DEPRESSION AS A FUNCTION OF SOCIAL SUPPORT IN HIV PATIENTS.
The aim of the present study was to determine whether lack of social support leads to depression in HIV patients or not. It was hypothesized that: (1) there would be low level of social support and high level of depressive symptoms in HIV patients, and (2) there would be strong negative relationship between the overall depression scores of the patients and their scores on the esteem subscale of the social support scale. The sample comprised of 50 HIV patients aged between 20 to 25 years, with at least secondary school education. Sample was selected from different organizations of Karachi. Siddiqui Shah Depression Scale (1997) and Social Support Scale (2005) were administered on the patients. Pearson Product correlation and descriptive statistic including frequency and percentages, was applied for the statistical analysis of the data using statistical package for social sciences (SPSS 12 version).
Results reflect that a number of patients score in high range on measure of depression (96%), while 66 % of them perceive the social support, and 70% of them perceive the esteem support they receive as low. The results indicated strong negative correlation between levels of depression and social support in HIV patients (r = - .672, p less than .05). Moreover, analysis of the results also showed that HIV patients with low esteem score on social support scale showed high depressive scores(r = - .627, p less than .05).
Social support plays a vital role in individual's health and well being. A general theory that has been drawn from various researches over the past few decades postulates that social support essentially predicts the outcome of physical and mental health for individuals at every stage of life i.e. from childhood to old age (Cutrona and Russell, 1990, Acitelli and Antonucci, 1994, Cutrona and Suhr, 1994).
Social support networks include all those people who know us and care for us like parents, siblings, spouses, close and other friends, workmates, acquaintances and neighbors. There are six criteria of social support that researchers have used to measure the level of overall social support available for the specific person or situation. First, they would look at the amount of attachment provided from a lover or spouse. Second, measuring the level of social integration that the individuals are involved with, it usually comes from a group of people or friends. Third, is the assurance of worth from other, such as positive reinforcement, that could inspire and boost the self-esteem. The fourth criterion is the reliable alliance support that is provided from others, which means that the individual knows that he/she can depend on receiving support from family members whenever it was needed. Fifth criterion is the guidance/support given to the individual from an authority figure/person, such as a teacher or parents.
The last criterion is the opportunity for nurturance. It means the person would get some social enhancement by having children of his or her own and providing a nurturing experience (Cobb, 1979; Kahn, 1979; Schaefer, Coyne and Lazarus, 1981; Weiss, 1974).
Social support is one of the foremost contributions of the life quality along with satisfactory treatment course and it plays an important role in terminal illness (Carey, 1974). Social support has been claimed to have positive effects on a variety of outcomes, including physical health, mental well being and social functioning; while external locus of control, low social support, emotional stress, and poor coping mechanisms were associated with psychological symptoms and maladjustment to cancer (Klemm, 1994; Krishnasamy, 1996). Similar idea was suggested in a research conducted by Naheed (2000) which clearly indicates that family support plays a crucial role in the improvement of stroke patients. Likewise the findings of one more study suggest that social support and health are positively related. Thus in the light of the literature mentioned it can be summarized that social support plays a crucial role in physical and psychological well being of an individual.
Keeping in view the role played by social support in maintaining physical and psychological health of the individual an attempt was made in the present study to explore whether lack of social support results in development of depression among HIV patients. As despite of all the preventive measures taken the number of HIV patients all over the world is at rise. At the end of 1993 the World Health Organization (WHO) estimated that worldwide about 10 million people were infected with Human Immunodeficiency Virus (HIV).
HIV is a ribonucleic acid (RNA) containing retrovirus that was isolated and identified in 1983. HIV infects cells of the immune system and the nervous system. Infection of T4 (helper) lymphocytes eventually result in impaired cell mediated immunity, dramatically limiting the ability of the body to protect itself from other infectious agents and to prevent the development of specific neoplastic disorders. Infection of cell within the central nervous system result directly in the development of neuropsychiatric syndromes which are commonly further complicated in patients with AIDS by neuropsychiatric effects of opportunistic CNS infections, antiviral treatment related adverse effects, independent psychiatric syndromes and last but the most important myriad psychosocial stressors related to having an HIV related disorders (Kaplan, Sadock and Grebb, 1994).
Furthermore, major psychodynamic themes for HIV infected patients involve self blame, self esteem, and issues regarding death. The trained mental heath practitioners may help patient deal with feeling of guilt regarding behaviors that contributed to the development of HIV (Hirsch and D' Aquila 1993). It has been observed that HIV often can be accompanied with low self-esteem and depression which is described as having the blues, feeling sad, guilty, hopeless, helpless and melancholy and as reacting to the grief of losing some loved objects. The most prevalent definition is that of a dysphoric (chronic) feeling of illness and discontented mood and/or a pervasive loss of interest that is characterized by certain symptoms (Spitzer, Sheechy, and Endicott, 1977). Thus, it is worth mentioning here that HIV patients may benefit from psychological assistance in the form of psychological assessment and counseling as this will help HIV patients deal with the depression and other social, interpersonal aspect of the disease.
Despite this fact that on one hand several NGOs and other government agencies are making a lot of efforts in educating people to prevent HIV in Pakistan. However, on the other hand it is particularly unfortunate that there is increase in number of HIV positive cases reported in Pakistan in the last couple of years. Intravenous (IV) substance abusers are considered to be the most important source through which this virus is spreading to women, children and heterosexual men (Bokhari et al., 2007). A range of 4 to 40 % of HIV infected patients have been reported to meet the diagnostic criteria for depressive disorders (Mapou et al., 1993). It has been observed that HIV patients often feel guilt, shame and anger because the patients feel that they are being punished for a deviant lifestyle including unsafe sex, substance abuse or risky health care decisions. It's a well known fact that by the time adequate knowledge regarding the transmission of HIV epidemic was not available; people were scared of this modern plague.
Esteem support is the expression of regards of one's skills, value and abilities of a person. It furthers the reassurance of a person's competency which boost up his/her self esteem. According to Bandura (1977), reassuring a person in his/her competence may foster self-efficacy, and that is associated with greater persistence and less discouragement in goal-directed behavior. Reassuring may lessen the intensity of negative emotions enlarged by stressful events especially those involving failure or blame. HIV patients lack esteem support due to the stigma attached to it and they became depressed but in fact, due to the people expressions many depressed people do not feel helpless but instead tend to blame themselves too much and usually feel that they should have been able to do something to prevent bad events or out come.
That is, they seem to assume an unreasonable amount of responsibility for various things, even those over which they actually had no control (Buchwald et al., 1978; Raps et al., 1882; Rizley, 1978). Thus, it appears that the most depressives are excessively self-blaming rather than helpless peers. As a general practice HIV/AIDS patient were socially isolated for two reasons, one for acquiring this disease by indulging into immoral sexual practices, outside marriage sexual practice and secondly fear of being infected by the disease as a result of all forms of routine interactions. Fortunately the public health officials have been successful in advocating people regarding the modes of transmission of this disease through media and other means of communication and the scenario is different presently. However, there is still a strong stigma attached with this disease which is further complicated by the societal values and norms surrounding sexual acts and substance abuse.
This fact cannot be denied that once the individual is diagnosed to be HIV positive the attitude of family members, friends, employers and other significant others changes toward the person. In addition to this the stigma attached to this disease adversely effect the self esteem of the patients and coerce the individual to not only tolerate the biased attitude of the people around but also become socially withdrawn and refrain from expression of his/her feelings (McKegny and O' Dowd, 1992).
It has also been reported that patient's family, lover, and close friends are often important allies in treatment as they help them cope with the illness and support them in the difficult time. The ideas presented in the aforementioned points clearly imply that social support plays an important role in psychological well being of the HIV infected patients. Considering this fact it was assumed in the present study that there would be low level of social support and high level of depressive symptoms in HIV patients and there would be strong negative relationship between the overall depression scores of the patients and their scores on the esteem subscale of the social support scale.
The sample comprised of 50 HIV patients (already diagnosed cases) aged between 20 to 25 years, with at least secondary school education. Sample was selected from different organizations of Karachi including Alleviate Addiction Suffering, Marie Adelaide House of Hope, New light People living with HIV Care and Support Welfare house, Sindh AIDS Control Program, Alnijat Welfare Society and Marie Adelaide Leprosy Center Rehabilitation Program. Purposive and snowball sampling methods were used for data collection.
The data was collected with the help of two instruments:
Siddiqui Shah Depression Scale (SSDS; Siddiqui and Shah, 1977)
Siddiqui Shah Depression Scale have test re test reliability of .85, (Siddiqui and Shah, 1977). This 36 items scale, provides measures of depression. It is a 4 point scale, where "0" denoted no sadness, "1" normal sadness, "2" mild depression, and "3" severe depression. Taking a score of 26 as the lower and a score of 36 as the upper limit indicative of "mild depression", scores ranging from 37-49, interpretable as "moderate depression", whereas a score of 50 and above denoted the presence of "severe depression.
Social Support Scale (SSS; Malik and Ismail, 2005)
Social Support Scale with split half reliability of r = 0.79 (Malik and Ismail, 2005). A 52 items scale which provides measures of social support in five different areas i.e., informational support (item no. 5, 10, 16, 28, 36, 44,), tangible aid (items no. 4, 9, 31, 40, 49), emotional support (item no. 2, 7, 12, 15, 17, 20, 23, 26, 29, 35, 38, 41, 43, 46, 48, 51), esteem support (items no. 3, 8, 13, 19, 22, 25, 32, 34, 37, 42, 45), and social network support (items no. 1, 6, 11, 14, 8, 21, 24, 27, 30, 33, 39, 47, 50).
Quartile 1 (Q1) and Quartile 3 (Q3) had been calculated on the total scores of the remaining 51 items, (social support scale) and its five sub-scales in order to find out the classificatory indices of social support scale (i.e. high, moderate, low level of social support scale). Q1 for social support scale is 84, Q2 is 99 and Q3 is 114. High score would reflect high level of social support and low score would reflect low level of social support.
After taking informed consent from the participants, demographic information was obtained through a form which entailed information about the participant's age, gender, qualification, marital status, occupation and socioeconomic status. Siddiqui Shah Depression Scale with test re test reliability of .85 and Social Support Scale with split half reliability of r = .79, were administered on the patients.
Social support is characterized by physical and psychological comfort provided by other people by one's friends and family members (Amber and Ismail 2005) including the following major categories:
a. Informational Support: It means that one's get advices, suggestions, supervision and feed back on his/her actions.
b. Tangible Support: It means that to provide needed materials and different services.
c. Emotional Support: This type of support includes caring, empathetic and sympathetic behavior a person shows to others.
d. Social Network Support: It refers to a sense of belongingness to a group of shared interests and concerns.
e. Esteem Support: It refers to the expression of positive regards for one's abilities, skills and the encouragement of his/her goal directed behavior. (Bandura, 1977).
A mood state characterized by a sense of inadequacy, a feeling of despondency, a decrease in activity or reactivity, pessimism, sadness and related symptoms
Human Immune deficiency viurs, individuals infected with human immune deficiency virus that leads to deficiency fo the immune system.
Percentage of depression and social support in HIV patients
Correlation of depression with social and esteem support in HIV patients
Depression/Social Support###-.672###P less than .05###50
Depression/Esteem Support###-.627###P less than .05###50
Analyses of the results reveal that social support plays a significant role as a predictor of depression in HIV patients. The results are consistent with the hypotheses formulated and previous studies.
Table No. 1 shows the percentages for depression, social support and esteem support. In present study 96% HIV patients had high level of depression whereas 2% had low and moderate levels of depression. There were 66% HIV patients who received low level of social support, 28% moderate level of social support where as 6% of HIV patients received high level of social support. Furthermore, 70% HIV patients had low esteem support, 24% had moderate level and 6% had high level of esteem support.
The correlation coefficients were computed in Table No. 2 to examine the relationship of depression and social support as well as depression and esteem support. The results indicated strong negative correlation between levels of depression and social support in HIV patients (r = - .672, p less than .05). Moreover, analysis of the results also showed that HIV patients with low esteem score on social support scale showed high depressive scores(r = - .627, p less than .05). This showed low level of social support and high level of depression in HIV patients, analysis also suggested low level of esteem support and high level of depression in HIV patients. Certain reason and rationale can be coded in this context like HIV patients has low social support because of stigma attached to the disease. They may feel guilty over their behavior which might probably lead to difficulty in expression of their feelings social and interpersonal issues, low self esteem and consequently to depression.
The presence of social support helps and enables an individual to recover from illness more quickly (Roy, Stepteo, and Krischbaum, 1998). Disease support groups are also helpful, even if the communication is online, but some diseases are more likely to motivate seeking this kind of support than others. Support seeking is more apt to occur when the disease is stigmatizing (for example, Aids, Alcoholisms, Breast and Prostrate cancer) and least likely for a non-embarrassing disease such as coronary problem (Davison, Pennebaker, and Dickerson, 2000).
The absence of social support shows some disadvantage among the impacted individuals. In most cases, it can predict the deterioration of physical and mental health among the victims. The initial social support given is also a determining factor in successfully overcoming life stress. The presence of social support significantly predicts the individual's ability to cope with stress. Knowing that they are valued by others is an important psychological factor in helping them to forget the negative aspects of their lives, and thinking more positively about their environment. Social support not only helps improve a person's well-being, it affects their immune system as well. Thus, it also plays a major factor in preventing negative symptoms such as depression and anxiety (Cutrona andRussell, 1984).
Finally on the basis of the finding of the research it can be safely concluded that there exist a strong negative correlation between levels of depression and social support in HIV patients and esteem score on social support scale of HIV patients is negatively correlated to their depressive scores.
The present research findings is not only pivotal in highlighting the importance of social support in development of depressive symptoms in HIV patients but may also be instrumental in guiding the family members of patients, as the care giver needs to be sensitized about the significance of social support in determining the prognosis of the depressive symptoms in HIV patients.
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Institute of Professional Psychology Bahria University Karachi Campus, Pakistan
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|Author:||Zadeh, Zainab Fotowwat; Yousaf, Tahira|
|Publication:||Pakistan Journal of Psychology|
|Date:||Dec 31, 2009|
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