investigating the feasibility, acceptability, and efficacy of digital health interventions for people who experience severe mental health problems such as psychosis and bipolar disorder. Although the acceptability of digital health interventions for severe mental health problems appears to be relatively high and some people report successfully using the Internet and mobile phones to manage their mental health, the attitudes of mental health care staff toward such approaches have yet to be considered.
Objective:
The aim of this study was to explore mental health care staff experiences of clients with severe mental health problems engaging with the Internet and mobile phones to self-manage their mental health and their views toward these behaviors. The study also sought to examine the opinions expressed by mental health care staff toward digital health interventions for severe mental health problems to identify potential facilitators and barriers to implementation.
Methods:
Four focus groups were conducted with 20 staff working in mental health care services in the North West of the England using a topic guide. Focus groups involved 12 staff working in secondary care psychological services (7 participants in focus group 1 and 5 participants in focus group 4), 4 staff working in a rehabilitation unit (focus group 2), and 4 staff working in a community mental health team (focus group 3). Focus groups were transcribed verbatim, and transcripts were analyzed thematically to identify key themes that emerged from the data.
Results:
Four overarching themes, two with associated subthemes, were identified: (1) staff have conflicting views about the pros and cons of using Web-based resources and digital health interventions to manage mental health; (2) digital health interventions could increase access to mental health support options for severe mental health problems but may perpetuate the digital divide; (3) digital health interventions' impact on staff roles and responsibilities; and (4) digital health interventions should be used to enhance, not replace, face-to-face support.
Conclusions:
This study is the first, to our knowledge, to qualitatively explore the experiences and attitudes of mental health care staff toward individuals with severe mental health problems using the Internet, mobile phones, and digital health interventions to self-manage their mental health. Understanding the positive and negative experiences and views shared by staff toward both current and potential digital health intervention use has enabled the identification of several considerations for implementation. Additionally, the findings suggest mental health care staff need clear guidance and training in relation to their responsibilities in recommending reputable and secure websites, forums, and digital health interventions and in how to manage professional boundaries on the Internet. Overall, the study highlights that digital health interventions could be well received by staff working in mental health services but importantly, such management options must be presented to frontline staff as an avenue to enhance care and extend choice, rather than as a method to reduce costs.
... Given the great value placed on a social component, previous work has recommended that DMHIs should incorporate a feature or ability to connect with others [49]. However, although our study participants did consider a social component to be important when considering mental health technologies, these interactions may not necessarily have to be through the DMHI: participants in our study also valued being able to connect with others through the program and the digital literacy classes by connecting with staff members and loved ones by learning communication technologies such as WhatsApp and Zoom. ...
Background
Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits.
Objective
This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety.
Methods
A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis.
Results
A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others.
Conclusions
Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness.
... По нашему мнению, крайне значимым результатом является то наблюдение, что использование социальных сетей повышает вовлечённость в очное общение и социальную активность пациентов в целом [8]. Примечательно, что большинство исследований не обнаруживают влияния использования социальных сетей на ухудшение психического состояния пациентов [24]. При этом в последнее время отмечается возросший интерес исследователей к теме проблемного использования сети Интернет (Интернет-зависимости) [4], показано, например, что тенденция к интернетзависимому поведению более часто встречается среди пациентов с поведенческими расстройствами и шизофренией [2]. ...
The aim of the study was to develop a new valid psychometric diagnostic tool for a multi-factor social network assessment of schizophrenic patients, called «The structural assessment of the social network of schizophrenic patients». The new development is based on the social network analysis model elaborated by S. L. Phillips (1981) and translated into Russian by Gurovich I. Ya. et al. (2007). The authors of this article additionally developed an algorithm for assessing the activity of patients on social networks of the Internet. Reducing non-informative variables and conducting a confirmatory factor analysis in a sample of 265 observations of schizophrenic patients (F20.0) aged from 18 to 55, recruited in four medical organizations (145 patients admitted to the hospital and 55 outpatients), resulted in determining a four-factor structure of the patients’ social network: «Objective parameters», «Internet activity», «Emotional aspect of social support» and
«Reciprocal support». The method has demonstrated high internal and external validity, as well as applicability in the clinical practice in schizophrenia due to the low resource consumption and compact applicability. Measurable factor indicators of the patients’ social networks obtained by using the structural assessment of the social network of schizophrenic patients allow to determine the targets for psychocorrectional interventions and to increase the effectiveness of psychosocial rehabilitation. In addition an automated method for calculating final indicators has been developed, as well as manual, practical recommendations and corresponding printed forms.
... It was decided to conduct an online survey as surveys result in less social desirability bias than interviews [42] and allow recruiting geographically and clinically diverse samples. Evidence suggests that the majority of persons with serious and non-serious mental illness use the internet [44,56]. ...
Family relationships often play a critical role in the functional outcomes and wellbeing of persons with serious mental illness (SMI). However, research has not examined the interactions sexual minorities with SMI have with family members. This exploratory study aimed to examine whether supportive and/or problematic interactions between persons with serious mental illness and non-intimate partner relatives are associated with persons with SMI being sexual minorities. Between 2015 and 2017, 212 adults with SMI residing across the U.S. completed an online survey. Participants provided information regarding their interactions with a non-intimate partner relative in the past 6 months. Chi squared and Wilcoxon–Mann–Whitney tests were computed. The sexual orientation of participants was not significantly associated with supportive (co-residence, in-person contact, financial and other assistance, and happiness derived from the relationship) or problematic (emotional over-involvement, limit-setting, psychological abuse, and violence) interactions with non-intimate partner relatives. Practitioners are advised to attempt to include family members and address family relationships in rehabilitation services, regardless of the sexual orientation of persons with SMI.
... bias than interviews (9) and enable recruiting clinically and geographically diverse samples. Most people with serious and nonserious psychiatric disorders use the Internet (10,11). ...
Objective:
This study aimed to examine the rate at which persons with psychiatric disorders were victims of violence by reference relatives and the extent to which victimization and perpetration co-occurred in this population.
Methods:
A total of 523 adults with a psychiatric disorder completed an online survey. Chi-square and Fisher's exact tests were computed.
Results:
Since first diagnosis, 25% and 26% of respondents reported having been a victim of violence by reference relatives and having committed violence toward reference relatives, respectively. Thirteen percent of respondents reported having been a victim of violence by reference relatives, and 12% reported having committed violence toward reference relatives in the past 6 months. Victimization and perpetration often co-occurred.
Conclusions:
The risk of victimization and perpetration of family violence among persons with psychiatric disorders should be acknowledged. Assessing for risk of perpetrating family violence and intervening in such cases should entail assessing for and/or addressing victimization, and vice versa.
... Unfortunately, no representative sample exists assessing the availability of internet access among persons with SMI. However, available evidence from a convenience sample suggests that most persons with SMI do at least occasionally use the internet (Townsend, Zippay, Caler, & Forenza, 2016). It is also known that the majority of Americans have access to the internet (File & Ryan, 2014) and that persons with SMI appear to use other technological devices (i.e. ...
Background & Significance: Despite estimates that persons with serious mental illness (SMI) are between 2 and 8 times more likely to commit acts of violence than are members of the general population and that approximately 50% of all acts of violence by persons with SMI are against family members, the subject of family violence by persons with SMI has received little research attention. Hypothesis: After reviewing the literatures on community and family violence by persons with SMI, it was hypothesized that family violence by this population is associated with factors in four domains: 1) Perpetrator, 2) Victim, 3) Interaction, and 4) Community. Methods: A cross-sectional survey design was used. Between December 29, 2015 and April 1, 2017, 523 persons with SMI living in the U.S. completed an online survey. Respondents were recruited from a range of mental health organizations across the U.S. Respondents provided information regarding themselves, a reference relative, and the interactions they and reference relatives had with each other in the past 6 months, including possible acts of violence. The association of factors with the occurrence of violence by persons with SMI towards reference relatives was estimated with multivariate logistic regression. Results: Twelve percent (n = 13) of persons with SMI reported having committed violence towards their reference relative in the past 6 months. In the final multivariate logistic regression model, the following factors were significantly associated with violence by persons with SMI towards reference: Perpetrator—history of ever committing serious violence; Victim—age; Interaction— use of limit-setting practices by relatives, psychological abuse by persons with SMI and relatives, and violence by relatives. Conclusions: Mutual violence appears to play a considerable role in family violence by this population. Practitioners may better serve clients with SMI by offering to involve family members in their treatment and by assessing and intervening in family conflict. Interventions aimed at decreasing psychological abuse may help deescalate conflict and prevent physical violence. Interventions intended to decrease or modify limit-setting practices used by relatives towards persons with SMI may decrease the risk of family violence by this population.
... Furthermore, adults with mental disorders who have entered supportive housing as a resource from homelessness have also reported increases in social support from both family (Henwood et al. 2014) and other members of their housing community (Patterson et al. 2105). Additionally, sometimes the small social networks of individuals with SMI are buttressed by the usage of technology (Naslund et al. 2016;Townsend et al. 2016). ...
Individuals living with serious mental illness are at high risk of chronic homelessness, victimization, and intimate partner violence. In recent years, supportive housing programs have emerged as one way to prevent homelessness and victimization for this population, while also expanding social interactions and social networks. In concert with a focal supportive housing program, this research conducted two focus groups with 18 individuals who have a serious mental illness diagnosis. The authors sought to answer the research question, "What are perceptions of healthy and unhealthy relationships among formerly homeless people with serious mental illness?" To this end, the eight-item questionnaire was created around dimensions of power and control, as well as relationship equality. Findings from an inductive thematic analysis reveal three broad families of themes (relationship ideals, lived experiences, and risk/resources in supportive housing), around which smaller themes and subthemes are organized. Implications for policy, practice, and future research are also discussed.
... Furthermore, adults with mental disorders who have entered supportive housing as a resource from homelessness have also reported increases in social support from both family (Henwood et al. 2014) and other members of their housing community (Patterson et al. 2105). Additionally, sometimes the small social networks of individuals with SMI are buttressed by the usage of technology (Naslund et al. 2016;Townsend et al. 2016). ...
Although the process of leaving abusive relationships has received increased research attention, preparing to leave is still largely understudied. Despite an emphasis on safety planning, not all women take active steps to prepare, and the characteristics and experiences of those who do or do not actively prepare are unknown. We address this gap with a secondary data analysis of interviews with 25 abused mothers in the process of leaving. All women initially engaged in mental planning, where they had emotionally disconnected from their partners. Using constructivist grounded theory techniques, we identified two distinct groups: those whose mental planning led to active planning (n = 11), and those who moved directly from mental planning to leaving (n = 14) with little time or need to actively plan. The groups differed on several individual, relationship, and child factors, which may have impacted the ability or decisions to prepare. This study supports the feminist view that survivors are not helpless victims but active agents who strategize for safety. Those who engage solely in mental planning still prepare to leave, even if they do not engage in active planning. Practitioners should consider factors affecting preparations and acknowledge mental planning as a necessary effort in leaving.
Mobile sensing applications that collect active, Ecological Momentary Assessment data, and passive, Global Positioning System data provide reliable, longitudinal assessments of community integration. Ensuring their acceptability by vulnerable populations is warranted. Acceptability‐related perceptions of a mobile sensing application were gathered via focus groups with homeless‐experienced Veterans with serious mental illness (n = 19) and individual interviews with providers (n = 5) to inform subsequent application tailoring and testing. Rapid assessment generated structured summaries and matrix analyses integrated participant data. Active data collection was deemed noninvasive, with more concerns of passive data “ending up in the wrong hands.” Providers recommended clear descriptions and promotion of choice to navigate privacy concerns and guardedness. Participants felt the application possessed clinical value for enhancing patient‐provider interactions and community integration efforts. Overall, participants found application features acceptable and expressed Veterans’ willingness to engage in research using mobile sensing technology. Recommendations to enhance acceptability are discussed.
People with psychosis (PWP) have difficulties in establishing and maintaining social connections. An earlier systematic review on the use of online social networking (OSN) in psychosis found only 11 studies published before January 2014, but with promising findings. These studies showed no difference in OSN use between PWP and general population. Given the limited number of articles found and the rapid advances in OSN, we carried out an update review to assess evidence on how PWP use OSN. Several electronic databases were searched for the literature published between January 2014 and May 2018. Data from included studies were narratively synthesized. Thirteen additional studies examined the use of OSN in PWP in 2014-2018. Updated evidence confirms that PWP seem to use OSN at least as much as the general population, although only when not acutely unwell. PWP who are younger and have higher education level are more likely to use OSN. There was no evidence of worsening psychological symptoms due to OSN. Some studies showed patient-reported concerns about negative experiences and the inability to identify online social contacts. The use of OSN by PWP is a subject of increasing interest with a rapidly developing evidence base. The frequent use of OSN by PWP and the absence of evidence of symptom worsening are encouraging findings. This would justify the inclusion of OSN among the strategies to reduce social isolation in psychosis. Research methodologies should be improved by developing standardized measures to assess use and associated risks.
It is widely documented that persons with mental illness (MI) experience much stigma, contributing to undesirable outcomes for persons with MI and posing barriers to their psychosocial rehabilitation. It is our argument that stigma and violence have a reciprocal relationship. In particular, stigma increases the risk of violence by this population by acting as a barrier to treatment participation and by increasing criminogenic risk factors among this population. Discrimination in social relationships, housing, and employment increases the likelihood that persons with MI will experience substance abuse, unemployment, stressed family relationships, antisocial characteristics, and less engagement in prosocial activities, all of which are known to increase the risk of criminal behavior. It is well documented that family members are the most common victims of violence by persons with MI. However, many family victims do not report acts of violence to authorities due to fear of exacerbating the stigma of MI. As such, not only does stigma increase the risk of violence by persons with MI, it also decreases the likelihood that family victims will report violence, preventing them from receiving victim services and other valuable supports. Reduction in stigma may be an essential element of a comprehensive approach to decreasing the risk of violence by persons with MI and increasing reporting and service use among family members who have been victims by persons with MI.
Background
Severe mental disorders like psychotic disorders including schizophrenia and schizoaffective disorders have a 12-month-prevalence of 2.6, bipolar disorders of 1.5 % in Germany. The relapse risk is high; so many patients need intensive monitoring and lifelong treatment. A high medication adherence is essential for a successful treatment. But in practice, medication adherence is low and decreases over time. Telemedical care concepts might improve treatment and bridge gaps between in- and outpatient treatment.
A telemedical care concept based on regular telephone calls and short text messages was developed. The primary objective is to assess whether regular telephone calls and text messages can improve the medication adherence of patients. Secondary objectives are the reduction of rehospitalization rates, the improvement of quality of life and of the severity of symptoms.
Methods/design
The Tecla study (Post stationary telemedical care of patients with severe psychiatric disorders) is a two-armed prospective randomized controlled trial. The participants in the intervention group receive in addition to usual care regular telephone calls every 2 weeks and weekly text messages on patient-individual topics during a 6 months period. Patients in the control group receive only regular care. Inclusion criteria are a physician-diagnosed bipolar disorder, schizoaffective disorder or schizophrenia and a signed informed consent. Exclusion criteria are planned inpatient treatments within the next 6 months and being non-reachable by phone. After 3 and 6 months both groups receive follow up assessments.
Discussion
The primary objective of this study is the medication adherence that is measured with the Medication Adherence Report Scale, German version (MARS-D). The MARS-D is a self-report with five items. Adherent behaviour is mostly overestimated using self-reports. The strength of the MARS-D is to detect non-adherent behaviour. The original Medication Adherence Report Scale in English language (MARS-5) was developed to encourage the patient to answer truthfully to the questions that are asked in a non-threatening and non-judgmental way to minimize social desirability bias in admitting non-adherent behaviour.
Trial registration
This study is registered at 2015\05\21at the German Clinical Trials Register DRKS00008548.
Objectives:
Older adults are the fastest growing age group in Australia, necessitating an increase in appropriate mental health services in the coming years. While Internet-delivered mental health treatments have been established as acceptable and efficacious among younger samples, little research has explored whether they would be similarly useful in older populations.
Methods:
The participants were part of the Australian Rural Mental Health study, which explores mental health and well-being in residents of non-metropolitan New South Wales. A postal survey was used to assess knowledge of and intentions to use Internet-delivered mental health treatments. Demographics, mental health, and frequency of Internet use were also measured.
Results:
The survey was completed by 950 adults aged 50-93. The sample was largely unfamiliar with Internet mental health services, with 75% reporting that they had never heard of them and a further 20% not knowing any details of what they involved. Intentions to use these services were also low, at 13.5%; however, this increased with level of familiarity. Respondents with higher psychological distress, higher education, and more frequent Internet use were significantly more likely to consider using Internet treatments.
Conclusions:
Among older adults, overall awareness of Internet-delivered mental health treatments appears to be limited; however, higher familiarity contributes to higher intentions to use these treatments. Importantly, respondents with higher distress and greater computer literacy were more likely to consider mental health treatments delivered via the Internet. Future research exploring strategies to increase the promotion of these services to older samples may further improve their perceptions and use.
This chapter reviews some of the online tools civic organizations have used to engage adults successfully in deliberation and action around public issues. The chapter offers examples of different tools and describes strengths and weaknesses of various technological features.
Objective:
Recent years have witnessed an expansion of Internet- and mobile-phone-based interventions for health promotion, yet few studies have focused on the use of technology by individuals with mental illness. This study examined the extent to which patients at an inner-city community psychiatry clinic had access to information and communications technology (ICT) and how they used those resources.
Methods:
Patients of an outpatient, inner-city community psychiatry program (N=189) completed a survey that included questions about demographics and ICT use which were adapted from an existing local population-based health survey (community sample, N=968). Frequencies of ICT use were assessed for the clinic sample and questions common to both the surveys completed by the clinic and community samples were compared using logistic regression.
Results:
Among clinic cases, 105 (55.6%) reported owning or using a computer, 162 (85.7%) reported owning or using a mobile phone, and 112 (59.3%) reportedf using the Internet. Among those who used mobile phones, the majority reported using them daily; 42% of those who used the Internet reported using it several times per day. Differences in frequency of Internet use between samples were not significant, but clinic participants used the Internet more intensively to email, instant message, access health information, and use social media sites.
Conclusions:
A majority of patients in this community psychiatry clinic sample use ICT. Greater access to and use of the Internet by those with mental illness has important implications for the feasibility and impact of technology-based interventions.
Poor adherence to antipsychotic medication is a widespread problem, and the largest predictor of relapse in patients with psychosis. Electronic reminders are increasingly used to improve medication adherence for a variety of medical conditions, but have received little attention in the context of psychotic disorders. We aimed to explore the feasibility and acceptability of including short message service (SMS) medication reminders in the aftercare plan of service users discharged from inpatient care on maintenance antipsychotic medication.
We conducted a cross-sectional, trust-wide survey in the inpatient units of the Oxleas National Health Service (NHS) Foundation Trust in the UK between June 29 and August 3, 2012. Using a self-report questionnaire and the Drug Attitude Inventory, we examined inpatient attitudes towards antipsychotic drugs, past adherence to antipsychotic medication, frequency of mobile phone ownership, and interest in receiving SMS medication reminders upon discharge from the ward. Predictors of a patient's interest in receiving electronic reminders were examined using simple logistic regression models.
Of 273 inpatients, 85 met eligibility criteria for the survey, showed decisional capacity, and agreed to participate. Of the 85 respondents, over a third (31-35%) admitted to have forgotten to take/collect their antipsychotic medication in the past, and approximately half (49%) to have intentionally skipped their antipsychotics or taken a smaller dose than prescribed. Male patients (55%), those with negative attitudes towards antipsychotics (40%), and those unsatisfied with the information they received on medication (35%) were approximately 3 to 4 times more likely to report past intentional poor adherence. The large majority of respondents (80-82%) reported having a mobile phone and knowing how to use SMS, and a smaller majority (59%) expressed an interest in receiving SMS medication reminders after discharge. No variable predicted a patient's interest in receiving electronic reminders of antipsychotics.
Automatic SMS reminders of antipsychotic medication were acceptable to the majority of the survey respondents as an optional service offered upon discharge from inpatient care. Automatic electronic reminders deserve further investigation as a flexible, minimally invasive, cost-effective and broadly applicable tool that can potentially improve antipsychotic adherence and clinical outcomes.
This study aims to examine the causal priority in the observed empirical relationships between Internet addiction and other psychological problems. A cross-lagged panel survey of 361 college students in Hong Kong was conducted. Results show that excessive and unhealthy Internet use would increase feelings of loneliness over time. Although depression had a moderate and positive bivariate relationship with Internet addiction at each time point, such a relationship was not significant in the cross-lagged analyses. This study also found that online social contacts with friends and family were not an effective alternative for offline social interactions in reducing feelings of loneliness. Furthermore, while an increase in face-to-face contacts could help to reduce symptoms of Internet addiction, this effect may be neutralized by the increase in online social contacts as a result of excessive Internet use. Taken as a whole, findings from the study show a worrisome vicious cycle between loneliness and Internet addiction.
Because of the growing amount of information on the internet and people’s increasing dependence on information, internet skills should be considered as a vital resource in contemporary society. This article focuses on the differential possession of internet skills among the Dutch population. In two studies, an in-depth range of internet skills are measured by charging subjects assignments to be accomplished on the internet. Subjects were recruited by applying a random stratified sampling method over gender, age, and education. While the level of operational and formal internet skills appeared quite high, the level of information and strategic internet skills is questionable. Whereas education appeared an important contributor to all skill levels, age only appeared a significant contributor to operational and formal skills. The results strengthen the findings that the original digital divide of physical internet access has evolved into a divide that includes differences in skills to use the internet.
Mobile phone-based assessment may represent a cost-effective and clinically effective method of monitoring psychotic symptoms in real-time. There are several software options, including the use of native smartphone applications and text messages (short message service, SMS). Little is known about the strengths and limitations of these two approaches in monitoring symptoms in individuals with serious mental illness.
The objective of this study was to compare two different delivery modalities of the same diagnostic assessment for individuals with non-affective psychosis-a native smartphone application employing a graphical, touch user interface against an SMS text-only implementation. The overall hypothesis of the study was that patient participants with sewrious mental illness would find both delivery modalities feasible and acceptable to use, measured by the quantitative post-assessment feedback questionnaire scores, the number of data points completed, and the time taken to complete the assessment. It was also predicted that a native smartphone application would (1) yield a greater number of data points, (2) take less time, and (3) be more positively appraised by patient participant users than the text-based system.
A randomized repeated measures crossover design was employed. Participants with currently treated Diagnostic and Statistical Manual (Fourth Edition) schizophrenia or related disorders (n=24) were randomly allocated to completing 6 days of assessment (four sets of questions per day) with a native smartphone application or the SMS text-only implementation. There was then a 1-week break before completing a further 6 days with the alternative delivery modality. Quantitative feedback questionnaires were administered at the end of each period of sampling.
A greater proportion of data points were completed with the native smartphone application in comparison to the SMS text-only implementation (β = -.25, SE=.11, P=.02), which also took significantly less time to complete (β =.78, SE= .09, P<.001). Although there were no significant differences in participants' quantitative feedback for the two delivery modalities, most participants reported preferring the native smartphone application (67%; n=16) and found it easier to use (71%; n=16). 33% of participants reported that they would be willing to complete mobile phone assessment for 5 weeks or longer.
Native smartphone applications and SMS text are both valuable methods of delivering real-time assessment in individuals with schizophrenia. However, a more streamlined graphical user interface may lead to better compliance and shorter entry times. Further research is needed to test the efficacy of this technology within clinical services, to assess validity over longer periods of time and when delivered on patients' own phones.
How Internet and mobile phone use is related to network size and diversity Evidence from the US General Social Surveys (GSS) suggests that during the past 20 years, people have become increasingly socially isolated and their core discussion networks have become smaller and less diverse. One explanation offered for this trend is the use of mobile phones and the Internet. This study reports on the findings of a 2008 survey that replicates and expands on the GSS network methodology to explore the relationship between the use of new technologies and the size and diver-sity of core networks. The findings conflict with the results of the 2004 GSS, i.e. we find that social isolation has not increased since 1985. However, the current study supports the conclusions that the size of core networks has declined and the number of nonkin in core networks has diminished. Mobile phone and Internet use, especially specific uses of social media, were found to have a positive relationship to network size and diversity. In discussing these trends, we speculate that specific social media provide for a 'pervasive awareness' within personal networks that has increased the specialization of close ties. We argue that this same pervasive awareness provides for heightened surveillance of network members, the result of which is a higher level of perceived diversity within networks based on metrics that include political affiliation. People are increasingly socially isolated. The size of core networks has declined and these relations are increasingly composed of similar others. A likely culprit, for this unexpected change in the structure of affiliation, is the rise of the Internet
Much research on political participation and civic engagement centers on the question: ''What motivates people to get involved?'' Several communication variables have been purported to influence these activities, such as television, newspaper, and Internet use. The general conclusion is that civic and political participation is declining. However, the rates of decline (or increase) in these activities among certain racial and cultural groups, such as Blacks compared with Whites, is not clear. Furthermore, the roles of religion and the church—an important component in creating bonds and networks that encourage such participation—have received little attention among communication scholars. The authors sought to examine the intricacies among race, religiosity, and polit-ical and civic engagement by expanding the current literature on social capital to include cultural and contextual components of church involvement. They found that in a national sample, the more involved Blacks are with church and the more frequently they attend services, the more involved they are in their communities. Moreover, their findings are consistent with previous research regarding media use; newspaper reading, and Internet use were positively related with civic engagement and voting, whereas television use was not. Implications for communication research, social capital, and measurement of race and culture are discussed.
Preventive interventions are developed for children of parents with mental and substance use disorders (COPMI), because these children have a higher risk of developing a psychological or behavioral disorder in the future. Mental health and substance use disorders contribute significantly to the global burden of disease. Although the exact number of parents with a mental illness is unclear, the subject of mentally ill parents is gaining attention. Moreover there is a lack of interventions for COPMI-children, as well of (cost-) effectiveness studies evaluating COPMI interventions. Innovative interventions such as e-health provide a new field for exploration. There is no knowledge about the opportunities for using the internet to prevent problems in children at risk. In the current study we will focus on the (cost-) effectiveness of an online health prevention program for COPMI-children.
We designed a randomized controlled trial to examine the (cost-) effectiveness of the Kopstoring intervention. Kopstoring is an online intervention for COPMI-children to strengthen their coping skills and prevent behavioral and psychological problems. We will compare the Kopstoring intervention with (waiting list) care as usual. This trial will be conducted entirely over the internet. An economic evaluation, from a societal perspective will be conducted, to examine the trial's cost-effectiveness. Power calculations show that 214 participants are needed, aged 16-25. Possible participants will be recruited via media announcements and banners on the internet. After screening and completing informed consent procedures, participants will be randomized. The main outcome is internalizing and externalizing symptoms as measured by the Youth Self Report. For the economic evaluation, healthcare costs and costs outside the healthcare sector will be measured at the same time as the clinical measures, at baseline, 3, 6 and 9 months. An extended measure for the intervention group will be provided at 12 months, to examine the long-term effects. In addition, a process evaluation will be conducted.
Recent developments, such as international conferences and policy discussions, show the pressing need to study the (cost-) effectiveness of interventions for vulnerable groups of children. This study will shed light on the (cost-) effectiveness of an online preventive intervention.
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The rapid expansion of the Internet has increased the ease with which the public can obtain medical information. Most research on the utility of the Internet for health purposes has evaluated the quality of the information itself or examined its impact on clinical populations. Little is known about the consequences of its use by the general population.
Is use of the Internet by the general population for health purposes associated with a subsequent change in psychological well-being and health? Are the effects different for healthy versus ill individuals? Does the impact of using the Internet for health purposes differ from the impact of other types of Internet use?
Data come from a national US panel survey of 740 individuals conducted from 2000 to 2002. Across three surveys, respondents described their use of the Internet for different purposes, indicated whether they had any of 13 serious illnesses (or were taking care of someone with a serious illness), and reported their depression. In the initial and final surveys they also reported on their physical health. Lagged dependent variable regression analysis was used to predict changes in depression and general health reported on a later survey from frequency of different types of Internet use at an earlier period, holding constant prior depression and general health, respectively. Statistical interactions tested whether uses of the Internet predicted depression and general health differently for people who initially differed on their general health, chronic illness, and caregiver status.
Health-related Internet use was associated with small but reliable increases in depression (ie, increasing use of the Internet for health purposes from 3 to 5 days per week to once a day was associated with .11 standard deviations more symptoms of depression, P = .002). In contrast, using the Internet for communication with friends and family was associated with small but reliable decreases in depression (ie, increasing use of the Internet for communication with friends and family purposes from 3 to 5 days per week to once a day was associated with .07 standard deviations fewer symptoms of depression, P = .007). There were no significant effects of respondents' initial health status (P = .234) or role as a caregiver (P = .911) on the association between health-related Internet use and depression. Neither type of use was associated with changes in general health (P = .705 for social uses and P = .494 for health uses).
Using the Internet for health purposes was associated with increased depression. The increase may be due to increased rumination, unnecessary alarm, or over-attention to health problems. Additionally, those with unmeasured problems or those more prone to health anxiety may self-select online health resources. In contrast, using the Internet to communicate with friends and family was associated with declines in depression. This finding is comparable to other studies showing that social support is beneficial for well-being and lends support to the idea that the Internet is a way to strengthen and maintain social ties.
In this article, the concept of digital divide and its relation to social exclusion is analysed. After describing the several facets of the digital divide, the question is asked whether the divide is widening or narrowing? The definition of digital divide is reconsidered and the article argues that access to the technology alone is but a very rudimentary indicator of actually making use of digital opportunities. This is expanded in the section on risks arising from digital exclusion. Finally, implications of this approach of the digital divide for social work and social care are considered.
The role of the Internet in facilitating and preventing suicide is reviewed. Two online suicide prevention programs are described: SAHAR in Israel and Befrienders worldwide. Examples are provided of crisis intervention by e-mail. Finally, some caveats are presented based on experiences with crisis intervention by telephone.
A high level of social contacts has been recognized as one of the main predictors of outcome in schizophrenia. However, a variety of issues concerning the sociability of schizophrenics still need to be clarified. Focusing on ex-mental patients residing in a large Manhattan hotel, an analysis is made of the relationship between several social network variables, psychopathology, and rehospitalization. The findings indicate that: (1) Schizophrenics have significantly fewer linkages than nonpsychotics, but even the most impaired schizophrenics are not totally isolated. (2) Within the schizophrenic spectrum there are differences with respect to network size, complexity, directionality, and interconnectedness. (3) Rehospitalization is dependent upon two factors, degree of psychopathology and hotel network size.
The present investigation used qualitative methods to explore the response to housing and experience of community integration of formerly homeless individuals diagnosed with severe mental illness recently housed in both independent and staffed residential settings. Findings indicate that entering into housing after a long period of homelessness is associated with improvements in community integration for most individuals diagnosed with severe mental illness. However, for a meaningful minority, the adaptation to housing may also be associated with challenges that can complicate the integration process. Implications of findings are discussed in the context of how best to tailor programs to meet the complex needs of persons diagnosed with severe mental illness and to maximize community integration.
While online, some people self-disclose or act out more frequently or intensely than they would in person. This article explores six factors that interact with each other in creating this online disinhibition effect: dissociative anonymity, invisibility, asynchronicity, solipsistic introjection, dissociative imagination, and minimization of authority. Personality variables also will influence the extent of this disinhibition. Rather than thinking of disinhibition as the revealing of an underlying "true self," we can conceptualize it as a shift to a constellation within self-structure, involving clusters of affect and cognition that differ from the in-person constellation.
The internet provides new ways of forming social relationships among people with breast cancer and is increasingly used for this purpose. This qualitative study, using ethnographic case-study method, aimed to explore how support groups on the internet can break the social isolation that follows cancer and chronic pain, by analysing the storytelling emerging on the Scandinavian Breast Cancer Mailing list. Using participant observation and face-to-face or online interviews of participants, we investigated the motivations of 15 women who chose the internet to counteract social isolation after breast cancer. The results showed that the women were empowered by the exchanges of knowledge and experience within the support group. The internet was considered a means for finding ways of living with breast cancer. Our study suggests that internet support groups have important potential for the rehabilitation of cancer patients.
The 2 studies reported here use observational data from message boards to investigate how adolescents solicit and share information related to self-injurious behavior. Study 1 examines the prevalence and nature of these message boards, their users, and most commonly discussed topics. Study 2 was intended to explore the correlations between content areas raised for discussion. Both studies were intended to shed light on the role of message boards in spreading information about self-injurious practices and influencing help-seeking behavior. More than 400 self-injury message boards were identified. Most are populated by females who describe themselves as between 12 and 20 years of age. Findings show that online interactions clearly provide essential social support for otherwise isolated adolescents, but they may also normalize and encourage self-injurious behavior and add potentially lethal behaviors to the repertoire of established adolescent self-injurers and those exploring identity options.
Development of information technology has created new opportunities and challenges in suicide prevention, research, and clinical practice. This article presents an overview of the wide range of telecommunication-based suicide prevention approaches. Interventions using the Internet, telephone, and videoconferencing are discussed, including crisis intervention, referral, and support, suicide risk assessment, psychotherapy for individuals at risk, and online-based suicide prevention training and education. Research regarding effectiveness of telecommunication-based suicide prevention in various demographic and clinical populations is reviewed, as well as concerns regarding this type of intervention. Future areas of research and development in the use of telecommunication media in prevention of suicide are discussed.
Technology is the key to solving mental healthcare access problems in the twenty-first century. Perhaps the greatest challenge we face in harnessing the possibilities of information technology in healthcare today is to ensure that we do it in a manner that is clearly evidence-based. This means innovations must be evaluated in a variety of contexts, using designs to ensure they are feasible and acceptable to our patients, are effective in treating the symptoms and disorders for which they are applied, and ultimately are structured to have the best possible balance of increasing access, minimising costs, and maximising clinical outcomes. As a service delivery medium, telemedicine, or telepsychology, offers a viable means of delivering high quality, specialised mental health services to people with significant access-to-care barriers, such as those living in remote or rural areas, lacking in transportation, or experiencing ambulatory problems such as many elderly people do. Randomised controlled trials have demonstrated the clinical efficacy of telemedicine for specific populations with discrete psychiatric disorders. Going forward we must discover how to best integrate telemedicine with in-person care and other forms of communications technology, including the Internet, mobile technology and its “apps”, social media, virtual reality, “smart homes,” and wearable monitoring devices. It is also imperative that we better integrate these approaches with primary medical care so that “mental healthcare” does not continue to be viewed as independent from physical health.
Our objective was to examine the association of mobile phone use and ownership with psychopathology, cognitive functioning, and functional outcome in 196 outpatients aged 40 years and older who were diagnosed with schizophrenia.
Participants reported their past and current mobile phone use on a standardized self-report scale and they were administered tests of global cognition, functional capacity, and informant-rated functional outcome.
The great majority of subjects had used a mobile phone (78%) but few currently owned one (27%). After adjusting for age (mean age 51), any past mobile phone use was associated with less severe negative symptoms, and higher global cognitive performance, functional capacity, and functional outcome. A total of 60% of participants reported being comfortable with mobile phones, but comfort was not associated with any cognitive or functional outcomes.
Most of the older patients with schizophrenia have used mobile phones and lifetime mobile phone use is a positive indicator of cognitive and functional status.
The evaluation and impact of public libraries is highly topical as local authorities make decisions about what can and cannot be provided through the public purse. This article reports the outcomes of a research workshop which used the Delphi method to gather opinions from expert stakeholders on this subject. Key themes included the value and social benefits of libraries; the need for effective communication; the need for research; the role of CILIP; and the required next steps. The authors suggest the novel approach of using a human rights-based approach to support arguments in favour of public library provision.
Scholars disagree about the impact of the Internet on civic and political engagement. Some scholars argue that Internet use will contribute to civic decline, whereas other scholars view the Internet as having a role to play in reinvigorating civic life. This article assesses the hypothesis that Internet use will contribute to declines in civic life. It also assesses whether Internet use has any significant effect on engagement. A meta-analysis approach to current research in this area is used. In total, 38 studies with 166 effects are examined. The meta-data provide strong evidence against the Internet having a negative effect on engagement. However, the meta-data do not establish that Internet use will have a substantial impact on engagement. The effects of Internet use on engagement seem to increase nonmonotonically across time, and the effects are larger when online news is used to measure Internet use, compared to other measures.
The social networks of individuals with severe mental illness admitted to long-term in-patient settings and living in two types of supported housing, small congregate community residences and independent living with support, were compared. The Interview Schedule for Social Interaction (ISSI) was used. The results showed no substantial differences in social networks between the two types of supported community residences. These were pooled for further analyses and comparisons between in-patient settings and supported community settings. No differences were found between the two settings either for the four subscales of ISSI or for the overall ISSI score. Stepwise regression analysis revealed a positive association between perceived quality of life and social network and an inverse relation between negative symptoms and social network. Other factors possibly influencing social networks across housing settings are discussed. More qualitative data is called for in the study of social networks of persons with severe mental illness.
The purpose of this study is to examine the effects of home computer access on low-income families participating in the Computer for Families program. The study focused on participants (1) general computer usage, access and knowledge; (2) employment; (3) education; and (4) their children’s-computer access, usage and academic performance. The study methodology consisted of a quasi-experimental design using qualitative and quantitative approaches, including focus groups, pretests and post-tests, and self-reported surveys with experimental and control groups. Statistically significant findings suggest that participants in the Computers for Families program were more likely than non-participants to have access to the Internet from home, use a computer for more than 1 h per day, complete online job applications, and submit job applications and resumes electronically. Social and behavioral implications regarding computer access and usage in low-income urban communities are discussed.
QAA Subject Benchmark 5.9 requires social work students to demonstrate the ability to have a critical understanding of the social impact of ICT, including an awareness of the impact of the ‘digital divide’. In the twenty-first century, the implications of digital exclusion may become increasingly relevant for the social work profession with its values of empowerment and anti-oppressive practices. As governments and organisations move closer to the provision of online services, the social worker may find themselves addressing the disempowerment of service users and carers disconnected from a virtual welfare state. The concern is that Benchmark 5.9 does not go far enough, that the full significance of this requirement may not be sufficiently realised and a greater awareness urgently called for.
Computers and Internet-based programs have great potential to make psychological assessment and treatment more cost-effective. Computer-assisted therapy appears to be as effective as face-to-face treatment for treating anxiety disorders and depression. Internet support groups also may be effective and have advantages over face-to-face therapy. However, research on this approach remains meager.
As they relate to user-generated content on the internet, civic engagement and psychological empowerment have received significant interest in recent years. While past studies have examined online civic participation and political empowerment, the way in which civic engagement offline and content generation online are related to psychological empowerment has not been thoroughly explored. The purpose of this study is to address the roles that gratifications of content generation online (e.g. satisfying recognition needs, cognitive needs, social needs and entertainment needs) and civic engagement offline play in predicting levels of user-generated content on the internet; and how the gratifications of content generation online, civic engagement offline and user-generated content influence the three components of psychological empowerment (i.e. self-efficacy, perceived competence and desire for control). This study reasserts that psychological empowerment can be enhanced by one’s degree of content generation online and by both one’s attitude and behavior in civic engagement offline.
This research compared technology use among homeless young adults with that of college students as a means of understanding technology use among young adults today; people who have grown up with technology. Specifically, social network site (SNS) usage was assessed for two age-matched young adult samples, one drawn from a large introductory psychology subject pool, and a second from homeless young adults who were approached for participation when they entered metropolitan shelters. Overall, technology use was strikingly similar. These results call for a paradigm shift in researchers' understand-ing of technology use and indicate that contemporary young adults sampled across socio-economic class and varying ethnicities are far more similar than prior research would suggest. These results call into question whether the term ''digital divide'' is useful for describing group differences in technology use as our results suggest the divide has narrowed considerably. Published by Elsevier Ltd.
Purpose: We examined the feasibility of using cell phones to monitor medication adherence among homeless participants and collected data for research purposes.
Data sources: Ten homeless individuals with a co-occurring substance use and psychiatric disorders who were receiving psychopharmacologic treatment participated in the study. All psychopharmacologic treatment was provided by a psychiatric mental health nurse practitioner. Cell phones were provided to participants with unlimited phone service for 45 days. An automated telephone system was programmed to call participants daily for 30 days. All participant responses were reported to a computer and reviewed by study staff on a daily basis.
Conclusions: The automated calls reached study participants 93% of days and, when reached, participants reported 100% adherence with the prescribed medication regimen. Exit interviews indicated strong support for the usefulness of the phone and the value of the call and survey as reminders to take their medication. No patients dropped out of this study.
Implications for practice: This pilot study establishes the feasibility of using cell phones to monitor and manage medication regimens for hard-to-reach populations, such as the homeless with co-occurring disorders. It also establishes that this technology would work for research data collection.
Disclaimer The views expressed in this article do not represent the views of the Veterans Administration or the United States Government.
New psychosocial interventions, derived from social learning theory and cognitive-behavior therapy, including relapse prevention, motivational interviewing, and the transtheoretical model of behavior change, are philosophically and practically applicable to evidence-based medicine and are often developed in such a way as to allow rapid translation to the Internet. The Internet also has the potential to improve communication among patients and providers. This article discusses the reasons for using the Internet in practice. The Internet can facilitate the collection. coordination, dissemination, and interpretation of data. Primary care and mental health care patients are interested in the use of the Internet in health care, and they are coming to expect this from their providers. Factors for Internet service provision include: accessibility, inclusivity, flexibility, and coordination/integration. Two models of Internet mental health care provision and support are discussed: (1) A Web-based program to prevent and treat eating disorders; and (2) Internet support groups and online psychoeducation. There is an urgent need for controlled studies in these areas at almost all levels. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Conclusions about the impact of the Internet on civic engagement have been hampered by the unavailability of before and after measures, a shortage of varied and multiple indicators of attitudes and behaviors regarding engagement, and insufficient attention to generational differences. This article seeks to address these weaknesses by employing a quasi-experimental design that draws on the 1982 and 1997 waves of a panel study that began with a national sample of the high school class of 1965 and that also includes that generation's lineage successor. Comparisons between those using and not using the Internet demonstrated that the digital divide, the original pre-Internet gap in civic engagement, remained in place or increased slightly over time. Taking into account pre-Internet levels of civic engagement and key socioeconomic characteristics indicates that Internet access has positive effects on several indicators of civic engagement. Comparisons of civic engagement among Internet users according to how much they employ the Internet for political purposes revealed modest bivariate associations and very little independent effect at the multivariate level. The connection between the Internet and civic engagement differed across the two generations in some respects, explained in part by intergenerational divergence in the intersection between the stage of individual political development and incorporation of the Internet into a person's media repertory.
This study explored the structure and quality of social network support among a group of adult consumers of community-based mental health programs known as clubhouses. The structure and quality of social network support was also examined by diagnosis, specifically between consumers living with and without schizophrenia. The study involved a sample of 221 consumers across 15 clubhouse programs. Social network nominations were collected using a semistructured social network interview strategy. Over 97% of the participants identified at least one source of support in their social network with an average of five nominations. Family members were identified as the most common source of support whereas fellow clubhouse members were least likely to be nominated. Clubhouse members with schizophrenia were less likely to identify family members and were more likely to rate their support networks as more important and engage in greater levels of contact than consumers with other diagnoses. The structure and quality of social network supports were not associated with level of social functioning, length of clubhouse membership or level of participation or other selected demographic variables typically associated with the size and quality of support. © 2008 Wiley Periodicals, Inc.
Several national bodies have proposed using mobile technology to improve mental health services. But rates of current use and interest in using technology to enhance services among individuals with serious mental illness are uncertain. The authors surveyed 1,592 individuals with serious mental illness regarding their use of mobile devices and interest in using mobile technologies to enhance mental health services. Seventy-two percent of survey respondents reported currently owning a mobile device, a rate approximately 12 % lower than the general adult population. The most common uses were for talking, followed by texting, and internet activities. Both mobile device users and nonusers expressed interest in future mobile services.
This study examined ways that young adults with mental illnesses (1) currently use social networking; and (2) how they would like to use a social networking site tailored for them. The authors examined differences between those with mental health conditions and those without.
An online survey was administered by the National Alliance on Mental Illness (NAMI) to 274 participants; of those, 207 reported being between 18 and 24 years old. The survey included questions about current social networking use, the key resources respondents believed young adults living with mental illness need, and the essential components that should be included in a social networking site specifically tailored to young adults living with mental illness. Pearson Chi-square analyses examined the differences between those who reported having a mental illness and those who did not.
Results indicate that almost all (94%) participants with mental illnesses currently use social networking sites. Individuals living with a mental illness are more likely than those not living with a mental illness to report engaging in various social networking activities that promote connectivity and making online friends. Individuals living with mental illnesses are also more likely to report wanting resources on independent living skills and overcoming social isolation available on a social networking site.
Young adults living with mental illnesses are currently using social networking sites and express high interest in a social networking site specifically tailored to their population with specific tools designed to decrease social isolation and help them live more independently. These results indicate that practitioners should themselves be aware of the different social networking sites frequented by their young adult clients, ask clients about their use of social networking, and encourage safe and responsible online behaviors.
Although social integration tends to have positive effects on the mental health of housed adolescents, the role of homeless adolescents' social networks is more ambiguous. Social network data were collected from 136 homeless adolescents in Hollywood, California to examine how network ties are associated with symptoms of anxiety and depression. Face-to-face relationships with street-based peers were a risk factor for both anxiety and depression, while contacting home-based friends through social networking technology was found to be protective for depression. Community-based and public agencies serving homeless adolescents should consider facilitating the maintenance of these protective relationships by providing internet access.
Traditional therapies for addictions are underutilized and characterized by high attrition rates suggesting they may not meet the needs of a proportion of individuals with addiction-related problems including problem drinking, smoking, substance use and problem gambling. Internet-based therapy has emerged as a new treatment modality for psychological disorders and health issues and this review is the first attempt to summarize and evaluate the evidence of the effectiveness of Internet therapy for addictions. Extensive literature searches were conducted to identify studies meeting the criteria of delivering structured Internet-based treatment programs for addictions that incorporated a component of trained therapist interaction. Only nine studies met criteria for inclusion with seven representing a randomized controlled trial. These included seven papers reporting on tobacco-cessation programs, one Internet-based therapy for pathological gambling, and one treatment program for substance abuse. A range of therapeutic models, treatment components and outcome measures was included across these studies. Positive treatment effects were reported following completion of therapy and at longer-term follow-up. The review concluded that Internet-based therapies for addictions are effective in achieving positive behavioral changes but that more research is required to determine the comparative effectiveness of various Internet-based therapies and their components.
To examine the association between sexual health and internet use, including social networking websites such as MySpace and Facebook, among a sample of homeless adolescents at high risk of contracting HIV/AIDS.
In 2009, a survey of internet use among 201 homeless adolescents was carried out. Multivariate logistic regression models assessed how patterns of use were associated with engaging in exchange sex (sex for money, drugs, or housing), recent HIV testing, and online partner-seeking behaviors.
Among the surveyed adolescents, 96.5% reported internet use. Most youth accessed the internet at public libraries or youth service agencies. Increased time online and recent engagement in exchange sex were both positively associated with online partner-seeking. Youth connected to family members online were less likely to practice exchange sex and more likely to report a recent HIV test. Youth connected to street-based peers online were more likely to practice exchange sex, whereas youth connected to home-based peers online were more likely to report a recent HIV test.
Although these data are preliminary, homeless youth need more access to the internet, as access facilitates connecting with family and home-based peers whose presence may reduce sexual risk-taking. Access, however, must be carefully monitored to prevent youth soliciting sex online.
Mobile devices can be used to deliver psychosocial interventions, yet there is little prior application in severe mental illness. We provide the rationale, design, and preliminary data from 3 ongoing clinical trials of mobile interventions developed for bipolar disorder or schizophrenia. Project 1 used a personal digital assistant to prompt engagement in personalized self-management behaviors based on real-time data. Project 2 employed experience sampling through text messages to facilitate case management. Project 3 was built on group functional skills training for schizophrenia by incorporating between-session mobile phone contacts with therapists. Preliminary findings were of minimal participant attrition, and no broken devices; yet, several operational and technical barriers needed to be addressed. Adherence was similar to that reported in nonpsychiatric populations, with high participant satisfaction. Therefore, mobile devices seem feasible and acceptable in augmenting psychosocial interventions for severe mental illness, with future research in establishing efficacy, cost effectiveness, and ethical and safety protocols.
The psychological sense of community is an important aspect of community life; yet, it remains largely unexamined among individuals with serious mental illness (SMI). Sense of community represents the strength of bonding among community members; and this social phenomenon likely impacts the process by which individuals with SMI integrate into community life. The current study examined sense of community (SOC) for individuals with SMI by assessing the relationships between neighborhood experiences, unique factors related to SMI (e.g., mental illness diagnosis), and sense of community in the neighborhood. Participants were 402 residents of supported housing programs who used mental health services in South Carolina. Hierarchical linear regression was utilized to determine which components of community life helped to explain variability in sense of community. In total, 214 participants reported that it is very important for them to feel a sense of community in their neighborhoods. Neighbor relations, neighborhood safety, neighborhood satisfaction, neighborhood tolerance for mental illness, and housing site type emerged as significant explanatory variables of sense of community. These findings have implications for interventions aimed at enhancing SOC and community integration for individuals with SMI.
This study examines the effects of perceived housing environment on selected well-being outcomes of a seriously mentally ill population in supported housing programs. Individuals live independently in their own apartments and use supportive mental health services as needed. The study conceptualizes one's housing environment as existing at the apartment, neighborhood and the surrounding community levels of analysis that, taken together, form a multi-dimensional construct of housing environment. Self-report data from interviews with a sample of seriously mentally ill adults is paired with (a) observer ratings of housing environments, (b) census profiles of the surrounding community and (c) case manager ratings of clients' functioning in order to explore the effects of supported housing environments on well-being outcomes. Well-being is operationalized here as levels of psychiatric distress, recovery orientation, residential satisfaction, and adaptive functioning. Hierarchical regression models posit that apartment, neighborhood and census tract level variables are unique predictors of these domains of well-being. Results show that neighborhood level variables, especially those relating to the social environment, are the most influential predictors for understanding variance in well-being, with apartment level variables also contributing to understanding of housing environment effects. The census tract level predictors did not contribute a significant amount of explanation of the variance in well-being outcomes. Implications for supported housing programs and the role of ecological levels of analysis in conceptualizing and measuring housing environment influence are discussed.
The general importance of an individual's support network has been recognized in the field of community mental health; yet a more detailed understanding of how a client's available social ties may contribute to his or her adjustment is presently lacking. This study used network analysis to examine differences in the social networks of mental health clients to identify factors associated with positive social adjustment. Subjects were selected from three different types of mental health programs as well as from the general population of Marion County, Oregon. Results generally revealed that subjects from the community sample more often would look to immediate family members for support. Better functioning chronic clients emphasized professional contacts, whereas more poorly adjusted chronic clients would look to friends for support. The results have implications both for understanding the nature of the support available to a client and mobilizing the support resources of the existing network of relationships to aid adjustment to community living.
Despite the consensus regarding community integration as a major goal of mental health policy and the emergence of supportive independent housing as a critical component of community mental health services, mental health services research has not examined the extent to which housing and service characteristics are associated with community integration of persons with psychiatric disabilities in supportive independent housing. The main goal of this paper is to propose a conceptual model of factors influencing community integration that takes into account the differential configuration of housing setting and support structure in supportive independent housing. The conceptual model encompasses a multidimensional conceptualization of community integration and considers an array of housing and service characteristics that are potentially relevant determinants of community integration. On the basis of the proposed model, this paper outlines the methodological considerations for future research with regard to measurement, research designs, and statistical models.
More than half of people with severe mental illness are lonely, the subjective state associated with social isolation and lack of desired relationships. Their loneliness is related to impaired ability to make and keep friends, lack of opportunities to participate in social activities, and stigma associated with mental illness that creates barriers between them and their communities. Treatment for people with severe mental illness often fails to include social network interventions that have the potential to decrease loneliness. Knowledge of social network interventions-their characteristics, effectiveness, and applicability for specific patients-can guide nurses' use of these treatment modalities.
We determined whether patients with serious mental illness were more likely to report low social support than those without serious mental illness.
We conducted a national, cross-sectional study of VA patients in Fiscal Year 1999 who were diagnosed with a serious mental illness, as well as a random sample of VA patients without a diagnosis of serious mental illness (N = 8,547) from the National Psychosis Registry who also completed the VA's Large Health Survey of Veteran Enrollees (LHSV) 9-item questionnaire on social support. Using generalized estimating equations; we assessed patient's likelihood of reporting low social support, while controlling for patient socio-economic and clinical factors.
In multivariable models adjusting for patient factors, patients with serious mental illness were more likely to report low instrumental support, e.g., having no one to help with chores (OR = 1.41, p < 0.001) and low emotional support, e.g., having no one to relax with (OR = 2.05, p < 0.001).
Patients diagnosed with serious mental illness reported low social support across different dimensions. Recovery-oriented services for persons with serious mental illness should focus on improving and sustaining emotional and instrumental supports for this vulnerable population.