Social Support in Multiple Sclerosis: Social Support in Multiple Sclerosis Aaron Turner, Ph.D.


Presentation Objectives: Presentation Objectives Characterize the experience of social support in multiple sclerosis Outline the benefits of support Describe gender differences in support


What is social support?: What is social support? “Information from others that one is loved and cared for, esteemed and valued, and part of a network of communication and mutual obligation” (Cobb, 1976)


Conceptions of Support: Conceptions of Support Tangible Aid Assistance Emotional Affirmation Affection Informational Promotes problem solving and information Integration in a Network Size Duration Membership


Why is Social Support Important in medical settings?: Why is Social Support Important in medical settings? Associated with reduced morbidity and mortality in community samples Better outcomes in Congestive heart failure Kidney disease Stroke Diabetes control Cancer Pregnancy outcome


Social Networks and MS: Social Networks and MS 9 people in average social network Family members, friends, caregivers Average contact: 3 daily 4 weekly 2 yearly (Wineman,1990)


How does support change with MS?: How does support change with MS? Relationship Deterioration Question Percent Endorsed I worry I am not a good mate 45% My spouse/significant other babies me 44% Benefit Finding Question Percent Endorsed MS has helped me be closer to my family 71% I am more compassionate towards others 65% (Mohr et al., 1999)


Needs may change over time: Needs may change over time Self reported perceived needs: Newly diagnosed and younger Psychological services Vocational services Longer diagnosed and older Transportation Home care Attendants (Kraft et al., 1986)


Individuals with MS endorse less social support over time: Individuals with MS endorse less social support over time “Variety, amount, and quality of social contacts are all diminished by MS.” (Mohr, 1999) Possible Reasons: Activity/participation restrictions Social isolation Less exposure to individuals without illness Cognitive Impairment Depression and anxiety Married individuals report more support throughout the course of illness


Social Support and Psychosocial Adaptation: Social Support and Psychosocial Adaptation Supportiveness Un-supportiveness Functional Disability Perceived Uncertainty Depression .27 .37 .24 (Wineman, 1990) .24 Social Network List and Support System Scale: Socialization, tangible assistance, advice and guidance, social reinforcement, emotional sustenance (Fiore, Becker, & Coppel, 1983)


Social Support and Psychosocial Adaptation: Social Support and Psychosocial Adaptation Supportiveness Un-supportiveness Functional Disability Perceived Uncertainty Purpose in Life .27 -.27 -.27 .23 -.22 (Wineman, 1990) Social Network List and Support System Scale: Socialization, tangible assistance, advice and guidance, social reinforcement, emotional sustenance (Fiore, Becker, & Coppel, 1983)


Social support and depression: Social support and depression Beck Depression Inventory (BDI) Perceived Social Support† r Family Based -.60*** Friend Based -.71*** †Perceived social support inventory: Family and friend based (Heller, Amaral, & Procidano, 1978) (McIvor, Riklan, & Reznikoff, 1984)


Social Support and Depression: Social Support and Depression Depressed Not Depressed SSSI Score -1.5 3.0 SSSI = Social Stress and Support Interview (occupation, money, housing, social life, marriage, family) Range = -6 (no support/stress) to 6 (support in all areas) Depressed vs. not by structured clinical interview (Gilchrist & Creed, 1994)


Stress buffering effects of social support: Stress buffering effects of social support (Pakenham, 1999)


SOCIAL SUPPORT AMONG VETERANS WITH MULTIPLE SCLEROSIS : SOCIAL SUPPORT AMONG VETERANS WITH MULTIPLE SCLEROSIS Rhonda M. Williams, Ph.D., Aaron P. Turner, Ph.D., Michael Hatzakis, MD, Serena Chu Ph.D., Arthur Rodriquez, MD, MS, James D. Bowen, M.D., Jodie Haselkorn MD, MPH


Sample: Sample 451 veterans (44%) who returned surveys 86% male mean age of 55 62% married, 23% divorced, 8% single, 5% separated, 2% were widowed 93% Caucasian, 5% Native American, 2% African American


Measure: Measure Medical Outcomes Study Modified Social Support Survey (MSSS; Sherbourne & Stewart, 1991) 18 items Possible scores 1-100 (higher = more support)


4 kinds of Social Support: 4 kinds of Social Support Tangible (e.g., take you to doctor) Information/Emotional (e.g., listen, give advice) Affection (e.g., hug you) Positive Social Interaction (e.g., do something fun with you) Total


Results: Results Moderate levels of total social support M = 69.64 Similar to the original validation sample M = 70.1 (individuals with chronic medical conditions) High: tangible support, M = 71.73 Low: emotional/informational support, M = 67.29


Social support and patient/disease characteristics: Social support and patient/disease characteristics Tangible Social Support Variable r Age (years) .14* Disease duration (years) .13* Mobility .19*


Men report more support: Men report more support M (SD) = 70.9 (28.0) vs. 62.0 (26.0) F(1,445) = 5.98, p<.05


People living with someone report more support: People living with someone report more support M (SD) = 37.0 (24.0) vs. 77.0 (23.0) F(1,417) = 41.91, p<.001


People with higher incomes report more support: People with higher incomes report more support M (SD) 60.4 (31.5) vs. M (SD) = 74.9 (23.8) F(1,417) = 11.62, p<.001


People with relapsing course report more support: People with relapsing course report more support M (SD) 75.8 (22.4) vs. M (SD) = 66.3 (29.9) F(1,445) = 8.02, p<.05


Support associated with marriage differs by gender: Support associated with marriage differs by gender F(1,405) = 10.75, p<.001


Support associated with income differs by gender: Support associated with income differs by gender F(1,405) = 6.10, p<.01


Summary: Summary Disease duration and decreased mobility associated only with greater tangible support Men report more support People living with someone report more support People with higher incomes report more support People with relapsing course report more support Men report greater support benefits from marriage Women report greater support benefits from higher income Williams, Turner et al., in press