Social Isolation Predicts Frequent Attendance in Primary Care.

Background: Frequent attenders in primary care have complex physical and mental healthcare needs as well as low satisfaction with their health care. Interventions targeting mental health or psychoeducation have not been effective in reducing attendance. Here, we test the proposition that both frequent attendance and poor health are partly explained by unmet social needs (i.e., limited social group support networks). Methods: Study 1 (N = 1,752) was a large, cross-sectional community sample of primary care attenders in Scotland. Study 2 (N = 79) was a longitudinal study of a group of young people undergoing a life transition (moving countries and commencing university) that increased their risk of frequent attendance. Study 3 (N = 46) was a pre-post intervention study examining whether disadvantaged adults who joined a social group subsequently had reduced frequency of primary care attendance. Results: All three studies found that low social group connectedness was associated with a higher frequency of primary care attendance. This was not attributable to poorer health among those who were socially isolated. In Study 3, joining a social group led to reduced primary care attendance to the extent that participants experienced a (subjective) increase in their social group connectedness. Conclusions: Unmet social needs among frequent attenders warrant closer consideration. Interventions that target social group connectedness show promise for reducing overutilization of primary care services.

On the reciprocal effects between multiple group identifications and mental health: A longitudinal study of Scottish adolescents.

OBJECTIVES: The aim of the study was to investigate the link between social group identification and mental health outcomes in a sample of secondary school pupils. Based on previous work, it was predicted that multiple high group identifications would protect against psychological ill health. Furthermore, it was predicted that better mental health would also predict greater number of group identifications, thus creating a 'virtuous circle'. DESIGN: A longitudinal questionnaire design was used. METHODS: A total of 409 Scottish secondary school pupils aged 13-17 completed a questionnaire twice over a year. Pupils' responses regarding their mental health and the extent of their identification with three groups (the family, school, and friends) were measured. RESULTS: A path analysis of the data showed that greater number of high group identifications predicted better mental health outcomes amongst participants. However, better mental health also predicted greater number of high group identifications, suggesting that there is a cyclical relationship between both variables. CONCLUSIONS: The findings have both theoretical and practical implications. They highlight the importance of conceptualizing the link between group identification and mental health as cyclical, rather than unidirectional. This reconceptualization has implications for mental health promotion strategies, as it highlights the importance of attempting to turn a potentially 'vicious cycle' of social disidentification and mental ill health into a 'virtuous cycle' of social identification and mental health. PRACTITIONER POINTS: Results showed that in a population of 409 high school pupils, the more high group identifications pupils had, the better their mental health outcomes. Better mental health also predicted a greater number of high group identifications over time. The findings suggest that we would benefit from conceptualizing the relationship between group identification and mental outcomes as being cyclical rather than unidirectional. Viewing the relationship between group identification and mental health in this way enables us to consider interventions which help turn a 'vicious cycle' into a 'virtuous cycle'. Limitations A potential limitation of the work relates to the use of self-report questionnaires which may elicit socially desirable responses. The sample only consists of high school pupils from mainstream public schools within Scotland.

Greater number of group identifications is associated with lower odds of being depressed: evidence from a Scottish community sample.

PURPOSE: Group identification has been shown to be associated with reduced risk of depression, but this research has important limitations. Our aim was to establish a robust link between group identification and depression whilst overcoming previous studies' shortcomings. METHODS: 1824 participants, recruited from General Practice throughout Scotland, completed a questionnaire measuring their identification with three groups (family, community, and a group of their choice), as well as their intensity of contact with each group. They also completed a self-rated depression measure and provided demographic information. Their medical records were also accessed to determine if they had been prescribed antidepressants in the previous 6 months. RESULTS: The number of group identifications was associated with both lower self-rated depression and lower odds of having received a prescription for antidepressants, even after controlling for the number of contact-intensive groups, level of education, gender, age, and relationship status. CONCLUSIONS: Identifying with multiple groups may help to protect individuals against depression. This highlights the potential importance of social prescriptions, where health professionals encourage a depressed patient to become a member of one or more groups with which the patient believes he/she would be likely to identify.

Diversity of Group Memberships Predicts Well-Being: Cross-Sectional and Longitudinal Evidence.

Groups have their health and well-being impacted by satisfying their members' needs and providing resources to help cope with threats. Multiple group memberships serve to accumulate these benefits and also provide resilience to the effects of group loss. However, the additional well-being benefits of belonging to multiple different types of group remain to be determined. In a preregistered cross-sectional survey in Nottingham, England (Study 1, N = 328), we found that group-type diversity predicted well-being and that this effect was fully serially mediated by increased creative self-efficacy, then reduced loneliness. To confirm our hypothesis in a more robust sample we conducted longitudinal analyses on the English Longitudinal Study of Aging (ELSA) dataset (Study 2, N = 5,838) finding that group-type diversity at time one (T1) predicted well-being at T2 (4 years later), even when accounting for wellbeing and loneliness at T1. We discuss the implications for enhancing group-based health interventions.

Weathering the economic storm together: Family identification predicts future well-being during COVID-19 via enhanced financial resilience.

The economic crisis precipitated by the coronavirus disease (COVID-19) pandemic has placed considerable financial pressures on households across the world. These are compounded by the enforced isolation accompanying pandemic restrictions, during which individuals can struggle to access external assistance and often need to rely heavily on the social, emotional, and financial support of other family members. Previous research indicates that family financial stress has negative consequences for the mental health and well-being of members, but that heightened family identification can provide individuals with a stronger sense of collective financial resilience. In the present study, an online longitudinal survey of U.K. residents (N = 172) shows that, in summer 2020, the positive relationship between individuals' family identification and their well-being 1 month later was mediated by levels of perceived family financial efficacy and financial stress. These findings build upon existing evidence of the pivotal role of the family in financial well-being and suggest that supporting family units to cope with shared financial challenges may have psychological benefits over and above supporting individual family members. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The mental health benefits of community helping during crisis: Coordinated helping, community identification and sense of unity during the COVID-19 pandemic.

Communities are vital sources of support during crisis, providing collective contexts for shared identity and solidarity that predict supportive, prosocial responses. The COVID-19 pandemic has presented a global health crisis capable of exerting a heavy toll on the mental health of community members while inducing unwelcome levels of social disconnection. Simultaneously, lockdown restrictions have forced vulnerable community members to depend upon the support of fellow residents. Fortunately, voluntary helping can be beneficial to the well-being of the helper as well as the recipient, offering beneficial collective solutions. Using insights from social identity approaches to volunteering and disaster responses, this study explored whether the opportunity to engage in helping fellow community members may be both unifying and beneficial for those engaging in coordinated community helping. Survey data collected in the UK during June 2020 showed that coordinated community helping predicted the psychological bonding of community members by building a sense of community identification and unity during the pandemic, which predicted increased well-being and reduced depression and anxiety. Implications for the promotion and support of voluntary helping initiatives in the context of longer-term responses to the COVID-19 pandemic are provided. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Collectively coping with coronavirus: Local community identification predicts giving support and lockdown adherence during the COVID-19 pandemic.

The role of shared identity in predicting both ingroup helping behaviour and adherence to protective norms during COVID-19 has been extensively theorized, but remains largely under-investigated. We build upon previous Social Identity research into community resilience by testing the role of pre-existing local community (or 'neighbourhood') identity as a predictor of these outcomes, via the mediator of perceived social support. Community residents in the UK completed a longitudinal online survey four months before lockdown (T1; N = 253), one month before lockdown (T2; N = 217), and two months into lockdown (T3; N = 149). The cross-lagged panel analysis shows that T1 community identification predicts T3 giving and receiving of pandemic-related support, and that these effects occur via the perception of community support at the second time point (while the alternative pathway from T1 support via T2 identification is non-significant). Moreover, we show that T1 community identification also directly predicts lockdown adherence at T3. Our findings point to the pivotal role played by community identity in effective behavioural responses to the pandemic, and the need to support and foster community development to facilitate local community resilience as the crisis continues to unfold.

Longitudinal associations between family identification, loneliness, depression, and sleep quality.

OBJECTIVES: The prevalence of depression and loneliness is increasing in Western nations, and both have been shown to cause poor sleep quality, with evidence suggesting that loneliness also predicts depression. The Social Cure perspective can shed light on these relationships and thus informs the present study. Specifically, it was hypothesized that the extent of participants' identification with a significant social group, their family, would positively predict sleep quality and that this relationship would be mediated by loneliness and depression. DESIGN: A two-lave longitudinal online survey was used. METHODS: Participants completed an online survey at T1 (N = 387) and 1 year later at T2 (N = 122) assessing the extent to which they identified with their family. Their loneliness, depressive symptomology, and sleep quality/insomnia severity were also measured. RESULTS: Consistent with predictions, cross-sectional and longitudinal serial mediation models indicated that family identification was a negative predictor of loneliness, which in turn was a positive predictor of depression, which predicted poor sleep quality/insomnia. CONCLUSIONS: This is the first Social Cure study to explore the mediated relationship between social identification and sleep quality. As well as advancing the Social Cure perspective, these results have implications for how health professionals understand, prevent, and treat sleep problems. Statement of contribution What is already known on this subject? The prevalence of depression and loneliness is increasing in Western nations, and both have been shown to cause poor sleep quality. Weak social networks have been shown to predict restless sleep over time, and that depressed mood mediates this relationship. What does this study add? Family identification negatively predicted poor sleep quality cross-sectionally. Depression and loneliness positively predicted poor sleep quality over time. Depression and loneliness mediated the family identification-sleep quality relationship over time.

Greater University Identification-But not Greater Contact-Leads to More Life Satisfaction: Evidence from a Spanish Longitudinal Study.

BACKGROUND: A growing body of literature has highlighted the relationship between group identification (a subjective sense of belonging to one's social group, coupled with a subjective sense of commonality with the group's members) and well-being. However, little of this work is longitudinal, and few studies address reciprocal causality or control for intensity of contact with fellow group members. METHOD: We investigated the effect of university identification on satisfaction with life (SWL) over time (and vice versa) in 216 Spanish undergraduates, with seven months between T1 and T2. RESULTS: While greater university identification T1 predicted higher SWL T2, SWL T1 did not predict university identification T2. University contact T1 was unrelated to SWL T2. CONCLUSIONS: These results show that university identification impacts positively on SWL over time (rather than SWL impacting positively on university identification over time), and this is not reducible to the effects exerted by university contact. The implications for those who work with students are discussed.

Greater number of group identifications is associated with healthier behaviour in adolescents.

We investigated the relationship between group identification (with the family, school, and friendship groups) and adolescent health behaviour (smoking, binge drinking, and cannabis use). 1,111 students from 4 Scottish secondary (high) schools completed a questionnaire which included measures of group identification, group contact, health behaviours, and demographic variables. We found that identification with the family and school groups predicted reduced odds of substance use, whereas identification with the friend group predicted increased odds of substance use. Furthermore, the greater the number of social groups with which the participant strongly identified, the lower the odds that he/she participated in negative health behaviours. In contrast, merely having contact (rather than identifying strongly) with these groups increased the odds of participation in these behaviours. We suggest that group identification influences behaviour to the extent that it encourages adherence to group norms.

The Nation and the Family: The Impact of National Identification and Perceived Importance of Family Values on Homophobic Attitudes in Lithuania and Scotland.

The meanings attached to the nation can be consequential for group members' attitudes and beliefs. We examined how national identity definition can influence the extent of individuals' homophobia with 159 Lithuanian and 176 Scottish university students who completed a questionnaire which measured their national identification, homophobia, and the extent to which they felt traditional family values were central to their nation's identity. Consistent with nation-wide differences in the significance given to the family, Lithuanian participants perceived family values to be more important for their national identity and expressed higher levels of homophobia than did Scottish participants. Moreover, the relationship between level of national identification and homophobia was stronger in Lithuania than in Scotland. Analyses revealed that the perceived importance of family values helped explain the difference between homophobia levels in Lithuania and Scotland. In both sites we found an indirect effect of national identification on homophobia via the perceived importance of family values, but this effect was significantly stronger for Lithuanian participants. These findings illustrate the ways in which identification with the nation is relevant to attitudes concerning sexuality, and how this varies according to national context. Our work indicates that LGBT rights campaigns should be informed by the knowledge that homophobia may be perpetuated by national valorisation of the family.

Identification with social groups is associated with mental health in adolescents: Evidence from a Scottish community sample.

The promotion and maintenance of mental health is an increasingly important societal issue. Previous research has shown that identification with social groups is positively associated with adult mental wellbeing, with multiple group identifications being particularly beneficial. The aim of the current study was to investigate whether the same is true for adolescents. 1111 Scottish secondary school students aged 13-17 completed a questionnaire investigating mental health symptoms and the extent of their identification with their family, school, and friendship groups. Higher identification with each group predicted better mental health. There was also an additive effect of group identification, with the odds of reporting psychiatric disturbance decreasing for every additional group with which participants identified strongly. These effects held even when age, gender, and group contact were controlled for. Our findings have implications for the prevention and treatment of mental problems, offering an alternative to traditional ways of viewing mental illness in adolescence and beyond.

Greater number of group identifications is associated with healthier behaviour: Evidence from a Scottish community sample.

OBJECTIVES: This paper investigates the interplay between group identification (i.e., the extent to which one has a sense of belonging to a social group, coupled with a sense of commonality with in-group members) and four types of health behaviour, namely physical exercise, smoking, drinking, and diet. Specifically, we propose a positive relationship between one's number of group identifications and healthy behaviour. DESIGN: This study is based on the Scottish portion of the data obtained for Wave 1 of the two-wave cross-national Health in Groups project. Totally 1,824 patients from five Scottish general practitioner (GP) surgeries completed the Wave 1 questionnaire in their homes. METHODS: Participants completed measures of group identification, group contact, health behaviours, and demographic variables. RESULTS: Results demonstrate that the greater the number of social groups with which one identifies, the healthier one's behaviour on any of the four health dimensions considered. CONCLUSIONS: We believe our results are due to the fact that group identification will generally (1) enhance one's sense of meaning in life, thereby leading one to take more care of oneself, (2) increase one's sense of responsibility towards other in-group members, thereby enhancing one's motivation to be healthy in order to fulfil those responsibilities, and (3) increase compliance with healthy group behavioural norms. Taken together, these processes amply overcompensate for the fact that some groups with which people may identify can actually prescribe unhealthy behaviours.

The effects of identification with a support group on the mental health of people with multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is associated with various psychological problems, including depression and anxiety. Whilst MS support groups are intended to improve mental health, this goal is not always achieved. Taking a social identity approach, we hypothesise that it is the level of subjective identification with a support group (rather than simply support group membership per se) that positively affects the mental health of people with MS. METHODS: 152 individuals with MS were recruited via UK MS support groups and completed a questionnaire. This included measures of support group identification, depression, anxiety and satisfaction with life, as well as control variables (education level and age). RESULTS: Analyses revealed that, as hypothesised, support group identification was significantly linked to depression, anxiety and satisfaction with life. Moreover, group identification explained a significant amount of variance in addition to that explained by education and age on each health outcome. Repeating the analysis to compare each of the three main sub-types of MS revealed these effects to be present for individuals with relapsing-remitting (RR) and Primary Progressive (PP) MS, but not for those with secondary progressive (SP) MS. CONCLUSIONS: We suggest that identifying highly with an MS support group has important positive outcomes for MS patients' mental health. This has implications for practicing clinicians: people with MS (particularly RRMS and PPMS) should be encouraged to engage with support groups, but more must be done to ensure they subjectively identify with these groups, rather than merely attend them.

Comparing social contact and group identification as predictors of mental health.

Current research on social integration and mental health operationalizes social integration as frequency of interactions and participation in social activities (i.e., social contact). This neglects the subjective dimension of social integration, namely group identification. We present two studies comparing the effect exerted by social contact and group identification on mental health (e.g., depression, stress) across two different groups (family; army unit), demonstrating that group identification predicts mental health better than social contact.

The impact of adopting ethnic or civic conceptions of national belonging for others' treatment.

National belonging is often defined in terms of "ethnic" ancestry and "civic" commitment (with the latter typically implying a more inclusive conception of belonging). The authors report three Scottish studies manipulating the prominence of these criteria. In Study 1 (N = 80), a Chinese-heritage target was judged more Scottish (and his criticisms of Scotland better received) when Scotland was defined in civic terms. In Study 2 (N = 40), a similar manipulation in a naturalistic setting showed a civic conception of belonging resulted in more help being given to a Chinese-heritage confederate. Study 3 (N = 71) replicated Study 2 and showed the effect was mediated by judgments of the confederate's Scottishness. These studies emphasize the importance of exploring how ingroup identity is defined.