Social Support and Social Networks in COPD: A Scoping Review

Figures & data

Figure 1. Flow chart depicting selection of papers for inclusion in the review and reasons why papers were excluded.

Table 1. Impact of social support on mental health

Author/Date	Sample/Setting	Study Type and Intervention if Applicable	Social Support Measure	Outcome and Outcome Measure	Main Finding for Social Support (Include n analysed if different from n in sample)	Social support of benefit
Toshima et al. (17) 1992	N=119 patients with COPD from a PR program at University of California, San Diego, USA.	RCT – comprehensive PR program vs educational control	Short version of The Social Support Questionnaire	Depression assessed using the Center for Epidemiological Studies Depression scale (CES-D)	At baseline, depression score was significantly correlated with social support quantity and social support satisfaction.	+
Keele-Card et al. (18) 1993	N=30 clients with COPD and their spouses recruited from a private pulmonary clinic in a small midwestern city, USA.	Cross-sectional	The Social Support questionnaire	Loneliness assessed by UCLA loneliness scale and Depression symptoms assessed by CES-D	For patients with COPD, social support satisfaction correlated negatively with loneliness and depression, but no correlation found for spouses.	+
^Grodner et al. (19) 1996	N=110 patients with COPD who participated in an RCT of PR in San Diego, USA.	RCT of 8-week intervention involving either comprehensive PR or education control with follow up at 2, 6 and 12 months, then 6 years.	Short form of The Social Support Questionnaire including number of persons (SSQ-N) AND satisfaction with support (SSQ-S)	Depression symptoms assessed by CES-D	Negative correlation for depression symptoms and satisfaction with social support.	+
^McCathie et al. (20) 2002	N=92 males including both discharged in-patients and outpatients, Sydney Australia.	Cross-sectional	Illness specific (rheumatoid arthritis) social support scale	Depression assessed using BDI and anxiety symptoms assessed by State Trait Anxiety Inventory.	Higher levels of positive social support were linked to lower levels of depression and anxiety.	+
Kara et al. (21) 2004	N=30 patients with COPD and their spouses recruited from an outpatient clinic of a university hospital in eastern Turkey	Cross-Sectional	Perceived Social Support from Friends and Family Scale	Loneliness assessed by UCLA loneliness scale and Depression assessed by Beck Depression Inventory (BDI)	A negative relationship found between loneliness and social support for both patients and their spouse.
Similarly, negative association found between depression and social support for both patients and spouses	+
Alexopoulos et al. (22) 2006	N=63 consecutively admitted PR patients with COPD and major depression, New York, USA	Before and after study to assess the effectiveness of a comprehensive intervention incorporating tailored treatment regimen and PR.	Duke Social Support Index	Depression symptoms assessed by the Hamilton Depression Rating Scale (HAM-D)	Social support and satisfaction with treatment were predictors of improvement in depression following PR	+
Koenig (23) 2006	N=711 consecutively hospitalised Chronic Pulmonary Disease Patients at Duke University medical centre, North Carolina, USA.	Prospective. Patients with minor depression assessed at 6 and 12 weeks. Those with major depression at 6, 12, 18 and 24 weeks.	Duke Social Support Index	Course of depression assessed using Longitudinal Interval Follow-up Evaluation (LIFE-II).	Patients with minor depression remitted more quickly during 12 weeks of follow up with greater social support, but no difference for those with major depression.	+
Coultas et al. (24) 2007	N=207 COPD patients from 17 primary care clinics part of an urban academic health centre, Jacksonville, Florida, USA.	Cross-sectional analysis as part of a RCT of nurse assisted home care for patients COPD.	Medical Outcome Study (MOS) Social Support questionnaire	Depression symptoms assessed using the CES-D	Social support inversely related to the level of depressive symptoms	+
Holm et al. (27) 2010	N=542 COPD living in the community who had been assessed or treated for COPD at one of 2 medical centres in Denver Colorado, USA	Cross-sectional	General Family Functioning sub-scale of the Family Assessment Device	Psychological distress assessed by summing depression and anxiety domains of the Hospital Anxiety and Depression Scale (HADS)	Unsupportive family relationships were associated with psychological distress. Unsupportive family relationships were indirectly associated with smoking status via psychological distress	+
Medinas-Amoros et al. (28) 2012	N=80 consecutively hospitalised COPD patients, assessed after 10 days of hospitalisation, Majorca, Spain.	Cross-sectional	MOS Social Support Survey	Hospital Stress rating scale	Linear regression analysis showed the predictive value of social support on stress level during hospitalisation.	+
DiNicola et al. (26) 2013	N=452 individuals from a population based cohort of US adults living with obstructive airways disease.	Cross-sectional	Positive and Negative Social Exchanges scale	Anxiety Symptoms assessed using the HADS.	Multiple regression analysis revealed that the receipt of instrumental support, feeling let down by others and unsympathetic support predicted higher patient anxiety.	+
Lee et al. (25) 2013	N=209 patients with COPD recruited from 3 university hospitals and 2 clinics in the southern area of South Korea	Cross-sectional	Personal Resource Questionnaire (PRQ)	Depression and Anxiety assessed using the Korean version of the HADS.	Patients with more perceived social support experienced fewer depressive symptoms through the use of problem-oriented coping strategies.	+

+ indicates social support of statistically significant benefit; 0 indicates social support of no statistically significant benefit.

PR = Pulmonary Rehabilitation.

^ Paper reports results for multiple outcomes.

Table 2. Impact of social support on self-efficacy and adherence

Author/Date	Sample/Setting	Study Type and Intervention if Applicable	Social Support Measure	Outcome and Outcome Measure	Main Finding for Social Support (Include n Analysed if Different From n in Sample)	Social Support of Benefit
^Grodner et al. (19) 1996	N=110 patients with COPD who participated in an RCT of PR in San Diego, USA.	RCT of 8 week intervention of either comprehensive PR or education control with follow up at 2, 6 and 12 months, then 6 years.	The Social Support Questionnaire including number of persons (SSQ-N) AND satisfaction with support (SSQ-S)	Self-Efficacy assessed from instrument adapted from Kaplan et al. (1984) using walking sub-scale	Positive correlation at baseline for satisfaction with social support and self-efficacy for walking	+
Young et al. (33) 1999	N=88 outpatients enrolled in a 4 week PR program, Auckland, New Zealand.	Cross sectional	Modified O'Reilly and Thomas (1989) General and Social Support Questions specific to risk reduction efforts	Adherence to PR program	52 participants completed the program and 36 did not. Those who did not complete the program were more likely to lack social support for COPD related problems.	+
Xiaolian et al. (32) 2002	N=120 COPD outpatients in Chengdu, China	Cross sectional	Modified Perceived Social Support from ‘Family Scale’	Self-care behaviour scale for COPD patients	91% of patients reported high levels of family support. A slightly statistically significant positive relationship between family support and total self-care behaviour score was found.	+
^Hesselink et al. (39) 2004	N=53 patients with COPD and N=220 with asthma from primary care in the Netherlands.	Cross-Sectional	Social Support List - Interactions	Self-Efficacy, mastery and self-esteem assessed by the Self-Efficacy Scale, 5-item Pearlin Mastery Scale, and the question “on the whole, I'm satisfied with myself?”	Social support was not correlated with self-efficacy, mastery or esteem for COPD patients.	0
Kara-Kasikci and Alberto (30) 2007	N=200 outpatients with COPD in eastern Turkey	Cross-Sectional	Perceived Social Support from ‘Family scale’	Self-efficacy and self-care behaviour score from the COPD Self-Efficacy Scale	Significant positive relationship between family support and self-care behaviour, and family support and self-efficacy.	+
Bonsaksen et al. (31) 2012	N=86 (39.1%) COPD and N=134 (60.9%) morbid obesity attending a patient education course, Oslo, Norway.	Baseline data (cross-sectional) from a longitudinal study	Single question “I think I have enough support from people with whom I have a close relationship?”	Self-efficacy assessed using the General Perceived Self-Efficacy Scale.	COPD participants had higher levels of social support than obese participants. In the COPD group, higher social support predicted higher self-efficacy after controlling for physical activity and other illness perception variables.	+
Lee et al. (29) 2013	N=249 outpatients with COPD from 5 hospitals in South Korea	Cross sectional	Personal Resource Questionnaire 2000	Self-efficacy assessed using COPD Self-Efficacy Scale	In uni-variate analyses, social support was significantly different between patients with high vs low self-efficacy, but was not a significant predictor in a binary logistic regression model.	0

+ indicates social support of statistically significant benefit; 0 indicates social support of no statistically significant benefit.

PR = Pulmonary Rehabilitation.

^ Paper reports results for multiple outcomes.

Table 3. Impact of social support on functional status, quality of life and self-rated health

Author/Date	Sample/Setting	Study Type and Intervention if Applicable	Social Support Measure	Outcome and Outcome Measure	Main Finding for Social Support (include n analysed if different from n in sample)	Social Support of Benefit
Blake et al. (40) 1990	N=32 intervention and N=36 control subjects assessed at 12 month follow up recruited from 2 outpatient speciality clinics, Missouri, USA.	RCT of a psychosocial intervention that emphasized the role of social supports and the use of stress reduction techniques. Results from 12 month follow up reported here.	McKay 13-item social support index.	Functional status measured using the Sickness Impact Profile (SIP)	The experimental group had better physical function and overall function, but there were no significant differences between groups for social support after controlling for baseline scores.	0
Lee et al. (41) 1991	N=30 COPD patients with FEV1 less than 40% pred. and on oxygen therapy from pt. list of 2 metropolitan hospitals, Toronto, Canada.	Cross-sectional	Personal Resource Questionnaire (PRQ)	Functional status measured using the Sickness Impact Profile (SIP)	PRQ score (social support) was moderately negatively correlated with functioning (SIP score) although was not a significant predictor in multiple regression analysis.	0
Anderson (42) 1995	N=126 COPD patients from a private pulmonary specialty practice in the Pacific North west region of the U.S.A.	Cross-sectional	Personal Resource questionnaire (PRQ)	QoL measured by the 16 item Quality of Life Scale (QOLS).	Social support had a direct positive effect on life quality and was moderately positively correlated with QOLS score.	+
Graydon et al. (43) 1995	N=143 entered the study but only N=71 participants completed the study. Community sample with COPD living in or adjacent to metropolitan Toronto, Canada.	Prospective. Six visits to participants homes at six month intervals.	Personal Resource Questionnaire (PRQ)	Functional status assessed by Sickness Impact Profile (SIP)	PRQ score (social support) was (weakly) negatively correlated with functioning (SIP score) although was not a significant predictor in multiple regression analysis.	0
^Grodner (19) 1996	N=110 patients with COPD who participated in an RCT of PR in San Diego, USA.	RCT of 8 week intervention of either comprehensive PR or education control with follow up at 2, 6 and 12 months, then 6 years.	Short form of The Social Support Questionnaire including number of persons (SSQ-N) AND satisfaction with support (SSQ-S)	QoL assessed using the Quality of Well Being (QWB) Scale	Higher satisfaction with support at baseline was not related to QWB scale score.	0
Scharloo et al. (44) 1998	N=244 consecutive adult patients, (80 COPD; 80 rheumatoid arthritis; 80 psoriasis) recruited from Leiden University Medical Centre hospital outpatient clinics, Netherlands.	Cross sectional	Utreschtse Coping List – seeking social support sub-scale	Functional status assessed by the Daily Activities of Life scale and generic function using the Dutch version of the Medical Outcome Study Short Form General Health Survey	Coping strategy characterised by seeking social support explained small but significant amounts of variance for patients with psoriasis, but not COPD.	0
^McCathie et al. (20) 2002	N=92 males including both discharged in-patients and outpatients, Sydney Australia.	Cross-sectional	Illness specific (rheumatoid arthritis) social support scale	QoL assessed using St George's Respiratory Questionnaire (SCRG)	Higher levels of positive social support were not associated with quality of life.	0
^Hesselink et al. (39) 2004	N=53 patients with COPD and N=220 with asthma from primary care in the Netherlands.	Cross-Sectional	Social Support List - Interactions	QoL assessed using the QoL in Respiratory Illness Questionnaire.	Social support was not associated with QoL for COPD or asthma patients	0
Trappenburg et al. (45) 2005	N=81 consecutive patients enrolled in an outpatient PR program at a University hospital, Leuven, Belgium	Before and after study involving a 12 week PR program administered as a multidisciplinary outpatient program.	The Social Support List	Outcomes of PR including exercise capacity, QOL, functional status assessed using the Chronic Respiratory Disease questionnaire and Modified Pulmonary Functional Status and Dyspnoea Questionnaire	At baseline, score for positive social interaction indicated an average level of social support. All outcomes improved following PR but no relationship between baseline social support scores and PR outcomes including 6 minute walk test, QoL, or functional status.	0
						(Continued)

Table 3. (Continued)

Author/Date	Sample/Setting	Study Type and Intervention if Applicable	Social Support Measure	Outcome and Outcome Measure	Main Finding for Social Support (include n analysed if different from n in sample)	Social Support of Benefit
Marino et al. (35) 2008	N=156 depressed COPD patients following hospital admission to the Burke Rehabilitation Hospital, New York, USA.	Cross-Sectional	Duke Social Support Inventory	Overall functioning assessed using the WHO Disability Assessment Schedule II	Instrumental support, and subjective social support predicted overall functioning in bivariate analysis, but social interaction frequency was not related to overall functioning. In multivariate analyses, only greater subjective social support was independently associated with better functioning	+
Arne et al. (34) 2011	N=1,475 Community sample with COPD selected from stratified random sample in five counties in central Sweden.	Repeated Cross-sectional	Single question “Do you have any persons in your vicinity who can provide you with personal support in case of personal problems or life crises?”	Self-rated health assessed from the question “how do you rate your general health status? and QoL assessed using the EuroQoL	Social support and absence of economic problems almost doubled the odds for better self-rated health and QoL	+
Mertens et al. (46) 2011	N=361 community dwelling Dutch men and women, (176 COPD; 185 TII Diabetes) with symptoms of depression.	Cross-Sectional	Social Support List of Interactions (SSL-I-12).	QoL - Physical, Mental and Social function domains of the SF36	Amongst the group with COPD, no associations were found between social support and physical, mental or social function.	0
Bonsaksen et al. (47) 2014	N=60 participants in a patient education course with moderate to severe COPD, at 6 different sites in Norway.	Prospective	Single question “I think I have enough support from people with whom I have a close relationship”	QoL measured using the SF12	Higher social support was related to higher Mental Component Summary (MCS) score at baseline controlling for other factors, but not physical component summary score (PCS). At follow up, social support was not directly related to MCS or PCS when the other factors were controlled for.	0

+ indicates social support of statistically significant benefit; 0 indicates social support of no statistically significant benefit.

PR = Pulmonary Rehabilitation.

QoL = Quality of Life.

WHO = World Health Organisation.

^ Paper reports results for multiple outcomes.

Table 4. Impact of social support on hospital re-admission and mortality

Author/Date	Sample/Setting	Study Type and Intervention if Applicable	Social Support Measure	Outcome and Outcome Measure	Main Finding for Social Support (include n analysed if different from n in sample)	Social Support of Benefit
Almagro et al. (48) 2006	N=129 consecutive hospitalised COPD patients in Barcelona, Spain	Prospective	Social Resources Scale	Hospital readmission in 12 months	Social variables not significantly related to readmission	0
Chen and Narsavage (49) 2006	N=145 consecutive patients with COPD scheduled for hospital discharge in 6 regional hospitals in Pingtung area, Taiwan.	Prospective	Personal Resource Questionnaire	Hospital readmission at 14 days and 90 days	Perceived family support was not related to readmission.	0
Coventry et al. (37) 2011	N=79 COPD patients cared for by nurse led early discharge service in Manchester, UK.	Prospective	ENRICHD Social Support Inventory	Hospital readmission in 12 months	Perceived social support not associated with readmission.	0
^Grodner et al. (19) 1996	N=110 patients with COPD who participated in an RCT of PR in San Diego, USA.	RCT of 8 week intervention of either comprehensive PR or education control with follow up at 2, 6 and 12 months, then 6 years.	Short form of The Social Support Questionnaire including number of persons (SSQ-N) AND satisfaction with support (SSQ-S)	Mortality	Higher satisfaction with social support at baseline related to improved survival at 6 years for females, but not males.	+

+ indicates social support of statistically significant benefit; 0 indicates social support of no statistically significant benefit.

^ Paper reports results for multiple outcomes.

Table 5. Social networks and COPD

Author/Date	Sample/Setting	Study Type	Network Measure	Outcomes	Main Finding for Social Network	Larger Social Network of Benefit
Keele-Card and Barron (36) 1993	N=30 clients with COPD and their spouses recruited from a private pulmonary clinic in a small midwestern city, USA.	Cross-sectional	6-item, The Social Support questionnaire	Network size for COPD clients and their spouse, Loneliness and Depression	Number of people reported as sources of social support was similar for patients and spouses (n=2.38 and 2.07 respectively, p=NS). COPD patients relied more on spouse for support, cw. spouse who relied more on non-family.	0
					Number of people in network was not correlated with loneliness or depression.
Grodner et al. (19) 1996	N=110 patients with COPD who participated in an RCT of PR in San Diego, USA.	RCT of 8 week intervention of either comprehensive PR or education control with follow up at 2, 6 and 12 months, then 6 years.	Short form of The Social Support Questionnaire including number of persons (SSQ-N) AND satisfaction with support (SSQ-S)	Self-Efficacy, Well-Being, Depression, Mortality	Positive relationships at baseline between number of persons in network and self-efficacy for walking, disease severity, exercise tolerance and self-reported shortness of breath. Negative correlation found between number of persons and depression symptoms.	+
					After PR, number of persons in network was associated with improved breathlessness at 2, 6 and 12 months.
Marino et al. (35) 2008	N=156 depressed COPD patients following hospital admission to the Burke Rehabilitation Hospital, New York, USA.	Cross-Sectional	Duke Social Support Inventory	Overall functioning assessed by the WHO Disability Assessment Schedule II	Participants had a mean social network size of 4.7 (SD=4.2).	0
					Social network size was associated with overall functioning in bivariate analysis, but just failed to reach statistical significance in multivariate analyses.

PR = pulmonary rehabilitation.

+ Indicates larger social network of statistically significant benefit; 0 indicates larger social network of no statistically significant benefit.

Table 6. Instruments used to assess social support and social networks

Instrument Name (abbreviation) and Original Reference	What is Assessed	Length	Used by
McKay 13-item index [McKay et al. (50)]	Six dimensions of support (personal networks, community networks, intimacy, satisfaction-loneliness, appreciation-understanding, tangible assistance.)	13 items	Blake et al. (1990) (40)
The Social Support Questionnaire (SSQ-N and SSQ-S) [Sarason et al. (51)]	Number of persons in network providing social support (SSQ-N) and Satisfaction with support (SSQ-S)	6 (2 part) items	Toshima et al. (1992) (17); Keele-Card and Barron 1993 (18); Grodner et al. 1996 (19)
Illness specific (rheumatoid arthritis) social support scale (ISSS) [Revenson and Schiaffino (52)]	The scale rates how often the social network responds in different ways when individuals are not feeling well due to illness.	37 items	^McCathie et al. (20) 2002
Perceived Social Support from Friends and Family Scale [Procidano and Heller (53)]	Provides a score for perceived support from family and from friends	40 items	Xiaolian et al. (32) 2002; Kara and Mirici 2004 (21); Kara-Kasikci and Alberto (30) 2007
Duke Social Support Index (DSSI) [abbreviated versions Koening et al. (55)]	DSSI measures multiple dimensions of social support including network size, social interaction frequency, instrumental support and subjective support.	11 items	Alexopoulos et al. 2006 (22); Koenig 2006 (23); Marino et al. 2008 (35)
Medical Outcome Study (MOS) Social Support questionnaire [Sherbourne and Stewart (16)]	Assesses perceptions of availability of different functional aspects of social support	19 items	Coultas et al. 2007 (24); Medinas-Amoros et al. 2012 (28)
General family functioning subscale of the Family Assessment Device (FAD) [Byles et al. (57)]	Provides a global assessment of general family functioning	12 items	Holm et al. (27) 2010
Positive and Negative Social Exchanges scale (PANSE) [Newsom et al. (58)]	Developed for use with older adults and addresses several aspects of both positive and negative domains of social exchanges.		DiNicola et al. (26) 2013
Personal Resource Questionnaire (PRQ) [Brandt and Weinert (60)]	Assesses the extent to which the individual feels valued, is an integral part of a group, provides attachment/intimacy and has available informational, emotional and material help.	25 items	Lee et al. (41) 1991; Anderson (42) 1995; Graydon et al. (43) 1995; Chen and Narsavage 2006 (49); Lee et al. (29) 2013
Utrechtse Coping List – seeking social support sub-scale [Schreurs et al. (61)]	Subscale that asks about seeking social support	5 items	Scharloo et al. (44) 1998
Social Support List – Interactions (SSL12-I) [Kempen and van Eijk (62)]	Measures received social support in terms of emotional, informative and instrumental support.	12 items	Hesselink et al. 2004 (39); Trappenburg et al. 2005 (45); Mertens et al. 2011 (46)
Social Resources Scale of the Older Americans Resources and Services (OARS) Program	The Duke OARS (Older Americans Resources and Services) Program, was developed as a means of determining the impact of services and alternative service programs on the functional status of older persons. The first section of this structured interview seeks information on five dimensions of functioning including Social Resources	15 items	Almagro et al. (48) 2006
ENRICHD Social Support Inventory [Berkman et al. (63)]	Initially developed for use with coronary heart disease patients. Measures level of perceived emotional support, instrumental support and informational support.	7 items	Coventry et al. (37) 2011
Single question “Do you have any persons in your vicinity who can provide you with personal support in case of personal problems or life crises?”	Perceived availability of social support	1 question	Arne et al. (34) 2011
Single question “I think I have enough support from people with whom I have a close relationship?”	Satisfaction with social support	1 question	Bonsaksen et al. (31) 2012; Bonsaksen et al. (47) 2014

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