What are psychosocial nursing interventions?

The term psychosocial refers to psychological and social factors that influence mental health. Psychosocial adversity has a major impact on stress-related disorders. Mental illness may cause a variety of psychosocial problems such as decreased quality of life. Stigma can burden the client’s and the family members’ lives and without adequate support, stigma may erode the morale of the family caregivers and result in the withdrawal from potential supporters, leaving the client into possible relapse (Iseselo et al., 2016).

Definition

Psychosocial disorders are mental illnesses caused or influenced by life experiences. Social influences such as peer pressure, parental support, cultural and religious background, socioeconomic status, and interpersonal relationships mold our personalities and influence our psychological makeup (Encyclopedia of Children’s Health, 2022).

Etiology

The etiology of psychosocial disorders is often diverse and not completely understood. The majority of psychosocial disorders are thought to because by a complex combination of biological, genetic, familial, and social factors or biopsychosocial influences. The role of each of these factors can differ for every individual so that a disorder such as depression that is caused by genetic factors in one person may be caused by a traumatic life event in another (Encyclopedia of Children’s Health, 2022).

Epidemiology

In 2017, it was estimated that 970 million people worldwide had a mental or substance abuse disorder. The largest number of people had an anxiety disorder, estimated at around 4% of the population. Globally, around 1 in 7 people (15%) have one or more mental or substance use disorders. There is a broad category of mental health and substance use disorders by the Institute for Health Metrics and Evaluation (IHME) and WHO. This category comprises a range of disorders including depression, anxiety, personality disorders, eating disorders, schizophrenia, intellectual and developmental disability, and alcohol and drug use disorders. On average, depression, anxiety, eating disorders, and bipolar disorder is more prevalent in women. Gender differences in schizophrenia prevalence are mixed across countries, but it is typically more common in men. Alcohol and drug use disorders are more common in men (Dattani et al., 2021).

Modifying Factors

In statistical terms, modifying factors interact with psychosocial risk factors. Modifying variables may conceptually increase the vulnerability of an individual to the impact of the risk factor or buffer its effect. at the very least, knowledge of the modifying variables is useful by helping specify more narrow groups at risk for late-life depression.

• Genetic indicators. Kendler and colleagues have identified genetic factors that appear to modify the impact of life events on the depression risk (Kendler et al., 2001).
• Gender. Various studies have indicated that psychosocial factors can have a different risk in women as compared to men.
• Marital status. Two studies have observed a greater risk for psychosocial disorders associated with marital separation or divorce in men than women (Bruce and Kim, 1992).
• Personality type. Mazure et al. (2002) found that stressful life events were associated with depression only when the nature of the event matched the personality type of the individual. In their study, interpersonal events were associated with depression only among individuals who report sociotropy, whereas achievement-related events were associated with depression only among individuals who report autonomy.
• Age. The distribution of modifying variables varies by age. For example, advanced age may improve self-esteem and maturation that protects older adults against the impact of psychosocial risk factors (Gove et al, 1989). Conversely, aging sometimes results in the loss of sense of personal control over one’s environment or losses in social support resources, losses that might reduce the ability of older adults to buffer the negative impact of psychosocial risk factors (Bruce, 2002).

Risk Factors

Psychosocial factors are loosely defined as factors related to the psychological or social environment and processes. Psychosocial factors encompass many life experiences as well as the environmental context in which individuals pursue their lives. Understanding the role of psychosocial factors in the risk of disease is important, as psychosocial factors may offer innovative avenues for prevention and treatment.

• Negative life events and ongoing difficulties. The impact of life stressors, especially life events has received a great deal of study for a long time. As summarized by McLean and Link, the two major conceptualizations of how life events affect mental health include 1) life events as disruptive experiences that necessitate changes and readjustment; and 2) life events as meaningful experiences that arouse negative emotions (Bruce, 2002).
• Medical illness. A strong and consistently observed risk factor for psychosocial disorders such as depression in late life is a medical illness, especially diseases of the cardiovascular system. Similar to other life events, the onset or exacerbation of severe or life-threatening illness may be profoundly meaningful and may often engender considerable disruption to one’s normal life (Bruce, 2002).
• Bereavement. The death of a spouse or loved one is among the more clearly specified life events, yet these events vary in numerous ways, ranging from the circumstances leading up to the death. The death itself may be expected or unanticipated, traumatic, or relatively peaceful (Bruce, 2002).
• Disability. Disability and functional decline generally reflect some combination of physical, cognitive, and psychological impairments. The complexity of disability as a construct, relative to some other psychosocial factors, poses considerable challenges to risk-factor analyses (Bruce, 2002).
• Trauma. The class of events labeled traumatic events are by definition the most extreme forms of life events. Traumatic events differ from other life events by being outside the scope of common or expected life experiences. The “horrible and unthinkable” can be categorized on several spectrums, for example, the extent to which an event involves full communities as opposed to being limited to one or a few individuals, is brief or prolonged, is instigated by humans versus those occurring by nature, and if human-made, is intentional as opposed to accidental.

Types of Psychosocial Disorders

The Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision (DSM-IV-TR) lists 16 different subtypes or categories of mental illness. The major categories of mental disorders involving significant psychosocial factors include:

• Substance-related disorder. Disorders related to alcohol and drug abuse, dependence, and withdrawal.
• Schizophrenia and other psychotic disorders. These include schizoid disorders, delusional disorders, and psychotic disorders.
• Mood disorders. Affective disorders such as depression and bipolar disorders.
• Anxiety disorders. Disorders in which a certain situation or place triggers excessive fear and/or anxiety symptoms such as panic disorder, agoraphobia, social phobia, obsessive-compulsive disorder, post-traumatic stress disorder, and generalized anxiety disorder.
• Somatoform disorders. Somatoform disorders involve clinically significant physical symptoms that cannot be explained by a medical condition.
• Factitious disorders. disorders in which an individual creates and complains of symptoms of a non-existent illness in order to assume the role of a patient.
• Sexual and gender identity disorders. Disorders of sexual desire, arousal, and performance.
• Eating disorder. Anorexia and bulimia nervosa are eating disorders that are defined as the disruption in eating behavior with excessive concern about body weight that impairs physical health or psychosocial functioning (Balasundaram & Santhanam, 2022).
• Adjustment disorders. Adjustment disorders involve an excessive emotional or behavioral reaction to a stressful event.
• Personality disorders. Maladjustments of personality, including conduct, paranoid, narcissistic, avoidant, dependent, and obsessive-compulsive personality disorder.
• Developmental disorders. Disorders usually diagnosed in infancy, childhood, or adolescence may be partially psychosocial in nature.

Interventions

Psychosocial interventions capitalize on psychological or social actions to produce a change in psychological, social, biological, and/or functional outcomes. Psychosocial interventions for mental health and substance use disorders are interpersonal or informational activities, techniques, or strategies that target biological, behavioral, cognitive, emotional, interpersonal, social, or environmental factors with the aim of improving health functioning and well-being.

• Cognitive-behavioral therapy. Cognitive-behavioral therapy is used for a wide array of mental health and substance use disorders. It combines behavioral techniques with cognitive psychology- the scientific study of mental processes, such as perception, memory, reasoning, decision making, and problem-solving. The goal is to replace maladaptive behavior and faulty cognitions with thoughts and self-statements that promote adaptive behavior.
• Community-based treatment. Assertive community treatment encompasses an array of services and interventions provided by a community-based, interdisciplinary, mobile treatment team. The team consists of case managers, peer support workers, psychiatrists, social workers, psychologists, nurses, and vocational specialists. The approach is designed to provide comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious mental health and substance use disorders.
• Vocational rehabilitation. Pre-vocational training and supported employment are two different approaches to helping severely mentally ill people obtain employment. the key principle of pre-vocational training is that a period of preparation is necessary before entering competitive employment. In contrast, the key principle of supported employment is that placement in competitive employment should occur as quickly as possible, followed by support and training on the job (Crowther et al., 2001).
• Peer support services. Peer support services (PSSs) are novel interventions recently adopted in mental health systems worldwide. It is a system of giving and receiving help founded on key principles of respect, shared responsibility, and an agreement of what is helpful. The Mental Health Foundation in the UK defined peer support as “the help and support that people with lived experience of a mental illness or a learning disability can give to one another” (Mahomed & Machin, 2020).
• Integrated care interventions. Integrated care is an organizing principle for healthcare delivery that aims to improve patient care through better coordination of services provided. This includes case management, discharge management, multidisciplinary teams, complex interventions, primary vs secondary interventions, and self-management interventions (Flanagan et al., 2017).

Nursing Diagnosis

Ineffective coping

Assessment

Verbalization of inability to or ask for help / chronic worry / delayed decision making / muscular tension, frequent headaches, insomnia, fatigue / poor concentration / high illness rate / alteration in social particpation / inappropriate use of defense mechanism

Problem

Inadequate level of confidence

Impaired adaptive behaviors

Self-blame or projection of blame

Inability to manage activities of daily living (ADLs)

Nursing Diagnosis

Risk for compromised family coping

Assessment

Anxiety/depression / inadequate or lack of support system/change in communication patterns / altered family role participation / destructive behavior to self and others

Problem

Unrealistic expectations

Family disorganization and role changes

Disability or disease progression

Nursing Diagnosis

Readiness for enhanced family coping

Assessment

Description of the growth impact of the crisis on their values / engaging in health-promoting lifestyle / effective communication between family members/understanding of family roles and participation

Nursing Diagnosis

Anxiety

Assessment

Restlessness / irritability / apprehensive / trembling / palpitations / nausea and vomiting / impaired attention / forgetfulness / difficulty concentrating

Problem

Narrowed focus of attention

Inability to cope

Distortion of reality

Inappropriate use of defense mechanisms

Nursing Diagnosis

Situational low self-esteem

Assessment

Feelings of uselessness and worthlessness / self-negating verbalizations / indecisive behavior / reports situational challenge to self-worth/inability to deal with a situation or an event

Problem

Impaired social interaction

Poor perception of self

Nursing Diagnosis

Grieving

Assessment

Verbal expression of distress / denial of loss / altered eating habits / impaired sleep pattern / disorganization / psychological distress

Problem

Inability to cope

Non-participation in ADLs

Absence of social/familial participation

Destructive behavior

Nursing Diagnosis

Risk for self-directed/other-directed violence

Assessment

Aggressiveness / delusions, hallucinations / increased anxiety / hostility and increased anger / suicidal ideations

Problem

Self-destructive behaviors

Substance abuse

Life-threatening self- or other-directed injury

Suicide

Relationship conflicts

Nursing Diagnosis

Risk for impaired religiosity

Assessment

Sense of guilt or retribution/feelings of anger or hostility towards religion/withdrawal from others and religious activities/dependence on alcohol or medications/feelings of hopelessness/lack of motivation/lack of energy

Problem

Lack of social interaction

Spiritual crises

Personal crises

Ineffective coping or support

Nursing Diagnosis

Risk for ineffective self-health management

Assessment

Verbalized difficulty with regulation/integration of one or more prescribed regimen / verbalized not taking action to include treatment regimen in daily routines/acceleration of illness symptoms

Problem

Mistrust on regimen and/or healthcare personnel

Powerlessness

Development of preventable complications

Progression of illness

Nursing Diagnosis

Risk for post-trauma syndrome

Assessment

Palpitations / headaches / irritability / hypervigilance or exaggerated startle response / difficulty in concentrating / aggression / denial / repression / detachment / altered mood states / compulsive behavior / anxiety

Problem

Difficulty with interpersonal relationships

Dependence on others

Serious injury or threat to self

Inappropriate expression of emotions

Dysfunctional family role

Nursing Diagnosis

Disturbed thought processes

Assessment

Ideas of reference / hallucinations / delusions / nonreality-based thinking / inaccurate interpretation of the environment / memory deficit / disorientation / hypervigilance or hypovigilance / distractibility / egocentricity / confabulation / inappropriate social behavior

Problem

Disruption in cognitive operations and activities

Injury to self or others

Malnutrition

Difficult interpersonal relationships

Ineffective communication

Mistrust/suspicion of others and surroundings

Nursing Diagnosis

Social isolation

Assessment

Feelings of rejection or loneliness/insecurity in public/absence of supportive SOs / hostility projected in voice or actions / withdrawn / no eye contact/preoccupation with own thoughts / seeking to be alone/repetitive, meaningless actions

Problem

Altered physical appearance and mental status

Altered state of well-being

Unacceptable social behaviors

Inability to engage in personal relationships

Nursing Diagnosis

Interrupted family processes

Assessment

Expressions of conflict within the family / less satisfaction with family / somatic complaints such as headaches, abdominal pain, palpitations/changes in stress-reduction behaviors/nonparticipation in family activities / unavailable emotional support/changes in intimacy

Problem

Changes in family relationships or functioning

A shift in family roles

Lack of communication

Difficult interpersonal relationships

Nursing Diagnosis

Self-care deficit

Assessment

Inability to manage ADLs / unkempt appearance / cognitive impairment/inability to wash body parts / impaired ability to put on or take off clothing/difficulty completing toileting tasks/inability to eat independently / decreased strength/loss of muscle control and coordination

Problem

Depression

Loss of mobility

Discomfort

Musculoskeletal or neuromuscular impairment

References

1. Balasundaram, P., & Santhanam, P. (2022, January 10). Eating Disorders – StatPearls. NCBI. Retrieved March 3, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK567717/
2. Bruce, M. L. (2002, August 1). Psychosocial Risk Factors for Depressive Disorders in Late Life. Biological Psychiatry, 52(3), 175-184. https://doi.org/10.1016/S0006-3223(02)01410-5
3. Crowther, R., Marshall, M., Bond, G. R., & Huxley, P. (2001, April 23). Vocational rehabilitation for people with severe mental illness. NCBI. Retrieved March 6, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170889/
4. Dattani, S., Ritchie, H., & Roser, M. (2021, August). Mental Health. Our World in Data. Retrieved March 6, 2022, from https://ourworldindata.org/mental-health
5. Encyclopedia of Children’s Health. (2022). Psychosocial Personality Disorders – symptoms, meaning, average, Definition, Description, Demographics, Causes and symptoms. Encyclopedia of Children’s Health. Retrieved March 3, 2022, from http://www.healthofchildren.com/P/Psychosocial-Personality-Disorders.html
6. Flanagan, S., Damery, S., & Combes, G. (2017, September 29). The effectiveness of integrated care interventions in improving patient quality of life (QoL) for patients with chronic conditions. An overview of the systematic review evidence. NCBI. Retrieved March 6, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622519/
7. Iseselo, M. K., Kajula, L., & Yahya-Malima, K. I. (2016). The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban-based study in Dar es Salaam, Tanzania. BMC Psychiatry, 16(146). DOI 10.1186/s12888-016-0857-y
8. Mahomed, F., & Machin, K. (2020, June 9). Peer Support in Mental Health: Literature Review. NCBI. Retrieved March 6, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7312261/