Mutuality between Military Veterans with Depression and Their Close Supports
Keywords:
Social ties, social support, mutual supportAbstract
Mutuality—the bidirectional flow of feelings, activities, and thoughts between close relationships—provides a useful framework to examine mutual support, but litle is known about mutuality between patients with depression and members of their social network. We conducted semi-structured interviews of 30 patients with symptoms of major depression and 17 of their close supports. All interviews were coded by at least two research team members, and output from codes were sorted into themes. Empowerment,
engagement, and empathy were the most common forms of mutuality between patients and close supports. Equitable exchange of support was key to experiencing empowerment and led to ongoing engagement in each other’s lives. When empathy was absent, its
detrimental effects were pronounced. In the most intimate and authentic relationships, patients and close supports adopted a “team” identity. Social support interventions that identify and increase features of mutuality may be an innovative approach to combat depression.
References
Ali, K., Farrer, L., Gulliver, A., & Grifths, K. M. (2015). Online peer-to-peer support for
young people with mental health problems: A systematic review. JMIR Mental Health,
2(2), e19. htps://doi.org/10.2196/mental.4418
Bright, J. I., Baker, K. D., & Neimeyer, R. A. (1999). Professional and paraprofessional
group treatments for depression: A comparison of cognitive-behavioral and mutual
support interventions. Journal of Consulting and Clinical Psychology, 67(4), 491–501.
htps://doi.org/10.1037/0022-006X.67.4.491
Chen, J. I., Hooker, E. R., Niederhausen, M., E. Marsh, H., Saha, S., Dobscha, S. K., &
Teo, A. R. (2020). Social connectedness, depression symptoms, and health service
utilization: A longitudinal study of Veterans Health Administration patients. Social
Psychiatry and Psychiatric Epidemiology, 55(5), 589–597. htps://doi.org/10.1007
/s00127-019-01785-9
Chen, Y.-C., Pai, J.-S., & Li, I.-C. (2008). Haemodialysis: Te effects of using the empowerment concept during the development of a mutual-support group in Taiwan.
Journal of Clinical Nursing, 17(5a), 133–142. htps://doi.org/10.1111/j.1365-2702.2007
.02186.x
Chien, L.-Y., Chu, H., Guo, J.-L., Liao, Y.-M., Chang, L.-I., Chen, C.-H., & Chou, K.-R.
(2011). Caregiver support groups in patients with dementia: A meta-analysis. International Journal of Geriatric Psychiatry, 26(10), 1089–1098. htps://doi.org/10.1002/gps
.2660
Coan, J. A., Kasle, S., Jackson, A., Schaefer, H. S., & Davidson, R. J. (2013). Mutuality and
the social regulation of neural threat responding. Atachment & Human Development,
15(3), 303–315. htps://doi.org/10.1080/14616734.2013.782656
Cohen, S. (2004). Social relationships and health. American Psychologist, 59(8), 676–684.
htps://doi.org/10.1037/0003-066X.59.8.676
Dellafore, F., Chung, M. L., Alvaro, R., Durante, A., Colaceci, S., Vellone, E., & Pucciarelli, G. (2019). Te association between mutuality, anxiety, and depression in heart
failure patient-caregiver dyads: An actor-partner interdependence model analysis.
Te Journal of Cardiovascular Nursing, 34(6), 465–473. htps://doi.org/10.1097/JCN
.0000000000000599
Doré, B. P., Morris, R. R., Burr, D. A., Picard, R. W., & Ochsner, K. N. (2017). Helping
others regulate emotion predicts increased regulation of one’s own emotions and
decreased symptoms of depression. Personality and Social Psychology Bulletin, 43(5),
729–739. htps://doi.org/10.1177/0146167217695558
Gariépy, G., Honkaniemi, H., & Quesnel-Vallée, A. (2016). Social support and protection
from depression: Systematic review of current fndings in Western countries. British
Journal of Psychiatry, 209(4), 284–293. htps://doi.org/10.1192/bjp.bp.115.169094
Genero, N. P., Miller, J. B., Surrey, J., & Baldwin, L. M. (1992). Measuring perceived mutuality in close relationships: Validation of the Mutual Psychological Development
Questionnaire. Journal of Family Psychology, 6(1), 36–48. htps://doi.org/10.1037
/0893-3200.6.1.36
George, L. K., Blazer, D. G., Hughes, D. C., & Fowler, N. (1989). Social support and the
outcome of major depression. British Journal of Psychiatry, 154(4), 478–485. htps://
doi.org/10.1192/bjp.154.4.478
Gilad, D., Lavee, Y., & Innes-Kenig, O. (2009). Te structure of dyadic support among
couples with and without long-term disability. Journal of Behavioral Medicine, 32(5),
453–465. htps://doi.org/10.1007/s10865-009-9216-5
Heisler, M., Choi, H., Piete, J. D., Rosland, A., Langa, K. M., & Brown, S. (2013). Adults
with cardiovascular disease who help others: A prospective study of health outcomes.
Journal of Behavioral Medicine, 36(2), 199–211. htps://doi.org/10.1007/s10865-012
-9414-4
Heisler, M., Halasyamani, L., Cowen, M. E., Davis, M. D., Resnicow, K., Strawderman, R.
L., Choi, H., Mase, R., & Piete, J. D. (2013). Randomized controlled effectiveness trial of reciprocal peer support in heart failure. Circulation: Heart Failure, 6(2), 246–253.
htps://doi.org/10.1161/CIRCHEARTFAILURE.112.000147
Heisler, M., Vijan, S., Makki, F., & Piete, J. D. (2010). Diabetes control with reciprocal
peer support versus nurse care management: A randomized trial. Annals of Internal
Medicine, 153(8), 507. htps://doi.org/10.7326/0003-4819-153-8-201010190-00007
Hyde, J., Wendleton, L., Fehling, K., Whitle, J., True, G., Hamilton, A., Gierisch, J.
M., Ertl, K., Fix, G., Barker, A., Wehler, C. J., White, B., Ritchie, M. F., & Ono, S. S.
(2018). Strengthening Excellence in Research through Veteran Engagement (SERVE):
Toolkit for veteran engagement in research (Version 1). Veterans Health Administration,
Health Services Research and Development. htps://www.hsrd.research.va.gov/for
_researchers/serve/
Johansson, T., Keller, S., Winkler, H., Ostermann, T., Weitgasser, R., & Sönnichsen, A.
C. (2016). Effectiveness of a peer support programme versus usual care in disease
management of diabetes mellitus type 2 regarding improvement of metabolic control:
A cluster-randomised controlled trial. Journal of Diabetes Research, 2016, 1–10. htps://
doi.org/10.1155/2016/3248547
Kahana, E., Bhata, T., Lovegreen, L. D., Kahana, B., & Midlarsky, E. (2013). Altruism,
helping, and volunteering: Pathways to well-being in late life. Journal of Aging and
Health, 25(1), 159–187. htps://doi.org/10.1177/0898264312469665
Kelly, J. F., Hoffman, L., Vilsaint, C., Weiss, R., Nierenberg, A., & Hoeppner, B. (2019).
Peer support for mood disorder: Characteristics and benefts from atending the Depression and Bipolar Support Alliance mutual-help organization. Journal of Affective
Disorders, 255, 127–135. htps://doi.org/10.1016/j.jad.2019.05.039
Kim, C.-O., Jeong, Y., Park, Y., Bae, J.-S., Kwon, Y., Cho, M., Yoo, C. H., & Lee, K.-E.
(2021). Reinforcement effects of social network intervention during nutritional supplementation in frail older adults. Gerontology, 67(5), 620–632. htps://doi.org/10
.1159/000514676
Kim, E. S., Whillans, A. V., Lee, M. T., Chen, Y., & VanderWeele, T. J. (2020). Volunteering and subsequent health and well-being in older adults: An outcome-wide longitudinal approach. American Journal of Preventive Medicine, 59(2), 176–186. htps://doi
.org/10.1016/j.amepre.2020.03.004
Kirshbaum-Moriah, D., Harel, C., & Benbenishty, J. (2018). Family members’ experience
of intensive care unit support group: Qualitative analysis of intervention: Nurse/social worker led ICU support group for family members. Nursing in Critical Care, 23(5),
256–262. htps://doi.org/10.1111/nicc.12272
Konrath, S., & Brown, S. (2013). Te effects of giving on givers. In M. L. Newman & N. A.
Roberts (Eds.), Health and social relationships: Te good, the bad, and the complicated.
(pp. 39–64). American Psychological Association. htps://doi.org/10.1037/14036
-003
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H.
(2009). Te PHQ-8 as a measure of current depression in the general population.
Journal of Affective Disorders, 114(1–3), 163–173. htps://doi.org/10.1016/j.jad.2008.06
.026
Lester, A. M., Goodloe, C. L., Johnson, H. E., & Deutsch, N. L. (2019). Understanding
mutuality: Unpacking relational processes in youth mentoring relationships. Journal
of Community Psychology, 47(1), 147–162. htps://doi.org/10.1002/jcop.22106
Manne, S. L., Kashy, D. A., Virtue, S., Criswell, K. R., Kissane, D. W., Ozga, M., Heckman,
C. J., Stapleton, J., & Rodriguez, L. (2018). Acceptance, social support, beneftfnding, and depression in women with gynecological cancer. Quality of Life Research,
27(11), 2991–3002. htps://doi.org/10.1007/s11136-018-1953-x
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K.
(2015). Purposeful sampling for qualitative data collection and analysis in mixed
method implementation research. Administration and Policy in Mental Health and
Mental Health Services Research, 42(5), 533–544. htps://doi.org/10.1007/s10488-013
-0528-y
Park, E. O., & Schumacher, K. L. (2014). Te state of the science of family caregiver-care
receiver mutuality: A systematic review. Nursing Inquiry, 21(2), 140–152. htps://doi
.org/10.1111/nin.12032
Patil, S. J., Ruppar, T., Koopman, R. J., Lindbloom, E. J., Elliot, S. G., Mehr, D. R., &
Conn, V. S. (2018). Effect of peer support interventions on cardiovascular disease risk
factors in adults with diabetes: A systematic review and meta-analysis. BMC Public
Health, 18(1), 398. htps://doi.org/10.1186/s12889-018-5326-8
Pietrzak, R. H., Johnson, D. C., Goldstein, M. B., Malley, J. C., Rivers, A. J., Morgan, C.
A., & Southwick, S. M. (2010). Psychosocial buffers of traumatic stress, depressive
symptoms, and psychosocial difculties in veterans of Operations Enduring Freedom
and Iraqi Freedom: Te role of resilience, unit support, and postdeployment social
support. Journal of Affective Disorders, 120(1–3), 188–192. htps://doi.org/10.1016/j.jad
.2009.04.015
Pucciarelli, G., Buck, H. G., Barbaranelli, C., Savini, S., Simeone, S., Juarez-Vela, R., Alvaro, R., & Vellone, E. (2016). Psychometric characteristics of the mutuality scale in
stroke patients and caregivers. Te Gerontologist, 56(5), e89–e98. htps://doi.org/10
.1093/geront/gnw083
Randolph, M. E., & Reddy, D. M. (2006). Sexual functioning in women with chronic pelvic pain: Te impact of depression, support, and abuse. Journal of Sex Research, 43(1),
38–45. htps://doi.org/10.1080/00224490609552297
Seterfeld, M., Walsh, M., Frey, A.-L., & McCabe, C. (2016). Increased social anhedonia
and reduced helping behaviour in young people with high depressive symptomatology. Journal of Affective Disorders, 205, 372–377. htps://doi.org/10.1016/j.jad.2016.08
.020
Suton, L. B., & Erlen, J. A. (2006). Effects of mutual dyad support on quality of life in
women with breast cancer. Cancer Nursing, 29(6), 488–498. htps://doi.org/10.1097
/00002820-200611000-00010
Tantillo, M., & Sanfner, J. (2003). Te relationship between perceived mutuality and bulimic symptoms, depression, and therapeutic change in group. Eating Behaviors, 3(4),
349–364. htps://doi.org/10.1016/S1471-0153(02)00077-6
Teo, A. R., Choi, H., & Valenstein, M. (2013). Social relationships and depression: Tenyear follow-up from a nationally representative study. PLoS ONE, 8(4), e62396.
htps://doi.org/10.1371/journal.pone.0062396
Teo, A. R., Forsberg, C. W., Marsh, H. E., Saha, S., & Dobscha, S. K. (2017). No-show
rates when phone appointment reminders are not directly delivered. Psychiatric Services, 68(11), 1098–1100. htps://doi.org/10.1176/appi.ps.201700128
Teo, A. R., Marsh, H. E., Forsberg, C. W., Nicolaidis, C., Chen, J. I., Newsom, J., Saha, S.,
& Dobscha, S. K. (2018). Loneliness is closely associated with depression outcomes
and suicidal ideation among military veterans in primary care. Journal of Affective Disorders, 230, 42–49. htps://doi.org/10.1016/j.jad.2018.01.003
Teo, A. R., Marsh, H. E., Ono, S. S., Nicolaidis, C., Saha, S., & Dobscha, S. K. (2020). Te
importance of “being there”: A qualitative study of what veterans with depression
want in social support. Journal of General Internal Medicine. htps://doi.org/10.1007
/s11606-020-05692-7
Teurer, K., Wister, A., Sixsmith, A., Chaudhury, H., & Lovegreen, L. (2014). Te development and evaluation of mutual support groups in long-term care homes. Journal of
Applied Gerontology, 33(4), 387–415. htps://doi.org/10.1177/0733464812446866
Tomini, F., Groot, W., & Tomini, S. M. (2016). Informal care and gifs to and from older
people in Europe: Te interlinks between giving and receiving. BMC Health Services
Research, 16(1), 603. htps://doi.org/10.1186/s12913-016-1830-7
Travis, J., Roeder, K., Walters, H., Piete, J., Heisler, M., Ganoczy, D., Valenstein, M., &
Pfeiffer, P. (2010). Telephone-based mutual peer support for depression: A pilot
study. Chronic Illness, 6(3), 183–191. htps://doi.org/10.1177/1742395310369570
Valenstein, M., Pfeiffer, P. N., Brandfon, S., Walters, H., Ganoczy, D., Kim, H. M., Cohen,
J. L., Benn-Burton, W., Carroll, E., Henry, J., Garcia, E., Risk, B., Kales, H. C., Piete,
J. D., & Heisler, M. (2016). Augmenting ongoing depression care with mutual peer
support intervention versus self-help materials alone: A randomized trial. Psychiatric
Services, 67(2), 236–239. htps://doi.org/10.1176/appi.ps.201400454
Wang, D., & Gruenewald, T. (2019). Te psychological costs of social support imbalance:
Variation across relationship context and age. Journal of Health Psychology, 24(12),
1615–1625. htps://doi.org/10.1177/1359105317692854
Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018). Associations between
loneliness and perceived social support and outcomes of mental health problems: A
systematic review. BMC Psychiatry, 18(1), 156. htps://doi.org/10.1186/s12888-018
-1736-5
Wang, S., & Lau, A. S. (2015). Mutual and non-mutual social support: Cultural differences in the psychological, behavioral, and biological effects of support seeking. Journal of Cross-Cultural Psychology, 46(7), 916–929. htps://doi.org/10.1177
/0022022115592967
Wendleton, L. R., Martin, L. A., Stewart Steffensmeier, K. R., LaChappelle, K., Fehling, K., Etingen, B., Ray, C., Carnevale, D., Hardie, C., Grimes, I., & Ono, S. S.
(2019). Building sustainable models of veteran-engaged health services research.
Journal of Humanistic Psychology, 002216781984553. htps://doi.org/10.1177
/0022167819845535
Downloads
Published
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License permitting all use, distribution, and reproduction in any medium, provided the work is properly cited.
