Sufficient Social Support Research Articles

Patient education programs for childhood atopic dermatitis: who is interested?

Atopic dermatitis (AD) is a skin disease which causes psychological distress to patients and their families. Patient education programs for childhood AD have positive effects on the severity of the skin disease as well as on psychological variables. So far it has not been determined whether particular patient characteristics lead to being interested in patient education programs. The aim of this cross-sectional study was to identify exploratory predictors of being interested in patient education programs in parents of children with atopic dermatitis. A severity index (SCORAD) as well as questionnaire data were collected from 73 parents of children with AD to measure satisfaction with medical care, quality of life, coping strategies, and the subjective benefit of former treatments as possible predictors. A regression analysis revealed that besides dissatisfaction with medical care, low social support and high active problem-solving behavior were significant predictors of interest in patient education programs (R(2) = 0.244). Our study gives a preliminary indication that participation in a patient education program for childhood AD should be offered to parents without sufficient social support, but who would like to gather more information on coping with AD. This could also enhance satisfaction with the medical care provided.

DETERMINANTS OF PREVENTIVE BEHAVIOR REGARDING CARDIOVASCULAR DISEASES AND RISK FACTORS IN PATIENTS WITH ESSENTIAL HYPERTENSION AND CHRONIC ISCHEMIC HEART DISEASE

Aim. To analyze potential determinants of preventive behavior (PB) in patients with essential hypertension (HT) and chronic ischemic heart disease (CIHD), and to establish their significance and hierarchy. Material and methods. Patients with HT (n=285) and CIHD (n=223) were studied. Questioning of all patients was performed to assess the characteristics of their PB. Differentiated multivariate analysis of activity and efficacy of PB determinants was performed in HT and CIHD patients by the method of step-by-step backward logistic regression. Results. Awareness of the cardiovascular diseases (CVD) and its prevention (odds ratio [OR] 6.08) as well as high level of general education (OR=2.29) were the most significant determinants of active PB in HT patients. Sufficient social support (OR=3.77), awareness of CVD and its prevention (OR=3.16) were the most significant determinants of active PB in patients with CIHD. Efficacy of PB in patients with HT and CIHD mostly depends on satisfaction of medical service (OR=10.2 and 6.63, respectively), social support (OR=6.25 and 10.5, respectively), adequate awareness of CVD and its prevention (OR, 6.92 and 6.64, respectively). Conclusion. PB activity and efficacy in patients with HT and CIHD depends on many contributing and impeding factors. Disregarding these factors can result in failure in preventive efforts at both individual and population levels.

Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study

Purpose. We conducted a qualitative study into the return-to-work process of workers partially on sick leave due to common mental disorders. Our objectives were to describe the barriers to a full return to work, solutions, communicating to the working environment and the aim of a full return to work, all as perceived by the workers.Method. Workers who had partially returned to work and were partially on long-term sick leave due to a stress-related, anxiety or depressive disorder were eligible for this study. Fourteen workers were interviewed and the interviews were transcribed verbatim and coded.Results. The perceived main barriers were: inability to set limits, recognise exhaustion and to control cognitions and behaviour such as perfectionism. A general pattern in the process was that all workers perceived barriers to a full return to work; most workers were able to mention solutions; all workers aimed for a full return to work, and after some time all workers were met with sufficient understanding and social support from their supervisor and health care professional. However, hardly any worker intended to implement or utilise the solutions at the workplace, except the structural adaptations of the work demands.Conclusions. The pattern we found suggests a critical intention–behaviour gap between solutions and intentions for a full return to work and its implementation at work. This implies that we should develop new interventions that focus on helping workers and their environment to bridge this gap.

The Association Between Perceived Social Support and Health Among Patients at a Free Urban Clinic

This study examines the association between perceived social support and the prevalence of physical and mental health conditions among adult patients of an urban free medical clinic. Patients (n = 289) completed a health risk assessment (HRA) questionnaire that addressed a number of medical and social issues, including perceived social support and whether patients had been told they had certain health conditions. Among these questions were 2 validated instruments: the PRIME-MD for mental health disorder assessment and CAGE for alcohol risk assessment. A deidentified database of responses was analyzed for statistical associations between perceived social support and these health conditions. Among those with insufficient perceived social support there were higher rates of having physician-measured overweight/obesity, a heart condition, a previous heart attack, anxiety, and depression. The association between perceived social support and cardiovascular health existed among women but not among men. Higher income, not smoking, and consumption of high-fiber foods were associated with sufficient social support. Perceiving sufficient social support was associated with lower rates of several mental and physical health disorders. Social support may act as a barrier or buffer to poor health caused by the stressful living conditions often experienced by low-income underinsured people. Males and females may experience this social support buffering differently.

Creating a More Resilient Safety Net for Persons with Chronic Disease: Beyond the “Medical Home”

Mega-disasters the scale and scope of Hurricane Katrina have been exceedingly rare in the USA. Nonetheless, careful study of such disasters can provide lessons learned that can lend essential insights to guide planning for future events of any size.1 Such disasters can also expose previously under-recognized frailties in society that, like the under-built levees of New Orleans, readily buckle under stress. One such frailty exposed by the storm was the health care safety net. Katrina was in many ways the “perfect storm” not only because of her meteorological characteristics but because she struck a portion of the world with high prevalence of chronic conditions, high rates of uninsured, and a geographically and financially consolidated safety net system.2 At the heart of the devastated area was the Medical Center of Louisiana at New Orleans (formerly known as Charity Hospital), the primary source of first-contact and chronic disease care for hundreds of thousands of uninsured and underinsured persons in the Greater New Orleans area. Katrina’s devastating flood rendered this Center completely inoperable. This confluence of events left hundreds of thousands of vulnerable patients with chronic conditions in the most densely populated hurricane-affected areas suddenly with no access to care. In this issue of JGIM, the Hurricane Katrina Community Advisory Group present the findings of their telephone survey assessing the impact of Hurricane Katrina of survivors with chronic disease among a sample from New Orleans and other affected areas.3 In their large representative sample, one in five persons reported having cut back or terminated treatment for a major chronic illness after the hurricane. Characteristics independently associated with treatment disruption included age younger than 65, having fewer relatives within and beyond hurricane-affected areas, and suffering two or more geographic relocations by early 2006, roughly 4–6 months after the disaster. Insurance was not an independent predictor in multivariable analysis, but this variable may have been difficult to disentangle from age, given the role of Medicare. Their complementary listing of respondents’ self-reported reasons for treatment interruption highlighted limited access to physicians and medications, insurance/payment issues, and competing demands for patient’s time and attention. These factors are strikingly similar to those reported in research among Americans experiencing homelessness in the absence of major humanitarian disasters.4,5 Minimizing disruption to the care of persons with chronic disease requires weaving a health care safety net resilient to the stress of disasters and to the more personalized disasters such as job loss or loss of one’s home.6 The design of a resilient health care safety net should pivot on recognition that continuing care for patients with chronic illness and their associated complex needs requires sufficiently nuanced policies. We posit that a health care safety net, capable of caring for patients with chronic disease during routine times and disasters, must take account not one, but three types of “homes”, each interdependent and supporting the other. Health care policies to shore up the safety net should drive the development of a web-enabled “medical home”,4,5 a portable financing mechanism for their care, an “insurance home”, and sufficient social support and resources to allow for self-care and management sufficient to help them respond to life’s challenges, a “social home”.

Social Support for African American Low-Income Parents

Summary Urban parents, particularly single mothers living within inner-city communities, often struggle to obtain sufficient social support for themselves and for parenting. Support for these parents is particularly important given the prevalence of risk-taking behaviors among youth in these communities, which necessitates vigilant monitoring of these youth. The current study explored from whom low-income mothers obtain social support, the influence of child externalizing on source of social support, and how social support and child behavior interrelate with parental monitoring and supervision. Contrary to expectations, parental monitoring at time 1 did not predict child externalizing at time 2, but, as expected, a significant negative association was noted at time 1 between these constructs. Higher time 1 child externalizing did predict lower time 2 maternal monitoring, suggesting frustrated efforts by mothers to monitor high externalizing children. Mothers reporting strong support networks, however, showed higher levels of monitoring, and mothers who turned to children for social support also showed a tendency to monitor more closely. Although mothers of high externalizing children reported poor support quality, mothers did not discriminate between high and low externalizing children when choosing source of social support. These findings suggest the importance of monitoring prior to child initiation into risk-taking behavior, and the possible role of children in strengthening support networks.

Relationship between social support and occupational stress

To explore the relationship between social support and occupational stress. A cross-sectional survey involving 654 career people from different industries was conducted. Social support, the occupational stressors, personalities, and occupational strain were measured by using Occupational Stress Instrument. The people from different occupations got different level of social support. Social support scores were significantly positively related to interpersonal relation, responsibility for people, responsibility for thing, advancement and participation, task identity, training adequacy, challenge, autonomy, job satisfaction, mental health, affective ambulance, positive emotion, self-esteem and coping strategy (P<0.05 or P<0.01), negatively to careers, role conflict, role ambiguity, job future ambiguity, negative emotion, depression symptoms, daily life stress and work locus of control scores (P<0.05 or P<0.01). The scores of interpersonal relation, responsibility for people, responsibility for thing, advancement and participation, task identity, training adequacy, challenge, autonomy, job satisfaction, mental health, affective ambulance, positive emotion, self-esteem and coping strategy with sufficient social support were significantly higher than those of deficient social support (P<0.05 or P<0.01). The scores of role conflict, role ambiguity, job future ambiguity, negative emotion, depression symptoms, daily life stress and work locus of control were higher than those of the latter (P<0.05 or P<0.01). Stepwise regression analysis showed that social support was the predictor of depression (R(2)>0.05). Social support affects occupational stress largely and plays an important role in maintaining mental health of career people. The people from different occupations get different level of social support.

The Herth Hope Index (HHI) and related factors in the Japanese general urban population

In this study we sought to demonstrate the reliability and validity of the Japanese Herth Hope Index (HHI) 12, a psychometric instrument for measuring hope, in a general urban population, and to investigate factors correlated with the HHI score. Anonymous written surveys were collected from 255 male and female residents living in Tokyo "N" ward and Saitama "T" township aged 20-69. The Cronbach α coefficient was 0.89, and confirmatory factor analysis showed three-dimensionality. We also observed hope to strongly correlate with having reasons for living and benefit-finding, confirming the reliability and validity of the Japanese HHI scale. Mean HHI score was 35.5. Stratified multi ple linear regression analysis on factors which correlated with the HHI score showed HHI scores to correlate positive with age, the presence of a spouse, and sufficient psychosocial support. We also found that younger subjects receiving sufficient social support enjoyed HHI scores equivalent to older subjects, while women's higher HHI scores appeared attributable to extensive social support networks. No correlation was observed with adverse experiences or history of illness. This study shows that HHI scores in the general urban population are not unexpectedly high compared with pre viously studied subjects with serious disease, that advanced age correlates with higher HHI scores, and that receipt of social support may mediate positive influences on the HHI score.

Policy implications of a pan-tropic assessment of the simultaneous hydrological and biodiversity impacts of deforestation

Tropical deforestation has many consequences, amongst which alteration of the hydrological cycle and loss of habitat and biodiversity are the focus of much public interest and scientific research. Here we examine the potential biodiversity and hydrological impacts of an extreme deforestation scenario - the loss of all tropical forest areas currently identi- fied by the World Wildlife Fund as being threatened. Existing tropical forest areas are first classified according to two categories of biological distinctiveness - high and low - using indicators developed by the WWF. We apply the tropical deforestation scenario to a macro- scale hydrologic model, keeping track of the share of change in basin runoff that originates from the deforestation of areas of high versus low biological distinctiveness and where that change could impact human populations. Of particular interest are those basins where loss of the most threatened tropical forest areas would give rise to significant biodiversity loss and to potentially large hydrological impacts. In such cases it is conceivable that biodiver- sity conservation could "free-ride" on the concerns of resident populations to maintain the forests for the purpose of minimizing hydrological change. Where such an outcome seems likely, biodiversity conservation efforts might be better targeted elsewhere, perhaps to basins where the loss of forest areas with high biological distinctiveness would have less population impacts, hence requiring an alliance between biological and hydrological interests to gain sufficient social and financial support for conservation.

Developing the Construct of Social Support in Parkinson's Disease

Although social support has been recognized as an integral component of health and quality of life, the concept has not been adequately defined in the literature on Parkinson's disease. The purpose of this study was to explore the meaning of social support in Parkinson's disease by examining social support as perceived by both the individuals with Parkinson's and their caregivers. Participants and caregivers completed the Parkinson's Disease Quality of Life Questionnaire (PDQ-39), and these data were used to analyze the degree of convergence between client and caregiver report and examine the role of social support as related to other quality of life domains. The results indicate that caregivers perceived the clients' quality of life to be more problematic than the clients perceived their own quality of life. Clients and their caregivers demonstrated a greater degree of convergence on overt domains, such as mobility and cognition, and showed little convergence on subjective quality of life domains, including social support, suggesting that clients and caregivers were using different criteria to assess social support and other covert domains. It was also found that social support was more interrelated with other quality of life domains when reported by the caregiver as compared to the client. This finding suggests that caregivers may utilize the client's performance in other quality of life domains, such as emotional well-being, in determining whether sufficient social support is being provided. Thus, caregivers and clients may utilize different factors in their analysis of social support. The complex nature of social support in Parkinson's disease is discussed as related to the differing perspectives of caregivers and clients. These varying perspectives make it essential for clinicians to recognize both perspectives of social support, in order to develop appropriate assessments and interventions.

Credibility of institutions: Forestry, social conflict and titling in China

In the reform of a forestry sector governed by centralist, socialist principles towards a sector suited to the challenges of the market economy, the Chinese government needs to establish institutions that can be perceived as credible by social actors. In other words, the creation of institutions that rally sufficient social and political support in order to be effective. Against this backdrop, this article consciously opts to refer to institutional “credibility” instead of the more fashionable concept of institutional “trust”. Whereas scholarly discussions about trust focus more on the relation of trust between social actors, credibility puts more emphasis on the institution itself, and the role of government in its successful creation or failure. Failure to effectively undertake institutional reform might put the social acceptability or credibility of institutions at risk, and can lead to the emergence of “empty institutions” with little, or even, a negative effect on social and political actors. Applying this concept to China's forestry sector, this article identifies three critical areas that call for careful rethinking how to “get institutions right”: the titling of forest holdings; the restructuring of the forest administration; and the design of forest laws and policies with particular reference to lease and ownership.

Depression and associated factors of informal caregivers versus professional caregivers of demented patients

To examine the differences in depressive state and associated factors between informal and professional caregivers, a cross-sectional study was carried out in 23 informal home-based caregivers of demented patients, 24 professional caregivers working in the dementia ward of a psychiatric hospital, and 31 controls. Measurements included severity of dementia (Clinical Dementia Rating Scale, Mini Mental State Examination, MMSE) and levels of caregivers depression (Beck Depression Inventory; BDI), care burden (Zarit Caregiver Burden Interview; ZBI) and quality of life (World Health Organization-Quality of Life-26, WHO-QOL26). Informal caregivers had the highest BDI score and ZBI and the lowest QOL among the three studied groups. Regarding informal caregivers, there was a strong positive correlation between BDI and ZBI scores. The BDI and ZBI scores were significantly high when patients exhibited behavioral problems. The four WHO-QOL categories (physical domain, psychological domain, social relationships and environment) had a strong negative correlation with BDI. Regression analysis demonstrated that the psychological domain points of WHO-QOL, role strain factor of ZBI and MMSE score were significantly associated with BDI. Regarding professional caregivers, their BDI score had a strong negative correlation with the physical and psychological domains and environment categories of WHO-QOL. Regression analysis demonstrated that their BDI score was significantly associated with the psychological domain and environment. It is thus very important to provide sufficient social care services and/or personal support to informal caregivers.

The deterioration and mobilization effects of trauma on social support: Childhood maltreatment and adulthood military violence in a Palestinian community sample

Objectives: To show that exposure to childhood maltreatment deteriorates, whereas exposure to adulthood military violence mobilizes social support; Second, to show that associations between traumatic events and mental health problems are mediated through social support and, subsequently, adulthood military violence is associated with low level and childhood maltreatment with high level of mental health symptoms; third, to explore whether the moderating (protecting) effect of sufficient and satisfactory social support would differ among victims of childhood maltreatment and adulthood military violence. Method: The participants were a random-sample of Palestinian men and women ( n = 585) of 16–60 years of age. Exposure to military violence in adulthood was assessed by the Harvard Trauma Questionnaire (HTQ_I), and to childhood maltreatment by a 13-item questionnaire developed for the study. A Social Network Schedule was applied to assess the function, source, and satisfaction with social support, and the Revised SCL90-R Symptoms Checklist to assess mental health symptoms. Results: Findings supported our hypothesis that exposure to childhood maltreatment was associated with low levels of social support, whereas exposure to adulthood military violence was associated with high levels of social support. Contrary to our second hypothesis, both childhood maltreatment and adulthood military violence were associated with high levels of mental health symptoms. Finally, high level and satisfactory social support moderated the association between exposure to military violence in adulthood and mental health symptoms, but not between childhood maltreatment and mental health symptoms. Conclusion: The findings emphasize that the nature of trauma, that is, whether familial or political, determines the availability of protective resources versus vulnerability, which should be considered when tailoring interventions to trauma victims.

Women's priorities for lay health home visitors: implications for eliminating health disparities among underserved women.

While racial, ethnic, and socioeconomic health disparities in maternal and child health persist among women, few studies describe experiences of low-income women during pregnancy. We undertook a qualitative study of women's self-reported experiences with home visitors to gain understanding of priorities for participation and service delivery. Lay health home visitors provided satisfactory services and maintained close relationships with their clients. The mother-to-mother relationship is critical in facilitating continued participation in and ensuring positive health and social outcomes from lay health home visitation services. Many women lacked sufficient social support during their pregnancy and received this from the health visitor. Appropriate integration of lay health visitors with traditional prenatal care may alleviate many of the deleterious stressors that low-income women experience and may ultimately impact racial, ethnic, and socioeconomic disparities in maternal and child health.

Monitoring compliance for patients on antihypertensive medication with the new instrument of compliance praxis survey (COMPASS)

Low compliance is suspected as a major reason for treatment failure in hypertensive patients. To identify patients with low compliance at the commencement of antihypertensive treatment, the compliance praxis survey (COMPASS) was utilised. A total of 161 physicians identified 2389 hypertensive patients treated by ACE-inhibitor. The physicians rated the compliance of the patients at baseline and at 6-month follow-up prospectively. Standard care was given. The mean age of patients was 64.5 years (54.4% women). The baseline overall score of compliance was medium to high in 97.3% of patients. A quarter of all patients (24.7%) were described as having difficulties to follow lifestyle changes, 22.3% lacked sufficient social support, and 31.0% were unwilling to obtain additional information about illness and treatment. Patients who had received prior treatment for cardiovascular disease were less compliant than those who received first treatment within this study (P=0.05). Younger (P<0.01), male patients (P<0.01), and those without prior cardiovascular disease (P<0.001) were significantly more likely to stop the antihypertensive treatment without a doctor's recommendation. Doctors’ rating of compliance at baseline correlated well with ongoing treatment at 6-month follow-up. In conclusion, the COMPASS survey questionnaire is a useful instrument for doctors to differentiate between patients who lack resources and to then counsel patients based on their individual needs.

Personality related to coping and social support among Iranian refugees in Sweden.

The aim of this study was to investigate the interrelatedness between temperament and character according to Cloninger's biosocial theory of personality, coping behavior, and social support among traumatized refugees. Personality, psychopathological disturbances, coping resources, and social support were assessed in 100 Iranian refugees resettled in Sweden who had been exposed to various extreme traumatic life events in Iran before their escape. Individuals traumatized by war experiences as soldiers, with low Beck Depression Inventory scores showed the lowest scores in Harm Avoidance and the highest in Self-Directedness and Cooperativeness. Concerning coping resources and social support, these subjects scored slightly higher and the traumatized refugees with high Beck Depression Inventory scores scored slightly lower compared with nontraumatized subjects. Resilient refugees are characterized by low harm avoidance, high self-directedness, and high cooperativeness scores which enables them to develop effective coping strategies to obtain sufficient social support and thus to become more resistant against severe trauma.

The COMpliance Praxis Survey (COMPASS): a multidimensional instrument to monitor compliance for patients on antihypertensive medication.

Low compliance is suspected as a major reason for treatment failure in hypertensive patients. To identify patients with low compliance at the commencement of antihypertensive treatment, the compliance praxis survey (COMPASS) was utilised. A total of 161 physicians identified 2389 hypertensive patients treated by ACE-inhibitor. The physicians rated the compliance of the patients at baseline and at 6-month follow-up prospectively. Standard care was given. The mean age of patients was 64.5 years (54.4% women). The baseline overall score of compliance was medium to high in 97.3% of patients. A quarter of all patients (24.7%) were described as having difficulties to follow lifestyle changes, 22.3% lacked sufficient social support, and 31.0% were unwilling to obtain additional information about illness and treatment. Patients who had received prior treatment for cardiovascular disease were less compliant than those who received first treatment within this study (P=0.05). Younger (P<0.01), male patients (P<0.01), and those without prior cardiovascular disease (P<0.001) were significantly more likely to stop the antihypertensive treatment without a doctor's recommendation. Doctors' rating of compliance at baseline correlated well with ongoing treatment at 6-month follow-up. In conclusion, the COMPASS survey questionnaire is a useful instrument for doctors to differentiate between patients who lack resources and to then counsel patients based on their individual needs.

Subjective lack of social support and presence of dependent stressful life events characterize patients suffering from major depression compared with healthy volunteers.

The aim of this study was to characterize and compare patients with major depression and healthy volunteers concerning stressful negative life events, social support and social network occurring during a 12-month period. Forty outpatients who fulfilled DSM-IV criteria for major depression and 19 healthy volunteers were included in the study. The results showed no significant differences between the patients and the volunteers concerning the number of independent life events, perceived sufficient persons in the network, the number of family members, having a partner, and perceiving family members as offering the best support. Thus, there were differences in the number of both dependent stressful life events, especially increased arguments with partner and family members, and life events including personal illness. The patient group had experienced a greater number of these events compared with the volunteer group. Comparisons between the two groups revealed differences concerning social support and social network. Fewer patients, especially women, felt they had sufficient social support, had fewer persons in the network, less contact with persons in the network, and fewer confidants compared with the volunteers.

Association of a lack of psychosocial resources and the risk of giving birth to small for gestational age infants: a stress hypothesis.

To test the stress hypothesis that women who give birth to small for gestational age infants lack important psychosocial coping resources, such as a sufficient social network, social support and control in daily life. A prospective cohort study of nulliparous pregnant women. Antenatal care units in the city of Malmö, Sweden. All women (n = 994) during a one year period (1991-1992) were invited, and 872 (87 x 7%) participated. This study was restricted to pregnancies resulting in singleton live birth (n = 826); 6 x 7% of infants were classified as small for their gestational age. Self-administered questionnaires were given to all women at the time of their first antenatal visit. The classification of small for gestational age was based on a gender-specific intrauterine growth reference curve. Newborn babies were classified as being small for gestational age if their birthweight was > 2 SD below the mean weight for gestational age. Lack of psychosocial resources, such as social stability, social participation, emotional and instrumental support, all increased the likelihood of delivering an infant that was small for gestational age. The odds ratios when controlled for demographic background factors, lifestyle factors and anthropomorphic measures were: OR 1 x 7 (95% CI 0 x 9-3 x 3) for women with poor social stability; OR 2 x 2 (95% CI 1 x 1-4 x 4) for women with poor social participation; OR 2 x 6 (95% CI 1 x 2-5 x 7) for women with poor instrumental support; and OR 1 x 5 (95% CI 0 x 8-2 x 8) for women with poor emotional support. Simultaneous exposure to a poor total network index, as well as a poor total support index showed a significantly increased odds ratio for having a small for gestational age baby: OR 3 x 3 (95% CI 1 x 6-6 x 7) and OR 2 x 7 (95% CI 1 x 3-5 x 6), respectively. A synergy index of 9 x 0 and 6 x 8 supported the assumption of an interaction between immigrant status and poor total network or poor total support, in a synergistic direction. The findings support the stress-hypothesis that a lack of psychosocial resources might increase the risk of giving birth to a baby that is small for gestational age.

The experience of social support in patients suffering from treatment-refractory depression—A pilot study

The purpose of this study was (1) to ascertain to what extent a group of patients with treatment-refractory depression perceive that they have received sufficient social support, and (2) to define clinical variables that differentiate such patients from those who perceive that they have not received sufficient social support. Twenty-seven treatment-refractory patients with major depression were included in the study. The result showed that only 37% had what was judged as insufficient social support. Those with insufficient and sufficient social support had equally severe depressions, the same number of stressful life events, and the same number of persons in their social network. Patients with insufficient social support were characterized by (1) a subjective conviction that the number of persons in their network was insufficient, and (2) female gender. Emotional support was valued higher than any other kind of support.