Social Support and Functional Outcome In Severe Mental Illness: The Mediating Role of Proactive Coping

Background: Individuals with severe mental illness (SMI) must cope with numerous psychosocial stressors that have a severe and negative impact on their ability to fulfill basic social roles such as employee, spouse, or parent. Traditional investigations of coping have examined ways to manage stressors that can be referred to as ‘reactive coping'. Recent advances have extended the coping construct to include striving toward future-oriented growth and the search for meaning in stressful encounters through paradigms such as Proactive Coping Theory. Proactive coping represents an integration of positive reappraisal, whereby stressful circumstances are re-construed as having meaning or purpose based on their perceived potential to promote growth, with intrinsic motivation which is derived from internally-driven rewards related to purpose that yields a positively-focused striving toward goals. Further, social-psychological paradigms suggest that social support facilitates adaptive coping modalities such as proactive coping. Yet the majority of studies have examined social support and coping separately, and only a single study has examined proactive coping among people with SMI; therefore, we have no models for understanding more holistic approaches to coping in SMI. This study examines a theoretically-based structural model of social support as an antecedent to positive reappraisal and intrinsic motivation and tests whether the relationship between social support and role functioning is mediated through these linked processes of reappraisal and motivation. An understanding of the way that social support impacts proactively coping with the challenges posed by mental illness sets the stage for enhanced functioning, and is crucial for intervention development to improve functional outcomes and quality of life among this population. Methods: This study used baseline data from an NIMH-funded longitudinal investigation examining biopsychosocial variables that impact functional outcomes for people with SMI. The sample consists of 159 individuals diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features, and major depression with psychotic features who participated in community-based psychosocial rehabilitation services. Measures of social support, positive reappraisal, intrinsic motivation, and role functioning were gathered through structured clinical interviews and self-report surveys. A latent path analysis was conducted to confirm an adequate factor structure for measurement models and verify the structural model. Results: SEM results showed: (i) a strong measurement model, and (ii) that the proactive coping model under study displayed an excellent fit to the data (χ2 = 147.97, df = 128, p = 0.10, CFI = 0.98, TLI = 0.97, RMSEA = 0.03). As hypothesized, the relationship between social support and role functioning was mediated through positive reappraisal and intrinsic motivation (indirect effect estimate = 0.07, p = 0.04). The model explained 57% of the variance in role functioning. Conclusion: The major role of social support and proactive coping in facilitating role functioning is of particular relevance for people with SMI who are faced with enduring stressful circumstances such as persistent symptoms and significant impairments in functioning. Interventions to increase social support and proactive coping may help individuals to progress from reactive modes of stress-management to proactive strategies, thereby enhancing functioning and social integration among a highly marginalized population.