"I'm more than my sport": Exploring the dynamic processes of identity change in athletic retirement

Retirement is one of the most impactful career transitions athletes face. Researchers recognise the role that athletic identity plays in this, but analysis of identity content and change processes is limited. Addressing this gap, we conducted a qualitative study exploring the experience of identity change in 21 competitive and successful elite athletes who had retired from sport. All participated in a one-session psychoeducational program that explored the challenges of transitioning out of sport before being interviewed about their understanding of identity in sport, and their experiences negotiating identity loss and change in retirement. Using reflexive thematic analysis, we identified three themes: (i) the role of identity and self-categorizations in shaping sport performance, (ii) adjusting to identity loss (with subthemes indicating that this experience varied depending on the extent to which a person had multiple or exclusive identities), and (iii) attempts to remoor identity in the transition (with subthemes of searching for a new identity and actively repurposing identity). We interpret these themes through the lens of the Social Identity Model of Identity Change and show that this provides a framework for extending our understanding the complexities of identity change associated with retirement from elite sport.

A latent profile analysis of the nature of social group memberships and their contribution to retirement outcomes

Positive experiences of groups (e.g., the extent to which groups are important and supportive) tend to be associated with better retirement adjustment outcomes. However, group experiences are not always positive, and we know little about their varied contribution to adjustment outcomes. We addressed this gap by exploring the nature of social group memberships - in terms of varying positive and negative experiences of groups - to better understand how social group memberships shape retirement adjustment, life satisfaction and mental health. A latent profile analysis (using data from 489 retirees and their membership of 1887 groups) identified four profiles of social group memberships: optimal (63%), slightly straining (13%), low-supportive (18%) and ambivalent (6%). Subsequent regression analysis showed that these different profiles of group membership were differentially associated with retirement adjustment outcomes: belonging to more optimal groups was associated with better perceived adjustment, higher life satisfaction and better mental health, while belonging to slightly straining and ambivalent groups contributed to poorer adjustment, lower life satisfaction and greater depression. These findings have implications for theory and practice, not least because they advance our understanding of the diversity of people's group memberships and their contribution to retirement and health outcomes.

You've Got E-Mail: A Pilot Study Examining the Feasibility and Impact of a Group-Based Technology-Training Intervention Among Older Adults Living in Residential Care

Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre-post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults (n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.

Measures of Subjective Memory for People with Epilepsy: A Systematic Review of Measurement Properties

People with epilepsy frequently express concern about the burden of memory problems in their everyday lives. Self-report memory questionnaires may provide valuable insight into individuals' perceptions of their everyday memory performance and changes over time. Yet, despite their potential utility, the measurement properties of self-report memory questionnaires have not been evaluated in epilepsy. This systematic review aimed to provide a critical appraisal of the measurement properties of self-report memory questionnaires for adults with epilepsy. Following protocol registration (PROSPERO CRD42020210967), a systematic search of PubMed, EMBASE, Web of Science, CINAHL, and PsychInfo from database inception until 27 May 2021 was conducted. Eligible studies were published in English-language peer-reviewed journals, recruited adults with epilepsy, and reported on the development or evaluation of the measurement properties of a self-report memory questionnaire. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology was used to evaluate each study of a measurement property, and results were qualitatively synthesised. In total, 80 articles and one test manual were located containing 153 studies of measurement properties pertinent to 23 self-report memory questionnaires. Overall, no scale could be recommended outright for the evaluation of subjective memory symptoms in adults with epilepsy. This was due to the near absence of dedicated content validation studies relevant to this population and shortcomings in the methodology and scientific reporting of available studies of structural validity. Recommendations to support the advancement and psychometric validation of self-report memory questionnaires for people with epilepsy are provided.

Examining the Utility of a Multiple Group Membership Intervention for Alleviating the Effects of Age-Based Stereotype Threat on Older adults' Memory Performance

This study examined the effectiveness of a multiple group membership intervention for reducing the negative effects of age-based stereotype threat (ABST) on older adults' objective memory performance and subjective memory concerns. Healthy older adults (N = 68) were randomly allocated to an ABST + threat-removal (ABST+TR) or ABST + active-control (ABST+AC) condition. After activating ABST, the ABST+TR condition completed a group-listing task and the ABST+AC condition completed a meal-listing task. Participants then completed the Rey Auditory Verbal Learning Test (RAVLT) and Everyday Memory Questionnaire - Revised. One significant difference was found in memory performance between conditions; specifically, after controlling for age, gender, and number of items listed, those in the ABST+TR condition performed significantly better on the RAVLT memory interference trial. Further, listing a greater number of group memberships was associated with better memory performance in the ABST+TR condition. No significant difference was found in subjective memory concerns between the ABST+TR condition and the ABST+AC condition. Overall, the current findings indicated that raising the salience of multiple group memberships offered limited protection for older adults' cognitive test performance in the context of ABST.

Connecting to Community: A Social Identity Approach to Neighborhood Mental Health

ACADEMIC ABSTRACT

Integrative theorizing is needed to advance our understanding of the relationship between where a person lives and their mental health. To this end, we introduce a social identity model that provides an integrated explanation of the ways in which social-psychological processes mediate and moderate the links between neighborhood and mental health. In developing this model, we first review existing models that are derived primarily from a resource-availability perspective informed by research in social epidemiology, health geography, and urban sociology. Building on these, the social identity model implicates neighborhood identification in four key pathways between residents' local environment and their mental health. We review a wealth of recent research that supports this model and which speaks to its capacity to integrate and extend insights from established models. We also explore the implications of the social identity approach for policy and intervention.

PUBLIC ABSTRACT

We need to understand the connection between where people live and their mental health better than we do. This article helps us do this by presenting an integrated model of the way that social and psychological factors affect the relationship between someone's neighborhood and their mental health. This model builds on insights from social epidemiology, health geography, and urban sociology. Its distinct and novel contribution is to point to the importance of four pathways through which neighborhood identification shapes residents' mental health. A large body of recent research supports this model and highlights its potential to integrate and expand upon existing theories. We also discuss how our model can inform policies and interventions that seek to improve mental health outcomes in communities.

A longitudinal examination of the role of social identity in supporting health and well-being in retirement

Social factors are major determinants of the success of retirement transitions. However, we do not yet fully understand the nature and basis of this impact, particularly as it relates to social group belonging. To address this issue the present article investigated the role that social group memberships play in supporting people's health and well-being in the early phase of transitioning to retirement. More specifically, we drew on the social identity model of identity change (SIMIC) to examine two pathways in which social group processes are theorized to influence adjustment to life change-social identity continuity and social identity gain. To test these pathways, a sample of Australian workers who had transitioned to retirement in the last 12 months (N = 170) were surveyed about their (a) preretirement multiple group memberships and postretirement maintained and new group memberships and (b) their perceived physical health, mental health, and life satisfaction after retirement. While preretirement group memberships did not affect retirement outcomes directly, they supported them indirectly by enabling people both to maintain some existing group memberships and to gain some new group memberships postretirement; as predicted by SIMIC. These findings confirm the importance of social factors and of social group membership in particular, for retiree health and well-being. Theoretically, they support the generalizability of SIMIC and its capacity to explain adjustment to diverse life changes including retirement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A stepped down physical activity support program for military service veterans: The Active Choices pilot study

ISSUE ADDRESSED

Referral to supervised physical activity (PA) programs is an effective treatment for military service veterans (MSVs) suffering from a range of chronic diseases. However, many MSVs fail to maintain PA regimes once discharged from supervision. This pilot study assessed Active Choices, a stepped-down program to support MSVs in the transition from allied health treatment to self-managed PA.

METHODS

Participants were 34 Australian MSVs (mean [SD] age = 61 [15.8] years) who were completing supervised referral to an exercise physiologist or physiotherapist. MSVs stepped-down to Active Choices and received a 12-week, evidence-based PA support program (2020-2021). Analyses compared within-group changes in accelerometer-assessed PA at three time points (Weeks 0, 12, and 24; linear mixed model). Program retention, PA choices, and allied healthcare service costs were also evaluated.

RESULTS

Relative to baseline (64 [26] min/day), mean (SD) moderate-to-vigorous PA increased (74 [28] min/day; p < .05) and was maintained (62 [28] min/day) at weeks 12 and 24, respectively. Retention in the program was high (86% [29/34 participants] completion rate at 12 weeks), with water-based group activities the most popular PAs of choice (14/24 activities). Average allied healthcare service costs during the study were lower than typical costs for MSVs (60.51 vs. 97.06 AUD/week).

CONCLUSION

The findings highlight the potential of Active Choices to support MSVs in the transition from supervised to self-managed MVPA. SO WHAT?: The program could promote the health of veterans and reduce costs for ongoing referral if impact is replicated at scale.

Why a group-level analysis is essential for effective public policy: The case for a g-frame

Societal problems are not solved by individualistic interventions, but nor are systemic approaches optimal given their neglect of the social psychology underpinning group dynamics. This impasse can be addressed through a group-level analysis (a "g-frame") that social identity theorizing affords. Using a g-frame can make policy interventions more adaptive, inclusive, and engaging.

Therapists who foster social identification build stronger therapeutic working alliance and have better client outcomes

BACKGROUND

For decades we have known that therapeutic working alliance is a key contributor to client engagement and positive outcomes in therapy. However, we have made little progress in narrowing down its determinants, which is critical in supporting trainees to optimize such alliance. We make a case for the value of incorporating social psychological frameworks into models of alliance and explore the role of social identity processes in the development of therapeutic alliance.

METHOD

Across two studies, over 500 psychotherapy clients completed validated measures of alliance, social identification with their therapist, positive therapy outcomes, and a range of client and therapist characteristics.

FINDINGS

Social identification strongly predicted alliance in both samples, whereas client and therapist characteristics showed few such associations. Alliance mediated the relationship between social identification and positive therapy outcomes. In addition, we found evidence that (a) personal control is a key psychological resource in therapy that arises from social identification, and (b) therapists who engage in identity leadership (i.e., who represent and build a social identity that they share with clients) are more likely to foster social identification and its downstream benefits.

INTERPRETATION

These data show that social identity processes are key to the emergence of working alliance. We conclude with a discussion of how recent social identity and identity leadership interventions might be adapted to train therapists in relevant identity-building skills.

The group mechanism in treatment: group identification and cohesion contributes to reducing chronic lower back pain by increasing personal control

PURPOSE

There is increasing recognition of the contribution that group processes, particularly identification and cohesion, make to outcomes of group delivered health treatments. This study examined the role that these particular group processes play in the treatment of lower back pain, and a theorised mechanism of personal control through which group treatment might enhance outcomes.

METHODS

Participants (N = 85) elected to either receive NeuroHAB^®, a defined functional movement therapy of 8 weeks duration, or continue with treatment-as-usual (TAU). Pain intensity and disability were assessed at baseline (T1) and post-intervention or 8 weeks later (T2), as well as at a 1-month follow-up (T3). Only the NeuroHAB^® participants additionally completed weekly questionnaires that measured treatment group identification, cohesion, and personal control.

RESULTS

NeuroHAB^® was significantly more effective than TAU in reducing pain intensity and disability at T2 and T3. Furthermore, among NeuroHAB^® recipients, stronger treatment group identification and cohesion early in the program predicted better pain outcomes over time, and this relationship was fully mediated by perceptions of personal control.

CONCLUSION

These data provide further support for the role of group identification and cohesion as a contributing mechanism of change in group-based treatments and extend this to the domain of pain management.Implications for RehabilitationA focus on defined functional movement therapy, as offered by the NeuroHAB^® group program, was found to improve pain outcomes in patients with lower back pain.A key ingredient in the NeuroHAB^® rehabilitation program was its group delivery.Group delivery supported treatment group identification and cohesion which, through enhancing the perception of personal control, reduced pain intensity and disability.

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.

Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health

Groups 4 Health (G4H) is a group psychotherapy program that targets social group disconnection. An emerging evidence base supports its efficacy in reducing loneliness, depression, and social anxiety. However, to date there has been no formal analysis of its acceptability to clients and therapists, nor an investigation of its feasibility for wider implementation. This input from end users is crucial to ensure the program's wider suitability and to contribute to its improvement. This study drew data from three clinical trials, including 266 G4H clients and 68 G4H therapists. From the Phase III trial only, additional data were available from 90 clients in a dose-controlled cognitive-behavioral therapy (CBT) comparison group, and focus groups/interviews with 6 therapists and 13 clients. Client satisfaction was high, with all average ratings &gt;7/10, significantly exceeding the CBT comparison group. Therapist satisfaction with each module was &gt;5/7. Retention was &gt;80%. Homework completion was high, with &lt;10% of clients saying that they had not attempted the homework. Therapists and clients both emphasized the benefits arising from G4H, and the contribution of the group context itself as a vehicle to achieve positive outcomes.

Is self always prioritised? Attenuating the ownership self-reference effect in memory

The current study demonstrates the abolishment of the Ownership Self Reference Effect (OSRE) when elaborate details of a distant other-referent are provided. In a 2 (High versus Low information) × 2 (Self versus Other) experimental design, we tested the capacity for the SRE to be modulated with social saliency. Using a well-established ownership paradigm (Collard et al., 2020; Cunningham et al., 2008; Sparks et al., 2016), when the other was made socially salient (i.e. details and characteristics about the other were provided to the participant prior to encoding), no SRE emerged, such that self-owned and other-owned items were recalled with comparable accuracy. In contrast, when the other was not salient (i.e., no details about them were provided), participants accurately recalled a higher proportion of self-owned items, demonstrating a typical SRE in source memory. The degree of self- or other- referencing was not related to measured variables of closeness, similarity or shared traits with the other. Although the SRE is an established and robust effect, the findings of the current study illustrate critical circumstances in which the self is no longer prioritised above the other. In line with our predictions, we suggest that the self has automatic attributed social salience (e.g. through ownership) and that enhancing social salience by elaborating details of the other, prioritisation can expand to encapsulate an other beyond the self and influence incidental memory.

Controlled Trial Examining the Strength-Based Grit Wellbeing and Self-Regulation Program for Young People in Residential Settings for Substance Use

This cohort-controlled trial examined whether the 12-session Grit Wellbeing and Self-regulation Program enhanced the treatment outcomes of young people accessing residential alcohol and other drug (AOD) treatment. Grit focuses on increasing wellbeing and reducing substance use and mental health problems by building self-regulation skills, strengths, social connections, and health behaviours. Participants were 194 (66% male, Mage 27.40) young people (aged 18-35 years) accessing a six-week residential treatment program for substance use. Participants received standard treatment, or standard treatment plus Grit (two sessions/week for six weeks). The primary outcome was substance use, measured as: (i) global substance use and (ii) alcohol, methamphetamine, and cannabis use involvement. Secondary outcomes included wellbeing, depression, anxiety, and vocational engagement. Participants were assessed at baseline, and 6-weeks (secondary outcomes only), 3-months, 6-months, and 12-months post-program enrolment. Results revealed that both groups showed a significant improvement in all outcomes at three months, and improvements were maintained at 6- and 12-month follow-ups. The Grit group had a larger reduction in methamphetamine and cannabis use involvement compared to the control group. This study presents promising evidence that a six-week residential program can achieve improvements in AOD use, depression, anxiety, wellbeing and vocational engagement. Further, targeting self-regulation may enhance such programs.

Health practitioner beliefs regarding the impact of age-based stereotype threat on performance in the cognitive assessment of older adults

OBJECTIVES

Health practitioners' understanding of the impact of age-based stereotype threat (ABST) on the cognitive test performance of older adults is not well understood. This study aimed to investigate health practitioners' ability to recognize the influence of ABST in the cognitive assessment of older adults and their perceptions of its impact in practice.

METHODS

One-hundred and twenty-nine health practitioners (86% female; M age = 39.75, SD = 11.50) with experience in conducting cognitive assessments with older adults (mainly psychologists and occupational therapists) completed an online survey assessing demographic and practice characteristics, aging beliefs, a hypothetical cognitive assessment scenario, and perceived impact of ABST on practice.

RESULTS

Overall, health practitioners rated ABST factors in the assessment scenario as less detrimental to cognitive performance than internal and external factors. In a hierarchical regression model, lower recognition of ABST and negative aging beliefs significantly accounted for lower perceived impact of ABST on older adults' cognitive test performance in practice (R² = .37, p < .001).

CONCLUSION

Health practitioners may not recognize the influence of ABST on assessment findings, especially if they hold negative aging beliefs. The findings highlight the need to improve health practitioners' knowledge of ABST to increase the validity of cognitive testing in older adults.

O2-7 Leading the Way Together: A cluster randomised controlled trial of the 5R Shared Leadership Program in older adult walking groups

Background

With a rapidly ageing society, healthy ageing has become a key challenge for older adults. Engagement in physical activity, and particularly walking, is a key strategy that contributes to healthy ageing. The present study aimed to evaluate the efficacy of a group walking program for older adults that incorporates the 5R Shared Leadership Program (5RS), compared to a regular group walking program. By implementing a structure of shared leadership and strengthening peer leaders' identity leadership, 5RS has in other contexts been associated with greater performance and well-being.

Methods

Our cluster randomised controlled trial included 19 older adult walking groups (i.e., the clusters; N = 503; Mage = 69.23 years, SD = 6.68), which all participated in a 12-week structured group walking program. Nine of these walking groups (n = 304) were randomly assigned to the intervention condition and received additionally the 5RS program.

Results

Results revealed that 5RS was successful in strengthening the identity leadership qualities of the appointed peer leaders. Moreover, multilevel regressions showed that 5RS succeeded in increasing group cohesion and walking activity to a greater extent than a regular group walking program, while participants' group identification and well-being increased to a similar extent in both conditions. Furthermore, structural equation modelling revealed that group identification mediated the impact of peer leaders' identity leadership on group cohesion and well-being (but not walking activity).

Conclusion

We can conclude that by harnessing the capacity of the group and its peer leaders, 5RS constitutes a promising intervention to engage older adults in physical activity.

Double jeopardy: How lower levels of support during COVID-19 exacerbated the relationship between loneliness and distress

While the relationship between loneliness and psychological distress is well documented, the mechanisms underlying this relationship are less clear. One factor known to be related to loneliness as well as psychological distress, is social support, with some studies suggesting that support-both received and provided-can serve as a mechanism to reduce the distress associated with loneliness. In this paper we examine the mediating role of both aspects of support in the relationship between loneliness and psychological distress in the COVID-19 context. We used a multi-country dataset collected at two timepoints during the pandemic; the first during the early stages (N = 6,842, 11 countries) and the second collected for a subset of countries (N = 1,299, 3 countries) 3 months later. Across all eleven countries, results revealed significant positive associations between loneliness and distress. Furthermore, using longitudinal data, we investigated the directionality of this relationship and found that increased loneliness over time was associated with increased psychological distress. The data also showed that both feeling unsupported and feeling unable to provide support to others mediated this relationship. These findings point to the need to facilitate people's ability to draw effective social support and help others-particularly at times when social connectedness is threatened-as a way of alleviating the psychological distress that commonly presents with loneliness.

A controlled evaluation of the effect of social prescribing programs on loneliness for adults in Queensland, Australia (protocol)

BACKGROUND

In social prescribing, link workers support individuals whose persistent health problems are exacerbated by loneliness by connecting them to community-based social activities. This approach is well established in the UK and is gaining attention in Australia. However, a major limitation of research to date has been a lack of theoretically informed and rigorous evaluations of social prescribing. We will address these points in this study, applying a social identity framework to examine the effects of group-based social prescribing (SP) activity compared to primary care treatment as usual (TAU).

METHODS

Ninety participants experiencing loneliness recruited from primary care services and community centres across five sites in Southeast Queensland will be assigned to one of two conditions (SP, TAU) and assessed at two timepoints (baseline, + 8 weeks). Individuals will be aged 18 years and over, have sufficient English language skills to provide consent, and at the time of recruitment they will not be experiencing acute symptoms or social issues that require urgent intervention. Primary outcomes are loneliness, mental well-being, and health service use (total number of GP, hospital, and allied health visits in the past 3 months). Secondary outcomes will assess social group processes, including number of important social groups, new group identification, multiple identity compatibility, and group-based support and emotion regulation.

DISCUSSION

This study will provide comprehensive data about the extent to which, and how, social prescribing to community-based group activities may help people to feel less lonely, more socially integrated, and healthy over the first 8 weeks. If effective, this social identity-informed model of social prescribing can be disseminated in communities across Australia.

TRIAL REGISTRATION

ANZCTR, Registered 8 June 2022 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12622000801718.aspx.

Leading the way together: a cluster randomised controlled trial of the 5R Shared Leadership Program in older adult walking groups

BACKGROUND

With a rapidly ageing society, healthy ageing has become a key challenge. Engagement in physical activity, and particularly walking, is a key strategy that contributes to healthy ageing amongst older adults. The purpose of the present study was to evaluate the efficacy of a group walking program for older adults that incorporates the 5R Shared Leadership Program (5R^S). By implementing a structure of shared leadership and strengthening peer leaders' identity leadership, 5R^S aims to cultivate a shared social identity amongst participants, which has in other contexts been associated with greater performance and well-being.

METHODS

A cluster randomised controlled trial was conducted to test the efficacy of the 5R^S group walking program on group identification, group cohesion, walking activity, and well-being, compared to a regular group walking program for older adults. Nineteen older adult walking groups (i.e., the clusters; N = 503; M_age = 69.23 years, SD = 6.68) all participated in a 12-week structured group walking program. Nine walking groups (n = 304) were randomly assigned to the intervention in which participants received the 5R^S program in addition to regular group walking.

RESULTS

5R^S was successful in strengthening the identity leadership qualities of the appointed peer leaders. Multilevel regressions showed that 5R^S succeeded in increasing group cohesion and walking activity to a greater extent than a regular group walking program, while participants' group identification and well-being increased to a similar extent in both conditions. Furthermore, structural equation modelling revealed that group identification mediated the impact of peer leaders' identity leadership on group cohesion and well-being (but not walking activity).

CONCLUSION

By harnessing the capacity of the group and its peer leaders, the 5R^S program offers a promising intervention to engage older adults in physical activity.

TRIAL REGISTRATION

The study was retrospectively registered as clinical trial on 9 September 2021 ( NCT05038423 ).

"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.

Groups 4 Health versus cognitive-behavioural therapy for depression and loneliness in young people: randomised phase 3 non-inferiority trial with 12-month follow-up

BACKGROUND

Depression treatments are typically less effective for young people than for adults. However, treatments rarely target loneliness, which is a key risk factor in the onset, maintenance and development of depression.

AIMS

This study evaluated the efficacy of a novel loneliness intervention, Groups 4 Health (G4H), relative to the best-practice treatment of cognitive-behavioural therapy (CBT) in reducing loneliness and depression over a 12-month period (Australian New Zealand Clinical Trial Registry: ACTRN12618000440224).

METHOD

The study was a phase 3 randomised non-inferiority trial comparing G4H with dose-controlled group CBT. Participants were 174 people aged 15-25 years experiencing loneliness and clinically significant symptoms of depression, who were not in receipt of adjunct treatment. Participants were recruited from mental health services in Southeast Queensland, Australia. Randomisation was conducted using computer software. Follow-up assessments and statistical analyses were masked to allocation. Both interventions consisted of five 75 min group-based psychotherapy sessions. The primary outcomes were depression and loneliness, with a non-inferiority margin of 2.20 for depression.

RESULTS

The trial enrolled 174 participants between 24 April 2018 and 25 May 2019, with 84 in the G4H condition and 90 in the CBT condition. All randomised participants were included in the intention-to-treat analyses (n = 174). The pre-post effect sizes for depression were dG4H = -0.71 and dCBT = -0.91. For loneliness, they were dG4H = -1.07 and dCBT = -0.89. At 12-month follow-up, the absolute difference between groups on depression was 1.176 (95% CI -1.94 to 4.29) and on loneliness it was -0.679 (95% CI -1.43 to 0.07). No adverse effects were observed.

CONCLUSIONS

G4H was non-inferior to CBT for depression and showed a slight advantage over CBT for loneliness that emerged after treatment completion.

Exploring links between social identity, emotion regulation, and loneliness in those with and without a history of mental illness

OBJECTIVE

Emotion regulation and social identity theorizing provide two influential perspectives on loneliness. From an emotion regulation perspective, loneliness is understood as a negative emotional state that can be managed using emotion regulation strategies. A social identity perspective views loneliness as resulting from a loss or lack of important social groups and related identities. This study aimed to explore the relationships between key constructs drawn from both perspectives, with a view to understanding loneliness in adults with and without a history of mental illness.

DESIGN AND METHODS

Participants (N = 875) with a mental illness history (MH Hx, n = 217; M_age  = 45 years, 59% female) and without a mental illness history (No MH Hx, n = 658; M_age  = 47 years, 48% female) completed a survey comprising measures of group membership and connectedness, emotion regulation strategies, and loneliness.

RESULTS

The MH Hx group reported higher internal affect worsening strategy use and loneliness than those No MH Hx. Hierarchical regressions indicated that the unique contributions of emotion regulation strategies and social identity factors to loneliness were equivalent between the groups. Together, social identity and emotion regulation explained 37% of the variance in loneliness in the No MH Hx subsample and 35% in the MH Hx subsample.

CONCLUSION

These findings suggest that both emotion regulation and social identity had significant unique contributions to the reported loneliness of people when controlling for demographics and each other in those with and without a history of mental illness. Integration of the two frameworks may provide novel avenues for the prevention and management of loneliness.

PRACTITIONER POINTS

Individuals with a history of mental illness report more use of internal emotion worsening regulation strategies and greater loneliness than those with no such history, but there were no differences in social identity factors. Internal emotion worsening strategies and social support received from others explained the variance in reported loneliness for both those with and without a history of mental illness. Internal emotion improving strategies were significant for those with a history of mental illness, while social support given was significant for those without a history of mental illness. Screening clients for emotion regulation difficulties, social disconnectedness, and loneliness may provide clinicians with an indication of risk for developing psychological distress/disorders.

GROUPS 2 CONNECT: An online activity to maintain social connection and well-being during COVID-19

COVID-19 has had significant negative consequences for well-being. As well as the primary effects of the virus itself, secondary effects have resulted from the social isolation caused by the lockdowns imposed to slow the spread of the virus. Recognising the toxic effects of isolation, researchers, practitioners and policy-makers are conscious of the need to mitigate the negative effects of social distancing. Drawing on insights from a large body of research on the Social Identity Approach to Health, we devised an online activity-GROUPS 2 CONNECT (G2C)-aimed at helping people to maintain social connectedness when face-to-face interaction was not possible. Across four studies (N = 1021), we found that after completing the G2C activity, participants reported an increase in perceived quality of social connection, perceived ability to stay connected and well-being, with results showing that for two of the three longitudinal studies these uplifts were stable over time, and for all studies, the uplifts remained consistently higher for those who reported completing their social connection goals. These findings provide initial evidence of the value of G2C as a tool to support social connection, thereby reducing the risk of social isolation.

Groups 4 Health protects against unanticipated threats to mental health: Evaluating two interventions during COVID-19 lockdown among young people with a history of depression and loneliness

BACKGROUND

Decades of research indicate that when social connectedness is threatened, mental health is at risk. However, extant interventions to tackle loneliness have had only modest success, and none have been trialled under conditions of such threat.

METHOD

174 young people with depression and loneliness were randomised to one of two evidence-based treatments: cognitive behaviour therapy (CBT) or Groups 4 Health (G4H), an intervention designed to increase social group belonging. Depression, loneliness, and well-being outcomes were evaluated at one-year follow-up; COVID-19 lockdown restrictions were imposed partway through follow-up assessments. This provided a quasi-experimental test of the utility of each intervention in the presence (lockdown group) and absence (control group) of a threat to social connectedness.

RESULTS

At one-year follow-up, participants in lockdown reported significantly poorer wellbeing than controls who completed follow-up before lockdown, t(152)=2.41, p=.017. Although both CBT and G4H led to symptom improvement, the benefits of G4H were more robust following an unanticipated threat to social connectedness for depression (χ²(16)=31.35, p=.001), loneliness (χ²(8)=21.622, p=.006), and wellbeing (χ²(8)=22.938, p=.003).

LIMITATIONS

Because the COVID-19 lockdown was unanticipated, this analysis represents an opportunistic use of available data. As a result, we could not measure the specific impact of restrictions on participants, such as reduced income, degree of isolation, or health-related anxieties.

CONCLUSIONS

G4H delivered one year prior to COVID-19 lockdown offered greater protection than CBT against relapse of loneliness and depression symptoms. Implications are discussed with a focus on how these benefits might be extended to other life stressors and transitions.

Stepped-down intervention programs to promote self-managed physical activity in military service veterans: A systematic review of randomised controlled trials

OBJECTIVES

A stepped-down program is one where clients transition from the care of a health professional to self-managed care. This study reviewed the effectiveness of stepped-down interventions to promote self-managed physical activity for health in military service veterans.

DESIGN

Systematic review.

METHODS

Literature searches of 11 electronic databases were performed (up to 28th April 2020) to identify randomised controlled trials that assessed self-managed physical activity interventions in military service veterans. Data were extracted on study characteristics, intervention programs (with strategies mapped against a taxonomy of behaviour change techniques), and physical activity outcomes; secondary outcomes were physical fitness/function, psychosocial health, and cost effectiveness. Study quality was assessed using a 15-item checklist adapted from the TESTEX scale.

RESULTS

Searches identified 26 studies (all from the United States; N = 45 to 531 participants) representing 17 intervention programs. Studies were of good quality (M = 10.7; SD = 2.3). More than half (54%) reported positive between-group intervention effects for physical activity outcomes (mean increase of 80 min/week in self-reported physical activity at 10-12 months). Physical fitness/function outcomes improved in 38% of studies, but no studies found significant intervention effects for psychosocial health or cost effectiveness outcomes. Behaviour change techniques most frequently used to elicit physical activity changes were education, goal setting, goal review and self-monitoring.

CONCLUSIONS

Stepped-down programs that include specific behaviour change techniques have the potential to promote self-management of physical activity in military service veterans. Multi-national randomised controlled trials that use objective physical activity measures are needed to further build the evidence base.

Loneliness in older age: What is it, why is it happening and what should we do about it in Australia?

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self-esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi-level approach to addressing loneliness.

Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial

Background

A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans.

Objective

This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans’ Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA.

Methods

The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans’ Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences.

Results

Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so.

Conclusions

Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents.

Trial Registration

Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx

International Registered Report Identifier (IRRID)

PRR1-10.2196/21911

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.

Rethinking the nature of the person at the heart of the biopsychosocial model: Exploring social changeways not just personal pathways

Karunamuni et al.'s (2020) biopsychosocial-pathways (BPS-P) model provides an important framework for elaborating on Engel's (1977) biopsychosocial (BPS) model of health. In particular, the BPS-P model improves on Engel's by articulating and evidencing the multiple pathways between biological, psychological, and social influences on health and identifying mechanisms that might be implicated in these pathways. Yet its analytic treatment of these influences as "separate systems" means that, as with Engel's model, the BPS-P model is more a list of ingredients than an integrated whole. In this commentary, following Haslam et al.'s (2019) specification of a sociopsychobio model, we underscore the value of a synthetic appreciation of biology, psychology, and society as dynamically interdependent aspects of an integrated whole which is more than just the sum of its parts and the pathways between them. In particular, our alternative framework centres on an appreciation of people as social beings whose group memberships and associated social identities open up 'changeways' (not just pathways) that, as we have seen during the COVID-19 pandemic, can fundamentally restructure biology, psychology and society.

Overcoming Age-Based Stereotypes to Optimise Cognitive Performance in Older Adults: A Systematic Review of Methodology and Existing Evidence

BACKGROUND AND OBJECTIVES

Age-based stereotype threat (ABST) poses serious risks for the cognitive screening of older adults. This review aimed to identify and critically appraise the methodology and existing evidence of studies investigating the use of threat-removal (TR) strategies to overcome the effects of ABST on the cognitive performance of older adults. The types of strategies, their effectiveness in optimising cognitive performance, and factors influencing their effectiveness were examined.

RESEARCH DESIGN AND METHODS

A systematic review was conducted following PRISMA guidelines. PsycINFO, PubMed, Embase, Web of Science, and Scopus were searched from 1st January 1995 to 6th November 2019. Two authors independently assessed article eligibility and appraised methodological quality of eligible articles using an adaptation of the STROBE guidelines. Narrative synthesis was used to summarise results.

RESULTS

Thirty articles, reporting on 36 studies, were eligible and included. Overall, evidence for the effectiveness of TR was mixed and varied according to the explicitness of strategies and comparison conditions used. Studies examining blatant TR strategies, and those using a combination of blatant and subtle TR strategies, provided limited support for their effectiveness in overcoming ABST. However, studies evaluating subtle TR strategies provided preliminary support for their effectiveness in overcoming ABST.

DISCUSSION AND IMPLICATIONS

Existing studies provide limited evidence regarding the effectiveness of TR strategies in overcoming ABST due to methodological limitations. Recommendations are made for the design of future studies to differentiate the benefits of TR strategies from the detrimental effects of ABST, thus potentially informing their use in clinical practice.

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.

Life Change, Social Identity, and Health

Life change affects health. Research aimed at understanding the consequences of life change has primarily focused on the important roles played by stress, social support, individual differences, and broader socioeconomic factors in shaping health outcomes, most notably mental health decline. In this review we extend these accounts by exploring social identity-based determinants of adjustment to life change. We do so by drawing on social identity theorizing and, in particular, the Social Identity Model of Identity Change (SIMIC). This points to the importance of multiple, maintained, new, and compatible group memberships as determinants of people's responses and adjustment to life change. We apply this model to understand the health consequences of adjustment to life change in four diverse areas: pursuit of higher education, migration, trauma and resilience, and recovery from illness and injury. Finally, we provide direction for future research on SIMIC and the health consequences of life change.

A qualitative study exploring how city bus drivers manage sleepiness and fatigue

Sleepiness is an important consideration for workplace safety, especially in relation to shift work. There is limited understanding of how practical applications of countermeasures are used to manage sleepiness in a professional setting. One under-researched group is city bus drivers. This qualitative study investigated the use of individual sleepiness countermeasures within a sample of city bus drivers. Nine semi-structured focus groups were convened to explore the broader experience and management of sleepiness (n = 62, largest proportion aged 45-54 y, mean bus driving experience 13.3 y). The conversations of the focus groups were audio-recorded (total: 682 min) and transcribed anonymously verbatim. Discussions specifically relating to personal countermeasure use were isolated from the original transcripts, creating nine new transcripts for a targeted analysis on the topic of individual countermeasure use. Thematic analysis identified two main themes: (1) strategies used to counteract sleepiness and (2) barriers to individual countermeasure use, each with several subthemes. A variety of countermeasures were used, including strategies with limited potential for counteracting sleepiness, such as opening a window, drinking water, talking, stretching, and consuming forms of sugar. Workplace restrictions, such as access to facilities, limitations of food/drink consumption, and tight schedules, were the strongest influences on countermeasure choice. It is important that bus drivers have access to, and are aware of the effectiveness of, countermeasures to manage sleepiness during shift work. It is vital that the actions of drivers and shift workers are better understood in the planning of organizational countermeasures.

Innovative solutions to enhance safe and green environments for ageing well using co-design through patient and public involvement

BACKGROUND

There is a need to develop innovative solutions to enhance safe and green physical environments, which optimise health, wellbeing and community participation among older adults. To develop solutions that meet the needs of a diverse ageing population, an interdisciplinary approach is needed. Our aim was to identify the needs of older people in relation to ageing well in the environment by bringing together knowledge from different perspectives using Patient and Public Involvement.

METHODS

An international consortium (Retrofit living For ageing well through Understanding and Redesign of Built environments consortium: ReFURB) was established in April 2018, including ten core members, to (i) explore cutting-edge solutions to safe living for ageing populations and (ii) develop innovative approaches to everyday physical environments, which bring about health benefits. We used a co-design, interdisciplinary framework involving older adults, carers, physiotherapists, geriatricians, engineers, human movement experts, geographers and psychologists from the UK and Australia. This engaged people in a 1 day workshop that comprised a series of presentations from international speakers on urban design, social connectedness, hazards and injury prevention, and the physical environment. Small group discussions (facilitated by consortium members) followed presentations to consider the opportunities, challenges and barriers encountered with ageing, which included the use of creative engagement activities (LEGO® Serious Play, mind maps, poster gallery walk), to help participants share personal stories and reflect on the issues raised. Thematic coding was used to synthesise the outputs of the small group work.

RESULTS

Five themes were identified across the workshops: access and transport; involvement of the whole community; restoration rather than redesign; assistive and digital technology; and intergenerational approaches. These dimensions related to the physical, social and nature-based qualities of everyday environments, as they pertain to ageing well.

CONCLUSIONS

Co-design was a valuable tool that helped understand the perceptions of participants and essential to develop effective interventions and solutions. Participants highlighted several issues affecting people as they age and key environmental considerations to promote wellbeing, activity, and participation. The consortium identified gaps in the existing evidence base and are now planning activities to further develop research ideas in collaboration with our co-design participants.

Reducing loneliness among people with substance use disorders: Feasibility of 'Groups for Belonging'

INTRODUCTION AND AIMS

Although loneliness is common among people with substance use disorders, few interventions to reduce loneliness have been developed for this population. This study aimed to determine the feasibility of delivering a six-session group-based intervention, 'Groups for Belonging', that builds social group connectedness.

DESIGN AND METHODS

Participants were 41 individuals accessing residential substance use treatment services. The primary aims of the present study were to determine indicators of feasibility of Groups for Belonging; namely, demand (recruitment, attendance and retention) for and acceptability (program adherence and participant satisfaction) of the Groups for Belonging program in residential substance use treatment settings.

RESULTS

Over half of the people attending the services were interested in participating in Groups for Belonging. Of 41 participants who commenced the program, 20 participants completed the program per protocol. In terms of acceptability, the average number of sessions attended was 3.7 (SD = 1.76, range 1-6). Program adherence was 99.3% and overall satisfaction with the program was high, with 95% of participants reporting they enjoyed Groups for Belonging.

DISCUSSION AND CONCLUSIONS

The Groups for Belonging program may be feasible for delivery in residential substance use treatment services. Findings from this study suggest that an adequately powered replication study is warranted.

The Dynamics of Acculturation Among Older Immigrants in Australia

This study explores different acculturation pathways that older immigrants follow, and the social/cultural identities they claim (or do not claim), as they live and age in Australia. Data were collected from 29 semi-structured, in-depth interviews with older immigrants (65+ years) from nine cultural backgrounds. We used participants’ self-defined cultural identity to explore how these cultural identities were enacted in different contexts. Mapping self-defined cultural identity with narratives about what participants do in relation to ethnic and host cultures, we found three dynamic acculturation pathways: (a) identifying with the ethnic culture while embracing aspects of Australian culture, (b) identifying with Australian culture while participating in the ethnic culture, and (c) identifying with both cultures while maintaining the way of life of the ethnic culture. These pathways show that acculturation strategies are not necessarily consistent with self-defined identity, within the same individual or over time. Rather, the participants’ narratives suggest that their life in the settlement country involves ongoing negotiation across people, culture, and relationships. The findings highlight the importance for acculturation research to be situated in the context in which immigrants find themselves, to capture the nuances of these dynamic acculturation experiences.

GROUPS 4 HEALTH reduces loneliness and social anxiety in adults with psychological distress: Findings from a randomized controlled trial

OBJECTIVE

Loneliness is a key public health issue for which various interventions have been trialed. However, few directly target the core feature of loneliness-lack of belonging. This is the focus of Groups 4 Health (G4H), a recently developed intervention that targets the development and maintenance of social group memberships to support health.

METHOD

To investigate the efficacy of this intervention, a randomized controlled trial was conducted with participants (N = 120) assigned to G4H or treatment-as-usual (TAU) by computer software. Assessment of primary (loneliness) and secondary (depression, social anxiety, general practitioner visits, multiple group membership) outcomes was conducted at baseline and 2-month follow-up using mixed-model repeated-measures analyses.

RESULTS

G4H produced a greater reduction in loneliness (d = -1.04) and social anxiety (d = -0.46) than TAU (d = -0.33 and d = 0.03, respectively). G4H was also associated with fewer general practitioner visits at follow-up (d = -0.33) and a stronger sense of belonging to multiple groups (d = 0.52) relative to TAU (d = 0.30 and d = 0.33, respectively). Depression declined significantly in both G4H (d = -0.63) and TAU (d = -0.34), but follow-up analyses showed this was greater in G4H among those not receiving adjunct psychopharmacological treatment and whose symptoms were milder.

CONCLUSIONS

Findings suggest that G4H can be a useful way to treat loneliness and highlight the importance of attending to group memberships when tackling this important social challenge. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Friendships that money can buy: financial security protects health in retirement by enabling social connectedness

Background

Research on the health and wellbeing of retirees has tended to focus on financial security and financial planning. However, we suggest that one reason why financial security is important for retirees is that it enables social connectedness, which is critical for healthy ageing.

Methods

This paper tests this hypothesis cross-sectionally (N = 3109) and longitudinally (N = 404) using a population-weighted mixed effects mediation model in two nationally representative samples of Australian retirees.

Results

Analyses provide robust support for our model. Subjective financial security predicted retiree health cross-sectionally and longitudinally. Social connectedness also consistently predicted mental health and physical health, on average four times more strongly than financial security. Furthermore, social connectedness partially accounted for the protective effect of subjective financial security.

Conclusions

We discuss the implications of these findings for public health, with a particular emphasis on how social connectedness can be better supported for people transitioning to retirement.

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.

Social identity mapping online

Social identities play an important role in many aspects of life, not least in those pertaining to health and well-being. Decades of research shows that these relationships are driven by a range of social identity processes, including identification with groups, social support received from groups, and multiple group memberships. However, to date, researchers have not had access to methods that simultaneously capture these social identity processes. To fill this void, this article introduces an online Social Identity Mapping (oSIM) tool designed to assess the multidimensional and connected nature of social identities. Four studies (total N = 721) featuring community, student, new parent, and retiree samples, test the reliability and validity of oSIM. Results indicate that the tool is easy to use, engaging, has good internal consistency as well as convergent and discriminant validity, and predicts relevant outcomes across a range of contexts. Furthermore, using meta-analytic findings, the tool is able to index a higher-order social identity construct, here introduced as a supergroup. This new concept provides holistic information about groups (reflecting an integrated index of several social identity processes) that are predictive of well-being outcomes, as well as outcomes related to successful adjustment to challenging life events. We discuss how the tool can be used to tackle key debates in the literature and contribute to theory by affording researchers the opportunity to capture the nuanced and contextual nature of social identity in action. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Social identity differentiation predicts commitment to sobriety and wellbeing in residents of therapeutic communities

RATIONALE

Therapeutic communities (TC) for alcohol and other drug treatment rely strongly on social factors as agents of recovery; an approach known as 'community-as-method'. This study adopted a social identity approach in examining the relative strength of participants' recovery group identity and substance using group identity at admission (T1) and after six months (T2) in a TC.

OBJECTIVES

Were to investigate whether identity differentiation - the extent to which respondents see themselves more as belonging to recovery groups than belonging to substance using groups - (a) is related to individuals' primary substance of concern (i.e., amphetamine type stimulants; alcohol; other drugs), and (b) predicts positive indicators of recovery six months after entering a therapeutic community.

METHOD

Adults (N = 307) entering one of five Australian therapeutic communities (TC) completed measures of identification (user, recovery), commitment to sobriety, psychological distress, and personal wellbeing.

RESULTS

Participants' endorsement of the user and recovery identity at T1 and T2 did not differ as a function of primary substance of concern. User identity diminished over the six months while recovery identity remained high, regardless of primary drug category. Identity differentiation measured at T2 accounted for 20-25% variance in commitment to sobriety and wellbeing, after accounting for participant demographics, addiction severity, and T1 identity variables.

CONCLUSIONS

These findings highlight the importance of the relative strength of recovery over substance use related identities in supporting recovery indicators and the central role of the TC in supporting this trajectory.

The connecting adolescents to reduce relapse (CARR) trial: study protocol for a randomized controlled trial comparing the efficacy of Groups 4 Health and cognitive behaviour therapy in young people

Background

Depression is the leading cause of disability in young people (aged 15–25) globally. Loneliness is a major factor in the development and relapse of depression in young people, yet few interventions directly address loneliness. Groups 4 Health (G4H) – a novel, theoretically derived group psychotherapy intervention – may address this disconnect. Previous trials (Phase I and Phase II) have found G4H to be efficacious in reducing symptoms of depression. However, the efficacy of G4H compared to current evidence-based treatments (Phase III) has not been investigated. This protocol details the design and methodology of the Connecting Adolescents to Reduce Relapse (CARR) trial, a randomised control trial assessing the efficacy of G4H in young people relative to cognitive behavioural therapy (CBT).

Methods

The CARR trial is a two-arm non-inferiority randomised controlled trial that will compare the efficacy of G4H to the most widely used evidence-based treatment for depression, CBT, at program completion and 6- and 12-month follow up. Participants will be 200 young people (aged 15–25) with symptoms of depression and/or loneliness recruited from community and university mental health services. We hypothesise that the interventions will be comparable in reducing depression symptoms, but that G4H will be superior in reducing loneliness. Because loneliness is a primary risk factor for depression relapse in young people, we therefore expect the benefits of Groups 4 Health to be particularly apparent at 12-month follow up.

Discussion

This trial will be the first to evaluate an intervention that targets loneliness, in comparison to the current gold standard treatment approach – CBT. If found to be effective, this program offers a new approach to treatment and relapse prevention of depression among young people.

Trial registration

Trial prospectively registered on ANZCTR (ACTRN12618000440224), registered on 27/03/2018.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7011-y) contains supplementary material, which is available to authorized users.