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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3130 — Health-Related Social Control among Veterans with Depression

Mavandadi S, Philadelphia VA Medical Center, University of Pennsylvania; Jacques N, Philadelphia VA Medical Center; Sayers S, and Oslin D, Philadelphia VA Medical Center, University of Pennsylvania;

Objectives:
Social control attempts, or attempts by social network members to influence and regulate a target person's behavior, have been shown to significantly predict health behaviors and psychological well-being in non-clinical populations. Despite the fact that depression is associated with compromised interpersonal functioning and poor health behaviors, social control processes have not been studied within the context of depression. Thus, the objectives of this study were to: a) explore differential vulnerability to spousal social control attempts among veterans with varying levels of depression symptom severity (i.e., mild to severe), and b) examine the degree to which positive and negative social control attempts predict behavioral and affective responses among patients with depression.

Methods:
Participants included 90 married veterans referred by their primary care providers to the Philadelphia VA Medical Center Behavioral Health Laboratory for a mental health/substance use assessment. Data on sociodemographic characteristics, depressive symptomatology, health behaviors (e.g., smoking, drinking, exercise), positive (e.g., encouragement, praise) and negative (e.g., guilt, nagging, coercion) spousal social control attempts, and behavioral (e.g., engaging in the behavior, ignoring one’s spouse) and affective (e.g., contentment, resentment, sadness) responses were collected.

Results:
The sample was primarily male and Caucasian (mean age = 65.3 (SD = 8.1) years). Although unrelated to frequency of social control attempts or behavioral responses, higher depressive symptoms were significantly associated with less positive (r = -.34, p = .003) and more negative (r = .50, p <.001) affective responses. Multiple regression models revealed that while positive and negative control attempts were unrelated to positive behavioral responses (e.g., successfully engaging in the target health behavior), more frequent negative attempts were associated with increased negative behavioral responses overall (b = .37, SE = .09, p <.001) and, specifically, patients ignoring their spouse (b = .55, SE = .13, p <.001), doing nothing in response to the attempt(s) (b = .30, SE = .14, p = .03), and doing the opposite of what the spouse desired (b = .43, SE = .13, p = .002). Moreover, negative social control attempts predicted fewer positive and greater negative affective responses (p’s <.001).

Implications:
Findings suggest that social control strategies, particularly negative control attempts, vary in the extent to which they promote and, conversely, discourage positive behavioral change, emotional responses, and health outcomes among patients with depression.

Impacts:
Identifying helpful and unhelpful social control attempts by spouses and family members of veterans with depression may better inform health care delivery models that involve family members in veterans’ care.


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