The relationships between loneliness and mental and physical health are moderated by the tendency for interpersonal victimhood: A study of young adult cancer patients.

OBJECTIVES: To assess whether loneliness is inversely related to young adult cancer patients' subjective reports of mental and physical health, and to explore whether such inverse relationships are moderated by young adult cancer patients' tendency for interpersonal victimhood. METHODS: Young adult cancer patients (N = 140) ranging in age from 19-39 years completed two questionnaires distributed three months apart. Patients reported loneliness, their tendency for interpersonal victimhood, and mental and physical health. Hypotheses were tested using the PROCESS macro for SPSS, which tests for main effects and moderation effects. FINDINGS: Loneliness was inversely related to mental health, but there was no main effect of loneliness on physical health. Tendency for interpersonal victimhood significantly moderated the relationships between loneliness and both mental and physical health, such that a greater tendency for interpersonal victimhood strengthened the inverse relationships between loneliness and both mental and physical health. CONCLUSION: Loneliness continues to be an important predictor of mental health for young adult cancer patients, and this relationship is strengthened when a patient has a greater tendency for interpersonal victimhood. Health care providers, family members, and other supporters should monitor the quantity and quality of patients' relationships with others and also facilitate conversations that can address aspects of the tendency for interpersonal victimhood, such as rumination or the need for recognition.

Exploring the Barriers to Social Support Interactions: A Qualitative Study of Young Adult Cancer Patients and Young Adult Supporters.

This study explores the reasons why young adults (ages 18-39) struggle to provide or avoid providing support to young adult cancer patients. The study also explores young adult cancer patients' perceptions of why they have not received support from individuals who did not provide support. A total of 722 reasons were collected through online surveys and analyzed: 438 were provided by young adults who knew a young adult with cancer (N = 131), and young adult cancer patients (N = 111) provided 284 reasons why they believe they did not receive support. Initially using a previous typology of 16 nonsupport reasons, an abductive thematic analysis yielded a total of 21 barriers to the provision of social support. These barriers were categorized across four higher-order categories: recipient-focused, supporter-focused, relationship-focused, and context-focused. Some reasons provided by young adult supporters were not provided by young adult patients and vice versa, suggesting the potential for discrepancies between why cancer patients believe they did not receive support and nonsupporters' actual reasons for not providing support. These various reasons why people struggled to provide support or avoided providing support can act as a list of barriers that future researchers and practitioners can address through the development of resources and interventions aimed at fostering adequate support provision throughout individuals' cancer experiences. Cancer patients can address the experience of nonsupport by individuals in their lives by being more direct in communicating their support desires and, when unsuccessful, using cognitive reappraisal strategies.

Nonsupport Experiences of Young Adult Cancer Patients: Prevalence, Acceptability, and Outcomes of Not Receiving Support.

This study provides foundational data regarding instances of nonsupport (i.e. instances when support was expected from someone but not received) in the cancer context. In a sample of 205 young adult cancer patients from 22 countries, approximately three out of every five patients reported having experienced nonsupport at some point during their cancer journey. Men and women patients were approximately equally as likely to have experienced nonsupport and were approximately equally likely to be recalled by a cancer patient as a nonsupporter. Results showed that patients who had experienced nonsupport reported worse mental and physical health, greater depression, and greater loneliness than those who had not experienced an instance of nonsupport. Patients were also presented with a previously published list of 16 reasons why people choose to forgo communicating support to cancer patients, and patients rated each reason's acceptability. Nonsupport reasons that assumed communicating support would create a burden for the patient (e.g. providing support would create a privacy issue; the supporter feared losing control of their own emotions) were rated as more acceptable. Reasons involving the nonsupporter making assumptions or decisions about the broader social support process were seen as less acceptable (e.g. communicating support does not help; assuming support is not desired). Together, these results demonstrate the prevalence and impact of nonsupport on cancer patients' health outcomes and provide justification for nonsupport as an important avenue for future social support research.

Determinants of loneliness during the COVID-19 pandemic in the United States: A one-year follow-up study.

An initial study on loneliness during the first month of the COVID-19 pandemic in the United States found that those who were living alone or who were single experienced greater loneliness than those who lived with others or were in a romantic relationship. This study presents follow-up analyses using data collected from the same sample (N = 428) at a total of five points in time throughout the first year of the COVID-19 pandemic in the United States. Unlike most studies using a longitudinal design to track loneliness throughout the COVID-19 pandemic, the results of this study showed that loneliness scores generally decreased over this time period. However, additional analyses showed that when participants experienced a de-escalation in their romantic relationship status (e.g., transitioning from being in a dating relationship to being single or from being married to separated), loneliness scores increased. Because prior research shows a connection between living alone and loneliness, the researchers also tested whether decreases in the number of people one lives with predicted increases in loneliness. The data was inconsistent with this prediction. Overall, these findings join a minority of other longitudinal studies investigating loneliness during the COVID-19 pandemic that found either a decrease or no change in loneliness, while also illustrating that increases in loneliness during the COVID-19 pandemic occurred after people experienced a de-escalation in their romantic relationship status. These findings underscore the importance of life events during the COVID-19 pandemic that may increase loneliness-specifically transitioning out of romantic relationships. Thus, future research on predictors of loneliness should continue to use longitudinal designs to determine how changes in one's life predict changes in loneliness.

Mixed Messages: II. Outcomes Associated with the Proportion and Placement of Negative Statements in Support Messages.

Few studies on emotional support have investigated mixed messages - instances when emotional support messages contain both positive and negative statements. Although researchers have recognized that mixed messages occur, most supportive communication research has ignored these ambivalent messages. We contend based on the negativity bias that the more negative statements that occur in an emotional support message, the less effective the message is. To test this possibility, we presented cancer patients (N = 417) with messages that consisted of 0%, 20%, 40%, 60%, or 80% negative statements. Patients rated the messages on five variables: message effectiveness, affective improvement, supporter competence, likelihood to seek future support, and being better off if the supporter had said nothing. A significant positive linear trend occurred for all five variables. The results suggest that the presence and amount of negative statements within an emotional support message has a considerable influence on the recipient's perception of the message and supporter. From a practical standpoint, the results suggest that cancer patients' supporters should act cautiously when communicating negative statements within supportive messages, as even a brief negative statement may cause irreparable damage to the overall quality of a support message.

Mixed Messages: I. The Consequences of Communicating Negative Statements Within Emotional Support Messages to Cancer Patients.

BACKGROUND: Not all emotional support messages consist purely of positive statements. Some emotional support messages received by cancer patients simultaneously communicate statements of caring but also negative statements, such as criticisms of patients' actions. OBJECTIVE: This study tests if a negative statement occurring within an emotional support message affects cancer patients' perceptions of the effectiveness of the entire emotional support message as well as the perceived competence of the supporter communicating the emotional support message. METHODS: Cancer patients watched video recordings of emotional support messages and subsequently provided ratings on message effectiveness and supporter competence. Some emotional support messages included negative statements, whereas other messages did not. RESULTS: Messages that included a negative statement were rated lower on message effectiveness than messages without negative statements. Cancer patients rated supporters communicating messages with a negative statement as having significantly less competence than those who did not communicate a negative statement. CONCLUSION: A single negative statement occurring within an emotional support message may result in cancer patients viewing the emotional support as less effective and the supporter as less competent.

Success Bias and Inflation Bias After Planning and Communicating Emotional Support.

This study investigates the potential for cancer patients' supporters to experience cognitive biases after communicating emotional support messages. A success bias was predicted, such that those who planned their messages would rate those messages as more effective in comparison with those who did not plan their messages (H1a-H1c). An inflation bias was also predicted, such that supporters would rate their messages as more effective than cancer patients who also rated the messages (H2a-H2c). One hundred laboratory participants were randomly assigned to a planning or distraction task before recording an emotional support message for a friend who had hypothetically been diagnosed with cancer. Laboratory participants rated their own messages in terms of relational assurances, problem-solving utility, and emotional awareness. Subsequently, cancer patients viewed and rated the laboratory participants' messages on the same characteristics. Participants who planned their messages rated their messages significantly higher than those who did not plan their messages in terms of relational assurance and problem-solving utility but not emotional awareness. Irrespective of planning or distraction condition, participants also rated their messages significantly higher on all three dependent variables than did cancer patients. Supporters should be aware of the propensity to overrate their supportive abilities and guard against the assumption that planning messages results in more effective support messages.

Social Interface Model: Theorizing Ecological Post-Delivery Processes for Intervention Effects.

Successful prevention programs depend on a complex interplay among aspects of the intervention, the participant, the specific intervention setting, and the broader set of contexts with which a participant interacts. There is a need to theorize what happens as participants bring intervention ideas and behaviors into other life-contexts, and theory has not yet specified how social interactions about interventions may influence outcomes. To address this gap, we use an ecological perspective to develop the social interface model. This paper presents the key components of the model and its potential to aid the design and implementation of prevention interventions. The model is predicated on the idea that intervention message effectiveness depends not only on message aspects but also on the participants' adoption and adaptation of the message vis-à-vis their social ecology. The model depicts processes by which intervention messages are received and enacted by participants through social processes occurring within and between relevant microsystems. Mesosystem interfaces (negligible interface, transference, co-dependence, and interdependence) can facilitate or detract from intervention effects. The social interface model advances prevention science by theorizing that practitioners can create better quality interventions by planning for what occurs after interventions are delivered.

Nonsupport Versus Varying Levels of Person-Centered Emotional Support: a Study of Women with Breast Cancer.

Social support studies often focus on psychological outcomes for the support recipient and also presume potential support providers who will attempt to provide support in the first place. Therefore, the negative relational outcomes associated with not receiving emotional support when support is expected (nonsupport) are an understudied topic. Instances of nonsupport were compared to various emotional support messages on relational and psychological outcomes to understand how nonsupport compares against support messages of varying quality. Two hundred twenty-four women with breast cancer were asked to think of a person expected to provide emotional support if they disclosed their diagnosis on social media. Participants were given either a hypothetical support message from this person or told the person provided no message even though a message was expected. Dunnett's t tests were used to analyze the nonsupport condition against low, moderate, and highly person-centered support messages. Providing no emotional support message (nonsupport) creates low levels of emotional improvement and high levels of negative relational ramifications similar to low person-centered messages. Moreover, only participants receiving the low person-centered message agreed on average they would rather have received no message at all instead. Because low person-centered messages and saying nothing whatsoever both create negative relational ramifications, support providers should strive to communicate emotional support messages with at least a moderate amount of person-centeredness. These findings further suggest those who are expected to provide emotional support cannot dodge this obligation since nonsupport is shown to have negative relational outcomes to low person-centered support messages.

Complementary Support from Facilitators and Peers for Promoting mHealth Engagement and Weight Loss.

This study investigates the effects of mHealth interventions on sustainable behavior change and weight loss, drawing on in-app user activity data and online survey data. Specifically, we focus on the interactions within mobile support groups in Noom, an mHealth application for obesity intervention, to delve into how social support from facilitators and peers may play differential roles in promoting health outcomes. The results of structural equation modeling (N = 301) demonstrated that (a) perceived facilitator support was positively associated with group members' health information acquisition such as fitness-themed article reading whereas perceived peer support was positively linked to group participation such as posting and responding; (b) perceived peer support was positively related to normative influence among group members, which subsequently increased group members' responses to others' posts; and (c) health information reading and in-group posting promoted weight loss; however, merely responding to others' posts did not lead to weight-loss success. The findings suggest that the complementary influences of facilitators and peers must be considered to enhance the efficacy of support group interventions.

Face Threats and Additional Reasons for Perceiving Support as Unwanted: A Study of Recently Diagnosed Cancer Patients.

This study investigated instances of support that were deemed unwanted by a recipient in the wake of a cancer diagnosis. The investigation was framed by politeness theory and considered the face threats evident in cancer patients' descriptions of unwanted support. Additional reasons for viewing support as unwanted, as well as the outcomes of receiving unwanted support, were also explored. Interviews (N = 15) were conducted with cancer patients who had been initially diagnosed within the previous 12 months. Analyses demonstrated that face threats are among the reasons for viewing some support as problematic; however, additional reasons beyond face threats also occurred. The most frequently occurring reasons for regarding support as unwanted were threats to the receiver's negative face and messages failing to convey empathy. Finally, the influence of receiving unwanted support on cancer patients is discussed in terms of recipients' ability to manage emotions, respond to the support, potentially view the support provider negatively, and assert greater control over future supportive interactions.