Thompson Tess, Rodebaugh Thomas L, Pérez Maria, Struthers James, Sefko Julianne A, Lian Min, Schootman Mario, Jeffe Donna B
George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
Department of Psychology, Washington University in St. Louis, St. Louis, MO, USA.
Soc Sci Med. 2016 May;156:55-63. doi: 10.1016/j.socscimed.2016.03.023. Epub 2016 Mar 17.
Low social support has been linked to negative health outcomes in breast cancer patients.
We examined associations between perceived social support, neighborhood socioeconomic deprivation, and neighborhood-level social support in early-stage breast cancer patients and controls.
This two-year longitudinal study in the United States included information collected from telephone interviews and clinical records of 541 early-stage patients and 542 controls recruited from 2003 to 2007. Social support was assessed using the Medical Outcomes Study Social Support Survey (MOS-SS). Residential addresses were geocoded and used to develop measures including neighborhood social support (based on MOS-SS scores from nearby controls) and neighborhood socioeconomic deprivation (a composite index of census tract characteristics). Latent trajectory models were used to determine effects of neighborhood conditions on the stable (intercept) and changing (slope) aspects of social support.
In a model with only neighborhood variables, greater socioeconomic deprivation was associated with patients' lower stable social support (standardized estimate = -0.12, p = 0.027); neighborhood-level social support was associated with social support change (standardized estimate = 0.17, p = 0.046). After adding individual-level covariates, there were no direct neighborhood effects on social support. In patients, neighborhood socioeconomic deprivation was associated with support indirectly through marriage, insurance status, negative affect, and general health. In controls, neighborhood socioeconomic deprivation was associated with support indirectly through marriage (p < 0.05).
Indirect effects of neighborhood socioeconomic deprivation on social support differed in patients and controls. Psychosocial and neighborhood interventions may help patients with low social support, particularly patients without partnered relationships in deprived areas.
社会支持不足与乳腺癌患者的不良健康结局相关。
我们研究了早期乳腺癌患者及对照人群中感知到的社会支持、社区社会经济剥夺与社区层面社会支持之间的关联。
这项在美国开展的为期两年的纵向研究纳入了2003年至2007年招募的541例早期患者和542例对照人群的电话访谈及临床记录信息。使用医学结局研究社会支持调查问卷（MOS - SS）评估社会支持。对居住地址进行地理编码，并用于制定相关指标，包括社区社会支持（基于附近对照人群的MOS - SS评分）和社区社会经济剥夺（人口普查区特征的综合指数）。使用潜在轨迹模型来确定社区条件对社会支持的稳定（截距）和变化（斜率）方面的影响。
在仅包含社区变量的模型中，社会经济剥夺程度越高，患者的稳定社会支持越低（标准化估计值 = -0.12，p = 0.027）；社区层面的社会支持与社会支持变化相关（标准化估计值 = 0.17，p = 0.046）。纳入个体层面的协变量后，社区对社会支持无直接影响。在患者中，社区社会经济剥夺通过婚姻、保险状况、负面情绪和总体健康状况间接影响社会支持。在对照人群中，社区社会经济剥夺通过婚姻间接影响社会支持（p < 0.05）。
社区社会经济剥夺对社会支持的间接影响在患者和对照人群中有所不同。心理社会和社区干预可能有助于社会支持不足的患者，尤其是贫困地区没有伴侣关系的患者。
