Original ArticleSources of social support as determinants of psychiatric morbidity after severe life events: Prospective cohort study of female employees
Introduction
Numerous studies have shown an association between stressful life events and problems with mental health in various populations [1], [2], [3], [4], [5], [6], [7], [8], [9]. However, social support is assumed to have an emulative function when a person is under considerable stress [10], [11], [12], [13]. For example, the stress-buffering hypothesis [14], [15] maintains that support from “significant others” should counteract the pathological consequences of such events as divorce, chronic illness, and unemployment, on mental health [16], [17], [18], whereas an increased risk of illness among persons who have recently experienced a serious life event may partly stem from the absence of adequate support sources [19], [20], [21]. However, recent longitudinal studies among nonclinical populations have raised doubts regarding the buffering effects of social support between life events and psychiatric ill health [22], [23], [24], [25]. Instead, they rather support the chronic strain hypothesis [15], which proposes that various long-term stressors such as poor social resources themselves deteriorate mental health. Thus, the findings suggest that life events and social support are independent predictors of psychiatric morbidity.
Although a large body of research has indicated that sources of social support, such as partner support or friend support, are associated with mental health [26], [27], [28], [29], most of this work has been cross-sectional and therefore has not determined the time order of the associations [30], [31], [32], [33], [34]. Such evidence is of little help in testing the chronic strain hypothesis and the stress-buffering hypothesis. In the few longitudinal studies, however, both the independent and buffering effects of some individual sources of support, such as friends, coworkers, and relatives, on the maintenance of mental health has been reported [35], [36], [37]. Nevertheless, due to several methodological limitations, firm prospective evidence is still lacking regarding the extent to which specific sources of support act as predictors and buffers of mental health changes after critical life events.
One of the problems with the previous research is the lack of control of the initial level of the criterion-dependent variables. Therefore, validity is a concern because, without control of mental health at baseline, the possibility of a reversed association (health affecting social support) cannot be excluded. In addition, the measurement of social support is a weakness. Social support as a buffer against the negative effects of life events has usually been tested only with respect to postevent social support moderators, and the uncontaminated support moderators prior to the event, as suggested by recent methodological studies [38], have been neglected. Hence, researchers have generally focused on the effects of the mobilization of support when investigating the associations between severe life events, sources of support, and mental health. To our knowledge, large-scale prospective studies on distinct life events and psychiatric morbidity have not examined the effects of potential pre- and postevent sources of support within the same study. In addition, the study samples have been limited. A considerable amount of research on sources of social support and psychiatric morbidity has been conducted among clinically selected (breast cancer, HIV patients, etc.) or unemployed (elderly persons, adolescents, etc.) populations using rather small samples. Therefore, the possibility to extrapolate the findings to active working populations is limited.
The aim of this study was to investigate the independent and moderating role of preevent and postevent sources of support in relation to psychiatric morbidity in a large-scale sample of employed women. As research on life events has indicated that women are more vulnerable, especially when undesired life events occur to a close person [39], [40], [41], [42], [43], we separately studied various types of life events, such as death or illness of a family member, interpersonal conflict with a close person, and serious financial difficulty. Previously, these types of events have been found to be among the most severe life events to occur during a person's life span [2], [44], [45], [46], [47]. To examine whether the effects of social support are support specific, we studied six common sources of support: partner, relative, friend, coworkers, supervisor, and network heterogeneity. The research questions were as follows: (1) Are the sources of social support independently related to psychiatric morbidity (the chronic strain hypothesis)?; (2) To what extent is preevent social support from various sources able to prevent psychiatric morbidity after different types of life events (the stress-buffering hypothesis)?; and (3) If there are buffering impacts, are the sources of support preevent (the buffer resource model) or postevent modifiers (the buffer mobilization model)?
Section snippets
Participants
This study is part of the 10-town study [48] coordinated by the Finnish Institute of Occupational Health. In 1997, we sent 11 570 identifiable full-time municipal workers of eight Finnish towns a questionnaire inquiring about sources of support, psychiatric morbidity, and other variables (9615 employees were from a representative sample and 1955 from an additional sample from three towns). Of these, 7732 (67%) agreed to participate in the study and responded to the questionnaire. In October
Results
The distribution of demographic characteristics, alcohol consumption, and hostility is shown in Table 1. Altogether 6% of the studied women reported death or illness of a family member during the past year, 6% had had interpersonal conflicts, and 7% reported severe financial difficulties, respectively. A total of 24% had been GHQ cases at Time 1, while the corresponding figure for Time 2 was 29%. The correlation of age, marital status, and occupational status with particular types of life
Discussion
We examined two major hypotheses of social support and mental health in the context of the different severe life events assumed to represent “triggers of the processes leading to uncontrollable changes” [46] that finally threaten one's mental health. The chronic strain hypothesis maintains that poor social support increases mental health problems. The stress-buffering hypothesis, in turn, suggests that the health-deteriorating consequences of life events depend, at least partly, on the
Acknowledgments
The study was supported by the University of Tampere, the Academy of Finland (Grant 54585, and Projects 77560 and 105195), the Yrjö Jahnsson Foundation (Grant 5082), the Finnish Work Environment Fund (Projects 101190 and 103432), and the participating towns.
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