Session Five (Social Support and Caregiving)

Question 1

What are the two ways of conceptualising social support?

Answer 1

• An objective entity (the social networks we form)

- A subjective entity (the perceived support/satisfaction we experience)

Question 2

Who makes up our primary social network?

Answer 2

Family members, friends, acquaintances (work colleagues, social contacts, neighbours).

This group is marked by it’s relative density (likely a cluster where most people know each other). Instrumental dependent or reciprocal.

Question 3

What did Creswell et al’s 1992 study into social networks show?

Answer 3

• Aimed to describe the social networks of Sz patients
• Measured the size and satisfaction of their networks.
• Showed that perceived support is far more important than the theoretical availability of support
• 65% of people were satisfied with their networks despite them being small.
• Social support is a multidimensional model (both size and satisfaction play a role, supports the subjective vs objective distinction).

Question 4

What did Kaplan and Hartwell’s 1997 study tell us about social networks?

Answer 4

• Aimed to determine the contribution of social networks to diabetes management
• Looked at long term control in men and women
• Measured their social network size initially, then compared body weight, Hb levels and programme attendance initially and at follow up

Findings:

• Complex, relationship between network size and health is multidimensional, multi-factorial
• Greater satisfaction was associated with poorer control in men but better control in women
• Larger networks were associated with poorer control in both (more so in men), poorer attendance in women BUT fewer symptoms in men.

Question 5

What have major studies told us about the relationship between social support and health?

Answer 5

• SS is associated with reduced CVD mortality and morbidity.
• Some evidence for an association between SS and psych morbidity
• Some evidence that support rather than network size is whats important.

But generally there is very little clear cut evidence, and these studies vary wildly in their methodological approach.

Question 6

Outline the Buffering hypothesis of social support and health?

Answer 6

• Social resources only affect a person’s health if they are under stress
• Social support buffers the individual from the potentially pathogenic effect of stressful events.
• Social support prevents a situation or event being perceived as stressful.
• SS ameliorates the impact of a stressful situation by; providing a solution, reducing the impact of the problem, facilitating coping

Question 7

How has it been proposed social support can aid in the management of health crises?

Answer 7

• Aid with positive appraisal of the issue
• Aid with the emotional response to a crisis
• Provide solution
• Reduce impact

Question 8

What are the two main theories explaining how social support influences health?

Answer 8

• The buffering hypothesis

- Direct effect hypothesis

Question 9

Outline the Direct Effect Hypothesis of Social support in healthcare?

Answer 9

• Social resources are beneficial irrespective of stress
• Support affects health even when there is no stress x support interaction

Does this by….

• Social support influences health related behaviour
• Social support increases an individuals perception of control over their environment
• Social support increase’s a person’s self worth
• Social support enables for situations of health risk (e.g. economic hardship) to be avoided.

Question 10

What did Cohen and Wills show in 1985, regarding social support and health?

Answer 10

Evidence is consistent with both the direct and buffering hypotheses.

• Buffering effect is shown when the experiment measures the patient under stress
• Direct effect is shown when the experiment measures an individual’s integration into their social network.

Question 11

Define informal caregiving?

Answer 11

Someone who looks after or gives help or support to family members, friends, neighbours or others with long term physical or mental ill health, disability, or problems relating to old age.

Question 12

How prevalent is informal caregiving in the UK?

Answer 12

11% of the adult population.

Most commonly women.

Question 13

Informal caregiving is on the rise in the UK, what trends can explain this?

Answer 13

• Increased life expectancy, therefore larger ageing population
• Shift in what diseases people are contracting, less deaths due to acute diseases more due to chronic diseases (require more care)
• Declining birth rate, more people able to care for adults rather than kids
• Government policies of deinstitutionalisation

Question 14

Outline Nolan’s typology of caregiving. What does care giving involve?

Answer 14

Good care is…

• Anticipatory (planning for future demands)
• Preventative (monitoring at distance)
• Supervisory (monitoring with intervention)
• Instrumental care (doing things)
• Protective (maintaining the recipients sense of self)
• Preservative (preserving the recipient’s dignity, hope, sense of control)
• Constructive care (building or rebuilding an identity and role for the recipient)
• Reciprocal (receiving support from he recipient)

Question 15

Describe the Stress-Appraisal-Coping model of Caregiving (Szmukler)?

Answer 15

• Stressors (e.g. patients illness, demands of caregiving) affect…
• Appraisal and Coping (which also influence each other), which both affect
• Outcomes
• There are further Mediating Factors such as social support.

Question 16

What are some examples of mediating factors in Informal Caregiving?

Answer 16

• Factors relating to the Recipient (demanding or disruptive behaviours)
• Factors relating to the carer (personality, mastery, coping, social support, carer’s illness perception)
• Relationship between the two (quality of relationship, identity as a couple)
• Shared perceptions they have (beliefs about perceived care needs, support provided, illness itself)

Question 17

What are the consequences on the carer of caregiving?

Answer 17

Emotional, Physical, and Financial burden.

This can involve:

• Coping with increased needs of ill person
• Coping with disruptive behaviours
• Restrictions on social life and leisure activites
• Infringement of privacy
• Disruption of household and work routines
• Conflicting multiple role demands
• Disruption of family relationships

Question 18

What does the literature suggest about the link between informal caregiving and health?

Answer 18

• Adverse effect on physical and mental health (Whitney, 2007)
• Immunological effect of caregiving (Kiecolt-Glaser, 1995)
• Might also be positive effects (Carbonneau, 2010)

Question 19

What did Harvey et al, 2001, aim to show about Informal caregiving?

Answer 19

• Aim was to establish the determinant’s of relative’s caregiving experience when conceptualised using a stress-appraisal-coping paradigm.
• Found that patient’s symptomatology did not predict relative’s appraisal.
• Psychological distress was predicted by relative’s negative appraisal of the patient.
• Appraisal was influenced by age of the patient, employment status, social functioning..
• Suggests appraisal of the situation plays a role in the stress experienced by caregivers.

Question 20

What does the literature say about the association between informal caregiving and outcomes?

Answer 20

• Associated with poorer outcomes, especially health.
• Informal caregiving can be associated with positive outcomes.

HOWEVER:

• there aren’t enough studies that compare carers to non-carers
• and most that do only look at mental health patients (or dementia), rarely things like MS which might cary a higher burden.
• so research is actually not massively clear

Question 21

What is Coping?

Answer 21

• A response to stress (when demands exceeds an individual’s resources)
• An individual’s efforts to manage environmental and internal demands

Question 22

What are the 3 important psych theories around Coping?

Answer 22

• Crisis theory
• Cognitive adaptation
• Positive growth and benefit-finding

Question 23

Outline Crisis Theory of Coping (Moos and Schaefer, 1984)?

Answer 23

• A crisis represents a disruption to established personal/social identity (e.g. Job loss, illness, caregiving)
• Drive towards homeostasis and equilibrium
• Individuals are self-regulators, and will always try and find a way back to a sort of stable state.

3 Processes involved In managing a crisis:

1) Cognitive appraisal; Is this a crisis?
2) Adaptive tasks; Dealing with the problem in a way that preserves emotional balance and self-image
3) Developing Coping skills; Can be Appraisal focused (cognitive redefinition), Problem focused (take action, seek advice) or Emotion focused (affective regulation, emotional discharge, acceptance)

Question 24

What did Buchi et al, 1997, tell us about Crisis theory?

Answer 24

• Aim was to determine the physical or psychosocial predictors for the success of pulmonary therapy for COPD
• Measured their physiological health, QoL and levels of Coping
• Found that patients with higher Health Satisfaction or QoL at baseline showed greater improvements in functioning.
• Shows that some cognitive factors, such as Coping, have an influence on how people handle something like pulmonary rehab.

Question 25

Outline the theory of Cognitive Adaptation?

Answer 25

Coping involves…

• A search for meaning (why did this happen, what effect has it had)
• A search for mastery (how can I manage this, what can I do in the future)
• Processes of self-enhancement (social comparison theory)
• Illusions (positive interpretations of reality)

Question 26

What did Stiegelis (2003) show about Cognitive Adaptation in healthcare?

Answer 26

• Compared cancer patient’s perceptions of optimism, control and self esteem to that of healthy references. Aimed to determine the effect of these perceptions on psychological distress.
• Found that cancer patients experienced higher levels of optimism and self-esteem
• No group differences in perceived control
• Lower levels of optimism and control at baseline were predictive of anxiety at 3 month follow up.
• Lower perceived control predicted depressive symptoms.
• Supports the idea that cognitive adaption occurs in people facing crisis, and that the extent of this can influence their mental health relating to their condition.

Question 27

Outline the Positive Growth and Benefit Finding theory of coping?

Answer 27

Crisis leads to a process of transformation;

1) Perceived changes in the self
2) Become closer to family
3) Change philosophy in life
4) Better perspective in life
5) Strengthened belief system

Question 28

What did Reed’s 1994 research into Positive Growth and Benefit Finding tell us?

Answer 28

• Aim was to examine the relationship between realistic acceptance and mortality in men with AIDS.
• Measured their biological markers of the disease, self-reported health status, Psych adjustment, coping and optimism
• Looked to establish levels of Realistic Acceptance in the patients ( a measure based on their active coping, avoidance, community involvement, information seeking)…
• Found a significant link between acceptance and survival time
• Those with low realistic acceptance survived 9 months longer than those with high acceptance scores.
• Think this suggests as we go through a condition we improve our ability to accept it, go through s positive process