Functional Social Support Research Articles

Social network, presence of cardiovascular events and mortality in hypertensive patients.

The aim of this study was to ascertain the relationship between social network and the appearance of mortality (cardiovascular events (CVEs)) in patients with arterial hypertension (AHT). This is a cohort study of 236 patients with a 9-year follow-up. Measurements included age, sex, blood pressure (BP), diabetes, hypercholesterolemia, marital status, social network, social support, stage of family life cycle (FLC), mortality and CVEs. Patients with a low social network registered higher global mortality (hazards ratio (HR) 2.6 (95% confidence interval (CI) 1.3; 5.5)) as did the oldest patients (HR 5.6 (1.9; 16.8)), men (HR 3.5 (95% CI 1.3; 9.3)) and subjects in the last FLC stages (HR 4.3 (95% CI 1.3;14.1)). Patients with low social support registered higher cardiovascular mortality (HR 2.6 (95% CI 1.1; 6.1)) as did the oldest patients (HR 12.4 (95% CI 2.8; 55.2)) and those with diabetes (HR 3.00 (95% CI 1.2; 7.6)). Patients with a low social network registered more CVEs (HR 2.1 (95% CI 1.1; 4.1)) than patients with an adequate network, as did the oldest patients (HR 3.1 (95% CI 1.4; 6.9)), subjects who presented with a higher grade of severity of AHT (HR 2.7 (1.3; 5.5)) and those in the last FLC stages (HR 2.5 (95% CI 1.0; 6.2)). A low social network is associated with mortality and the appearance of CVEs in patients with AHT. Low functional social support is associated with the appearance of cardiovascular mortality.

Geriatric Assessment in Older Adults with Newly Diagnosed Multiple Myeloma

Background: Multiple myeloma (MM) is a disease of aging, with a median age at diagnosis of 71. Geriatric assessment, a multi-dimensional assessment of the health of an older adult, has been shown to be feasible, predictive of chemotherapy toxicity, and prognostic in patients with solid tumors. However, the feasibility of geriatric assessment and the frequency of geriatric syndromes in older adults with newly diagnosed MM are not known.Methods: We undertook a pilot prospective cohort study of adults over age 65 with newly diagnosed multiple myeloma. Eligible patients were within 3 months of diagnosis, understood spoken and written English, and had a life-expectancy of ≥ 6 months. Participants completed the primarily self-administered Cancer and Aging Research Group geriatric assessment tool (Hurria et al, JCO, 2011), including measures of functional status, falls, comorbidities, medications, psychological state, social support, cognition and physical performance.Results: From August 2012 – June 2014, 29 patients enrolled at Washington University School of Medicine. The median age was 70 (range 65-84); 79.3% were white, 13.8% black, 3.4% Asian, and 3.4% reported Hispanic ethnicity. ISS stages were as follows: I (10.3%), II (34.5%), III (34.5%), unknown (20.7%).The geriatric assessment was feasible in the clinic setting, and acceptable to participants: 89.7% of patients felt that there were no items on the questionnaire which were difficult to understand and were satisfied with the length. Only 2 participants (6.9%) reported that there were items that upset them in the geriatric assessment (items on sexual health and dying). Most (58.6%) were able to complete the assessment with no assistance.The median clinician-reported Karnofsky-Performance Status (KPS) was 80% (range 50-90%), as was the patient-reported KPS (median 80%, range 30-100%). Requiring assistance with daily activities was extremely common: 57.1% of patients required some or complete assistance with one or more instrumental activities of daily living (IADL), most commonly with housework (61.7%), transportation (37.9%), meal preparation (34.5%), shopping (27.5%), and taking medications (21.5%). Patients frequently reported limitation in performing vigorous activities (89.6%), in moderate activities (72.4%), in walking several blocks (65.5%), or in walking up one flight of stairs (55.1%). Half of participants (48.3%) reported limitation in walking one block. Nearly one-third (31%) required assistance with self-care (bathing or dressing).Patients commonly reported one or more comorbidities, including arthritis (42.9%), emphysema/chronic bronchitis (10.7%), hypertension (32.1%), heart disease (14.3%), diabetes (14.3%), chronic liver or kidney disease (14.8%), and depression (28.6%). Polypharmacy was extremely common. The median number of medications taken on a scheduled and as needed basis was 10 (range 2-23). Sensory impairments were common: 31% reported their vision was fair or worse; 24% reported their hearing was fair or worse. Three patients (10.3%) screened positive for cognitive impairment on the Blessed Orientation-Memory-Concentration Test, while none reported a clinical diagnosis of dementia.Of the 26 patients who completed the Timed Up and Go test (TUG), the median time to complete was 11.3 seconds (range 7.2-19.8 seconds); 26.9% required >13.5 seconds to complete the TUG, which is associated with an increased risk for falls. One in five (21.4%) participants reported one or more falls in the 6 months prior to assessment.Conclusions: A brief, primarily self-administered geriatric assessment was feasible and satisfactory to the participants. Geriatric syndromes including comorbidities, functional dependence, polypharmacy, sensory impairment and falls were common in this cohort, despite most patients having a KPS which is considered “good” in clinical practice. Future study is needed to examine whether the presence of geriatric syndromes in older adult with myeloma is predictive of chemotherapy toxicity, as it is in solid tumors, and whether interventions based on impairments identified in a geriatric assessment can improve outcomes in older adults with myeloma. DisclosuresNo relevant conflicts of interest to declare.

Women's autonomy and social support and their associations with infant and young child feeding and nutritional status: community-based survey in rural Nicaragua.

To evaluate the associations of women's autonomy and social support with infant and young child feeding practices (including consumption of highly processed snacks and sugar-sweetened beverages) and nutritional status in rural Nicaragua. Cross-sectional study. Feeding practices and children's nutritional status were evaluated according to the WHO guidelines complemented with information on highly processed snacks and sugar-sweetened beverages. Women's autonomy was assessed by a seventeen-item questionnaire covering dimensions of financial independence, household-, child-, reproductive and health-related decision making and freedom of movement. Women's social support was determined using the Duke-UNC Functional Social Support Questionnaire. The scores attained were categorized into tertiles. Los Cuatro Santos area, rural Nicaragua. A total of 1371 children 0-35 months of age. Children of women with the lowest autonomy were more likely to be exclusively breast-fed and continue to be breast-fed, while children of women with middle level of autonomy had better complementary feeding practices. Children of women with the lowest social support were more likely to consume highly processed snacks and/or sugar-sweetened beverages but also be taller. While lower levels of autonomy and social support were independently associated with some favourable feeding and nutrition outcomes, this may not indicate a causal relationship but rather that these factors reflect other matters of importance for child care.

Structural and Functional Support in the Prediction of Smoking Cessation in Caregivers of Children with Asthma

Caregivers of children with asthma smoke at rates similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma. Both functional (Interpersonal Support Evaluation List) and structural social support (living with another smoker, partner status, and the proportion of smoking friends) were measured at baseline. Participants received an asthma-education and smoking cessation intervention based on Motivational Interviewing. Biochemically-verified abstinence was assessed at six months post treatment. Results indicated that functional support predicted smoking abstinence even when controlling for relevant covariates and structural support (OR = .896, p = .025). Exploratory analyses revealed that this effect was driven primarily by the self-esteem ISEL subscale. Smoking cessation that focuses on building general functional support, particularly self-esteem support, may be beneficial for smoking cessation in caregivers of children with asthma.

Measuring social support in patients with advanced medical illnesses: An analysis of the Duke-UNC Functional Social Support Questionnaire.

To date, no measure of social support has been developed specifically for either palliative care or oncology settings. The present study examined the psychometric properties of the Duke-University of North Carolina Functional Social Support Questionnaire (DUFSS) in order to (1) assess the adequacy of the scale in the context of severe medical illness and (2) evaluate whether a brief subset of items might generate roughly comparable utility. The 14-item DUFSS was administered to 1,362 individuals with advanced cancer or AIDS. Classical test theory (CTT) and item response theory (IRT) analyses were utilized to develop an abbreviated version of the DUFSS that maintained adequate reliability and validity and might increase the feasibility of its administration in a palliative care setting. The reliability and concurrent validity of the DUFSS-5 were evaluated in a separate validation sample of patients with advanced cancer. Analyses generated a five-item version of the DUFSS (the DUFSS-5) that collapsed response levels into only three options, instead of five. Correlations between the DUFSS-5 and measures of depression, quality of life, and desire for hastened death, as well as regression models testing the main-effect and buffering models of social support, provided support for the utility of the DUFSS-5. Both the DUFSS and the abbreviated DUFSS-5 appear to have adequate reliability and validity in this setting. Moreover, the DUFSS-5 represents a potentially important option for healthcare researchers, particularly for those working in palliative care settings where issues of patient burden are paramount. Such analyses are critical for advancing the development and refinement of psychosocial measures, but have often been neglected.

Functional status and quality of life of stroke survivors undergoing rehabilitation programmes in a hospital setting.

While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life. The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support. Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge. Questionnaires for the evaluation of functional status, health-related QoL, individualised QoL, psychological distress, coping strategies and social support were administered to them. While functional status improves significantly after treatment, individualised evaluations of QoL seem to be less affected. Adaptive coping strategies and social support showed significant correlations with positive outcomes on specific QoL domains, whereas psychological distress was associated with negative outcomes. The data from the present study support the evidence that different measures of QoL and functional status are not strongly associated one another, and that psychological distress, coping strategies and social support can be significantly related to specific outcome measures.

Ethnicity, Social Support, and Depression Among Elderly Chilean People

ABSTRACTRecent evidence regarding the relationship between social support and depression in elderly people shows the important role of ethnicity. This research describes the characteristics of social support in a sample of elderly people aged 60 and above living in northern Chile (n = 493), and analyzes the differences in the relationship between social support and depression between an indigenous group (Aymara population, n = 147) and a nonindigenous group (white, Caucasian, mestizo, n = 346). Various dimensions of social support were considered: structural elements, functional social support according to source, and community participation. The results show the existence of significant differences in the characteristics and dimensions of social support depending on sex, ethnicity, and marital status. Further, the central role of the family group is observed for both Aymara and nonindigenous elderly people. The hierarchical regression models obtained result in notable differences in the role of the structural, functional, and community elements of support in explaining depression for the ethnic groups considered.

6. Adaptive reproduction: How timing of psychosocial stimulus affects birth outcome

In the United States approximately one in eight babies is preterm. Thirty percent of preterm births are attributable to endocrine/immune changes related to stress processing. The evolving contribution of the maturing placenta, an active endocrine and immune organ, to stress processing is understudied. This project evaluated Adaptive Reproduction as a theory for understanding how environmental stressors and psychoneurological states impact birth outcomes. Two hypotheses were tested: (1) does the impact of stress, depression, tobacco use and social support on adverse birth outcomes vary across the gestation? And (2) does the experience of perinatal intimate partner violence (IPV) affect the timing of the impact of these variables on birth outcomes? Multilevel structural equation modeling was performed on data from BabyBEEP (R01 NR05313), a smoking cessation intervention RCT for low-income pregnant women ( N = 695). Thirty-four percent of the women experienced perinatal intimate partner violence. Both hypotheses were supported. When controlling for other variables, stress and social support have paradoxical effects at different stages of pregnancy. In women experiencing perinatal IPV, depression in early pregnancy is associated with preterm birth. Adaptive reproduction provides plausible explanation for why psychoneuroimmune alterations lead to preterm birth and low birthweight. This explains how community and individual level preconceptional and prenatal interventions aimed at enhancing functional social support and stress resilience improve outcomes and suggests modifications in timing of the interventions for enhanced effects.

Breast and ovarian cancer in the older woman.

Nearly half of all women diagnosed with breast or ovarian cancer are age 65 years or older with the number of women diagnosed expected to increase as the population ages and life expectancy improves. Older women are less likely to be offered standard cancer treatments, are more likely to develop higher toxicity, and have higher mortality. Chronologic age should not be the only factor used for making treatment decisions. Functional dependence, organ function, comorbidity, polypharmacy, social support, cognitive and/or psychosocial factors, overall life expectancy, and patient's goals of care are equally vital and should be assessed before and during treatment. In this review, current evidence and treatment guidelines for older women with breast or ovarian cancer are outlined.

Social Network and Stroke Risk

See related article, p 2868. Humans are social animals. The quality and quantity of our relationships with other humans (social network) underpin our happiness and success.1 A social network structure also provides functional social support. It assists us emotionally and physically, informs and educates us, and improves our health-related choices and behaviors.2 But does it protect us from stroke? Several epidemiological studies have reported small social network and limited social support to be associated with an increased incidence of mortality, coronary heart disease, cancer, and mood disorders,3–13 but only 4 studies have examined the association with stroke and the results are conflicting.5,6,14,15 In the first study, of 2603 members of a US health maintenance organization, there was no difference in the 15-year incidence of stroke among those in the lowest versus highest tertile of social network indices.5 However, in the second study, of 32 624 US male health professionals, socially isolated men had an increased risk of stroke (relative risk, 2.21; 95% confidence interval [CI], 1.12–4.35), which was dose-dependent ( P for trend=0.008).6 A subsequent study of 629 women with suspected myocardial infarction also found a higher rate of stroke among more socially isolated women than those with more social relationships (adjusted hazards ratio [HR], 2.7; 95% CI, 1.1–6.7). …

Associations of structural and functional social support with diabetes prevalence in U.S. Hispanics/Latinos: results from the HCHS/SOL Sociocultural Ancillary Study.

Little research has examined associations of social support with diabetes (or other physical health outcomes) in Hispanics, who are at elevated risk. We examined associations between social support and diabetes prevalence in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Participants were 5,181 adults, 18-74 years old, representing diverse Hispanic backgrounds, who underwent baseline exam with fasting blood draw, oral glucose tolerance test, medication review, sociodemographic assessment, and sociocultural exam with functional and structural social support measures. In adjusted analyses, one standard deviation higher structural and functional social support related to 16 and 15% lower odds, respectively, of having diabetes. Structural and functional support were related to both previously diagnosed diabetes (OR = .84 and .88, respectively) and newly recognized diabetes prevalence (OR = .84 and .83, respectively). Higher functional and structural social support are associated with lower diabetes prevalence in Hispanics/Latinos.

Glycemic control among U.S. Hispanics/Latinos with diabetes from the HCHS/SOL Sociocultural Ancillary Study: do structural and functional social support play a role?

Social support is one potential source of health-related resiliency in Hispanics with diabetes. This study examined relationships of structural (i.e., social integration) and functional (i.e., perceived) social support with glycemic control (glycosylated hemoglobin; HbA1c) in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. This study included 766 men and women representing multiple Hispanic ethnic backgrounds, aged 18-74 years, with diagnosed diabetes who completed fasting blood draw, medication review, and measures of sociodemographic factors, medical history, structural support (Cohen Social Network Index), and functional support (Interpersonal Support Evaluation List-12). After adjusting for sociodemographic covariates and medication, a one standard deviation increase in functional support was related to an 0.18% higher HbA1c (p = 0.04). A similar trend was observed for structural support; however, this effect was non-significant in adjusted models. Greater functional support was associated with poorer glycemic control in Hispanics.

Risk Prediction Models to Predict Emergency Hospital Admission in Community-dwelling Adults

Risk prediction models have been developed to identify those at increased risk for emergency admissions, which could facilitate targeted interventions in primary care to prevent these events. Systematic review of validated risk prediction models for predicting emergency hospital admissions in community-dwelling adults. A systematic literature review and narrative analysis was conducted. Inclusion criteria were as follows; community-dwelling adults (aged 18 years and above); Risk: risk prediction models, not contingent on an index hospital admission, with a derivation and ≥1 validation cohort; emergency hospital admission (defined as unplanned overnight stay in hospital); retrospective or prospective cohort studies. Of 18,983 records reviewed, 27 unique risk prediction models met the inclusion criteria. Eleven were developed in the United States, 11 in the United Kingdom, 3 in Italy, 1 in Spain, and 1 in Canada. Nine models were derived using self-report data, and the remainder (n=18) used routine administrative or clinical record data. Total study sample sizes ranged from 96 to 4.7 million participants. Predictor variables most frequently included in models were: (1) named medical diagnoses (n=23); (2) age (n=23); (3) prior emergency admission (n=22); and (4) sex (n=18). Eleven models included nonmedical factors, such as functional status and social supports. Regarding predictive accuracy, models developed using administrative or clinical record data tended to perform better than those developed using self-report data (c statistics 0.63-0.83 vs. 0.61-0.74, respectively). Six models reported c statistics of >0.8, indicating good performance. All 6 included variables for prior health care utilization, multimorbidity or polypharmacy, and named medical diagnoses or prescribed medications. Three predicted admissions regarded as being ambulatory care sensitive. This study suggests that risk models developed using administrative or clinical record data tend to perform better. In applying a risk prediction model to a new population, careful consideration needs to be given to the purpose of its use and local factors.

Threatened with death but growing: changes in and determinants of posttraumatic growth over the dying process for Taiwanese terminally ill cancer patients.

Posttraumatic growth at end of life, a positive psychological consequence of dealing with a life crisis, may be catalyzed by the trauma of facing mortality. Studies on cancer patients' posttraumatic growth have overwhelmingly examined early-stage survivors. Of the few studies on advanced cancer patients, none anchored posttraumatic growth with the patient's death. Therefore, the purposes of this study were to describe longitudinal changes in and to identify determinants of posttraumatic growth over the dying process. A convenience sample of 313 cancer patients was recruited and followed until death. Posttraumatic growth was measured by the Posttraumatic Growth Inventory. Determinants were evaluated from sociodemographics, cancer characteristics, social context variables, and coping strategies using a multiple linear regression model. The dying process may be too threatening and stressful for cancer patients to experience profound posttraumatic growth as manifested by low Posttraumatic Growth Inventory scores (26.13 ± 21.59 to 40.33 ± 27.71 on a 0-105 scale) without significant changes as death approached. However, terminally ill cancer patients who were not defeated by the initial threat of death experienced posttraumatic growth. Patients were at risk for low-level posttraumatic growth if they were male, were non-middle aged, had low educational attainment, had a non-metastatic disease, recently recognized terminally ill status, had severe symptom distress, had high functional dependence and weak social support, and were unaware or had low acceptance of their prognosis. Interventions are needed to appropriately relieve symptom distress, facilitate functional independence, enhance social support, and improve prognostic awareness and acceptance to inspire positive changes for cancer patients at end of life.

Validation of the MOS Social Support Survey 6-item (MOS-SSS-6) measure with two large population-based samples of Australian women

This study aimed to validate a 6-item 1-factor global measure of social support developed from the Medical Outcomes Study Social Support Survey (MOS-SSS) for use in large epidemiological studies. Data were obtained from two large population-based samples of participants in the Australian Longitudinal Study on Women's Health. The two cohorts were aged 53-58 and 28-33 years at data collection (N = 10,616 and 8,977, respectively). Items selected for the 6-item 1-factor measure were derived from the factor structure obtained from unpublished work using an earlier wave of data from one of these cohorts. Descriptive statistics, including polychoric correlations, were used to describe the abbreviated scale. Cronbach's alpha was used to assess internal consistency and confirmatory factor analysis to assess scale validity. Concurrent validity was assessed using correlations between the new 6-item version and established 19-item version, and other concurrent variables. In both cohorts, the new 6-item 1-factor measure showed strong internal consistency and scale reliability. It had excellent goodness-of-fit indices, similar to those of the established 19-item measure. Both versions correlated similarly with concurrent measures. The 6-item 1-factor MOS-SSS measures global functional social support with fewer items than the established 19-item measure.

Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors.

Examination of reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post-diagnosis). We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy and 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke-UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach's alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported. The overall response rate was 60.5 % (577 respondents/953 eligible). Compared with non-responders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally non-deprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group. With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy.

Validation of interpersonal support evaluation list-12 (ISEL-12) scores among English- and Spanish-speaking Hispanics/Latinos from the HCHS/SOL Sociocultural Ancillary Study.

The Interpersonal Support Evaluation List-12 (ISEL-12; Cohen, Mermelstein, Kamarck, & Hoberman, 1985) is broadly employed as a short-form measure of the traditional ISEL, which measures functional (i.e., perceived) social support. The ISEL-12 can be scored by summing the items to create an overall social support score; three subscale scores representing appraisal, belonging, and tangible social support have also been proposed. Despite extensive use, studies of the psychometric properties of ISEL-12 scores have been limited, particularly among Hispanics/Latinos, the largest and fastest growing ethnic group in the United States. The current study investigated the reliability and structural and convergent validity of ISEL-12 scores using data from 5,313 Hispanics/Latinos who participated in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Participants completed measures in English or Spanish and identified their ancestry as Dominican, Central American, Cuban, Mexican, Puerto Rican, or South American. Cronbach's alphas suggested adequate internal consistency for the total score for all languages and ancestry groups; coefficients for the subscale scores were not acceptable. Confirmatory factor analyses revealed that the one-factor and three-factor models fit the data equally well. Results from multigroup confirmatory factor analyses supported a similar one-factor structure with equivalent response patterns and variances between language groups and ancestry groups. Convergent validity analyses suggested that the total social support score related to scores of social network integration, life engagement, perceived stress, and negative affect (depression, anxiety) in the expected directions.

Trajectories of Social Support and Well-Being Across the First Two Years of Widowhood

The death of a spouse can be one of the most challenging events an older adult can face, yet many exhibit resilience. The present study examined the trajectories of structural and functional social support components, depression, and life satisfaction across the first two years of widowhood. The majority of structural and functional support trajectories exhibited stability across the first two years postloss. However, emotional support and support provided by family members did display a slight decline across time. Depression showed a linear pattern across time (e.g., decline in depressive symptomology) and life satisfaction demonstrated evidence of a one-year anniversary effect.

Feasibility of geriatric assessment in community oncology clinics

Emerging results support the value of geriatric assessment (GA) in determining the risk and benefits of cancer treatment in older adults. A brief GA tool consisting of valid and reliable measures has been developed; however, little data exist on the ability to perform the GA in community oncology clinics. The objective of this study was to determine the feasibility of performing the GA in the community. Patients aged ≥65 were eligible. The GA included a health care provider assessment of performance status, cognitive function, a Timed Up and Go test, and a self-administered patient questionnaire that evaluated measures of functional status, comorbidity, psychological state, social support, and nutritional status. From 2009 to 2013, 1088 patients were assessed including 339 (31%) from seven community clinics across North Carolina. The median amount of time to complete the patient-report portion of the GA was 19min in the academic center versus 22min in the community. The median amount of time to complete the entire GA was 23min in the academic center and 30min in community settings. Significantly more patients in the community required assistance completing the questionnaire (24% vs. 14%); however, most patients required no assistance (76%). A brief GA can be performed in community oncology clinics. The time to complete the professional assessments and patient self-assessments were similar in both settings. Future studies are planned to determine if such assessments can improve cancer care for older patients.

Apoyo social y funcionalidad familiar en personas con trastorno mental

Antecedentes. Cuando algún miembro de la familia presenta un padecimiento mental como la esquizofrenia, y un familiar asume el rol de cuidador, el apoyo social es elemental para afrontar con éxito la funcionalidad familiar y los problemas que ocasionan. Objetivo. Determinar los factores de apoyo social y estructural asociados con la percepción de funcionalidad familiar en las personas con trastorno mental y los familiares cuidadores. Material y método. Estudio descriptivo, correlacional, transversal, no probabilístico, de participación secuencial, en dos grupos: 72 pacientes ambulatorios diagnosticados con un trastorno de salud mental y 66 familiares cuidadores. Se utilizaron tres instrumentos: el Cuestionario MOS, el Cuestionario APGAR-Familiar y el Cuestionario Duke-UNC-11. Resultados. La Funcionalidad familiar (APGAR) es percibida por 58.3% de los pacientes; el 19.4%, disfuncionalidad severa y 22.2%, disfuncionalidad leve. En los familiares, 66.7% percibe funcionalidad familiar; 10.6%, disfuncionalidad severa y 22.7%, disfuncionalidad leve. En el reporte del apoyo estructural (MOS) se observó una diferencia estadísticamente significativa (t=-2.478, gl=136, p=0.014) en la percepción de apoyo instrumental entre los pacientes (?=11.68) y los familiares. Estos últimos percibieron menor apoyo instrumental (?=9.91). En cuanto al apoyo funcional social (Duke-UNC-11) no se indica diferencia (t=1.170, gl=136, p=.244) entre los familiares (?=40.36) y los pacientes (?=38.07). El modelo de regresión lineal mostró que los pacientes con mayor tiempo de evolución y con diagnóstico de esquizofrenia predicen disfuncionalidad; en cambio el apoyo social predice funcionalidad (p<.001). En los familiares, a mayor tiempo de evolución se pronostica disfuncionalidad en tanto que el apoyo social predijo funcionalidad (p<.001). Conclusión. Es evidente que en la funcionalidad familiar el apoyo social juega un papel importante en pacientes que padecen problemas mentales y en los familiares cuidadores. En los pacientes se observó que a mayor AS perciben mayor funcionalidad familiar. En los familiares el apoyo estructural demostró una mejor percepción de funcionalidad familiar, lo que permite disminuir la probabilidad de recaídas y hospitalización.