66 Coping and Social Support
stage disease was recently conducted by Butler, Koopman,
Classen, and Spiegel (1999), who studied a relatively large
group of metastatic breast cancer patients. This cross-
sectional study suggested that avoidance was associated with
smaller emotional support networks. Unfortunately, the
methodology would not allow for evaluation of causality; it is
possible that patient avoidant symptoms lead them to avoid
others and thus lead to a smaller group of people providing
emotional support.
AIDS
Social support has been evaluated as a key determinant of
psychological adaptation among individuals dealing with the
myriad of both medical and social stresses associated with
HIV and AIDS. In addition, the stigma associated with this
disease places patients at high risk for social isolation.
Friends and family members may experience helplessness or
fear in response to the AIDS diagnosis, and therefore may
have problems providing support (Siegel, Raveis, & Karus,
1997). Many of the early studies used cross-sectional
methodologies. These studies suggested that perceived avail-
ability of support is associated with psychological distress in
persons with AIDS (e.g., Hays, Chauncey, & Tobey, 1990)
and in persons with asymptomatic HIV (Blaney et al., 1990;
Grassi, Caloro, Zamorani, & Ramelli, 1997), and several
studies found that the number of members of the support net-
work and the satisfaction with support were associated with
depressive symptoms (Ingram, Jones, Fass, Neidig, & Song,
1999). Similar “ndings were reported in longitudinal studies
(Hays, Turner, & Coates, 1992; Nott, Vedhara, & Power,
1995). Swindells and colleagues (1999) followed 138 pa-
tients with HIV over a six-month period of time. Less satis-
faction with social support at baseline was predictive of a de-
cline in quality of life.
Studies have also investigated the possibility that different
types of support are associated with distress. Satisfaction with
informational support appears to be the strongest correlate of
distress in persons with symptomatic HIV (Hays et al., 1990).
However, this type of support is a less strong correlate of dis-
tress in persons with asymptomatic HIV (Hays et al., 1992).
Studies examining potential buffering effects of social sup-
port, using both cross-sectional (Pakenham, Dadds, & Terry,
1994) and longitudinal (Siegel et al., 1997) designs, did not
“nd evidence supporting a buffering effect of social support.
Arthritis
Rheumatoid arthritis (RA) is a chronic, unpredictable, and
progressive in”ammatory disease affecting primarily the
joints. Osteoarthritis is a similar chronic disease that is
painful, but typically less disabling and progressive in nature.
Both diseases have numerous physical consequences, includ-
ing pain and severe physical disability that can result in
signi“cant social and psychological impact. It is perhaps
because of the chronic and disabling nature of RA that the
“ndings regarding the role of both perceived and received so-
cial support have been consistent. Studies using measures of
both perceived available support and support received (e.g.,
Doeglas et al., 1994), structural (e.g., Pennix et al., 1997),
qualitative (e.g., Af”eck, Pfeiffer, Tennen, & Fi“eld, 1988;
Revenson, Schiaf“no, Majerovitz, & Gibovsky, 1991), and
quantitative (e.g., Evers, Kraaimaat, Geenen, & Bijlsma,
1997; Nicassio, Brown, Wallston, & Szydlo, 1985; Pennix
et al., 1997) measures have all shown associations. Although
the majority of studies have employed cross-sectional de-
signs, several studies using longitudinal designs have also re-
ported associations between social support and psychological
distress (e.g, Evers et al., 1997).
Brown, Wallston, and Nicassio (1989) examined the lon-
gitudinal association between social support and depression
and whether social support had a moderational role in the re-
lation between arthritis-related pain and depressive symp-
toms in a group of 233 RA patients followed over a one-year
period. The quality and number of social ties were assessed.
There was no signi“cant association between the number of
close friends and relatives and depression. However, the
quality of emotional support predicted later depression even
after controlling for the effects of demographics, pain, and
disability factors. A moderating effect for social support was
not found.Mechanisms for Social Support’s Effects on Well-BeingSocial support is likely to have both direct and indirect effects
on psychological outcomes. There have been a number of dis-
cussions of how support may impact psychological outcomes.
One potential mechanism is that advice and guidance from
others may alter the threatening appraisal of a dif“cult situa-
tion to a more benign appraisal of a situation. For example, a
breast cancer patient who is facing mastectomy may see the
surgery as a threat to her body image; however, if her husband
suggests that reconstructive surgery will restore her body to
close to what it was prior to the surgery, her appraisal of the
situation as threatening may lessen. Second, social support
can function as a coping assistant; that is, supportive others
may provide help in identifying adaptive coping strategies
and assistance in using these strategies (Thoits, 1985). Stud-
ies of individuals with arthritis (Manne & Zautra, 1989) and
cancer (Manne, Pape, Taylor, & Dougherty, 1999) have found