546776 research-article2014
HPQ0010.1177/1359105314546776Journal of Health PsychologyHe et al.
Article
Effect of perceived social support and dispositional optimism on the depression of burn patients
Journal of Health Psychology 1–7 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105314546776 hpq.sagepub.com
Fei He1, Qin Zhou1, Zhijing Zhao2, Yuan Zhang1 and Hao Guan2
Abstract Burn wounds have a significant impact on the mental health of patients. This study aimed to investigate the impact of perceived social support and dispositional optimism on depression of burn patients. A total of 246 burn patients accomplished the Multidimensional Scale of Perceived Social Support, the Revised Life Orientation Test, and Depression Scale. The results revealed that both perceived social support and optimism were significantly correlated with depression. Structural equation modeling indicated that optimism partially mediated the relationship between perceived social support and depression. Implications for prevention of depression in burn patients were discussed.
Keywords burn patients, depression, dispositional optimism, mediating effect, perceived social support
Introduction The gradual transformation of the biomedical model into the biopsychosocial model has increasingly attracted academic attention, particularly with regard to the mental health of patients (He et al., 2013; Wright et al., 2010; Zhang and Jin, 2014). Burns are among the most common traumas that, in a serious event, can significantly affect the mental health of patients (Gould et al., 2011). Statistical data show that 10–44 percent of burn patients have experienced various forms of psychological symptoms or disorders during the early period of their injuries and that 30–40 percent of these patients have demonstrated significant, lasting psychological disorders. The incidence rate of post-traumatic stress disorder (PTSD) among adult burn patients ranges between 7 and
45 percent (Bakker et al., 2013; Patterson et al., 1990). However, burns may exert varying degrees of influence on individuals with different personality traits. Holeva et al. investigated 256 burn patients and found that these patients demonstrated neuroticism and a low tendency to develop a higher anxiety. Moreover, the anxiety of the burn patients was highly correlated with the occurrence of PTSD (Holeva and Tarrier, 1Northwest 2Xijing
University, China Hospital, China
Corresponding author: Hao Guan, Department of Burns and Cutaneous Surgery, Xijing Hospital, Changle West Road, No. 169, Xi’an, 710032, China. Email: [email protected]
Downloaded from hpq.sagepub.com at Bobst Library, New York University on May 20, 2015
2
Journal of Health Psychology
2001). In other words, individual factors have a significant role in influencing the post-traumatic mental health of patients. Depression is among the most common psychological problems of burn patients (Van Loey and Van Son, 2003; Wiechman et al., 2001). A study on the etiology of depression shows that perceived social support plays a key role on the incidence of depression. Favorable perceived social support not only protects the individuals from stress but also allows for a favorable emotional experience for individuals (Bennett and Shepherd, 2013; Kettmann and Altmaier, 2008; Maeda et al., 2013). Dispositional optimism was proposed by Carver and Scheier, who defined optimism as a stable psychological quality and a positive personality trait. Dispositional optimism indicates that individuals have a positive expectation toward their future development and hope to achieve many favorable results (Bozo et al., 2009; Carver and Scheier, 2014). Studies on dispositional optimism have increased over the past three decades, and several related studies that are performed on different groups have found that dispositional optimism is related with other psychological factors (Carver and Scheier, 2014). The cognitive theory of depression by Beck (1964) argued that people with a “depression schema” tend to suffer from depression. This schema comprises a series of dysfunctional attitudes, integrates the past experience of an individual with his or her knowledge of himself or herself, and pertains to the relative stable cognitive characteristics of an individual when he or she is placed in a specific context. The contextrelated cognition icon is then activated by this schema, thereby affecting how an individual perceives, codes, and acquires information from the situation to produce a series of cognitive distorted thinking. For example, “I have to do well in all the things, otherwise I am a loser” or “I am an unlovable person if someone does not agree with me”; the activation of the depression will make individuals evaluate themselves negatively (i.e. negative self-perception), therefore developing negative perceptions toward
society and the future (Braet et al., 2013; Brewin et al., 1996; Carter et al., 2013). We hypothesized that, as protective factors of individuals under stress, perceived social support affects the depression of burn patients by influencing their cognitive schemata. In addition, we hypothesized that, as an important part of self-awareness, optimism has an intermediary role between perceived social support and depression.
Method Participants and procedure Participants were 246 burn patients (153 men and 93 women) from two general hospitals in Xi’an city and all received high school degree or above. All burns were due to scalds, and second-degree burnt area covered 30–40 percent. Patients with head and face burns were excluded. The ages of burn patients ranged from 20 to 30 years (97 were single and 149 were married), with a mean of 25.77 years (standard deviation (SD) = 2.14 years). All the patients in accordance with the inclusive criteria agreed to participate in this research. Questionnaires were distributed at the second time when patients came to the hospital, and participants completed the questionnaires in a separate room. Participants were told that they were engaging in a psychological investigation in which there were no correct or incorrect answers. Data collection lasted 4 months, from November 2013 to February 2014. All participants provided informed consent before completing the measures (guardians on the behalf of the minors signed the informed consent) and received ¥50 in compensation. The research described in this article meets the ethical guidelines of Xijing Hospital and has been approved by the ethics committee of the Fourth Military Medical University.
Instruments Multidimensional Scale of Perceived Social Support. The Multidimensional Scale of Perceived
Downloaded from hpq.sagepub.com at Bobst Library, New York University on May 20, 2015
3
He et al. Social Support (MSPSS) is a brief measure of perceived social support designed to measure the respondent’s perception of the adequacy of the support he or she receives (Stewart et al., 2014). The MSPSS is a 12-item scale with seven possible responses to each statement (scored 0–6) giving a score out of a maximum of 72 with higher score indicating greater perceived social support. Three subscale scores for the PSSS can be computed, that is family support, friends support, and significant other support. A Chinese vision of MSPSS with satisfactory content validity and reliability (Chou, 2000) was adopted. In this study, Cronbach’s alpha coefficient for the MSPSS was 0.824, suggesting good internal consistency. Dispositional optimism (Revised Life Orientation Test). Revised Life Orientation Test (LOT-R), developed by Scheier, Carver, and Bridges, is a 6-item measure (plus 4 filler items) of individual differences in dispositional optimism and pessimism. Items are rated from 1 (strongly disagree) to 5 (strongly agree) (Scheier et al., 1994). Examples of items include “In uncertain times, I usually expect the best” and “If something can go wrong for me, it will.” Scale scores are the sum of items with reverse coding of relevant items. Higher scores reflect a greater tendency to expect more positive outcomes. A Chinese version tested on a mainland Chinese population demonstrated good reliability and validity (e.g. He et al., 2013; Zhao et al., 2014). In this study, Cronbach’s alpha coefficient for the LOT-R was 0.737, suggesting good internal consistency. Self-rating Depression Scale. Self-rating Depression Scale (SDS), developed by Zung, is a selfreport measure of depression consisting of 20 items, with a 4-point scale ranging from a little of the time (1) to most of the time (4). Of the 20 items, 10 are worded positively and 10 are worded negatively. The former 10 items are reversed items. The validity and the reliability of the SDS have been reported (Zung, 1986). A Chinese version of Zung’s SDS has demonstrated adequate content validity and satisfactory
Table 1. Inter-correlations among three latent variables. Mean SD
1
2
3
1. Perceived 68.85 10.05 1 social support 2. Optimism 19.76 7.33 0.39 1 3. Depression 70.88 5.41 −0.61 −0.43 1 SD: standard deviation. N = 246; all correlation coefficients are significant at p
HPQ0010.1177/1359105314546776Journal of Health PsychologyHe et al.
Article
Effect of perceived social support and dispositional optimism on the depression of burn patients
Journal of Health Psychology 1–7 © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1359105314546776 hpq.sagepub.com
Fei He1, Qin Zhou1, Zhijing Zhao2, Yuan Zhang1 and Hao Guan2
Abstract Burn wounds have a significant impact on the mental health of patients. This study aimed to investigate the impact of perceived social support and dispositional optimism on depression of burn patients. A total of 246 burn patients accomplished the Multidimensional Scale of Perceived Social Support, the Revised Life Orientation Test, and Depression Scale. The results revealed that both perceived social support and optimism were significantly correlated with depression. Structural equation modeling indicated that optimism partially mediated the relationship between perceived social support and depression. Implications for prevention of depression in burn patients were discussed.
Keywords burn patients, depression, dispositional optimism, mediating effect, perceived social support
Introduction The gradual transformation of the biomedical model into the biopsychosocial model has increasingly attracted academic attention, particularly with regard to the mental health of patients (He et al., 2013; Wright et al., 2010; Zhang and Jin, 2014). Burns are among the most common traumas that, in a serious event, can significantly affect the mental health of patients (Gould et al., 2011). Statistical data show that 10–44 percent of burn patients have experienced various forms of psychological symptoms or disorders during the early period of their injuries and that 30–40 percent of these patients have demonstrated significant, lasting psychological disorders. The incidence rate of post-traumatic stress disorder (PTSD) among adult burn patients ranges between 7 and
45 percent (Bakker et al., 2013; Patterson et al., 1990). However, burns may exert varying degrees of influence on individuals with different personality traits. Holeva et al. investigated 256 burn patients and found that these patients demonstrated neuroticism and a low tendency to develop a higher anxiety. Moreover, the anxiety of the burn patients was highly correlated with the occurrence of PTSD (Holeva and Tarrier, 1Northwest 2Xijing
University, China Hospital, China
Corresponding author: Hao Guan, Department of Burns and Cutaneous Surgery, Xijing Hospital, Changle West Road, No. 169, Xi’an, 710032, China. Email: [email protected]
Downloaded from hpq.sagepub.com at Bobst Library, New York University on May 20, 2015
2
Journal of Health Psychology
2001). In other words, individual factors have a significant role in influencing the post-traumatic mental health of patients. Depression is among the most common psychological problems of burn patients (Van Loey and Van Son, 2003; Wiechman et al., 2001). A study on the etiology of depression shows that perceived social support plays a key role on the incidence of depression. Favorable perceived social support not only protects the individuals from stress but also allows for a favorable emotional experience for individuals (Bennett and Shepherd, 2013; Kettmann and Altmaier, 2008; Maeda et al., 2013). Dispositional optimism was proposed by Carver and Scheier, who defined optimism as a stable psychological quality and a positive personality trait. Dispositional optimism indicates that individuals have a positive expectation toward their future development and hope to achieve many favorable results (Bozo et al., 2009; Carver and Scheier, 2014). Studies on dispositional optimism have increased over the past three decades, and several related studies that are performed on different groups have found that dispositional optimism is related with other psychological factors (Carver and Scheier, 2014). The cognitive theory of depression by Beck (1964) argued that people with a “depression schema” tend to suffer from depression. This schema comprises a series of dysfunctional attitudes, integrates the past experience of an individual with his or her knowledge of himself or herself, and pertains to the relative stable cognitive characteristics of an individual when he or she is placed in a specific context. The contextrelated cognition icon is then activated by this schema, thereby affecting how an individual perceives, codes, and acquires information from the situation to produce a series of cognitive distorted thinking. For example, “I have to do well in all the things, otherwise I am a loser” or “I am an unlovable person if someone does not agree with me”; the activation of the depression will make individuals evaluate themselves negatively (i.e. negative self-perception), therefore developing negative perceptions toward
society and the future (Braet et al., 2013; Brewin et al., 1996; Carter et al., 2013). We hypothesized that, as protective factors of individuals under stress, perceived social support affects the depression of burn patients by influencing their cognitive schemata. In addition, we hypothesized that, as an important part of self-awareness, optimism has an intermediary role between perceived social support and depression.
Method Participants and procedure Participants were 246 burn patients (153 men and 93 women) from two general hospitals in Xi’an city and all received high school degree or above. All burns were due to scalds, and second-degree burnt area covered 30–40 percent. Patients with head and face burns were excluded. The ages of burn patients ranged from 20 to 30 years (97 were single and 149 were married), with a mean of 25.77 years (standard deviation (SD) = 2.14 years). All the patients in accordance with the inclusive criteria agreed to participate in this research. Questionnaires were distributed at the second time when patients came to the hospital, and participants completed the questionnaires in a separate room. Participants were told that they were engaging in a psychological investigation in which there were no correct or incorrect answers. Data collection lasted 4 months, from November 2013 to February 2014. All participants provided informed consent before completing the measures (guardians on the behalf of the minors signed the informed consent) and received ¥50 in compensation. The research described in this article meets the ethical guidelines of Xijing Hospital and has been approved by the ethics committee of the Fourth Military Medical University.
Instruments Multidimensional Scale of Perceived Social Support. The Multidimensional Scale of Perceived
Downloaded from hpq.sagepub.com at Bobst Library, New York University on May 20, 2015
3
He et al. Social Support (MSPSS) is a brief measure of perceived social support designed to measure the respondent’s perception of the adequacy of the support he or she receives (Stewart et al., 2014). The MSPSS is a 12-item scale with seven possible responses to each statement (scored 0–6) giving a score out of a maximum of 72 with higher score indicating greater perceived social support. Three subscale scores for the PSSS can be computed, that is family support, friends support, and significant other support. A Chinese vision of MSPSS with satisfactory content validity and reliability (Chou, 2000) was adopted. In this study, Cronbach’s alpha coefficient for the MSPSS was 0.824, suggesting good internal consistency. Dispositional optimism (Revised Life Orientation Test). Revised Life Orientation Test (LOT-R), developed by Scheier, Carver, and Bridges, is a 6-item measure (plus 4 filler items) of individual differences in dispositional optimism and pessimism. Items are rated from 1 (strongly disagree) to 5 (strongly agree) (Scheier et al., 1994). Examples of items include “In uncertain times, I usually expect the best” and “If something can go wrong for me, it will.” Scale scores are the sum of items with reverse coding of relevant items. Higher scores reflect a greater tendency to expect more positive outcomes. A Chinese version tested on a mainland Chinese population demonstrated good reliability and validity (e.g. He et al., 2013; Zhao et al., 2014). In this study, Cronbach’s alpha coefficient for the LOT-R was 0.737, suggesting good internal consistency. Self-rating Depression Scale. Self-rating Depression Scale (SDS), developed by Zung, is a selfreport measure of depression consisting of 20 items, with a 4-point scale ranging from a little of the time (1) to most of the time (4). Of the 20 items, 10 are worded positively and 10 are worded negatively. The former 10 items are reversed items. The validity and the reliability of the SDS have been reported (Zung, 1986). A Chinese version of Zung’s SDS has demonstrated adequate content validity and satisfactory
Table 1. Inter-correlations among three latent variables. Mean SD
1
2
3
1. Perceived 68.85 10.05 1 social support 2. Optimism 19.76 7.33 0.39 1 3. Depression 70.88 5.41 −0.61 −0.43 1 SD: standard deviation. N = 246; all correlation coefficients are significant at p
