International Collaborative Study of Social Support

Edwin B Fisher, Ph.D.

Project Overview (study continuation):
Social support is a very important ingredient in health and well being. Social isolation or the absence of social support is as strongly associated with death as cigarette smoking. Yet, as much as we all know how it feels when someone is “there” for us, we do not understand very well what are the key components of social support, how it is related to various aspects of health and well being, and how it may be promoted or enhanced.

With funding from the Longer Life Foundation, Dr. Edwin Fisher, formerly of Washington University in St. Louis and now at the University of North Carolina in Chapel Hill, has developed, along with his colleagues, a distinction between two types of support: Nondirective (cooperating without “taking over,” accepting feelings and choices of support recipients) and Directive (“taking over,” prescribing “correct” choices and feelings, e.g., “you’ve got to look at the half of the glass that’s full”). Among patients with several different cancers, diabetes, asthma, and lupus, as well as among community samples, Nondirective Support is associated with better health status, better health behaviors (e.g., nonsmoking), better quality of life, and fewer negative emotions such as depression. Directive Support tends to be associated with worse status in each of these areas. However, Directive Support appears to be useful in acute or urgent circumstances and situations in which the individual is not well prepared to deal with challenges he or she must face.

In previous work funded through the Longer Life Foundation, Dr. Fisher and colleagues in Norway and Thailand have administered measures of Nondirective and Directive Support along with measures of health and well being to older adults, as part of a study of over 1300 families from five provinces of Thailand, participants in a worksite injury rehabilitation program in Norway, and over 300 community residents (51% African American) in St. Louis, Missouri. Findings indicate that the distinction between Nondirective and Directive Support is quite robust across these several settings, populations, and cultures. However, there is some difference in how Nondirective and Directive Support are expressed across these settings/populations/cultures. Thus, items that are associated with Directive Support in US samples may be associated with Nondirective Support in Thai or Norwegian samples, while the basic distinction between the category of Nondirective and Directive Support remains strong in all three cultures. Also, across all three settings/populations/cultures, Nondirective Support tends to be associated with better quality of life and fewer reports of symptoms of disease or distress. Thus, the distinction between Nondirective and Directive Support appears to be robust while, at the same time, showing interesting differences in the specific ways it is at play in different cultures.

With requested funding, this project will continue to recruit sites from Finland, Hungary, Spain, and/or Latin/South America to include measures of Nondirective and Directive Support in studies of health and well-being. Based on these, Dr. Fisher and his colleagues will publish a series of papers documenting patterns of Nondirective and Directive Support in different cultures, ways in which they are related to health and quality of life in different cultures, and ways in which they may be distinctive in specific cultures. Based on these studies on Nondirective and Directive Support within the several cooperating countries, a large proposal to an appropriate organization making grants in international health will be prepared. In comparison to the current studies that incorporate the measure of Nondirective and Directive support into existing studies, this would support a shared, common protocol to take a comprehensive and longitudinal look at social support and varied indicators of health and well being as they change over time in different cultures.

Final Report:
This project was originally funded through the regular grants of the Longer Life Foundation to Dr. Fisher through the Department of Medicine and, within it, the Division of Health Behavior Research at Washington University in St. Louis. Dr. Fisher moved to the School of Public Health at the University of North Carolina at Chapel Hill in August of 2005 through which the project received continued support with previously unspent funds in 2006.  Read the full Final Report.