Naturally Occurring Peer Support through Social Media: The Experiences of Individuals with Severe Mental Illness Using YouTube

Increasingly, people with diverse health conditions turn to social media to share their illness experiences or seek advice from others with similar health concerns. This unstructured medium may represent a platform on which individuals with severe mental illness naturally provide and receive peer support. Peer support includes a system of mutual giving and receiving where individuals with severe mental illness can offer hope, companionship, and encouragement to others facing similar challenges. In this study we explore the phenomenon of individuals with severe mental illness uploading videos to YouTube, and posting and responding to comments as a form of naturally occurring peer support. We also consider the potential risks and benefits of self-disclosure and interacting with others on YouTube. To address these questions, we used qualitative inquiry informed by emerging techniques in online ethnography. We analyzed n = 3,044 comments posted to 19 videos uploaded by individuals who self-identified as having schizophrenia, schizoaffective disorder, or bipolar disorder. We found peer support across four themes: minimizing a sense of isolation and providing hope; finding support through peer exchange and reciprocity; sharing strategies for coping with day-to-day challenges of severe mental illness; and learning from shared experiences of medication use and seeking mental health care. These broad themes are consistent with accepted notions of peer support in severe mental illness as a voluntary process aimed at inclusion and mutual advancement through shared experience and developing a sense of community. Our data suggest that the lack of anonymity and associated risks of being identified as an individual with severe mental illness on YouTube seem to be overlooked by those who posted comments or uploaded videos. Whether or not this platform can provide benefits for a wider community of individuals with severe mental illness remains uncertain.     

Sex differences in children’s investment in peers

It is hypothesized from within an evolutionary framework that females should be less invested in peer relations than males. Investment was operationalized as enjoyment in Study 1 and as preference for interaction in Study 2. In the first study, four- and six-year-old children’s enjoyment of peer interaction was observed in 26 groups of same-sex peers. Girls were rated as enjoying their interactions significantly less than boys. In the second study, six- and nine-year-old children were interviewed about the individuals with whom they spend time in their homes and neighborhoods and about the individuals who participate in their favorite activities. The proportion of individuals named by children who were peers was significantly lower for girls than boys both in children’s neighborhoods and in children’s favorite activities. Results strongly support the hypothesis that females and males have evolved differential preferences for interaction with peers.     

The Role of Social Contexts in Adolescence: Context Protection and Context Risk in the United States and China

A theoretical framework about protective factors (models protection, controls protection, support protection) and risk factors (models risk, opportunity risk, vulnerability risk) was employed to articulate the content of 4 key contexts of adolescent life—family, peers, school, and neighborhood—in a cross-national study of problem behavior among 7th-, 8th-, and 9th-grade adolescents in the United States (n = 1,596) and the People's Republic of China (n = 1,739). Results were very similar in both samples and across genders. Measures of protection and risk in each of the 4 contexts uniquely contributed to the account of problem behavior involvement even when individual-level measures of protection and risk were controlled. Context protection was also shown to moderate individual-level risk and protection in 1 context moderated risk within that context and in other contexts. Controls protection—protection provided by rules, regulations, and expected sanctions for transgression from adults and peers—was the most important measure of context protection in all but 1 context. The family and peer contexts were the most influential in the U.S. sample, and the peer and school contexts were the most influential in the Chinese sample; the neighborhood context was least influential in both samples.     

“If my buddies use drugs,will I?” Peer effects on Substance Consumption Among Teenagers

During adolescence, interactions with peers influence a teen’s attitudes and behaviors. Adolescents seek for peer approval and acceptance, which may bring them to engage in health-risky behaviors such as smoking and drinking. In this study, we estimate the impact of peers on the drug use of Spanish students aged 14 to 18. We focus on the consumption of alcohol and tobacco, the most prevalent substances used at those ages. We estimate the effect of the average classmates’ consumption—the measure of peers’ use—on individual consumption. Since peers’ use affects individual use and vice versa, we correct for this bias using instrumental variables. Results show that peers’ consumption increases substantially the probability of using alcohol, while it does not significantly affect tobacco consumption. Our results are not sensitive to using different time spans of consumption. This study shows also novel evidence indicating that the higher the proportion of grade-retained students in the class, the stronger the peer effects, especially for alcohol. This suggests that future reforms of the grade retention policy should also consider the negative effects on non-academic outcomes, such as substance use.     

Experience of Primary Care among Homeless Individuals with Mental Health Conditions

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.     

Beneficial Coercion in Psychiatric Care: Insights from African Ethico‐Cultural System

There is a ‘catch 22’ situation about applying coercion in psychiatric care. Autonomous choices undeniably are rights of patients. However, emphasizing rights for a mentally‐ill patient could jeopardize the chances of the patient receiving care or endanger the public. Conversely, the beneficial effects of coercion are difficult to predict. Thus, applying coercion in psychiatric care requires delicate balancing of individual‐rights, individual well‐being and public safety, which has not been achieved by current frameworks. Two current frameworks may be distinguished: the civil liberty approach and the Stone model. Both frameworks are restrictive, and not respectful of human dignity. In a civil liberty approach, individuals who are severely mentally‐ill but not dangerous would be denied care because they do not meet the dangerousness threshold or because the use of coercion will not lead to rebirthing of autonomy. This is unsatisfactory. Albeit involuntary interventions such as talk therapies, peer‐support etc., may not always lead to rebirthing of autonomy or free patients from mental illness; they can however help to maintain the dignity of each mentally ill patient. In place of these frameworks, this study proposes a new ethical framework for applying coercion in psychiatric care that is respectful of human dignity. Specifically, it draws on insights from the African ethico‐cultural system by using the Yoruba concept Omo‐olu‐iwabi to develop this new framework. This way, the study shows that only a more respectful approach for applying coercion in psychiatric care can lead to the careful balancing of the competing interests of individual's rights, individual's well‐being and public safety.     

Impulsive Social Influence Increases Impulsive Choices on a Temporal Discounting Task in Young Adults

Adolescents and young adults who affiliate with friends who engage in impulsive behavior are more likely to engage in impulsive behaviors themselves, and those who associate with prosocial (i.e. more prudent, future oriented) peers are more likely to engage in prosocial behavior. However, it is difficult to disentangle the contribution of peer influence vs. peer selection (i.e., whether individuals choose friends with similar traits) when interpreting social behaviors. In this study, we combined a novel social manipulation with a well-validated delay discounting task assessing impulsive behavior to create a social influence delay discounting task, in which participants were exposed to both impulsive (smaller, sooner or SS payment) and non-impulsive (larger, later or LL payment) choices from their peers. Young adults in this sample, n = 51, aged 18–25 had a higher rate of SS choices after exposure to impulsive peer influence than after exposure to non-impulsive peer influence. Interestingly, in highly susceptible individuals, the rate of non-impulsive choices did not increase after exposure to non-impulsive influence. There was a positive correlation between self-reported suggestibility and degree of peer influence on SS choices. These results suggest that, in young adults, SS choices appear to be influenced by the choices of same-aged peers, especially for individuals who are highly susceptible to influence.     

Intraspecific brood parasitism can increase the number of eggs that an individual lays in its own nest

Intraspecific brood parasitism involves laying eggs in the nest of another individual of the same species without subsequently caring for the eggs or hatchlings. Where individuals lay in their own nest as well as parasitically, previous works predicted that parasitism leads to fewer eggs being laid in an individual's own nest, compared with the equivalent situation without parasitism. This is predicted to occur both to reduce the effects of competition from parasitically laid individuals and because parasitism can be used to reduce competition between siblings. Here, we present a quantitative model of this situation. This model indicates that the brood-reduction prediction does not hold universally. For some plausible parameter combinations, parasitism causes an increase rather than a decrease in the number of eggs laid by an individual in its own nest. This occurs because parasitism becomes a less profitable tactic as more eggs are laid by nest owners due to increasing within-nest competition. Increasing clutch size will also increase competition between the host's own offspring, but can still be advantageous if the induced reduction in parasitism is sufficient.     

Peer Support Workers in Health: A Qualitative Metasynthesis of Their Experiences

ObjectivePeer support models, where an individual has a specific illness or lifestyle experience and supports others experiencing similar challenges, have frequently been used in different fields of healthcare to successfully engage hard-to-reach groups. Despite recognition of their value, the impact of these roles on the peer has not been systematically assessed. By synthesising the qualitative literature we sought to review such an impact, providing a foundation for designing future clinical peer models.MethodsSystematic review and qualitative metasynthesis of studies found in Medline, CINAHL or Scopus documenting peer worker experiences.Results1,528 papers were found, with 34 meeting the criteria of this study. Findings were synthesised to reveal core constructs of reframing identity through reciprocal relations and the therapeutic use of self, enhancing responsibility.ConclusionsThe ability of the Peer Support Worker to actively engage with other marginalised or excluded individuals based on their unique insight into their own experience supports a therapeutic model of care based on appropriately sharing their story. Our findings have key implications for maximising the effectiveness of Peer Support Workers and in contributing their perspective to the development of a therapeutic model of care.     

Strategies for integrating disparate social information

Social information use is widespread in the animal kingdom, helping individuals rapidly acquire useful knowledge and adjust to novel circumstances. In humans, the highly interconnected world provides ample opportunities to benefit from social information but also requires navigating complex social environments with people holding disparate or conflicting views. It is, however, still largely unclear how people integrate information from multiple social sources that (dis)agree with them, and among each other. We address this issue in three steps. First, we present a judgement task in which participants could adjust their judgements after observing the judgements of three peers. We experimentally varied the distribution of this social information, systematically manipulating its variance (extent of agreement among peers) and its skewness (peer judgements clustering either near or far from the participant''s judgement). As expected, higher variance among peers reduced their impact on behaviour. Importantly, observing a single peer confirming a participant''s own judgement markedly decreased the influence of other—more distant—peers. Second, we develop a framework for modelling the cognitive processes underlying the integration of disparate social information, combining Bayesian updating with simple heuristics. Our model accurately accounts for observed adjustment strategies and reveals that people particularly heed social information that confirms personal judgements. Moreover, the model exposes strong inter-individual differences in strategy use. Third, using simulations, we explore the possible implications of the observed strategies for belief updating. These simulations show how confirmation-based weighting can hamper the influence of disparate social information, exacerbate filter bubble effects and deepen group polarization. Overall, our results clarify what aspects of the social environment are, and are not, conducive to changing people''s minds.     

Effect of rearing style on the development of social behaviour in young ravens (Corvus corax)

Early social experiences can affect the development and expression of individual social behaviour throughout life. In particular, early-life social deprivations, notably of parental care, can later have deleterious consequences. We can, therefore, expect rearing procedures such as hand-raising—widely used in ethology and socio-cognitive science—to alter the development of individual social behaviour. We investigated how the rearing style later affected (a) variation in relationship strength among peers and (b) individuals’ patterns of social interactions, in three captive groups of juvenile non-breeders consisting of either parent-raised or hand-raised birds, or a mix of both rearing styles. In the three groups, irrespectively of rearing style: strongest relationships (i.e., higher rates of association and affiliations) primarily emerged among siblings and familiar partners (i.e., non-relatives encountered in early life), and mixed-sex and male–male partners established relationships of similar strength, indicating that the rearing style does not severely affect the quality and structure of relationships in young ravens. However, compared to parent-raised ravens, hand-raised ravens showed higher connectedness, i.e., number of partners with whom they mainly associated and affiliated, but formed on average relationships of lower strength, indicating that social experience in early life is not without consequences on the development of ravens’ patterns of social interaction. The deprivation of parental care associated with the presence of same-age peers during hand-raising seemed to maximize ravens’ propensity to interact with others, indicating that besides parents, interactions with same-age peers matter. Opportunities to interact with, and socially learn from peers, might thus be the key to the acquisition of early social competences in ravens.     

A Reflection on Moral Distress in Nursing Together With a Current Application of the Concept

The concept of moral distress can be extended from clinical settings to larger environmental concerns affecting health care. Moral distress—a common experience in complex societies—arises when individuals have clear moral judgments about societal practices, but have difficulty in finding a venue in which to express concerns. Since health care is large in scale and climate change is proving to be a major environmental problem, scaling down health care is inevitably a necessary element for mitigating climate change. Because it is extremely challenging to discuss these concerns in health care settings, those concerned about climate change and health care experience distress. This article outlines some philosophical concepts and perspectives that may be useful in mitigating this distress.     

On the social nature of eyes: The effect of social cues in interaction and individual choice tasks

In an experimental setting, we applied a dual strategy to better understand the effect of pictures of eyes on human behavior. First, we investigated whether the effect of eyes was limited to interaction tasks in which the subjects' decisions influenced the outcomes of other subjects. We expanded the range of tasks to include individual choice tasks in which the subjects' decisions only influenced their own outcomes. Second, we investigated whether pictures of eyes were one of many social cues or were unique in their effect. We compared the effect of pictures of eyes with the effect of a different condition in which we presented the subjects with pictures of other students (peers). Our results suggest that the effect of pictures of eyes is limited to interaction tasks and that eyes should be considered distinct from other social cues, such as reminders of peers. While pictures of eyes uniformly enhanced pro-social behavior in interaction tasks, this was not the case for reminders of peers. Furthermore, the reminders of peers led to more rational behavior in individual choice tasks, whereas the effect of pictures of eyes was limited to situations involving interaction. Combined, these findings are in line with the claim that the effect of pictures of eyes on behavior is caused by a social exchange heuristic that works to enhance mutual cooperative behavior.     

Between Myth and Madness: The Premigration Dream of Leaving Among Young Somali Refugees

Many young Somali refugees experience long premigration waits and a poorly delimited transition period in a succession of countries before reaching their final destination. During this difficult passage, a myth dealing with departure and exodus is collectively constructed, and it serves as a dynamic, mobilizing dream that orients individual strategies. This substitution of 'dream travel' for real travel during the transition period, especially if it is prolonged, may cause Somali youths to lose contact with reality and eventually to slide into madness. The authors' approach is based on three assumptions: (a) that pastoralism predisposes the Somali to value travel as a way of maturing, (b) that age-based peer groups create special migratory dynamics, and (c) that an ethic of solidarity involves many people in the adventure of a migrant youth. When trapped in an indefinite transition period, young men share khat-chewing sessions during which they relate success stories and dreams of leaving. Many grow frustrated with the delay, and if their departure plans fall through, the 'dream trip' often becomes 'dream madness.' Actual cases illustrate how some young Somali get lost in their dreams. A young Somali's vulnerability is heightened when he extricates himself from the system of reciprocal obligations or when the liminal stage ends with the mourning of the impossible dream. In the universe of madness visited by some young Somali migrants, the boundaries between the real and the imaginary are poorly marked. The paper is based on fieldwork carried out in the Horn of Africa and in Canada, interviews with Somali immigrants and members of the community, and clinical psychiatric data collected in Montreal.     

The Persistence of a Local Dialect When a National Standard Language is Present: An Evolutionary Dynamics Model of Cultural Diversity

In recent decades, cultural diversity loss has been a growing issue, which can be analyzed mathematically through the use of the formalism of the theory of cultural evolution. We here study the evolutionary dynamics of dialects in order to find the key processes for mitigating the loss of language diversity. We define dialects as different speech systems of the same language which are mutually intelligible. Specifically, we focus on the survival of a local dialect when competing against a national standard language, with the latter giving an advantage in occupational and economic contexts. We assume individuals may use different dialects, in response to two different situations: they may use the national language in a formal workplace, while they may use a local dialect in family or close friend meetings. We consider the choice of a dialect is guided by two forces: (1) differential attractiveness of the local/standard language and (2) willingness to speak the same dialect (conformity factor) inside a private group. We found that the evolutionary outcome critically depends on how conformity works. Conformity enhances the effect of differential attractiveness between the local dialect and the standard language if conformity works favoring only those states in which all speakers use the same dialect (unanimity pressure model), but conformity has no effect at all if it works in proportion to the fraction among peers (peer pressure model).     

Peer Outreach Work as Economic Activity: Implications for HIV Prevention Interventions among Female Sex Workers

Female sex workers (FSWs) who work as peer outreach workers in HIV prevention programs are drawn from poor socio-economic groups and consider outreach work, among other things, as an economic activity. Yet, while successful HIV prevention outcomes by such programs are attributed in part to the work of peers who have dense relations with FSW communities, there is scant discussion of the economic implications for FSWs of their work as peers. Using observational data obtained from an HIV prevention intervention for FSWs in south India, we examined the economic benefits and costs to peers of doing outreach work and their implications for sex workers’ economic security. We found that peers considered their payment incommensurate with their workload, experienced long delays receiving compensation, and at times had to advance money from their pockets to do their assigned peer outreach work. For the intervention these conditions resulted in peer attrition and difficulties in recruitment of new peer workers. We discuss the implications of these findings for uptake of services, and the possibility of reaching desired HIV outcomes. Inadequate and irregular compensation to peers and inadequate budgetary outlays to perform their community-based outreach work could weaken peers’ relationships with FSW community members, undermine the effectiveness of peer-mediated HIV prevention programs and invalidate arguments for the use of peers.     

Infant stumptailed macaques reared with mirrors or peers: Social responsiveness,attachment, and adjustment

Comparisons of activity toward mirrors and peers in infant macaques being reared with one of these stimuli as the primary rearing partner revealed markedly greater social responsiveness to a fully accessible cagemate than to one's own reflection. Measures of exploration, aggression, and especially play all revealed the cagemate to be the more potent social stimulus. Mirror-reared infants given additional experience of a live peer behind a transparent partition were less responsive to the mirror than were infants with no social stimulation other than a mirror. In contrast, cagemate-directed behavior of peer-reared infants was not seriously affected by additional exposure to a mirror. A fully accessible peer also elicited more social responding than a peer behind a transparent partition, and infants with experience of both a live cagemate and mirrors were generally more responsive toward the former. Greater agitation in peer-reared than in mirror-reared stumptailed monkeys during separations from their rearing partners suggests that exposure to the physically accessible partner led to stronger attachments. Infants reacted positively to a moderately unfamiliar environment but showed behavioral disruption when placed in a very unfamiliar environment. Disruption was especially evident in peer-reared infants, in which exposure to the unfamiliar environment was compounded with the absence of the attachment figure. Mirror-rearing appeared to reduce the tendency toward ‘isolation syndrome’ behaviors compared to alone-rearing, and these behaviors appear to be less common in stumptailed than in rhesus macaques.     

Peer Influence on Adolescent Alcohol Use: The Moderating Role of Parental Support and Discipline

This study tested the moderating effects of parental social support and consistency of discipline on the relation between adolescents' affiliation with drug-use promoting peers and their subsequent alcohol use. Participants were a subsample (n = 300) of 454 children of alcoholics and matched community controls (ages 101/2-151/2 years). Results indicated that mothers' and fathers' social support and consistency of discipline buffered the effects of peer group affiliation on girls' alcohol use; however, both variables exacerbated peer effects on boys' alcohol use. For girls, results are consistent with the notion that parenting behaviors can serve as protective factors by promoting qualities that serve to resist peer group pressure. For boys, increases in support and discipline behaviors may be interpreted as threats to autonomy.     

The association between four citation metrics and peer rankings of research influence of Australian researchers in six fields of public health

Doubt about the relevance, appropriateness and transparency of peer review has promoted the use of citation metrics as a viable adjunct or alternative in the assessment of research impact. It is also commonly acknowledged that research metrics will not replace peer review unless they are shown to correspond with the assessment of peers. This paper evaluates the relationship between researchers' influence as evaluated by their peers and various citation metrics representing different aspects of research output in 6 fields of public health in Australia. For four fields, the results showed a modest positive correlation between different research metrics and peer assessments of research influence. However, for two fields, tobacco and injury, negative or no correlations were found. This suggests a peer understanding of research influence within these fields differed from visibility in the mainstream, peer-reviewed scientific literature. This research therefore recommends the use of both peer review and metrics in a combined approach in assessing research influence. Future research evaluation frameworks intent on incorporating metrics should first analyse each field closely to determine what measures of research influence are valued highly by members of that research community. This will aid the development of comprehensive and relevant frameworks with which to fairly and transparently distribute research funds or approve promotion applications.     

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap­proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.