Social network characteristics of Black African and Caribbean people with psychosis in the UK.

Poorer social networks predict more coercive pathways to care and other adverse outcomes in people with psychosis. People from Black African and Caribbean backgrounds have more negative experiences within UK mental health care systems and family relationships often breakdown. This study aimed to examine the social network characteristics of Black African and Caribbean people experiencing psychosis and associations between network characteristics and severity of psychosis, negative symptoms, and general psychopathology. Fifty-one participants completed social network mapping interviews (a gold standard approach to assessing social network composition) and the Positive and Negative Syndrome Scale. This is the first study to explicitly measure social network size amongst Black people with psychosis living within the UK and results showed that participants' social network size (mean = 12) was comparable to that of other psychosis samples. Networks were of moderate density and comprised disproportionately more relatives than other relationship types. Poor network quality was related to more severe psychosis symptoms suggesting that social network quality may be an important factor in influencing the severity of psychosis. Findings highlight the need for community-based interventions and family therapies to mobilise sources of social support for Black people with psychosis within the UK.

Engagement with services in Black African and Caribbean people with psychosis: The role of social networks, illness perceptions, internalized stigma, and perceived discrimination.

OBJECTIVES: Research and policies in the United Kingdom have repeatedly highlighted the need to reduce ethnic disparities and improve engagement with mental health services among Black African and Caribbean people with psychosis. The aim of this study was to examine the role of social network characteristics and psychological factors in engagement with services in Black people with psychosis. METHODS: A cross-sectional study was conducted with 51 Black African and Caribbean adults with non-affective psychosis and currently receiving care from mental health services in England. Measures were completed to examine relationships between social networks, illness perceptions, perceived racial or ethnic discrimination in services, internalized stigma, and current engagement with services from service user and staff perspectives. RESULTS: Social network composition (ethnic homogeneity) moderately correlated with better service user and staff reported engagement. Greater perceived personal control over problems was associated with better staff reported engagement. Lower perceived ethnic or racial discrimination in services, and specific illness perceptions (higher perceived treatment control, greater self-identification with psychosis symptoms, more concern and greater emotional response related to problems) were associated with better service user reported engagement. Internalized stigma was not associated with service engagement. Multivariate regression analyses suggested that a more ethnically homogenous social network was the strongest predictor of better service user and staff reported engagement. CONCLUSIONS: Psychosocial interventions that target social networks, perceived ethnic and racial discrimination in services, and illness perceptions may facilitate better engagement and improve outcomes. Further longitudinal studies are required to examine causal mechanisms.

Social networks and symptomatic and functional outcomes in schizophrenia: a systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis to examine the strength of associations between social network size and clinical and functional outcomes in schizophrenia. METHOD: Studies were identified from a systematic search of electronic databases (EMBASE, Medline, PsycINFO, and Web of Science) from January 1970 to June 2016. Eligible studies included peer-reviewed English language articles that examined associations between a quantitative measure of network size and symptomatic and/or functional outcome in schizophrenia-spectrum diagnoses. RESULTS: Our search yielded 16 studies with 1,929 participants. Meta-analyses using random effects models to calculate pooled effect sizes (Hedge's g) found that smaller social network size was moderately associated with more severe overall psychiatric symptoms (N = 5, n = 467, g = - 0.53, 95% confidence interval (CI) = - 0.875, - 0.184, p = 0.003) and negative symptoms (N = 8, n = 577, g = - 0.75, 95% CI = - 0.997, - 0.512, p = 0.000). Statistical heterogeneity was observed I2 = 63.04%; I2 = 35.75%,) which could not be explained by low-quality network measures or sample heterogeneity in sensitivity analyses. There was no effect for positive symptoms (N = 7, n = 405, g = - 0.19, 95% CI = 0.494, 0.110, p = 0.213) or social functioning (N = 3, n = 209, g = 0.36, 95% CI = - 0.078, 0.801, p = 0.107). Narrative synthesis suggested that larger network size was associated with improved global functioning, but findings for affective symptoms and quality of life were mixed. CONCLUSION: Psychosocial interventions which support individuals to build and maintain social networks may improve outcomes in schizophrenia. The review findings are cross-sectional and thus causal direction cannot be inferred. Further research is required to examine temporal associations between network characteristics and outcomes in schizophrenia and to test theoretical models relating to explanatory or mediating mechanisms.

Translocality, Network Structure, and Music Worlds: Underground Metal in the United Kingdom.

Translocal music worlds are often defined as networks of local music worlds. However, their networked character and more especially their network structure is generally assumed rather than concretely mapped and explored. Formal social network analysis (SNA) is beginning to attract interest in music sociology but it has not previously been used to explore a translocal music world. In this paper, drawing upon a survey of the participation of 474 enthusiasts in 148 live music events, spread across 6 localities, we use SNA to explore a significant "slice" of the network structure of the U.K.'s translocal underground heavy metal world. Translocality is generated in a number of ways, we suggest, but one way, the way we focus upon, involves audiences traveling between localities to attend gigs and festivals. Our analysis of this network uncovers a core-periphery structure which, we further find, maps onto locality. Not all live events enjoy equal standing in our music world and some localities are better placed to capture more prestigious events, encouraging inward travel. The identification of such structures, and the inequality they point to, is, we believe, one of several benefits of using SNA to analyze translocal music worlds.

Negotiating inter-professional interaction: playing the general practitioner-pharmacist game.

Despite a mutual interest in optimising the benefits of medication for patients, the general practitioner (GP) and community pharmacist (CP) often work in isolation from one another, both physically and figuratively. Sources of tension include pharmacy's 'shopkeeper' image, traditional medical hierarchies and potential encroachment on professional boundaries. This article examines GP and CP perceptions of their interactions and negotiations and, drawing on the works of Stein and Goffman, identifies a set of 'unwritten' rules, termed the 'GP-pharmacist game', which involves the concept of 'face-work'. Qualitative interviews with 20 GPs and 23 CPs located in four geographically and demographically different areas in England were conducted during 2010-11. Key rules of the game include the pharmacist avoiding blaming the GP, using discretion in front of patients, and balancing the necessity and frequency of the communication. This article argues that whilst adhering to the 'GP-pharmacist game' may avoid conflict and 'get the job done', it may also constrain efforts to meet wider health care policy aims of a more collaborative relationship.

Bridging the gap: the roles of social capital and ethnicity in medical student achievement.

OBJECTIVES: Within medical education, there is a discrepancy between the achievement level of White students and that of their ethnic minority peers. The processes underlying this disparity have not been adequately investigated or explained. This study utilises social network analysis to investigate the impact of relationships on medical student achievement by ethnicity, specifically by examining homophily (the tendency to interact with others in the same group) by ethnicity, age and role. METHODS: Data from a cross-sectional social network study conducted in one UK medical school are presented and are analysed alongside examination records obtained from the medical school. Participants were sampled across the four hospital placement sites; a total of 158 medical students in their clinical phase (Years 3 and 4) completed the survey. The research was designed and analysed using social capital theory. RESULTS: Although significant patterns of ethnic and religious homophily emerged, no link was found between these factors and achievement. Interacting with problem-based learning (PBL) group peers in study-related activities, and having seniors in a wider academic support network were directly linked to better achievement. Students in higher academic quartiles were more likely to be named by members of their PBL group in study activities and to name at least one tutor or clinician in their network. Students from lower-achieving groups were least likely to have the social capital enabling, and resulting from, interactions with members of more expert social groups. CONCLUSIONS: Lower levels of the social capital that mediates interaction with peers, tutors and clinicians may be the cause of underperformance by ethnic minority students. Because of ethnic homophily, minority students may be cut off from potential and actual resources that facilitate learning and achievement.

(Net)Working out: social capital in a private health club.

In Bowling Alone Robert Putnam considers the possibility that the growth of private health clubs and the rising rates of membership to such clubs might represent a counter-trend to his thesis on the decline in social capital. In this paper I explore this idea using ethnographic data and social network analysis. I show both that and how networks form in health clubs and I discuss the ways in which these networks constitute social capital for their members. In addition, however, I explore the 'dark side' of this form of social capital. I argue that high integration amongst some members of a fitness class can generate a power differential between those members and other, less integrated members who experience this negatively. Furthermore, with an eye on Burt's (2005) important thesis on brokerage and closure, I argue that brokerage between relatively closed clusters of agents can lead to inter-group rivalry and conflict, which, in turn, is experienced negatively by those involved.

The field of psychiatric contention in the UK, 1960-2000.

In this paper I discuss the question of how we should understand the concept of "social movements", particularly as applied to health related movements. My argument is that movements should be understood as "fields of contention". This concept, as I develop it, emphasizes two key aspects of social movement mobilization. Firstly, departing from traditional models of movements, which tend to view them as unified "things", it draws our attention to the numerous groups and agents who interact within the internal space of a "movement" and to the relations, alliances and conflicts between those various groups/agents as they unfold through time. Secondly, it draws our attention to the embedding of social movement struggles within multiple differentiated contexts of struggle, each of which affords different opportunities for struggle but each of which makes different demands upon activists if struggle is to prove effective. The model of fields of contention is explored within the paper using empirical data on a variety of "social movement organizations" (SMOs) which have formed around the mental health system in the UK over the last forty years.

Not being mentally ill.

Much of the social scientific work on psychiatry and mental health, from a variety of competing perspectives, has focused upon power and the social construction of 'mental illness'. Very little attention has been paid to resistance or to the various ways in which 'patients' or 'survivors' (as some now prefer to refer to themselves) have sought to socially deconstruct 'mental illness'. This paper seeks to redress that balance by way of a detailed examination of some of the key practices of resistance which have developed within the context of the UK mental health survivors movement. Using key concepts from Bourdieu's theory of practice, it examines the challenge which survivors have mounted to the symbolic power of psychiatry, and the resistance habitus which their opposition has given rise to.

Global anti-corporate struggle: a preliminary analysis.

This paper offers a preliminary analysis of the recent wave of anti-corporate protest that has swept across numerous countries throughout the world. In the first part of the paper the social structure of this phenomenon is examined. Specifically, it is argued that it should be understood as a 'field', in Pierre Bourdieu's sense of the term. In the second part of the paper the factors which account for the emergence of this field are explored, using a 'value-added' model which focuses upon the interplay of strains, situational definitions, focal events, opportunities and the circulation of protest relevant resources. The paper is conceived as a preliminary analysis which outlines a framework and draws out important themes. It is not offered as a complete account but rather as a basis from which more specific and focused studies might stem.