The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury

IPV survivors' and service providers' perspectives on brain injury screening/evaluation process and impact

This study explores the perspectives of intimate partner violence (IPV) survivors and staff of brain injury (BI) screening, and the neuropsychological evaluation (NPE) process. We gathered qualitative data from 17 participants - 10 IPV survivors, at risk for a BI, who had received BI screening and a NPE and a total of 7 staff in IPV-serving organizations. Interviews were recorded, transcribed verbatim and analysed for key themes using thematic analysis. Survivors were over 18 years of age; the majority were between 19 and 45 years old, unemployed, unmarried, and had children. Survivors were angry, scared, and embarrassed to learn that they might have an IPV-related BI. They were thankful to have an explanation for some of their cognitive symptoms, which disrupted their daily activities, social relationships, and overall quality of life. Staff were pleased to be able to provide valuable information to their clients that could have a positive impact on their wellbeing. Overall, screening for a BI and participation in the NPE were well tolerated by IPV survivors with a possible BI. Inclusion of the perspectives of IPV survivors and support staff is an essential first step to better understanding their needs so interventions can be developed to aid their recovery.

PROTOCOL: Group-based interventions for posttraumatic stress disorder: A systematic review and meta-analysis of the role of trauma type

This is the protocol for a Campbell systematic review. The primary objective is to assess the effects of group-based treatments on posttraumatic stress disorder (PTSD) symptomology in people diagnosed with PTSD (by a clinician or screening instrument) or referred to a PTSD treatment group for their symptoms by a medical professional. We will also examine a range of moderators that may affect the efficacy of group-based treatments, including the nature of the trauma (interpersonal, stigmatized) and the group fit (in terms of gender and shared vs. unshared trauma). Further, we will also explore what, if any, group-based and social identity factors are recorded and how they relate to PTSD outcomes.

Increased social identification is linked with lower depressive and anxiety symptoms among ethnic minorities and migrants: A systematic review and meta-analysis

Evidence suggests that social identities, which provide purpose and a sense of belonging to the social world, promote resilience against psychological strain and protect well-being. This is especially important in ethnic minorities, who experience exclusion and discrimination from the majority group, and in migrant populations where adverse experiences, such as prejudice, disconnection from previous identities and issues of integration into the host country, negatively impact well-being. Drawing from the social identity theory, a meta-analysis was conducted examining the influence of group memberships and sense of belonging on ethnic minority and migrant mental health (depression and anxiety). The final search on three databases (i.e., PubMed, PsycINFO, Web of Science) was conducted on August 9th, 2022, identifying 3236 citations before removing any duplicates within and between databases. Across the 74 studies that met the inclusion criteria for the meta-analysis, increased social identification (ethnic, national and other types of identification) was associated with low psychological symptoms. We found that social identification is protective against common psychological disorders but with small effect sizes for depression (r = - 0.09, CI = [- 0.12; - 0.06]) and anxiety (r = - 0.08, CI [- 0.12; - 0.03]). Results are discussed with regard to the role that social context plays on ethnic minority and migrant mental health and the importance of facilitating migrant integration with the host society after displacement.

Group memberships and post-traumatic growth: How we connect determines how we recover

This paper examines key processes from the social identity model of traumatic identity change in the context of the aftermath of a natural disaster. It focuses on the roles of (i) group membership gain, (ii) group membership continuity, (iii) social identity revitalisation, and (iv) the severity of natural disaster exposure on post-traumatic growth (PTG) and post-traumatic stress (PTS). PARTICIPANTS: (N = 410, M_age = 53.24 years) comprised adult survivors of the Australian 2019-20 Black Summer bushfires, recruited to complete an online survey via geo-targeted Facebook advertisements. RESULTS: showed that group membership gain was positively correlated with PTG, whilst group membership continuity negatively correlated with PTS, highlighting the different roles played by group gain and continuity in post-trauma recovery. Preliminary evidence for the validity of a new author-developed social identity revitalisation measure was found, which mediated some relationships between group gain and continuity and PTG and PTS. Lastly, the extent that participants were affected by the fires moderated the relationship between group gain and PTS. Specifically, for those most affected, group gain was correlated with lower reported PTS, whilst for those less affected, group gain was correlated with higher reported PTS. We discuss implications for theory and draw attention to the concept of revitalisation, which shows promise as a potentially critical contributor to post-trauma recovery.

The mediating role of self-continuity on the link between childhood adversity and loneliness in later life

Many factors may influence adaptation to critical life events such as divorce and bereavement in the second half of life, including having faced childhood adversity. However, pathways to reduced adaptation success are poorly understood. Self-continuity, an identity mechanism that incorporates life changes into a coherent life story, may contribute to better adaptation to adult critical life events, such as feeling less socially and emotionally lonely. We investigated the mediating role of self-continuity channeling the effects of childhood adversity on later life adaptation outcomes among individuals who had experienced divorce or bereavement. Data were derived from the longitudinal LIVES Intimate Partner Loss Study conducted in Switzerland from 2012 to 2016. The sample consisted of individuals who had experienced divorce (n = 416, Mage = 57.35) or bereavement (n = 339, Mage = 71.36) in later life, and a continuously married control group (n = 925, Mage = 67.04). Multilevel moderated mediations were used. Self-continuity mediated the effect of childhood adversity on emotional loneliness for all marital groups, but to a greater extent among divorcees. Self-continuity also mediated the effect of childhood adversity on social loneliness; however, this effect did not differ by marital group. In conclusion, childhood adversity was associated to greater loneliness in later life through self-continuity. Divorcees were the most impacted group regarding emotional loneliness, as they experienced lower levels of self-continuity. Interventions that aim to reinforce self-continuity may help overcome social and emotional loneliness, especially for individuals who have experienced the loss of their partner through divorce.

Resources for Patient Mental Health and Well-being after Orthopaedic Trauma

Orthopaedic trauma is an unanticipated life-altering experience for patients. Additionally, the prevalence of psychiatric disorders has been found to be higher in patients with trauma than in the general adult population. Symptoms of depression, anxiety, or posttraumatic stress disorder have been reported in up to 56% of patients throughout their postoperative course. Furthermore, symptoms of any one of these illnesses have been consistently associated with worse patient outcomes after treatment of traumatic orthopaedic injuries. This includes increased levels of pain and disability, postoperative complications, and, in some cases, higher rates of hospital readmission. For most patients with trauma, focus is placed on physical therapy and rehabilitation in the acute postoperative setting to help patients regain function and strength; however, more recent studies have demonstrated equal importance of the social and psychological factors involved with trauma and their impact on outcomes. Therefore, it is essential for orthopaedic surgeons and other members of the care team to be adept in the screening and treatment of psychiatric disorders. For patients struggling with these conditions, several treatment resources exist, which can be used both during their admission and after discharge. Thus, earlier recognition and intervention with appropriate treatment and referrals should be emphasized to improve outcomes. This review discusses the social and psychological impacts of orthopaedic trauma on patients' mental health and well-being and outlines numerous resources available to patients as they recover from their injuries.

‘It’s a life-changing point for me’: critical consciousness, collective empowerment and global awareness as activist identity change in ‘popular education’

The Youth Global Awareness Programme (YGAP) is a 2-week residential ‘popular education’ programme for young, diverse, international, labour movement activists, run by the International Federation of Workers Education Associations in Cape Town, South Africa. In this mixed method study (N = 47), we draw on the Social Identity Approach to Education and Learning. We propose that the participatory, peer-to-peer learning during YGAP leads to activist identity change, where critical consciousness, collective empowerment and global awareness develop as group norms. The first longitudinal questionnaire study found significant increases in activist identity and critical consciousness, which predicted increased collective empowerment. In the second focus group study, data were analysed with reflexive thematic analysis and two themes provide compelling evidence of learning during YGAP as identity change processes. Participants’ commonalities and differences enhanced activist identities with global awareness. Simultaneously, new knowledge, passion, hope and connection to a global activist community created collective empowerment.

New group memberships formed after an acquired brain injury and posttraumatic growth: A prospective study

Predicting positive psychosocial outcomes following an Acquired Brain Injury (ABI) remains a challenge. Considerable research demonstrates that social group memberships can have positive effects on psychological well-being, particularly during life transitions. Social group memberships are argued to help people derive a sense of self. This prospective study examined if social group memberships (number of groups and connectedness with groups) could predict posttraumatic growth (PTG) in those affected by ABI. Thirty-six participants (10 females, M_age= 46.56, SD = 11.46) engaged in community rehabilitation services completed measures at two time-points. Mediation analyses demonstrated that the number of new group memberships (groups formed post-injury) predicted greater PTG at time 2, via stronger connectedness with these new group memberships (controlling for initial PTG). The observed results suggest that a focus on developing and strengthening connections with new group memberships may promote positive adjustment after brain injury.

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.

Social group memberships, physical activity, and physical health following retirement: A six-year follow-up from the English Longitudinal Study of Ageing

OBJECTIVES

To investigate whether belonging to more social groups supports people to be physically active following retirement and confers physical health benefits as a result.

DESIGN

A longitudinal design was used, drawing on data spanning an eight-year period from the English Longitudinal Study of Ageing.

METHODS

In a population sample of retirees (N = 243), mediation models were used to examine relationships between number of post-retirement group memberships, subsequent post-retirement physical activity, and subsequent physical health.

RESULTS

Belonging to a greater number of social groups predicted greater physical activity following retirement. More group memberships also consistently predicted both subjective and objective indicators of greater physical health via greater physical activity.

CONCLUSIONS

Supporting people to maintain - and ideally increase - their group memberships in retirement may have benefits for their engagement in physical activity and long-term physical health.

Bidirectional Relationships Between Posttraumatic Stress Disorder and Social Functioning During Cognitive Processing Therapy

This study investigated temporal relationships between posttraumatic stress symptoms and two indicators of social functioning during cognitive processing therapy. Participants were 176 patients (51.5% female, M age = 39.46 [SD = 11.51], 89.1% White, 42.6% active duty military/veteran) who participated in at least two assessment time points during a trial of cognitive processing therapy. Posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-IV) and interpersonal relationship and social role functioning problems (Outcome Questionnaire-45) were assessed prior to each of 12 sessions. Multivariate multilevel lagged analyses indicated that interpersonal relationship problems predicted subsequent PTSD symptoms (b = .22, SE = 0.09, cr = 2.53, p = .01, pr = .46) and vice versa (b = .05, SE = 0.02, cr = 2.11, p = .04, pr = .16); and social role functioning problems predicted subsequent PTSD symptoms (b = .21, SE = 0.10, cr = 2.18, p = .03, pr = .16) and vice versa (b = .06, SE = 0.02, cr = 3.08, p < .001, pr = .23). Military status moderated the cross-lag from social role functioning problems to PTSD symptoms (b = -.35, t = -2.00, p = .045, pr = .16). Results suggest a robust association between PTSD symptoms and social functioning during cognitive processing therapy with a reciprocal relationship between PTSD symptoms and social functioning over time. Additionally, higher social role functioning problems for patients with military status indicate smaller reductions in PTSD symptoms from session to session.

Making connections: Social identification with new treatment groups for lifestyle management of severe obesity

Groups are regularly used to deliver healthcare services, including the management of obesity, and there is growing evidence that patients' experiences of such groups fundamentally shape treatment effects. This study investigated factors related to patients' shared social identity formed within the context of a treatment group for the management of severe obesity. A cross-sectional survey was administered to patients registered with a UK medical obesity service and enrolled on a group-based education and support programme. Patients (N = 78; M_BMI = 48 on entry to the service) completed measures of group demographics (e.g., group membership continuity) and psychosocial variables (e.g., past experiences of weight discrimination) and reported their social identification with the treatment group. The results showed that patients identified with the treatment group to the extent that there was continuity in membership across the programme and they perceived themselves more centrally in terms of their weight status. Weight centrality was negatively associated with external social support and positively associated with experiences of weight discrimination. Group continuity was positively correlated with session attendance frequency. Patients presenting to clinical treatment services with severe obesity often do so after sustained weight loss failure and exposure to negative societal experiences. This study highlights that providing a treatment environment wherein these experiences can be shared with other patients may provide common ground for development of a new, positive social identity that can structure programme engagement and progression.

"Putting a new perspective on life": a qualitative grounded theory of posttraumatic growth following acquired brain injury

Purpose: An acquired brain injury (ABI) is often described as a devastating experience and yet positive changes as a result of this event have been described. This study sought to understand the process of developing posttraumatic growth (PTG) following ABI.Method: Semi-structured interviews were conducted with 10 adults with ABI, recruited from three sites of a community day service for people with ABI. Grounded theory was used to explore the development of positive changes experienced as a result of the injury.Results: PTG appeared to occur in a non-linear way as participants negotiated processes captured in the following themes: "living with a life changing injury," "trying to beat it and acceptance," "identifying with a new you and others," and "meaningful positive change." Intra- and inter-personal comparisons emerged as important in accepting changes and reconnecting with pre-injury identity. This seemed to underpin accessing social and practical opportunities giving rise to connection with strengths and growth.Conclusions: This study extends prior research into the process of adjustment and positive outcomes such as growth, although conclusions are limited to this specific sample and context. Further research and clinical practice development addressing acceptance and community engagement to develop positive change following ABI is required.IMPLICATIONS FOR REHABILITATIONExperience of PTG develops over time and influenced by intra-and-inter-personal processes.Acceptance and shared experiences with others may contribute to positive psychological change.Interventions supporting pre-and-post injury comparisons with others could help acceptance.The focus on the management and expression of emotions associated with loss may be beneficial.

Psychosocial reactions to upper extremity limb salvage: A case series

STUDY DESIGN

Case series.

INTRODUCTION

A salvaged limb is one that has undergone a major traumatic injury, followed by repeated surgical attempts in order to avoid amputation. Psychological recovery for individuals with lower extremity limb salvage has been examined in a number of studies. However, psychosocial reactions for individuals with upper extremity (UE) limb salvage are understudied in the literature.

PURPOSE OF THE STUDY

The purpose of this study was to explore the process of psychosocial adaptation for 3 trauma cases after UE limb salvage.

METHODS

The Reactions to Impairment and Disability Inventory was used to assess psychosocial adaptation. Physical function outcomes (pain, range of motion, edema, sensation, and dexterity) are presented. The Disabilities of the Arm, Shoulder, and Hand measure was used to assess perceived disability. Medical and rehabilitation history are discussed for each case, in order to provide in-depth understanding of the impact of these injuries.

RESULTS

Reactions to injury varied across the cases; however, outcomes suggest that psychosocial adaptation may be influenced by the experience of pain, the ability to participate in valued roles and activities, and having a supportive social network.

DISCUSSION

For this population, therapists may consider emphasizing pain management, focusing on client-centered goals and interventions, and facilitating peer support. Providers should closely monitor patients for signs of poor adaptation, such as hand-hiding behaviors.

CONCLUSIONS

This study is among the first to examine psychological outcomes for the UE limb salvage population. Future research would be beneficial to provide deeper understanding of the psychosocial challenges for these individuals.

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.

Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis

Background

As more patients are surviving intensive care, mental health concerns in survivors have become a research priority. Among these, post-traumatic stress disorder (PTSD) can have an important impact on the quality of life of critical care survivors. However, data on its burden are conflicting. Therefore, this systematic review and meta-analysis aimed to evaluate the prevalence of PTSD symptoms in adult critical care patients after intensive care unit (ICU) discharge.

Methods

We searched MEDLINE, EMBASE, LILACS, Web of Science, PsycNET, and Scopus databases from inception to September 2018. We included observational studies assessing the prevalence of PTSD symptoms in adult critical care survivors. Two reviewers independently screened studies and extracted data. Studies were meta-analyzed using a random-effects model to estimate PTSD symptom prevalence at different time points, also estimating confidence and prediction intervals. Subgroup and meta-regression analyses were performed to explore heterogeneity. Risk of bias was assessed using the Joanna Briggs Institute tool and the GRADE approach.

Results

Of 13,267 studies retrieved, 48 were included in this review. Overall prevalence of PTSD symptoms was 19.83% (95% confidence interval [CI], 16.72–23.13; I² = 90%, low quality of evidence). Prevalence varied widely across studies, with a wide range of expected prevalence (from 3.70 to 43.73% in 95% of settings). Point prevalence estimates were 15.93% (95% CI, 11.15–21.35; I² = 90%; 17 studies), 16.80% (95% CI, 13.74–20.09; I² = 66%; 13 studies), 18.96% (95% CI, 14.28–24.12; I² = 92%; 13 studies), and 20.21% (95% CI, 13.79–27.44; I² = 58%; 7 studies) at 3, 6, 12, and > 12 months after discharge, respectively.

Conclusion

PTSD symptoms may affect 1 in every 5 adult critical care survivors, with a high expected prevalence 12 months after discharge. ICU survivors should be screened for PTSD symptoms and cared for accordingly, given the potential negative impact of PTSD on quality of life. In addition, action should be taken to further explore the causal relationship between ICU stay and PTSD, as well as to propose early measures to prevent PTSD in this population.

Trial registration

PROSPERO, CRD42017075124, Registered 6 December 2017.

Electronic supplementary material

The online version of this article (10.1186/s13054-019-2489-3) contains supplementary material, which is available to authorized users.

Resolving Not to Quit: Evidence That Salient Group Memberships Increase Resilience in a Sensorimotor Task

There is evidence that the social groups to which people belong can be a source of resilience in challenging times. In this paper, we examine whether social group memberships can also increase resilience in the face of negative performance feedback by encouraging task persistence. In two experiments (Ns = 63, 61) participants completed three rounds of a performance task. In the experimental conditions (but not the control) participants were first asked to think about, and consider the importance of, either one or five important social groups of which they were members. In both experiments, participants who reflected on important social groups were more likely to persist in practicing the task after negative performance feedback than those in the control condition. In Experiment 2 only, there was also evidence of performance improvement after negative feedback for participants in experimental but not control conditions. There was no evidence that self-reported confidence, motivation, or self-efficacy accounted for the observed effects. Overall, this is the first study to provide evidence that salient group memberships can increase resilience in a sensorimotor task. Significantly, the findings suggest that groups are not just a context but also a critical psychological resource for performance following failure feedback.

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.

Collective influences on individual functioning: Multiple group memberships, self-regulation, and depression after acquired brain injury

A growing body of research demonstrates the role that social groups play in protecting health and well-being in the context of adjusting to acquired brain injury (ABI). However, the psychological processes that underpin this relationship are less well understood. The present research extends this work by testing a theoretically derived model about the role of multiple social group belonging in contributing to improved self-regulation and depression symptoms. A cross sectional survey was conducted involving 50 adults with ABI (M_age = 45 years, SD = 12.10; range 22-67 years) who completed a series of self-report measures indexing social group membership, self-regulation, and depression. Support for the predicted model was found with mediation analysis showing that multiple group belonging predicted lowered depression symptoms, by providing a basis for enhancing self-regulation. The findings suggest that belonging to multiple groups provides individuals with multiple opportunities for social interaction with which to trial and develop self-regulatory skills, which, in turn, has a positive influence on depression.

The ties that bind: Ingroup ties are linked with diminished inflammatory immune responses and fewer mental health symptoms through less rumination

The present research explored whether components of social identity, namely ingroup ties, affect, and centrality, were differentially linked to mental health and inflammatory immune responses, and whether rumination mediated those relations. Study 1 (N = 138) indicated that stronger ingroup ties were associated with fewer mental health (depressive and post-traumatic stress) symptoms; those relations were mediated by the tendency for individuals with strong ties to rely less on ruminative coping to deal with a stressful life event. Study 2 (N = 54) demonstrated that ingroup ties were negatively associated with depressive symptoms, dispositional rumination, as well as stress-linked inflammatory elements at the physiological level. Consistent associations for centrality and ingroup affect were absent, suggesting that ingroup ties may have unique health benefits.

Like a bridge over troubled water? A longitudinal study of general social support, colleague support, and leader support as recovery factors after a traumatic event

Background: Whereas the association between social support and psychological distress has been well-established through both cross-sectional and longitudinal studies, less is known about whether social support influences rate of change in psychological distress over time. Nor is it clear whether social support predicts baseline psychological distress, or, more importantly, whether social support may contribute to more rapid recovery following trauma exposure. Objective: This study aimed to determine the extent to which social support contributed to the recovery process among individuals with psychological distress after being exposed to trauma. Methods: Prospective survey data from ministry employees were collected 10, 22, and 34 months after the 2011 Oslo bombing that targeted the governmental quarters. We explored recovery in a clinical subsample (N = 238) of individuals with elevated levels of psychological distress (defined as mean 10-item Hopkins symptom checklist score > 1.85) one year after the event. A linear latent growth curve of psychological distress with general social support from friends and family, colleague support, and leader support as predictors was examined. Results: High levels of general social support and leader support were independently associated with a more rapid decline in psychological distress over time. Conclusions: General social support, as well as support from a leader in one's working life, may facilitate recovery from psychological distress after exposure to a traumatic event. Enhancing social support from family and friends, as well as in work settings, may benefit those with psychological distress following a traumatic workplace event.

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.

The importance of social identities in the management of and recovery from 'Diabulimia': A qualitative exploration

INTRODUCTION

A significant barrier to recovery for individuals with co-morbid eating disorders and type 1 diabetes is the way in which group members self-categorise. Nonetheless, identity issues are neglected during the recovery process. The aim of this paper is to explore how group memberships (and the associated identities) both contribute to and hinder recovery in this cohort.

METHOD

Transcripts from five online focus groups with 13 members of an online support group for individuals with 'Diabulimia' were thematically analysed.

RESULTS

Findings suggested that those with whom one shares a recovery identity can be well placed to provide psychological resources necessary for successful recovery although such connections can be damaging if group norms are not managed. Members recognised that other important relationships (including family and friends and health professionals) are also key to recovery; these other group memberships (and the associated identities) can be facilitated through the recovery identity group membership, which allows for external validation of the recovery identity, provides encouragement to disclose the illness to supportive others, and provides information to facilitate positive service interactions.

CONCLUSIONS

While clinical interventions typically focus on eliminating disordered behaviours, we suggest that these should also include strengthening important group memberships that promote recovery.

'Everyone here wants everyone else to get better': The role of social identity in eating disorder recovery

Retention of a positively valued illness identity contributes to poor outcomes for individuals with eating disorders (EDs). Consequently, dis-identification from the illness identity and the adoption of a recovery identity are vital for successful recovery. While social identity processes have been shown to influence ED maintenance, their role in recovery is rarely considered. This study explores how a sense of shared identity helps individuals with EDs manage their condition and promotes recovery. Transcripts from 18 online support sessions involving 75 participants were thematically analysed. Our findings suggest that the illness identity initially operates as a social identity that forms the basis for connections with similar others. For those wishing to recover, identity-based support is then perceived to be more effective than that found outside the group. Online interactions also facilitate construction of a new shared recovery identity which promotes a shift from the illness identity as a primary source of definition and endorses group norms of illness disclosure and treatment engagement. While in the clinical literature, ED identity is seen as problematic and interventions are targeted at challenging an individual's self-concept, we suggest that interventions could instead harness identity resources to support a transition to a recovery identity.

The More (Social Group Memberships), the Merrier: Is This the Case for Asians?

While previous studies have consistently shown that belonging to multiple groups enhances well-being, the current research proposes that for Asians, multiple group memberships (MGM) may confer fewer well-being benefits. We suggest that this is due, in part, to Asian norms about relationships and support seeking, making Asians more reluctant to enlist social support due to concerns about burdening others. Overall, MGM was associated with enhanced well-being in Westerners (Study 2), but not Asians (Studies 1-3). Study 2 showed that social support mediated the relationship between MGM and well-being for Westerners only. In Study 3, among Asians, MGM benefited the well-being of those who were least reluctant to enlist support. Finally, reviewing the MGM evidence-base to date, relative to Westerners, MGM was less beneficial for the well-being of Asians. The evidence underscores the importance of culture in influencing how likely individuals utilize their group memberships as psychological resources.

A common-sense model of injury perceptions

The aim of this study was to clarify the difference between perceptions of injury and illness. A qualitative study using semi-structured interviews was conducted with 38 individuals who had been injured in the past, 8 medical psychologists, 62 graduate psychology students, and 19 health professionals treating injured patients. Data were analyzed by modified analytic induction and constant comparison methods. Common-sense perceptions of injury overlapped with some perceptions of illness, and 4 new themes were elicited. It was concluded that there are themes unique to injury perceptions that should be recognized in research as well as in clinical interventions.

The Connection Prescription: Using the Power of Social Interactions and the Deep Desire for Connectedness to Empower Health and Wellness

Social connection is a pillar of lifestyle medicine. Humans are wired to connect, and this connection affects our health. From psychological theories to recent research, there is significant evidence that social support and feeling connected can help people maintain a healthy body mass index, control blood sugars, improve cancer survival, decrease cardiovascular mortality, decrease depressive symptoms, mitigate posttraumatic stress disorder symptoms, and improve overall mental health. The opposite of connection, social isolation, has a negative effect on health and can increase depressive symptoms as well as mortality. Counseling patients on increasing social connections, prescribing connection, and inquiring about quantity and quality of social interactions at routine visits are ways that lifestyle medicine specialists can use connection to help patients to add not only years to their life but also health and well-being to those years.

Breaking good: breaking ties with social groups may be good for recovery from substance misuse

According to the Social Identity Model of Identity Change, maintaining social identities and support over time is good for health and well-being, particularly during stressful transitions. However, in this study we explore the circumstances under which maintaining social identities - such as 'substance user' - may be harmful to health, and when a successful transition constitutes identity change, rather than maintenance. This prospective study examined social identities of 132 adults entering a drug and alcohol therapeutic community (TC) at admission, three fortnightly intervals and exit, as well as a representative subsample of 60 participants at follow-up. Repeated measures ANOVA results showed that user identity decreased significantly over time, such that 76% of the sample decreased in user identity strength over the first month in the TC. At the same time, recovery identity ratings increased significantly over time, with 64% of the sample staying the same or increasing their recovery identity ratings over the first month. Identity change, indexed by the change in the difference score between user identity and recovery identity over the treatment period, accounted for 34% of the variance in drinking quantity, 41% of the variance in drinking frequency, 5% of the variance in other drug use frequency, and 49% of the variance in life satisfaction at follow-up, after accounting for initial substance abuse severity and social identity ratings at entry to the TC. The findings indicate that moving from a substance using identity towards a recovery identity constitutes an important step in substance abuse treatment.

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.

Feeling connected again: interventions that increase social identification reduce depression symptoms in community and clinical settings

BACKGROUND

Clinical depression is often preceded by social withdrawal, however, limited research has examined whether depressive symptoms are alleviated by interventions that increase social contact. In particular, no research has investigated whether social identification (the sense of being part of a group) moderates the impact of social interventions.

METHOD

We test this in two longitudinal intervention studies. In Study 1 (N=52), participants at risk of depression joined a community recreation group; in Study 2 (N=92) adults with diagnosed depression joined a clinical psychotherapy group.

RESULTS

In both the studies, social identification predicted recovery from depression after controlling for initial depression severity, frequency of attendance, and group type. In Study 2, benefits of social identification were larger for depression symptoms than for anxiety symptoms or quality of life.

LIMITATION

Social identification is subjective and psychological, and therefore participants could not be randomly assigned to high and low social identification conditions.

CONCLUSIONS

Findings have implications for health practitioners in clinical and community settings, suggesting that facilitating social participation is effective and cost-effective in treating depression.

Social group memberships protect against future depression, alleviate depression symptoms and prevent depression relapse

A growing body of research suggests that a lack of social connectedness is strongly related to current depression and increases vulnerability to future depression. However, few studies speak to the potential benefits of fostering social connectedness among persons already depressed or to the protective properties of this for future depression trajectories. We suggest that this may be in part because connectedness tends to be understood in terms of (difficult to establish) ties to specific individuals rather than ties to social groups. The current study addresses these issues by using population data to demonstrate that the number of groups that a person belongs to is a strong predictor of subsequent depression (such that fewer groups predicts more depression), and that the unfolding benefits of social group memberships are stronger among individuals who are depressed than among those who are non-depressed. These analyses control for initial group memberships, initial depression, age, gender, socioeconomic status, subjective health status, relationship status and ethnicity, and were examined both proximally (across 2 years, N = 5055) and distally (across 4 years, N = 4087). Depressed respondents with no group memberships who joined one group reduced their risk of depression relapse by 24%; if they joined three groups their risk of relapse reduced by 63%. Together this evidence suggests that membership of social groups is both protective against developing depression and curative of existing depression. The implications of these results for public health and primary health interventions are discussed.