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Table 3 Findings grouped by outcome

From: A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death

Outcome Study Exploratory or specific hypothesis Analysis method Covariates included in models Sample size (n) Findings
Psychiatric outcomes
 PTSD Bottomley 2017 [31] Exploratory Regression model with social support as a predictor. T1 PTSD (at a mean of 1.66 years since loss) 47 Of 12 social support variables, need for advice, need for physical assistance and satisfaction with physical assistance were included in the model. Satisfaction with physical assistance was the only significant predictor, negatively predicting PTSD severity at T2 (6 month follow-up) (p<.03, b=-.18).
Burke 2010 [33] Exploratory Correlations n/a 54 Of 6 variables measured, percentage of actual negative relationships significantly correlated with PTSD severity (.28, p<.05).
Heeke 2017 [38] Specific hypothesis Latent class analysis Gender, years of education, number of assaultive/accidental traumatic events, relationship to person lost, how loss happened and time since loss. 308 Social support was the only factor associated with PTSD symptoms compared to the resilient class (OR= .95, p=.005).
Rheingold 2015 [47] Exploratory Generalised estimating equations Variables found to significantly differ by diagnostic status: employment status, deceased contributing to household income. 47 Lack of social support was independently associated with increased risk of meeting criteria for PTSD (beta =.19, Wald x2 = 4.64, p<.05).
Sprang 1998 [50] Exploratory Regression model with social support as a predictor. Gender, age, race, subjective health status, income, marital status, past experience with death, time since death and religious beliefs. 171 Greater social support was associated with lower rates of PTSD symptoms (beta=.415, p<.005; 43.2% of variance).
Xu 2017 [52] Exploratory Regression model with social support as a predictor. Ethnicity, residence location, gender, age, monthly income, education level, age of child and gender of child. 176 Low social support was a significant risk factor for meeting criteria for PTSD (OR= .244, beta=-1.41, p=.002, 95% CI).
 Depression Bottomley 2017 [31] Exploratory Regression model with social support as a predictor. T1 depression (at a mean of 1.66 years since loss) 47 Of twelve social support variables, need for advice, need for physical assistance and satisfaction with physical assistance were included in the model but none were significant predictors.
Burke 2010 [33] Exploratory Correlations n/a 54 Of six social support measures, two were significantly correlated with depression severity: grief support (-.27, p<.05) and percentage of anticipated negative relationships (.28, p<.05).
Cowan 1985 [27] Exploratory Regression model with social support as a predictor. Stress, age, gender, importance of deceased and perceived preventability of death. 69 Perceived social support was associated with greater depression severity (p<.05, b=-.14), accounting for 38% of variance in the model.
Fullerton 1999 [36] Exploratory Regression model with social support as a predictor. Age, marital status, social network index, disaster specific social support, family distress, maximum closeness to deceased crew, transience, hardiness, social desirability and initial impact of event (IES). 71 Support from friends and support from family were entered as separate predictors in each model.
In models controlling for total IES and IES intrusion scores, neither perceived social support variable was associated with depression severity.
Controlling for IES avoidance (10%), perceived social support from friends was negatively associated with depression severity (5% of variance; beta=-.03, p=.027).
Oexle 2019 [45] Specific hypothesis Regression model with social support as a predictor. Age, gender, pre-loss mental illness, time since loss, relationship to deceased and perceived closeness to deceased. 195 Greater perceived social support was significantly associated with a lower level of depressive symptoms (beta=-.53, p<.001).
Rheingold 2015 [47] Exploratory Generalised estimating equations with social support as a predictor. Variables found to significantly differ by diagnostic status: age, employment status, deceased contributing to household income. 47 Lack of social support was independently associated with increased risk of meeting criteria for MDD (beta =.40, Wald x2 = 14.37, p<.005).
Spino 2016 [48] Specific hypothesis Regression model with social support as a predictor. Physical health encumbrance. 44 Three social support variables were used as predictors.
In a linear regression model, higher network score was associated with a significant decrease depression severity (beta= -0.53, p=.011).
In a linear regression model, higher relationship score was associated with a significant decrease depression severity (beta= -0.18, p=.011).
In the multiple regression model, higher total support score (beta= -0.02, p=.001) was associated with a significant decrease in depression severity.
 Complicated grief Bottomley 2017 [31] Exploratory Regression model with social support as a predictor. T1 complicated grief (at a mean of 1.66 years since loss) 47 Of twelve social support variables, satisfaction with physical assistance was the only significant predictor out of the three social support variables included in the model, positively predicting complicated grief severity at T2 (6 month follow-up) (beta=.20, p<.05).
Burke 2010 [33] Exploratory Correlations n/a 54 Of six social support measures, two were significantly correlated with complicated grief severity: percentage of actual negative relationships (.28, p<.05) and available support system (-.28, p<.05).
Kristensen 2010 [40] Exploratory Regression model with social support as a predictor. Gender, pre-disaster employment, relationship to deceased, previous experience of loss, time elapsed before death confirmed. 130 Two social support variables were included in analysis: low positive social support (OR=.24, p=.012) and high negative social support (OR=3.81, p=.012) were significantly associated with meeting criteria for complicated grief.
Levi-Belz 2019 [43] Specific hypothesis Regression model with social support as a predictor. Time since loss, attachment style, self-disclosure and interaction between secure attachment, social support and self-disclosure. 156 Greater perceived social support was significantly associated with lower severity of complicated grief (beta=-.30, p<.01).
Li 2015 [44] Exploratory Regression model with social support as a predictor. n/a 803 Social support was not significantly associated with meeting criteria for complicated grief.
Rheingold 2015 [47] Exploratory Generalised estimating equations with social support as a predictor. Variables found to significantly differ by diagnostic status: age, deceased contributing to household income. 47 Lack of social support was not significantly associated with increased risk of meeting criteria for complicated grief.
 Anxiety Bottomley 2017 [31] Exploratory Regression model with social support as a predictor. T1 anxiety (at a mean of 1.66 years since loss) 47 Need for advice, need for physical assistance and satisfaction with physical assistance were included in the model. Satisfaction with physical assistance was the only significant predictor, negatively predicting anxiety severity at T2 (6 month follow-up) (p<.001, b=-.30).
 Prolonged grief Heeke 2017 [38] Specific hypothesis Latent class analysis with social support as a predictor. Gender, years of education, number of assaultive/accidental traumatic events, relationship to person lost, how loss happened and time since loss. 308 The amount of perceived social support did not predict membership of the PGD class.
 Suicidal ideation Oexle 2019 [45] Specific hypothesis Regression model with social support as a predictor. Age, gender, pre-loss mental illness, time since loss, relationship to deceased and perceived closeness to deceased. 195 Greater perceived social support was significantly associated with lower severity of suicidal ideation (beta=-2.87, p<.001).
Psychological wellbeing outcomes
 Emotional distress Heeke 2017 [38] Specific hypothesis Latent class analysis with social support as a predictor. Gender, years of education, number of assaultive/accidental traumatic events, relationship to person lost, how loss happened and time since loss. 308 Less social support was a predictor of the emotional distress class (OR= .92, p<.001).
 Grief Sprang 1998 [50] Exploratory Regression model with social support as a predictor. Gender, age, race, subjective health status, income, marital status, past experience with death, time since death and religious beliefs. 171 Greater social support predicted lower extent of grief (beta=-.479, p<.005).
 Grief difficulties Oexle 2019 [45] Specific hypothesis Regression model with social support as a predictor. Age, gender, pre-loss mental illness, time since loss, relationship to deceased and perceived closeness to deceased. 195 Greater perceived social support was significantly associated with decreased grief difficulties (beta=-.47, p<.001).
 Initial impact of event Fullerton 1999 [36] Exploratory Regression model with social support as a predictor. Age, marital status, social network index, disaster specific social support, family distress, maximum closeness to deceased crew, transience, hardiness and social desirability. 71 Neither perceived social support measure (support from friends/ support from family) was a good predictor of total or avoidance IES.
Low perceived social support from friends predicted a higher intrusive initial IES score (beta=-.44, p=.044).
 Loneliness Spino 2016 [48]   n/a n/a n/a Statistical analyses not reported.
 Mental distress Murphy 1988 [28] Exploratory Regression model with social support as a predictor. T1 mental distress, age, sex, education, stress, self-efficacy and social support 49 Social support did not significantly predict severity of mental distress
 Mourning Sprang 1998 [50] Exploratory Regression model with social support as a predictor. Gender, age, race, subjective health status, income, marital status, past experience with death, time since death and religious beliefs. 171 Greater social support significantly predicted lower extent of mourning (beta=.350, p<.005).
 Personal growth Oexle 2019 [45]   Regression model with social support as a predictor. Age, gender, pre-loss mental illness, time since loss, relationship to deceased and perceived closeness to deceased. 195 Greater perceived social support was significantly associated with increased personal growth (beta=-44, p<.05).
 Recovery Murphy 1988 [28] Exploratory n/a n/a n/a Social support was not included in the regression model predicting recovery.
 Resiliencea Bailey 2013 [29] Exploratory Regression model with social support as a predictor. n/a 48 Unadjusted model where traumatic stress predicted greater levels of resilience was significant (b = -.241, p<.049). The adjusted model with social support as a mediator was also significant (b=.297, p=.032).
  Stress-related growth Levi-Belz 2015 [42] Specific hypothesis Regression model with social support as a predictor. Time since loss, adaptive coping, maladaptive coping, self-disclosure, interaction between time and interpersonal variables. 135 Combined with self-disclosure as a predictive interpersonal variable, social support predicted levels stress-related growth (beta=.11, p=.027).
  1. Key: aResilience was defined as stress coping ability