Social Support Instrument Research Articles

Social support and achievement motivation: Can they alleviate burnout in swimming athletes?

Background and Study Aim. In the world of sport, boredom is detrimental because it can affect performance and decrease achievement. Coaches and athletes should pay attention to boredom as an early potential warning signal to potentially become more severe. The purpose of this study was to determine the role of social support and achievement motivation in alleviating burnout in swimming athletes. Materials and Methods. This quantitative research employs an ex post facto approach. The participants in this study were members of the Sleman Regency swimming club in Yogyakarta, totaling 73 athletes (43 males, 30 females). The social support instrument used was The Perceived Available Support in Sport Questionnaire (PASSQ), the motivation instrument used was The Sports Motivation Questionnaire (SMQ), and the burnout instrument used was the Athlete Burnout Questionnaire (ABQ). The analysis was performed using regression techniques in the Statistical Package for Social Sciences (SPSS) version 21 software. Results. The results showed that social support (t = ‑2.773, p = 0.007) and achievement motivation (t = ‑2.777, p = 0.007) had a negative and significant effect on burnout in swimming athletes. Conclusions. It can be concluded that social support and achievement motivation can alleviate burnout in swimming athletes, with an influence of 31.20%.

A Scoping Review of Instruments Used in Measuring Social Support among Refugees in Resettlement.

This study aimed to systematically review current research on the application of existing social support scales in research with refugees in resettlement, assess their quality, and identify gaps in measurement to enhance research and practice. A scoping review was conducted on the extant literature published until March 2023. A team of researchers conducted search, sorting, and data extraction processes following best practices for scale development and validation. Of the 1185 studies collected from the search process, 41 articles were retained in the final analysis, from which 17 distinct social support instruments used in research with resettled refugees were identified. An assessment of all 17 instruments showed the presence of one or more limitations associated with construct, criterion, convergent, and/or discriminant validity. Test of reliability was assessed in all studies, with a range of 0.80 to 0.90. Our findings show that most of the research evaluating social support among resettled refugees is conducted without measurement instruments adequately validated in the resettlement context. This analysis highlights the need for rigorously developed social support scales that reflect the lived experiences, needs, and priorities of resettled refugees.

Psychometric testing of the Chinese version of the Perinatal Infant Care Social Support tool: a methodological study.

This study aimed to translate the Perinatal Infant Care Social Support (PICSS) instrument into Chinese and to verify the reliability and validity of the translated version. This study used a cross-sectional design to examine the reliability and validity of the Chinese version of the PICSS (C-PICSS). A cohort of 150 first-time mothers in China participated, attending hospital follow-up care at 6 weeks postpartum. Data were collected after obtaining informed consent from the mothers. The majority of mothers were aged between 20 and 29 years, with a mean age of 26.25 (±3.90) years. An item analysis of the 19 items in the C-PICSS showed that all items had an item-total score correlation above 0.2. This resulted in a Kaiser-Meyer-Olkin value of 0.92 and a significant Bartlett's test of sphericity (χ2=1,778.65, p<.001), confirming the suitability of the data for factor analysis. Correlation analyses revealed a strong positive relationship between infant care social support and general social support (r=.62, p<.001), and a negative relationship between infant care social support and postpartum depression (r=-.38, p<.001). Higher scores for infant care social support were associated with reporting positive relationships with their husbands (t=3.72, p<.001) and high levels of spousal involvement (t=4.09, p<.001). In terms of structural support, spouses were identified as the primary source. The research results indicate that C-PICSS is reliable and valid as an indicator of social support for infant care among Chinese mothers.

The roles of health literacy and social support in the association between smartphone ownership and frailty in older adults: a moderated mediation model

BackgroundUnderstanding the role of smartphones to promote the health status of older adults is important in the digital society. Little is known about the effects of having smartphones on physical frailty despite its positive effect on the well-being of older adults. This study aimed to explore the association between smartphone ownership and frailty in community-dwelling older adults and its underlying mechanism.MethodsWe used data from the Korean Frailty and Aging Cohort Study and analyzed 2,469 older adults aged 72–86 years. Frailty, health literacy, and social support were assessed by Fried’s frailty phenotype, the Behavioral Risk Factor Surveillance System health literacy module, and the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Instrument, respectively. The mediation model and moderated mediation model were estimated, where the mediator was health literacy and the moderator was social support, to explore the relationship between smartphone ownership and frailty.ResultsOf our study participants, 58.9% owned smartphones, and 10.9% were classified as frail. Smartphone ownership was negatively associated with frailty (β = −0.623, p < 0.001). Health literacy mediated the relationship between smartphone ownership and frailty (β = −0.154, boot confidence interval [CI] = − 0.222, − 0.096), and social support moderated the mediation effect (β = −0.010, Boot CI = − 0.016, − 0.004).ConclusionsOwning smartphones among older adults could reduce the risk of frailty. Promoting health literacy and social support among older adults with smartphones would be effective to prevent frailty.

Social support in recently diagnosed diabetic patients: Risk factor for depression?

Background: social support is important for adaptation in chronic diseases, such as diabetes and depression, because it favors recovery and adherence to treatment. Introducing its evaluation in the follow-up of diabetic patients can reduce complications derived from secondary non-adherence. Aims: to establish social support in diabetic patients and its correlation with depressive symptoms. Methods: a cross-sectional analytical study nested in a cohort of 173 recently diagnosed diabetic patients (<6 months) in Colombia over 18 years of age, treated in a cardiovascular risk program in 2022. The Chronic Illness Social Support Inventory was used. Results: Most of the participants were women (77.5%); single(83.8%), age (mean = 62.6 years (SD 12.3)); glycemia (mean = 146.4 (SD 65.5)), glycosylated hemoglobin (mean = 7.6 (SD 1.7)). Cronbach's α coefficient for the general scale of the social support instrument was 0.9859. The mean social support was 168.5 (SD 37.4), range 38-228. The total social support score was normally distributed (Shapiro Wilk p > 0.05). The correlation between domains was statistically significant. The PHQ9 total score was significantly associated with the domains of Personal Interaction and Guide but did not significantly correlate with the overall social support score. The respondents who were at risk of developing depression were referred for treatment. Conclusions: findings suggest that perceived social support may play a significant role in the prevention and treatment of depression in diabetic patients. It is desirable that health professionals consider evaluating and enhancing social support to improve their mental health. More research is needed to gain a comprehensive understanding of this relationship.

A Systematic Review of Social Support Instruments for Measurement-Based Care in Posttraumatic Stress Disorder.

Social support is a treatment target for individuals with post-traumatic stress disorder (PTSD) but is not systematically assessed in clinical care. This review evaluated the quality of patient-reported social support instruments used in PTSD research to identify candidates for measurement-based care (MBC) with this population. A systematic review identified all validated measures of social support used in research with traumatized populations after 1990. Instrument development/validation studies were then evaluated using components of the updated COSMIN guidelines. Instruments were rated for clinical utility and evidence of their psychometric properties in use with traumatized individuals was synthesized. Twenty-nine instruments were identified across 231 studies. Evaluation of development articles found 14 instruments with sufficient evidence of content validity and internal consistency reliability that could be considered for clinical use. Of these, nine had comparable properties in traumatized samples and could be preliminarily included in MBC of social support in the treatment of PTSD. Additional studies on measures' responsiveness and test-retest reliability are needed. Existing measures of social support could improve clinical care of PTSD when used routinely to provide feedback on this critical component of health. MBC of social support may also improve clinical care of other psychiatric conditions.

The Relationship between the Social Support of Principal and Self-Compassion of School Counselors to the Performance of School Counselors

In this study, 115 people participants were selected through a simple random sampling using a lottery technique. The research data was collected using a Likert scale with three types of research instruments, namely the social support instrument, which consisted of 32 valid items with a reliability coefficient of 0.769. The self-compassion instrument consists of 26 valid items with a Cronbach's alpha of 92. The performance instrument consisting of 15 valid items with a reliability coefficient of 0.878. Simultaneous test results using an Fcount of 5.203 (Fcount&gt;Ftable) with a significance of 0.007. These results indicate that there is a significant relationship between social support and self-compassion to the performance of school counselors. The partial correlation test shows that there is a significant positive relationship between social support and performance and self-compassion to the performance, as indicated by the values (r) 0.437 and 0.243 with a significance of 0.007 and 0.009 (p 0.05). The R2 value is 0.298, in which social support and self-compassion make a simultaneous effective contribution of 29.8% to performance. Social support provides a greater relationship to performance than self-compassion with an effective contribution of 21.4% for social support and 8.4% for self-compassion. Therefore, it can be concluded that all the hypotheses put forward confirmed to be proven in the sense that the higher the social support and self-compassion is, the higher the performance of school counselors in Central Jakarta.

Unraveling the Link between Self-efficacy and self-management in Breast Cancer Patients during the COVID-19 Pandemic: A Cross-sectional Study

Background: The COVID-19 pandemic necessitates that cancer patients take on a more active role in self-managing their illness and adjusting to the altered healthcare resources. To perform self-management behaviors, patients may need an adequate level of self-efficacy. However, little is known about breast cancer patients’ self-efficacy and self-management in pandemic times. Aim: This study aimed to assess the self-efficacy and self-management of breast cancer patients undergoing therapy during the COVID-19 pandemic and identify their associations. Methods: A descriptive-analytical, cross-sectional design was used. One hundred and eight breast cancer patients undergoing treatment were recruited from the National Cancer Center in Indonesia. Participants completed questionnaires that consisted of the Cancer Behavior Inventory, the Depression Anxiety Stress Scale, the Enrichd Social Support Instrument, and the Self-Management Assessment Scale. Data were analyzed using multiple regression. Results: The study found that 45.4% and 42.6% of breast cancer patients under treatment had a low level of self-efficacy and self-management, respectively. Self-efficacy is positively associated with self-management in breast cancer patients (p=0.001) after controlling for various factors, including cancer stage, psychological factors, and social support. The factor most related to self-management is self-efficacy, as measured by the odds ratio (OR), which was 16.713 (95% CI: 4.424-63.137), while the ORs of social support and stage were 4.968 (95% CI: 1.785-13.831) and 0.190 (95% CI: 0.044-0.820), respectively. Conclusion: It can be concluded that self-efficacy is strongly and positively associated with self-management in breast cancer patients undergoing treatment. Therefore, nursing interventions focusing on enhancing patients’ self-efficacy are needed.

Validating the Korean Version of the Duke Social Support Index

Considering the increasing number of older people and one-person households of older people in South Korea as well as the importance of social support among older people, there is a need to develop an instrument that assesses both the structural and functional social support of older people. Accordingly, this is the first study to validate the Korean version of the 10-item Duke Social Support Index (DSSI-10), which is composed of the social interaction and satisfaction with social support subscales. A total of 293 respondents who were over 65 years old and attended welfare centers located in the surrounding area of Seoul participated in this study. We found that the Korean version of the DSSI is a reliable and valid social support instrument that exhibits a two-factor structure like its English version. The DSSI also has the advantage of being able to measure structural and functional social support simultaneously. Developing the Korean version of the DSSI will provide a valuable social support instrument for researchers and practitioners in South Korea, where social support scales measuring both types of social support for older people do not yet exist.

Clinical and psychosocial factors associated with quality of life in patients with head and neck cancer: an analytical cross-sectional study from a lower-middle-income country

IntroductionThe disease course of head and neck (H&N) cancer can severely impair patients’ quality of life (QoL). In Pakistan, a South Asian lower-middle-income country (LMIC), psychosocial factors may impact QoL. We aimed to assess QoL and associated factors amongst patients with H&N cancer in Pakistan.MethodsAn analytical cross-sectional study was conducted amongst adult (≥ 18 years) patients with H&N cancer who were ≥ 4 weeks post-initiation of treatment. The survey assessed QoL (European Organization for Research and Treatment of Cancer Quality of Life Questionnaires), anxiety and depression (Hospital Anxiety and Depression Scale), and social support (Enriched Social Support Instrument). Multivariable linear regression was performed for analysis.ResultsA total of 250 patients (mean age: 51.6 years) were included. The majority of patients were married (87%) and living with multigenerational/extended family households (53%). On multivariable linear regression, ongoing cancer treatment (beta coefficient: -13.93), having a tracheostomy (-10.02), and receiving adjuvant chemoradiotherapy (-8.17) were significantly associated with poorer global QoL. Additionally, poorer QoL was associated with depression (-24.37) and anxiety (-13.34). However, having more household family members was associated with better global QoL (0.34).ConclusionThe QoL of patients with H&N cancer in Pakistan is affected by both the nature of cancer treatment as well as sociocultural factors such the number of household family members. Given that poorer QoL is associated with worse mental health outcomes, there is a need to develop and implement psychosocial interventions to improve the QoL of patients with H&N cancer in Pakistan, particularly during active treatment.

Automated Digital Counseling Program (ODYSSEE-Kidney Health): A Pilot Study on Health-Related Quality of Life.

In-person counselling programs promote self-care behaviour and health-related quality of life (HRQoL). ODYSSEE Kidney Health (ODYSSEE-KH) is an automated, scalable, digital counselling program for patients with CKD. This open-label, single-arm pilot study tested the efficacy potential of ODYSSEE-KH to improve HRQoL in patients with CKD. Adults with categories G3b to 5D CKD were recruited from nephrology clinics in Toronto, Canada. Patients (n=29) received access to ODYSSEE-KH in conjunction with usual care. Generalized linear models and pairwise comparisons of mean change scores were conducted to assess the primary outcome: Mental Component Score (MCS) of the Kidney Disease Quality of Life - Short Form (KDQoL-SF) instrument. Secondary outcomes included: MCS mental health scale, 36-item KDQoL-SF, Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire for depression (PHQ-9), Enhancing Recovery in Coronary Heart Disease Social Support Instrument (ESSI), and 3-item Revised UCLA Loneliness (RULS-3) scale. Mean age was 53.5 years (SD=18.3); 35% women; 56% White; 93% completed ≥ post-secondary education; patients came from the Multi-Care Kidney Clinic (n=9), the Home Peritoneal Dialysis Unit (n=12), and the Home Hemodialysis Unit (n=8); and 24 participants completed the 4-month end of study questionnaires. Outcomes were assessed according to tertiles of program logon minutes: median (range) = 67 (62-108), 212 (119-355), and 500 (359-1573) minutes. Patients in the highest tertile of engagement showed significant improvements on the MCS vs. the moderate tertile group (p = 0.01). Significant dose-response associations were observed for MCS Mental Health (p<0.05), KDQoL Burden on Kidney Disease (p<0.01), KDQoL Effect of Kidney Disease on Everyday Life (p<0.01), aggregated KDQoL summary (p<0.05), GAD-7 (p<0.01), PHQ-9 (p<0.05), ENRICHD-SSI (p<0.01), and RULS-3 (p<0.01). ODYSSEE-KH demonstrated feasibility as an automated, scalable, digital self-care program for patients with CKD. There is evidence of efficacy potential to improve HRQoL. Further evaluation with a larger sample is warranted.

Instrument for Social Support in Physical Education

The purpose of this research is to develop a social support instrument in physical education learning. This research is an R&amp;D research and development from Borg &amp; Gall (1983) which divides the development stages into 10 stages, namely 1) data collection for preliminary research 2) Development planning is carried out by determining the objectives and preparing a trial plan. 3) Developing initial products, which are then evaluated by 2 expert judgment and make product revisions 4) Small group trials. 5) Product revision 6) Field trial (medium group). 7) Conduct product revision 8) Field trial (large group). 9) Conducting the final stage revision 10) Making a research report. The population in this study were public high school students in Bandung City aged 15-18 years. The research sample was 241 students who were taken using random sampling technique. Data collection in this study using a questionnaire. The analysis used Exploratory factor analysis (EFA) technique and continued with Confirmatory Factor Analysis (CFA) technique. The reliability test results show a Cronbach's Alpha value of 0.926. Because the value is above 0.6, it can be concluded that the measuring instrument in this study is reliable and has good construct validity and reliability quality.

Development of Gambling Behaviour and Its Relationship with Perceived Social Support: A Longitudinal Study of Young Adult Male Gamblers

Young adult men who gamble frequently face an elevated risk of developing gambling-related problems. So far, little is known about how changing levels of perceived social support interact with the course of gambling behaviour and gambling-related problems in this population. Using data from a prospective single-arm cohort study (Munich Leisure Time Study), we applied hierarchical linear models to investigate the longitudinal association of changes in perceived emotional and social support (hereafter PESS; operationalized as ENRICHD Social Support Instrument score) with gambling intensity, gambling frequency, and fulfilled criteria for gambling disorder. Pooling data from three time points (baseline, 12-month and 24-month follow-ups) to assess two 1-year intervals, these models disentangle the associations of (a) “level of PESS” (cross-sectional, between participants) and (b) “changes in individual PESS” (longitudinally, within-participants). Among the 169 study participants, higher levels of PESS were associated with fewer gambling-related problems (− 0.12 criteria met; p = 0.014). Furthermore, increasing individual PESS was associated with lower gambling frequency (− 0.25 gambling days; p = 0.060) and intensity (− 0.11 gambling hours; p = 0.006), and fewer gambling-related problems (− 0.19 problems; p < 0.001). The results suggest a mitigating influence of PESS on gambling behaviour and gambling-related problems. Increasing individual PESS appears more decisive for this pathway than high initial levels of PESS. Treatment and prevention strategies that activate and reinforce beneficial social resources in people with gambling-related problems are recommended and promising.

Long-Term Changes in Poststroke Depressive Symptoms: Effects of Functional Disability and Social Support.

Long-term changes in specific depressive symptoms have rarely been studied in stroke patients. Such changes and the effects of social support and functional disability on specific symptoms after a long-term follow-up period (LTP) were investigated. The Montgomery-Åsberg Depression Rating Scale (MADRS), ENRICHD Social Support Instrument, and modified Rankin Scale (mRS) for functional disability were administered at baseline, a 6-month follow-up, and an LTP (35-83 months). Effects of social support and poor functional outcome (mRS score of 3 to 6) on the 10 single items included on the MADRS were identified. Among 222 patients, mRS score, total MADRS score, and all single-item scores except "concentration difficulties," "inability to feel," and "suicidal thoughts" improved at the 6-month follow-up. From the 6-month follow-up to the LTP, the total MADRS score and half of the single-item scores worsened, although the functional outcome measure continued to improve. In multivariable linear regression tests, low social support was associated with "reduced sleep" (standardized β=0.20; 95% CI=0.06 to 0.34, p=0.005) and "pessimistic thoughts" (standardized β=0.16, 95% CI=0.03 to 0.30, p=0.019), and poor functional outcome was associated with all specific symptoms (standardized β values=0.18-0.43, all p<0.02) except "reduced sleep." Although total MADRS and single-item scores improved in parallel with improvements in functional outcome at the 6-month follow-up, these scores worsened afterward. The lack of social support and presence of functional disability were both associated with total MADRS scores. However, specific symptoms were differentially affected, suggesting that tailored strategies should be applied to manage depression in stroke patients.

Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

Background: Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support. Methods: There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models. Results: There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates ( Figure ). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant. Conclusion: Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

Which Protective Factors Are Associated with the Mental Health of Syrian Students in Germany? A Register-Based Cross-Sectional Study

The aim of this online, register-based cross-sectional study was to investigate the frequency of psychological distress and protective factors among 136 Syrian students in Germany. The survey measured depression and anxiety (Patient Health Questionnaire-4), post-traumatic stress (Impact of Event-Scale-6), as well as resources social support (ENRICHD Social Support Instrument), optimism (Optimism-Pessimism-2 Scale) and religiosity (Duke Religion Index). A total of 26.50% of the sample were female. A total of 38.93% met criteria for clinically relevant depressive respectively generalized anxiety symptoms and 15.72% showed prominent PTSD scores. Participants screened positive for mental distress reported significantly less social support (p = 0.001) and less optimism (p = 0.002) than participants without mental distress. In multiple regression analyses, higher levels of feeling welcome in Germany, social support and intrinsic religiosity were significantly associated with lower levels of depression and generalized anxiety. Significant associations with lower PTSD levels were found with higher levels of social support and optimism. The results show that Syrian students in Germany are more psychologically burdened compared to other Syrian refugee samples, except for PTSD. This suggests that besides the stress caused by flight and trauma, stressors such as studying and social isolation could be considered as additional impediments for mental health and require intervention measures.

Education Research: Impact of Burnout on Neurology Residents and Research Fellows in Europe

Background and Objectives To investigate the prevalence of burnout profiles and their contributing factors in European neurology residents, junior neurologists, and research fellows. Methods The members of the Resident and Research Fellow Section (RRFS) of the European Academy of Neurology were surveyed using standardized instruments for burnout, job satisfaction, social support, depression, work-related fatigue, work-life integration, and impact of life events, from September 1, 2020, to January 6, 2021. Results The response rate was 23.1% (332 responders of 1,439 contacted RRFS members); the median age of participants 30 years, with 61.5% being female. Our analysis revealed that 73.9% of the responders showed a perturbation in the Maslach Burnout Inventory dimensions, thus fulfilling the criteria for a dysfunctional phenotype within the burnout spectrum: burnout (22.6%), overextended (26.1%), ineffective (21.0%), and disengaged (4.1%). Multivariate logistic regression analysis indicated that elevated number of night shifts per month, work-related fatigue, and low professional satisfaction are independent risk factors for burnout. Being a certified neurologist, working in an academic environment, and a higher job satisfaction are associated with the engaged profile, a productive state characterized by high energy, strong involvement, and a sense of efficacy. Discussion Burnout experience is highly prevalent among neurology residents, junior neurologists, and research fellows in Europe. The profile-based approach in this survey captures the multifaceted nature of burnout experience, therefore highlighting mitigating strategies that can be tailored to the distinct dysfunctional burnout profile.

Social Support and Breastfeeding Outcomes Among a Racially and Ethnically Diverse Population

Social support is a modifiable social determinant of health that shapes breastfeeding outcomes and may contribute to racial and ethnic breastfeeding disparities. This study characterizes the relationship between social support and early breastfeeding. This is a cross-sectional analysis of baseline data collected in 2019-2021 for an RCT. Social support was measured using the Enhancing Recovery in Coronary Heart Disease Social Support Instrument. Outcomes, collected by self-report, included (1) early breastfeeding within the first 21 days of life, (2) planned breastfeeding duration, and (3) confidence in meeting breastfeeding goals. Each outcome was modeled using proportional odds regression, adjusting for covariates. Analysis was conducted in 2021-2022. Self-reported race and ethnicity among 883 mothers were 50% Hispanic, 17% Black, 23% White, and 10% other. A large proportion (88%) of mothers were breastfeeding. Most breastfeeding mothers (82%) planned to breastfeed for at least 6 months, with more than half (58%) planning to continue for 12 months or more. Most women (65%) were confident or very confident in meeting their breastfeeding duration goal. In adjusted models, perceived social support was associated with planned breastfeeding duration (p=0.042) but not with early breastfeeding (p=0.873) or confidence in meeting breastfeeding goals (p=0.427). Among the covariates, maternal depressive symptoms were associated with lower breastfeeding confidence (p<0.001). The associations between perceived social support and breastfeeding outcomes are nuanced. In this sample of racially and ethnically diverse mothers, social support was associated with longer planned breastfeeding duration but not with early breastfeeding or breastfeeding confidence.

Derivation and validation of a predictive model for chronic stress in patients with cardiovascular disease.

Chronic stress in patients with cardiovascular disease (CVD), including peripheral artery disease (PAD), is independently associated worse outcomes. A model that can reliably identify factors associated with risk of chronic stress in patients with CVD is needed. In a prospective myocardial infarction (MI) registry (TRIUMPH), we constructed a logistic regression model using 27 patient demographic, socioeconomic, and clinical factors, adjusting for site, to identify predictors of chronic stress over 1 year. Stress at baseline and at 1-, 6- and 12-month follow-up was measured using the 4-item Perceived Stress Scale (PSS-4) [range 0-16, scores ≥6 depicting high stress]. Chronic stress was defined as at least 2 follow-up PSS-4 scores ≥6. We identified and validated this final model in another prospective registry of patients with symptomatic PAD, the PORTRAIT study. Our derivation cohort consisted of 4,340 patients with MI (mean age 59.1 ± 12.3 years, 33% females, 30% non-white), of whom 30% had chronic stress at follow-up. Of the 27 factors examined, female sex, current smoking, socioeconomic status, and economic burden due to medical care were positively associated with chronic stress, and ENRICHD Social Support Instrument (ESSI) score and age were inversely related to chronic stress. In the validation cohort of 797 PAD patients (mean age 68.6±9.7 years, 42% females, 28% non-white, 18% chronic stress) the c-statistic for the model was 0.77 and calibration was excellent. We can reliably identify factors that are independently associated with risk of chronic stress in patients with CVD. As chronic stress is associated with worse outcomes in this population, our work identifies potential targets for interventions to as well as the patients that could benefit from these.

The moderating effect of cognitive function on the association between social support and depressive symptoms among community-dwelling older adults: Cross-sectional and longitudinal analyses

BackgroundThe moderating effect of cognitive function on the association between social support and late-life depressive symptoms has not been thoroughly investigated. Identifying cognitive function as a possible moderator of this association might help plan community-based interventions for late-life depressive symptoms. MethodsParticipants were community-dwelling older adults who visited a community-based mental health center. The ENRICHD Social Support Instrument and the Montgomery-Asberg Depression Rating Scale were used to evaluate social support and depressive symptoms, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Data from 1088 and 506 participants were included in the cross-sectional and longitudinal analyses, respectively. Multiple linear regression analysis was performed to assess the effects of social support on depressive symptoms and the possible moderating effect of cognition. ResultsAfter adjusting for possible confounders, greater social support at baseline was associated with fewer depressive symptoms in both cross-sectional (estimate = −0.25 standard error [SE] = 0.03, P < 0.001) and longitudinal analyses (estimate = −0.11, SE = 0.05, P = 0.014). Moreover, the association between social support and depressive symptoms was significantly moderated by cognitive function (P for interaction < 0.001 for cross-sectional analysis, and P for interaction = 0.011 for longitudinal analysis). LimitationsThe tool for assessing social support was self-reported. There may have been a selection bias in the study sample. ConclusionsGreater social support was associated with fewer late-life depressive symptoms in both analyses. However, social support may have less benefits for alleviating depressive symptoms in older adults with cognitive decline.