Social Support and Social Isolation in Psychiatric Disorders
I have led several studies that demonstrated the potent effect of social contact and relationships on the risk for and course of psychiatric disorders. One project looked at the mode of social contact and depression among a nationally representative sample of older adults. This body of work has often used longitudinal observational data to demonstrate the beneficial impact of social support, as well as the detrimental influence of negative social interactions. Results have focused in particular on major depressive disorder and suicide risk. This work has been supported by the Robert Wood Johnson Foundation and my role as a Clinical Scholar and been by highlighted by national media. I served as the primary investigator on all of these studies. I am currently investigating how depression care for military veterans can be improved by involving their close relations. I am also exploring the use of social media platforms to engage veterans in mental health care.
- Teo AR, Choi H, Andrea SB, Valenstein M, Newsom JT, Dobscha SK, Zivin K. Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey. J Am Geriatr Soc. 2015 Oct;63(10):2014-22. PubMed PMID: 26437566.
- Shute N. Mate Doesn't Have Your Back? That Boosts Depression Risk. [Internet]. National Public Radio. 2013 May. Available from: http://www.npr.org/sections/health-shots/2013/05/01/180290358/mate-doesnt-have-your-back-that-boosts-depression-risk.
- Teo AR, Lerrigo R, Rogers MA. The role of social isolation in social anxiety disorder: a systematic review and meta-analysis. J Anxiety Disord. 2013 May;27(4):353-64. PubMed PMID: 23746493.
- Teo AR, Choi H, Valenstein M. Social relationships and depression: ten-year follow-up from a nationally representative study. PLoS One. 2013;8(4):e62396. PubMed PMID: 23646128; PubMed Central PMCID: PMC3640036.
Suicide Prevention in At-Risk Health Populations
In more recent work I have been exploring how social support and social networks can be effectively used to mitigate risk of social isolation and suicide. I have focused on applications in two distinct, at-risk communities: military veterans and ethnic minorities. The work in veterans is directly applicable to intervention development in real-world, complex health care systems (e.g., the VA), and the has included community-based outreach and use of my cultural and linguistic fluency in Japanese. I served as the primary investigator or co-investigator on all of these studies.
- Denneson LM, Teo AR, Ganzini L, Helmer DA, Bair MJ, Dobscha SK. Military Veterans' Experiences with Suicidal Ideation: Implications for Intervention and Prevention. Suicide Life Threat Behav. 2015 Aug;45(4):399-414. PubMed PMID: 25367753.
- Teo AR, Stufflebam KW, Lu F, Fetters MD. Use of a public film event to promote understanding and help seeking for social withdrawal. Asia Pac Psychiatry. 2015 Jun;7(2):157-63. PubMed PMID: 25427837.
- Teo AlanR. Question, Persuade, and Refer: How you can help someone in crisis. Center for Japanese Studies, University of Michigan; 2015 February 06; Ann Arbor, MI.
- Dobscha SK, Denneson LM, Kovas AE, Teo A, Forsberg CW, Kaplan MS, Bossarte R, McFarland BH. Correlates of suicide among veterans treated in primary care: case-control study of a nationally representative sample. J Gen Intern Med. 2014 Dec;29 Suppl 4:853-60. PubMed PMID: 25355088; PubMed Central PMCID: PMC4239287.
Social Withdrawal, Hikikomori and Psychiatry Across Cultures
As one way to understand how social relationships impact mental health, my work has examined an extreme variant of social withdrawal called hikikomori. These publications provided a cogent review of the extant literature, identified pressing research gaps and questions based on my synthesis of the literature, and contributed some of the very first peer-reviewed research studies on hikikomori in the English medical literature. This work has been widely disseminated by national and international media, established my reputation as an international expert on hikikomori, and inspired interest amongst a new generation of researchers in the nascent field. I served as the primary investigator on all of these studies. I am currently developing and testing a scale to detect and measure hikikomori.
- Kato TA, Kanba S, Teo AR. Hikikomori: experience in Japan and international relevance. World Psych. 2018 Feb;17(1):105-106. PubMed PMID: 29080513.
- Wong PWC, Lin LL, Li TMH, Kato TA, Teo AR. Does hikikomori (severe social withdrawal) exist among young people in urban areas of China? Asian J Psychiatr. 2017 Dec 13;30:175-176. PMID: 29352535.
- Teo AR, Stufflebam K, Saha S, Fetters MD, Tateno M, Kanba S, Kato TA. Psychopathology associated with social withdrawal: Idiopathic and comorbid presentations. Psychiatry Res. 2015 Jul 30;228(1):182-3. PubMed PMID: 25977071.
- Teo AR, Fetters MD, Stufflebam K, Tateno M, Balhara Y, Choi TY, Kanba S, Mathews CA, Kato TA. Identification of the hikikomori syndrome of social withdrawal: Psychosocial features and treatment preferences in four countries. Int J Soc Psychiatry. 2015 Feb;61(1):64-72. PubMed PMID: 24869848.
- Wang SS. The Fight to Save Japan’s Young Shut-Ins. [Internet]. Wall Street Journal. 2015 Jan. Available from: http://www.wsj.com/articles/the-fight-to-save-japans-young-shut-ins-1422292138.
- Teo AR. A new form of social withdrawal in Japan: a review of hikikomori. Int J Soc Psychiatry. 2010 Mar;56(2):178-85. PubMed PMID: 19567455; NIHMSID: VAPA788435; PubMed Central PMCID: PMC4886853.
Risk Assessment in Mental Health Settings
Combining both my insights as a clinician and skills as a researcher, I have also contributed to the science of risk assessment in mental health settings. Assessment of risk of suicide and risk of harm to others are both essential roles of clinicians in psychiatric settings. Our work has examined the accuracy of methods to identify veterans and military personnel at risk for suicide and suicide attempts, and suggested to VA policy makers that use of no single risk assessment method has been sufficiently replicated in research to support use in routine clinical practice. Other work that has been disseminated by the national press found that violence risk assessment conducted by psychiatric resident physicians is no better than chance.
- Nelson HD, Denneson L, Low A, Bauer BW, O'Neil Maya, Kansagara D, Teo AlanR. Systematic review of suicide prevention in U.S. military veterans. VA ESP Project. 2015 Nov; #05-225.
- Hamilton Jon. Mental Health Gun Laws Unlikely To Reduce Shootings. [Internet]. NPR. 2013 Jan. Available from: http://www.npr.org/sections/health-shots/2013/01/17/169529792/mental-health-gun-laws-unlikely-to-reduce-shootings.
- Healy M. Predicting violent behavior: not guesswork, but far from certain. [Internet]. Los Angeles Times. 2012 Dec. Available from: http://articles.latimes.com/2012/dec/17/news/la-heb-predicting-violent-behavior-20121217.
- Teo AR, Holley SR, Leary M, McNiel DE. The relationship between level of training and accuracy of violence risk assessment. Psychiatr Serv. 2012 Nov;63(11):1089-94. PubMed PMID: 22948947; NIHMSID: NIHMS788421; PubMed Central PMCID: PMC4907265.