Feature

How group membership can help combat depression


Tegan Cruwys


14/08/2018 3:30:20 PM

Depression is a kind of suffering that too many people know firsthand. Psychologist and researcher Dr Tegan Cruwys takes a close look at the value of social connectedness.

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Dr Tegan Cruwys and her research teams found that groups have an important role to play in helping beat depression because they play an important role in its development.

Approximately one in five people experience depression at some stage in their life – and the figure is even higher in areas afflicted by disaster, trauma, or poverty. So it would be a lucky person indeed who avoids seeing depression in either themselves or the people they love.
 
Because of its capacity to strike so close to home, most people are well aware of the key signs of clinical depression: notably, the experience of profound sadness, a loss of enjoyment and interest, changes in energy levels and appetite, and a sense of guilt or hopelessness about the future.
 
Depression has received more research attention than most other mental health issues, and thankfully we have two forms of treatment that work: psychological therapy and antidepressant medication.
 
But here is the bad news: over the last 30 years, existing treatments have not reduced the prevalence nor the disability caused by depression.
 
This suggests that we need new approaches to treatment that are low-cost, non-stigmatising, and that protect people across the lifespan (and not only during periods of acute symptoms). My colleagues and I set out to look for these new approaches.
 
A growing body of evidence – explored in our book – suggests that social connectedness is a good place to start looking for these new solutions.
 
The first study that we conducted to explore the link between social connectedness and depression included more than 4000 adults living in England aged over 50, who were tracked over six years. We compared people with severe depression with those who had fewer, if any, symptoms of depression.
 
Consistent with a lot of existing research, the first finding was that people who were depressed tended to report belonging to far fewer social groups than the rest of the population.
 
Looking at how these group memberships changed over the next two years, we found that people who joined more groups in this time – regardless of how many they belonged to at baseline – were less likely to be depressed four and six years later. These effects were much stronger among those with a history of depression.
 
Putting this in concrete terms, if a person with depression at baseline joined three groups across the next two years, they reduced their risk of relapse another four years later by as much as 63%. Any way you look at it, this is a striking result. Importantly, it suggested that, in starting to hone in on the link between social group memberships and depression, we were onto something meaningful and important that other researchers had overlooked.   
 
So, is it that social isolation causes depression, as we might interpret from the above results, or the other way around? In fact, many health professionals who treat people with depression are trained to expect the latter, and see social isolation as a consequence of depression.
 
To get a handle on this, we conducted a follow-up study, examining the effect of social isolation on psychological distress over time and the effect of psychological distress on social isolation over time. Following a sample of more than 21,000 New Zealand adults across four years, we compared the size and significance of these longitudinal relationships.
 
As one might expect, we found that the effect worked both ways. However, the effect of social isolation on psychological distress over time was about three times stronger than the converse. What this suggests is that social isolation both leads to, and follows from, depression. But it also tells us that in most cases, people become socially isolated before, not after, they become depressed.
 
While this evidence is compelling, in science nothing is more compelling than experimental evidence – and so this was the methodology we applied in our next study.
 
We invited 88 young adults into the laboratory and assigned them to one of three conditions: to write about one group membership that was important to them, three group memberships, or to just skip this part of the study (the equivalent of writing about no groups).
 
Participants then completed a problem-solving test, but what we did not tell them was that these were unsolvable problems. After 10 minutes all participants were individually given feedback that they scored 0 on the test.
 
What we were most interested in, though, was how participants interpreted this failure. Compared to the participants who had been writing about one or three of their social groups, participants who did not write about any groups were significantly more likely to interpret their failure in a way that was internal, global and stable: ‘I failed because I’m stupid’ (rather than, say, because the test was too hard or the time too short).
 
This kind of interpretation is known as a depressive attribution style, and it is a recognised marker of depression. These participants were also more likely to report negative affect following their failure experience.
 
All in all, then, this experiment suggests that merely thinking about the social groups we belong to can make us more resilient in the face of life stress, and less likely to respond with unhelpful interpretations and negative emotions that, if repeated over time, may well culminate in depression.
 
What is true in the lab, of course, isn’t always true in practise. It is also true that not all groups are the same. Certainly, we can all think of times we have been involved in group activities that have felt like a chore, and where it is hard to imagine a benefit to our mental health. Indeed, the social identity approach says that just ‘showing up’ at a social group activity is not enough to make a difference. It is only when those groups are incorporated into our self-concept, thereby becoming social identities, that they enable health benefits.
 
Our next study, then, aimed to test the role of social identification as the ‘active ingredient’ in groups that combats depression.
 
In this study, we were looking to translate the above findings into practise by exploring how social identity principles could be applied in clinical and community settings.
 
We followed two samples across a period of several months: first, a group of 91 outpatients with depression or anxiety disorders who joined a therapy group to receive cognitive-behaviour therapy; second, a group of 52 disadvantaged people, the majority of whom had complex mental health issues, who joined a recreational group facilitated by social workers.
 
What we found, as expected, was that depression symptoms decreased over time in both groups. However, and consistent with a social identity approach to depression, we found that the more strongly people identified with the social group that they had joined, the greater the improvement in their depression symptoms over time. Put another way, even among people undergoing evidence-based cognitive behavioural therapy for depression, benefits were more likely to accrue to those people who identified with others in their therapy group.
 
So what have we found, overall?
 
An increasing body of evidence suggests that social isolation (a lack or loss of social identities) is not only associated with depression, but is causally implicated in its development, maintenance, and effective treatment. This is exciting not just because it breaks new theoretical ground, but because it helps us to address the need for new directions in depression treatment.
 
As an approach to treatment, social group connectedness suffers few of the issues related to access, compliance, and relapse that can make antidepressants and therapy less viable for sufferers.
 
Social groups are an affordable intervention because they can reach many people in need, and are not the exclusive purview of highly-trained mental health professionals. Moreover, compliance tends not to be a barrier to social group connectedness, as the ‘side effects’ are not typically aversive, and with this approach it is also possible to avoid the stigma that can be associated with traditional diagnosis and therapy.
 
Being involved in social groups is open to people across their lives, and thus this approach holds promise not only for people with acute depression symptoms, but also to protect against its onset and relapse.
 
The key point is that groups have an important role to play in helping beat depression because they have an important role to play in its development.
 
Understanding this provides a platform not just for better insight into the condition but for a more sustainable approach to treatment. Indeed, because groups are probably the most natural and effective vehicle for self-development that humans have devised, this may feel less like treatment and more just like life at its best. 
 
This is an abridged version of an article which first appeared in The Psychologist.



depression group membership social connectedness





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