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Size of the social network versus quality of social support: which is more protective against PTSD?

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Abstract

Purpose

Supportive social networks are important to the post-traumatic response process. However, the effects of social network structure may be distinct from the perceived function of those networks. The present study examined the relative importance of role diversity and perceived strength of social support in mitigating post-traumatic stress disorder (PTSD).

Methods

Data were drawn from respondents who report lifetime potentially traumatic events in the National Epidemiologic Survey on Alcohol and Related Conditions (N = 31,650). The Social Network Index (SNI) was used to measure the diversity of social connections. The Interpersonal Support Evaluation List (ISEL-12) was used to measure the perceived availability of social support within the network. Odds of current PTSD were compared among individuals representing four dichotomous types of social support: high diversity/high perceived strength, high diversity/low perceived strength, low diversity/high perceived strength, and low diversity/low perceived strength to examine which type of support is more protective against PTSD.

Results

Unadjusted odds of PTSD were 1.59 (95 % CI 1.39–1.82) for those with low versus high perceived support strength, and 1.10 (0.94–1.28) among those with non-diverse versus diverse social networks. Compared to the reference group (high diversity/high perceived strength), the adjusted odds of current PTSD were higher for two groups: low diversity/low perceived strength (OR = 1.62; 1.33–1.99), and low diversity/high perceived strength (OR = 1.57; 1.3–1.91). The high diversity/low perceived strength group had no greater odds of PTSD (OR = 1.02; 0.81–1.28).

Conclusion

The diversity of a social network is potentially more protective against PTSD than the perception of strong social support. This suggests that programs, which engage individuals in social groups and activities may effectively attenuate the risk of PTSD. A better understanding of how these networks operate with respect to PTSD prevention and mitigation holds promise for improving psychiatric health.

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References

  1. Durkheim E. (1951) Suicide, a study in sociology. Glencoe, Ill.: Free Press. (Originally published in 1897)

  2. Berkman LF, Glass T, Brisette I, Seeman TE (2000) From social integration to health: Durkheim in the New Millennium. Soc Sci Med 51:843–857

    Article  CAS  PubMed  Google Scholar 

  3. Cohen S, Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychol Bull 98(2):310–357

    Article  CAS  PubMed  Google Scholar 

  4. Berkman LF, Glass T (2000) Social integration, social networks, social support, and health. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, New York, pp 137–173

    Google Scholar 

  5. Kaniasty K, Norris FH (2008) Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. J Trauma Stress 21:274–281

    Article  PubMed  Google Scholar 

  6. Berkman LF, Syme SL (1979) Social networks, host resistance and mortality: a nine year follow-up study of Alameda County residents. Am J Epidemiol 109:186–204

    CAS  PubMed  Google Scholar 

  7. Cohen S, Gottlieb B, Underwood L (2000) Social relationships and health. In: Cohen S, Underwood L, Gottlieb B (eds) Measuring and intervening in social support. Oxford University Press, New York, pp 3–25

    Google Scholar 

  8. Fleming R, Baum A, Gisriel MM, Gatchel RJ (1982) Mediating influences of social support on stress at Three Mile Island. J Hum Stress 8:14–22

    Article  CAS  Google Scholar 

  9. Joseph S (1999) Social support and mental health following trauma. In: Yule W (ed) Post-traumatic stress disorders. Concepts and therapy. Wiley, Chichester, pp 71–91

    Google Scholar 

  10. Moak ZB, Agrawal A (2010) The association between perceived interpersonal social support and physical and mental health: results from the National Epidemiological Survey on Alcohol and Related Conditions. J Public Health (Oxf) 32(2):191–201

    Article  CAS  Google Scholar 

  11. Wills TA, Cleary SD (1996) How are social support effects mediated: a test for parental support and adolescent substance use. J Pers Soc Psychol 71:937–952

    Article  CAS  PubMed  Google Scholar 

  12. Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68(5):748–766

    Article  CAS  PubMed  Google Scholar 

  13. Cohen S (1988) Psychosocial models of social support in the etiology of physical disease. Health Psychol 7:269–297

    Article  CAS  PubMed  Google Scholar 

  14. Wethington E, McLeod JD, Kessler RC (1987) The importance of life events for explaining sex differences in psychological distress. In: Barnett RC, Biener L, Baruch GK (eds) Gender and stress. The Free Press, New York, pp 144–156

    Google Scholar 

  15. Belle D (1987) Gender differences in the social moderators of stress. In: Barnett RC, Biener L, Baruch GK (eds) Gender and stress. The Free Press, New York, pp 257–277

    Google Scholar 

  16. Bowlby J (1973) Attachment and loss. Hogarth Press, London

    Google Scholar 

  17. Oxman TE, Berkman LF, Kasl S, Freeman DH Jr, Barrett J (1992) Social support and depressive symptoms in the elderly. Am J Epidemiol 135(4):356–368

    CAS  PubMed  Google Scholar 

  18. Ozer EJ, Best SR, Lipsey TL, Weiss DS (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 129(1):52–73

    Article  PubMed  Google Scholar 

  19. Chen CM, Yi H, Falk DE, Stinson FS, Dawson DA, Grant BF (2010) Alcohol use and alcohol use disorders in the United States, a 3-year follow-up: main findings from the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). National Institute on Alcohol Abuse and Alcoholism, Bethesda

    Google Scholar 

  20. American Psychiatric Association (2001) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington

    Google Scholar 

  21. Grant BF, Dawson DA, Hasin DS (2004) The Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV Version. National Institute on Alcohol Abuse and Alcoholism, Bethesda

    Google Scholar 

  22. Bohnert KM, Breslau N (2011) Assessing the performance of the short screening scale for post-traumatic stress disorder in a large nationally-representative survey. Int J Methods Psychiatr Res 20(1):E1–E5

    Article  PubMed Central  PubMed  Google Scholar 

  23. Uddin M, Aiello AE, Wildman DE, Koenen KC, Pawelec G, de los Santos R, Galea S (2010) Epigenetic and immune function profiles associated with posttraumatic stress disorder. Proc Natl Acad Sci USA 107(20):9470–9475

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP, Grant BF (2008) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend 92(27):1–3

    Google Scholar 

  25. Cohen S (1991) Social supports and physical health. In: Greene AL, Cummings M, Karraker KH (eds) Life-span developmental psychology: perspectives on stress and coping. Erlbaum Associates, Hillsdale, pp 213–234

    Google Scholar 

  26. Cohen S, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM Jr (1997) Social ties and susceptibility to the common cold. JAMA 277(24):1940–1944

    Article  CAS  PubMed  Google Scholar 

  27. Cohen S (2004) Social relationships and health. Am Psychol 59(8):676–684

    Article  PubMed  Google Scholar 

  28. Brookings JB, Bolton B (1988) Confirmatory factor analysis of the Interpersonal Support Evaluation List. Am J Community Psychol 16(1):137–147

    Article  CAS  PubMed  Google Scholar 

  29. Hall LA, Sachs B, Rayens MK (1998) Mother’s potential for child abuse: the roles of childhood abuse and social resources. Nurs Res 47:87–95

    Article  CAS  PubMed  Google Scholar 

  30. Cohen S, Mermelstein R, Kamarck T, Hoberman H (1985) Measuring the functional components of social support. In: Sarason IG, Sarason BR (eds) Social support: theory, research and application. Martinus Nijhoff, The Hague, pp 73–94

    Google Scholar 

  31. Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF (2005) Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 66:677–685

    Article  PubMed  Google Scholar 

  32. Grant BF, Dawson DA, Stinson FS, Chou PS, Kay W, Pickering R (2003) The alcohol use disorder and associated disabilities interview schedule-IV (AUDADIS-IV): reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug Alcohol Depend 71:7–16

    Article  PubMed  Google Scholar 

  33. Hasin D, Carpenter KM, McCloud S, Smith M, Grant BF (1997) The alcohol use disorder and associated disabilities interview schedule (AUDADIS): reliability of alcohol and drug modules in a clinical sample. Drug Alcohol Depend 44:133–141

    Article  CAS  PubMed  Google Scholar 

  34. Chatterji S, Saunders JB, Vrasti R, Grant BF, Hasin D, Mager D (1997) Reliability of the alcohol and drug modules of the alcohol use disorder and associated disabilities interview schedule–alcohol/drug-revised (AUDADIS-ADR): an international comparison. Drug Alcohol Depend 47:171–185

    Article  CAS  PubMed  Google Scholar 

  35. Hasin DS, Paykin A (1999) Alcohol dependence and abuse diagnoses: concurrent validity in a nationally representative sample. Alcohol Clin Exp Res 23:144–150

    CAS  PubMed  Google Scholar 

  36. Hasin DS, Muthuen B, Wisnicki KS, Grant BF (1994) Validity of the bi-axial dependence concept: a test in the US general population. Addiction 89:573–579

    Article  CAS  PubMed  Google Scholar 

  37. SAS Institute Inc, SAS 9.1.3 (2000–2004) Help and Documentation, Cary, NC: SAS Institute Inc

  38. Research Triangle Institute (2008) Software for Survey Data Analyses (SUDAAN) 10, Research Triangle Park, NC: RTI

  39. Eriksson CB, Van De Kemp H, Gorsuch R, Hoke S, Foy DW (2001) Trauma exposure and PTSD symptoms in international relief and development personnel. J Trauma Stress 14:205–219

    Article  Google Scholar 

  40. Ozer EJ, Weinstein RS (2004) Urban adolescents’ exposure to community violence: the role of support, school safety, and social constraints in a school-based sample of boys and girls. J Clin Child Adolesc Psychol 33:463–476

    Article  PubMed  Google Scholar 

  41. George LK (1989) Stress, social support, and depression over the life-course. In: Markides K, Cooper C (eds) Aging, stress, social support, and health. Wiley, London, pp 241–267

    Google Scholar 

  42. Johnson TP (1991) Mental health, social relations, and social selection: a longitudinal analysis. J Health Soc Behav 32(4):408–423

    Article  CAS  PubMed  Google Scholar 

  43. Kawachi I, Berkman LF (2000) Social cohesion, social capital, and health. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, New York, pp 174–190

    Google Scholar 

  44. Lin N, Ye X, Ensel WM (1999) Social support and depressed mood: a structural analysis. J Health Soc Behav 40(4):344–359

    Article  CAS  PubMed  Google Scholar 

  45. Koenen KC, Stellman JM, Stellman SD, Jr Sommer JF (2003) Risk factors for course of posttraumatic stress disorder among Vietnam veterans: a 14-year follow-up of American Legionnaires. J Consult Clin Psychol 71:980–986

    Article  PubMed  Google Scholar 

  46. Galea S, Ahern J, Tracy M, Hubbard A, Cerda M, Goldmann E, Vlahov D (2008) Longitudinal determinants of posttraumatic stress in a population-based cohort study. Epidemiology 19(1):47–54

    Article  PubMed  Google Scholar 

  47. King DW, Taft C, King LA, Hammond C, Stone ER (2006) Directionality of the association between social support and posttraumatic stress disorder: a longitudinal investigation. J Appl Soc Psychol 36:2980–2992

    Article  Google Scholar 

  48. Cohen J, Cohen P (1983) Applied multiple regression/correlation analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale

    Google Scholar 

  49. Guay S, Billette V, Marchand A (2006) Exploring the links between posttraumatic stress disorder and social support: processes and potential research avenues. J Trauma Stress 19:327–338

    Article  PubMed  Google Scholar 

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Correspondence to Jonathan Platt.

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Platt, J., Keyes, K.M. & Koenen, K.C. Size of the social network versus quality of social support: which is more protective against PTSD?. Soc Psychiatry Psychiatr Epidemiol 49, 1279–1286 (2014). https://doi.org/10.1007/s00127-013-0798-4

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