197 Summary and General discussion 7 preliminary evidence of distinct effects in females versus males and patients with or without primary substance use disorders and comorbid disorders. Therefore, the research in this dissertation is in line with a large body of research, emphasizing that there is no effective “one-size-fits-all” social network intervention, encouraging a shift towards personalized approaches for psychiatric patients (Cassidy et al., 2019; Heaney & Israel, 2008; Priebe et al., 2020; Purgato, Singh, Acarturk, & Cuijpers, 2021; Siette et al., 2017). In this section, we briefly discuss the possible influence of sex, substance use, and comorbidity, respectively, on treatment effects of social network interventions among forensic psychiatric patients. Noteworthy, the findings stem from exploratory analyses, examining small subgroups of patients, and therefore need to be interpreted with caution. Sex To the best of our knowledge, this is the first study providing evidence for differential treatment effects of social network interventions in males compared to females (chapter 2 and 5). However, sex differences in social support have been previously debated in research (Matud, Ibañez, Bethencourt, Marrero, & Carballeira, 2003). Although both males and females benefit from social support, research showed that the relationship between social support and wellbeing was more important in females compared to males (Antonucci & Akiyama, 1987; Schwarzer & Leppin, 1989). Additionally, compared to males, females tended to use more support from family and friends to cope with stressful situations (Day & Livingstone, 2003). In line with this, our findings in chapter 2 suggested that interventions aimed at improving supportive social networks might be more effective in reducing psychiatric symptoms in female psychiatric patients. Furthermore, the findings could indicate that females were more susceptible to these interventions, as social support was found to have a greater impact on mental health in females. In contrast, in chapter 5 unfavorable treatment effects were found in female forensic psychiatric patients receiving the social network intervention compared to usual care, while benefits were found in males. Moreover, we also noticed more study dropout (i.e., failed measurements) in female patients. The contrasting findings in chapter 2 and 5 could be explained by the different study samples (i.e., psychiatric patients and forensic psychiatric patients, respectively). Although speculative, the negative findings among females of a forensic psychiatric population could be explained by the gender paradox (Cao, Sun, Dong, Yao, & Huang, 2018; Loeber & Keenan, 1994), as these females possibly had more complex problems that prevented them from participating in the study and intervention and impeded treatment effects.
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