The complexity of the role of social support in relation to the psychological distress associated with cancer

Abstract

It is hardly surprising that clinical and research efforts have focussed on the role of social support for cancer patients, given the high level of distress typically associated with the diagnosis and treatment of cancer. However, social support is a metaconcept that requires careful delineation. In this regard, social support has been described as comprised of components that are informational, instrumental, emotional, affirmation, and appraisal [1]. Although these elements may overlap, adequate assessment of the various dimensions will ensure that appropriate clinical applications can be drawn from research findings. Social network size may be a separately studied variable that relates to social support [2]. Gender, age, marital status, and education may influence social support needs and social network size. The studies in this special section have focussed on social network size and the perceived adequacy of social support for cancer patients, as well as for parent caregivers of married cancer patients in relation to depression and health-related quality of life. Effective measurement of perceived support is considered the best lever to establish the relative significance of modifiable social factors for health and well-being [3]. The level of satisfaction with one’s social support is a useful first question in this regard. Not surprisingly, Hann et al.’s [4] large-scale study reported that greater perceived adequacy of social support among cancer patients was associated with less depression with no differences by age or gender. In considering social network size and depression, Haan et al. [4] found that, gender is an important variable. Among women with cancer, an increased number of family and friends was significantly related to less depression, whereas network size did not affect men. Given that 20% of the population gender difference in depression has been found to be attributable to emotional reliance [5], it may be of interest to determine how social network size may play a role in this regard. Certainly, the marital relationship has a greater positive effect on health for men, with women tending to obtain support from a broader network [6]. Social network size has also been found to have a bearing on health-related quality of life across all dimensions of functioning among women with breast cancer. In the welldesigned prospective longitudinal study of women with invasive breast cancer, Michael et al. [7] found that those who were isolated or moderately isolated had lower mental and physical health as well as vitality. Of interest, development of a smaller or larger social network following the diagnosis of cancer was associated with a slightly lower than average functional health status. Further research is necessary to determine how social network size and various social support dimensions interact in a protective manner.