Water clubs in residential care: Is it the water or the club that enhances health and well-being?

"Learning by osmosis": the transformative social identity journey of physiotherapists developing psychologically-informed practice, a reflexive thematic analysis

BACKGROUND

Despite efforts to support physiotherapists in integrating psychosocial aspects of care to biological ones, clinical practice remains dominated by biomechanistic priorities. To facilitate change, attention and actions need to consider not only the individual level of the therapists but also the cultural and structural levels of the profession. How these multi-layered social dynamics shape practice have not previously been investigated. The Social Identity Approach (SIA) provides a relevant framework to this exploration.

AIM

This study aimed to identify the social identity processes involved in the development of psychologically-informed physiotherapy (PIP) to understand how they may influence practice change.

METHODS

Nine semi-structured interviews were conducted with self-identified psychologically-informed physiotherapists. A Reflexive Thematic Analysis informed by SIA principles enabled to consider meaning as the product of social processes.

FINDINGS

The analysis of participants' experiences in moving from a primarily biomechanistic practice toward the integration of psychosocial aspects of health demonstrated: 1) a transformative "mind-blowing" identity journey; 2) a journey that is not made in isolation; and 3) where leadership matters.

CONCLUSION

Changes in clinical practice involve dynamics at the collective level of the practice environment and of the physiotherapy profession itself, rather than solely at the individual level of clinicians. An understanding of these complex social processes at a managerial level could be important to better support leaders and clinicians in implementing PIP in clinical practice.

Circumstances that promote social connectedness in older adults participating in intergenerational programmes with adolescents: a realist review

OBJECTIVES

Limited social connectedness in older adults is a risk factor for poor physical and mental health. Older adults who are socially isolated, lonely and disconnected have a higher risk of chronic illness, depression and premature death. Current literature suggests that improved social connectedness reduces these risks. Intergenerational programmes are an effective way to improve health outcomes. Despite this, there is yet to be a review using realist review methods that seeks to identify the circumstances that promote social connectedness in older adults participating in intergenerational programmes with adolescents.

DESIGN

A realist review methodology was chosen to account for the complexity of intergenerational interventions. Nine studies were included. In line with realist review methodology, iterative data extraction and analysis was conducted to identify the specific contexts, mechanisms and outcomes of the programmes. Specific circumstances were identified to develop theories relating to improved social connectedness in older adults.

DATA SOURCES

MEDLINE, PsycINFO, CINAHL were searched using English language limitation.

ELIGIBILITY CRITERIA

Included participants were aged 65 and over (older adults) and between 13 and 19 years (adolescents) participating in intergenerational programmes from non-familial generations. Studies had to be published in English between 2000 and 2020 and could be quantitative, qualitative or mixed-methods primary research studies.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used a bespoke data extraction form. All authors were involved in the synthesis process which used the extracted data to illuminate the contexts, mechanisms and outcomes that underpinned reviewed programmes.

RESULTS

The nine included studies were set in different contexts, including community organisations, schools and aged care facilities. They used an array of interventions including reminiscence therapy, craft or space for conversation. Despite study heterogeneity, the parallels in psychosocial development between older adults and adolescents were shown to be a likely driver for improved social health outcomes. Programmes most likely to improve social health outcomes were those that acknowledged psychosocial development, were delivered in community settings, leveraged pedagogical frameworks, used trained facilitators and supported participants to build relationships through shared purpose.

CONCLUSIONS

This review contributes a logic model to support the design and development of intergenerational programmes involving adolescents to improve social connectedness in older adults. Future research to test the logic model in practice is needed.

The influence of college students' academic stressors on mental health during COVID-19: The mediating effect of social support, social well-being, and self-identity

COVID-19 caused harmful mental consequences to the public, and mental health problems were very common among college students during the outbreak of COVID-19. Academic stressors were the main stress for college students, and social support, social well-being, and self-identity were widely known as protective factors for mental health. Therefore, the study aimed to investigate the influence of academic stressors on mental health and the mediating effect of social support, social well-being, and self-identity among college students during the outbreak of COVID-19. With 900 college students as subjects, using the college students' academic stressors questionnaire, social support questionnaire, social well-being scale, self-identity scale, and depression anxiety stress scales (DASS-21), the results showed that: (1) academic stressors had a significantly negative correlation with social support, social well-being, and self-identity while having a significantly positive correlation with mental health; (2) academic stressors could positively predict mental health; (3) this effect was mediated by social support, social well-being, and self-identity; (4) work stressor was an important stressor during COVID-19, and had the same role as academic stressors in the structural equation model. The results of this study suggested that adjusting the academic stressors or work stressors of college students and enhancing social support could improve social well-being and self-identity, and might effectively protect their mental health under the COVID-19 pandemic environment.

"Let's get physical" - or social: The role of physical activity versus social group memberships in predicting depression and anxiety over time

BACKGROUND

Physical activity is often promoted as a way to prevent and combat anxiety and depression in adolescents. However, very little research has sought to establish whether the benefits of exercise arise from the excercise itself or from the social context in which it takes place. We explore the hypothesis that it is not physical activity on its own, but rather adolescents' engagement in group life (as part of a sports group or otherwise), that accounts for positive mental health effects associated with physical activity.

METHODS AND RESULTS

We conducted a longitudinal study that tracked 558 high-school boys and found that anxiety and depression over time was not predicted by (a) T1 physical fitness as determined by 7 speed and agility tests, or (b) engaging in multiple sports as co-curricular activies at T1. In contrast, multiple group memberships - irrespective of the activity - predicted reduced depression and anxiety over time, particularly when these were groups that adolescents identified with and experienced as compatible with each other.

LIMITATIONS

Limitations relate to (a) physical fitness only being measured at T1, (b) the absence of a measure of frequency and duration of physical activity, and (c) the homogeneity of the sample.

CONCLUSIONS

We conclude that group memberships and the social identities that adolescents derive from these groups (including, but not restricted to, those involving sport) function as a psychological resource to reduce anxiety and depression over time.

Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

The Effects of Social Identity and Emotional Connection on Subjective Well-Being in Times of the COVID-19 Pandemic for a Spanish Sample

This study analyzes whether the degree of social identity and the degree of emotional connection influence the subjective well-being of individuals that participated in collective acts of support for health personnel fighting against the COVID-19 pandemic. Our sample was composed of 810 participants who resided in Spain (339 women and 471 men) with an average age of 34.22 (SD = 12.56). All of them frequently participated in the acts of support that took place each day of the lockdown decreed by the National Government on 14 March 2020. The results show that the greater identification with the group (the country) and the greater the emotional connection, the higher the scores obtained in subjective well-being. The results also show that emotional connection had a positive effect on emotional subjective well-being, mediated by the social identity activated in the collective act. The results are interpreted from the perspective of social identity that highlights the role played by social identity in influencing health and subjective well-being.

Community identification, social support, and loneliness: The benefits of social identification for personal well-being

Levels of loneliness across the world have reached epidemic proportions, and their impact upon population health is increasingly apparent. In response, policies and initiatives have attempted to reduce loneliness by targeting social isolation among residents of local communities. Yet, little is known about the social psychological processes underpinning the relationships between community belonging, loneliness, and well-being. We report three studies which apply the Social Identity Approach to Health to examine the mechanisms underpinning the relationships between community identity, health, and loneliness. Hypotheses were tested through secondary analyses of the 2014-2015 UK Community Life Survey (N = 4,314) as well as bespoke household surveys in a more (N = 408) and less (N = 143) affluent community at high risk of loneliness. Studies 1 and 2a demonstrated that the relationship between community identification and well-being was mediated by increased social support and reduced loneliness. In Study 2b, community identification predicted well-being through reduced loneliness, but not through social support. Our results are the first to evidence these relationships and suggest that community-level interventions that enhance community identification and peer support can promote a potential Social Cure for loneliness.

Network Modeling of Assisted Living Facility Residents' Attendance at Programmed Group Activities: Proximity and Social Contextual Correlates of Attendance

BACKGROUND AND OBJECTIVES

Social engagement, including participation in group activities, supports older adults' mental and physical health. However, many residents of assisted living facilities do not participate in their facility's programmed group activities. Explaining residents' attendance at group activities is complex; attendance is associated with a confluence of individual-level and contextual factors. The aim of this study was to assess the effects of multilevel factors on attendance, including residents' proximity to activity location and the potential for one resident's attendance to depend on other residents' attendance.

RESEARCH DESIGN AND METHODS

We used bipartite exponential random graph models to examine the attendance of 35 residents at 563 programmed group activities. We simultaneously modeled the effects of the geospatial distance from a resident's apartment to the activity and the tendency for residents to attend activities with similar groups of other residents (i.e., shared attendance) on the likelihood of attendance, while controlling for individual-level factors (demographic and health indicators) and activity popularity.

RESULTS

Greater distance was associated with a reduced likelihood of attendance (p < .001) and residents tended to attend activities with similar subsets of other residents (p < .001).

DISCUSSION AND IMPLICATIONS

Findings suggest that greater distance to group activities may be a barrier to attendance. Implications include facility design, placement of activities and apartments, and mobility-related strategies to increase activity participation. It is also important to recognize that participation in activities is dependent on social context. We recommend that proximity to activities and social contextual factors be considered in future examinations of attendance at group activities.

Life is about "constant evolution": the experience of living with an acquired brain injury in individuals who report higher or lower posttraumatic growth

OBJECTIVE

To explore the experience of living with an Acquired Brain Injury (ABI) in individuals who report higher or lower posttraumatic growth (PTG).

METHOD

A multi-method design was employed. Participant scores on the Posttraumatic Growth Inventory (PTGI) were used to identify groups for qualitative comparative analysis. Individual semi-structured interviews were conducted with fourteen individuals with ABI. Data were analysed thematically.

RESULTS

Four themes emerged. The first two themes: "In my mind I was fine" surviving in aftermath of acquiring a brain injury and The everyday as "derailing" capture the transition process from an initial rehabilitation state characterised by neuropsychological and avoidance coping, towards active rebuilding for PTG. Internal building blocks for PTG and Growing in the social world: "you need to have that social connection" elaborate on the internal (e.g., acceptance, integration of the pre and post-injury self) and external (e.g., social relationships) factors seen to facilitate or obstruct PTG.

CONCLUSIONS

Under certain conditions, individuals living with ABI may construe positive growth from their experiences. Practitioners can support PTG development by providing individual and family-based supports aimed at increasing acceptance, the integration of self, and social connection throughout all stages of ABI rehabilitation.IMPLICATIONS FOR REHABILITATIONInternal factors such as having a flexible and positive mindset and external factors such as one's social environment can affect how individuals living with an ABI construe positive growth.Individuals with ABI and their families require access to individualised longitudinal support for neuropsychological and social challenges that can result in increased distress and obstruct the development of PTG.Efforts to facilitate acceptance and support the integration of the pre and post-injury self through recognition of continuity of self and processing of new schematic beliefs can benefit PTG development.Rehabilitation providers should support individuals with ABI to develop or maintain a positive social identity within new or existing social groups.

Longitudinal Evidence for the Effects of Social Group Engagement on the Cognitive and Mental Health of Chinese Retirees

BACKGROUND

Research investigating the health benefits of social group participation in the retirement transition has provided little insight into the longitudinal effects on cognitive health and the generalizability of these relationships to non-Western samples. The present paper addresses these issues by examining the effects of social group engagement on the cognitive performance and depression symptoms of Chinese older adults followed over 4 years in their transition to retirement.

METHODS

Using the China Health and Retirement Longitudinal Study (CHARLS) data, a sample of 1,297 Chinese seniors transitioning to retirement were followed between 2011 and 2013, and then 2 years later (in 2015) after retirement. Group-based social engagement was used to predict retiree cognitive performance and depression symptoms across time.

RESULTS

After controlling for established demographic covariates and close relationship factors at baseline, social group engagement at baseline positively predicted overall cognitive performance and depression symptoms. Moreover, positive change in group engagement was associated with reduced decline in cognitive performance over the 4-year retirement transition period.

DISCUSSION

The current findings demonstrate the generalizability of the health benefits of social group engagement to cognitive health and to a non-Western (Chinese) sample of retirees.

Social enterprises' impact on older people's health and wellbeing: exploring Scottish experiences

The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample (n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health.

Sing4Health: protocol of a randomized controlled trial of the effects of a singing group intervention on the well-being, cognitive function and health of older adults

Background

Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants.

Methods

We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention.

Participants

140 retired older adults (> 60 years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n = 70) and a control (n = 70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation.

Discussion

Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants.

Trial registration

NCT03985917. Registered 14th June 2019 (retrospectively registered).

Social Prescribing as 'Social Cure': A longitudinal study of the health benefits of social connectedness within a Social Prescribing pathway

We examined whether the Social Cure (SC) perspective explains the efficacy of a Social Prescribing (SP) pathway which addresses healthcare needs through enhancing social connections. Data were collected at pathway entry from patients with long-term health conditions, or who felt isolated/lonely/anxious (N = 630), then again 4 months later (N = 178), and 6-9 months later (N = 63). Being on the pathway was associated with increased group memberships between T0 and T1. The relationship between increased group memberships and quality-of-life was serially mediated by belonging, support and loneliness. This study is the first to show SP enhances health/well-being via SC mechanisms.

Structured activity and multiple group memberships as mechanisms of increased depression amongst young people not in employment, education or training

AIMS

Young people Not in Employment, Education and Training (NEET) are at increased risk of depression, yet mechanisms of this association are poorly understood. We hypothesised that being NEET has both behavioural and social identity consequences and that reductions in structured activity and multiple group memberships underlie increased depression in this group. Our purpose was to assess first whether depression was greater for NEET compared to non-NEET young people from the same geographical locality, and secondly, whether a loss of structured activity leading to a reduction in multiple group memberships explains the NEET-depression association.

METHODS

The present study was a cross-sectional between-groups design using convenience sampling. Measures of depression, structured activity and multiple group memberships were obtained from 45 NEET young people and 190 university students (non-NEET).

RESULTS

The NEET group reported significantly more depression symptoms compared to the non-NEET student control group. A path model specifying NEET status as a predictor of depression, with this association mediated by a reduction in structured activity and fewer multiple group memberships (standardised indirect = 0.03, unstandardised indirect = 0.62, P = 0.052, 95% bias corrected confidence intervals [0.21,1.44]), provided excellent fit to our data: χ² (3) = 0.26, P = 0.968, comparative fit index (CFI) = 1.00, root mean square error of approximation (RMSEA)<0.01, standardized root mean square residual (SRMR) = 0.01).

CONCLUSIONS

Our findings suggest that depression is elevated amongst NEET young people compared to non-NEET students from the same locality. The association between NEET status and depression was partially mediated by reduced structured activity and its association with reduced multiple group memberships. Although using cross-sectional data, our findings suggest social interventions may be a key resource in ameliorating depression amongst NEET young people; through preserving engagement in structured activity and the wellbeing benefits derived from arising multiple group memberships.

What moderates the attainment gap? The effects of social identity incompatibility and practical incompatibility on the performance of students who are or are not Black, Asian or Minority Ethnic

A successful journey through higher education is, for many, a once in a lifetime opportunity for social mobility. Unfortunately, one notable feature of higher education systems is that students from some backgrounds do not achieve the same academic attainments as do others. The current study tests the role of one particular set of processes: social identity (in)compatibility on academic performance. Participants were recruited at two time points from a pool of first year undergraduates at a modern London University (N = 215) of which 40.1% were classed as Black, Asian or Minority Ethnic (BAME), 57.1% as non-BAME and 2.8% did not provide this information. A prospective design was employed: Alongside demographic data, measures at the start of the academic year consisted of measures of student and ethnic identity, and both practical and identity incompatibility. At the end of the academic year, average marks achieved were gained for each student from the university’s registry system. Results indicate that BAME students had equal levels of student identity to non-BAME students, but higher levels of ethnic identity. They also typically experienced higher levels of both practical and identity incompatibility. Finally, BAME students had lower attainment than did non-BAME students. Both practical and identity incompatibility appeared to moderate this effect. However, contrary to predictions, it was only under conditions of low and medium levels of incompatibility that BAME students attained lower marks than their non-BAME peers. The theoretical and practical implications of these findings are discussed.

Social identification-building interventions to improve health: a systematic review and meta-analysis

There is growing evidence that social identity processes play an important role in a range of health outcomes. However, we know little about the nature and effectiveness of interventions that build social identification with the aim of promoting health. In the present research, we systematically review and meta-analyze interventions that build social identification to enhance health and wellbeing. A total of 27 intervention studies were identified (N = 2,230). Using a three-level meta-regression, results indicate that social identification-building interventions had a moderate-to-strong impact on health (Hedges g = 0.66; 95%CIs[0.34, 0.97]). Analyses revealed significant variation in intervention effectiveness as a function of its type: group-relevant decision making (g = 1.26), therapy programmes (g = 1.02), shared activities (g = 0.40), and reminiscence (g = -0.05). By contrast, there was much less variation across health outcomes: quality of life (g = 0.80), physical health (g = 0.76), self-esteem (g = 0.69), well-being (g = 0.66), (reduced) anxiety (g = 0.61), (reduced) depression (g = 0.58), cognitive health (g = 0.55), and (reduced) stress (g = 0.49). Finally, speaking to the mechanism of the interventions, interventions tended to be more effective to the extent that they succeeded in building participants' social identification with the intervention group. We discuss the theoretical and practical implications of social identification-building interventions to foster health and outline an agenda for future research and practical application.

Reporting on novel complex intervention development for adults with social communication impairments after acquired brain injury

PURPOSE

Interventions are often poorly described in published controlled trials, with relatively little information regarding intervention development, content and fidelity. This makes it difficult to conduct replication studies, interpret and compare findings across studies and for therapists to deliver the intervention in clinical practice. Complete reporting of interventions (including fidelity) is now recommended for treatment studies, and this standardized approach is achieved using the Template for Intervention Description and Replication (TIDieR). The aim of this article is to describe the multi-phase process of developing a novel intervention for adults with acquired brain injury (ABI) and report on the findings from involving practicing therapists in this process.

METHODS

Phase 1 involved a review of relevant literature and specifying the intervention as a prototype intervention manual. Phase 2 comprised a focus group with eight practicing therapists exploring their experiences and perceptions of the intervention, potential active components, and essential elements; it also included a review of the prototype manual. Data from the focus group discussion was transcribed and analyzed thematically. Phase 3 investigated actual fidelity of the intervention undertaken, achieved by observers viewing videoed sessions and appraising against the fidelity checklist, which was then analyzed using Cohen's kappa.

RESULTS

Project-based intervention was defined as having six essential elements: a project or tangible end product focus; group-based intervention; individualized communication-based goals; communication partner involvement; acknowledgement and support of participants' cognitive ability; and consideration and plan to address impaired awareness. Analysis of focus group data revealed four themes of essential elements; group context; therapeutic skills; and manual core components and informed the development of a fidelity checklist with 13 essential and 6 desirable criteria. Fidelity assessed using percent agreement was acceptable for almost all rater pairs; where significant, Kappa coefficients had values ranging from poor to excellent (k = 0.34-1.0) depending on rater pair and session.

DISCUSSION

The TIDieR framework provided a clear systematic approach for the complete description and reporting of a complex communication intervention for people with ABI. This article comprehensively described the development and manualisation of intervention in collaboration with practicing therapists which can be used for future testing. In addition, the process undertaken has the potential to inform rehabilitation researchers in other fields on the development of complex interventions.Implications for rehabilitationThe results of this study detail the steps needed to describe an intervention, from the identification of the essential elements through to the creation of a manual and checklist to show fidelity. The process provides a starting point for other rehabilitation researchers developing complex interventions.This article provides a clear and comprehensive description of a novel intervention containing six essential elements for people with acquired brain injury presenting with communication impairments.Project-based intervention is one intervention, which intends to help improve communication skills and quality of life in people with acquired brain injury.This study highlights the important role practicing therapists can play in the creation of an intervention manual and fidelity checklist and in ensuring that sufficient detail is provided to help therapists implement the intervention into clinical practice.

Ageing well in a foreign land as a process of successful social identity change

PURPOSE

Over and above the risks associated with ageing, older migrants are also at risk of social isolation. The social identity approach, and the Social Identity Model of Identity Change (SIMIC) in particular, provides a theoretical basis from which to understand the factors contributing to social isolation and how this then impacts on older migrants' capacity to age well in a foreign land. Building on the recognition that migration involves a major life change, we explore this transition qualitatively focusing specifically on social connectedness and adjustment.

METHODS

In semi-structured interviews with 29 older migrants in Australia, we examined participants' experiences of migration and perceptions of identity and identity change. We also considered in more detail experiences of the most and least socially isolated individuals to understand adjustment trajectories.

RESULTS

We found evidence supporting the key processes described in SIMIC (relating to social identity continuity, social identity gain, and perceived identity compatibility), suggesting that where adjustment was positive it was experienced as a process of successfully adapting to identity change.

CONCLUSION

We emphasise the importance of identity resources as substantial and concrete assets that can enhance the well-being among older adults aging in a foreign land.

The relation between social identity and test anxiety in university students

Social identification has been shown to be a protective resource for mental health. In this study, the relationships between social identification and emotional, as well as cognitive symptoms of test anxiety are investigated. Participants were university students diagnosed with test anxiety (N = 108). They completed questionnaires regarding a range of psychopathologic stress symptoms, and their social identification with fellow students and with their study program. Results reveal negative relations between social identification and almost all investigated emotional and cognitive symptoms of test anxiety. Based on this study, interventions could be developed that strengthen the social identity of university students.

Strengthening quitter self-identity: An experimental study

OBJECTIVES

Smoking-related self-identity processes are important for smoking cessation. We examined whether quitter self-identity (i.e. identification with quitting smoking) could be strengthened through a writing exercise, and whether expected social support for quitting, manipulated through vignettes, could facilitate identification with quitting.

DESIGN

Participants (N = 339 daily smokers) were randomly assigned to a 2 (identity: strengthened quitter self-identity vs. control) × 3 (social support: present vs. absent vs. neutral control) between-participants design.

MAIN OUTCOME MEASURES

The main outcome was post-test quitter self-identity.

RESULTS

Post-test quitter self-identity was not strengthened successfully. Only a small and marginally significant intervention effect was found on quitter self-identity, which did not generalise to positively influence quit-intention or behaviour. The social support manipulation did not facilitate quitter self-identity. Secondary content analyses showed that quitter self-identity was strengthened among participants who linked quitting smoking to their lifestyle, wanted to become quitters for health reasons, and whose reasons for becoming quitters included approach of positive aspects of quitting, but not among participants who linked quitter self-identity to their self-perceptions.

CONCLUSIONS

Results provide insight into the content of smokers' self-conceptualizations as quitters. Writing exercises should be improved and tested to eventually successfully strengthen quitter identities.

An intervention for pulmonary rehabilitators to develop a social identity for patients attending exercise rehabilitation: a feasibility and pilot randomised control trial protocol

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a degenerative condition that can impair health-related quality of life (HRQoL). A number of self-management interventions, employing a variety of behavioural change techniques (BCTs), have been adopted to improve HRQoL for COPD patients. However, a lack of attention has been given to group management interventions with an emphasis on incorporating BCTs into rehabilitators' practice. This study aims to pilot and feasibly explore a social identity group management intervention, delivered by COPD rehabilitation staff to patients attending exercise pulmonary rehabilitation. Doing so will help inform the plausibility of the intervention before conducting a full trial to evaluate its effectiveness to improve HRQoL.

METHODS

This is a two-centre, randomised cross-over controlled trial. Two pulmonary rehabilitation centres based in the UK will be randomly allocated to two treatment arms (standard care and intervention). Outcome measurements relating to HRQoL and social identity will be completed pre- and post-exercise rehabilitation. Focus group interviews will be conducted at the end of exercise rehabilitation to capture participants' contextualised experiences of the intervention. COPD rehabilitators will undertake semi-structured interviews at the end of the trial to garner their holistic perspectives of intervention fidelity and implementation.

DISCUSSION

This is the first study to adopt a social identity approach to develop a rehabilitator-led, group management intervention for COPD patients attending exercise pulmonary rehabilitation. The results of this study will provide evidence for the feasibility and sample size requirements to inform a larger study, which can ascertain the intervention's effectiveness for improving HRQoL for COPD patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02288039. Date 31 October 2014.

Improving specific autobiographical memory in older adults: impacts on mood, social problem solving, and functional limitations

Older adults have difficulty recalling specific autobiographical events. This over-general memory style is a vulnerability factor for depression. Two groups receiving interventions that have previously been successful at reducing over-general memory in depressed populations were compared to a control group. Participants were healthy older adults aged ≥70 years: memory specificity training (MEST; n = 22), life review (n = 22), and control group (n = 22). There were significant improvements in autobiographical memory specificity in the MEST and life review groups at post-training, relative to the control group, suggesting that over-general memory can be reduced in older adults. Change in social problem solving ability and functional limitations were related to change in autobiographical memory specificity, supporting the suggested role of specific retrieval in generating solutions to social problems and maintaining independence. Qualitative analysis of participants' feedback revealed that life review may be more appropriate for older adults, possibly because it involves integrating specific memories into a positive narrative.

Increasing water intake in pre-school children with unhealthy drinking habits: A year-long controlled longitudinal field experiment assessing the impact of information, water affordance, and social regulation

OBJECTIVE

We investigated the effect of three interventions to increase the plain water consumption of children with unhealthy drinking habits, with an innovative approach combining the three layers of Installation Theory: embodied competences, affordances and social regulation.

METHODS

334 preschool children and their carers were allocated to three interventions: Control (control): no intervention, Information (info): online coaching sessions on water health benefits aiming at modifying embodied competences (knowledge), Information + Water Affordance (info + w): the same plus home delivery of small bottles of water. After three months, half of the info and info + w subjects were allocated to Social Regulation (+social) (on-line discussion forum) or no further intervention (-social). Intake of plain water and all other fluid types of the children were recorded by the carers 6 times over a year using an online 7-day fluid-specific dietary record.

RESULTS

Over 1 year, all groups significantly increased daily water consumption by 3.0-7.8 times (+118 to +222 mL). Info + w + social and Info-social generated the highest increase in plain water intake after one year compared to baseline, by 7.8 times (+216 mL) and 6.7 times (+222 mL) respectively; both significantly exceeded the control (3.0 times, +118 mL), whilst the effect of info + w-social (5.0 times, +158 mL) and info + social (5.3 times, +198 mL) did not differ from that of control. All groups saw a decrease of sweetened beverages intake, again with info + w + social generating the largest decrease (-27%; -172 mL). No changes in other fluids or total fluid intake were observed.

CONCLUSIONS

Sustainable increased water consumption can be achieved in children with unhealthy drinking habits by influencing representations, changing material affordances, and providing social regulation. Combining the three provided the strongest effect as predicted by Installation Theory.

Associations of participation in community assets with health-related quality of life and healthcare usage: a cross-sectional study of older people in the community

BACKGROUND

Community assets are promoted as a way to improve quality of life and reduce healthcare usage. However, the quantitative impact of participation in community assets on these outcomes is not known.

METHODS

We examined the association between participation in community assets and health-related quality of life (HRQoL) (EuroQol-5D-5L) and healthcare usage in 3686 individuals aged ≥65 years. We estimated the unadjusted differences in EuroQol-5D-5L scores and healthcare usage between participants and non-participants in community assets and then used multivariate regression to examine scores adjusted for sociodemographic and limiting long-term health conditions. We derived the net benefits of participation using a range of threshold values for a quality-adjusted life year (QALY).

RESULTS

50% of individuals reported participation in community assets. Their EuroQol-5D-5L scores were 0.094 (95% CI 0.077 to 0.111) points higher than non-participants. Controlling for sociodemographic characteristics reduced this differential to 0.081 (95% CI 0.064 to 0.098). Further controlling for limiting long-term conditions reduced this effect to 0.039 (95% CI 0.025 to 0.052). Once we adjusted for sociodemographic and limiting long-term conditions, the reductions in healthcare usage and costs associated with community asset participation were not statistically significant. Based on a threshold value of £20 000 per QALY, the net benefits of participation in community assets were £763 (95% CI £478 to £1048) per participant per year.

CONCLUSIONS

Participation in community assets is associated with substantially higher HRQoL but is not associated with lower healthcare costs. The social value of developing community assets is potentially substantial.

Stressful life transitions and wellbeing: A comparison of the stress buffering hypothesis and the social identity model of identity change

The relationship between stressful life transitions and wellbeing is well established, however, the protective role of social connectedness has received mixed support. We test two theoretical models, the Stress Buffering Hypothesis and the Social Identity Model of Identity Change, to determine which best explains the relationship between social connectedness, stress, and wellbeing. Study 1 (N=165) was an experiment in which participants considered the impact of moving cities versus receiving a serious health diagnosis. Study 2 (N=79) was a longitudinal study that examined the adjustment of international students to university over the course of their first semester. Both studies found limited evidence for the buffering role of social support as predicted by the Stress Buffering Hypothesis; instead people who experienced a loss of social identities as a result of a stressor had a subsequent decline in wellbeing, consistent with the Social Identity Model of Identity Change. We conclude that stressful life events are best conceptualised as identity transitions. Such events are more likely to be perceived as stressful and compromise wellbeing when they entail identity loss.

Activating and Guiding the Engagement of Seniors With Online Social Networking: Experimental Findings From the AGES 2.0 Project

OBJECTIVE

Guided by theoretical and empirical work attesting to the health benefits of social connections, we tested whether Internet connectivity, and training in its use for social purposes, can support the well-being of older adults receiving care.

METHOD

Participants ( N = 76) were randomly assigned to receive 3 months training versus care-as-usual. Cognitive and mental health were assessed before and after the intervention.

RESULTS

Results show significant cognitive improvements across time in the training, but not control, group. This effect was mediated through a combination of increased social activity, improved self-competence, and maintained personal identity strength. Indirect effects on mental health outcomes via these processes were also observed.

DISCUSSION

These findings suggest that Internet access and training can support the self and social connectedness of vulnerable older adults and contribute positively to well-being.

Groups 4 Health: Evidence that a social-identity intervention that builds and strengthens social group membership improves mental health

BACKGROUND

Social isolation and disconnection have profound negative effects on mental health, but there are few, if any, theoretically-derived interventions that directly target this problem. We evaluate a new intervention, Groups 4 Health (G4H), a manualized 5-module psychological intervention that targets the development and maintenance of social group relationships to treat psychological distress arising from social isolation.

METHODS

G4H was tested using a non-randomized control design. The program was delivered to young adults presenting with social isolation and affective disturbance. Primary outcome measures assessed mental health (depression, general anxiety, social anxiety, and stress), well-being (life satisfaction, self-esteem) and social connectedness (loneliness, social functioning). Our secondary goal was to assess whether mechanisms of social identification were responsible for changes in outcomes.

RESULTS

G4H was found to significantly improve mental health, well-being, and social connectedness on all measures, both on program completion and 6-month follow-up. In line with social identity theorizing, analysis also showed that improvements in depression, anxiety, stress, loneliness, and life satisfaction were underpinned by participants' increased identification both with their G4H group and with multiple groups.

LIMITATIONS

This study provides preliminary evidence of the potential value of G4H and its underlying mechanisms, but further examination is required in other populations to address issues of generalizability, and in randomized controlled trials to address its wider efficacy.

CONCLUSIONS

Results of this pilot study confirm that G4H has the potential to reduce the negative health-related consequences of social disconnection. Future research will determine its utility in wider community contexts.

"Depression is who I am": Mental illness identity, stigma and wellbeing

BACKGROUND

Previous research has found that in the face of discrimination, people tend to identify more strongly with stigmatized groups. Social identification can, in turn, buffer wellbeing against the negative consequences of discrimination. However, this rejection identification model has never been tested in the context of mental illness identity.

METHODS

A survey was conducted with 250 people with diagnosed depression or current symptoms of at least moderate clinical severity.

RESULTS

Experiencing mental illness stigma was associated with poorer wellbeing. Furthermore, people who had experienced such stigma were more likely to identify as a depressed person. Social identification as depressed magnified, rather than buffered, the relationship between stigma and reduced wellbeing. This relationship was moderated by perceived social norms of the depressed group for engaging in depressive thoughts and behaviors.

CONCLUSIONS

These findings suggest that mental illness stigma is a double-edged sword: as well as the direct harms for wellbeing, by increasing identification with other mental illness sufferers, stigma might expose sufferers to harmful social influence processes.

Group Ties Protect Cognitive Health by Promoting Social Identification and Social Support

OBJECTIVE

Social relationships are protective of cognitive health as we age and recent findings show that social group ties (e.g., with community and peer groups) are especially important. The present research examines this relationship further to explore (a) the contribution of group, relative to interpersonal, ties and (b) underlying mechanism.

METHOD

Two cross-sectional survey studies were conducted. Study 1 was conducted online (N = 200) and Study 2 involved face-to-face interviews (N = 42).

RESULTS

The findings confirmed group ties as a stronger predictor of cognitive health than individual ties. It also supported our proposed sequential mediation model suggesting that the benefits of group ties arise from their capacity to enhance a sense of shared social identification and this, in turn, provides the basis for effective social support.

DISCUSSION

Both studies provided evidence consistent with claims that group ties were especially beneficial because they cultivated social identification that provided the foundation for social support.

Dehydration, Hypernatremia, and Hyponatremia

Disturbances of serum sodium are one of the most common findings in older persons. They are also a major cause of hospital admissions and delirium and are associated with frailty, falls, and hip fractures. Both hypernatremia and hyponatremia are potentially preventable. Treatment involves treating the underlying cause and restoring sodium and volume status to normal. The arginine vasopressin antagonists, vaptans, have increased the therapeutic armamentarium available to physicians.

Affiliative and "self-as-doer" identities: Relationships between social identity, social support, and emotional status amongst survivors of acquired brain injury (ABI)

Social support is an important factor in rehabilitation following acquired brain injury (ABI). Research indicates that social identity makes social support possible and that social identity is made possible by social support. In order to further investigate the reciprocity between social identity and social support, the present research applied the concepts of affiliative and "self-as-doer" identities to an analysis of relationships between social identity, social support, and emotional status amongst a cohort of 53 adult survivors of ABI engaged in post-acute community neurorehabilitation. Path analysis was used to test a hypothesised mediated model whereby affiliative identities have a significant indirect relationship with emotional status via social support and self-as-doer identification. Results support the hypothesised model. Evidence supports an "upward spiral" between social identity and social support such that affiliative identity makes social support possible and social support drives self-as-doer identity. Our discussion emphasises the importance of identity characteristics to social support, and to emotional status, for those living with ABI.

Social engagement in older residents of assisted living facilities

OBJECTIVES

As a core component of successful aging, social engagement is widely known to play an important role in promoting the health and well-being of older populations. Given the unique nature of assisted living facility (ALF) settings, the present study made a distinction between social engagement within and outside the facility and explored how these two types of social engagement would interact with functional disability in predicting depressive symptoms of older residents in ALFs. We hypothesized that the positive impact of social engagement within the facility would be greater among residents with higher levels of functional disability.

METHOD

Using data from 150 ALF residents in Florida (Mage = 82.8, SD = 9.41), the direct and moderating effects of functional disability and the two types of social engagement on depressive symptoms were assessed.

RESULTS

Supporting the hypothesis, the interaction between functional disability and social engagement within the facility was found to be significant. The finding demonstrates the particular importance of social engagement within the facility for those with reduced physical function. For them, the limited but available opportunities for social activities and interpersonal contacts within the facility seem to bring substantial psychological benefits.

CONCLUSION

The findings call attention to efforts to promote social activities and interpersonal contacts within ALFs.

Social identification moderates the effect of crowd density on safety at the Hajj

Crowd safety is a major concern for those attending and managing mass gatherings, such as the annual Hajj or pilgrimage to Mecca (also called Makkah). One threat to crowd safety at such events is crowd density. However, recent research also suggests that psychological membership of crowds can have positive benefits. We tested the hypothesis that the effect of density on safety might vary depending on whether there is shared social identification in the crowd. We surveyed 1,194 pilgrims at the Holy Mosque, Mecca, during the 2012 Hajj. Analysis of the data showed that the negative effect of crowd density on reported safety was moderated by social identification with the crowd. Whereas low identifiers reported reduced safety with greater crowd density, high identifiers reported increased safety with greater crowd density. Mediation analysis suggested that a reason for these moderation effects was the perception that other crowd members were supportive. Differences in reported safety across national groups (Arab countries and Iran compared with the rest) were also explicable in terms of crowd identification and perceived support. These findings support a social identity account of crowd behavior and offer a novel perspective on crowd safety management.

Depression and Social Identity: An Integrative Review

Social relationships play a key role in depression. This is apparent in its etiology, symptomatology, and effective treatment. However, there has been little consensus about the best way to conceptualize the link between depression and social relationships. Furthermore, the extensive social-psychological literature on the nature of social relationships, and in particular, research on social identity, has not been integrated with depression research. This review presents evidence that social connectedness is key to understanding the development and resolution of clinical depression. The social identity approach is then used as a basis for conceptualizing the role of social relationships in depression, operationalized in terms of six central hypotheses. Research relevant to these hypotheses is then reviewed. Finally, we present an agenda for future research to advance theoretical and empirical understanding of the link between social identity and depression, and to translate the insights of this approach into clinical practice.

Water-loss dehydration and aging

This review defines water-loss and salt-loss dehydration. For older people serum osmolality appears the most appropriate gold standard for diagnosis of water-loss dehydration, but clear signs of early dehydration have not been developed. In older adults, lower muscle mass, reduced kidney function, physical and cognitive disabilities, blunted thirst, and polypharmacy all increase dehydration risk. Cross-sectional studies suggest a water-loss dehydration prevalence of 20-30% in this population. Water-loss dehydration is associated with higher mortality, morbidity and disability in older people, but evidence is still needed that this relationship is causal. There are a variety of ways we may be able to help older people reduce their risk of dehydration by recognising that they are not drinking enough, and being helped to drink more. Strategies to increase fluid intake in residential care homes include identifying and overcoming individual and institutional barriers to drinking, such as being worried about not reaching the toilet in time, physical inability to make or to reach drinks, and reduced social drinking and drinking pleasure. Research needs are discussed, some of which will be addressed by the FP7-funded NU-AGE (New dietary strategies addressing the specific needs of elderly population for a healthy ageing in Europe) trial.