Characterization and Predictors of Community Integration of People with Psychiatric Problems: Comparisons with the General Population

Community integration is a construct that an increasing body of research has shown to have a significant impact on the wellbeing and recovery of people with psychiatric problems. However, there are few studies that explore which factors can be associated and predict community integration. Moreover, community integration has been mostly studied in minority groups, and current literature on the definition and manifestation of community integration in the general population is scarcer. Thus, the current study aims to characterize community integration and explore possible predictor variables in a sample of participants with psychiatric problems (PP, N=183) and a sample of participants from the general population (GP, N=211). Results show that people with psychiatric problems present above average values of community integration, but are significantly lower than their healthy counterparts. It was also possible to observe that community integration does not vary in terms of the sociodemographic characteristics of both groups in this study. Correlation and multiple regression showed that, among several variables that literature present as relevant in the community integration process, only three variables emerged as having the most explanatory value in community integration of both groups: sense of community, basic needs satisfaction and submission. These results also shown that those variables have increased explanatory power in the PP sample, which leads us to emphasize the need to address this issue in future studies and increase the understanding of the factors that can be involved in the promotion of community integration, in order to devise more effective interventions in this field.




References:
[1] J. V. Ruiloba, Introducción a la psicopatología y la psiquiatría, 5th ed.
Barcelona: Masson, 2002.
[2] A. F. Espinosa, Psiquiatria. Rio de Janeiro: McGraw-Hill, 1998.
[3] N. Jacobson and D. Greenley, “What is recovery? A conceptual model
and explication,” Psychiatr. Serv., vol. 52, no. 4, pp. 482–485, 2001.
[4] J. A. Racino, “Community living for adults with developmental
disabilities: A housing and support approach,” J. Assoc. Pers. With Sev.
Handicap., vol. 20, no. 4, pp. 300–310, 1995.
[5] Y. I. Wong, D. Metzendorf, and S. Min, “Neighborhood experiences and
community integration: perspectives from mental health consumers and
providers,” Soc. Work Ment. Health, vol. 4, no. 3, pp. 45–59, 2006.
[6] Y. L. Wong and P. L. Solomon, “Community integration of persons with
psychiatric disabilities in supportive independent housing: A conceptual
model and methodological considerations,” Ment. Health Serv. Res., vol.
4, no. 1, pp. 13–28, 2002.
[7] Y.-L. I. Wong, J. Matejkowski, and S. Lee, “Social integration of people
with serious mental illness: network transactions and satisfaction,” J.
Behav. Health Serv. Res., vol. 38, no. 1, pp. 51–67, Jan. 2011.
[8] T. Aubry and J. Myner, “Community integration and quality of life: A
comparison of persons with psychiatric disabilities in housing programs
and community residents who are neighbors,” Can. J. Ment. Heal., vol.
15, no. 1, pp. 5–20, 1996.
[9] P. T. Yanos, A. Stefanic, and S. Tsemberis, “Psychological community
integration among people with psychiatric disabilities and nondisabled
community members,” J. Community Psychol., vol. 39, no. 4, pp. 390–
401, May 2011.
[10] P. Jivanjee, J. Kruzich, and L. J. Gordon, “Community integration of
transition-age individuals: Views of young with mental health
disorders,” J. Behav. Heal. Serv. Res., vol. 35, no. October, pp. 402–418,
2008.
[11] N. C. Ware, K. Hopper, T. Tugenberg, B. Dickey, and D. Fisher, “A
theory of social integration as quality of life,” Psychiatr. Serv., vol. 59,
no. 1, pp. 27–33, Jan. 2008.
[12] S. P. Segal and L. Everett-Dille, “Coping styles and factors in
male/female social integration,” Acta Psychiatr. Scand., vol. 61, pp. 8–
20, 1980.
[13] J. M. Kruzich, “Community integration of the mentally ill in residential
facilities,” Am. J. Community Psychol., vol. 13, pp. 553–563, 1985.
[14] C. Abdallah, C. I. Cohen, M. Sanchez-Almira, P. Reyes, and P. Ramirez,
“Community Integration and Associated Fators Among Older Adults
With Schizophrenia,” Psychiatr. Serv., vol. 60, no. 12, pp. 1642–1648,
2009.
[15] L. Gulcur, S. Tsemberis, A. Stefancic, and R. M. Greenwood,
“Community integration of adults with psychiatric disabilities and
histories of homelessness,” Community Ment. Health J., vol. 43, no. 3,
pp. 211–28, Jul. 2007.
[16] J. Leff and R. Warner, Inclusão Social de Pessoas com Doenças
Mentais. Coimbra: Almedina, 2008.
[17] G. Browne and M. Hemsley, “Housing and living with a mental illness:
exploring carers’ views,” Int. J. Ment. Health Nurs., vol. 19, no. 1, pp.
22–9, Mar. 2010.
[18] Y.-L. Irene Wong and V. Stanhope, “Conceptualizing community: a
comparison of neighborhood characteristics of supportive housing for
persons with psychiatric and developmental disabilities.,” Soc. Sci.
Med., vol. 68, no. 8, pp. 1376–87, May 2009.
[19] B. Kloos and S. Shah, “A social ecological approach to investigating
relationships between housing and adaptive functioning for persons with
serious mental illness.,” Am. J. Community Psychol., vol. 44, no. 3–4,
pp. 316–26, Dec. 2009.
[20] K. M. Boydell, B. M. Gladstone, E. Crawford, and J. Trainor, “Making
do on the outside: Everyday life in the neighborhoods of people with
psychiatric disabilities,” Psychiatr. Rehabil. J., vol. 23, no. 1, pp. 11–18,
1999.
[21] T. Aubry, B. Tefft, and R. F. Currie, “Predicting intentions of
community residents toward neighbors with psychiatric disabilities,”
Psychosoc. Rehabil. J., vol. 18, no. 3, pp. 51–66, 1995.
[22] C. J. Silverman and S. P. Segal, “Who belongs? An analysis of exmental
patients’ subjective involvement in the neighborhood,” Adult
Resid. Care J., vol. 8, no. 2, pp. 103–113, 1994.
[23] R. Kobau, C. Diiorio, D. Chapman, and P. Delvecchio, “Attitudes about
mental illness and its treatment: validation of a generic scale for public
health surveillance of mental illness associated stigma,” Community
Ment. Health J., vol. 46, no. 2, pp. 164–76, Apr. 2010.
[24] V. Moldovan, “American Journal of Attitudes of Mental Health Workers
toward Community Integration of the Persons with Serious and
Persistent Mental Illness,” Am. J. Psychiatr. Rehabil., vol. 10, no.
November, pp. 10–30, 2007.
[25] A. H. Thompson, H. Stuart, R. C. Bland, J. Arboleda-Florez, R. Warner,
R. A. Dickson, N. Sartorius, J. J. Lopez-Ibor, C. N. Stefanis, and N. N.
Wig, “Attitudes about schizophrenia from the pilot site of the WPA
worldwide campaign against the stigma of schizophrenia.,” Soc.
Psychiatry Psychiatr. Epidemiol., vol. 37, no. 10, pp. 475–482, 2002.
[26] W. W. S. Mak, C. Y. M. Poon, L. Y. K. Pun, and S. F. Cheung, “Metaanalysis
of stigma and mental health.,” Soc. Sci. Med., vol. 65, no. 2, pp.
245–61, Jul. 2007. [27] P. W. Corrigan and J. R. Shapiro, “Measuring the Impact of Programs
that Challenge the Public Stigma of Mental Illness,” Clin Psychol Rev.,
vol. 30, no. 8, pp. 907–922, 2010.
[28] A. D. Henry and A. M. Lucca, “Facilitators and barriers to employment:
The perspectives of people with psychiatric disabilities and employment
service providers,” Work A J. Prev. Assess. Rehabil., vol. 22, no. 3, pp.
169–182, 2004.
[29] N. Rüsch, A. R. Todd, G. V Bodenhausen, M. Olschewski, and P. W.
Corrigan, “Automatically activated shame reactions and perceived
legitimacy of discrimination: A longitudinal study among people with
mental illness,” J. Behav. Ther. Exp. Psychiatry, vol. 41, no. 1, pp. 60–3,
Mar. 2010.
[30] P. Corrigan, “How stigma interferes with mental health care,” Am.
Psychol., vol. 59, no. 7, pp. 614–25, Oct. 2004.
[31] J. D. Livingston and J. E. Boyd, “Correlates and consequences of
internalized stigma for people living with mental illness: a systematic
review and meta-analysis.,” Soc. Sci. Med., vol. 71, no. 12, pp. 2150–61,
Dec. 2010.
[32] P. Gilbert, R. Bhundia, R. Mitra, K. McEwan, C. Irons, and J. Sanghera,
“Cultural differences in shame-focused attitudes towards mental health
problems in Asian and Non-Asian student women,” Ment. Health. Relig.
Cult., vol. 10, no. 2, pp. 127–141, Mar. 2007.
[33] F. W. Hickling, H. Robertson-hickling, and V. Paisley,
“Deinstitutionalization and attitudes toward mental illness in Jamaica : a
qualitative study,” Rev Panam Salud Publica, vol. 29, no. 3, pp. 169–
176, 2011.
[34] T. Broer, A. P. Nieboer, and R. A. Bal, “Quest for client autonomy in
improving long term mental health care,” Int. J. Ment. Health Nurs., vol.
19, pp. 385–393, 2010.
[35] K. M. Strack and S. E. Schulenberg, “Understanding empowerment,
meaning, and perceived coercion in individuals with serious mental
illness,” J. Clin. Psychol., vol. 65, no. 10, pp. 1137–48, Oct. 2009.
[36] G. Nelson, J. Lord, and J. Ochocka, “Empowerment and mental health in
community: narratives of psychiatric consumer/survivors,” J.
Community Appl. Soc. Psychol., vol. 11, no. 2, pp. 125–142, Mar. 2001.
[37] D. W. McMillan and D. M. Chavis, “Sense of Community: A Definition
and Theory,” J. Community Psychol., vol. 14, no. January, pp. 6–23,
1986.
[38] S. B. Sarason, The psychological sense of community: Perspectives for
community psychology. San Francisco: Jossey-Bass, 1974.
[39] G. Townley and B. Kloos, “Examining the psychological sense of
community for individuals with serious mental illness residing in
supported housing environments,” Community Ment. Health J., vol. 47,
no. 4, pp. 436–46, Aug. 2011.
[40] G. Townley and B. Kloos, “Development of a measure of sense of
community for individuals with serious mental illness residing in
community settings.,” J. Community Psychol., vol. 37, no. 3, pp. 362–
380, Mar. 2009.
[41] P. Gilbert and S. Allan, “Assertiveness, submissive behavior, and social
comparison,” Br. J. Clin. Psychol., vol. 33, pp. 295–306, 1994.
[42] A. Akin, “Self-Compassion and Submissive Behavior,” Educ. Sci., vol.
34, no. 152, pp. 138–147, 2009.
[43] S. Allan and P. Gilbert, “Submissive behavior and psychopathology,”
Br. J. Clin. Psychol., vol. 36, no. 4, pp. 467–488, 1997.
[44] E. L. Deci and M. Vansteenkiste, “Self-determination theory and basic
need satisfaction: Understanding human development in positive
psychology,” Ric. di Psicol., vol. 27, pp. 23–40, 2004.
[45] E. L. Deci and R. M. Ryan, Handbook of self-determination research.
New Jersey: University of Rochester Press, 2002.
[46] E. L. Deci and R. M. Ryan, Intrinsic motivation and selfdetermination in
human behavior. New York: Plenum, 1985.
[47] L. Molix and C. P. Nichols, “Satisfaction of basic psychological needs
as a mediator of the relationship between community esteem and
wellbeing,” Int. J. Wellbeing, vol. 3, pp. 20–34, 2013.
[48] G. R. Bond, M. P. Salyers, A. L. Rollins, C. A. Rapp, and A. Zipple,
“How Evidence-Based Practices Contribute to Community Integration,”
Community Ment. Health J., vol. 40, no. 6, pp. 569–588, 2004.
[49] J. Cabral, C. Barreto Carvalho, C. da Motta, and M. Sousa, “Community
Integration Scale of adults with psychiatric problems (CIS-APP-34),”
no. To be published, 2005.
[50] D. M. Chavis, K. S. Lee, and J. D. Acosta, “The Sense of Community
(SCI) Revised: The Reliability and Validity of the SCI-2.,” in 2nd
International Community Psychology Conference, 2008.
[51] M. M. Johnston and S. J. Finney, “Measuring basic needs satisfaction:
Evaluating previous research and conducting new psychometric
evaluations of the Basic Needs Satisfaction in General Scale,” Contemp.
Educ. Psychol., vol. 35, no. 4, pp. 280–296, 2010.
[52] S. S. Sousa, J. L. P. Ribeiro, A. L. Palmeira, P. J. Teixeira, and M. N.
Silva, “Estudo da basic need satisfaction in general scale para a língua
portuguesa,” Psicol. Saúde Doenças, vol. 13, no. 2, pp. 209–219, 2012.
[53] J. Cabral, C. Barreto Carvalho, C. da Motta, M. Sousa, and P. Gilbert,
“Attitudes towards Mental Health Problems Scale: Confirmatory Factor
Analysis and validation in the Portuguese population,” Am. J. Psychiatr.
Rehabil., p. To be published, 2015.
[54] K. Goss, P. Gilbert, and S. Allan, “An exploration of shame measure:
The other as Shamer scale,” Pers. Individ. Dif., vol. 17, no. 5, pp. 713–
717, 1994.
[55] A. T. Beck, R. A. Steer, and G. K. Brown, BDI-II: Beck Depression
Inventory Manual. San Antonio, 1996.
[56] M. H. Gomes-Oliveira, C. Gorenstein, F. L. Neto, L. H. Andrade, and Y.
P. Wang, “Validation of the Brazilian Portuguese Version of the Beck
Depression Inventory-II in a community sample,” Rev. Bras. Psiquiatr.,
vol. 34, no. 785, pp. 389–394, 2012.