Social comparisons and chronic illness: research synthesis and clinical implications

Abstract

The chronically ill patient must adjust to new life circumstances and manage ongoing threats to personal health. Patients often make comparisons with each other, which can have effects on their psychological and physical well-being. One question is whether health psychologists can develop interventions to strategically facilitate the use of such comparisons to optimise adjustment. This paper critically reviews evidence on patients' comparisons in studies using selection, narration and reaction methods. Discussion focuses on gaps in the empirical literature and describes some new basic concepts in social comparison, which may advance knowledge about the process in medical patients. Recommendations also are provided about the kinds of studies needed to inform the future design of effective social comparison interventions.

Keywords:

• social comparison
• chronic illness
• physical health status
• affect
• self-perception
• motivation

Notes

1. Although no peer-reviewed, published review has addressed these issues, a book chapter by Tennen, McKee, and Affleck (2000) covered related literature. This previous review had a broader scope, incorporating both studies on medical conditions that are not chronic (e.g., traumatic injury) and health risk perceptions among physically healthy individuals. Only a limited number of studies of chronic illness samples (N = 14) were included, and the review did not focus on implications for psychosocial interventions. Thus, the present review is more focused on chronic illness patients, and is more up-to-date in its coverage (N = 37).

2. An additional criterion required that specific illnesses and proportion of sample with each illness were identifiable; two studies were excluded because this information was not reported (Dewar, 2003; Leach & Shoenberg, 2008).

3. Helgeson and Taylor (1993) and Bennenbroek et al. (2002) found that when patients were explicitly asked about preferences for various comparison targets, lateral comparisons were most common. These studies are unique in their inclusion of lateral targets in a list of potential comparisons, as most studies offer only upward and downward options. The preponderance of lateral comparisons may have resulted from this methodological difference. Whether this finding would generalise to other samples is currently unclear.

4. Van der Zee, Buunk, and Sanderman (1996b) also differentiated by mode (and by dimension) in their assessment of comparison preferences. Detailed information on preferences was then reduced using factor analysis, and means of ratings for distinct preferences were not reported. As a result, only information about the direction of comparison preferences is interpretable.

5. Patients who rated health care providers as less accessible also rated comparison targets as more informative; inaccessibility of health care providers (i.e., absence of objective information) may contribute to uncertainty and, in turn, increase the perceived informativeness of comparisons, although this proposition was not tested.

6. Van der Zee et al. (1996b) presented a path model suggesting the following causal chain: increased physical and psychological distress ⇒ increased the need for comparison ⇒ increased frequency of downward comparisons ⇒ increased subjective well-being. Although this model had adequate statistical fit, it requires replication in both cancer and other illness samples. Several alternative models are also plausible.

7. We do not entirely agree with the claim that these results are consistent, ‘…with the idea that prototype images are a source of information for self-evaluation’ (Dijkstra et al., 2008, p. 126), because the self-evaluations were made prior to the invocation of a prototype. A different interpretation is that self-appraisals affected the evaluation of prototype images. The need to self-enhance may have prompted patients, who have already made self-assessments, to rate the prototypes as similar, but slightly worse-off than the self.

8. Mahler and Kulik (1998) also included an information-only condition, in which a cardiac nurse presented information about the surgery but no comparison patient was shown.

9. Kulik and colleagues present hospital roommates as comparison targets in the context of affiliation, but do not label targets according to direction (e.g., ‘lateral’ and ‘upward’). Targets are discussed according to direction in the present review in order to facilitate integration with the broader literature, which typically differentiates targets by direction (or dimension, etc.).