Consistent with previous studies [e.g., 4, 37], psychological distress for the PTSD sample was significantly higher than the non-PTSD matched sample. Also in line with research reporting negative social consequences as a function of PTSD [7, 24], significantly lower levels of social support were observed overall, and for each of the five sub-categories including attachment, social integration, reassurance of worth, reliable alliance, and guidance. The fact that the entire spectrum of social support subtypes assessed by the SPS-SF was lower for the PTSD sample is an important consideration given the proposition that diverse social support resources are necessary to reduce the risk of social and emotional isolation which could translate into a variety of negative outcomes including distress, poor cognitive ability, deprived sleep, and social detachment, resulting in depression and poor life satisfaction .
In terms of the regression analysis conducted using PTSD diagnosis as a moderator of the relationship between overall social support and psychological distress, higher social support was associated with lower psychological distress for respondents with and without a diagnosis of PTSD; however, the effect was significantly stronger for the PTSD sample. Hence, depending on which causal hypothesis one may assume (i.e., social causation or social erosion) , it would appear that social support’s salutary properties may be even more important for the mental health of PTSD sufferers, or psychological distress may have a more detrimental impact social support within the context of PTSD.
While gender emerged as a significant predictor in the overall hierarchical regression, implicating higher psychological distress among the female PTSD group, no significant difference was observed when psychological distress scores were compared between PTSD males and females, a finding contrary to those noted in the general population whereby women typically have significantly higher levels [e.g., 39]. Despite the fact that gender comparisons for social support in the PTSD sample yielded little in terms of significant differences, PTSD women did report significantly higher levels attachment, a finding consistent with the Meyer et al. (2018) study suggesting that functional impairment for men may reflect distancing from others . In terms of the potential social support-PTSD causal relationship, this may raise an interesting question as to whether social erosion may be more likely among male PTSD sufferers, and hence an important topic for future studies.
When age, gender, personal income, and subtypes of social support were regressed onto psychological distress for the entire PTSD sample, two variables emerged in Block 1, including gender (as previously mentioned), and total personal income, while social integration and guidance emerged in Block 2. In terms of social integration, higher scores were associated with lower psychological distress, a finding that has been previously reported within the context of PTSD risk and symptomology [e.g., 11, 21, 40]. It would seem that such studies insinuate a social causation perspective suggesting that the salutary influence of social support serves to attenuate the impact of PSTD. For instance, it has been proposed a higher sense of connectedness (particularly with close family and friends) may be beneficial in providing positive alterations to posttraumatic cognitions, which in turn may result in improvement from overall PTSD symptoms .
The potential health enhancing influence of social integration within the context of PTSD may also be partially explained by a sense of identification with, or similarly to others in one’s social network. Indeed, inherent in the SPS-SF items associated with the social integration subscale is a sense of sharing similar attitudes and beliefs with others. In the case of combat scenarios, for instance, this certainly makes intuitive sense as military personnel share a very close and unique bond in terms of training, family life, risks, combat experiences, etc. This reasoning also appears consistent with research reporting that veterans with combat exposure were less likely to develop PTSD when they reported having strong relations with fellow veterans, and that such connections were stronger predictors of later PTSD than family or other community relations [e.g., 13].
Since female respondents outnumbered male respondents 2:1 in the current study’s PTSD sample, it is not surprising that social integration also emerged as a primary predictor when a separate hierarchical regression analysis was conducted for the female PTSD group. Given that sexual assault is a common PTSD-inducing trauma among women [1, 3, 26], perhaps the support-provider’s perceived similarity to (or identification with) a victim’s experience is another key factor associated with lower psychological distress levels in this particular context.
The regression analysis featuring the male PTSD sample revealed three significant variables, i.e., total personal income and age in Block 1, and reliable alliance (i.e., having a network one can rely on during emergencies) in Block 2. Given that total personal income was evident in the overall sample, such an observation may be more reflective of the type of traumatic event experienced within the entire PTSD sample. For instance, in the case of natural disasters, it seems feasible that financial means could indicate a person’s greater capacity to manage various resulting challenges, thus leading to relatively lower distress levels. Indeed, studies into natural disasters do show that support in the form of material resources such as food and shelter certainly serve to address a significant source of distress [e.g., 42].
However, in the case of medical emergencies (where the likelihood tends to increase with age – another significant predictor for men in Block 1), people are more likely to experience restrictions in their physical abilities and hence challenges in the form of daily activity limitations, which may certainly result in significant distress [43, 44]. In this scenario, while access to reliable alliance support could be quite beneficial in regards to buffering overall distress, the fact that it surfaced primarily among the male PTSD group seems comparable to research which has found that tangible support, including assistance from others, was not a significant predictor of later development of PTSD in a sample of sexual assault victims . It also seems similar to findings in depression research whereby tangible support (i.e., daily activity support) was more likely to predict shorter depression duration in men and not women [16, 17].
Perhaps one of the most interesting findings of the current study was that the SPS-SF subscale of ‘guidance’ emerged as a positive predictor of psychological distress among PTSD women. Given that the two items associated with this subscale included “I have someone to talk to about decisions in my life” and “I have a trustworthy person to turn to if I have problems”, it would seem that a theme of ‘advice giving’ is representative. Moreover, in the sexual assault literature, a frequently cited risk relates to the potential for social contacts to be overbearing and opinionated following a victim’s disclosure [45, 44, 46]. Although intentions are meant to be supportive, such assertive responses on behalf of confidants may subsequently result in a victim’s sense of lack of control, and consequently a greater likelihood of avoidance behavior (47, 45, 46], two scenarios with a capacity to facilitate the onset of PTSD [44, 45, 47]. However, if one were to truly question the causal direction within the context of both the social causation and social erosion models, two scenarios seem likely; 1) interestingly, it may be the case that social support operates on psychological distress in a deleterious way, resulting in more distress, or 2) psychological distress operates on social support, serving to increase one’s perception of guidance availability. In any event, such propositions certainly represent lucrative issues of future inquiry.
We acknowledge limitations of the current study. Perhaps most importantly, due to the design of the CCHS-MH data file, the specific type of trauma that might have resulted in the development of PTSD for participants was not reported. Indeed, future studies should include trauma type as a separate variable to gain further insight into the potential benefits and challenges of social support components, overall, and men and women separately. Other limitations of the study include the fact that data were cross-sectional and correlational (which precludes any inferences of causation). A final limitation would be that the data used for the current study were founded on self-reported diagnoses which can be problematic in terms of participant honesty, memory, comprehension, etc. However, the fact that we observed a 2:1 female to male ratio of reported PTSD in the CCHS-MH sample does alleviate some concerns about self-report reliability as it does reflect gender-prevalence differentials reported in the literature [e.g., 3, 14]. Additionally, as mentioned previously, using a sample of self-reported PTSD individuals allows us to capture a more generalizable sample of those suffering with PTSD. One could argue clinical research samples fail to include those individuals who are unable to or unwilling to obtain treatment and therefore provides a strength of external validity.