AUTHOR=Fekete Christine , Tough Hannah , Arora Mohit , Hasnan Nazirah , Joseph Conran , Popa Daiana , Strom Vegard , Middleton James 

TITLE=Are Social Relationships an Underestimated Resource for Mental Health in Persons Experiencing Physical Disability? Observational Evidence From 22 Countries

JOURNAL=International Journal of Public Health

VOLUME=Volume 66 - 2021

YEAR=2021

URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2021.619823

DOI=10.3389/ijph.2021.619823

ISSN=1661-8564

ABSTRACT=Background: Poor mental health poses a major burden of disease in people experiencing physical disabilities. To advance evidence on modifiable resources to support mental health, we investigated associations between social relationships and mental health in people with spinal cord injury (SCI). 
Methods: Data from 12,330 participants of the International SCI community survey (InSCI) from 22 countries were analyzed. Structural (partnership status, living situation) and qualitative aspects of social relationships (belongingness, relationship satisfaction, problems with social interactions) were regressed on the SF-36 mental health index (MHI-5), stratified by countries and for the total sample using multilevel models. 
Findings: Qualitative aspects of social relationships were consistently related to clinically relevant higher MHI-5 scores and lower risk of mental health disorders (MHI-5 >56). Partnership status and living situation were inconsistently associated with mental health in our sample. 
Conclusions: This study provides evidence that qualitative aspects of social relationships are important resources for mental health. Interventions to establish and maintain a high quality of relationships should be considered in rehabilitation programs to reduce long-term mental health problems in persons experiencing physical disabilities.