Institute of Health and Society, Université catholique de Louvain, Clos Chapelle-aux-Champs, B1.30.15, 1200, Brussels, Belgium.
Soc Psychiatry Psychiatr Epidemiol. 2019 Jun;54(6):725-735. doi: 10.1007/s00127-019-01660-7. Epub 2019 Feb 13.
For severely mentally ill (SMI) users, continuity of care requires consistency between the supports provided by the members of their social support network. However, we know little about their network cohesion and its association with continuity of care. We set out to investigate this association and hypothesised that it would depend on the severity of the user's situation and on his/her living arrangements.
We conducted face-to-face interviews with 380 SMI users recruited in outpatient and inpatient mental health services in three areas in Belgium. Data regarding users' social networks were collected using an ego-network mapping technique and analysed with social network analysis. The cohesion indicators were density (frequency of connections between network members), centralisation (having a small number of central people), and egobetweenness (the user's centrality in his/her own network). Participants' perception of continuity of care was measured by the Alberta Continuity of Services Scale.
Results show that cohesion indicators were associated with continuity of care only for users with high-severity problems, regardless of their living arrangements. The numbers of network members, professionals, and services in the network were all negatively associated with continuity of care for all the users.
Satisfactory continuity of care requires fewer professionals or services in a user's network and a dense network for users with the most severe problems. This implies that those providing care must not only be able to increase cohesion within a network, but also to adapt their interventions to support the transition to a different, individualised network structure when severity decreases.
对于严重精神障碍（SMI）患者，连续性护理需要其社会支持网络成员提供的支持之间保持一致。然而，我们对他们的网络凝聚力及其与连续性护理的关系知之甚少。我们着手调查这种关联，并假设它将取决于患者病情的严重程度及其居住安排。
我们对 380 名在比利时三个地区的门诊和住院精神卫生服务机构招募的 SMI 患者进行了面对面访谈。使用自我网络映射技术收集有关患者社交网络的数据，并使用社交网络分析进行分析。凝聚力指标包括密度（网络成员之间的连接频率）、集中化（有少数核心人物）和自我中介性（用户在其自身网络中的中心性）。参与者对连续性护理的感知通过艾伯塔连续性服务量表进行衡量。
结果表明，凝聚力指标仅与高严重程度问题的患者的连续性护理相关，而与他们的居住安排无关。网络中的成员数量、专业人员数量和服务数量均与所有患者的连续性护理呈负相关。
令人满意的连续性护理需要患者网络中的专业人员或服务数量较少，且对于最严重问题的患者而言，网络较为密集。这意味着提供护理的人员不仅要能够提高网络内部的凝聚力，还要能够根据严重程度的降低，调整其干预措施，以支持向不同的个性化网络结构的过渡。
