Associations between social support and stroke survivors’ health-related quality of life—A systematic review

Objective

Social support to stroke survivors has been recognized as an important determinant of their health-related quality of life (HRQoL), but this relationship is not clarified to date. More insight in the relationships between various types (i.e. emotional, instrumental, or informational support) and sources (i.e. partner, children) of social support and HRQoL might target post-stroke educational and counseling interventions to strengthen patient's social networks and supportive relationships.

Methods

Systematic review.

Results

11 original articles could be included. Most of these articles studied the overall perceived social support without further specification of type or source. They show a positive relation between perceived social support and stroke survivors’ HRQoL. Relations between perceived social support and HRQoL seems to be more often significant and were stronger than relationships between specific social support types or sources and HRQoL.

Conclusion

Due to the small number of studies and the heterogeneity in methods of assessing social support, a clear statement about the specific influence of social support source or type could not be made.

Practice implications

Attention should be paid to promoting social support on the short and long term. Further research is needed to clarify the influence of social support type and source.     

Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain

Background

Economic recession affects quality of life by increasing rates of mental disorders in particular. Social support can be an important protective factor.

Aim

To estimate the impact of being personally affected by an economic crisis on health-related quality of life (HRQoL), taking into account the possible buffering effect of perceived social support.

Design and setting

Data from the first wave (March 2012 to November 2012) of the ‘Social Support and Quality of Life Study’, a longitudinal study carried out in a primary health care centre in a deprived neighbourhood of Barcelona, Spain.

Method

A total of 143 participants were assessed using the 12-item Short-Form Health Survey, the List of Threatening Experiences and the Duke Social Support scales. The effect of economic crisis on mental and physical HRQoL was assessed using ordinary least squares regression models to test the interaction between social support and having experienced an economic crisis.

Results

There was no statistical association between having suffered an economic crisis and physical HRQoL. The interaction between social support and economic crisis was also tested without finding any statistical association. An interaction was detected between social support and economic crisis in relation to mental HRQoL; those who had low levels of social support and had also experienced an economic crisis had the lowest levels of mental HRQoL.

Conclusion

Social support constitutes a safety net that offers protection against the adverse effect of economic recessions on mental health. Primary care professionals are in a key position to promote social activities and to strengthen social networks in the community.     

Psychiatry: life events and social support in late life depression

OBJECTIVES:

To examine the association of life events and social support in the broadly defined category of depression in late life.

INTRODUCTION:

Negative life events and lack of social support are associated with depression in the elderly. Currently, there are limited studies examining the association between life events, social support and late-life depression in Brazil.

METHODS:

We estimated the frequency of late-life depression within a household community sample of 367 subjects aged 60 years or greater with associated factors. “Old age symptomatic depression” was defined using the Composite International Diagnostic Interview 1.1 tool. This diagnostic category included only late-life symptoms and consisted of the diagnoses of depression and dysthymia as well as a subsyndromal definition of depression, termed “late subthreshold depression”. Social support and life events were assessed using the Comprehensive Assessment and Referral Evaluation (SHORT-CARE) inventory.

RESULTS:

“Old age symptomatic depression” occurred in 18.8% of the patients in the tested sample. In univariate analyses, this condition was associated with female gender, lifetime anxiety disorder and living alone. In multivariate models, “old age symptomatic depression” was associated with a perceived lack of social support in men and life events in women.

DISCUSSION:

Social support and life events were determined to be associated with late-life depression, but it is important to keep in mind the differences between genders. Also, further exploration of the role of lifetime anxiety disorder in late-life depression may be of future importance.

CONCLUSIONS:

We believe that this study helps to provide insight into the role of psychosocial factors in late-life depression.     

Development and validation of the online social support for smokers scale

Background

Social networks play an important role in smoking. Provision of social support during cessation is a cornerstone of treatment. Online social networks for cessation are ubiquitous and represent a promising modality for smokers to receive and provide the support necessary for cessation. There are no existing measures specific to online social support for smoking cessation.

Objective

The objective was to develop a measure of social support to be used in online smoking cessation treatment research.

Methods

Initial items for the Online Social Support for Smokers Scale (OS4) were based on existing theory and scales delineated in various taxonomies. Preliminary field analysis (N = 73) was conducted on 23 initial items to optimize the scale. Further development was conducted on a refined 15-item scale in the context of a large randomized trial of Internet and telephone cessation treatment with follow-ups at 3, 6, 12, and 18 months. In all, 1326 participants were randomized to an enhanced Internet arm that included a large online social network; psychometric analyses employed 3-month follow-up data from those reporting use of the enhanced Internet intervention at least once (n = 873). Items were subjected to a factor analysis, and the internal consistency reliability of the scale was examined along with construct and criterion validity. Other measures used in the study included demographics, nicotine dependence, partner support for cessation, general social support, social integration, stress, depression, health status, online community use, Internet use behaviors, intervention satisfaction, and 30-day point prevalence abstinence.

Results

The final 12-item OS4 scale demonstrated high internal consistency reliability (Cronbach alphas .86-.89) across demographic and smoking strata of interest. The OS4 also demonstrated good construct and criterion validity, with the directionality of the observed associations providing support for most a priori hypotheses. Significant Pearson correlations were observed between the OS4 and the Partner Interaction Questionnaire (PIQ) Positive subscale (ρ = .24, P < .001). As hypothesized, participants with the highest OS4 scores were more likely to have actively participated in the enhanced Internet community and to have high levels of satisfaction with the enhanced Internet intervention. In logistic regression analyses, the OS4 was highly predictive of 30-day point-prevalence abstinence at 6, 12, and 18 months (all P values <.001). The odds of abstinence at 6 months rose by 48% for each standard unit increase in online social support (95% confidence interval [CI] 1.17 - 1.71), dropping only slightly to 37% at 12 and 18 months (95% CI 1.17 - 1.59).

Conclusions

The OS4 is a brief, reliable, and valid instrument for measuring online social support for smoking cessation. Results should be replicated and extended, but this study suggests the OS4 can be used to advance theory, understand mechanisms, and potentially help to improve the tailoring of Internet-based smoking cessation treatments. It can also inspire development of similar measures for other online health-related intervention research.

Trial registration

Clinicaltrials.gov #{"type":"clinical-trial","attrs":{"text":"NCT00282009","term_id":"NCT00282009"}}NCT00282009; http://clinicaltrials.gov/ct2/show/{"type":"clinical-trial","attrs":{"text":"NCT00282009","term_id":"NCT00282009"}}NCT00282009 (Archived by WebCite at http://www.webcitation.org/60XNj3xM6)     

Caregiving burden and its determinants in Polish caregivers of stroke survivors

Introduction

Despite the growing body of literature on the consequences of providing non-professional care to stroke survivors, the determinants of caregiving burden are still not fully recognized. Identification of significant determinants can facilitate caregiver intervention programs. The aim of this study was to evaluate the level of burden borne by caregivers of stroke patients and to identify the most important determinants of burden at 6 months after hospitalization.

Material and methods

Data were collected from 150 pairs of stroke patients/caregivers. Caregiver burden was assessed on the Caregiver Burden scale (CB). Several characteristics were measured as potential predictors of the burden. Special attention was paid to the caregiver''s sense of coherence (SOC) and anxiety. Regression analysis was employed to test the hypothesized relationships between these variables and the burden.

Results

Forty-seven percentage of the caregivers reported a substantial burden (severe or moderate). Caregiver SOC (p < 0.001), anxiety (p < 0.001) and the patients’ functional status (p < 0.001) were the most important predictors of the overall burden and the most consistent predictors of the majority of aspects included in the CB scale. Caregiver health, patient''s gender, time spent caregiving and social support were also factors related to the burden. The identified predictors explained 67% of the variance in the overall burden.

Conclusions

Clinicians and other professionals should focus on the coping abilities of caregivers, their emotional state and the level of patients’ dependency, as these are the vital and modifiable factors affecting caregiver burden following stroke.     

Spousal support in a behavior change intervention for cholesterol management

Objective

To evaluate spousal involvement in a nurse-led intervention for patients with high cholesterol in which patients set health goals and spouses learned support strategies.

Methods

Qualitative interviews were conducted with 29 patients and 26 spouses who received the intervention during a trial. Interviews were stratified by patient LDL-C change (better, same, worse). Coded text was content analyzed, and organized into thematic matrices, with columns indicating individuals (spouse or patient) and rows indicating dyads.

Results

Patients and spouses reported no drawbacks to spousal involvement; some patients whose LDL-C did not improve wanted more focus on spouse health. Spouses said that the nurse's expertise and interest were helpful and they were better able to communicate with patients about health. Although the program helped couples work together, spouses with better or same LDL-C talked more about functioning as a unit, whereas those whose partners had worse LDL-C talked more about functioning as individuals.

Conclusion

Although the spousal role was accepted, there were variations in level of involvement. More active spousal involvement might relate to better patient outcomes. For less involved spouses, more focus on their health may improve commitment or involvement.

Practice implications

These findings can inform ways to generate spousal support in future trials.     

Perceived Social Support Mediates the Longitudinal Relations between Ambivalence over Emotional Expression and Quality of Life among Chinese American Breast Cancer Survivors

Purpose

The present study examined perceived social support as a mediator of the longitudinal link between ambivalence over emotional expression (AEE) and quality of life among a sample of Chinese breast cancer survivors.

Methods

Ninety-six Chinese breast cancer survivors recruited from Southern California completed four surveys in total: (1) a baseline survey (T1), 1-month follow-up (T2), 3-month follow-up (T3), and 6-month follow-up (T4). Participants filled out a paper-pen questionnaire containing the Ambivalence over Emotional Expression Questionnaire (AEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), and the Medical Outcomes Study Social Support Scale (MOS-SSS).

Results

Higher T1 AEE was associated with lower T1 social support (B?=??0.01, SE?=?0.004, p?<?0.01) which in turn was associated with lower quality of life at T2 (B?=?2.98, SE?=?0.64, p?<?0.01), T3 (B?=?2.14, SE?=?0.54, p?<?0.01), and T4 (B?=?2.08, SE?=?0.68, p?<?0.01).

Conclusions

These results suggest that the harmful effect of AEE on quality of life is explained by reduced social support. Given the detrimental effects of AEE on social support and quality of life, future research on interventions that facilitate emotional disclosure is needed. Implications for the effects of Chinese culture on AEE are discussed.

     

Treatment outcomes and perception of social acknowledgment in war veterans: follow-up study

Aim

To assess treatment outcomes of psychotherapy for war veterans suffering from posttraumatic stress disorder (PTSD) and to investigate self-perceived social acknowledgment.

Methods

In this prospective cohort study, a set of psychological instruments was used to assess the level of posttraumatic stress symptoms (Clinician-administered PTSD Scale, Impact of Event Scale – Revised), symptoms of general psychopathology (Brief Symptom Inventory), quality of life (The Manchester Short Assessment of Quality of Life), and perceived social acknowledgment on a sample of 152 Croatian war veterans participating in group psychotherapy. All participants were interviewed at baseline and followed up after 3 and 12 months. We analyzed the changes in symptom levels over the course of one year, as well as the correlations between symptoms (both at baseline and after therapy) and perceived social acknowledgment.

Results

The analysis of symptom levels at the beginning of group therapy and after 12 months showed minimal or no changes in their intensity. Only the symptoms of intrusion (ANOVA, F-value = 7.09, P<0.001) were significantly reduced after a period of 12 months. Levels of hostility (ANOVA, F-value = 7.85, P<0.001) and psychoticism were significantly increased (ANOVA, F-value = 7.80, P<0.001) at the end of the treatment. Other categories of posttraumatic symptoms and the level of general psychopathology did not change significantly during the course of treatment. The results showed that war veterans perceive extremely low levels of social acknowledgment, especially from their wider social environment: 92.9% perceived a lack of acknowledgment from governmental institutions and 95.4% from the state in general.

Conclusion

Despite some methodological constraints, our results showed that even 10 years after the traumatization, PTSD symptoms among war veterans remained intense and that undergoing therapy over a year did not produce significant improvements, except on the dimension of intrusion. Veterans were highly sensitive to the way their primary social environment and the society as a whole react to their problems.Assessing treatment outcomes of therapeutic activities in war veterans is important for both methodological and clinical reasons. There is still a shortage of relevant studies (1), or at least of adequate follow-up studies dealing with the assessment of trauma-related treatment outcomes in our region (2). It is particularly important to identify the factors associated with positive outcomes of treatment and the process of adjustment (3-12). The existing treatment outcome studies provide strong evidence that contextual factors are of great relevance to any discussion of treatment (13,14). Because of these factors, an identical treatment can lead to different outcomes in different psychosocial conditions, especially in the treatment of trauma.Posttraumatic stress disorder (PTSD) is common among combat veterans and is associated with significant psychiatric and medical comorbidity, social impairments, and reduced quality of life (13). Data gathered on Persian Gulf War veterans showed that veterans with PTSD, compared with veterans without PTSD diagnosis, had less social support and family cohesion, as well as a higher prevalence of avoidant coping styles (8).The way that people are treated by others after traumatic experiences may affect their recovery. Survivors of war-related traumatic events are likely to be extremely sensitive on how others react to them and how they describe or make attributions about the traumatic event and the role they played in it. Differences in social acknowledgment may have an impact on how trauma survivors process their traumatic experiences, both emotionally and cognitively.Social acknowledgment is defined as the person''s perception of positive reactions from the society that recognizes the trauma they have experienced and their current difficult situation (15). The term “social” includes the following: closest social network of a victim (eg, partner, family, and friends); significant persons (eg, local authorities, clergy); groups (eg, at the workplace, fellow citizens); and impersonal expressions of opinions (eg, media) about the experiences of the victims or survivors (15). Solomon et al (16,17) showed that poor social integration and low societal appreciation of homecoming soldiers in the Lebanon War was related to more severe posttraumatic symptomatology.Some authors distinguish between the concepts of social support and social acknowledgment, even though their correlation is high (15). Social support can be defined as the degree of emotional and instrumental support a person receives from the people in his/her environment. Social acknowledgment includes the wider social context, which means that it is not simply individuals but also social pressure groups that influence the person with their judgments.Positive social acknowledgment includes unconditional support to the person. However, trauma survivors can experience negative feedback as well, including indifference, rejection, and being blamed for their condition. As with stress, perceptions of social support may, on the one hand, be confounded with symptomatology (16) but, on the other hand, may be the best indicator of personal and situational resources (17-20).The main goal of this study was to assess treatment outcomes (symptoms of intrusion, avoidance, and hyperarousal; associated symptoms of general psychopathology; subjective quality of life) for war veterans included in formal psychotherapy (21). In addition, we explored the relation between the scores on these outcome measures and perceived social acknowledgment.     

Social Relationship Factors,Preoperative Depression,and Hospital Length of Stay in Surgical Patients

Purpose

The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields.

Method

Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure.

Results

Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS.

Conclusion

Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes.

Trial Registration

NCT01357694

     

The impact of the hospital work environment on social support from physicians in breast cancer care

Objective

Research on determinants of a good patient–physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians’ provision of social support to patients.

Methods

Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians’ social resources as well as job demands and control and patients’ perceived support from physicians have been studied in multilevel models.

Results

Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians.

Conclusion

The results highlight the importance of the work environment for a good patient–physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care.

Practice implications

Health policy and hospital management could create conditions conducive to better patient–physician interaction by strengthening the social capital and by increasing job security for physicians.     

Social support and glycemic control in type 2 diabetes: A systematic review of observational studies

Objective

We aim to systematically review observational studies examining the association between social support and glycemic control in adults with type 2 diabetes.

Methods

We searched MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science and Sociological Abstracts to July 2012 for observational studies investigating the association between structural or functional aspects of social support (social networks, community ties, marital status, family support, perceived, actual, emotional or instrumental social support) and glycemic control (HbA1c).

Results

From electronic and reference searches, 29 studies were eligible. Twenty different assessments of social support were used. Family support and composite measures of support were most frequently associated with reduced HbA1c. There was no evidence for a beneficial effect of other support measures on HbA1c.

Conclusion

We found marked variation in population, setting, measurement of social support and definition of outcome, limiting the methodological validity of research. Social support may be important in the management of type 2 diabetes, the need for consensus and standardization of measures is highlighted.

Practice implications

The presence of informal support should be explored in routine diabetes care.     

Verbal communication among Alzheimer's disease patients, their caregivers, and primary care physicians during primary care office visits

Objective

Primary care visits of patients with Alzheimer's disease (AD) often involve communication among patients, family caregivers, and primary care physicians (PCPs). The objective of this study was to understand the nature of each individual's verbal participation in these triadic interactions.

Methods

To define the verbal communication dynamics of AD care triads, we compared verbal participation (percent of total visit speech) by each participant in patient/caregiver/PCP triads. Twenty-three triads were audio taped during a routine primary care visit. Rates of verbal participation were described and effects of patient cognitive status (MMSE score, verbal fluency) on verbal participation were assessed.

Results

PCP verbal participation was highest at 53% of total visit speech, followed by caregivers (31%) and patients (16%). Patient cognitive measures were related to patient and caregiver verbal participation, but not to PCP participation. Caregiver satisfaction with interpersonal treatment by PCP was positively related to caregiver's own verbal participation.

Conclusion

Caregivers of AD patients and PCPs maintain active, coordinated verbal participation in primary care visits while patients participate less.

Practice implications

Encouraging verbal participation by AD patients and their caregivers may increase the AD patient's active role and caregiver satisfaction with primary care visits.     

Psychosocial functioning of spouses in the chronic phase after stroke: Improvement or deterioration between 1 and 3 years after stroke?

OBJECTIVE: To describe the psychosocial functioning of spouses of stroke patients at 1 and 3 years after stroke and identify predictors of substantial negative change in psychosocial functioning. METHODS: Prospective study (N=119). Five domains of psychosocial functioning were assessed: burden, life satisfaction, depression, harmony in the relationship and social support. We used paired t-tests to describe changes and identified substantial changes using an Effect Size of 0.5 as the cut-off point. RESULTS: Fifty-one percent reported significant burden, 46% were dissatisfied with life and 51% reported depressive symptoms 1 year after the stroke. Changes in psychosocial functioning between 1 and 3 years post stroke were reported by 27%-57% of the spouses. Although burden improved, life satisfaction, social support and harmony in the relationship deteriorated significantly. The percentage of spouses with depressive symptoms remained stable. Spouses with young children were at risk of deteriorating psychosocial functioning. CONCLUSIONS: A large proportion of spouses experience serious caregiver burden, depression and decreased life satisfaction, 1 year as well as 3 years after the stroke, and harmony in the relationship, social support and life satisfaction decline over time. PRACTICE IMPLICATIONS: Rehabilitation programmes should give more attention to the relationship with the patient's partner, family life and the maintenance of a support network.     

Elder Abuse in the African Diaspora: A Review

Background

As with many other populations, abuse of older adults is a growing problem across the Africa Diaspora. Modernization and urbanization are eroding the traditional values of respect for older adults. Also, older adults living in environments with limited social and economic resources, and having no means of economic support create a recipe for elder abuse and neglect.

Anticipatory grief of spousal and adult children caregivers of people with dementia

Background

Anticipatory grief (AG) among caregivers of people with dementia is common and has been found to be related to negative health outcomes. Previous studies showed different patterns of AG between spousal and adult children caregivers of people with dementia (PWD) at different stages; however, the levels of such grief are not yet compared. The findings in Western studies are very limited, and inconsistencies have also been found in Asian studies.

Methods

One hundred and eight primary caregivers (54 spousal and 54 adult children) of community-dwelling PWD were recruited from elderly community services sectors in Hong Kong, China through quota sampling. The demographics, AG (measured by the Marwit-Meuser Caregiver Grief Inventory-short form), subjective caregiver burden, and well-being of the participants were assessed. A Functional Assessment Staging Test was used to grade the stages of dementia of the PWD. In this study, those in stages 4 and 5 were regarded as being at an earlier stage, and those in stages 6 and 7 at a later stage of dementia.The Mann-Whitney U-test and the Chi-square test were used to compare the variables between spousal and adult children caregivers, and the Kruskal–Wallis test was used to compare the outcomes among the sub-groups (spousal caregivers caring for relatives with earlier/later stage dementia; and adult children caregivers caring for relatives with earlier/later stage dementia). A post-hoc analysis was also conducted to identify differences between the sub-groups. Pearson’s correlation was performed to investigate the bivariate relationships among AG, subjective caregiver burden, and well-being.

Results

The results showed that spousal caregivers caring for relatives in a later stage of dementia experienced the highest level of AG and subjective caregiving burden, as compared with spousal caregivers caring for relatives in an earlier stage of dementia and adult children caregivers. Well-being was significantly negatively correlated with AG and subjective caregiver burden, while AG was also significantly correlated with subjective caregiver burden.

Conclusion

This study found that spousal caregivers of relatives in a later stage of dementia have significantly higher levels of AG, warranting special attention and extra support from palliative professionals.

     

Comparing support to breast cancer patients from online communities and face-to-face support groups

Objective

To compare support for three groups by considering usage patterns with regard to two peer support resources, online communities, and face-to-face support groups, among patients with breast cancer in Japan.

Methods

We conducted a cross-sectional survey of 1039 breast cancer patients.

Results

Factor analysis indicated that all groups show the five aspects of support: “Emotional support/Helper therapy,” “Emotional expression,” “Conflict,” “Advice,” and “Insight/Universality.” Within the group using two support resources, the support scores of “Emotional expression” and “Advice” were higher for the online community, and those of “Emotional support/Helper therapy,” and “Insight/Universality” were higher for the face-to-face support group. Among the three groups, the members who received the most peer support were those who used both an online community and a face-to-face support group.

Conclusion

Patients who received the most social support from peers were in the group using both online communities and face-to-face support groups.

Practice implications

Healthcare providers should provide information about peer support through not only traditional face-to-face support groups but also online communities.     

Social Support Patterns of Collegiate Athletes Before and After Injury

Context:

Social support has been identified as an important factor in facilitating recovery from injury. However, no previous authors have prospectively assessed the change in social support patterns before and after injury.

Objective:

To examine the preinjury and postinjury social support patterns among male and female collegiate athletes.

Design:

Prospective observational study.

Setting:

A Big Ten Conference university.

Patients or Other Participants:

A total of 256 National Collegiate Athletic Association Division I male and female collegiate athletes aged 18 or older from 13 sports teams.

Main Outcome Measure(s):

Injury incidence was identified using the Sports Injury Monitoring System. Social support was measured using the 6-item Social Support Questionnaire. Data on preinjury and postinjury social support patterns were compared.

Results:

Male athletes reported more sources of social support than female athletes, whereas female athletes had greater satisfaction with the support they received. Athletes'' social support patterns changed after they became injured. Injured athletes reported relying more on coaches (P  =  .003), athletic trainers (P < .0001), and physicians (P  =  .003) for social support after they became injured. Athletes also reported greater postinjury satisfaction with social support received from friends (P  =  .019), coaches (P  =  .001), athletic trainers (P < .0001), and physicians (P  =  .003).

Conclusions:

Our findings identify an urgent need to better define the psychosocial needs of injured athletes and also strongly suggest that athletic trainers have a critical role in meeting these needs.     

Social support as a protective factor in suicide: Findings from two nationally representative samples

Background

Suicide is a problem of worldwide concern and research on possible protective factors is needed. We explored the role of social support as one such factor. Specifically, we hypothesized that increased social support would be associated with decreased likelihood of a lifetime suicide attempt in two nationally representative samples as well as a high-risk subsample.

Methods

We analyzed the relationship between social support and lifetime history of a suicide attempt, controlling for a variety of related psychopathology and demographic variables, in the National Comorbidity Study Replication (NCS-R), a United States sample and the Adult Psychiatric Morbidity Study (APMS), an English sample.

Results

Results indicate that social support is associated with decreased likelihood of a lifetime suicide attempt controlling for a variety of related predictors in both the full US sample (OR=0.68, p<.001) and the full English sample (OR=0.93, p<.01).

Limitations

The cross-sectional data do not allow true cause and effect analyses.

Conclusions

Our findings suggest social support is associated with decreased likelihood of a lifetime suicide attempt. Social support is a highly modifiable factor that can be used to improve existing suicide prevention programs worldwide.     

Social support and online postpartum depression discussion groups: a content analysis

Objective

Social support has a positive influence on women's childbearing experience and is shown to be a preventive factor in postpartum depression. This study examined the perceived value and types of social supports that characterize the discussions of women who participate in postpartum depression online discussion groups.

Methods

A directed content analysis was used to examine 512 messages posted on a postpartum depression online support group over six months.

Results

The majority of the women's postings illustrated emotional support followed by informational and instrumental support.

Conclusions

Online support groups provide women experiencing postpartum depression a safe place to connect with others and receive information, encouragement and hope.

Practice implications

Education strategies are needed to address the many questions regarding PPD medical treatment. Recommending vetted links to PPD online support groups will create opportunities for women to share their experiences and obtain support.