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PubMed1992

Social environment and health--a social epidemiological frame of reference.

Growing interest in epidemiological studies and prevention has led to increased awareness of the importance of the social environment to health. In this field of research, which might be designated social epidemiology, there is today extensive research into the possible association between different types of social factors and ill-health in the population. This article presents a social epidemiological frame of reference and some social factors of importance when one is studying the relationships between the social environment and health. Important social factors in the model are social stratification, social network, social support and life-style factors. Two other main categories of social factors in the model are circumstances and events related to social stratification or occupation and social network respectively. These may be factors in the external or internal work environment and variables describing the general activity level of the individual or different types of stressful social network-related life events. Other important factors in the model are physiological and clinical factors and three different types of health indicator. In the field of social epidemiological research, there is an increasing need for the development of theoretical models and frameworks as support in the analysis of social factors and health. These could be based on experience and tradition in both epidemiological research and the social sciences.

Epidemiologic Methods↗
PubMedDate not supplied

Aspects of social support associated with depression at hospitalization and follow-up assessment among cardiac patients.

PURPOSE: High levels of depressive symptoms have been shown to affect the morbidity, mortality, and functioning of patients with myocardial infarction (MI). Findings have shown that social support is associated with depression in both patient and community samples. This study examined various aspects of social support as they relate to depressive symptoms in patients with MI, both in the hospital and 2 weeks later. METHODS: As part of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) pilot study, measures of perceived social support, social networks, social support received, and social conflict were administered to 196 patients with MI. These patients also were administered the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Depression was reassessed 2 weeks later. Relations between social support indicators and the depression measures were examined. RESULTS: The prevalence of depression symptoms was high, especially among poorer and younger patients. There was modest improvement across time. Patients with high social support scores, particularly those reflecting perceived support, had lower scores on depression measures at baseline. High levels of perceived support and low social conflict at baseline were associated with less follow-up depression, as measured by the Beck cognitive scale, but not the Beck somatic scale nor the Hamilton scale. There were few associations with measures of social networks and received support. CONCLUSIONS: Social support indicators were differentially related to depression among patients with MI while in the hospital and 2 weeks later. The pattern of associations also depended on the measure of depression. A broad assessment strategy of both social support and depression is needed for a full understanding of their interrelations.

Aged↗
PubMed2006

Social support and suicidal ideation in older adults using home healthcare services.

OBJECTIVE: The objective of this study was to examine the associations between objective and subjective social support and suicidal ideation in older adults receiving home healthcare services. METHOD: Participants were randomly selected from a sample of older adults newly starting skilled nursing care from a certified home health agency in Westchester County, NY. Research interviewers assessed 522 older adults aged 65 years and older who were receiving home care services. Subjective and objective components of social support were assessed using measures of social network, social interaction patterns, instrumental support, and perceptions of social support. Suicidal ideation was assessed using items from the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the Hamilton Depression Rating Scale. RESULTS: In bivariate analyses, neither objectively determined size of social network nor instrumental support was associated with suicidal ideation. However, lower social interaction patterns and lower perceived social support were significantly related to suicidal ideation. After adjusting for potential confounders, only lower perceived support remained significantly associated with suicidal ideation. In post hoc analyses of the perceptions of social support scale items, satisfaction with one's relationships and feeling useful to family and friends were significantly associated with a lower likelihood of suicidal ideation in the final multivariate logistic regression model controlling for possible confounding variables. CONCLUSIONS: Subjective social support is a potentially modifiable risk factor for suicide in later life. Findings suggest that the perception of social support is an important construct to examine in future longitudinal studies examining risk and protective factors for suicidal ideation and behaviors in older adults.

Aged↗
PubMed1994

Depression in painful chronic disorders: the role of pain and conflict about pain.

Chronic pain severity, the responses of the significant other to the patient's pain, and social network relationships were investigated for their contributions to depression among patients with myofascial pain disorders (N = 67) and arthritis (N = 83). Interview data were gathered using the Beck Depression Inventory, McGill Pain Inventory, Multidimensional Pain Inventory, and Interpersonal Relationships Inventory. Patients with myofascial pain disorders reported significantly more severe depression and pain, more conflict about their pain, and more network conflict than those with arthritis. They also reported less network social support. After controlling for the type of painful chronic disorder, multiple linear regression analyses indicated that more severe depression was significantly associated with more severe pain, conflict about pain, and less network social support. Conflict about pain may increase the risk of depression for patients with chronic painful disorders. Patients with myofascial pain disorders, however, may experience more conflict about their pain because of the absence of objective physical findings that corroborate the report of pain.

Adult↗
PubMed1996

Psychosocial resources and persistent smoking in early pregnancy--a population study of women in their first pregnancy in Sweden.

STUDY OBJECTIVE: To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. DESIGN: The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks. SETTING: The study was performed in the antenatal clinics in the city of Malmö, Sweden. PARTICIPANTS: The participants were all primigravidas living in the city of Malmö, Sweden, over a one year period, 1991-92. A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n = 404, 46.3%). MAIN RESULTS: At the first antenatal visit (63.6% (n = 257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29.5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2.7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2.2 (1.2, 4.0) and those with a low social participation RR 1.6 (1.0, 2.7), low instrumental support RR 2.6 (1.2, 6.0), low support from the child's father RR 2.1 (1.0, 4.2) and those exposed to job strain RR = 2.3 (1.1, 4.8). The associations were independent of potential confounders such as age, educational level, nationality, cohabiting status, passive smoking, and previous years of smoking. CONCLUSIONS: This study supports the stress hypothesis. Smoking can be one way women handle stress when demands become too great. In order to reduce smoking among pregnant women, maternity centre resources need to be focused more on women with low psychosocial resources who are at highest risk for continued smoking. It is also important to involve actively the woman's partner or other important people in the woman's social network.

Adolescent↗
PubMed2003

Women's networks and the social world of fertility behavior.

CONTEXT: Demographic phenomena occur within social contexts and, therefore, should be studied as social processes. However, how to conceptualize and measure the social worlds that individuals inhabit has been the subject of debate. METHODS: Data from a study conducted in Mali in 1996-1997 are used to explore the social networks of Bamanan women and their impact on fertility decisions. Ordinary least-squares and logistic regression techniques are employed to examine the relationship between selected household and social network characteristics and two fertility measures: children ever born and ever-use of contraceptives. RESULTS: Household characteristics do not have a significant effect on either outcome, whereas network attributes do. The more prominently conjugal kin are represented in a network, the fewer children a woman has ever had; however, fertility increases if the husband or unrelated older women are part of the network. Ever-use of contraceptives is elevated if the woman participates in a credit scheme, and rises as the proportion of network members located outside the village increases; it declines sharply as the proportion of network members who are conjugal kin increases, and is significantly elevated if the woman's mother is present. Network effects on fertility are much more pronounced for women aged 30 or older than for younger women, and network effects on contraceptive use are markedly different for younger and older women. CONCLUSIONS: Programs should consider not only women's individual and household characteristics, but also their larger social networks. Additionally, programs should be designed for specific age-groups, given the different network effects on older and younger women.

Adolescent↗
PubMed1996

Social ties and health: the benefits of social integration.

This article explores the relationship between level of social integration and various aspects of health. A search of the literature published since the mid-1970s (under the MEDLINE key words, "social ties," "social network," "social isolation," "social environment") presented strong evidence that social integration leads to reduced mortality risks, and to a better state of mental health. The evidence on physical health outcomes is less conclusive. There is no consistent evidence that social integration affects the incidence of disease (at least for cardiovascular outcomes). However, social integration does appear to have a highly beneficial effect on post-myocardial infarction prognosis (functioning and longevity). A physiologic basis for these effects on health outcomes is also indicated by research demonstrating that both social isolation and nonsupportive social interactions can result in lower immune function and higher neuroendocrine and cardiovascular activity while socially supportive interactions have the opposite effects. In conclusion, available data suggest that, although social integration is generally associated with better health outcomes, the quality of existing ties also appears to influence the extent of such health benefits. Clearly, individuals' networks of social relationships represent dynamic and complex social systems that affect health outcomes.

Health Status↗
PubMed1997

Religious involvement and depression in older Dutch citizens.

It has been suggested that religiosity helps prevent depression in older people. This study examines the association between religious involvement and depression in older Dutch citizens and focuses on models of the mechanism in which religious involvement has an impact on other factors related to depression. The subjects were 2,817 older adults aged 55-85 years living in the community who participated in the Longitudinal Aging Study Amsterdam. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Religious involvement was assessed using items on frequency of church attendance and strength of church affiliation. Further data were collected on physical health, size of social network, social support, sense of mastery and self-esteem. As in North American studies, religious involvement appeared to be inversely associated with depression, both on symptom and syndrome levels. Controlling for sociodemographics, physical impairment and network support did not substantially affect this association, particularly among subjects aged 75-85 years. The inverse association between religious involvement and depression was not selectively more pronounced among older people with physical impairments. However, the association appeared to be most specific for subjects with a small social network and those with a low sense of mastery.

Aged↗
PubMed1997

[Social support, social stress and health of slightly disabled elderly persons].

The paper examines the influence of social networks on social support and social stress and analyses the impact of social support and stress on health. 171 (t1, 1992) and 135 (t2, 1993) persons aged 75 and older in need of a little help but still living on their own were personally interviewed in three districts of the city of Zurich. The results demonstrate that social networks are important for mobilizing social support and that these mobilizing processes are characterized by sex differences: The family (i.e. the partner) is much more important for men than for women who rely both on family and non-family social networks. There are only weak relationships between social networks and social stress. Social support affects health positively by indirect mechanisms. From t1 to t2 social networks, social support and health remain rather constant while social stress changes substantially.

Activities of Daily Living↗
PubMed2000

Association of a lack of psychosocial resources and the risk of giving birth to small for gestational age infants: a stress hypothesis.

OBJECTIVE: To test the stress hypothesis that women who give birth to small for gestational age infants lack important psychosocial coping resources, such as a sufficient social network, social support and control in daily life. DESIGN: A prospective cohort study of nulliparous pregnant women. SETTING: Antenatal care units in the city of Malmö, Sweden. POPULATION: All women (n = 994) during a one year period (1991-1992) were invited, and 872 (87 x 7%) participated. This study was restricted to pregnancies resulting in singleton live birth (n = 826); 6 x 7% of infants were classified as small for their gestational age. METHODS: Self-administered questionnaires were given to all women at the time of their first antenatal visit. MAIN OUTCOME MEASURES: The classification of small for gestational age was based on a gender-specific intrauterine growth reference curve. Newborn babies were classified as being small for gestational age if their birthweight was > 2 SD below the mean weight for gestational age. RESULTS: Lack of psychosocial resources, such as social stability, social participation, emotional and instrumental support, all increased the likelihood of delivering an infant that was small for gestational age. The odds ratios when controlled for demographic background factors, lifestyle factors and anthropomorphic measures were: OR 1 x 7 (95% CI 0 x 9-3 x 3) for women with poor social stability; OR 2 x 2 (95% CI 1 x 1-4 x 4) for women with poor social participation; OR 2 x 6 (95% CI 1 x 2-5 x 7) for women with poor instrumental support; and OR 1 x 5 (95% CI 0 x 8-2 x 8) for women with poor emotional support. Simultaneous exposure to a poor total network index, as well as a poor total support index showed a significantly increased odds ratio for having a small for gestational age baby: OR 3 x 3 (95% CI 1 x 6-6 x 7) and OR 2 x 7 (95% CI 1 x 3-5 x 6), respectively. A synergy index of 9 x 0 and 6 x 8 supported the assumption of an interaction between immigrant status and poor total network or poor total support, in a synergistic direction. CONCLUSIONS: The findings support the stress-hypothesis that a lack of psychosocial resources might increase the risk of giving birth to a baby that is small for gestational age.

Adaptation, Psychological↗
PubMed1996

Usage and users of natural remedies in a middle-aged population: demographic and psychosocial characteristics. Results from the Malmö Diet and Cancer Study.

BACKGROUND: In Sweden, large amounts of money are spent annually on natural remedies (NRs), in spite of the fact that most products in this category lack scientific documentation of their efficacy and side-effects. The usage and users of natural remedies are not well defined. This paper describes NR use and NR users in a city in southern Sweden, and tests the hypothesis that the use of natural remedies is a strategy for coping with psychosocial stressors. METHODS: The study cohort consisted of 6545 men and women, aged 45-65 years, who during 1991 and 1992 participated in the Malmö Diet and Cancer Study, a large-scale prospective cohort study. Data on consumption of natural remedies were recorded during seven consecutive days, as part of a dietary assessment. Each participant also completed a questionnaire, covering education, work history, alcohol and smoking habits, perceived health, and psychosocial factors such as social network, social support, job strain and global control. Body composition was also measured. RESULTS: The prevalence of NR consumption was 26% among women and 17% among men. NR use was most common during winter and spring. The most popular products were ginseng, garlic, and various herb and plant extracts. Important determinants of NR usage were higher education, Swedish origin, and lifestyle factors like low body weight fat percentage and high alcohol consumption among women. Other determinants were higher age and non-smoking among men. None of the psychosocial factors appeared to influence the prevalence of NR consumption. CONCLUSIONS: The prevalence of NR consumption is influenced by sex, demographic factors, season of the year, and lifestyle. Use of NRs does not appear to be a common strategy for coping with psychosocial stress.

Journal Article↗
PubMed2006

Time in the United States, social support and health behaviors during pregnancy among women of Mexican descent.

Among women of Mexican descent, increased acculturation in the US has been associated with poorer health behaviors during pregnancy. This study examined a population of low-income women of Mexican descent in an agricultural community to determine: whether social support patterns were associated with age at arrival in the US; whether social support was associated with pregnancy behaviors; and whether increased social support could prevent some of the negative pregnancy behaviors that accompany acculturation. Participants were 568 pregnant women enrolled in prenatal care in the Salinas Valley, California. Participants were predominantly Spanish speaking, born in Mexico, and from farmworker families. Information on social networks, social support, age at arrival in the US, and pregnancy health behaviors was gathered during interviews conducted during pregnancy and immediately after delivery. Poorer health behaviors were observed among women who had come to the US at a younger age. Social support during pregnancy was lowest among women who had come to the US at an older age. High parity, low education, and low income were also associated with low social support. Higher social support was associated with better quality of diet, increased likelihood of using prenatal vitamins, and decreased likelihood of smoking during pregnancy. High social support also appeared to prevent the negative impact of life in the US on diet quality. Women with intermediate or low levels of social support who had spent their childhoods in the US had significantly poorer diet quality than women who had spent their childhoods in Mexico. However, among women with high social support, there was no difference in diet quality according to country of childhood. Thus, in the case of diet quality, increased social support appears to prevent some of the negative pregnancy behaviors that accompany time in the US among women of Mexican descent.

Acculturation↗
PubMed2002

The impact of depression on the well-being, disability and use of services in older adults: a longitudinal perspective.

OBJECTIVE: To study the impact of depression on the wellbeing, disability and use of health services of older adults. METHOD: Prospective community-based study, using a large (n = 2,200) sample of the elderly (55-85) in the Netherlands. Using a 3-year follow-up, the effect of depressive symptoms (CES-D) on disability, wellbeing and service utilization was assessed, controlling for competing need-for-care (chronic physical illness, functional limitation and cognitive decline), enabling (partner status, size of the social network, social support and locus of control), and predisposing factors (age, sex and level of education). RESULTS: Depressive symptoms have considerable impact on the wellbeing and disability of older people and clear economic consequences caused by inappropriate service utilization. Compared with other need-for-care variables the impact of depression is weaker (service utilization), similar (disability) or stronger (wellbeing). CONCLUSION: The steeply rising prevalence of competing health risks in later life does not influence the significance of depression.

Aged↗
PubMed1990

A social stress model of substance abuse.

The social stress model provides a framework for detecting protective factors that may contribute to adolescents' resiliency when confronted with compelling influences to engage in substance abuse. Parameters of the model were tested in 2 urban high school samples (N = 124) of Black (78%), White (16%), and Hispanic (6%) adolescents aged 12-14 years. Pretest and posttest measures, designed to detect the relative influence of stress, social networks, social competencies, and community resources on levels of students' usage, were completed at the beginning and end of the school year. The parameters of the model, estimated using LISREL7, indicated that the pathway from family characteristics to usage and from assertion to usage were significant. The paths from the remaining hypothesized variables were not significant. Implications for the design of prevention programs that facilitate youths' resiliency are discussed.

Adolescent↗
PubMed2000

A longitudinal model of social contact, social support, depression, and alcohol use.

The longitudinal relations among contact with one's social network (social contact), perceived social support, depression, and alcohol use were examined. An integrative model was developed from affect regulation theory and theories of social support and dysfunctional drinking. Data were obtained from a random sample of 1,192 adults. The 3-wave panel model was tested using structural equation modeling analysis. Results revealed that (a) social contact was positively related to perceived social support; (b) perceived social support was, in turn, negatively related to depression; and (c) depression was, in turn, positively related to alcohol use for 1 of 2 longitudinal lags. There was partial support for the feedback hypothesis that increased alcohol use leads to decreased contact with family and friends. Although the results generally supported the authors' hypotheses, the significant coefficients in the model were generally small in size.

Adult↗
PubMed1997

Social support: a conceptual analysis.

Using the methodology of Walker and Avant, the purpose of this paper was to identify the most frequently used theoretical and operational definitions of social support. A positive relationship between social support and health is generally accepted in the literature. However, the set of dimensions used to define social support is inconsistent. In addition, few measurement tools have established reliability and validity. Findings from this conceptual analysis suggested four of the most frequently used defining attributes of social support: emotional, instrumental, informational, and appraisal. Social network, social embeddedness, and social climate were identified as antecedents of social support. Social support consequences were subsumed under the general rubric of positive health states. Examples were personal competence, health maintenance behaviours, effective coping behaviours, perceived control, sense of stability, recognition of self-worth, positive affect, psychological well-being, and decreased anxiety and depression. Recommendations for future research were made.

Aged↗
PubMed2002

Ethnic differences in daily smoking in Malmö, Sweden. Varying influence of psychosocial and economic factors.

BACKGROUND: The aim was to investigate ethnic differences in daily smoking in Malmö, Sweden, and whether these differences could be explained by psychosocial and economic conditions. METHODS: The public health survey in Malmö 1994 is a cross-sectional study. A total of 5,600 individuals aged 20-80 years were randomly chosen to respond to a postal questionnaire. The participation rate was 71%. The study population was divided into seven categories according to country of birth; Sweden, Denmark/Norway, other Western countries, former Yugoslavia, Poland, Arabic-speaking countries and all other countries. A multivariate analysis was performed using a logistic regression model in order to investigate the importance of possible confounders on the ethnic differences in daily smoking. Finally, variables measuring social network, social support and economic conditions were introduced. RESULTS: The prevalence of daily smoking was significantly higher among both men and women born in Denmark/Norway (39.1% and 37.0%), men born in other Western countries (32.9%), Poland (34.0%) and Arabic-speaking countries (36.4%) than among Swedish men (21.7%) and women (23.8%). Women born in Arabic-speaking countries had a significantly lower smoking prevalence (7.1%). The multivariate analysis, including age, education and snuff, did not affect these results. A reduction of the odds ratio of daily smoking was observed for men born in Arabic-speaking countries and Poland after the introduction of the psychosocial and economic factors in the model. Only small changes were observed for women. CONCLUSION: There were significant ethnic group differences in daily smoking. Psychosocial and economic conditions in Sweden may be of importance in some ethnic groups.

Adult↗
PubMed2002

The role of mastery and social resources in the associations between disability and depression in later life.

PURPOSE: Although disability is widely acknowledged as a risk factor for late-life depression, few studies have studied the potential of psychosocial factors to alter the association between disability and depression. The present study assessed the impacts of mastery and social resources (social network, social support, and satisfaction with support) on depression and, in particular, whether they modify the link between disability and depression. DESIGN AND METHODS: The direct and moderating effects of mastery and social resources were empirically tested using a sample of 406 community-dwelling older adults who were cognitively intact (mean age = 72.3). RESULTS: Higher level of mastery and greater satisfaction with support had significant direct effects on depression and also buffered the adverse impact of disability on depression. IMPLICATIONS: The findings support the importance of psychosocial factors in modifying the association between disability and depression and suggest that efforts to enhance positive psychosocial attributes should be emphasized in interventions for older adults.

Activities of Daily Living↗