social support

Having a close friend or two to talk to---someone on whom you can depend for emotional support---can be great when little things accumulate or you temporarily feel down in the dumps. But can a friend talk you out of depression or lessen its pernicious effects? A study recently published in the British Journal of Psychiatry examined the viability of "befriending" as a tool in the treatment of emotional distress and depressive symptoms. The findings suggest that friendships, even therapeutic ones, aren't necessarily substitutes for good treatment.

Keep in mind the researchers weren't talking either about the garden variety of befriending (a term that has become common parlance among Facebook or Twitter users) or about a mild case of the blues. For the purposes of their study, the team of primary care researchers at the University of Manchester, Manchester, UK defined "befriending" as social support that was "initiated, supported and monitored by an agency" expressly for one or more parties to benefit. It was, by definition, a treatment for depression or emotional distress that was "non-judgmental, mutual and purposeful."

The meta-analysis (a systematic statistical analysis) looked at more than 24 studies that covered a wide range of depressed populations, including caregivers of individuals with dementia, adolescents, lonely widows, men with prostate cancer, and pregnant women. The frequency of befriending varied among the studies as well as the ways in which the befriending took place. Some contacts were made face-to-face, others were by telephone, and some were a combination of both. Befriending was delivered both by trained and untrained volunteers.

The researchers found that the befriending intervention was less effective than cognitive behavioral therapy (CBT) in adolescents with depression and in medication-resistant individuals with schizophrenia. It was also less effective than nurse cognitive-behavioral problem solving in caregivers of people with dementia. It was similar in effectiveness to a nurse education and self-efficacy intervention in older adults recovering from myocardial infarction, to local community support groups for new inner-city mothers, and to systemic family therapy in depressed adolescents.

Based on their data, the researchers were unable to conclude that "befriending" is an effective, evidence-based treatment. Instead, they suggested that more rigorous study was needed to compare "befriending" head-to-head with standard treatments (such as CBT and medication), and that individual preferences should be considered in determining what works, for whom, and under what circumstances. This study relied on meta-analytic techniques to look at the friendship question but it would be worthwhile for researchers to design more large studies that look closely at whether and how friendships can alter the course and outcomes of various types of depression.

The conventional wisdom is that the presence of social supports can serve as a buffer against depression. Sounds logical enough: Friendships offer an outlet for people to express their emotions, to put things into perspective, to feel less alone, to reduce stress, and to encourage someone who's feeling distressed to seek out professional help when needed. But people with severe depression often have a hard time reaching out to anyone and it is often equally difficult for friends, even very good ones, to know what to do to help them recover. There's a lot more to learn.

Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis

Nicola Mead, PhD, Helen Lester, MB, ChB, MD, FRCGP, Carolyn Chew-Graham, MB, ChB, MD, FRCGP and Linda Gask, PhD, FRCPsych, NIHR School for Primary Care Research, University of Manchester
Peter Bower, PhD, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK

The British Journal of Psychiatry (2010) 196: 96-101. doi: 10.1192/bjp.bp.109.064089

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How to Help a Friend or Relative Who is Depressed (From the NIMH)

If you know someone who is depressed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.

To help a friend or relative:

• Offer emotional support, understanding, patience and encouragement.
• Engage your friend or relative in conversation, and listen carefully.
• Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
• Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
• Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
• Remind your friend or relative that with time and treatment, the depression will lift.

Facts about Major Depression

According to the National Institute of Mental Health (NIMH), major depression is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. An episode may occur only once in a person's lifetime, but more often, it recurs throughout a person's life. , It is estimated to affect 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.

The emotional fallout of Susan Boyle’s unexpected and disappointing defeat on Saturday night was clearly devastating. The front-runner failed to take first place on the finale of Britain’s Got Talent, losing to a teenage dance group called Diversity. It’s hard to imagine how this somewhat shy and private middle-aged woman must have felt to have been suddenly catapulted into celebrity status and then knocked down, with 19 million viewers watching the debacle on TV. On stage, she handled the loss with grace but there were rumors of a series of backstage tantrums and cursing in response to the intense pressures she experienced as part of the competition.

According to media reports, one night later, Ms. Boyle had to be taken by ambulance from her hotel room to a London mental hospital run by the Priory Group. Under the Mental Health Act of 1983, someone in the UK can be detained for a maximum of 72 hours until that individual can be examined and treated by mental health professionals. But before any assessment could have taken place, there were media reports that hinted that Boyle was suffering from “mental exhaustion” and a “nervous breakdown.” If she is diagnosed with a mental disorder, this wouldn’t be surprising given the enormous amount of stress to which she was subjected.

To me, that Susan Boyle’s emotional unraveling immediately became fodder for the media is a far greater loss than coming in second in the competition. She involuntarily lost her right to privacy and while pundits were previously preoccupied with her appearance and dress, now there will be relentless questions and conjecture about her mental status, before and subsequent to her achieving the status of celebrity.

Despite decades of brain research that has proven that mental disorders are no-fault illnesses, the stigma associated with these disorders still remains pervasive. When someone is diagnosed with cancer or heart disease, people rally around the individual. When someone experiences the symptoms of an emotional disorder, their friends and opportunities for the future seem to disappear in tandem.

We can only hope that the entertainment handlers and the public who warmly embraced Ms. Boyle, an ordinary woman with exceptional talent, will continue to back her. She needs friendship and support more than ever before. Handled well, this can be a teachable moment for us all.

Do you have a friend with a mental disorder who needs information and/or support? Contact the NAMI helpline at 1-800-950-NAMI.

A reader of my blog is living overseas with several young children and is married to a man who routinely works long hours. Another woman I know is single; she recently moved to a new town to begin a demanding job that entails frequent travel. My own elderly mother has become frail with fewer and fewer opportunities to get out and mingle with her peers. What do these three women-at different stages of life-have in common? For various reasons, each is in the midst of a friendship drought.

There are times when, for various situational reasons, we simply don't have enough friends-or enough of the right kind of friends. We feel isolated and alone. Other times, people experience persistent friendship deficits because they are very shy, lack social skills, or just have a hard time befriending others. A new study published in Psychological Science (November 2008) suggests one instinctive antidote to feelings of loneliness and isolation: nostalgia.

In four different studies, psychologists at the University of Southampton and Sun Yat-Sen University in Guangshou, China looked at people from various walks of life, including schoolchildren, college students, and factory workers. They found that lonely people used nostalgia as a coping mechanism, drawing upon their sentimental memories of the past. The more lonely people were, the more nostalgic they tended to become as a way of increasing their self-perceived feeling of social support.

"Our findings show that nostalgia is a psychological resource that protects and fosters mental health," says Dr. Tim Wildschut of the University of Southampton. "It strengthens feelings of social connectedness and belongingness, partially improving the harmful repercussions of loneliness. The past, when appropriately harnessed, can strengthen psychological resistance to the vicissitudes of life."

One implication of these research findings: If your current situation doesn't lend itself to making new friends or connecting with the ones you already have, take a brief trip down memory lane and re-live the peaks of your past friendships.

My thoughts: While this coping mechanism might temporarily help you get over a friendship drought, the real fix is to find ways to more fully integrate friendship into the fiber of your life. The isolated mom may need to call upon a babysitter, the nomadic woman may need to use her cell phone more, and my elderly mother may need to connect with other women her age at a senior center.

Source: Press Release, University of Southampton, November 18, 2008, Nostalgic thoughts of happier times can help overcome loneliness.