Determinants of social connectedness in children and early adolescents with mental disorder: A systematic literature review

https://doi.org/10.1016/j.dr.2021.100960Get rights and content

Highlights

  • Systematic review on children with mental disorder and social connectedness (SC).

  • Mental disorders in children are often linked to reduced SC.

  • Skills, behavioral and social aspects, and symptoms are determinants for SC.

  • Measures of SC include friendship quality, loneliness, and peer relations.

  • SC should be considered when designing interventions for clinical populations.

Abstract

Social connectedness (SC), as a sense of belonging and a psychological bond a person may feel towards other people or groups, is imperative for the positive mental and physical development of children and early adolescents. Particularly children and early adolescents with a mental disorder often face difficulties feeling socially connected and experience the detrimental effects of loneliness. The present systematic review aims to investigate how far SC differs in children and early adolescents with a mental disorder compared to in those that develop neurotypically. Furthermore, it aims to examine the determinants of SC and predominant SC measurement techniques applied in youth with a mental disorder. Following a systematic PRISMA approach, 33 studies were included. In the majority of studies, SC was reduced in the affected population, with varying manifestations over different diagnoses. Determinants could be divided into skills, behavioral and social aspects, and symptoms. Various measurement techniques were applied, exploring friendship quality, loneliness, and peer relations along several dimensions. Interventions and possibilities of influencing SC in certain disorders seems possible and necessary to bring SC more into the focus of daily clinical routine and prevent adverse outcomes in this vulnerable population.

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.

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