Searching for an Optimal Match: The Unique Association Among Family, Friends, and Various Mental Health Outcomes Among Young Adults with Serious Mental Illness

Background and purpose: Young adults with serious mental illness (SMI) are at a distinctive developmental stage and thus their service and support needs are distinguished from children or older adults with SMI. However, evidence-based and developmentally appropriate mental health interventions particularly for young adults with SMI are critically lacking. Social relationships are the core of interventions for people with SMI. Thus, exploring the unique role of family and friends in mental health recovery for young adults with SMI will be useful to tailor developmentally appropriate interventions.

Methods: Young adults (i.e., ages 18 to 29) with SMI were selected from the National Survey of American Life for the secondary data analysis. Samples were predominantly female (n=210, 75.0%) and non-White (n=252, 90.0%). The most representative psychiatric diagnosis among samples was major depressive disorder (n=172, 61.4%). Social relationships were assessed using three constructs of family support, family negative interactions, and friend support. Negative interactions with friends cannot be included due to the absence of such indicators in the dataset. Followed by Whitley and Drake (2010)’s multidimensional approach to mental health recovery, psychological distresses, hope, work status, physical activity, and social participation were included to measure recovery outcomes. Structural Equation Modeling tested the association between social relationships and various mental health recovery outcomes simultaneously, after controlling for sex, racial minority status, age of onset, and income level.

Results: The final SEM model fits the data well: x2(df=134) =266.268, p<.001; RMSEA=.060 [90% CI .049 .070]; CFI=.946; TLI=.926. Results suggest that family and friend relationships are uniquely associated with individual domains of mental health recovery. Specifically, family support was associated with psychological distress (B=.226, p=.008), hope (B=.371, p<.001), social participation (B=-.191, p=.047). Friend support was associated with social participation (B=.360, p<.001) and physical activity (B=.139, p=.034). The level of negative interactions with family was not statistically significantly associated with any domains of mental health recovery.

Conclusions and implications: Findings suggest that differential sources of social relationships are uniquely associated with each domain of recovery. Family support is more relevant to promoting clinical and existential (i.e., hope) domains of recovery while friend support is more relevant to promoting physical and social domains of recovery among young adults with SMI. Specifically, to reduce psychological distress and to induce hope, alliance with family members will be more effective. On the other hand, to increase social participation and physical activity, alliance with friends will be more effective. For example, physical activity programs should actively consider including non-family members, desirably peers, to maximize the effectiveness of intervention. It is noteworthy that the direction of association differed between (a) family support and social participation, and (b) friend support and social participation. Family support was negatively associated with social participation while friend support was positively associated with social participation among young adults with SMI. Potentially, this may suggest that young adults with SMI who have good family support tend to remain at home, not seeking relationships beyond family members.