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Background: There is a large empirical basis for the importance of social networks and support for people with a mental illness. However, only a few studies have examined the predictors, changes and correlations of these constructs within a longitudinal framework. Aim: To analyze changes in social network diversity as measured by the number of social roles and perceived social support over the course of three years after a psychiatric hospitalization while controlling for sociodemographic and clinical variables. A further aim was to inquire whether some social roles are perceived as being more supportive than others. Method: Random coefficient models were applied to the data of a longitudinal study on the life circumstances of people with affective disorders or schizophrenia (N = 183). Results: The majority of participants had relatives, friends and co-workers, while a markedly smaller proportion had a spouse/partner or children. Social network diversity increased during the time period observed while the perception of social support did not change. Being male, without a job (competitive or sheltered), or having a low income predicted less diverse networks. Partners and friends were perceived as most supportive. Persons without a close friendship perceived less overall support, but only at baseline (hospitalization), while persons with a job on the competitive labor market felt better supported. Conclusions: Social disintegration in the course of mental illness that is found in some studies has no equivalent in our study in what concerns network diversity and perceived support. According to our results, characteristics of vocational and economic integration are of much greater relevance, as they enhance or hinder access to social participation. DOI: 10.1177/0020764007082344

Due to high unemployment rates, people with mental illness are at risk of poverty and are deprived of the social and psychological functions of work, such as the provision of social support, structuring of time, and self-esteem, with a negative effect on their perceived quality of life (QoL). Two distinct processes are held responsible for the low work force participation of people with mental illness: 'Social underachievement' and 'social decline'. Social underachievement signifies that, due to early illness onset, the educational attainment of people with mental illness is low and entry to the labor market fails. Social decline, on the other hand, describes the loss of competitive employment after illness onset, followed by prolonged periods of unemployment and difficulties to re-enter the labor market. This study examines how social underachievement and decline are reflected in the course of vocational status, income, and QoL of people with severe mental illness in the years after a psychiatric admission in a naturalistic longitudinal design. A total of 176 participants diagnosed with schizophrenia or affective disorders were interviewed during an index hospitalization in two large psychiatric hospitals in Zurich. Follow-up interviews were conducted 12 and 30 months after. Random coefficient models (multilevel models) were used to examine simultaneously the predictors and course of the variables of interest. A low number of psychiatric hospitalizations, a higher educational degree, a diagnosis of schizophrenia, and years of work experience predicted a higher vocational status. Vocational status decreased in first-admission participants with prolonged hospitalizations during the follow-up period. Income did not change over time and was positively influenced by a higher age of illness onset, competitive employment, higher education, and not having had a longer hospitalization recently. Subjective QoL significantly improved and was rated higher by people with any kind of employment than by participants without a job. Participants with an affective disorder, those with few hospitalizations but a recent inpatient stay of longer duration, showed lower QoL. Including employment issues early in treatment is especially important for people with an early illness onset and those with more severe forms of psychiatric disorder. A life course perspective enhances the understanding of patients' vocational potential and needs for support. Keywords: Switzerland; Mental illness; Employment; Income; Quality of life; Longitudinal studies

Background: Mental health authorities must know the public's attitude to community psychiatry when planning community mental health services. However, previous studies have only investigated the impact of demographic variables on the attitude to community psychiatry. Aim: To assess the influence of psychological and sociological parameters on the public opinion of community psychiatry in Switzerland. Method: Linear regression analyses of the results of a public opinion survey on a representative population sample in Switzerland (n = 1737). Results: Most respondents have positive attitudes to community psychiatry. In the regression analysis ([R.sup.2] adjusted = 21.2%), negative emotions towards mentally ill people as depicted in the vignette, great social distance, a positive attitude to restrictions, negative stereotypes, high rigidity and no participation in community activities significantly influenced negative attitudes to community psychiatry. Additionally, other parameters, e.g. contact with mentally ill people and the nationality of the interviewee, have a significant influence. Conclusions: In planning psychiatric community services, general individual traits and emotive issues should be considered because they influence the response towards community psychiatry facilities in the host community.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2005.05.014 Byline: Brigitte Mueller, Carlos Nordt, Christoph Lauber, Peter Rueesch, Peter C. Meyer, Wulf Roessler Keywords: Switzerland; Stigma; Social support; Social network; Mental illness; Coping Abstract: Perceived stigmatization of mentally ill people impairs their social relations and well-being. While perceived stigmatization theoretically and empirically has been accounted for as an independent and unalterable factor, this longitudinal study focuses on reciprocal effects between stigmatization and social ties. The duration of mental illness is included as a grouping variable to extend the longitudinal perspective. A sample of severely mentally ill persons (n=165) in two psychiatric hospitals in Zurich took part in a structured interview during their admission and 1 year later. Cross-lagged path models were designed to test the interrelations of (1) perceived stigmatization, (2) a defensive stigma coping orientation, (3) concrete stigmatizing experiences, and either (4) social network, or (5) perceived social support as dependent variables. Contrary to previous findings, neither of the three components of stigmatization tested has any influence on social network or support. Social support, though, strongly predicts perceived stigmatization 1 year later, but only in the group with a more recent onset of illness. This finding suggests that the perception of stigma is subject to modification in the course of new life circumstances and underlines the importance of activating social resources in the first years of mental illness. Duration of illness should be included as a central variable in future research, as it influences the nature of the relation between stigmatization and social ties. Author Affiliation: Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Militarstrasse 8, P.O. Box 1930 8021 Zurich, Switzerland

Background: The United Nations proclaimed 2001 the 'International Year of Volunteers'. Little is known about factors influencing the attitude to volunteering in psychiatry. However, knowledge about these factors is important as target groups to be addressed by an awareness and promotion campaign could be identified. Aims: To determine the influence of demographic, psychological and sociological factors on the attitude to volunteering in psychiatry. Methods: Multiple logistic regression analysis of the results of an opinion survey conducted on a representative population sample in Switzerland (n = 1737). Results: Public attitude is mostly positive. It depends, however, on the form of volunteering. Two explanatory models for volunteering in psychiatry were found: first, the 'antipathetic person' having social distance to and negative stereotypes towards the mentally ill, Second, the 'people with social responsibility and commitment' who have former experience in volunteering, a positive attitude to community psychiatry, interest in mass media, a social profession and perceive discrimination of mentally ill persons. Age and gender are significant predictors. Conclusions: An awareness and promotion campaign to use the vast potential of people willing to volunteer in psychiatry can be primarily focused on those with a basic interest in social issues. Volunteering must be limited in time and responsibility. Contacting people with a positive attitude by mass media is a promising way.

Abstract Background Vocational integration of people with mental illness is poor despite their willingness to work. The ‘Individual Placement and Support’ (IPS) model which emphasises rapid and direct job placement and continuing support to patient and employer has proven to be the most effective vocational intervention programme. Various studies have shown that every second patient with severe mental illness was able to find competitive employment within 18 months. However, the goal of taking up employment within two months was rarely achieved. Thus, we aim to test whether the new concept of limited placement budgets increases the effectiveness of IPS. Methods/Design Six job coaches in six out-patients psychiatric clinics in the Canton of Zurich support unemployed patients of their clinic who seek competitive employment. Between June 2010 and May 2011 patients (N=100) are randomly assigned to three different placement budgets of 25h, 40h, or 55h working hours of job coaches. Support lasts two years for those who find a job. The intervention ends for those who fail to find competitive employment when the respective placement budgets run out. The primary outcome measure is the time between study inclusion and first competitive employment that lasted three months or longer. Over a period of three years interviews are carried out every six months to measure changes in motivation, stigmatization, social network and social support, quality of life, job satisfaction, financial situation, and health conditions. Cognitive and social-cognitive tests are conducted at baseline to control for confounding variables. Discussion This study will show whether the effectiveness of IPS can be increased by the new concept of limited placement budgets. It will also be examined whether competitive employment leads in the long term to an improvement of mental illness, to a transfer of the psychiatric support system to private and vocational networks, to an increase in financial independence, to a reduction of perceived and internalized stigma, and to an increase in quality of life and job satisfaction of the patient. In addition, factors connected with fast competitive employment and holding that job down in the long term are being examined (motivation, stigmatization, social and financial situation). Trial register ISRCTN89670872

Abstract Background Tourette syndrome is a neuropsychiatric disorder characterized by motor and phonic tics. Deficient motor inhibition underlying tics is one of the main hypotheses in its pathophysiology. Therefore the question arises whether this supposed deficient motor inhibition affects also voluntary movements. Despite severe motor tics, different personalities who suffer from Tourette perform successfully as neurosurgeon, pilot or professional basketball player. Methods For the investigation of fine motor skills we conducted a motor performance test battery in an adult Tourette sample and an age matched group of healthy controls. Results The Tourette patients showed a significant lower performance in the categories steadiness of both hands and aiming of the right hand in comparison to the healthy controls. A comparison of patients’ subgroup without comorbidities or medication and healthy controls revealed a significant difference in the category steadiness of the right hand. Conclusions Our results show that steadiness and visuomotor integration of fine motor skills are altered in our adult sample but not precision and speed of movements. This alteration pattern might be the clinical vignette of complex adaptations in the excitability of the motor system on the basis of altered cortical and subcortical components. The structurally and functionally altered neuronal components could encompass orbitofrontal, ventrolateral prefrontal and parietal cortices, the anterior cingulate, amygdala, primary motor and sensorimotor areas including altered corticospinal projections, the corpus callosum and the basal ganglia.