Research That Matters (January 17 - 20, 2008)

Social support is most often associated with positive health and lower distress (Taylor, Repetti & Seeman, 1997; Burman & Margolin, 1992; Uchino, Cacioppo & Kiecolt-Glaser, 1996). However, recent research has discovered that social support exchanges do not necessarily improve health or alleviate distress and sometimes have the opposite effect (Bolger, Zuckerman & Kessler, 2000; Seidman, Shrout & Bolger, 2006; Dunbar, Ford & Hunt, 1998; Gleason, Iida, Bolger & Shrout, 2003; Shrout et al., 2006). The "esteem threat hypothesis" attempts to explain this paradox by proposing that receipt of support undermines the recipient's self-esteem or autonomy (Dunbar et al., 1998; Bolger et al., 2000; Gleason et al., 2003) and challenges the recipient's sense of competence (Shrout et al., 2006). Although the esteem threat hypothesis has often been cited, it has not been adequately tested. This study tests the esteem threat hypothesis by examining the effect of social support receipt on daily mood in diabetic adult outpatients receiving care from a large urban hospital. To support the esteem threat model, it was hypothesized that 1) mood would be more negative on days when the most social support was received and 2) diabetes management would be poorer on days when mood was most negative.

Methods

Thirty diabetic husbands and their wives participated in the study. Each partner was contacted daily by telephone for nine days and asked a series of questions regarding emotional support, practical support related to daily diabetes management behavior (medication compliance, glucose testing, diet and exercise) and daily mood using the Mood Adjective Checklist (Nowlis, 1965). Diabetes management was measured using an average of three daily blood glucose readings. Data was analyzed using linear regressions with SPSS 10.0 (SPSS, 1999).

Results

Hypothesis 1 was supported. Husbands' negative mood was associated with receipt of practical support (beta = .213, p < .01) and emotional support from their wives (beta = .281, p < .001). Hypothesis 2 was not supported. Poor diabetes management, measured by husbands' average glucose levels, was not predicted by negative mood. However, husbands demonstrated a significant increase in positive mood (beta = .132, p < .05) on days when they provided emotional support to their wives, after controlling for the amount of practical and emotional support provided by their wives. Husbands' positive mood was associated with better glucose control (beta = .248, p < .001).

Conclusions and Implications

This study lends support to the esteem threat hypothesis. Receipt of social support may undermine the recipient's sense of competence and autonomy, affecting mood. However, when the recipient can reciprocate by providing social support in return, it may restore some of the agency lost as a recipient. When working with couples coping with a chronic disease, social workers can help patients to find ways to give as well as receive support, helping improve mood. Further research is needed using a more specific model to better understand the mechanism of how social support operates with mood to affect health outcomes.