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Referral patterns to and from inpatient psychiatric services: a social network approach.

Interorganizational linkages have assumed more import for mental health service systems during the past three decades because of increased levels of complexity in service delivery patterns. This analysis examines these linkages from a relational perspective, with network of patient referral patterns as the basic unit. Multidimensional scaling is employed to discern patterns of interorganizational linkages in national patient referral data collected by the National Institute of Mental Health in 1975 and 1980 for patient samples from inpatient psychiatric services of state and county mental hospitals, private psychiatric hospitals, and public and nonpublic general hospitals. The multidimensional scaling techniques distinguish two structural characteristics of the interorganizational linkages of psychiatric inpatient services--public vs private services, and drift over time in referral patterns. Public and private inpatient psychiatric services are differentiated principally in terms of degree of interaction with legal agencies and private practice psychiatrists. Chronological change in referral patterns is characterized principally by changes in the degree of interaction with other inpatient or outpatient psychiatric services. Methodologically and theoretically, the techniques and findings described can enhance our understanding of interorganizational linkages and dynamics.

Delivery of Health Care↗

The social stress model of substance abuse among childbearing-age women: a review of the literature.

The Social Stress Model of Substance Abuse has been derived from numerous psychosocial theories and models. This model suggests that the likelihood of an individual engaging in drug abuse is influenced by the stress level and the extent to which it is offset by stress modifiers such as social networks, social competence and resources. This article synthesizes current empirical evidence for this model. Thirteen primary research studies of women are synthesized and described, with special attention to the four key constructs inherent in the model: stress, social networks, social competencies, and resources. Consistencies and inconsistencies in the findings, a critique of key methodological issues, implications for future research, and implications for clinical policy and practice are provided.

Adolescent↗

Social networks for women with serious mental illness.

Assessment of ways to work with situations as they exist, and capitalizing on positive factors or strengths within the client's life context, may enhance the nurse-client relationship, and the likelihood of positive outcomes. It is important to identify "natural helpers" and "natural community resources," such as churches and adult centers within the community and to assess the actual and potential contributions and needs of these resources.

Adolescent↗

Using social networks.

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Acquired Immunodeficiency Syndrome↗

Social influences, social context, and health behaviors among working-class, multi-ethnic adults.

Little research has explored the relationship between social influences (e.g., social networks, social support, social norms) and health as related to modifying factors that may contribute to health disparities. This is a cross-sectional analysis of fruit and vegetable intake and physical activity, using baseline data from two cancer prevention studies with working-class, multi-ethnic adults. Several social influence and social contextual variables were associated with fruit and vegetable intake and physical activity in both samples. Fruit and vegetable consumption was associated with social norms and social networks, although different contextual variables also were related to intake across the two samples. Physical activity was associated with social networks, social norms, and competing demands. By examining how key social influence and contextual mediating variables relate to health behaviors, we can learn more about the types of interventions that might be needed to promote sustained health behavior change in this population.

Adult↗

The Experience of Caregiving Inventory: further evidence.

BACKGROUND: The aim of this study was to reexamine the construct validity of the Experience of Caregiving Inventory (ECI) using new, independent data from a population of patients and their carers. This involved re-testing the ECI within the stress-coping model, but adding new variables which included independently rated (rather than carer-rated) assessments of the patient's symptoms and disabilities, a rating of social support (this time for the patient rather than the carer) and a measure of a range of service inputs. METHOD: Data were available on 69 patients and their carers from the PRiSM Psychosis Study. Two regression analyses were performed; the first to establish the extent to which the ECI predicted GHQ scores and the second to examine predictors of the ECI selected from the wider dataset on the basis of their likely relationship to carer appraisal. The second regression analysis was performed in two stages, allowing the effect of service factors to be assessed after controlling for the impact of patient personal characteristics such as illness-related or environmental factors. RESULTS: ECI scores accounted for 27% of the variance of GHQ scores. Over one-third of the ECI negative appraisal can be explained by a combination of patient disability (the Social Behaviour Score Total), extent of patients' social network (Social Network Schedule: Number of Friends) and involvement of a Community Psychiatric Nurse (CPN). At the same level of patient morbidity and informal social network, CPN contact reduced ECI scores. CONCLUSION: As hypothesised, ECI scores correlated significantly with the other measures in the directions predicted by the stress-coping model; that is, negative caregiving as measured by the ECI predicted carer morbidity, while it in turn was predicted by a combination of stressor variables (patient symptoms and disability) acting to increase it, and mediating variables (social support, service inputs) acting to reduce it. Implications for services are discussed.

Adaptation, Psychological↗

Network structure, social support, and psychological outcomes of pregnancy.

Fifty primigravid fathers and mothers responded to an investigator-developed tool that measured social network characteristics and perceived social support during the third trimester of pregnancy. At six weeks postpartum, these same parents completed the Postpartum Self-evaluation Questionnaire (PSQ) (Lederman, Weingarten, & Lederman, 1981). Relationships among network factors, perceived support, and postpartum outcomes were documented for four of the seven PSQ scales. A greater percentage of relatives in the network and more overlap with the spouse's network were important factors associated with positive postpartum outcomes for men, but not for women. Emotional and instrumental support were important variables in explaining six-week postpartum outcomes, whereas information and appraisal support were not significant variables at this time. Men scored lower than women on the PSQ scale measuring confidence in ability to cope with the tasks of parenting.

Adaptation, Psychological↗