Handbook of Psychology

64 Coping and Social Support

extended network (labeled social integration) in a randomly
selected sample of 50-year-old men in Sweden. The men
were followed for six years. Both attachment and social inte-
gration were lower in men who contracted coronary artery
disease, and the associations remained signi“cant after con-
trolling for other risk factors.

Pulmonary Disease

One study has examined the role of social support in pul-
monary disease. Grodner and colleagues (1996) studied both
satisfaction with support and the number of persons in the
support network as predictors of forced expiratory volume
(FEV), maximum oxygen uptake during a treadmill test, ex-
ercise endurance, perceived breathlessness, and perceived
fatigue. Participants were enrolled in a rehabilitation pro-
gram. The association of baseline social support with six-
year mortality was also assessed. Results indicated that the
number of network members was predictive or there was im-
provement in perceived breathlessness after the rehabilita-
tion, but support satisfaction was not associated with indices
of improvement. There was a difference between males and
females in the association between support satisfaction and
survival. For males, there was no difference in survival be-
tween the low and high social support groups. For females,
survival for subjects with high social support was signi“-
cantly better than for those with low social support. This
study provides preliminary evidence to suggest that social
support may promote morbidity and mortality among COPD
patients. However, it would be helpful to understand how so-
cial support networks in”uence outcomes for patients with
COPD. As with coronary artery disease and AIDS outcomes,
affective factors such as depressive symptoms, health behav-
iors including nutrition and adherence to medical and reha-
bilitation regimens, and potential physiological components
to social support and social isolation are potential mecha-
nisms that should be investigated.

Arthritis

One very interesting study has linked marital status with pro-
gression of functional disability in patients with RA. A large
cohort of 282 RA patients was followed for up to 9.5 years.
Progression of RA was determined using the Health Assess-
ment Questionnaire Index completed every six months. Over
time the progression rate of disability was higher among the
94 unmarried participants, even after adjusting for socio-
demographic factors. Although mechanisms for this slower
progression are not determined in this study, it is possible that
better nutrition, adherence to medical regimen, engagement

in correct types of physical activity, as well the instrumental

assistance and emotional support may in”uence both disease

progression and immunologic parameters contributing to RA

progression. Since marital status is not the most accurate

index of social support, future studies should measure sup-

port using other indicators.

Other Diseases

Relatively few studies have evaluated the link between social

support and disease outcomes other than HIV, AIDS, and car-

diac events. Social support has been studied in the context of

end-stage renal disease (ESRD). Burton, Kline, Lindsay, and

Heidenheim (1988) followed a group of 351 ESRD patients

for 17 months. Perceived social support was not associated

with mortality or with inability to perform home dialysis (ver-

sus returning to the clinic for dialysis).

Social Support and Psychological Outcomes

Social support has been one of the most studied predictors of

psychological adaptation to health problems, particularly dis-

abling medical problems such as arthritis or life-threatening

health problems such as cancer. Studies evaluating support•s

role in several key diseases will be reviewed next.

Cancer

Measurement of Support

Much of the early literature on social support and psycholog-

ical adaptation among individuals with cancer focused on

understanding what types of responses were perceived as

helpful, and what responses were perceived as unhelpful. Ex-

cellent theoretical and descriptive work was conducted by

Wortman and Dunkel-Schetter (1979, 1987) and Dunkel-

Schetter (1984), and later work by Dakof and Taylor (1990)

and Gurowka and Lightman (1995) attempted to delineate

both supportive and unsupportive responses. Dakof and

Taylor (1990) categorized types of social support into three

main categories: esteem/emotional support, informational

support, and tangible support. Unhelpful responses were not

categorized. The authors described nine unhelpful actions by

others: criticisms of the patients• response to cancer, mini-

mization of the impact of cancer on the patient, expressions

of too much worry or pessimism, expressions of too little

concern or empathy, avoiding social contact with the patient,

rudeness, provision of incompetent medical care, acting as a

poor role model, and provision of insuf“cient information. A

recent study by Manne and Schnoll (2001) used exploratory