Scoping review of the role of social support in women Veterans' psychosocial and health outcomes

Women veterans are a steadily growing population and have unique military experiences (e.g., report high rates of sexual harassment and assault) that are impactful across the lifespan. High levels of positive social support have been linked to a range of positive outcomes in both civilian and military populations. However, research has not consistently explored social support and interpersonal functioning in women veterans, or as potential mechanisms of change within interventions for women veterans. This is a scoping review of peer-reviewed articles that evaluated social support. Articles with at least 10% women or formally evaluated sex or gender in reference to social support were included. A total of 69 studies evaluated social support in relation to women veterans' health outcomes. From a biopsychosocial perspective, social support is an important construct to examine relative to health care engagement and response. Limited research considered aging women veterans needs or focused on the intersectional identities of women veterans. Positive social support can have major physical and mental health benefits, yet limited research and disparate methodological approaches minimize the ability to draw conclusions on how social support can best be leveraged to support women veterans. Women veterans' roles and military experiences (e.g., increased likelihood of combat exposure) are changing and this population is aging. Research is needed to inform best practices for this growing segment of the veteran population.

Exploration of the Effects of Protective Person–Environment Factors Between Functional Impairments and Stress in Individuals With Multiple Sclerosis: Mediation and Moderation Analyses

Functional impairments can lead to stress in individuals with multiple sclerosis (MS). The study examined protective person and environment factors (i.e., positive cognitive stress appraisal, core self-evaluations [CSE], resilience, hope, spirituality, social support, and environmental supports) as both mediators and moderators of this association to guide understanding of the experience of stress in this population. The sample consisted of 373 participants with MS. In simple mediation analyses, positive cognitive stress appraisal, CSE, resilience, hope, social support, and environmental supports served as a partial mediator between functional impairments and stress. In a parallel mediation analysis, significant unique indirect effects were observed for two of the seven hypothesized mediator variables (CSE and environmental supports). Separate moderator tests provided support for the CSE variable as a protective factor. The positive association between functional impairments and stress was weaker for persons reporting high CSE compared with those reporting low CSE. The findings provide implications for rehabilitation counseling practices by promoting CSE and environmental supports in improving rehabilitation and psychosocial outcomes for individuals with MS.

Mental Health Comorbidity in MS: Depression, Anxiety, and Bipolar Disorder

Among individuals with multiple sclerosis (MS), mental health comorbidities play a significant role in contributing to secondary disability and detracting from quality of life. This review examines current evidence surrounding three mental health issues of particular relevance to MS: depression, anxiety, and bipolar disorder. We review what is known of the prevalence, correlates, screening mechanisms, and current treatment of each issue and provide recommendations for future areas of research.

Social support and support groups among people with HIV/AIDS in Ghana

HIV/AIDS, a chronic burden in Ghana, poses social and health outcome concerns to those infected. Examining the Medical Outcome Study Social Support Survey (MOS-SSS) instrument among 300 Ghanaians from a cross-sectional design, Principal Component Analysis yielded four factors (positive interaction, trust building, information giving, and essential support), which accounted for 85.73% of the total variance in the MOS-SSS. A logistic regression analysis showed that essential support was the strongest predictor of the length of time an individual stayed in the support group, whereas positive interaction indicated negative association. The study's implications for policy, research, and practice were discussed.

Socio-Demographic Factors, Social Support, Quality of Life, and HIV/AIDS in Ghana

The increase in the access to biomedical interventions for people living with HIV/AIDS in the developing world has not been adequately matched with the requisite psychosocial treatments to help improve the effectiveness of biomedical interventions. Therefore, in this study the author seeks to determine whether socio-demographic characteristics and social support are associated with quality of life in individuals diagnosed with HIV/AIDS in Ghana. A convenience sample of 300 HIV/AIDS support group members was obtained via cross-sectional design survey. The Medical Outcome Studies (MOS) HIV Health Survey, the MOS Social Support Survey (MOS-SSS), and demographic questionnaire instruments were used to assess quality of life, social support, and demographic information respectively. Multiple regression analysis showed that there was a positive association between overall social support and overall quality of life (r = .51). It also showed that being younger, male, attending support group meetings for over a year, and having ≥ 13 years of schooling related to higher quality of life. Implications of the findings for practice, policy, and research in Ghana and the rest of the developing world are discussed.

What are the support needs of men with multiple sclerosis, and are they being met?

BACKGROUND

Multiple sclerosis (MS) is a chronic, degenerative condition of the central nervous system that can lead to high levels of disability and a range of psychological and social problems. Although considerable research has been conducted on the experience of living with MS and the disease's psychosocial consequences, much of this has focused on women, with the male perspective seldom considered. It is possible, therefore, that men differ from women in how they experience MS and the type of support or interventions that meet their needs.

METHODS

A literature review was undertaken to identify the specific support needs of men with MS, describe current support available to men with MS, and evaluate the extent to which these needs are met by current service provision.

RESULTS

The literature reviewed suggests that the needs of men with MS are different from those of women in terms of psychological factors such as well-being and mental health and support.

CONCLUSIONS

If interventions are to be evidence based, health-care professionals need to take into account the needs, desires, and capabilities of men with MS in the development of services. Further qualitative and quantitative research is required to address the gaps in the evidence base of support needs for men with MS.

The correlation between gray matter volume and perceived social support: a voxel-based morphometry study

Social support refers to interpersonal exchanges that include the combinations of aid, affirmation and affection. Perceived social support is a kind of subjective judgment of one's availability of social support. In spite of the importance of perceived social support to health, however, its neural substrate remains unknown. To address this question, voxel-based morphometry was employed to investigate the neural bases of individual differences in responses to the Perceived Social Support Scale (PSSS) in healthy volunteers (144 men and 203 women; mean age = 19.9; SD = 1.33, age range : 17-27). As a result, multiple regression analysis revealed that the PSSS scores were significantly and positively correlated with gray matter volume in a cluster that mainly included areas in posterior parts of posterior cingulate cortex, bilateral lingual cortex, left occipital lobe and cuneus. Highly-supported individuals had larger gray matter volume in these brain regions, implying a relatively high level of ability to engage in self-referential processes and social cognition. Our results provide a biological basis for exploring perceived social support particularly in relationship to various health parameters and outcomes.

The effects of identification with a support group on the mental health of people with multiple sclerosis

OBJECTIVE

Multiple sclerosis (MS) is associated with various psychological problems, including depression and anxiety. Whilst MS support groups are intended to improve mental health, this goal is not always achieved. Taking a social identity approach, we hypothesise that it is the level of subjective identification with a support group (rather than simply support group membership per se) that positively affects the mental health of people with MS.

METHODS

152 individuals with MS were recruited via UK MS support groups and completed a questionnaire. This included measures of support group identification, depression, anxiety and satisfaction with life, as well as control variables (education level and age).

RESULTS

Analyses revealed that, as hypothesised, support group identification was significantly linked to depression, anxiety and satisfaction with life. Moreover, group identification explained a significant amount of variance in addition to that explained by education and age on each health outcome. Repeating the analysis to compare each of the three main sub-types of MS revealed these effects to be present for individuals with relapsing-remitting (RR) and Primary Progressive (PP) MS, but not for those with secondary progressive (SP) MS.

CONCLUSIONS

We suggest that identifying highly with an MS support group has important positive outcomes for MS patients' mental health. This has implications for practicing clinicians: people with MS (particularly RRMS and PPMS) should be encouraged to engage with support groups, but more must be done to ensure they subjectively identify with these groups, rather than merely attend them.

Correlations Between Quality of Life and Adaptation Factors Among People With Multiple Sclerosis

OBJECTIVE. We examined the correlations between quality of life and three adaptation factors—adjusted self-concept, social support, and accessibility—in people with multiple sclerosis (MS).

METHOD. A convenience sample of 68 participants completed the Leeds Multiple Sclerosis Quality of Life scale (LMSQoL) and a questionnaire assessing the three adaptation factors.

RESULTS. We found significant moderate correlations between LMSQoL scores and adjusted self-concept (r = .56, p < .0001) and LMSQoL scores and social support (r = .52, p < .0001); a significant low correlation was found between LMSQoL and accessibility (r = .36, p = .003).

DISCUSSION. Adjusted self-concept, social support, and accessibility were found to be critical in participants’ psychosocial adaptation to the course of MS. Occupational therapy intervention should address these adaptation factors to help clients cope with MS and promote quality of life.

Perceived social support and depression among Veterans with multiple sclerosis

PURPOSE

To examine the association between perceived social support and self-reported depression among Veterans of the US Armed Forces ('Veterans') with multiple sclerosis (MS), and differences in this relationship between specific support subtypes (tangible, positive social interaction, emotional/informational and affective).

METHOD

Participants were Veterans with MS (N = 451) receiving medical services through the Veterans Health Administration who completed mailed surveys. Hierarchical regression examined the extent to which global perceived social support concurrently predicted depression among a predominantly male sample of individuals with MS. Exploratory correlational analyses examined the relationship between specific subtypes of perceived social support and depression.

RESULTS

Greater global perceived social support was associated with less depression after controlling for sociodemographic and disease-related variables. In follow-up analyses examining specific subtypes of support, greater positive social interaction, greater emotional/informational support, and greater affective support were related to less depression. There was no relationship between perceived tangible support and depression.

CONCLUSIONS

Interventions aimed at increasing positive social interactions, expressed affection and emotional/information support may be particularly helpful for individuals with MS and their caregivers.

Variables associated with communicative participation in people with multiple sclerosis: a regression analysis

PURPOSE

To explore variables associated with self-reported communicative participation in a sample (n = 498) of community-dwelling adults with multiple sclerosis (MS).

METHOD

A battery of questionnaires was administered online or on paper per participant preference. Data were analyzed using multiple linear backward stepwise regression. The dependent variable was an item response theory score of communicative participation measured by a subset of items from the Communicative Participation Item Bank asking respondents to rate how much their health condition interfered with participation in real-life speech communication situations. Thirteen independent variables were included in the model as self-reported symptoms: problems thinking, slurred speech, vision loss, pain, mobility, depression, fatigue, perceived social support, age, education level, employment status, gender, and MS duration.

RESULTS

Fatigue, slurred speech, depression, problems thinking, employment status, and social support were significantly associated with communicative participation, accounting for 48.7% of the variance.

CONCLUSIONS

Communicative participation is significantly associated with multiple variables, only some of which reflect communication disorders. If the goal of intervention is to improve communicative participation, intervention may need to extend beyond traditional speech-language pathology boundaries to include other health symptoms as well as personal, social, and physical environments.

A qualitative investigation of adaptation in older individuals with multiple sclerosis

PURPOSE

This qualitative investigation was designed to identify themes that underlie adaptation in older individuals with multiple sclerosis (MS).

METHOD

Thirteen individuals (age 60 and above) with MS were recruited from an MS Comprehensive Care Centre and local chapters of the National Multiple Sclerosis Society. Participants completed The Perceptions of Aging Interview by telephone. This open-ended interview was developed to explore two lines of inquiry: MS: Perceptions of Aging, which was based on the literature on adaptation in MS, and Life Strengths, which was adapted from Kivnick's Life Strengths Inventory.

RESULTS

The majority of participants reported having adapted to MS and aging. They described several themes and subthemes that seemed to influence their levels of adaptation: Social comparisons, mobility/independence, integration of MS into self-identity, acceptance, pacing and planning, finding meaning/cognitive reframing, social support, religion/spirituality and generativity.

CONCLUSIONS

The themes identified in this investigation are generally supported by the literatures on adaptation to MS and adaptation to aging. However, this is the first study to examine these factors in an older MS sample. Moreover, many of these themes are potentially modifiable through clinical intervention, and should be examined in future research with this population.

Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment

Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Demyelinization of nerve fibres not only affects the motor and sensory systems functionally, but may also cause psychopathological signs and symptoms. In addition to the psychiatric manifestations of MS, many patients have reactive psychological problems that are often hard to distinguish from the 'organic' causation of psychopathology. In any event, psychiatric comorbidity in MS deserves greater clinical attention than has been previously paid, because the presence of psychopathology may have deleterious effects on the disease process and impair coping with disability.

Health Promotion in People with Multiple Sclerosis

Chronic diseases like MS present unique challenges and opportunities for patients and the medical care system. Patients are challenged because they are under tremendous pressure to actively engage themselves in multiple prevention, treatment, and health maintenance behaviors, often before they feel ready. Health care providers are challenged because health-promotion activities require more time, counseling skills, and organizational resources than traditional, acute medical care. Patients, clinicians, and researchers face the challenge of determining which health-promotion activities are not only supported by the evidence but also appropriate for a given patient. New models of health promotion are being developed that integrate self-help and professional help. These approaches have been applied in other chronic diseases and should be adapted and studied among people with MS.