62 Chapter 2 other intervention characteristics (e.g., individual versus group approaches and intervention duration) in psychiatric patients in general, it is still unclear whether the effects are different in specific subgroups of patients. Moreover, given the wide confidence intervals of effect sizes in categories of informal and formal interventions found in this study, it could be possible that some patient groups might benefit more from informal approaches, whereas others could benefit more from formal approaches. Therefore, future studies are recommended that compare informal approaches consisting of volunteers (Brown et al., 2014), peer supporters, or natural supporters (SchwarTz & van Dam, 2020) to formal approaches with professional caregivers in the same study. In addition, given the consistently found small effects, future research is warranted to further improve the effectiveness of social network interventions for psychiatric patients (Beckers et al., 2022; Siette et al., 2017). We highlight two potential directions for development and research. First, social network interventions for psychiatric patients could be improved by extending the duration, as improving real life social networks of psychiatric patients with chronic and complex problems is considered a time-consuming task. Most of the social network interventions (70%) examined in this study were shorter than 12 months. Additionally, some evidence of stronger effects in interventions with longer durations on substance use was found, but the unique contribution of intervention duration was not demonstrated. Therefore, further research with more focus on long-term social network interventions is suggested. Second, a focus on mutual support (e.g., support from a volunteer or peer towards a patients and vice versa) in social network interventions could promote a sense of purpose and belonging or mattering as well as self-esteem, both of which are suggested important mechanisms positively influencing the relationship between social networks and mental health (Thoits, 2011). Moreover, a recent meta-analysis demonstrating strong evidence of the effectiveness of family interventions on relapse prevention in patients with schizophrenia, showed that family interventions in addition with mutual skills training support were most effective (Rodolico et al., 2022). Finally, to increase the methodological quality of studies, researchers are advised to use similar and validated outcome measures on specific outcome categories, such as the quantity, structure, and quality of positive as well as negative social networks, and self-perceived experiences of relationships (Wang et al., 2017).
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