The effect of low social support on short-term prognosis in patients following a first myocardial infarction

The objectives of the current study were (1) to assess adjustment in patients following a first myocardial infarction (MI) at 9 months compared with 4-6 weeks post-MI, (2) to examine the availability of and satisfaction with social support over time, and (3) to determine separate baseline psychosocial predictors of recurrent cardiac events. A questionnaire assessing post-traumatic stress disorder, anxiety, depression, health complaints, and social support, was distributed to consecutive patients 4-6 weeks and 9 months post-MI. Prior to assessment at follow-up, 8 (7%) of 112 patients had dropped out, and two had died due to cardiac causes. Objective clinical measures were obtained from medical records. There was an improvement in somatic and cognitive symptoms at follow-up, but no change in symptoms of arousal, depression, and anxiety. Half of the patients were afraid of a recurrent MI. There was a significant decrease in social support between baseline and follow-up, and lower social support at baseline was associated with a 10% increased risk of recurrent cardiac events at follow-up (OR: 0.90; 95% CI: 0.84 to 0.97) adjusting for all other variables. Some patients still experienced difficulties with psychosocial adjustment 9 months post-MI despite a reduction in somatic and cognitive symptoms. Social support decreased over time, which may have serious prognostic implications; lower social support at baseline was an independent predictor of recurrent events at 9 months. An important step for future research will be to investigate how social support can be enhanced in patients at risk.     

Social support and emotional adjustment during and after a severe life event: A study of wives of myocardial infarction patients

Abstract

This paper examines the relationship between quantitative and qualitative indicators of social support and anxiety. depression and use of health services in a sample of 37 wives of myocardial infarction (MI) patients. In a prospective design, the wives were interviewed during the acute phase of the illness, three months and 10 years post index-MI. Congruent with previous research, the quantitative aspect of social support, defined as number of persons giving help, was unrelated to adjustment, whereas qualitative aspect of social support, defined as the wives' dissatisfaction with social support, was associated with depression and use of health services. The observed association indicated, however, an effect in the opposite direction of the social support model. The findings were unexpected and may be due to a small sample. An alternative explanation is that long-term relationship between depression and social support is more complex, and more long-term studies are needed in this field.     

Social support and recovery from surgery

This study examined the relationship of naturally occurring social support from the spouse with the preoperative anxiety and postoperative recovery of 56 male coronary-bypass patients. Patients were divided into groups based on whether the overall quality of their marital relationship was perceived to be relatively good or bad at the time of surgery and on whether they received relatively high or low spouse support in the hospital (defined in terms of frequency of visits). A fifth group (n = 16), consisting of unmarried patients, enabled additional comparisons. The results indicated that, although groups were essentially equivalent in preoperative physical status, married patients who received higher hospital support took less pain medication and recovered more quickly than their low-support counterparts. In contrast, perceived quality of the marital relationship was a relatively insignificant factor. Speed of recovery for unmarried patients was generally slower than for married, high-support patients and faster than for married, low-support patients.     

Mismatches in social support and psychosocial adjustment to breast cancer.

Emotional support is known to provide psychosocial benefits for women with breast cancer, but women can experience a mismatch between support that is wanted and support that is received from their personal supporter. The role of wanted and unwanted support in psychosocial adjustment was examined in 79 women recovering from breast cancer. Four distinct patterns of desired support actions were found using cluster analysis. Patterns of wanted support were not related to better or worse psychosocial adjustment. However, a misalignment of support between the provider and the receiver significantly influenced psychosocial adjustment, and unwanted but received support (support commission) was uniquely associated with poor psychosocial adjustment. Clinical interventions using the support instrument could help match support providers' actions to receivers' preferences.     

Brief strategic therapy in first myocardial infarction patients with increased levels of stress: a randomized clinical trial

Background: Little is known about the impact of interventions targeting chronic stress levels on clinical outcomes among myocardial infarction (MI) patients with increased levels of stress. Objectives: To examine the impact of the addition of brief strategic therapy (BST) to usual care (UC) on clinical outcomes in first MI patients with increased levels of stress. Design: Eighty-one patients were randomly assigned to BST in conjunction with UC (medical treatment, risk factor information, and guidance on unhealthy behavior change) or to UC. Methods: The outcome measures were scores on the Perceived Stress Scale, reinfarction and cardiac mortality rates, and scores on the Health Survey. Measures were taken before, post-treatment, and at two follow-ups. Results: Patients subjected to BST showed reduced perceived stress at post-treatment and maintained decreased levels at follow-ups. At 1-year follow-up, they had a lower rate of non-fatal reinfarction, and at 2.5-year follow-up, they had a lower rate of fatal reinfarction. Their mental and physical health was improved at post-treatment and this was sustained at follow-ups. Conclusion: The addition of BST to UC favorably influences the disease course after MI in patients with increased levels of stress.     

Social support and psychosocial competence: Explaining the adaptation to college of ethnically diverse students

Examined relationships among social support, psychosocial competence, and adaptation to college in a sample of 357 African American, Asian American, Latino, and white college students. Social support and active coping were significant predictors of adaptation to college, whereas locus of control was not. However, there was an interaction between ethnicity and locus of control indicating that although internal African American, Latino, and white students had higher adaptation-to-college scores than external students, the opposite was true for Asian Americans. The relationships among social support, internality, and active coping were also explored. Satisfaction with social support and internality were positively related to active coping, but locus of control and social support were unrelated. Active coping and internality were significantly related to each other for all groups except for African Americans. Although most relationships were the same across groups, these findings call attention to the role of ethnicity as a moderator of college adjustment processes.     

Knowledge and expectations: Perceived illness in myocardial infarction patients

In a study of 367 patients with myocardial infarction (MI), questionnaires were developed to assess two central aspects of perceived illness: factual and consensual illness knowledge and subjective expectations for the personal consequences of the MI. In a factor analysis, these two aspects of perceived illness were found to load on separate factors, and the patients views of the personal consequences of the MI were only moderately associated with their general cardiac health knowledge. Among a series of sociodemographic, medical, and psychological variables, including a standardized in-hospital patient education programme, the two aspects of perceived illness also proved to have different determinants. Differences in factual and consensual illness knowledge were mainly related to differences in formal education, and this aspect of perceived illness was influenced by the standardized education programme. In contrast, differences in subjective expectations were associated with levels of hopelessness. The implications for psychosocial interventions in the rehabilitation of MI patients are discussed.     

Using the common-sense model to predict risk perception and disease-related worry in individuals at increased risk for venous thrombosis.

OBJECTIVE: This study applied the Common-Sense Model (CSM) to predict risk perception and disease-related worry in 174 individuals with a genetic predisposition to venous thrombosis (thrombophilia). DESIGN: Participants completed an adapted version of the Illness Perception Questionnaire-Revised (IPQ-R) and measures assessing risk perception and worry. RESULTS: Regression analyses revealed that illness perceptions were predictors of risk perception and thrombosis worry. The hypothesis that illness perceptions mediate the relationship between a person's experience of venous thrombosis and perceived risk and thrombosis worry could not be confirmed. CONCLUSIONS: Further research should refine the IPQ-R for populations at risk of a disease and examine the value of the CSM in explaining the relationship between risk perception, worry, and health behavior.     

Social support from friends and family in a Tibetan village

Friendships are prevalent in human societies. However, it is unclear whether people rely on the same strategy to derive support from friends and relatives. In the present study, I conducted a survey to elicit the egocentric support networks of 40 village residents in a Tibetan village in Qinghai province in China. The study showed that the participants reported equal amounts of support from friends and from relatives, and they preferred a shallow strategy over a deep strategy to derive support from friends; they equally preferred the two strategies to derive support from relatives. My study suggests that even if friends compensate for the variation of kin support in quantity, friendship should not be considered as one‐for‐one substitute for kinship.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

Social support from a friend,perceived support,and social problem solving

This research combined experimental and correlational methods to investigate the effects of social support on social problem-solving effectiveness and perceived stress. During a wait period, college students were given the opportunity to work on practice items from a mildly stressful social problem-solving task, either alone or in the company of a close friend. Participants and friends were allowed to talk about the practice items but were not required to do so, and supportive transactions were tape recorded and content analyzed. All students then completed social problem-solving and perceived stress items alone. Participants who waited with friends did not show superior problem-solving effectiveness unless companions provided particular supportive behaviors. Participants with high perceived support scores rated the experiment as less stressful than those with low scores, but perceived support was not related to companions' actual supportive behaviors. The results were discussed in terms of implications for understanding the mechanisms of social support.     

Social support and immune function among spouses of cancer patients

This study investigated whether social support was related to immune function among spouses of cancer patients. Effects of depression and negative life events were examined as potential mediators. Results showed evidence of greater immunocompetence on 2 of 3 dynamic measures: natural killer cytotoxicity and proliferation response to phytohemagglutinin among spouses who reported high levels of social support. All six components of social support assessed by the Social Provisions Scale (Cutrona & Russell, 1987) were strongly related to these indices of immune function. No evidence was found for mediation by either life events or depression.     

An evaluation of support groups for patients with long-term chronic pain and complex psychosocial difficulties

There is a significant group of chronic pain patients with complex psychosocial needs who are frequent users of hospital outpatient departments and who do not participate in or benefit from traditional pain management treatments and are convinced there is a medical solution to their problems. They are a particularly challenging group of patients to help, often shunned by medical and psychological professionals. A new type of ten-session psycho-social group for these patients that is less demanding than traditional pain management group programmes is investigated. It is designed to foster the development into community-based self-help groups and reduce the need for professional support and unnecessary medical intervention. Accounts of four groups of patients who participated in support groups and successfully established their own groups is presented. To assess changes in motivation, mood and pain disability standardized questionnaire measures were given before and after group attendance. Findings suggest that patients benefited and took increased responsibility for their pain management but did not demonstrate positive changes on measures of mood or level of pain disability. Patients experienced satisfaction with the groups and established their own self-help community groups. The positive experience of participants and staff suggests further work with support groups would be productive for this group of patients.     

Interpersonal sensitivity, partner support, patient-physician communication, and sexual functioning in men recovering from prostate carcinoma

Prostate carcinoma (PC) is the most commonly diagnosed cancer in men. Treatments for localized PC are associated with side effects including sexual dysfunction, which has been linked to decrements in health-related quality of life and elevated distress levels. In this study, we examined the relationship between 2 personality traits, interpersonal sensitivity and lack of sociability, assessed by the Inventory of Interpersonal Problems (IIP; Pilkonis, Kim, Proietti, & Barkham, 1996) and recovery of sexual functioning in 121 men (M age = 60.6 years) recently treated with radical prostatectomy. Interpersonal sensitivity refers to the predisposition to perceive and elicit criticism and rejection from others; lack of sociability refers to chronic difficulties taking the initiative in interpersonal situations. After adjusting for relevant covariates, interpersonal sensitivity, but not sociability, was significantly associated with lower levels of sexual functioning. Patient-physician communication and partner perceived social support were explored as mediators of this relationship. Although interpersonal sensitivity was significantly associated with both poorer patient-physician communication and lower levels of partner support, the results did not support mediation. This study provides preliminary evidence that certain IIP-assessed interpersonal styles may complicate the recovery of sexual functioning after surgical treatment for PC.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

Relationships at work and psychosocial risk: The feeling of belonging as indicator and mediator

Introduction/objectiveThis article highlights the links between, one the one hand, the feeling of belonging to the work group and, on the other hand, the tension and burnout experienced, amongst 444 employees in a hospital centre.MethodologyThe methodology is based on the use of 4 self-administered questionnaires (Karaseck's JCQ, Maslach's MBI, Quality of relationships with parties concerned and Feeling of belonging) and is based on correlations and multiple regressions.ResultsThe results highlight the fact that relationships perceived as generally relaxed with the different people concerned (care team, doctors, management and administrative staff), predicted Karaseck's three dimensions and those assessed by the Maslach Burnout Inventory (MBI). Similarly, the feeling of belonging predicted all these variables. Most of the time it played a mediating role between the perceived quality of relationships and the different measures of well-being at work. So, the feeling of belonging seems to be a variable of interest, which can play a key role in the prevention of suffering at work.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

Social support and recovery from sexual assault: A review

This article reviews empirical studies of social support and sexual assault in order to evaluate the empirical evidence for the role of support in recovery from mental health and physical health consequences of this crime. Evidence is mixed with regard to the effect of social support, with some studies showing no significant effect and others showing positive effects of support on postassault recovery. Negative aspects of social relations (e.g., negative social reactions), while less studied, show consistent and strong negative effects on sexual assault victims. Factors that may modify the relationship of support and sexual assault outcomes are reviewed, including: assault characteristics, specific support provider factors, victim coping and functioning, preassault support network, and other postassault experiences, such as criminal justice system involvement. Limitations of existing research are noted. Suggestions for future research on the relationship of social support and sequelae of sexual assault are provided, with a focus on development of support network interventions for victims.     

Social support, locus of control, and depressive symptoms in hemodialysis patients

This study aimed to reveal how social support and psychological well-being association might differ with locus of control orientation for chronically ill patients receiving a restrictive and unpleasant medical treatment (i.e., hemodialysis). Data were collected from 104 hemodialysis patients. After controlling for the variance accounted for by gender and duration of dialysis, for patients with internal locus of control, lack of "perceived social support" was found to be associated with depressive symptoms. On the other hand, for patients with external locus of control, the same analysis revealed that lack of "satisfaction from the received social support" was associated with depressive symptoms. Thus, for hemodialysis patients the variables associated with depressive symptoms varied with their locus of control orientations. Furthermore, the present study underlined the importance of considering different aspects of social support while studying with chronically ill patients.     

Subjective underemployment and psychosocial stress: the role of perceived social and supervisor support.

The purpose of this study was to examine the effects of subjective underemployment on psychosocial stress. The moderator effects of perceived social and supervisor support were also investigated. Data were collected during the summer of 1987 in a public utility governmental agency in the United States. The sample size was 212 with a 71% response rate. Multiple regression analysis was used to examine the relationship between subjective underemployment and psychosocial stress. As expected, the results revealed a significant positive relationship between subjective underemployment and five indexes of psychosocial stress. The interactions between subjective underemployment and social and supervisor support were not significant; however, the relationships were in the expected directions. Supervisor support was positive and significantly related to psychosocial stress, but social support was not.