Social Support and Social Conflict in Older Adults with COPD and Comorbid Anxiety

Background and Purpose: Adults diagnosed with Chronic Obstructive Pulmonary Disease (COPD) are more likely to report anxiety symptoms than adults with other chronic illnesses. As COPD progresses, adults become increasingly dependent on their support network due to the isolating nature of COPD's symptom and treatment burden. Little research has been completed to examine the relationship between social integration and anxiety in adults with COPD, though social support has been extensively studied in adults with chronic illness and comorbid depression. To address this gap, we conducted a secondary analysis of the National Social Life, Health and Aging (NSHAP) Wave 1 data to examine the relationship between three social integration measures and anxiety: perceived social support, social conflict, and social connectedness. 

Methods: NSHAP used a national area probability sampling of community residing adults aged 57 to 85. The subsample (N = 175) was comprised of participants answering affirmatively to a diagnosis of emphysema, chronic bronchitis, or chronic obstructive lung disease. Perceived social support was measured by averaging responses to how often participants could open up to and rely on their spouse and family members. Social conflict was measured by averaging responses to how often their spouse and family members made too many demands of or criticized the participant. Social connectedness was measured by the number of social ties generated by the NSHAP name generator. Anxiety was measured by the NSHAP Anxiety Symptom Measure (NASM), with a clinical cutoff point for detecting participants with frequent anxiety symptoms. Separate logistic regression analyses were conducted to determine the relationship between the three social integration measures and the likelihood that a participant would meet the anxiety symptoms cutoff. For significance tests, we used 0.05 as the rejection level.

Results: Perceived social support was found to decrease the likelihood that a participant met the anxiety cutoff (X²(1) = 15.16, p < .001). For every one unit increase in perceived social support, the odds a participant met the anxiety cutoff decreased by a factor of 0.05 (Exp(B) = 0.053, p = .001). Social conflict was found to increase the likelihood that a participant met the anxiety cutoff (X²(1) = 27.289, p < .001). For every one unit increase in social conflict, the odds a participant met the anxiety cutoff increased by a factor of 81.92 (Exp(B) = 81.92, p < .001). Social connectedness was also found to increase the likelihood that a participant met the anxiety cutoff (X²(1) = 5.180, p = .023). For every additional social tie reported, the odds a participant met the anxiety cutoff increased by a factor of 1.2 (Exp(B) = 1.24, p = .023).

Conclusions and Implications: Results support findings in chronic illness research that suggests negative social support, such as social conflict, has a positive relationship with psychological distress while perceived social support has an inverse relationship. The social connectedness finding suggests that type of relationship, rather than number, impacts anxiety. These findings suggest social integration needs further examination as a potential mechanism for preventing and treating anxiety in adults with COPD.