Results are consistent with previous research 7, 8
showing that both social network size and social support are correlated to better recovery for persons with serious mental illness. Prior literature suggests that patients with mental illness report a number of benefits from social support, including emotional, material, and psychological benefits, modeling, motivational encouragement, and others. 4
But in addition to social support and social networks, our results demonstrate that greater involvement in a wide range of activities is also related to better recovery, especially when levels of social support were lower. These activities may be more or less social in nature, more or less physically active, or occur inside or out of the home. The particular activities related to recovery may be highly individualized from one person to another. Choice of activity may even be a contributing factor in building a sense of control over one’s life. The data suggest that participation in a greater number of activities, regardless of the activity type, is associated with recovery.
Beyond social networks, social support, and activities, the only other variable associated with recovery in the final model was mental health status measured by the MCS. Recovery was not related to age, sex, diagnostic group, socioeconomic status, or other indicators. Other research, however, has found that recovery over time is related to variables such as physical health and changes in employment and marital status. 8
The current results are encouraging in that many of these potential factors are outside people’s ability to control; in contrast, it appears that recovery is potentially amenable to influence through social and behavioral factors.
In particular, people have the potential to exercise control over the behaviors in which they engage. The results suggest that being involved or active, in any of a wide variety of individualized activities, is related to better recovery. Moreover, to the extent that people do not enjoy strong social support, participation in activities may be of even greater importance. Of course, these data are cross-sectional and so it is unclear if activities promote recovery or if recovery enables people to be more active. There may be effects in both directions.
Regarding the interaction term, a hypothesis was tested that the combination of social support and activities would relate to higher recovery. This was found to be the case in that the association between activities and recovery was positive for all levels of support, however, rather than a simple cumulative effect, activities were particularly important when social support was low. Either activities or support may work to promote recovery when only one or the other is relatively high.
In addition to the cross-sectional design, limitations of the study include the way that activities and social support were measured. The measurement of activity was limited to a count, and may not reflect how meaningful specific activities are. In addition, not all potential activities are included, and other forms of physical, social, or spiritual activity may aid in recovery 25
but were not assessed here. Social networks and support were measured through only two items asking about network size and levels of support over the last month. The impact of this support and the positive or negative nature of support were not investigated, although the item we used is suggestive of qualitative feelings about receiving support. The sample was limited to persons who received care through the KPNW health plan. Future analyses may assess changes in recovery over time as they relate to social support, social networks, and activities.