Determinants of social connectedness in children and early adolescents with mental disorder: A systematic literature review
Introduction
Social connectedness (SC) is a basic human need (Baumeister & Leary, 1995). It can be defined as a sense of belonging and a psychological bond a person may feel towards other people or groups (Haslam, Cruwys, Haslam, & Jetten, 2015). Loneliness can be regarded as the negative spectrum of SC (Hare-Duke, Dening, De Oliveira, Milner, & Slade, 2019), not only referring to the act of being alone per se but also the perception of social isolation when being with other people (S. Cacioppo, Capitanio, & Cacioppo, 2014) or even the perception that existing social relationships are inadequate (Weiss, 1973). In response to these feelings, a person moves towards or away from others through positive or negative affect and activity (Karcher, 2001). Hence, with respect to individual needs, preferences, and social goals, social connectedness can manifest in varying quality and quantity aspects.
A recent model of social connectedness in healthy adolescents highlights the importance of identity for relationships with peers. Many determinants point to the assumption that forming an organized self is based on several internalized factors, supported by the environment of early adolescents (Mitic et al., 2021). It can be argued that this formation of identity can be impaired in children with mental disorders.
Social connectedness has a positive impact on mental and physical health, e.g. reducing substance abuse amongst youth and increasing their physical activity (Bond et al., 2007, Hill et al., 2015, Weatherson et al., 2018), while loneliness is a risk factor, e.g. for increased inflammation processes (Eisenberger, Moieni, Inagaki, Muscatell, & Irwin, 2017), elevated blood pressure (Hawkley et al., 2006), reduced physical activity (Hawkley, Thisted, & Cacioppo, 2009), depressive symptoms (Cacioppo et al., 2010, Cacioppo et al., 2006), addiction, and other health threats (Yang et al., 2016). There is even a suggestion that social ties during adolescence can have an impact on the healthy development of the adolescent brain (Lamblin, Murawski, Whittle, & Fornito, 2017).
Childhood and adolescence represent periods during which SC plays a critical role in social-emotional development. As the focus of interest gradually shifts from intrafamilial relationships towards social relationships with peers (Larson et al., 1996, Miller-Slough and Dunsmore, 2016), positive contact with peers provides the experience of intimacy and thereby helps to build trust and self-worth (Asher et al., 1996, Bagwell et al., 1998, Rubin, Dwyer, Kim, & Burgess, 2004). Close social networks with peers provide emotional support, companionship, and opportunities for meaningful social engagement and thus improve self-esteem, coping, experience of distress, sense of wellbeing, and quality of life (Bee, Berzins, Calam, Pryjmachuk, & Abel, 2013, Berkman & Glass, 2000, Fudge & Mason, 2004). At the same time, in adolescence youths face repeated changes in their social environment, particularly during school transitions (Rice, Frederickson, & Seymour, 2011). These changes may be viewed as indicator periods, showing typical social-emotional development and growth in the general population (Gifford-Smith, Brownell, & Abecassis, 2003); and they may pose additional challenges to youth with metal health problems.
Mental disorders often start during adolescence (Merikangas et al., 2010). The relationship between the symptoms of mental disorders and SC can be bidirectional (Cruwys, Haslam, Dingle, Haslam, & Jetten, 2014), which might lead to a downward spiral for affected youth. For example, it has been shown that loneliness can lead to symptoms of depression (Cacioppo et al., 2010) and depression can also cause social withdrawal (ICD-10). Similar relationships likely play a role in other mental disorders such as (social) anxiety disorder or drug abuse. Other conditions that begin during childhood often encompass symptoms that can make the achievement of good SC more challenging e.g. social communicative deficits in autism spectrum disorders (ASD) (Valla & Belmonte, 2013, Woodcock et al., 2019), or are commonly associated with problematic peer interaction, e.g. in attention deficit hyperactivity disorder (ADHD) (de Boo & Prins, 2007). Children with mental disorders appear to be not only more likely to have low SC, they are also more vulnerable to peer victimization (Acquah, Topalli, Wilson, Junttila, & Niemi, 2016, Paul et al., 2018), reinforcing the downward spiral. Interventions to improve SC will likely improve these children’s psychological development during adolescence. However, despite its undoubtable importance, SC and its determinants in children and adolescents with mental disorders are so far poorly understood.
One of the factors that is likely to have contributed to the limited available knowledge on SC in persons with mental disorders is the challenges around measuring SC in such populations, where cognitive and emotional deficits may limit the validity of available measures. Thus, measurement is important to consider in the quest for greater understanding of SC in persons with mental disorders (Hare-Duke, Dening, De Oliveira, Milner, & Slade, 2019).
In summary, SC plays an important role in coping with the many challenges of adolescence and supports mental health and wellbeing during this critical period in life. Understanding the determinants of SC is the basis for improving social ties and preventing children from experiencing loneliness and its detrimental effects. However, so far, there has been no systematic analysis of the factors that may determine SC in such populations.
Hence, the aims of this systematic review are (1) to investigate differences in SC between children and early adolescents with mental disorders and healthy subjects; (2) to understand the determinants that influence SC in children and early adolescents with mental disorders; (3) to summarize the measurement tools for SC and their constituent dimensions used in research in this population.
Section snippets
Method
Social connectedness is defined as a sense of belonging and a psychological bond a person may feel towards other people or groups. For this review, SC was operationalized through any aspect(s) of quality (such as intimacy, value, supportive function, or closeness) of social relations with at least one specific peer or with peers in general. Given that SC can be regarded as the positive end of a continuum on the other end of which lies the concept of loneliness, we also targeted studies
Results
Overall, 33 studies were included in the analysis. Study selection is shown in Fig. 1.
Most studies were conducted in the US and the most frequently investigated population was children with autism spectrum disorders (ASD). For a full list of countries and investigated disorders see Table 1.
The study quality was overall mediocre, as most studies only fulfilled half of the possible quality criteria. Only two studies met more than 80% of the quality criteria, none met all. Most studies did not
Discussion
The present systematic literature review explored differences in SC and its determinants between early adolescents with mental disorders and their healthy peers, with a view to informing potential intervention strategies to improve SC as an important protective factor. Furthermore, the review explored the measurement of SC in children with mental disorders to facilitate further research in the area.
Following a broad literature search for articles pertaining to SC in youth – during which more
Conclusion
Since SC in children with mental disorders appears to be reduced compared to a neurotypically developed population, the high health risk of loneliness makes it urgently necessary to evaluate interventions that directly improve SC in this population. Further research is necessary to specifically address possibilities of influencing SC in certain disorders. The question of subjective SC should be brought more into the focus of treatment in daily clinical routine. Corresponding determinants, which
Funding source
Ludwig Boltzmann Gesellschaft and Karl Landsteiner University.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References (125)
- et al.
Are children with obsessive-compulsive disorder at risk for problematic peer relationships?
Journal of Obsessive-Compulsive and Related Disorders
(2013) - et al.
Loneliness among students with special educational needs in mainstream seventh grade
Research in Developmental Disabilities
(2012) - et al.
Loneliness within a nomological net: An evolutionary perspective
Journal of Research in Personality
(2006) - et al.
Social incompetence in children with ADHD: Possible moderators and mediators in social-skills training
Clinical Psychology Review
(2007) - et al.
Social and emotional loneliness: A re-examination of Weiss’ typology of loneliness
Personality and Individual Differences
(1997) - et al.
Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis
Clinical Psychology Review
(2017) - et al.
Childhood peer relationships: Social acceptance, friendships, and peer networks
Journal of School Psychology
(2003) - et al.
Peer attachment and self-esteem: A meta-analytic review
Personality and Individual Differences
(2013) - et al.
Conceptual framework for social connectedness in mental disorders: Systematic review and narrative synthesis
Journal of Affective Disorders
(2019) - et al.
That’s what I like: The use of circumscribed interests within interventions for individuals with autism spectrum disorder. A systematic review
Research in Autism Spectrum Disorders
(2019)
Randomized controlled trial of a family intervention for children bullied by peers
Behavior Therapy
Social connectedness, mental health and the adolescent brain
Neuroscience and Biobehavioral Reviews
Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome
Research in Developmental Disabilities
Lifetime prevalence of mental disorders in U.S. adolescents: Results from the national comorbidity survey replication-adolescent supplement (NCS-A)
Journal of the American Academy of Child and Adolescent Psychiatry
Poor sleep quality is associated with discordant peer relationships among adolescents with Autism Spectrum Disorder
Research in Autism Spectrum Disorders
The link between emotion regulation, social functioning, and depression in boys with ASD
Research in Autism Spectrum Disorders
Adolescent loneliness and social anxiety as predictors of bullying victimisation
International Journal of Adolescence and Youth
Bully/victim problems among Greek pupils with special educational needs: Associations with loneliness and self-efficacy for peer interactions
Journal of Research in Special Educational Needs
Distinguishing friendship from acceptance: Implications for intervention and assessment
Loneliness in children
Child Development
Preadolescent friendship and peer rejection as predictors of adult adjustment
Child Development
Defining quality of life in the children of parents with severe mental illness: A preliminary stakeholder-led model
PloS One
Friendship quality and social information processing in clinically anxious children
Child Psychiatry and Human Development
Social integration, social networks, social support, and health
Children with social phobia have lower quality friendships than children with other anxiety disorders
Anxiety, Stress and Coping
Peer interaction and loneliness in high-functioning children with autism
Journal of Autism and Developmental Disorders
The need to belong: Desire for interpersonal attachments as a fundamental human motivation
Psychological Bulletin
Loneliness and friendship in high-functioning children with autism
Child Development
Children with autism and their friends: A multidimensional study of friendship in high-functioning autism spectrum disorder
Journal of Abnormal Child Psychology
Predicting friendship quality in autism spectrum disorders and typical development
Journal of Autism and Developmental Disorders
Handbook of peer interactions, relationships, and groups
Choice Reviews Online
Children‘s description of their peer interactions: Useful information for clinical child assessment
Journal of Clinical Child Psychology
Autism spectrum conditions: FAQs on autism, Asperger syndrome, and atypical autism answered by international experts
Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes
Journal of Adolescent Health
Measuring friendship quality during pre- and early adolescence
Journal of Social and Personal Relationships
Self-focused attention and depressive symptoms in adults with autistic spectrum disorder (ASD)
Journal of Autism and Developmental Disorders
Perceived social isolation makes me sad: Five year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago health, aging and social relations study
Psychology and Aging
Toward a neurology of loneliness
Psychological Bulletin
“Sometimes I want to play by myself”: Understanding what friendship means to children with autism in mainstream primary schools
Autism: The International Journal of Research and Practice
Involvement or isolation? The social networks of children with autism in regular classrooms
Journal of Autism and Developmental Disorders
Understanding the characteristics of friendship quality, activity participation, and emotional well-being in Taiwanese adolescents with autism spectrum disorder
Scandinavian Journal of Occupational Therapy
Testing the situationally modified Social Rank Theory on friendship quality in male youth with high-functioning autism spectrum disorder
Therapeutic Recreation Journal
Depression and social identity: An integrative review
Personality and Social Psychology Review
Being on your own or feeling lonely? Loneliness and other social variables in youths with autism spectrum disorders
Child Psychiatry and Human Development
Building relationships and combating bullying: Effectiveness of a school-based social skills group intervention
Journal of Clinical Child & Adolescent Psychology
Building friendships and combating bullying: Effectiveness of S.S.GRIN at one-year follow-up
Journal of Clinical Child and Adolescent Psychology
Quantity or quality? Assessing relationships between perceived social connectedness and recorded encounters
PLoS ONE
Differential effects of peer-assisted learning strategies on students’ social preference and friendship making
Behavioral Disorders
Cited by (10)
Social connectedness at the playground before and after COVID-19 school closure
2023, Journal of Applied Developmental PsychologyUnravelling the link between physical activity and peer social connectedness in young people with intellectual disabilities: a systematic review of quantitative studies
2024, Journal of Intellectual Disability ResearchExtracurricular activity participation, school belonging, and depressed mood: a test of the compensation hypothesis during adolescence
2023, Applied Developmental Science