She's Sort of like a Second Therapist to Me: Close Friendships of Young Women Living with Mood and Anxiety Disorders

Introduction:

Marginalized youth with mental health difficulties experience a challenging transition to adulthood, due to the intersection of developmental stage, mental illness, poverty, and trauma. Interpersonal relationships are an understudied component of this transition. Positive relationships are essential for health and well-being; yet youth with histories of mental illness and family violence may experience barriers to relationship formation and maintenance, including shame, stigma, symptom management, and structural oppression. To address this gap, this qualitative study explored the role of peer relationships in the lives of youth learning to live with a serious mental health condition.

Methods:

Within the context of a federally-funded feasibility study of a psychosocial intervention for transition age youth, which includes case management, psychotherapy, and mentoring, longitudinal interviews were conducted with 11 young women, ages 17-20 (n=22). Participants were from low-income backgrounds and ethnically diverse; 72% reported histories of child maltreatment. All participants met DSM-V criteria for mood and/or anxiety disorders. Semi-structured, open-ended in-depth interviews explored relationships with helping professionals, family and peers; interviews took place at an urban outpatient mental health clinic and were audio recorded and professionally transcribed. Utilizing Atlas.TI, coders analyzed transcripts using thematic analysis (Braun & Clarke, 2006) and relational-cultural theory as a framework (Miller & Stiver, 1997).

Results:

Most participants described having at least one close friend or intimate partner who knew them well and was in regular, current contact with them. Shared lived experience of mental illness or family conflict facilitated trust in relationships. Participants described several ways that friends supported each other in living with mental illness, including help with emotion regulation, coping strategies, distraction, and interruption of negative patterns of thought or behavior. One participant said of a friend, “if I’m in a very terrible mood, if I talk to him, my whole spirits lift.” Friends also provided less clinical but equally therapeutic support in the forms of companionship for leisure and artistic pursuits, as well as instrumental support during periods of familial or financial instability. Another participant reported, “if I really, really needed to go somewhere, I have peers that I could go to.” Most peer relationships were described as mutually supportive; many participants described how they had grown in their self-worth or understanding of self and others through being in these relationships. For example, one participant explained that, “friends, when you talk to them…you get more confidence in yourself.”

Conclusions and Implications:

Findings suggest that close friendships provide crucial support to these youth in their recovery journeys. Peer relationships supported recovery in a number of ways: more directly, by providing emotional and practical support around the challenges of living with a mood or anxiety disorder, and less directly, by providing companionship for outings and creative pursuits. Findings depict relationships as a source of resilience for youth; they also remind practitioners to expand treatment beyond the therapeutic dyad to include peers as recovery supports. Further research is needed to better understand how some marginalized youth overcome barriers of shame and stigma through peer relationships.