Social Networks in Young People with Psychosis: a SNA study
Research type
Research Study
Full title
Mapping and Understanding Social Networks in Young People with Psychosis: A Mixed-Method Social Network Analysis Study
IRAS ID
296413
Contact name
Andrew Gumley
Contact email
Duration of Study in the UK
0 years, 6 months, 28 days
Research summary
Research Summary
Social networks include any relationships in a person’s life, such as family and friends. Adults with experiences of psychosis report small networks and loneliness. However, the topic remains largely unexplored for young people with psychosis, who need to solve key tasks of building a self-identity and forming peer relationships whilst managing their difficulties.
The study aims to explore (a) the size, composition and characteristics of networks of young people with psychosis; and (b) their meaning making around how these networks support or hinder their recovery of valued roles and developmental tasks.A mixed-method social network analysis framework will be used with 6-10 young people (14-24 years old) who experienced psychosis within the past 2 years. Potential participants will be invited through their clinicians across inpatient psychiatric adolescent unit, outpatient (CAMHS) and early-intervention services in NHS Greater Glasgow & Clyde.
Following informed consent processes, participants will engage in two 1-hour long interview sessions. They will identify all network members within the last month, describing them across a range of attributes (e.g., gender, online versus face-to-face), mapping them visually on four concentric circles of closeness, and reflecting on their positive and negative roles in recovery. Interviews will be audio recorded and transcribed verbatim. Data analyses will include: descriptive statistics of the count and composition of networks and their characteristics, a quantitative and qualitative social network analysis of the visual maps constructed by participants, and thematic analysis of the qualitative interviews.
This project answers previous calls for in-depth exploration of challenges in building and maintaining social networks for people with psychosis. It is unique in its approach to overlap the quantitative descriptions of networks with a qualitative first-hand narrative of their role in recovery. This can inform clinical formulation of wider systemic risk and protective factors and targeted intervention drawing on network resources.
Summary of Results
Three young people aged 19-23 with experiences of psychosis within the past two years and actively engaged in early intervention for psychosis services completed the study.
The average social network size was of 33 network members. This mostly included close and extended family and friends. Network members from all groups (e.g., family, friends, clinicians, volunteering) were placed both closer and further away from the participant across all rings of the circles of closeness. Being engaged in more activities appeared to give more access to specific social networks, such as work or university colleagues. Recovery meant different things to different people; however, in general, it involved getting back to valued tasks, having new goals, being OK within oneself and having a better quality of life.
From our qualitative interviews, we found four themes:
1) Supportive networks were available, offering practical, emotional and illness management help. From all young people’s reports, it emerged that:
• family and close friends most often provided emotional support, such as being available for the person, discussing important things and offering reassurance, encouragement and hope. Practical support included help with applying for jobs or engaging in activities. Illness management support included hospital visits, helping with treatment decisions, helping understand the experience of psychosis and managing helpful/unhelpful behaviours.
• Everyone felt valued, accepted, paid attention to and held in mind by most of their networks. Being able to give something back and reciprocate in relationships was important for all, although some anxiety around how to do that was present. Being understood, accepted and forgiven were also important, particularly where the symptoms of psychosis were directed at network members. Relationships with other people with experiences of mental health difficulties were particularly valued here, as they shared experiences of isolation, relatedness, and inspiration from witnessing growth after adversity.
2) Internal factors (from the inside out) related to the participants themselves, such as social difficulties growing up or psychosis symptoms, influenced relationships and recovery. Here, participants may have talked about:
• Experiences of anxiety, low mood, social difficulties or health-related worries even before psychosis, which may have made it harder at times to reciprocate in relationships.
• Psychosis symptoms themselves influencing relationships, acting almost like a ‘make-it or break-it’ point. In a less desirable way, psychosis may have reduced independence, interfered with young people’s dreams and hopes for the future, removed them from valued interests, or expressed itself through unpleasant communication with people, leaving them with a fear that relationships may break down. However, experiences of psychosis have also led to positive changes, which seemed similar to what other studies labelled as ‘post-traumatic growth’. For example, key close relationships lasted through challenges and became stronger, whereas unhealthy, distant relationships that didn’t serve participants well may have been cut off.
• A need for alone time. For some of the participants, taking time to themselves away from the social world has been helpful in avoiding settings where people were drinking, in reducing shame and allowing for time to recharge. However, there was also a fear of having ‘too much time’ alone.
3) External factors (from the outside in) related to participants’ social networks, such as difficult upbringing and feelings of rejection, influenced experiences of psychosis and recovery. Participants talked about:
• How family context, such as witnessing other family members struggle with mental health difficulties or having experienced an unstable upbringing, may have come across in the psychosis symptoms or left them worrying about their own future and recovery. However, for some, psychosis did bring family members closer together.
• Experiences of rejection by others, such as not being included in activities or conversations, or being told inappropriate jokes. These may have led to participants feeling devalued or ashamed. However, these experiences did not appear to be very common, as networks often showed understanding and acceptance.
• Difficulties disclosing about experiences of psychosis. It appeared particularly harder to share at the beginning of a relationship or with more unfamiliar people, or with people without lived experience. It also appeared harder to share about psychosis specifically as compared to other mental health difficulties, which some participants felt others can relate more to.
4) Everyone wished to resume valued roles, identities and activities and build on the quality of relationships.
• Engaging in new activities could include getting a job, gaining more independence, growing their social networks whilst also managing other demands, and growing intimacy. Others trusting the young people in this process was important, although participants also appreciated that they can be helpful in taking on some responsibilities during recovery. Some uncertainty and fears appeared about getting back to valued things.
• Growing social networks could happen through organised activities, such as youth clubs, or one’s own initiated activities, such as university or volunteering. Having activities often gave a sense of purpose, responsibility, routine and opportunity to meet like-minded people. It also helped put things into perspective and manage stress better. Friends appeared particularly important for fun activities. However, it also appeared important to return to activities in a gradual way to avoid feeling overwhelmed or too stressed.REC name
West of Scotland REC 5
REC reference
21/WS/0089
Date of REC Opinion
5 Oct 2021
REC opinion
Further Information Favourable Opinion