Subjective well-being, general self-efficacy and coping with stress in former psychiatric patients preparing for the peer support role: an exploratory study

Over the last few decades, firm steps have been taken across the USA and European countries towards the deinstitutionalization of psychiatric health care [1, 2]. There is a broad consensus on the need to move away from treatment in large psychiatric hospitals towards comprehensive community-based care [3, 4]. In Poland, preparations are also underway to change the psychiatric care system [5]. In 2018, community-based Mental Health Centers were launched on a pilot basis and preparations began to sanction the profession of peer worker (PW). The aim of the training program is to build the PW’ abilities in providing support and educating others with regard to healthy lifestyle or mental hygiene and thus to help them to lead meaningful lives in the community. Similar to countries such as the USA [1, 6], Germany, UK, Netherlands, Norway, Slovenia, Sweden [7], Canada, Australia, New Zealand [8] “Experienced Involvement” (EX-IN, peer counselling) programs are predicated on the notion that people with similar experiences can support each other in situations of emotional stress. It was Harry Stack Sullivan who first recruited people recovering from schizophrenia to become his assistants at the clinic for people affected by schizophrenia and nowadays the development of peer supporting in mental health services has spread to Asia, South America and Africa [9]. Although peer support is usually provided independent of conventional mental healthcare, the idea in Poland is that candidates for PWs, after taking the training, would be formally offered a job and become a part of the health system structure.

Pursuing a PW role is in line with the assumptions of empowerment, as it makes it possible to strengthen the supporter’s resources and to increase the psychological benefits of the individual receiving the help [10, 11]. The values attributed to PW support include a relationship based on a balance of power, mutual identification, a comprehensive understanding of the mental crisis, with a focus on the potential positive aspects of the situation, building a safe and trust-inspiring interpersonal relationship between the supporter and the supported individual, based on shared experience [7].

The study presented in this paper focuses on subjective well-being (SWB), and on its possible correlates, in former psychiatric patients preparing for a role. PWs use their own experience of overcoming distress and their own abilities to support others who are currently struggling with crisis. The reason for such a study results from the perspective that the EX-IN training for PWs includes self-developmental aspects which should influence their capacity to provide support and to raise their quality of life. Assessing level of SWB and its correlates among participants of PW training may be helpful for designing further work-in-group programs for strengthening particular personal competencies in using psychological resources.

Subjective well-being is defined as “a person’s cognitive and affective evaluation of his or her life” [12]. This is a subjective state of general satisfaction with life [13], associated with a sense of happiness and self-fulfillment [14], making it possible to adapt in an optimum way to changing life conditions [15]. Ryff [16, 17] proposes an eudemonistic approach to SWB, which can be described in several dimensions. The SWB of peer supporters who, having experienced a mental crisis and the resulting difficulties, intend to help other people professionally, is particularly important.

Research into the determinants of SWB variability over the course of life has not yielded unambiguous results. According to longitudinal studies [18], important life events (and a stay in a psychiatric ward may be considered as such) determine a similar percentage of variance in subjective well-being as intra-personal determinants. Extent of psychopathological symptoms was found to be inversely related to life quality and some authors suggest that SWB may not necessarily be inferred from objective life circumstances [18, 19]. According to Pavot and Diener [13], life events have a rather short-term impact on SWB because people have an ability to adapt to new life conditions which is regulated to a greater extent by temperamental and personality-related factors.

Equally important may be other psychological resources influencing well-being, described by Taylor and Broffman [20], which become particularly significant when individuals face challenges [21, 22]. Literature review, especially the content of some theories of optimal human functioning, e.g. social-cognitive theory [23, 24] or self-determination theory [25] which underline the importance of a sense of agency when dealing with life problems and an analysis of reports so far on the determinants of positive re-adaptation of individuals discharged from inpatient psychiatric treatment [26] led us to identify a variable which might correspond to important psychological resources for maintaining a high level of SWB in individuals preparing for a PW role. This variable is perceived self-efficacy, described as an important resource factor in stress appraisal process.

Perceived self-efficacy, understood as an individual’s conviction concerning their personal ability to meet diverse conditions of the specific task, leading to the achievement of the intended results [27], reflects optimistic self-confidence and the belief that one can effectively cope with adversities in various areas of social functioning [28]. People with low self-efficacy have a tendency to stress out easily and doubt their own potentials compared to those with high self-efficacy level [29]. Some studies found that general self-efficacy beliefs are predictors of mastery [30] and a determinant of SWB or a factor related with or a mediator between SWB and general health [31]. It was found that mental health problems were associated with a lack of confidence which limited everyday activities and affected opportunities both in employment and relationships [32]. Therefore, perceived self-efficacy, which is connected to setting goals for oneself and rising from failure, can be considered both as a significant psychological resource and as a factor of positive mental resilience.

Additionally, adopting stress management strategies may be significant for SWB, especially in the case of strategies focused on task-based approaches to the problem. The situation of mental crisis and psychiatric hospitalization is a very stressful, difficult and complex experience that reduces quality of life [33, 34]. Isolation from one’s natural environment, strict discipline and lack of intimacy cause a complete change in the life perspective of an individual staying in hospital, leading to stress [35]. Therefore, a mental crisis and the related hospital treatment may directly compromise the individual’s SWB, just like the post-hospitalization period, which is a time of particular risk of adaptation difficulties [36]. Exposure to the stigma of mental illness is a significant impediment [37]. Studies have shown a correlation between emotional reactions and the stress related to the stigma caused by psychiatric hospitalization with quality of life and self-esteem [38]. The manner in which psychiatric hospital patients manage to return to participation in day-to-day social life may determine their recovery process and potential improvement in SWB. The choice of an appropriate strategy for coping with stress by candidates for a PW role is also important because they will become role models for the individuals they support.

Although the well-being of psychiatric hospital patients has been given research attention [39], it has not been studied in individuals preparing for a PW role. The study presented in this paper aims to fill the gap. It is one of the first studies among individuals who decided to take on a PW role and the very first study of its kind in Poland. Its purpose was to examine whether the participants of a PW workshop differed in terms of SWB and, if so, the question was asked whether those who differed in the level of SWB also differed in level of perceived self-efficacy, in terms of the strategies for coping with stress which they adopted and in sociodemographic and medical data.

The results made it possible to distinguish, among the PW workshop participants who were studied, two clusters of individuals differing significantly in terms of the SWB level. The existence of significant differences was also confirmed between individuals from the groups thus distinguished in terms of psychological resources, i.e. traits selected because of their potential significance for SWB, such as perceived self-efficacy and a tendency to apply strategies for coping with stress relying on active coping, positive reframing, behavioral disengagement and self-blame.

Referring to the results of the study on SWB conducted by Ryff [16] and to her descriptions of the SWB dimensions, it can be concluded that the respondents from cluster 1 are more autonomous and self-directed and they yield to outside pressure to a smaller extent than those belonging to cluster 2. They also judge themselves through personal standards, rather than depending on societal standards. They have a greater sense of environmental mastery, awareness of their own competences and a greater ability to transform the environment in accordance with values that are important to them, so they may find it easier to cope with the requirements coming from the environment. Individuals from this cluster also have a greater ability to fulfill their potential and to improve their skills compared to those from cluster 2. They also have more positive relations with others and they are more capable of trusting others and making friends compared to those belonging to cluster 2. They find it easier to control their own lives, pursue their goals, and find meaning in what they do. Respondents from cluster 1 accept themselves more, pursue self-fulfillment to a greater extent, and may also find it easier to accept their own flaws and see the advantages, which favors mental health, strengthens a realistic view of oneself, and that may give them greater resistance to stigma.

The results indicate that the individuals from the cluster scoring significantly higher on the Subjective Well-Being Scale also have significantly higher self-efficacy scores than the individuals from the other cluster. This continues to be in line with previous studies pointing to positive correlations between SWB and perceived self-efficacy [45]. Effective control of one’s own actions and achievement of goals, using active coping and planning strategies, connected with self-efficacy [27], may be an important element of recovery and of internal increasing of mental strength, and thus of a sense of general satisfaction, which is of key importance in the concept of SWB, and an especially significant one for future peer supporter staff, as agency is immanent to the PW role.

It seems that the presence of dispositions and traits such as activity, tendency to positive reframing, self-confidence, self-efficacy and satisfaction with one’s actions is also desirable in the PW role, given that providing professional help requires confidence in one’s own resources and frequent initiation of actions. According to the results, individuals from the cluster scoring higher on the SWB scale also adopt the strategy for coping with stress consisting in behavioral disengagement and self-blame much less frequently.

Higher resourcefulness of subjects from cluster 1 seem to be proved also by other differences between them and subjects from cluster 2: the significantly higher number of persons with higher education and with a job in cluster 1 may also suggest that they have other resources which respondents belonging to cluster 2 may be deprived of. There is also a significantly higher proportion of women in the cluster 1 than in the cluster 2, which may be important. With such a small number of respondents, however, cautious conclusions should be drawn regarding this result.

This preliminary analysis shows that there are statistically significant differences between candidates for PW role. The respondents differ significantly in terms of SWB. Those with higher SWB also have higher perceived self-efficacy, less often cope with stress by refraining from an attempt to resolve the difficult situation and blaming themselves, and are more determined to use positive reframing strategy, notice the optimistic aspects of the situation and actively fight. Continuation of the study will be possible after further PW trainings are launched.