Three types of preventive interventions: universal, selective or indicated

Preventive interventions aimed at stimulating social support can be defined into three types, depending on the group of people they are aimed at: universal, selective or indicated. Universal prevention consists of interventions directed at the whole population, regardless of their risk status of developing a mental disorder. Selective prevention is directed at individuals or groups with an increased risk of developing a mental disorder. Indicated prevention is targeted toward persons who have some symptoms of a mental disorder, but do not meet the diagnostic criteria for a full-blown mental disorder.

Promoting social support: an example of universal prevention

Examples of universal prevention are community projects aimed at strengthening social networks and promoting social support in specific areas. The ultimate goal of these interventions is to promote mental health. Examples of such universal interventions are the Stirling County study (Leighton, 1965) and the Eastlake study (Halpern, 1995). In the Stirling County study a community development programme was implemented in a socially disintegrated community. The purpose was to strengthen social cohesion and improve social conditions by collective action (i.e. providing more jobs and stimulating the economy), under the guidance of professionals. In the Eastlake study the aim was to improve the social conditions in a poorly functioning and unsafe neighbourhood. Also here, there was active participation of the inhabitants, under professional leadership. In both projects the mental health of the population improved significantly, as did the social interaction and cohesion.

People with stressful life-events target group for selective prevention

Selective prevention programmes aim to:

• Provide social support for people who have been exposed to stressful life events; and
• Reduce social isolation and loneliness in specific groups.

Examples of such programmes are social support groups and self-help groups. Both programmes aim at promoting mutual support between group members who usually share a problem such as bereavement, divorce, somatic illness or simply loneliness. The programs differ in leadership: social support groups have professional leaders, while self-help groups generally have leaders without formal training. However, the latter often do have assistance from professionals. Both program types have shown effectiveness in promoting mental health (Klytta & Wilz, 2007). Their effectiveness was demonstrated in an extensive review of social support provision to isolated elderly people. This review indicated that group activities with an educational or support input were more effective than interventions providing individual support, advice, information or health-needs assessment (Cattan et al., 2005).

Social support is one element of crisis intervention

Some interventions do include an element of social support even though they are not exclusively aimed at providing social support. An example is the so-called ‘crisis intervention’, an intervention dealing with the emotional reactions of people to disasters and traumatic events. This intervention often includes an important element of social support, in mobilizing support from the network of the victim (Weisæth, 2000).

Social skills training improves interpersonal relationships

In addition to social support groups and self-help groups, another type of intervention to stimulate social support is social skills training. Social skills training aims at helping the individual to improve his relationship with other people, and in doing so to increase his access to social support. An important part of the training is to improve the client’s understanding of social norms (e.g. in relation to intimacy) and to explain the importance of directing more attention to others. This would lead to the provision of more positive reinforcement for those who offer social support. Target groups can be subgroups from the general population, such as schools, as well as patient groups with special problems in interpersonal contact, such as schizophrenics (Smith et al., 1996).

Social support is often an element of indicated prevention programmes

Indicated prevention programmes aim to reduce the risk of people who already have symptoms of psychological stress from developing a mental disorder. Often, such (group-oriented) programs contain an element of social skills training, focusing on how to activate and improve social relations. A meta-analysis of a specific group of indicated prevention programmes, the Coping with Depression Courses, where social skills training may be an element, demonstrated that these courses are effective in preventing unipolar depression (Kühner, 2003). It is, however, difficult to disentangle the specific effects of the different elements of the course. Another example of indicated prevention is a group program for relatively socially isolated, middle-aged women living in a new urban neighbourhood. The women were selected based on the presence of symptoms of psychological distress. They were stimulated in making friends through various group activities and showed significant improvement in mental health together with strengthened social networks (Dalgard et al., 1995b).

Social support can be aimed at consequences of a mental disorder

Interventions to improve social support are also available for psychiatric patients and their families. These interventions are not aimed at preventing a mental disorder, but at living with the consequences of a mental disorder. A comprehensive overview of different types of social support interventions for psychiatric patients and their families is provided by Milne (Milne, 1999). These types of interventions can aim to establish supportive relationships between volunteers and patients, through for example befriending programmes (Harris et al., 1999b).

Social support can also be given to caregivers, such as family carers who help their elderly relatives with dementia to stay in their own home. In the case of family carers, the social support is aimed at strengthening the coping ability of the family member in a stressful life situation, and hence may prevent mental health problems in the carer (McKee et al., 1997).

Programmes for the family can also include the facilitation of mutual social support between the family members. Examples of this include family support (Atkinson & Coia, 1995), couple support (Cutrona, 1996), and parent support programmes (Asscher, 2005).

Social support can be aimed at changing unhealthy life style

Social support is often used and proven effective in life style interventions (quit smoking, exercise and nutrition (e.g. Weight Watchers)). A Cochrane review shows group interventions to be more effective in quitting smoking than self help and other less intensive interventions (Stead & Lancaster, 2005).