Social support as a predictor of perceived health status in patients with multiple sclerosis

Abstract

Objective

The main aim of this study was to investigate whether different levels of perceived social support are associated with different levels of perceived health status in multiple sclerosis (MS) patients.

Methods

Two hundred and seven MS patients (38.4 ± 10.6 years, 66.2% female) completed the Short-Form-36 Health Survey (SF-36) as the measure for perceived health status, and the perceived social support scale (PSSS) as the measure for social support. Functional disability was assessed using Kurtzke's expanded disability status scale (EDSS). The contribution of EDSS and PSSS for explaining the variance in SF-36 was investigated with multiple linear regression analysis.

Results

Demographic variables and EDSS explained 44% of the variance of the physical health summary scale in the SF-36. Demographic variables, EDSS and PSSS from family and friends explained 24% of the variance in mental health summary scale in the SF-36. Results varied according to the multiple linear regression analyses of predictors of variance in the eight dimensions of the SF-36.

Conclusion

PSSS from significant others was positively associated with general health dimension of perceived physical health status, while PSSS from family and friends was positively associated with perceived mental health status in MS patients.

Practice implications

The results show the importance of supporting social ties and relationships between MS patients and others.

Introduction

Multiple sclerosis (MS) is a chronic autoimmune disease with an uncertain course, with symptoms beginning between ages 20 and 50 years in 90% of the cases. It is the most common cause of neurological disability in young adults [1], [2]. The socio-medical model of the disablement process explains how chronic and acute conditions affect functioning in specific body systems, physical and mental activities, and activities of daily life in young adults with MS.

Personal and environmental factors can speed up or slow down the disablement of patients. Patients become limited not only in employment but also educational opportunities, or interpersonal relationships as well [3], [4], [5]. Functional disability has been associated with restricted social participation. The disease usually starts during the first two decades of employment in a patient's life. Several studies have investigated the relationship between functional disability and perceived health status in MS patients [6], [7], [8], [9].

Social support includes the supportive input which different people receive from their social environment, and almost any type of social interaction may be considered as social support [10], [11]. It is assumed that social support has two important types of functions: the health-sustaining function has a direct effect on the well being of individuals. Social support contributes to the positive adjustment and development of personality. On the other hand, social support also has an indirect stress reducing or buffering function [12], [13], [14].

Generally, social support is supposed to influence three basic levels: emotional (love and affection), instrumental (helping hands) and informational (providing information). The final component is the perception of social resources that refer to the subjective evaluation of the level of quality of the support [10], [15]. Emotional and informational supports can strengthen the perception that the stressor is not as bad as originally believed. Emotional support is helpful no matter who the source is. Emotional support is helpful when it comes from family and friends or when it comes from healthcare professionals [10]. However, patients usually prefer informational support more from the physicians and nurses than from family [10].

Social support has been the most frequently studied psychosocial resource. Structural aspects of social support usually refer to the functions performed for the individual by three groups: family, friends and significant others [16], [17]. The group ‘significant others’ includes persons who are relevant for the patients, in this case for instance co-workers, health care professionals or other MS patients [18]; that is to say, relevant persons besides ‘family (including partner)’, and ‘friends’. The authors of the scale of perceived social support presented the importance of exploring specifically whom subjects consider as constitutive of ‘special person’ in the significant others subscale. The meaning of significant others can be dependent on the patient's age, marital status, social and cultural conditions when interviewed. Significant others could be taken to refer to a number of different individuals. Clarification of this issue would be necessary [16]. Apart from these, important sources of informational support could be peer groups or psychotherapeutic groups led by experts [10]. Subjects who are employed or studying can feel positive relationships from significant others like colleagues, fellow students and teachers who can provide them social support. When they participate in a work team or study group, they can feel positive relationships with significant others like fellow students, teachers or co-workers who can provide them social support. Koopman et al. [19] identified the needs of individuals with MS.

The main aim of this study is to investigate whether different levels of perceived social support are associated with different levels of perceived health status in MS patients. We expected that:

• Social support provided by family, friends and significant others are positively associated with perceived physical and mental health status in MS patients independently from basic demographic variables and functional disability.

• Social support provided by family, friends and significant others are positively associated with the separate dimensions of perceived physical and mental health status in MS patients independently from basic demographic variables and functional disability.