Effects of social support and self-efficacy on psychological stress responses in chronic disease patients

Social support is well-known as a factor which influences on mental health or psychological well-being. Generally speaking, it has been suggested that the stronger one perceives his/her social support, the less he/she shows various psychological stress responses. The purposes of this study were to develop the scale for social support which influences on motivation for a long-term treatment in chronic disease patients, and to examine the effect of social support as patients' external resource and self-efficacy on health behavior as their internal resource on psychological stress responses respectively. In Study I, items relating to social support in daily life setting were collected from 50 patients with chronic disease (heart disease, diabetes mellitus, hypertension, and so on). As a result of factor analysis with varimax rotation based on data from 171 normal subjects over the age of 30, it was revealed that the social support scale for chronic disease patients has two main factors : I. Emotional support in daily life (12 items : e.g. 'You have an individual who understands you well') and II. Behavioral support for diseases (8 items : e.g. 'You have an individual who cooks daily meals considering calories'). Reliabilities of each subscale using Cronbach's alpha coefficient were high (.90 for factor I and .80 for factor II). The validity of the scale was checked from viewpoints of content validity and factorial validity. In Study II, relationship among social support, self- efficacy on health behavior and psychological stress responses was investigated. Subjects were 145 chronic disease patients (heart disease, diabetes mellitus, hypertension, and so on). They were requested to complete the social support scale for chronic disease patients which was developed in Study I, the scale of self-efficacy on health behavior, and psychological stress response scale (SRS-18). As a result of path analysis using the score of psychological stress responses as dependent variable and the scores of subscales of social support scale ('Emotional support in daily life' and 'Behavioral support for disease') and self-efficacy scale ('Active coping behavior with disease' and 'Controllability for health'), it was shown that social support does not influence on psychological stress responses directly, but does indirectly via self-efficacy on health behavior. Particularly, 'Behavioral support for disease' played an important role to enhance self- efficacy on health behavior. It was revealed that strong behavioral support for disease enhanced active coping behavior with disease, and then reduction of various psychological stress responses is achieved.