Baseline Social Support Research Articles

Time-varying social support and time to death in the cardiovascular health study.

There is a consensus that social connectedness is integral for a long, healthy life. However, studies of social support and survival have primarily relied on baseline social support measures, potentially missing the effects of fluctuations of perceived support over time. This is especially important for older adults who experience increased changes in disability. This study examined whether among older adults time-varying perceived social support was associated with time to death (main effect model of support) and whether time-varying disability was a modifier (stress-buffering model of support). Gender and marital status were also examined as modifiers. Older adults in the Cardiovascular Health Study (N = 5,201) completed self- report measures of demographics and psychological health and clinical risk factors for mortality at baseline (1989-1990). Perceived social support and disability were measured from baseline through Wave 11 (1998-1999). Cox regression of time to death with time-varying covariates was performed. Time-varying as well as baseline-only perceived social support was associated with greater survival in the unadjusted models but not after adjustment. Gender, marital status, and time-varying disability were not significant modifiers. In contrast with the previously reported association between baseline individual differences in perceived social support and time to death, older adults' baseline-only and fluctuating perceptions of perceived support over time were not associated with time to death after adjustment for other clinical physical and psychological risk factors. Research is needed to identify other relationship factors that may be more informative as time-varying predictors of health and longevity in large longitudinal data sets. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Gender-stratified analyses reveal longitudinal associations between social support and cognitive decline in older men

Objectives: Research has extensively examined the relationship between social support and health outcomes in older adults. Little is known, however, about the longitudinal associations between distinct dimensions of perceived social support and incident cognitive decline. The current longitudinal study examined whether dimensions of perceived social support were associated with increased risk of cognitive decline, and if the relationship differed by gender.Methods: 493 community-residing non-demented older adults were assessed for baseline social support via the Medical Outcomes Study-Social Support Survey (MOS-SSS). Incident cognitive impairment was determined using a 1 standard deviation below age and education adjusted total score on the Repeatable Battery for the Assessment of Neuropsychological Status Cox proportional-hazard models were used to analyze incident risk of cognitive impairment.Results: Higher perceived support, overall and in specific domains, at baseline was associated with increased risk of incident cognitive impairment. Further gender-stratified analyses revealed that higher perceived support at baseline was associated with increased risk of incident cognitive impairment only among males.Conclusion: Contrary to previous research, results from this longitudinal study suggest that perceived support might be an important risk factor for cognitive decline, notably in males, and should be integrated into multifactorial risk assessment and intervention procedures.

Prevalence and predictors of exclusive breastfeeding among immigrant and Canadian-born Chinese women.

Breastfeeding is the optimal method for infant feeding, yet migrant women may be at risk for suboptimal exclusivity rates. In a cohort of immigrant and Canadian-born Chinese women, our objectives were to (a) describe patterns and prevalence of exclusive breastfeeding at 1, 3, and 6months postpartum; (b) identify risk and protective factors associated with exclusivity; and (c) examine potentially differential importance of these factors across this 6-month period. This was a prospective study of 565 immigrants and Canadian-born Chinese women (Toronto, Canada). Exclusive breastfeeding was measured at 1, 3, and 6months postpartum. Predictors comprised fixed (demographics, history of depression, immigrant status, prenatal breastfeeding classes, in-hospital formula supplementation, baseline social support, and baseline acculturative stress) and time-dependent (depression, anxiety, fatigue, and breastfeeding problems) variables. Descriptive statistics, logistic regression, and generalized linear mixed models, respectively, were undertaken to address the objectives. Patterns of breastfeeding practices included exclusive breastfeeding in all time points (26.8%) or none (32.9%) and moving from exclusive to nonexclusive (20.3%) or nonexclusive to exclusive breastfeeding (15.2%). Women less likely to breastfeed exclusively at 1, 3, or 6months were those whose infants received in-hospital formula supplementation. Exclusivity attrition was higher between 3 and 6months than 1-3months. Immigrant status and in-hospital formula supplementation had a significant impact on exclusivity earlier in the postpartum period while breastfeeding problems were associated with decreased exclusivity across time. Proactive preventive efforts are need to maintain breastfeeding exclusivity especially between 3 and 6months if women are to meet international breastfeeding recommendations.

What’s the influence of social interactions on substance use and treatment initiation? A prospective analysis among substance-using probationers

Introduction: A person's social environment greatly affects the likelihood of substance use, which in turn affects risk for criminal behavior. This study examined how people's social environment early in probation contributed to later substance use and treatment outcome, both of which predict probation success.Methods: Data were analyzed from a randomized controlled trial of substance-using probationers (N = 316). Moderation analyses assessed the relationship between social support near the start of probation and substance use and treatment initiation after 2 and 6 months.Results: Abstinence at 2-months was associated with better baseline measures of support quality (more positive support, fewer negative interactions, and reduced conflict). Similar associations were identified for 6-month abstinence including better baseline quality, more positive support, and less family and peer conflict. There were no significant associations between the baseline social support and treatment initiation at 2-months. However, poorer baseline quality support and more negative interactions predicted increased treatment initiation at 6-months.Conclusions: Social support and the quality of an offender's social network have important implications for substance use and treatment compliance. The criminal justice system emphasizes ways to minimize negative social influences among offenders (i.e., probation conditions that limit contact with other offenders). However, this study suggests that behavior change is a function of not only reducing negative influences but also increasing positive or good quality supports.

Influencing Pathways to Quality of Life and HbA1c in Patients With Diabetes: A Longitudinal Study That Inform Evidence-Based Practice.

Determining possible associated factors and the influencing pathways to hemoglobin A1C (HbA1C) levels and quality of life (QoL) will facilitate the development of effective interventions to improve the physical and psychosocial health of patients with type 2 diabetes mellitus (T2DM). To test a hypothesized model that addressed the pathways among personal characteristics, social support, diabetes distress, and self-care behaviors to HbA1C and QoL. A total of 382 adults with T2DM were recruited. Self-reported questionnaires and medical records were used to collect data regarding personal characteristics, diabetes distress, and social support at baseline. The self-care behaviors characters were collected 6 months later, as well as QoL and HbA1C levels 1 year later. The 12-month QoL directly affected 12-month HbA1C levels. The 6-month self-care behaviors directly affected 12-month QoL, and indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline diabetes distress directly affected 12-month QoL. Moreover, baseline diabetes distress indirectly affected 12-month HbA1C levels through 12-month QoL. Baseline social support directly affected baseline diabetes distress and 6-month self-care behaviors. In addition, baseline social support indirectly affected 12-month QoL through baseline diabetes distress. Baseline social support also indirectly affected 12-month QoL through 6-month self-care behaviors. Enhancing QoL is important to improve HbA1C levels. Enhancing self-care behaviors is essential to improve subsequent HbA1C control and QoL. Reducing diabetes distress is crucial to improve subsequent QoL. Improving social support is suggested a favorable strategy to reduce diabetes distress and enhance subsequent self-care behaviors in patients with T2DM.

SOCIAL SUPPORT PREDICTS ILLNESS BEHAVIOR TRAJECTORIES IN THE SWEDISH ADOPTION/TWIN STUDY OF AGING

Social circumstances (e.g., stress, loneliness, support) predict illness behaviors, i.e., responses to symptoms of illness, but little is known about social influences on trajectories of illness behavior in late-life. We examined the predictive value of social support on illness behavior trajectories in SATSA. Participants were 1,314 twins (Mean age at baseline=60.26; SD=13.20; 58% female). Illness behavior was a single factor score calculated from four indicators across four surveys between 1987–2003 (i.e., somatic complaints, over-the-counter medication use, activity limitations due to pain, and perceived illness complications). Higher scores indicated greater likelihood of treatment seeking. Baseline social support measures indexed perceived availability of support from family and friends. Covariates were baseline comorbidity, gender, SES, marital status, and age (centered at 70 years). Illness behavior increased annually (Β=.16, SE=.02, p< .0001). People with more comorbidity (B=2.50, SE=.14, p< .0001) and females (B=2.63, SE=.46, p< .0001) reported higher illness behavior levels, whereas friend support (B= -.17, SE=.04, p< .0001) and age (B= -.20, SE=.02, p< .0001) negatively predicted illness behaviors. Further, age (B=.004, SE=.001, p< .0001) and comorbidity (B=.02, SE=.01, p=.02) predicted faster increases in illness behavior. While multi-morbidity predicts increases in illness behavior level and change, friend support, but not family support, predicts reduced levels. Hence, friend support might be a useful target for reducing overutilization of healthcare in older adults.

Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients.

The aim of this study was to explore the association between baseline social support, functional status, and change in health-related quality of life (HRQoL) in colorectal cancer patients and change in anxiety and depression measured by Hospital Anxiety and Depression Scale (HADS) at 1year after surgery. Consecutive patients who were due to undergo therapeutic surgery for the first time for colon or rectal cancer in 9 hospitals in Spain were eligible for the study. Patients completed the following questionnaires before surgery and 12months afterward: 1 HRQoL instrument, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire; a social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Barthel Index, to assess functional status; the HADS, to assess anxiety and depression; and questions about sociodemographic information. General linear models were built to explore the association between social support, functional status, and change in HRQoL and changes in anxiety and depression 12months after surgery. A total of 947 colorectal cancer patients took part in the study. Patients' functional status, social support, and change in HRQoL were associated with changes in anxiety and depression. Greater social support and improvements in physical, cognitive, and social functioning and in insomnia resulted in improvements in anxiety and depression. No functionally independent patients were associated with lesser improvements in anxiety and depression. Colorectal cancer patients who have more social support, are functionally independent and have higher improvements in HRQoL may have better results in anxiety and depression at 1year after surgery, adjusting for age, gender, location, occupation, and baseline HADS scores.

Social Perceptions Predict Change in Women's Mental Health and Health-Related Quality of Life During the First Semester of College

The transition to college is difficult for many students, and there is a need for improved understanding of experiences that may identify those at risk for negative mental and physical health outcomes. College women are particularly responsive to the social environment, though little is known about processes other than social support. This study investigated the social comparison orientation (SCO) as an independent predictor of change in perceived stress, depressive symptoms, and health-related quality of life during the first semester of college. First-semester college women (n = 157; 64% Caucasian, MBMI = 22.49 kg/m2) completed validated self-report measures of the aforementioned social and health experiences at the beginning and end of their first semester (nine weeks later). Controlling for baseline social support (which was not related to change over time), stronger (vs. weaker) SCO predicted increased depressive symptoms and decreased health-related quality of life (ps < 0.06, ηp2 = 0.05–0.07). More...

Exploring equity in primary-care-based physical activity interventions using PROGRESS-Plus: a systematic review and evidence synthesis.

BackgroundLittle is known about equity effects in primary care based physical activity interventions. This review explored whether differences in intervention effects are evident across indicators of social disadvantage, specified under the acronym PROGRESS-Plus (place of residence, race/ethnicity, occupation, gender, religion, education, social capital, socioeconomic status, plus age, disability and sexual orientation).MethodsSix bibliographic databases were systematically searched for randomised controlled trials (RCTs) of physical activity interventions conducted in primary care. Harvest plots were used to synthesize findings from RCTs reporting subgroup or interaction analyses examining differences in intervention effects across levels of at least one PROGRESS-Plus factor.ResultsThe search yielded 9052 articles, from which 173 eligible RCTs were identified. Despite PROGRESS-Plus factors being commonly measured (N = 171 RCTs), differential effect analyses were infrequently reported (N = 24 RCTs). Where reported, results of equity analyses suggest no differences in effect across levels or categories of place of residence (N = 1RCT), race (N = 4 RCTs), education (N = 3 RCTs), socioeconomic status (N = 3 RCTs), age (N = 16 RCTs) or disability (N = 2 RCTs). Mixed findings were observed for gender (N = 22 RCTs), with some interventions showing greater effect in men than women and others vice versa. Three RCTs examined indicators of social capital, with larger post-intervention differences in physical activity levels between trial arms found in those with higher baseline social support for exercise in one trial only. No RCTs examined differential effects by participant occupation, religion or sexual orientation.ConclusionThe majority of RCTs of physical activity interventions in primary care record sufficient information on PROGRESS-Plus factors to allow differential effects to be studied. However, very few actually report details of relevant analyses to determine which population subgroups may stand to benefit or be further disadvantaged by intervention efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0384-8) contains supplementary material, which is available to authorized users.

The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes.

Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos.

Reductions in physical pain predict lower risk of relapse following alcohol treatment

ObjectivePhysical pain is considered a potential predictor of relapse in alcohol-dependent individuals after treatment. The aim of this study was to evaluate whether reductions in pain level during the follow-up period after treatment were associated with lower relapse risk. MethodA sample of 366 participants was recruited from alcohol treatment centers in Warsaw, Poland. At baseline, information was obtained about pain level, demographics, childhood abuse, impulsivity, depressive symptoms, severity of alcohol and sleep problems. After finishing the alcohol treatment program, patients were followed for 12 months and alcohol drinking (relapse) as well as pain severity were evaluated. ResultsIn the followed-up group, 29.5% of patients confirmed that they drank any alcohol during past 4 weeks. Comparing follow-up to baseline pain, 48.6% of subjects reported an increased severity of pain, 28.8% reported the same level of pain, 22.6% reported decreased level of pain. There was a significant association between the decrease in level of pain and the lower risk of relapse. Other factors associated with relapse during 4 weeks prior to the follow-up were baseline severity of depressive symptoms, low baseline social support and number of drinking days during 4 weeks prior to entering treatment. In multivariate analysis, a decrease in pain level was associated with a lower likelihood of relapse (OR=0.159; 95%CI:0.04–0.62; p=0.008) even when controlled for other factors associated with relapse. ConclusionsDecreases in pain level following treatment for alcohol dependence are associated with, and may contribute to, a lower risk of alcohol relapse.

Friend and Family Support for Weight Loss in Adolescent Females.

Overweight and obesity rates in children and adolescents are concerning, particularly among girls. Social support from friends has been associated with healthier eating and higher levels of physical activity, yet little is known about the relationship between social support and weight loss among adolescents. This aim of this study was to prospectively examine the relationship between baseline social support from friends and family, changes in social support, and weight loss. Sixty-five adolescent girls completed a one-year weight loss intervention trial. Data were collected at baseline, 6 months, and 12 months. At baseline, family support was higher compared to friend support; however, lower friend support at baseline and increases in friend support from baseline to 6 months and 12 months were associated with weight loss. When controlling for other predictors of weight loss, change in friend support for healthy eating was predictive of weight loss at 12 months. These findings suggest that weight loss interventions for adolescent females might consider including strategies to elicit or to create and promote social support for healthy eating from peers. Future studies are needed to test this relationship.

Abstract 13542: Psychosocial Predictors of Duration of Obesity: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Cumulative exposure to excess adiposity contributes significantly to cardiovascular morbidity and mortality. However, little is known about associations of psychosocial factors [life events (LE) and social support (SS)] with duration of abdominal obesity (DOB). Methods: Baseline data were collected in CARDIA from 1985-1986 (N=5115). Participants completed an 11-item SS scale, from Seeman’s and Syme’s work (higher score=higher support), and a 66-item LE scale, from the Psychiatric Epidemiology Rating Interview (higher score=more stressful events exposure in prior year). Associations between baseline SS and LE and DOB were investigated using multivariable linear regression. Abdominal obesity was waist circumference (WC)&gt;102cm for men and &gt;88cm for women. DOB was defined as cumulative abdominal obesity years based on measured WC every 3-5 years in the 25-year study. Results: Among 4214 participants not initially obese, DOB ranged from 0-25 years with a median of 10 years/person. At baseline, those with high LE scores were younger, more likely to be black, with less education, greater total physical activity (PA), greater energy intake (EI) and current/past smoking, while those with high SS score were more likely to be female, black, with higher education, higher PA, lower EI and smoking. In stratified linear regression models adjusted for covariates, each 1-unit higher LE score was associated with longer DOB for white women (Table). In contrast, a 1-unit higher SS score was associated with shorter DOB for white women and white men. No associations were observed among black men or women. Conclusions: Psychosocial factors were associated with duration of abdominal obesity, with a positive association between LE score and DOB for white women, and an inverse association between SS score and DOB for white women and men. These factors may identify those most at risk for greater cumulative exposure to adiposity and may serve as obesity prevention targets.

Social support attenuates the harmful effects of stress in healthy adult women

ObjectiveThe purpose of this study was to test the hypothesis that social support buffers the effects of perceived stress on physical symptoms in healthy women. MethodsThe study was conducted in the Southwest United States and data were collected from 2006 to 2010. Participants were 52 healthy adult women who completed a baseline questionnaire and a 21-day daily diary. Social support was assessed in the baseline questionnaire and perceived stress and physical symptoms were assessed in the daily diary. Multilevel analyses were used to predict both same day and next day physical symptoms from baseline social support and daily perceived stress. ResultsThe hypotheses were supported when predicting both same and next day physical symptoms. For the same day, perceived stress and the social support × perceived stress interaction were both related to physical symptoms. For the next day, the social support × perceived stress interaction but not perceived stress was related to physical symptoms when controlling for previous day physical symptoms. The interactions were such that women higher in social support had smaller increases in same and next day physical symptoms on days of higher perceived stress than women lower in social support. ConclusionsSocial support may buffer the effects of daily perceived stress on physical symptoms in healthy women. Future research should investigate what aspects and in what contexts social support may reduce the effects of perceived stress on physical symptoms and examine how social support may affect the development of long-term health problems through increases in daily physical symptoms.

The Moderating Role of Perceived Social Support on Alcohol Treatment Outcomes.

This study examined the extent to which perceived social support is related to longitudinal treatment outcomes among heavy drinkers randomized to a brief, telephone-based care management intervention versus standard care. This is a secondary analysis of data from a randomized trial comparing an enhanced, brief alcohol intervention to standard care. Participants comprised 136 male, heavy drinkers (mean age = 57.3 years) receiving primary care at Corporal Michael J. Crescenz Veterans Affairs Medical Center clinics. Participants in the intervention arm received a telephone-based care management intervention focused on helping patients reduce their alcohol use. Primary measures included the Timeline Followback method for number of heavy drinking days and the Multidimensional Scale of Perceived Social Support for self-reported baseline social support. Although there was no significant main effect for baseline perceived social support on number of heavy drinking days over time, there was a significant three-way interaction (Perceived Social Support × Randomization Group × Time). Specifically, among patients reporting high support, those randomized to the intervention arm experienced significantly greater declines in number of heavy drinking days over time. Conversely, among patients reporting low support, those randomized to standard care experienced more improvement over the course of followup. Perceived social support may be related to differential outcomes depending on whether patients are in care management or standard care. For those receiving brief intervention, certain therapy techniques may mobilize pre-existing social resources and/or enhance the ability for patients to use their social supports, suggesting the need for replication and further research in understanding this interaction.

Social support and its implications in older, early-stage breast cancer patients in CALGB 49907 (Alliance A171301).

Studies point to a direct association between social support and better cancer outcomes. This study examined whether baseline social support is associated with better survival and fewer chemotherapy-related adverse events in older, early-stage breast cancer patients. This study is a pre-planned secondary analysis of CALGB 49907/Alliance A171301, a randomized trial that compared standard adjuvant chemotherapy versus capecitabine in breast cancer patients 65 years of age or older. A subset reported on the extent of their social support with questionnaires that were completed 6 times over 2 years. The median age of this 331-patient cohort was 72 years (range: 65, 90); 179 (55%) were married, and 210 (65%) lived with someone. One hundred forty-five patients (46%) described a social network of 0-10 people; 110 (35%) of 11-25; and 58 (19%) of 26 or more. The Medical Outcomes Study (MOS) social support survey revealed that the median scores (range) for emotional/informational, tangible, positive social interaction, and affectionate social support were 94 (3, 100), 94 (0, 100), 96 (0, 100), and 100 (8, 100), respectively. Social support scores appeared stable over 2 years and higher (more support) than in other cancer settings. No statistically significant associations were observed between social support and survival and adverse events in multivariate analyses. However, married patients had smaller tumors, and those with arthritis reported less social support. Although social support did not predict survival and adverse events, the exploratory but plausible inverse associations with larger tumors and arthritis suggest that social support merits further study.

Variations in the Role of Social Support on Disclosure Among Newly Diagnosed HIV-Infected People Who Inject Drugs in Vietnam.

Stigma and perceived social support can influence the decision to disclose HIV positive status, especially for people who inject drugs (PWID). In this analysis, the association between social support and HIV disclosure among 336 newly diagnosed HIV-infected PWID in Northern Vietnam was assessed. One month after diagnosis, 34.8 % of participants had not disclosed to anyone. Disclosure to anyone and to a family member specifically, was associated with baseline social support in the form of positive interactions and a history of incarceration. Disclosing to a family member was less likely among those who had unprotected sex in the previous 3 months. Disclosure to an injecting partner was more likely among those with a history of being in a drug treatment program, knowing someone on ART and believing that ART is safe. These data suggest that social support may facilitate disclosure among family members, including spouses, while disclosure to injecting partners is greater when PWID know that ART is a safe and viable option.

Abstract 147: Perceived Social Support is Related to Initial Severity of Post-Stroke Depression, but Not to Depression Improvement

Background: Post-stroke depression (PSD) is a common occurrence after stroke, with multiple associated co-morbidities, and is often undermanaged. Perceived social support has been shown to be related to the presence of PSD; however, little is known about the relationship of social support and its specific dimensions to baseline PSD severity and depression improvement. Methods: We conducted a secondary analysis of data collected as part of a PSD cohort study in which depressed and non-depressed patients were matched 1:1 and enrolled at approximately one month post-stroke. PSD presence was assessed by a structured clinical interview, and PSD severity by the total PHQ-9 score. PSD improvement was measured at 12 weeks, and was defined as a PHQ-9 score &lt; 5 or a decrease by at least 50% from baseline. We constructed multivariable regression models to assess the relationships between social support, as measured by the Medical Outcomes Study Social Support Survey (MOS-SSS) and its subscales, clinical and demographic covariates, and PSD presence, severity, and improvement. Results: Among 385 ischemic stroke patients (203 non-depressed and 182 depressed), baseline MOS-SSS scores were associated with initial PSD presence (OR: 0.987, 95% CI = [0.976, 0.998]), but were not predictive of PSD improvement at 12 weeks (OR: 0.997, 95% CI = [0. 983, 1.011]). The positive social interaction dimension of social support was a significant contributor to variance in baseline PSD severity in all study participants (semi-partial R2: 8.65E-3, p=0.03), especially in the depressed cohort (semi-partial R2: 2.66E-2, p=0.02). Conclusions: Self-reported social support was independently associated with the presence and severity of PSD one month post-stroke. However, we did not find a relationship between baseline social support and subsequent depression improvement independent of other clinical and demographic factors. This suggests that depression interventions may be effective even in patients with low initial social support. Positive social interactions, in the form of leisure or recreational activities, may help to prevent or attenuate initial PSD severity.

Impact of Psychosocial Factors on Functional Improvement in Latino Older Adults After Tai Chi Exercise

Increasing evidence underscores the health benefits of Tai Chi (TC), although there is limited evidence of benefits among racial and ethnic minorities. This study investigated the impact of psychosocial status on balance among 23 Latino seniors after a twice-a-week, 12-week TC exercise program. Functional status was measured at baseline, immediately after, and three months following the TC exercise program, using the Timed Up and Go Test and Tinetti Falls Efficacy Scale. Psychosocial status was measured at baseline by the Center for Epidemiologic Studies Depression Scale and Norbeck Social Support Questionnaire. Both measures of functional status improved and were sustained after three months of TC. Greater improvement was significantly related to a higher level of baseline social support. More depressed seniors reported less fear of falling after TC. Depression and social support are important moderators of functional improvement after TC among Latino seniors.

Predictors of change in quality of life in older adults with generalized anxiety disorder.

Quality of life (QOL) is lower in older adults with generalized anxiety disorder (GAD). QOL generally improves following cognitive-behavioral treatment for GAD. Little is known, however, about additional variables predicting changes in QOL in older adults with GAD. This study examined predictors of change in QOL among older participants in a randomized clinical trial of cognitive behavioral therapy (CBT) for GAD, relative to enhanced usual care (EUC). Hierarchical multilevel mixed-model analyses were used to examine inter-individual and intra-individual factors that predicted QOL over time. Predictors were categorized into treatment, personal and clinical characteristics. QOL improved over time, and there was significant variability between participants in change in QOL. Controlling for treatment condition, baseline general self-efficacy, baseline social support, within-person variation in worry and depression and average levels of depression across different time points predicted changes in QOL. QOL has increasingly been used as an outcome measure in treatment outcome studies to focus on overall improvement in functioning. Attention to improvement in symptoms of depression and worry, along with psychosocial variables, such as social support and self-efficacy, may help improve QOL in older adults with GAD. This study was a secondary study of data from a randomized clinical trial (NCT00308724) registered with clinical.trials.gov.