Culture and Social Support: Who Seeks It and Why?

Validity and reliability of the Malay version multidimensional scale of perceived social support (MSPSS-M) among teachers

PURPOSE

The multidimensional scale of perceived social support (MSPSS) was developed to measure perceived social support. It has been translated and culturally adapted among natives literate in the Malay language. However, its psychometric properties for teachers who are majority females and married have not been assessed.

METHODS

This was a cross-sectional study conducted among the public secondary school teachers in the central region of Peninsular Malaysia from May to July 2013. A total of 150 and 203 teachers were recruited to perform exploratory factor analysis and confirmatory factor analysis (CFA), respectively. Reliability testing was evaluated on 141 teachers via internal consistency and two-week interval test-retest.

RESULTS

The 12-item three-factor structure of MSPSS-M was revised to 8-item two-factor structure. The revised MSPSS-M demonstrated excellent fit in CFA with adequate divergent and convergent validity and good factor loadings (0.80-0.90). The revised MSPSS-M also displayed good internal consistency with Cronbach's alpha of 0.91, 0.93 and 0.92 and good test-retest reliability with intraclass correlation of 0.89, 0.88 and 0.88 in the total scale, family and friends factors, respectively.

CONCLUSION

The revised 8-item MSPSS-M is a reliable and valid tool for assessment of perceived social support among teachers.

A Case Study of Exploring Older Chinese Immigrants' Social Support within a Chinese Church Community in the United States

The number of older Chinese immigrants living in the United States is increasing steadily. They are faced with challenges to meet their needs for social support and are unlikely to turn to formal services. This case study utilizes an ecological framework to analyze social support among Chinese immigrants age 65 year and older within a Christian Chinese church community, and to explore the ways in which a Chinese church functions as the source of social support for older Chinese immigrants. Seven months of participant observation and ten face-to-face, in-depth interviews were conducted with 65+ Chinese adults who attended one Chinese church in the Southern United State and included questions concerning patterns of support and personal relationships within the church. Findings revealed that gender, living arrangements, working experiences, ability to drive, and English language skills were related to support the older Chinese immigrants sought, received, and provided. Although the Chinese church can be a viable source of supplementary support, some participants in this study felt the support they received from the church was insufficient, particularly in terms of emotional support. Therefore, suggestions are outlined that may assist Chinese churches to be more proactive in better understanding and providing services that meet the different needs and desires of older Chinese immigrants.

Social support and the self-rated health of older people: A comparative study in Tainan Taiwan and Fuzhou Fujian province

The lack of social support in elderly populations incurs real societal costs and can lead to their poor health. The aim of this study is to investigate the self-rated health (SRH) and social support among older people as well as its associated factors.We conducted a cross-sectional study among 312 urban community-dwelling elderly aged 65 to 90 years in Tainan Taiwan and Fuzhou Fujian Province from March 2012 to October 2012. A Spearson correlation test, independent t test, a Pearson χ test, a linear regression analysis, and a multiple-level model were performed to analyze the results.The participants identified children as the most important source of objective and subjective support, followed by spouse and relatives. Tainan's elderly received more daily life assistance and emotional support, showed stronger awareness of the need to seek help, and maintained a higher frequency of social interactions compared with the elderly in Fuzhou. The mean objective support, subjective support, and support utilization scores as well as the overall social support among Tainan's elderly were significantly high compared with the scores among Fuzhou's elderly. Further, Tainan's elderly rated better SRH than Fuzhou's elderly. Correlation analysis showed that social support was significantly correlated with city, age, living conditions, marital status, and SRH. Multiple linear regression analysis, with social support as a dependent variable, retained the following independent predictors in the final regression model: city (4.792, 95% confidence interval [CI]: 3.068-6.516, P = 0.000), age (-0.805, 95% CI: -1.394 to -0.135, P = 0.013), marital status (-1.260, 95% CI: -1.891 to -0.629, P = 0.000), living conditions (4.069, 95% CI: 3.022-5.116, P = 0.000), and SRH -1.941, 95% CI: -3.194 to -0.688, P = 0.003). The multiple-level model showed that city would impact older people's social support (χ = 5.103, P < 0.001). Marital status (-2.133, 95% CI: -2.768 to -1.499, P = 0.000), education (1.697, 95% CI: 0.589-2.805 P = 0.003), living conditions (4.20, 95% CI: 1.762-6.638, P = 0.000), and SRH (-3.144, 95% CI: -4.502 to -1.727, P = 0.000) were the associated factors. Thus, city, age, marital status, education, living conditions, and SRH might be the associated factors for social support among older people.This study presents some feasible implications for social support improvement in China and in other nations worldwide.

Psychosocial correlates of benefit finding in breast cancer survivors in China

Breast cancer is number one in incidence and sixth in mortality among all cancers of women in China. Prior work identified positive consequences following diagnosis and treatment, including benefit finding among breast cancer survivors from Western countries. This study evaluated psychosocial correlates of benefit finding in breast cancer survivors in China. A total of 148 participants completed measures of coping, perceived stress, depressive symptoms, social support, and benefit finding. Results indicated that benefit finding was positively related to active coping and negatively related to depression. Future research may evaluate whether interventions to enhance active coping will improve outcomes among Chinese breast cancer survivors.

The Effectiveness of Somatization in Communicating Distress in Korean and American Cultural Contexts

Previous research has documented that Asians tend to somatize negative experiences to a greater degree than Westerners. It is posited that somatization may be a more functional communication strategy in Korean than American context. We examined the effects of somatization in communications of distress among participants from the US and Korea. We predicted that the communicative benefits of somatic words used in distress narratives would depend on the cultural contexts. In Study 1, we found that Korean participants used more somatic words to communicate distress than US participants. Among Korean participants, but not US participants, use of somatic words predicted perceived effectiveness of the communication and expectations of positive reactions (e.g., empathy) from others. In Study 2, we found that when presented with distress narratives of others, Koreans (but not Americans) showed more sympathy in response to narratives using somatic words than narratives using emotional words. These findings suggest that cultural differences in use of somatization may reflect differential effectiveness of somatization in communicating distress across cultural contexts.

Values, Coping Strategies, and Psychopathological Symptoms Among Adolescents With Asthma

Values are related to coping strategies. However, little is known about the relationship between values and coping strategies among people suffering from chronic illnesses. This study investigates the mediating role of coping strategies specific to asthma on the relationship between the value of health, the value of an exciting life, and anxiety/depression symptoms among Russian and French adolescents with asthma. Adolescents aged 14 to 16 years with moderate and severe asthma ( N = 100, 58 males) were recruited in Russia and France and completed the Rokeach Value Survey, the Asthma-Specific Coping Scale, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Among Russian adolescents, the coping strategy of hiding asthma mediated the relationship between the value of health and depression symptoms. Among French adolescents, the coping strategies of ignoring asthma and adopting a restricted lifestyle mediated the relationship between the value of an exciting life and depression/anxiety symptoms. Among Russian and French girls, the coping strategy of ignoring asthma mediated the relationship between the value of health and anxiety/depression symptoms. Valuing an exciting life, French adolescents used coping strategies that led them to ignore asthma more, and as a result, experienced greater levels of anxiety and depression. Valuing health, Russian adolescents used coping strategies in which they hid their asthma less, but experienced more symptoms of depression. Valuing health, Russian and French girls used coping strategies in which they ignored their asthma less and experienced symptoms of anxiety and depression less.

Association of received social support with depressive symptoms among older males and females in Singapore: Is personal mastery an inconsistent mediator?

RATIONALE

Personal mastery has been shown to be a mediator of the relationship between perceived social support and depressive symptoms. Less is known about its role in the context of received social support. While there is some evidence that received social support may improve one's sense of personal mastery, other studies highlight that received social support may induce dependence and lower one's sense of personal mastery. In addition, less is known about structural factors such as gender that may alter this relationship.

OBJECTIVE

To examine gender differences in how personal mastery mediates the relationship between received social support and depressive symptoms.

METHODS

Using data from a nationally representative study of community dwelling older adults in Singapore, we test the hypothesis that personal mastery is an inconsistent mediator of the received social support-depressive symptoms association using mediation analysis and that gender is associated with this inconsistent mediation.

RESULTS

We find support for our hypothesis of personal mastery as an inconsistent mediator, and observe both the direct and indirect effects of received social support on depressive symptoms to be stronger in females than in males.

CONCLUSION

Depressive symptoms for females may be more sensitive to received social support than males, which may be due to gendered pathways and expectations of support. This study highlights the need to further examine both the beneficial and detrimental effects of received social support on psychological health in tandem, considering the effect of mediating variables such as personal mastery to understand its nuanced pathways.

Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission

Background

South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders.

Methods

We used data from the National Health Insurance Service National Sample Cohort 2002–2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3).

Results

There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919–0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures.

Conclusions

Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare.

Coping strategies used by traumatic spinal cord injury patients in Sri Lanka: a focus group study

PURPOSE

Psychosocial consequences of traumatic spinal cord injury (SCI) have been well documented in Western populations, but there is no published literature on such incidence in the Sri Lankan population. The purpose of this study was to explore the psychosocial impact of SCI in a Sri Lankan population and to examine this population's coping mechanisms.

METHODS

Participants were recruited purposively at the Ragama Rheumatology and Rehabilitation Hospital, the sole rehabilitation facility for SCI patients in Sri Lanka. Focus groups were conducted with 23 consenting individuals. Interview transcripts were analysed using descriptive thematic analysis.

RESULTS

Four domains of life impact, three types of active coping strategies and four types of external supports were identified. Decreased ambulation and burden on family life were significant concerns for male and female participants alike. Religious practices were reported most frequently as active coping strategies, followed by positive reframing and goal-setting. Reported external supports included guided physiotherapy, informational workshops, social support and peer networks.

CONCLUSION

Rehabilitation efforts for Sri Lankan SCI patients should be sensitive to psychosocial concerns in addition to physical concerns in order to help patients re-integrate into their family lives and community. Furthermore, religious practices should be respected as possible aids to rehabilitation. Implications for Rehabilitation Rehabilitative efforts should be conscientious of patients' psychosocial well-being in addition to their physical well-being. Hospital-based rehabilitative efforts for traumatic spinal cord injury patients should promote functional independence and community re-integration. Spiritual and/or religious practices should be respected as ways by which traumatic spinal cord injury patients may confront personal challenges that arise following injury.

Imprisoned Husbands: Palestinian Wives and Experiences of Difficulties

This study aimed to investigate difficulties experienced by the wives of Palestinian men arrested and held in Israeli prisons. 16 captives' wives were interviewed using a semi-structured interview to provide them with a greater opportunity to speak about their experiences. Three main research questions were discussed; community difficulties, social support, and coping strategies. A thematic analysis was used throughout the interviews. We concluded that in addition to the stress of being separated from their husbands, the frustrating visitation process to prison and the ongoing political conflict, the wives expressed a frustrating social network characterized by constant interferences in their personal lives and the choices they make. Most women expressed a lack in psychosocial support given through governmental and non-governmental organizations; in addition they expressed a need for that kind of support. Coping strategies ranged from religious, acceptance, distraction, to planning strategies.

Race/ethnicity and gender differences in mental health diagnoses among Iraq and Afghanistan veterans

Veterans who served in Operation Enduring Freedom (OEF; predominantly in Afghanistan) and Operations Iraqi Freedom and New Dawn (OIF and OND; predominantly in Iraq) and are enrolled in the VA are comprised of a growing cohort of women and higher proportions of racial/ethnic minorities than civilians. To compare rates of mental health disorders by race/ethnicity and gender for this diverse cohort, we conducted a retrospective analysis of existing records from OEF/OIF/OND veterans who were seen at the VA 10/7/01-8/1/2013 (N=792,663). We found that race/ethnicity was related to diagnoses of mental health disorders. Asian/Pacific Islanders (A/PIs) were diagnosed with all disorders at lower rates than whites, and American Indian/Alaska Native (AI/AN) males were diagnosed with most disorders at higher rates than white males. Research is needed to identify contributing factors to differential rates of diagnoses based on race/ethnicity and gender. A/PIs and AI/ANs have unique patterns of mental health diagnoses indicating they should be considered separately to present a comprehensive picture of veteran mental health.

Does a Favor Request Increase Liking Toward the Requester?

Although a request for help can impose a burden on the provider and has the potential of harming a relationship, the theory of amae suggests that in fact it could help promote a stronger relationship. In an experiment, both Japanese and American participants who were asked for help from a confederate increased their liking of the confederate relative to the baseline. Sociable impression of the confederate and perceived closeness of the relationship also increased relative to the baseline. There was, however, no such increase when participants helped the confederate without receiving a direct request. This study suggests that despite the potential risks to relationships, asking favors can provide opportunities for requesters to build and promote relationships.

Cultural Differences in Support Provision

Emotional expression is highly valued in individualistic cultures, whereas emotional restraint is prioritized in collectivistic cultures. We hypothesized that high-quality relationships in these cultures would exhibit the forms of support provision congruent with their respective expectations. Study 1 examined support transactions among friends in response to a laboratory stressor and found that objectively judged relationship quality (RQ) more strongly positively predicted emotion-focused support provision behaviors by European Americans than by Asian Americans. Study 2, a questionnaire study, found that self-reported RQ predicted emotion-focused support provision more strongly among European Americans than among Japanese. Study 3 investigated more indirect forms of support and found that RQ more strongly predicted worrying about and monitoring close others enduring stressors and spending time with them without talking about the stressor among Asian Americans compared with European Americans. These findings suggest that RQ is expressed in terms of support provision in culturally normative ways.

Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya'an, China

Aim

The aim of this study is to assess the depression of pregnant women in the aftermath of an earthquake, and to identify the social support that they obtained, their coping styles and socio-demographic factors associated with depression.

Methods

A total of 128 pregnant women from three hospitals in the epicenter area were recruited immediately after the Ya’an earthquake. Their depression was investigated using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of 14; the social support that they obtained was measured using the Social Support Questionnaire; and their coping styles were assessed using the Coping Styles Questionnaire.

Results

Immediately after the earthquake, the incidence rate of depression in pregnant women was 35.2%, higher than that of the general pregnant population (7%-14%). The EPDS scores were significantly correlated with gestation age at the time of the earthquake, objective support, subjective support, use of support, negative coping style, and positive coping style. The regression analysis indicated that risk factors of prenatal depression include the number of children, relatives wounded, subjective support, and coping styles. A further analysis of the interaction between social support and two types of coping styles with depression showed that there was interaction effect between subjective social support and positive coping styles in relation to EPDS scores. There was an inverse relationship between low EPDS scores and positive coping styles and high social support, and vice versa.

Conclusion

The timing of the occurrence of the earthquake may not necessarily affect the progress of the illness and recovery from depression, and psychological intervention could be conducted in the immediate aftermath after the earthquake. The impact of coping styles on prenatal depression appeared to be linked with social support. Helping pregnant women to adopt positive coping styles with good social support after a recent major earthquake, which is a stressor, may reduce their chances of developing prenatal depression.

Linkages between mental health need and help-seeking behavior among adolescents: Moderating role of ethnicity and cultural values

Risk of developing emotional and behavioral mental health problems increases markedly during adolescence. Despite this increasing need, most adolescents, particularly ethnic minority youth, do not seek professional help. Informed by conceptual models of health behavior, the current study examined how cultural values are related to help seeking among adolescents from 2 distinct racial/ethnic groups. Using a prospective survey design, 169 Vietnamese American and European American youth in 10th and 11th grade reported on their mental health need, as measured by emotional/behavioral mental health symptoms and stressful life events, with participants reporting on their help-seeking behavior at 6-month follow-up assessments. Multinomial logistic regression analyses indicated that mental health need interacted with cultural values and ethnicity to predict help-seeking behavior. Specifically, associations between symptoms and stressful life events, and help-seeking behavior were smaller among Vietnamese American adolescents, and among adolescents with strong family obligation values. These results underscore the complex sociocultural factors influencing adolescents' help-seeking behavior, which have important implications for engaging youth in needed mental health care.

"Please Don't Make Me Ask for Help": Implicit Social Support and Mental Health in Chinese Individuals Living with HIV

China faces a growing HIV epidemic; psychosocial needs of HIV-positive individuals remain largely unaddressed. Research is needed to consider the gap between need for mental healthcare and lack of sufficiently trained professionals, in a culturally acceptable manner. This study assessed explicit and implicit forms of social support and mental health symptoms in 120 HIV-positive Chinese. Explicit social support refers to interactions involving active disclosure and discussion of problems and request for assistance, whereas implicit social support refers to the emotional comfort one obtains from social networks without disclosing problems. We hypothesized and found using multiple linear regression, that after controlling for demographics, only implicit, but not explicit social support positively predicted mental health. Future research is warranted on the effects of utilizing implicit social support to bolster mental health, which has the potential to circumvent the issues of both high stigma and low professional resources in this population.

Associations between multiple health risk behaviors and mental health among Chinese college students

Although there is substantial evidence that health risk behaviors increase risks of premature morbidity and mortality, little is known about the multiple health risk behaviors in Chinese college students. Here, we investigated the prevalence of multiple health risk behaviors and its relation to mental health among Chinese college students. A cross-sectional study was conducted in Wuhan, China from May to June 2012. The students reported their health risk behaviors using self-administered questionnaires. Depression and anxiety were assessed using the self-rating depression scale and self-rating anxiety scale, respectively. A total of 2422 college students (1433 males) aged 19.7 ± 1.2 years were participated in the study. The prevalence of physical inactivity, sleep disturbance, poor dietary behavior, Internet addiction disorder (IAD), frequent alcohol use and current smoking was 62.0, 42.6, 29.8, 22.3, 11.6 and 9.3%, respectively. Significantly increased risks for depression and anxiety were found among students with frequent alcohol use, sleep disturbance, poor dietary behavior and IAD. Two-step cluster analysis identified two different clusters. Participants in the cluster with more unhealthy behaviors showed significantly increased risk for depression (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.83, 2.67) and anxiety (OR: 2.32; 95% CI: 1.85, 2.92). This study indicates that a relatively high prevalence of multiple health risk behaviors was found among Chinese college students. Furthermore, the clustering of health risk behaviors was significantly associated with increased risks for depression and anxiety.

Leverage Between the Buffering Effect and the Bystander Effect in Social Networking

This study examined encouraged and inhibited social feedback behaviors based on the theories of the buffering effect and the bystander effect. A system program was used to collect personal data and social feedback from a Facebook data set to test the research model. The results revealed that the buffering effect induced a positive relationship between social network size and feedback gained from friends when people's social network size was under a certain cognitive constraint. For people with a social network size that exceeds this cognitive constraint, the bystander effect may occur, in which having more friends may inhibit social feedback. In this study, two social psychological theories were applied to explain social feedback behavior on Facebook, and it was determined that social network size and social feedback exhibited no consistent linear relationship.

Understanding the Links Between Social Support and Physical Health: A Life-Span Perspective With Emphasis on the Separability of Perceived and Received Support

Social support has been reliably related to physical health outcomes. However, the conceptual basis of such links needs greater development. In this article, I argue for a life-span perspective on social support and health that takes into account distinct antecedent processes and mechanisms that are related to measures of support over time. Such a view highlights the need to distinguish measures of perceived and received support and its links to more specific diseases (e.g., chronic, acute) and stages of disease development (e.g., incidence). I discuss both the novel implications of these theoretical arguments for research on social support and physical health, as well as the potential intervention approaches that are apparent from this perspective.

Racial/ethnic variations in the main and buffering effects of ethnic and nonethnic supports on depressive symptoms among five ethnic immigrant groups in Toronto

OBJECTIVES

This study examined variations in the main and buffering effects of ethnic and nonethnic social support on depressive symptoms associated with discrimination among five immigrant groups in Toronto.

DESIGN

Data were taken from the Toronto Study of Settlement and Health, a cross-sectional survey of adult immigrants from five ethnic communities (Vietnamese, Ethiopian, Iranian, Korean, and Irish) in Toronto. A total of 900 surveys were collected through face-to-face interviews conducted between April and September 2001.

RESULTS

Significant ethnic variations were observed in the effects of both ethnic and nonethnic social supports on discrimination-related depressive symptoms. Regarding the main effect, ethnic social support was significantly stronger for Iranian, Ethiopian, and Korean immigrants than for Irish immigrants. The benefits of nonethnic support were stronger for Iranian immigrants compared to the effect found in the Irish sample. With respect to stress-buffering or stress-moderating effects of social support, ethnic support was significant in all ethnic groups, except the Vietnamese group. Nonethnic support aggravated the negative impact of discrimination on depressive symptoms in the Irish group, but exerted a stress-buffering effect in the Iranian group.

CONCLUSIONS

Overall, social supports received from fellow ethnic group members had significant main effects (suppressing depressive symptoms) and stress-buffering effects and were most pronounced in the minority ethnic immigrant groups of Ethiopians, Koreans, and Iranians. The effects were least evident among the Vietnamese and Irish. Evidence for the stress-suppressing and stress-buffering role of cross-ethnic group supports was unclear, and even inverted among Irish immigrants. Empirical evidence from the current study seems to support the sociocultural similarity hypothesis of social support.

Mutual and Non-Mutual Social Support

Social support seeking is not uniformly beneficial for different cultural groups, and in fact, is experienced as less helpful and more distressing for Asians and Asian Americans compared with European Americans. However, relationship factors that may attenuate this cross-cultural difference are little understood. We examined the effects of mutual (i.e., interdependent) and non-mutual support on psychological, biological, and behavioral stress responses to support seeking using a laboratory stressor paradigm. Findings show that across all three distress indicators, East Asian Americans were more benefited when they construed support as mutual versus non-mutual, whereas European Americans’ response did not differ by support condition. Furthermore, the data support previous research showing that Asian Americans are more likely to seek support from discretionary (i.e., peers) than obligatory ties (i.e., parents). Our discussion addresses cultural differences in the priority placed on mutuality, interdependence, and harmony in relationships, and their implications for how people construe their relationships. Future areas for research are discussed.

Social Support in Two Cultures: Everyday Transactions in the U.S. and Empathic Assurance in Japan

We studied received social support using the cross-cultural method of situation sampling. College students from the US and Japan described and rated recent examples of received social support, both everyday support as well as support in response to stress. Middle class, European-American (EuA) students' situations fit a model in which support is frequent and offered freely in interactions, even for relatively minor issues. Even when it's unrequested, EuA support makes recipients feel in control, and support-givers are perceived to have acted by free choice. In contrast, results suggest that middle-class Japanese (Jpn) contexts favor support that is empathic and responsive to the recipients' degree of need. Japanese support was experienced positively when it was emotional support, when it was in more serious situations and when the support was rated as needed by the recipient. In Japan, although problem-based support is most common, it is not particularly positive, apparently because it is less likely to be perceived as needed.

Paths to Depression Among Two Different Cultural Contexts

Over the past two decades, there has been an increase in the number of Bedouin Arab students studying at institutions of higher education in Southern Israel. To date, research on Bedouin students is limited, particularly with regard to their coping and adjustment. The main aim of the current study is to shed more light on potential pathways between vulnerability factors and depression among Bedouin Arab and Jewish students. This study was designed to explore cultural differences in the levels of self-criticism, depression, coping, and social support among Bedouin Arab college/university students and their Jewish peers, and to examine the effects of self-criticism on depression in the two cultural contexts. To that end, we conducted a cross-sectional study of 108 Bedouin students and 109 Jewish students. The participants completed the Depressive Experiences Questionnaire, Medical Outcomes Study Social Support Survey, Orientations to Problems Experienced Inventory, the Center for Epidemiological Studies Depression Scale, and demographic questionnaire. In this work, we observed differences in the levels of self-criticism, depression, avoidant coping, and social support in the different groups. Moreover, among the Jewish participants, self-criticism affected depression directly. However, among the Bedouin Arabs, self-criticism affected depression only indirectly, through avoidant coping. The present study highlights the possibility that specific cultural contexts underscore the role of avoidant coping in the pathways between self-criticism and depression, whereas other cultural contexts underscore the direct effect of self-criticism on depression levels. Furthermore, the current research underscores the importance of cross-cultural perspectives in studies of vulnerability factors and depression.

Impact of Cultural Exposure and Message Framing on Oral Health Behavior: Exploring the Role of Message Memory

BACKGROUND

Health messages are more effective when framed to be congruent with recipient characteristics, and health practitioners can strategically choose message features to promote adherence to recommended behaviors. We present exposure to US culture as a moderator of the impact of gain-frame versus loss-frame messages. Since US culture emphasizes individualism and approach orientation, greater cultural exposure was expected to predict improved patient choices and memory for gain-framed messages, whereas individuals with less exposure to US culture would show these advantages for loss-framed messages.

METHODS

223 participants viewed a written oral health message in 1 of 3 randomized conditions-gain-frame, loss-frame, or no-message control-and were given 10 flosses. Cultural exposure was measured with the proportions of life spent and parents born in the US. At baseline and 1 week later, participants completed recall tests and reported recent flossing behavior.

RESULTS

Message frame and cultural exposure interacted to predict improved patient decisions (increased flossing) and memory maintenance for the health message over 1 week; for example, those with low cultural exposure who saw a loss-frame message flossed more. Incongruent messages led to the same flossing rates as no message. Memory retention did not explain the effect of message congruency on flossing.

LIMITATIONS

Flossing behavior was self-reported. Cultural exposure may only have practical application in either highly individualistic or collectivistic countries.

CONCLUSIONS

In health care settings where patients are urged to follow a behavior, asking basic demographic questions could allow medical practitioners to intentionally communicate in terms of gains or losses to improve patient decision making and treatment adherence.

Spousal support in diabetes self-management among Korean immigrant older adults

The authors of the current article investigated domains of spousal support among diabetic Korean older adults and their spouses. Two focus groups were conducted with diabetic participants from the greater Los Angeles Korean community, and three were conducted with their spouses. In the focus groups, participants were asked to describe the spousal support given or received for diabetes self-management. Each group comprised four to nine participants. Focus groups were audiotaped, transcribed, and translated; two independent coders identified domains of spousal support. Content analysis identified six domains: diet, exercise, emotional support, medical regimen, communication with clinicians, and information. Diet was the most frequently described domain across all groups. Gender differences were noted in domains of information, communication, and medical regimen among diabetic participants. Both diabetic and spouse participants identified individualizing spousal support and recognizing diabetes management as teamwork as important elements of successful spousal support. Spousal support education for Korean older adults may have the greatest impact by incorporating these six domains, addressing gender differences, providing tips on individualizing support, and cultivating teamwork.

Health care development: integrating transaction cost theory with social support theory

The emergence of Web 2.0 technologies has already been influential in many industries, and Web 2.0 applications are now beginning to have an impact on health care. These new technologies offer a promising approach for shaping the future of modern health care, with the potential for opening up new opportunities for the health care industry as it struggles to deal with challenges including the need to cut costs, the increasing demand for health services and the increasing cost of medical technology. Social media such as social networking sites are attracting more individuals to online health communities, contributing to an increase in the productivity of modern health care and reducing transaction costs. This study therefore examines the potential effect of social technologies, particularly social media, on health care development by adopting a social support/transaction cost perspective. Viewed through the lens of Information Systems, social support and transaction cost theories indicate that social media, particularly online health communities, positively support health care development. The results show that individuals join online health communities to share and receive social support, and these social interactions provide both informational and emotional support.

Loneliness and social support of older people living alone in a county of Shanghai, China

China has an ageing population with the number of older people living alone increasing. Living alone may increase the risk of loneliness of older people, especially for those in China where collectivism and filial piety are emphasised. Social support may fill the need for social contacts, thereby alleviating loneliness. However, little is known about loneliness and social support of older people living alone in China. This study investigated loneliness and social support of older people living alone, by conducting a cross-sectional questionnaire survey with a stratified random cluster sample of 521 community-dwelling older people living alone in a county of Shanghai. Data were collected from November 2011 to March 2012. The instruments used included the UCLA Loneliness Scale version 3 and the Social Support Rate Scale. The participants reported a moderate level of loneliness. Their overall social support level was low compared with the Chinese norm. Children were the major source of objective and subjective support. Of the participants, 53.9% (n = 281) and 47.6% (n = 248) asked for help and confided when they were in trouble, but 84.1% (n = 438) never or rarely attended social activities. The level of loneliness and social support differed among the participants with different sociodemographic characteristics. There were negative correlations between loneliness and overall social support and its three dimensions. The findings suggest that there is a need to provide more social support to older people living alone to decrease their feelings of loneliness. Potential interventions include encouraging more frequent contacts from children, the development of one-to-one 'befriending' and group activity programmes together with identification of vulnerable subgroups.

Family functioning in Asian families raising children with autism spectrum disorders: the role of capabilities and positive meanings

BACKGROUND

There has been increasing interest in exploring the factors contributing to successful adaptation and family functioning in ethnically and culturally diverse families who raise children with autism spectrum disorders (ASD), in order to inform more appropriate strength-based family support services. This pilot study used the Family Adjustment and Adaptation Response (FAAR) model as a theoretical framework to investigate the role of families' capabilities (coping strategies and resources of support) and positive meanings in raising a child with ASD in family functioning in an Asian context.

METHODS

Sixty-five Singaporean parents of 3- to 11-year-old children with ASD completed a series of questionnaires on demands, coping strategies, social support, positive meanings and family functioning.

RESULTS

Families reported a number of helpful coping strategies. Coping through family integration/optimism was most helpful, followed by understanding the condition and by developing esteem and psychological stability. Reported capabilities, but not positive meanings, mediated the relationship between demands and family functioning.

CONCLUSION

The findings are discussed in relation to existing literature, possible specific cultural issues, and the strengths and limitations of the study. Implications for supporting families of children with ASD in different social and cultural contexts are also discussed.