The relationship between social support and rehabilitation related outcomes: A meta-analysis

An abundance of social support research has accumulated over the past several decades (e.g., Barrera, 1986; Cohen & Willis, 1985; House, Umberson, & Landis, 1988; Sarason, Sarason, & Shearin, 1986; Schwarzer & Leppin, 1992; Vaux, 1988). The emergence of this research has been traced to the early work of Cassel (1976), Caplan (1974), and Cobb (1976), which identified social support as an important factor in the prevention of and susceptibility to illness and disease. Since this time, various disciplines have contributed to this body of literature including social psychology, health psychology, rehabilitation psychology, behavior medicine, and nursing. The fundamental premise driving these studies has been the widespread consensus that social support has a positive relationship to health and wellbeing. Specifically, researchers from an array of disciplines have found positive relationships between social support and a variety of outcomes typically associated with health, well-being, and coping (Auslander & Litwin, 1992; Pierce, Lakey, Sarason & Sarason, 1997; Schwarzer & Leppin, 1992). Further, social support has been found to be negatively related to stress (Russell & Cutrona, 1991), emotional distress (Dilworth-Anderson, Williams & Cooper, 1999), and mortality (Berkman & Syme, 1979), and shown to predispose persons to engage in health-promoting or in self-care behaviors (Hubbard, Muhlen, & Brown, 1984; Muhlenkamp & Sayles, 1986; Riffle, Yoho, & Sams, 1989). Contemporary social support research has extended to a variety of health conditions (e.g., cancer, cardiovascular disorders, multiple sclerosis, AIDS), psychological disorders (e.g., depression, anxiety, severe mental illness, addiction), and other life stressors (e.g., divorce, caregiving), and has been studied with an array of health and mental health related outcomes (i.e., recovery time, improved condition, health maintenance, and relapse). Of particular interest are the studies investigating social support within the rehabilitation context. For years, scholars have consistently stressed the importance of familial and peer support in the rehabilitation process (Brady, Koch, & Griffith, 2003; Bray, 1978; Cook & Ferritor, 1984; Kelly & Lambert, 1992; McKenna & Power, 2000; Power & Dell Orto, 1986; Safilios-Rothschild, 1970; Story & Certo, 1996; Sutton, 1985; Wright, 1960). And, there is growing evidence of a relationship between social support and rehabilitation related outcomes. For example, research suggests that social support is related to adjustment to disability, quality of life, psychological well-being, employment, treatment compliance, and survival rates among persons with disabilities and chronic illness (Belgrave & Walker, 1991; Dunbar, Ford, & Hunt, 1998; Elliot, Herrick, Patti, Witty, Godshall, & Spruell, 1991; Elliott, Herrick, Witty, Godshall, & Spruell, 1992; Evers, Kraaimaat, Geenen, Jacobs, & Bijlsma, 2002; Hatchett, Friend, Symister, & Wadhwa, 1997; Herrick, Elliott, & Crow, 1994; Holosko, Huege, 1998; Kaplan, 1990; Kaplan & Hartwell, 1987; Leach, Frank, Bouman, & Farmer, 1994; McColl & Rosenthal, 1994; McShane & Karp, 1993; Orr & Aronson, 1990; Rintala, Young, Hart, Clearman, & Fuhrer, 1992; Schulz & Decker, 1985; Symister & Friend, 2003; Zea, Belgrave, Townsend, Jarama, & Banks, 1996). While a number of studies have been conducted in the area of social support and rehabilitation, the evidence is ambiguous. The varied evidence base for social support is not unique to rehabilitation however; it is pervasive across a wide array of health related disciplines and contributes to the universal myth that social support is a unidimensional, global, positive force that works in some inexplicable way (Heller & Rook, 2001). Nonetheless, this area is of particular importance to our field as social support is integral to the ecological approach of rehabilitation, wherein characteristics of the individual and the environment are integrated to achieve optimal functioning and quality of life (Chronister, Johnson, & Berven, in press). …