Canadian Institute for Health Information
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The Role of Social
Support in Reducing
Psychological Distress
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What Is Distress?
• Psychological distress (distress)
– A non-specific negative state of mental health that includes
feelings associated with both depression and anxiety1
• Distress involves
– A perceived inability to cope effectively, change in
emotion, discomfort, communication of discomfort and
temporary or permanent harm to the individual as a result2
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What Is Known About
• How distress affects health?
– Living with distress is associated with developing other mental
health conditions3, 4
– Distress is also associated with increased risk of chronic and
severe physical illness5–8
• Who is more likely to experience distress?
– An elevated distress level or greater risk of the onset of distress
is more common among women, those with low income or lower
levels of education, unemployed populations and people with
compromised physical health9–12
• What can help distress improve?
– Research consistently shows that social support is a protective
factor against being or becoming distressed; however, evidence
on the role of social support in reducing distress is lacking
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What This Study Adds
• Highlights an analysis of population-based data and
demonstrates how social support can contribute to
improvements in people’s experience of distress
– The role of social support depends on whether structures
or functions of support are considered, as well as which
populations are studied
• Presents examples of interventions that can influence
distress and other mental health issues through social
support–related activities
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Methods
• Data Source: National Population Health
Survey (NPHS)
• Analyses are based on Canadians age 18 and older
who reported high distress at the start of any two-year
cycle and had a distress score at follow-up two years
later, over the decade beginning in 1998–1999
• 2,440 pairs of pooled observations: 1,660 reports by
females and 780 by males
• Logistic regression analysis was used to assess the
factors associated with reporting a transition from high
distress to low distress two years later
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Methods (cont’d)
• Distress was measured using a six-item scale (K6)3
– Respondents were asked whether in the past month they felt
sad, nervous, restless or fidgety, hopeless, worthless or that
everything was an effort
• The Medical Outcomes Study (MOS) was used to assess
social support3, 13
• Types of support
– Positive interaction: for example, someone to have a good time
with, to get together with for relaxation
– Affectionate support: for example, having someone to hug you
and make you feel wanted
– Emotional support: for example, having someone to give you
advice or suggestions, to share your private worries with
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Results
• There was no significant difference between men and
women in reporting improvements in distress
• Supports were significant in predicting transitions out of
distress, even after taking into account such factors as
being in a lower-income population or having a physical
health limitation
• Structures of social support—like being married—
and functions of support—like having someone to
provide emotional support—were linked to transitions
out of distress
• The relationship between social support and distress
differed for women and men
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Factors Predicting Transition
• Women who reported having regular social
interactions and the ability to talk with or confide in
someone were more likely to transition out of distress
– Women without those social supports were less likely to
transition out of distress
• For men in states of high distress, the structure of
relationships (for example, marriage) was important
in transitions out of distress
– Being married was not protective for women
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Factors Predicting Transition From
High to Low Distress Two Years Later
Restricted Physical Activity (vs. No Restriction)
–
Middle Income (vs. Lower)
+
High Income (vs. Lower)
+
–
Affection Support (High vs. Lower)
Positive Interaction (High vs. Lower)
+
Emotional Support (High vs. Lower)
+
Married/Common-Law (vs. Widowed/Separated/Divorced)
–
+
Single (vs. Widowed/Separated/Divorced)
Notes
+ More likely to transition.
– Less likely to transition.
Source
CIHI Analysis of National Population Health Survey, 1998–1999
to 2008–2009, Statistics Canada.
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What Is It About Social Support?
• Women who felt they had opportunities for the social
support components all or most of the time were
significantly more likely to report improved distress two
years later than women who reported having the
selected support component less often
• No single question was clearly linked with later
improvements in distress among men
• The only item not significant for women (someone
to have a good time with) was the only question
that approached significance for men (p = 0.06)
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How Does Distress Improve if You Have
Someone to . . .
Do Something Enjoyable With
*
Confide in or Talk to About Yourself or Your Problems
*
Share Your Most Private Worries and Fears With
*
Do Things With to Help Get Your Mind off Things
*
Get Together With for Relaxation
*
Count on to Listen to You When You Need to Talk
*
Turn to for Suggestions About How to Deal With a Problem
*
Give You Information to Help You Understand a Situation
*
Understand Your Problems
*
Give You Advice About a Crisis
*
Give Advice
*
Have a Good Time With
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Odds of Experiencing Improvement in Distress Based on Perceptions of Having the Specified Support
Available All or Most of the Time if Needed
Males
2.0
Females
Note
* Indicates support questions that are significantly associated with experiencing improvements in distress in the full model compared with having the
supports less than all or most of the time, after adjusting for age, marital status, income, employment, activity restriction and consulting on mental
health (p<0.05).
Source
CIHI Analysis of National Population Health Survey,
1998–1999 to 2008–2009, Statistics Canada.
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Conclusion: What We Know
• Analyses showed that the role of social support in
predicting improvements in distress differed based
on the type of support and the sex of the population
• Successful interventions can influence distress and
other mental health issues through social support;
effective approaches include
– Focusing on individuals’ skills at relating
– Providing opportunities for interaction
• In some cases, interventions can be integrated
with existing health services
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Conclusion: What We Still Don’t Know
• Opportunities exist for building better evidence on
social support and distress by
– Measuring different dimensions of support where possible
– Considering sex and gender differences in population,
clinical or evaluation studies
• The impact of income source and changes in income
on improvements in mental health may be avenues
for future research
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References
1. B. P. Dohrenwend et al., “Nonspecific Psychological Distress and Other Dimensions of
Psychopathology: Measures for Use in the General Population,” Archives of General
Psychiatry 37, 11 (1980): pp. 1229–1236.
2. S. H. Ridner, “Psychological Distress: Concept Analysis,” Journal of Advanced Nursing 45, 5
(2004): pp. 536–545.
3. R. C. Kessler et al., “Short Screening Scales to Monitor Population Prevalences and Trends
in Non-Specific Psychological Distress,” Psychological Medicine 32, 6 (2002): pp. 959–976.
4. J. Cairney et al., “Evaluation of 2 Measures of Psychological Distress as Screeners for
Depression in the General Population,” The Canadian Journal of Psychiatry 52, 2 (2007):
pp. 111–120.
5. P. J. Puustinen et al., “Psychological Distress Predicts the Development of the Metabolic
Syndrome: A Prospective Population-Based Study,” Psychosomatic Medicine 73, 2 (2011):
pp. 158–165.
6. J. Caron and A. Liu, “A Descriptive Study of the Prevalence of Psychological Distress and
Mental Disorders in the Canadian Population: Comparison Between Low-Income and
Non-Low-Income Populations,” Chronic Diseases in Canada 30, 3 (2010): pp. 84–94.
7. S. A. Stansfeld et al., “Psychological Distress as a Risk Factor for Coronary Heart Disease in
the Whitehall II Study,” International Journal of Epidemiology 31, 1 (2002): pp. 248–255.
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References (cont’d)
8. F. Rasul et al., “Psychological Distress, Physical Illness, and Risk of Coronary Heart
Disease,” Journal of Epidemiology & Community Health 59, 2 (2005): pp. 140–145.
9. T. Stephens, C. Dulburg and N. Joubert, “Mental Health of the Canadian Population:
A Comprehensive Analysis,” Chronic Diseases in Canada 20, 3 (1999): pp. 118–126.
10. J. Caron and A. Liu, “Factors Associated With Psychological Distress in the Canadian
Population: A Comparison of Low-Income and Non-Low-Income Sub-Groups,” Community
Mental Health Journal 47, 3 (2010): pp. 318–330.
11. A. Marchand and M. E. Blanc, “The Contribution of Work and Non-Work Factors to the Onset
of Psychological Distress: An Eight-Year Prospective Study of a Representative Sample of
Employees in Canada,” Journal of Occupational Health 52, 3 (2010): pp. 176–185.
12. H. Orpana, L. Lemyre and R. Gravel, “Income and Psychological Distress: The Role of the
Social Environment,” Heath Reports 20, 1 (2009): pp. 1–9.
13. C. D. Sherbourne and A. L. Stewart, “The MOS Social Support Survey,” Social Science &
Medicine 32, 6 (1991): pp. 705–714.
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Peer Reviewers
• Heather Orpana, PhD, Senior Research Analyst,
Public Health Agency of Canada
• Mike O’Shea, Mental Health Lead, North East Local
Health Integration Network, a representative on the
CCIM—CAP-MH Advisory Group
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About Us
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About the Canadian Institute for Health
Information (CIHI)
• Established in 1994 as independent, not-for-profit corporation
• Vision: Better data. Better decisions. Healthier Canadians.
• Mandate: To lead the development and maintenance of
comprehensive and integrated health information that
enables sound policy and effective health system
management that improve health and health care
• Data holdings: 27 databases of health information
• Range of stakeholders in health system and beyond
– Government organizations (for example, Health Canada,
Statistics Canada), ministries of health, regional health
authorities, non-government organizations, private-sector
organizations, professional associations, health facilities
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About the Canadian Population Health
Initiative (CPHI)
• CPHI is a branch within CIHI
• CPHI’s mission: To support policy-makers and health
system managers in Canada in their efforts to improve
population health and reduce health inequalities
through research and analysis, evidence synthesis
and performance measurement
• Work is guided by the CPHI Council, which includes
representatives from government organizations,
regional health authorities, and research and
academic institutes
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Thank You!
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