Social comparisons and chronic illness: research synthesis and clinical implications

Social Determinants and Consequences of Pain: Towards Multilevel, Intersectional, and Life Course Perspectives

Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to: 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macro-level factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider: a) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy and interpersonal conflict; b) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and c) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.

Loneliness and Its Predictors in Rare Versus Common Chronic Illnesses

BACKGROUND

Loneliness is a growing public health concern associated with substantial negative mental and physical health outcomes. Loneliness is especially relevant for individuals with a chronic illness, perhaps more so if their illness is rare. Little is known about the psychosocial experience of individuals with a rare chronic illness, and whether and how it may differ from the experience of individuals with common chronic illnesses. We compared the magnitude of loneliness in persons with a rare or common chronic illness and examined theoretically guided predictors of loneliness as follows: stigma, illness intrusiveness, social comparison, social support, support from healthcare providers, and self-efficacy.

METHOD

Individuals with a chronic illness (common or rare) completed an anonymous online survey (N = 952).

RESULTS

Individuals with common chronic illnesses were as lonely as those with a rare chronic illness. Loneliness in both groups was higher than that in population norms. Regression analyses reveal that independent of other predictors, loneliness was especially high among people who feel stigmatized by others, those who have less social support available, and people whose functioning is more disrupted by their illness (all p values < 0.01).

CONCLUSION

The similarity of loneliness in these groups reinforces the value of further systematic research to identify the needs of individuals with any type of chronic illness. Study findings highlight the importance of examining internalized stigma and social support as possible targets of intervention to reduce loneliness among individuals with a chronic illness, recognizing some of the unique features and challenges of their disorders, whether common or rare.

Daily social comparisons among women in midlife with elevated risk for cardiovascular disease: A within-person test of the identification/contrast model

Women age 40-60 are disproportionately affected by health problems that increase their risk for cardiovascular disease (CVD; e.g. hypertension). Social comparisons (i.e. self-evaluations relative to others) are known to influence health in this and other groups, but their nature and consequences in daily life are poorly understood. We conducted an ecological momentary assessment study over 10 days (5x/day) with 75 women ages 40-60 who had ≥1 CVD risk conditions (MAge = 51.6 years, MBMI = 34.0 kg/m2). Using a mix of frequentist and Bayesian analytic approaches, we examined characteristics of women's naturally occurring comparisons and tested predictions from the Identification/Contrast Model within-person (e.g. identifying with an upward target results in positive affect, whereas contrasting results in negative affect). Comparisons occurred at 21% of moments, with considerable within-person variability in response. In line with predictions from the Identification/Contrast Model, women were more likely to experience positive affect after upward identification or downward contrast and more likely to experience negative affect after upward contrast or downward identification, though observed nuances warrant additional consideration. Overall, findings support the Identification/Contrast Model to describe women's comparison experiences as they occur in daily life. Future work should determine pathways between the immediate consequences of comparisons and longer-term health outcomes.

Selection of social comparison standards in cardiac patients with and without experienced defibrillator shock

Patients with an implantable cardioverter-defibrillator (ICD) often report psychological distress. Literature suggests that patients with physical disease often compare their well-being and coping to fellow patients. However, we lack knowledge on social comparison among patients with ICD. In this study, we examined psychological distress and social comparison selection in patients with (ICD+) and without experienced ICD shocks (ICD-). We theorized that relative to ICD- patients, those with ICD+ display higher levels of psychological distress and thereby compare more frequently with fellow patients with more severe disease, but better disease coping and try to identify more strongly with these standards to improve their own coping. We recruited 92 patients with (ICD+, n = 38) and without an experienced ICD shock (ICD-, n = 54), who selected one of four comparison standards varying in disease severity and coping capacity. Relative to ICD-, ICD+ patients reported higher levels of device-related distress, but there were no significant differences in anxiety, depression, or quality of life. ICD+ patients selected more often comparison standards with poor coping and, irrespective of standard choice, displayed more negative mood following comparison. Our results show that ICD+ patients tend to perform unfavorable comparisons to fellow patients, which might explain higher psychological distress and worse coping. These findings warrant further research into social comparison as a relevant coping mechanism in ICD patients.

Adaptive coping strategies among individuals living with long-term chikungunya disease: a qualitative study in Curaçao

OBJECTIVE

Long-term chikungunya disease is characterised by persistent rheumatic symptoms following chikungunya virus infection. As there is no specific treatment available, affected individuals need strategies to adapt. However, research on these is scarce. This study aimed to explore which adaptive coping strategies are employed to manage persistent rheumatic symptoms in daily life.

SETTING

The study was conducted in Curaçao.

DESIGN AND PARTICIPANTS

An explorative qualitative study was conducted between September and October 2020, among a purposive sample of adults, 19 women and 4 men affected by long-term chikungunya disease. In-depth interviews were semi-structured and transcribed verbatim. The data were analysed using inductive thematic analysis.

RESULTS

The disease duration for all participants ranged between 68 and 74 months (6 years). In narrating their experiences of coping with long-term chikungunya disease, four themes were identified: (1) learning to live with the disease; (2) resilience for dealing with pain; (3) maintaining positive self-image and attitude; and (4) coping through spirituality.

CONCLUSION

To live with long-term chikungunya disease with dignity in spite of physical pain and discomfort, participants tried to retain a sense of control of oneself and one's lives, to not let the disease take over, focusing on the positive in their lives, and finding strength and remain hopeful. Interventions such as cognitive-behavioural therapy and mindfulness exercises may be effective in strengthening or regain affected individual's sense of competence and control by fostering adaptive coping skills and resilience. Subsequently, these interventions may improve health-related quality of life when rheumatic symptoms persist following chikungunya virus infection.

Dimensional and social comparisons in a health fitness context

Whereas prior research has found that people are influenced by both internal (e.g., dimensional) and external (e.g., social) comparative information in academic contexts, we experimentally examined the influence of such comparisons in a health fitness context. Participants engaged in "physical and mental fitness" tasks (e.g., performing sit-ups, memorizing words) and were randomly assigned to receive (1) social comparative feedback indicating their physical or mental fitness was better or worse than their peers or (2) dimensional comparative feedback indicating their performance in a target domain (e.g., mental fitness) was better or worse than a referent domain (e.g., physical fitness). Results showed that participants who made upward comparisons had lower fitness self-evaluations and more negative (less positive) emotional reactions to the feedback for the target domain, with the effect being nominally stronger for social than dimensional comparisons and for mental than physical fitness. Findings are discussed in the context of comparison-based models and health behavior theories.

Evaluation of the Scales for Social Comparison of Appearance and Social Comparison of Well-Being

People constantly compare their appearance and well-being to that of other individuals. However, a measure of social comparison of well-being is lacking and existing appearance-related social comparison assessment is limited to comparison tendency using predefined social situations. This limits our understanding of the role of social comparison in appearance and well-being. Therefore, we developed the Scale for Social Comparison of Appearance (SSC-A) and the Scale for Social Comparison of Well-Being (SSC-W) to assess upward and downward social comparisons with regard to (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective impact during the last 3 weeks. In one longitudinal and three cross-sectional studies (Ns = 500-1,121), we administered the SSC-A or SSC-W alongside measures of appearance social comparison, body satisfaction, self-concept, social rank, well-being, envy, rumination, depression, and anxiety. Confirmatory factor analyses supported the expected two-factor model representing upward and downward social comparison for both scales. Overall, upward comparison displayed the anticipated associations with the measured constructs, whereas downward comparison showed mostly small or nonsignificant correlations with the validators. The SSC-A and SSC-W are efficient measures of social comparison for appearance and well-being with good evidence for their reliability and validity in our samples.

Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment

BACKGROUND

Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence.

PURPOSE

To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs.

METHODS

We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet.

RESULTS

There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component.

CONCLUSIONS

The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.

Crying over spilled milk? A network analysis of aversive well-being comparison, brooding rumination and depressive symptoms

BACKGROUND

Comparative thinking about one's well-being is ubiquitous. Comparisons that threaten an individual's self-motives are aversive and interact with rumination and depression. Aversive well-being comparisons include upward social, past temporal, counterfactual, and criteria-based comparisons, as well as downward prospective temporal comparisons. Although the frequency, discrepancy, and affective impact of aversive comparison total scores have been associated with brooding rumination and depression, no study has investigated the interaction of specific comparison standards (e.g., social or counterfactual) with symptom cascades of brooding and depressive symptoms.

METHODS

To examine this interaction, we conducted network analyses on the interplay between aversive well-being comparisons, brooding rumination, and depression. Specifically, we conducted a cross-sectional study in N = 500 dysphoric individuals and a longitudinal study in N = 921 participants at two timepoints, three months apart. Participants completed measures of depression, brooding, and the Comparison Standards Scale for Well-being, which assessed the frequency, perceived discrepancy, and affective impact of aversive well-being comparisons.

RESULTS

Feelings of worthlessness emerged as the most central attribute in the networks of the dysphoric sample. Longitudinally, brooding and depressive symptoms predicted aversive comparisons, but not the other way around, which accounted for social and other-referent counterfactual comparisons to a greater degree than for other comparison types.

LIMITATIONS

We used nonclinical samples.

CONCLUSIONS

The findings highlight the critical role of comparison standards in depression. Further research is warranted to detect potential intervention targets for mitigating negative effects of negative self-evaluation.

'Like a ticking time bomb': A qualitative study exploring the illness experiences of adults with kidney stone disease

OBJECTIVE

Kidney stone disease (KSD) is a common, complex and painful urological condition, but how patients make sense of and respond to the challenges of KSD is poorly understood. Using the common-sense model of illness self-regulation (CSM-SR), we aimed to explore the illness experiences of individuals with KSD.

DESIGN

A qualitative design using individual semi-structured interviews.

METHODS

Thirty-three patients with KSD attending outpatient urology services participated in interviews informed by the CSM-SR. Data were analysed using reflexive thematic analysis. Themes were mapped onto the domains of the CSM-SR.

RESULTS

Five main themes were generated, broadly echoing domains within the CSM-SR: (1) making sense of KSD, (2) normality paused, (3) the psychological burden of KSD, (4) the tensions of managing KSD, and (5) improving understanding of KSD. Additionally, findings suggested that partners' perceptions of KSD were an additional contextual factor that informed patients' own perceptions and management of KSD. Participants appraised initial KSD symptoms as indicative of a serious health threat. Diagnosis brought some relief, however, KSD wielded multi-dimensional impacts on patients' perceptions, self-management and well-being. Anxiety, including fear of KSD recurrence, and low mood were common psychological burdens across narratives.

CONCLUSION

The majority of the themes identified were commensurate with an extended CSM-SR. This model has utility in informing how patients perceive and manage KSD. Examining patients' KSD representations and routinely assessing for psychological distress may be of benefit to improve health outcomes for this patient group.

Social comparisons between group members during behavioural weight loss treatment: comparison direction, scale, and associations with weight loss maintenance

OBJECTIVE

To examine distinct types of social comparisons (i.e. self-evaluations relative to others) in behavioural weight loss groups and their relations with weight loss maintenance.

DESIGN

Participants (N = 127, MBMI = 35.66 kg/m2) reported on their comparisons at mid-treatment (6 months), including identification of their primary individual comparison target (group member) and perceptions of their own treatment adherence versus that of their group and identified target.

MAIN OUTCOME MEASURES

Weight was assessed at baseline, mid-treatment, end-of-treatment (12 months), and 18- and 24-month follow-ups.

RESULTS

Comparisons with individual targets perceived as more successful with weight loss were most frequent (i.e. upward comparisons), though comparisons differed based on group versus individual targets and specific treatment behaviours (e.g. self-monitoring). Comparisons did not align with participants' own treatment progress, suggesting that comparisons reflect more than just their objective weight loss relative to others. Relations between participants' initial weight loss and maintenance was moderated by the type of individual target identified at mid-treatment (p = 0.02, sr = 0.27).

CONCLUSIONS

Social comparisons in group-based weight loss treatment are multifaceted and predict long-term weight loss maintenance. Additional work is needed to determine how best to harness comparison processes to promote success in behavioural weight loss treatment.

Aversive well-being comparisons in dysphoria and the role of brooding rumination

OBJECTIVES

Individuals frequently engage in comparisons on how they are doing relative to different standards. According to the general comparative-processing model, comparisons can be perceived as aversive (appraised as threatening the motives of the comparer) or appetitive (appraised as consonant with, or positively challenging the motives). Research indicates that aversive comparisons are associated with depression. We hypothesize that aversive comparisons play a significant role in the relationship between brooding rumination and depression. Drawing on central propositions of control theory that discrepancies instigate rumination, we investigated the mediating role of brooding rumination in this relationship. Reflecting the different directionality, we also examined whether well-being comparisons mediate the relationship between brooding rumination and depression.

METHODS

Dysphoric participants (N = 500) were administered measures of depression and brooding rumination, and the Comparison Standards Scale for Well-being. The latter assesses aversive social, temporal, counterfactual, and criteria-based comparisons regarding their (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective valence.

RESULTS

The relationship between the frequency of aversive comparisons with depression was partially accounted for by comparison discrepancy and engendered affective valence and brooding rumination. The relationship between rumination and depression was partially mediated by sequential comparison processes.

CONCLUSIONS

Longitudinal research needs to unravel the underlying directionality of the relationship between depression, brooding, and comparison. Relevant clinical implications of well-being comparison are discussed.

Selection of and Response to Physical Activity-Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies

BACKGROUND

Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood.

OBJECTIVE

We used an iterative approach to better understand users' selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets.

METHODS

Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior).

RESULTS

Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants' interactions with the platform (ie, the type of target selected, the time spent viewing the selected target's profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target's profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior.

CONCLUSIONS

Capturing physical activity-based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity-based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity.

Differences in symptom experience among patients with systemic sclerosis: a cluster analytic approach to identifying subgroups

OBJECTIVES

Symptoms of people who have SSc are heterogeneous and difficult to address clinically. Because diverse symptoms often co-occur and may share common underlying mechanisms, identifying symptoms that cluster together may better target treatment approaches. We sought to identify and characterize patient subgroups based on symptom experience.

METHODS

An exploratory hierarchical agglomerative cluster analysis was conducted to identify subgroups from a large SSc cohort from a single US academic medical centre. Patient-reported symptoms of pain interference, fatigue, sleep disturbance, dyspnoea, depression and anxiety were used for clustering. A multivariate analysis of variance (MANOVA) was used to examine the relative contribution of each variable across subgroups. Analyses of variance were performed to determine participant characteristics based on subgroup assignment. Presence of symptom clusters were tallied within subgroup.

RESULTS

Participants (n = 587; 84% female, 41% diffuse cutaneous subtype, 59% early disease) divided into three subgroups via cluster analysis based on symptom severity: (i) no/minimal, (ii) mild, and (iii) moderate. Participants in mild and moderate symptoms subgroups had similar disease severity, but different symptom presentation. In the mild symptoms subgroup, pain, fatigue and sleep disturbance was the main symptom cluster. Participants in the moderate symptoms subgroup were characterized by co-occurring pain, fatigue, sleep disturbance, depression and anxiety.

CONCLUSION

Identification of distinct symptom clusters, particularly among SSc patients who experience mild and moderate symptoms, suggests potential differences in treatment approach and in mechanisms underlying symptom experience that require further study.

"You get what you need when you need it": A mixed methods examination of the feasibility and acceptability of a tailored digital tool to promote physical activity among women in midlife

During midlife (ages 40-60), women experience myriad changes that elevate their risk for cardiovascular disease (CVD), including decreased physical activity (PA). Women cite lack of social support for PA and lack of active peers who can serve as role models as key barriers. Digital tools such as web applications can provide exposure to these social inputs; they are also accessible in daily life and require modest time investment. However, as few tools have been designed to meet the unique needs of women in midlife with CVD risk, our research team previously built a web application that is tailored for this population. In the present study, we used a convergent mixed methods design to develop a deep understanding of the feasibility, usability, and acceptability of this web application in a sample of identified end users. Participants (N = 27, MAge = 53 years, MBMI = 32.6 kg/m2) used the web application at the start of each day for 7 days and completed a 1-hour qualitative interview at the end of this test period. Integration of findings from two-level multilevel models (quantitative) and thematic analysis (qualitative) indicated support for the feasibility, usability, and acceptability of the new web application among women in midlife with CVD risk conditions and identified critical opportunities for improving the user experience. Findings also speak to the utility of options for content selection that can meet women's needs in daily life and highlight women's desire for PA resources that prioritize their perspectives.

How we compare: A new approach to assess aspects of the comparison process for appearance-based standards and their associations with individual differences in wellbeing and personality measures

We introduce a novel approach to assess habitual comparison processes, while distinguishing between different types of comparison standards. Several comparison theories (e.g., social) suggest that self-evaluations use different standards to inform self-perception and are associated with wellbeing and personality. We developed the Comparison Standards Scale for Appearance (CSS-A) to examine self-reported engagement with social, temporal, criteria-based, dimensional, and counterfactual comparisons for upward and downward standards in relation to appearance. The scale was completed by three hundred participants online alongside measures of appearance schemas, social comparison evaluations, depression, anxiety, stress, self-esteem, physical self-concept, narcissism, and perfectionism. The CSS-A was found to reliably assess individual differences in upward and downward comparison frequency and affective impact for multiple comparison standards. In line with theory, CSS-A upward comparisons were more frequent than downward comparisons and coincided with negative (versus positive) affective impact. Comparison intensity (i.e., comparison frequency × discrepancy) predicted negative and positive affective impact for upward and downward comparisons, respectively. This relationship was partially mediated by appearance concern for upward comparisons (a composite of appearance schemas and physical self-concept), yet moderated by negativity for downward comparisons (a composite of depression, anxiety, stress, and self-esteem). We offer a framework for measuring the comparison process that warrants further research on underlying comparison processes, for which the CSS(-A) and experience sampling methods should serve as useful tools.

Relations of perceived injustice to psycho-spiritual outcomes in advanced lung and prostate cancer: Examining the role of acceptance and meaning making

OBJECTIVE

Many advanced cancer patients struggle with anxiety, depressive symptoms, and anger toward God and illness-related stressors. Patients may perceive their illness as an injustice (i.e., appraise their illness as unfair, severe, and irreparable or blame others for their illness), which may be a risk factor for poor psychological and spiritual outcomes. This study examined relations between cancer-related perceived injustice and psycho-spiritual outcomes as well as potential mediators of these relationships.

METHODS

Advanced lung (n = 102) and prostate (n = 99) cancer patients completed a one-time survey. Using path analyses, we examined a parallel mediation model including the direct effects of perceived injustice on psycho-spiritual outcomes (i.e., anxiety, depressive symptoms, anger about cancer, anger towards God) and the indirect effects of perceived injustice on psycho-spiritual outcomes through two parallel mediators: meaning making and acceptance of cancer. We then explored whether these relations differed by cancer type.

RESULTS

Path analyses indicated that perceived injustice was directly and indirectly-through acceptance of cancer but not meaning making-associated with psycho-spiritual outcomes. Results did not differ between lung and prostate cancer patients.

CONCLUSIONS

Advanced cancer patients with greater perceived injustice are at higher risk for poor psycho-spiritual outcomes. Acceptance of cancer, but not meaning making, explained relationships between cancer-related perceived injustice and psycho-spiritual outcomes. Findings support testing acceptance-based interventions to address perceived injustice in advanced cancer patients.

Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review

Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.

Development of a Mobile Assessment Tool for Understanding Social Comparison Processes Among Individuals With Schizophrenia: Two-Phase Survey Study

Background

Digital tools may help to address social deficits in schizophrenia, particularly those that engage social comparison processes (ie, evaluating oneself relative to others). Yet, little is known about social comparison processes in schizophrenia or how best to capture between- versus within-person variability, which is critical to engaging comparisons in digital interventions.

Objective

The goals of this pilot study were to (1) better understand affective responses to social comparisons among individuals with schizophrenia, relative to healthy controls, using a validated global self-report measure; and (2) test a new brief, mobile assessment of affective responses to social comparison among individuals with schizophrenia, relative to the full measure. This study was conducted in 2 phases.

Methods

We first compared self-reported affective responses to social comparisons between individuals with schizophrenia (n=39) and healthy controls (n=38) using a traditional self-report measure, at 2 time points. We examined the temporal stability in responses and differences between groups. We then evaluated the performance of brief, mobile assessment of comparison responses among individuals with schizophrenia, completed over 12 weeks (n=31).

Results

Individuals with schizophrenia showed greater variability in affective responses to social comparison than controls on traditional measures and completed an average of 7.46 mobile assessments over 12 weeks. Mobile assessments captured within-person variability in affective responses in the natural environment (intraclass correlation coefficients of 0.40-0.60). Average scores for mobile assessments were positively correlated with responses to traditional measures.

Conclusions

Affective responses to social comparison vary both between and within individuals with schizophrenia and capturing this variability via smartphone surveys shows some evidence of feasibility. As affective variability is a potential indicator of poor outcomes among individuals with mental health conditions, in the future, a brief, mobile assessment of affective responses to social comparisons may be useful for screening among individuals with schizophrenia. Further research on this process is needed to identify when specific comparison messaging may be most effective in digital interventions and could suggest new therapeutic targets for illnesses such as schizophrenia.

Fear of Progression in chronic illnesses other than cancer: A systematic review and meta-analysis of a transdiagnostic construct

Fear of cancer recurrence (FCR) is the most common psychosocial issue amongst cancer survivors. However, fear of progression (FoP) has been studied outside of the cancer context. This review aimed to: (1) meta-synthesize qualitative studies of FoP in illnesses other than cancer; and (2) quantify the relationship between FoP and anxiety, depression, and quality of life (QoL) in non-cancer chronic illnesses. We identified 25 qualitative and 11 quantitative studies in a range of chronic illnesses. Participants described fears of progression and recurrence of their illness, including fears of dying, and fears of becoming a burden to family. Fears were often triggered by downward comparison (i.e. seeing people worse off than themselves). Participants coped in different ways, including by accepting the illness or seeking knowledge. Those for whom these fears caused distress reported hypervigilance to physical symptoms and avoidance. Distress, and seeking information, were associated with adherence. In quantitative analyses, FoP was moderately associated with QoL, and strongly associated with anxiety and depression. These results suggest that FoP in illnesses other than cancer is similar to FCR. FoP appears to be an important transdiagnostic construct associated with distress. Evidence-based FCR interventions could be adapted to better manage FoP in other illnesses.

Experiences of people with multiple sclerosis participating in a social cognitive behavior change physical activity intervention

BACKGROUND

Understanding the experiences of people with MS taking part in physical activity interventions is critical to inform future interventions.

AIM

The aim was to gain insight into the experiences of people with MS taking part in a behavior change group physical activity intervention with a novel social cognitive theory component.

METHODS

A qualitative semi-structured interview format was utilized. Questions focussed on expectations, views and beliefs at being involved in the study, beliefs on physical activity, and subjective evaluation of the trial content and delivery. Seventeen people were interviewed and data were analyzed using thematic analysis.

RESULTS

Three themes were generated: psychological and social factors, intervention processes, and MS identity. The acceptance of MS as an identity acted as an initial barrier to exercise, with a more positive, exercise-enabling identity post-intervention. Psychological factors such as self-efficacy and anxiety, as well as social factors such as social support, were found to play an important role in how participants experienced the program. Similarly, intervention processes included support for group-based activities and structure of exercise classes, and were also inter-linked to the other themes.

CONCLUSION

It appears that group-based exercise interventions are acceptable and feasible for people with MS. The qualitative findings support previously reported quantitative findings that the Step it Up intervention is effective at promoting physical activity and improving psychological outcomes.

How do I know how I am doing? Use of different types of comparison in judgment of well-being in patients seeking psychological treatment and healthy controls

Judgment of well-being is formed on the spot, and we know little about its foundations. We aimed at examining the role of comparison standards in informing evaluations of well-being in a clinical and a nonclinical sample. In a semi-structured face-to-face interview, individuals seeking psychological treatment and healthy control individuals rated how they have been feeling in general and relative to specific comparison standards and were each time invited to substantiate their ratings. Independent coders assessed number, type, direction, and specificity of reported comparisons. When asked to explain why they chose a particular rating of their well-being, 93% of clinical participants and 61% of nonclinical participants spontaneously reported some type of comparison standard. Both groups reported highest well-being ratings relative to social and past temporal comparisons and lowest relative to prospective temporal comparison. Furthermore, clinical participants engaged in more upward than downward comparisons, whereas this was not the case for healthy control participants. Our findings suggest that evaluations of well-being are informed by different comparison types and that individuals with clinical complaints use more comparisons when evaluating their well-being. The results encourage further investigation of comparative thinking as an underlying mechanism of judgment of well-being and ill-being.

(Dis)Connecting Through COVID-19: Experiences of Older Persons in the Context of a Volunteer-Client Relationship

The coronavirus (COVID-19) pandemic and mandated physical distancing requirements significantly impacted volunteer programs for older persons with many long-standing programs either ceasing altogether or pivoting to connecting through virtual technologies. In this study, we collected qualitative interview data from 23 clients and 33 volunteers to investigate their experiences during the COVID-19 pandemic and the effects on the volunteer-client relationship. Three themes were identified: pandemic emotions, negotiating social interactions, and growing through the COVID-19 pandemic. These findings provide important insights into the experiences of hospice organizations and their volunteers and clients during the COVID 19 pandemic, further highlighting the importance of acknowledging both older persons' vulnerability and their resilience, of building in compassionate community approaches to care, and of finding innovative ways to foster volunteer-client relationships during times when physical visiting is not possible.

The meaning and experience of gratitude for people living with dementia

RATIONALE

Supporting people to live well with dementia is an international government priority. People living with dementia experience a range of positive emotions despite the challenges associated with dementia. Further research is needed to explore how these positive experiences can be fostered to support well-being. There is empirical evidence of the benefits of gratitude in other clinical groups, but no studies have explored how gratitude is experienced by people living with dementia.

METHODS

In this mixed-methods study, eight people living with dementia shared their experiences of gratitude through interviews and gratitude diaries. Qualitative data were analysed using interpretative phenomenological analysis. Quantitative data regarding diary use were analysed using descriptive statistics.

FINDINGS AND CONCLUSIONS

Gratitude holds interpersonal and transpersonal meanings for people living with dementia, balanced with challenges of dementia and ageing. This study offers insight into the existence and relevance of gratitude for people living with dementia, highlighting the importance of using multiple methods in dementia research. Positive psychology interventions informed by these findings may be effective in supporting well-being for people with dementia.

Social Comparison and Stress Appraisal in Women with Chronic Illness

(1) Background: The present study examined how social comparison orientation, stress appraisal and different social comparison strategies interact in women facing chronic illness. (2) Methods: Assessments were conducted by a trained professional in face-to face semistructured interviews (n = 179 women with chronic illness). Main outcome measures included social comparison scales and a stress appraisal questionnaire. The mediation model, by a bootstrapping procedure, was used to analyze the interaction among variables. (3) Results: Regarding the relationships among variables studied, they were related to each other except for a downward contrast, which allowed us to propose our hypothetical mediation model. Results showed that stress appraisal fully mediates between social comparison orientation and social comparison strategies except for the upward identification strategy. (4) Conclusions: Our results suggest that uncertainty, feelings of threat and low control over one’s illness or, in general, stress appraisal, had an important mediating effects over social comparison processes in patients with chronic illnesses. Therefore, by understanding the stress appraisal process, and the variables that might modify it, we could improve the use of social comparison as a favorable coping strategy.

Relations between social comparisons and physical activity among women in midlife with elevated risk for cardiovascular disease: an ecological momentary assessment study

Women in midlife (ages 40–60) show decreases in physical activity (PA) that exacerbate risk for cardiovascular disease. Social comparisons (i.e., self-evaluations relative to others) are known to influence PA in other groups, but their association in this population is unknown. The present study used ecological momentary assessment to examine this relation among women in midlife with hypertension or another CVD risk condition (N = 75, M_BMI = 34.0 kg/m²). Participants completed 5 surveys per day and wore tri-axial accelerometers for 10 days. PA engagement was lower after women reported more comparisons than were typical for them (7–14% reductions in PA for each additional comparison). These relations varied across days of observation and relations were positive on 34–58% of days. Findings call for careful consideration of how best to harness any potential benefits of social comparison for promoting PA in this and other groups.

A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study

BACKGROUND

Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity.

OBJECTIVE

We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity.

METHODS

We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences.

RESULTS

This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=-.79; 95% CI -4.0 to 2.4; P=.63) or miles (b=-.07; 95% CI -0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members.

CONCLUSIONS

Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion.

A linguistic analysis of future narratives in adolescents with Complex Regional Pain Syndrome and their pain-free peers

BACKGROUND

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that often develops after injury, with a typical onset in adolescence. The impact of chronic pain is far-reaching, with many adolescents reporting atypical developmental trajectories compared with peers. Social Comparison Theory offers a framework for understanding how such comparisons influence well-being, whereby a heightened sense of disparity places adolescents at risk of poor cognitive, affective and social outcomes. Using a novel linguistic analysis programme, this study aims to investigate cognitive, affective and social language used by adolescents with CRPS in comparison to their peers during a task reflecting on their futures.

METHODS

A story completion task was completed by adolescents with CPRS (n = 49) and adolescents without pain (n = 48). This task involved asking adolescents to describe their imagined future. Narratives were analysed using a novel linguistic analysis programme, focusing on the cognitive, affective and social dimensions.

RESULTS

Findings revealed significant group differences in how adolescents with CRPS described their imagined futures. Adolescents with CRPS used significantly fewer positive affect and more negative affect, anger and sadness words, and greater insight and discrepancy words. No significant groups differences were found for social words.

CONCLUSIONS

Substantial differences in cognitive and affective words were found between adolescents with and without CRPS. Findings provide novel insights into current understandings of cognitive, affective and social processes in adolescents living with chronic pain, particularly with regard to adolescent developmental trajectories, and may in turn highlight potential targets in psychosocial interventions for adolescents living with chronic pain.

SIGNIFICANCE

Social comparisons are commonly undertaken by adolescents with CRPS in relation to peers, increasing risk for poor cognitive, affective and social outcomes. Findings promote the potential importance of targeting psychosocial factors in treatments for paediatric chronic pain.

Impact of stroke on affective well-being: findings from a large longitudinal nationally representative study

OBJECTIVES

To examine whether the incidence of stroke influences affective well-being (positive affect and negative affect), and whether such a relationship is moderated by general self-efficacy.

METHOD

Longitudinal data from 2008, 2011 and 2014 were used from a population-based sample of community-residing individuals ≥ 40 years in Germany (n = 9,659 in regression analysis). Affective well-being was quantified using the established Positive and Negative Affect Schedule (PANAS). A well-established scale by Schwarzer and Jerusalem was used to assess general self-efficacy. General practitioner diagnosed stroke was reported.

RESULTS

Fixed effects regressions showed that the incidence of stroke was associated with a decrease in positive affect in the total sample (β = -.17, p < .001) and in both sexes (men: β = -.16, p < .05; women: β = -.19, p < .01). In contrast to these findings, the incidence of stroke was not associated with changes in negative affect (total sample; stratified by sex). Moreover, general self-efficacy moderated the relation between stroke and positive affect.

CONCLUSION

Panel regression models showed that the incidence of stroke was associated with a decline in positive affect in the total sample and in both sexes. As the general self-efficacy moderated this association, it may be beneficial to enhance self-efficacy and prioritize coping strategies among stroke survivals.

Affective Consequences of Social Comparisons by Women With Breast Cancer: An Experiment

Objective

People with severe illness often meet and compare themselves with other patients. Some of these comparison standards do well, others do poorly. Such comparisons could have positive as well as negative consequences depending on whether people identify or contrast from the standard. In the present study, we examine whether patients with breast cancer can benefit from comparisons by engaging in favorable comparison processes.

Design

102 women diagnosed with breast cancer were randomly assigned to read a (fictitious) self-report from a well or poorly adjusted breast cancer patient.

Main Outcome Measures

Participants reported their affective reaction (mood, anxiety, depression) and specified their comparison process (identification or contrast).

Results

In general, participants engaged in favorable comparison processes by contrasting predominantly with poorly adjusted patients, and identifying with well-adjusted ones.

Participants’ Mood Assimilated to the Standard

Participants reported more positive mood after having been exposed to the well-adjusted than the poorly adjusted standard.

Anxiety and Depression Varied With the Type of Comparison Process

It was lower the more they avoided unfavorable comparisons (contrasting with the well-adjusted patient and identifying with the poorly adjusted one).

Conclusion

Patients adjust their comparison processes to the standard to experience favorable comparisons. Especially avoiding unfavorable comparison processes reduces the risk of negative consequences after encountering other patients. Thus, patients may profit from comparisons as long as they engage in the right process.

"The biggest barrier was my own self": the role of social comparison in non-traditional students' journey to medicine

INTRODUCTION

Social comparisons strongly influence an individual's concept of self, their aspirations and decisions. This study investigates how non-traditional applicants used social comparison to shape their preferences, beliefs and predictions whilst preparing an application for medical school.

METHODS

Semi-structured interviews were conducted with 12 UK medical students from non-traditional backgrounds to explore their process of 'getting ready' for medical school, and the role social comparison played in their experiences. Thematic analysis was used to inductively develop themes in the data, before findings were interpreted through the 'triadic model' of social comparison.

RESULTS

Findings revealed that participants looked to the opinions of those with similar norms and backgrounds to accept their desire to study medicine. They sought the opinions of 'experts' to affirm a belief in their suitability but lacked confidence until success in crucial examinations 'proved', in their own view, that they had the ability to do medicine. Social comparison to peers who were perceived to be less committed to medicine, and to relatable role models, reassured participants that someone from their background could succeed in medicine.

DISCUSSION

Our findings further understanding about 'how' and 'why' exposure to relevant experts, peers and role models can positively influence application to medicine through the lens of social comparison. We recommend widening access initiatives promote and foster various opportunities for social comparison to help counter non-traditional students' feelings of uncertainty about their ability and prospects, and to reorient their focus away from achieving the required grades before preparing the non-academic aspects of their application.

Exploring the association of social comparison with depression and anxiety: A systematic review and meta-analysis

Research has highlighted the role of social comparison processes in varying affect and psychological wellbeing. These processes can provide greater insight into cognitions and behaviours related to depression and anxiety disorders. This review aimed to examine the relationship of social comparison with depression and anxiety in clinically relevant samples, using a process-based approach. Studies of clinical and subclinical populations that utilized observational or experimental social comparison assessment were considered for review. A systematic literature search in Medline and PsycInfo databases produced 54 relevant studies (49 studies on adults and five on child and adolescent populations), 14 of which were suitable for a meta-analysis. A meta-analysis of the association of social comparison evaluation with depression and anxiety in clinical populations revealed weighted correlations of -0.53 and - 0.39, respectively. No subclinical studies were included in a meta-analysis due to a lack of comparable outcomes. Evidence suggests differences between depression and anxiety disorders in information seeking, where frequency and diversity of social comparisons vary; however, studies comparing disorders are lacking. Heterogeneity of experimental studies precluded inclusion in a meta-analysis. A narrative review of experimental data indicated depression and anxiety status is related to reactions to upward comparisons in the domains of affect and behaviour, where individual differences in evaluation can determine affective reactions and how comparison information is further sought. This review suggests social comparison has a significant association with depression and anxiety. However, the limited number of studies with clinical populations necessitates further research on social comparison processes in clinical samples.

Profiles of Women With Fibromyalgia and Social Comparison Processes

Background

Due to uncertainty regarding chronic pain in Fibromyalgia (FM) patients, there has been a growing interest in social comparison and its influence on emotional responses.

Aims

to analyze profiles in FM patients according to pain perception, social comparison strategies and anxiety and depression.

Methods

The sample consisted of 131 FM outpatients (Mean age: 50.15, SD = 11.1). Two scales were used: the Social Comparison Illness Scale and the Hospital Anxiety and Depression Scale.

Results

Two profiles were found by cluster analysis (K-means method): one (66%) with a higher level of pain perception, anxiety and depression and greater use of upward contrast and downward identification social comparison; and another (34%) with lower levels of pain perception, anxiety and depression and greater use of upward identification and downward contrast.

Conclusion

These profiles underline the interest in social comparison strategies and their role in FM.

Evaluating a genetic counseling narrative group session for people who have tested positive for the Huntington's disease expansion: An interpretative phenomenological analysis

Huntington's disease (HD) is an inherited neurodegenerative disorder characterized by motor problems, cognitive impairment, and mood disturbances. Given the emotional elements of both HD itself and the testing process for it, psychological interventions may be helpful for those families impacted by HD. A stand-alone genetic counseling narrative group has been offered by one regional genetics clinic in the north of England to support people's coping following predictive genetic testing for HD. Groups are held 4-5 times per year with patients attending a group on a single occasion. This study assessed participants' experiences of attending a group using the qualitative method interpretative phenomenological analysis (IPA). Telephone interviews were conducted with 12 people who had a mutation-positive HD predictive test result and who had taken part in a genetic counseling narrative group session between November 2017 and February 2018. Participants were asked about their experiences of the group and any impact it had had on their lives. Four themes emerged: 'The power of the group, 'Active elements of the narrative exercise', 'Subsequent impact of the session', and 'Another voice'. Participants described the positive impact of being able to meet and empathize with others in a similar situation, the group's positive impact on their mood and future outlook, and its beneficial impact on disclosure. While most participants were positive about the session, the final theme presented the voices of two participants for whom the groups were poorly timed. Given the sessions' generally positive impact, we recommend other centers consider offering people impacted by HD similar sessions.

Methods to Assess Social Comparison Processes Within Persons in Daily Life: A Scoping Review

Self-evaluations relative to others (i.e., social comparisons) have well-established implications for health and well-being, and are typically assessed via global, retrospective self-report. Yet, comparison is inherently a dynamic, within-person process; comparisons occur at different times, on a range of dimensions, with consequences that can vary by context. Global, retrospective assessment forces aggregation across contexts and reduces ecological validity, limiting its utility for informing a nuanced understanding of comparisons in daily life. Research across social and clinical psychology has implemented methods to assess comparisons naturalistically, involving intensive, repeated assessments of comparison occurrence, characteristics, and consequences in everyday life (via ecological momentary assessment or daily diaries). Although promising, this work to date lacks an overarching conceptual framework for guiding decisions about assessment design and implementation. To address this gap, the aims of this scoping review were: (1) to summarize available literature on within-person naturalistic assessment of social comparison, and (2) to provide a set of key considerations to inform future social comparison research using within-person naturalistic assessment. Searches in PubMed, PsycInfo, and CINAHL identified relevant articles published before June 2019. Articles were included if they described at least 3 comparison assessments within each participant, taken in the natural environment, and spaced no more than ~24 h apart (i.e., repeated momentary or daily assessment). In articles meeting these criteria (33 unique studies across 36 published papers), we summarized aspects of the comparison assessment, including recording methods, direction (e.g., upward, downward), target (e.g., friend, stranger), and dimension (e.g., status, appearance). Most studies assessed appearance comparisons (vs. other comparison dimensions) and collected information in response to signals (rather than initiated by participants). However, there was considerable heterogeneity in the number of assessments, assessment periods, recording modalities, and comparison predictors and outcomes assessed. Findings broadly establish heterogeneity in the aspects of comparison considered critical for within-person naturalistic assessment. We describe key decision points for future work to help advance within-person naturalistic assessment methods and improve the utility of such approaches to inform research, theory, and intervention.

Social comparison in parents of children with chronic conditions: Results from the Portuguese version of the Iowa-Netherlands Comparison Orientation Measure

Aim

The Iowa-Netherlands Comparison Orientation Measure (INCOM) is a measure for assessing individual differences in social comparison orientation. Despite the relevance of social comparison orientation in understanding adult patients' adjustment responses to chronic health conditions, the impact of parental social comparison processes in the context of chronic pediatric conditions remains unexplored. This study’s main goal was to examine the psychometric properties of the Portuguese version of the INCOM with parents of children with chronic health conditions.

Method

Two samples of parents of children with chronic pediatric conditions (asthma, epilepsy, diabetes and obesity) were used (test sample, N = 301; validation sample, N = 192). Parents completed self-reported measures of social comparison orientation, anxiety and depression symptoms and neuroticism.

Results

Regarding factorial validity, results supported the unidimensionality of a revised INCOM scale, comprised of nine items. Results also supported the reliability of the measure, and provided evidence of concurrent validity: parents with higher social comparison orientation presented more anxiety and depressive symptoms, and higher neuroticism scores, consistent with what was theoretically expected.

Conclusion

This study opens an important door in the field of pediatric chronic conditions, supporting the relevance of examining parents’ social comparison differences in future research, and the utility of the INCOM in the assessment of those differences.

The role of optimism, self-esteem, and self-efficacy in moderating the relation between health comparisons and subjective well-being: Results of a nationally representative longitudinal study among older adults

OBJECTIVES

It has been shown that negative health comparisons (i.e., when one's health is viewed as worse than the health of relevant others) are associated with subjective well-being (SWB). However, it remains an open question whether negative consequences of health comparisons on SWB might be attenuated by moderating resilience factors. Thus, the aim of this study was to investigate whether optimism, self-esteem, and self-efficacy moderate the relationship between health comparisons and SWB using a longitudinal approach.

DESIGN

Data from wave 3 (2008) to wave 5 (2014) of the German Ageing Survey which is a representative sample of community-dwelling individuals in Germany (≥40 years) were investigated.

METHODS

Validated scales were used to measure optimism, self-esteem, self-efficacy, and SWB. Linear fixed effects regressions were used (with n = 17,136 observations).

RESULTS

Regressions revealed that optimism moderates the relationship between negative health comparisons and negative as well as positive affect. Furthermore, self-efficacy moderates the relationship between negative health comparisons and life satisfaction as well as negative affect. Self-esteem moderates the relationship between health comparisons and negative as well as positive affect.

CONCLUSION

The study findings suggest that the negative consequences of negative health comparisons might be attenuated by optimism, self-esteem, and self-efficacy. Thus, programs aiming at increasing optimism, self-esteem, and self-efficacy might be helpful to maintain SWB. Statement of contribution What is already known on this subject? One recent study has investigated the relation between health comparisons and subjective well-being (SWB). Longitudinal studies are missing investigating the moderating factors in this relation. What does this study add? Our longitudinal study examined whether resilience factors moderate the relationship between health comparisons and SWB. Optimism moderates the relationship between health comparisons and negative as well as positive affect. Self-efficacy moderates the relation between health comparisons and cognitive well-being and negative affect.

Do people with arthritis differ from healthy controls in their internal comparison standards for self-reports of health, fatigue, and pain?

Objective

Patient-reported outcomes are central for the assessment and treatment of people with chronic disease. The primary aim of this study was to determine if people with arthritis differed from healthy individuals in their use of internal comparison standards when answering questions about their health and symptomatology. A secondary aim was to determine if average levels of the patient-reported outcomes were associated with the use of internal comparison standards, regardless of whether a participant had arthritis or no chronic medical condition.

Methods

People with a self-report diagnosis of any type of arthritis (n = 588) and healthy controls (n = 567) were recruited from an Internet panel and were randomly assigned to rate two of three outcomes: health, fatigue, and pain. After completing their rating, participants were presented with internal comparison standards and indicated which ones, if any, they used for the ratings they provided. The internal comparison standards were: Interpersonal (comparisons with other people); Historical (comparisons with the past); Imaginary comparisons (comparisons with a hypothetical scenario); or that none of the three were used.

Results

After controlling for group differences in demographic characteristics and outcome levels by including them in the analyses as covariates, people with arthritis were more likely to make Historical comparisons than healthy controls when rating their health. No other group differences in the use of internal comparison standards were found. We further found that the use of internal comparison standards was associated with health and symptom levels, regardless of whether a participant had arthritis or no medical condition. Poorer self-rated health, greater fatigue, and higher pain were associated with a greater likelihood of making a Historical comparison. Furthermore, poorer self-rated health was associated with a greater likelihood of making an Interpersonal comparison, and higher fatigue and pain with a greater likelihood of making an Imaginary comparison.

Conclusion

People with arthritis differed in their use of Historical comparison standards compared to those with no chronic medical condition for health ratings. In addition, poorer health and more severe symptomatology were associated with the use of internal comparison standards in both groups of participants, people with arthritis and healthy controls.

Social comparisons predict health-related quality of life and depressive symptoms across the first year of breast cancer treatment

BACKGROUND

Social comparisons (SCs) are common among cancer patients, but their prospective associations are not well understood. This study examined concurrent and prospective relationships of SCs with health-related quality of life (HRQOL) and depressive symptoms during the first year of breast cancer treatment.

METHODS

Nonmetastatic breast cancer patients (N = 240) enrolled in a larger intervention trial reported on the frequencies of SCs postsurgery (T1) and 6 months later (T2). HRQOL and depressive symptoms were assessed at T1, T2, and 12 months after T1 (T3). Path analysis via structural equation modeling was used to assess three models relating SCs to HRQOL and depressive symptoms from T1-T2, T1-T3, and T2-T3, controlling for stage of disease, intervention condition, and dispositional optimism.

RESULTS

Upward contrast SCs were associated with poorer concurrent HRQOL at T1 and T2, and with more concurrent depressive symptoms at T2. However, upward contrast SC at T1 predicted better T2 and T3 HRQOL. Upward identification SC at T1 predicted more T2 depressive symptoms, and at T2 was associated with poorer concurrent HRQOL and more concurrent depressive symptoms. Downward identification SCs at T1 were associated with poorer concurrent HRQOL. Downward identification SCs at T2 predicted poorer T3 HRQOL.

CONCLUSIONS

Upward SCs were related to compromised concurrent psychosocial well-being, but prospective effects varied by the interpretation of the comparison (ie, contrast vs identification). Findings have implications for the development and deployment of group-based psychosocial interventions during the early phases of survivorship, during which opportunities for SC are prevalent.

Prospective Relations between Social Comparison Orientation and Weight Loss Outcomes

Maintenance of weight loss after behavioral intervention tends to be poor, and there is need for an improved understanding of factors that are associated with successful maintenance. Social comparison is known to be a powerful influence on treatment outcomes for group-based behavioral weight loss programs, but little is known about the role of individual differences in social comparison orientation (i.e., tendency to value comparison information) in this context. The goal of this study was to examine prospective relations between social comparison orientation and long-term weight loss outcomes (percent weight loss and aerobic-intensity physical activity) among participants in behavioral weight loss treatment. Participants (n = 161, M_Age = 54, M_BMI = 34.4 kg/m²) completed a measure of social comparison orientation at pre-treatment baseline. Height and weight were measured in the research center and aerobic-intensity physical activity was assessed via accelerometer at baseline, mid- and end-of-treatment, and at 6 and 12 months post-treatment (representing maintenance). Multilevel models tested prospective relations between comparison orientation and treatment outcomes over time, with emphasis on differences during the post-treatment maintenance phase. Stronger (vs. weaker) general comparison orientation was associated with better maintenance of aerobic-intensity physical activity. However, stronger (vs. weaker) orientation toward comparisons with better-off others (i.e., upward comparison) was associated with less weight loss success during and after treatment. Social comparison orientation thus shows meaningful relations with long-term maintenance of key outcomes in group-based behavioral weight loss treatment, and warrants further investigation in this context.

Living a burdensome and demanding life: A qualitative systematic review of the patients experiences of peripheral arterial disease

Background

Peripheral arterial disease (PAD) has a significant negative impact on the quality of life of individuals. Understanding the experiences of people living with PAD will be useful in developing comprehensive patient-centred secondary prevention therapies for this population.

Aim

The aim of this study is to identify first-hand accounts of patients’ experiences of living with PAD.

Methods

Six databases (CINALH, PsyclNFO, MEDLINE, AMED, EMBASE, Social citation index/Science citation index via Web of Science (WOS)) and reference lists of identified studies were searched until September 2017 (updated February 2018). Qualitative studies reporting patients’ account of living with PAD were eligible for inclusion. A framework thematic synthesis was implemented.

Results

Fourteen studies with 360 participants were included. Pain and walking limitation were recurrent among the varied symptom descriptions. Patients’ ignorance and trivialisation of symptoms contributed to delays in diagnosis. Inadequate engagement in disease understanding and treatment decisions meant patients had poor attitudes towards walking treatments and unrealistic expectations about surgery. Depending on symptom progression, patients battle with walking impairment, powerlessness, and loss of independence which were a source of burden to them. Lack of disease understanding is central through patients’ journey with PAD and, although they subsequently began adaptation to long term living with PAD, many worried about their future.

Conclusions

Disease understanding is vital across the illness trajectory in patients with PAD. Although certain experiences are common throughout patient journey, some might be unique to a particular stage (e.g. unrealistic expectation about surgery, or rationale of walking in spite of pain in a supervised exercise program). Given that PAD is an overarching construct ranging from the mildest form of intermittent claudication to severe critical limb ischemia with ulceration and gangrene, consideration of important patient constructs specific to each stage of the disease may enhance treatment success. Systematic review registration CRD42017070417.

Social comparisons and long-term rehabilitation for traumatic brain injury: A longitudinal study

Little is known about social influences on long-term rehabilitation outcomes for traumatic brain injury, particularly social comparisons (i.e. self-evaluations relative to others). Patients in long-term rehabilitation ( n = 31) completed assessments at baseline and 1 year. Self-reported social comparison orientation was comparable to existing samples and showed stability over 1 year; affective responses to comparisons (e.g. frustration) were less stable. Social comparison orientation and affective responses were related to baseline executive and psychosocial functioning ( rs = 0.34-0.53) and predicted worse impairment and depression at 1 year ( ds = 0.67, 1.39). Greater attention to comparisons in long-term rehabilitation could improve outcomes.

Social comparisons in adults with type 2 diabetes: Patients' reasons for target selection

OBJECTIVE

To examine reasons for selecting a social comparison target (i.e. a specific other for relative self-evaluation), and their influence on affect and motivation for self-care, in type 2 diabetes (T2DM).

DESIGN

Adults with T2DM (n = 180, M_A1c = 7.6%) chose to read about one of four targets. Participants rated five reasons for their choice (strongly disagree - strongly agree), and rated affect and self-care motivation before and after reading.

RESULTS

To boost confidence in my ability to manage diabetes was rated highest overall (ps < 0.01), though choosing worse-off (vs. better-off) targets was associated with to gain useful information about how to improve (p = 0.04, [Formula: see text] = 0.05). Selection in order to feel better worked for those who chose better-off targets; choosing worse-off targets for this purpose worsened mood and stress (ps < 0.04, [Formula: see text]s = 0.02). Choosing worse-off targets to learn about similar others reduced self-care motivation (p < 0.01, [Formula: see text] = 0.05). Selection in order to boost confidence showed increased motivation only among those who chose better-off targets (p = 0.01).

CONCLUSIONS

Patients' reasons for a particular comparison are associated with short-term changes in affect and self-care motivation, and warrant greater empirical and clinical attention.

Using social media for health research: Methodological and ethical considerations for recruitment and intervention delivery

As the popularity and diversity of social media platforms increases so does their utility for health research. Using social media for recruitment into clinical studies and/or delivering health behavior interventions may increase reach to a broader audience. However, evidence supporting the efficacy of these approaches is limited, and key questions remain with respect to optimal benchmarks, intervention development and methodology, participant engagement, informed consent, privacy, and data management. Little methodological guidance is available to researchers interested in using social media for health research. In this Tutorial, we summarize the content of the 2017 Society for Behavioral Medicine Pre-Conference Course entitled 'Using Social Media for Research,' at which the authors presented their experiences with methodological and ethical issues relating to social media-enabled research recruitment and intervention delivery. We identify common pitfalls and provide recommendations for recruitment and intervention via social media. We also discuss the ethical and responsible conduct of research using social media for each of these purposes.

Patients' perspectives on social and goal-based comparisons regarding their diabetes health status

OBJECTIVE

Social comparisons (ie, self-evaluation in comparison with others) influence patients' perspectives of their disease and may impact motivation and health behavior; however, little is known about patients' perspectives toward receiving such information in a clinical context (eg, from their doctor's office or health system). This study aims to understand patients' perspectives and anticipated responses to receiving social comparison information regarding measures of their diabetes-related health status (eg, A1C) and how receiving such information would compare with goal-based comparisons (ie, self-evaluation in comparison with goal).

RESEARCH DESIGN AND METHODS

We conducted semistructured interviews with 25 patients with type 2 diabetes mellitus (T2DM) regarding social and goal-based comparisons involving their diabetes health status and qualitatively analyzed interviews for themes.

RESULTS

We identified seven major themes: self-relevance, motivation, self-concept, emotions, information seeking, medical care, and self-care. Participants commonly anticipated increased motivation and improved health behaviors in response to both social and goal-based comparisons. Subthemes unique to social comparisons included belief that this information would be motivating by engaging some patients' competitiveness, perception that this information was more 'personalized' than comparisons with a standard goal (eg, A1C<7), and desire to learn from individuals similar to oneself who were doing better.

CONCLUSIONS

Our findings provide significant insights into the anticipated response of patients with T2DM to receiving social and goal-based comparison information regarding their diabetes health status. Providing patients with diabetes with social and goal-based comparison information may affect motivation, mood, and self-concept in ways that may improve or sustain diabetes self-care behaviors for some patients.

Smartphone apps providing social comparison for health behavior change: a need for better tailoring to person and context

Smartphone apps that support health behavior change efforts often provide opportunities for users to compare their behaviors and progress to that of other users (i.e., social comparison). At present, however, available literature on features of these apps has two main limitations: (I) it shows little consistency in its application of the term social comparison, and (II) it does not take into account key aspects and consequences of social comparison that could improve user engagement and behavioral outcomes. In this piece, we provide examples to illustrate the problems in each domain of limitation, and we identify critical aspects of the broader social comparison literature that could inform the tailoring of social comparison features to individual users and contexts.

A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment

Purpose of the study

We consider the points at which cognitive impairment may impact on the pathway to loneliness for older people, through impeding social interaction with family and friends, or by interfering with judgments concerning satisfaction with relationships.

Design and methods

We conceptualize a mediation model anticipating that social resources (LSNS-6) will mediate the pathway between disability (Townsend Disability Scale) and loneliness (De Jong Gierveld 6-item scale) and a moderated-mediation model in which we hypothesize that cognitive impairment (MMSE) will moderate the association between disability and social resources and between social resources and loneliness. To validate the hypothesized pathways, we draw on the CFAS Wales data set (N = 3,593) which is a nationally representative study of community-dwelling people aged 65 and older in Wales.

Results

Disability had a significant indirect effect on loneliness through the mediating variable social resources. Cognitive impairment was significantly associated with social resources, but did not moderate the relationship between disability and social resources. Cognitive impairment had a significant impact on loneliness, and moderated the effect of social resources on loneliness.

Implications

Social structures can (dis)empower people with cognitive impairment and lead to exclusion from social resources or impact on the social construction of aging, cognitive impairment, and dementia. The sense of self for an older person with cognitive impairment may be influenced by social norms and stereotypes, or through a temporal social comparison with an "earlier" sense of self. We conclude that loneliness interventions should be theoretically informed to identify key areas for modification.