More than 181,000,000 of emergency department (ED) visits were for traumatic injury between 2006 and 2012 [5]. Traumatic injury can result in a variety of long-term mental health symptoms including anxiety, depression, and substance misuse (e.g., [8]). This study examined social support as a factor that could mitigate the development and severity of mental health symptoms among young adults who visited the ED for traumatic injury.
Social support is associated with psychopathology [3,7,14]. However, the unique role of parent and peer social support is mixed, and little work has examined the role of significant other support, despite its potential relevance in an ED sample [4,6,15]. To our knowledge, this is the first study to examine whether parent, peer, significant other, or a general social support is uniquely associated with mental health symptoms among young adults visiting the ED for a traumatic injury.
Data were collected in accordance with the university’s institutional review board (IRB). Participants were young adults between the ages of 18–30 who visited the ED with a traumatic injury at a large hospital in the Southeast between September 2016–July 2018. Individuals meeting these inclusion criteria were contacted asking them whether they would be interested in participating, involving completing the 30–45 min survey and allowing staff to access medical records. Of the 481 contacted, 79 participated (16.4%; consistent with prior studies in large public EDs (with 13–22% recruitment rates; [9,11]), 25 refused (5.2%), and 377 did not respond to any attempts at contact (78.4%). Most (75%) visited the ED because of a motor vehicle accident, with the next most common reason being an accidental fall (6%; e.g., off roof, down stairs). Participants were on average 24.32 years old (SD = 3.4; 52.6% male) and primarily White (76%; 24% Black).
Demographics.
Participants were asked their race/ethnicity, age, and sex.
Perceived social support.
Social support received from family, friends, and a special person was assessed using the Multidimensional Scale of Perceived Social Support [16].
Generalized anxiety symptoms.
Participants were asked to report on generalized anxiety disorder (GAD) symptoms using the Generalized Anxiety Disorder-7 [13], a screener for assessing generalized anxiety.
Depressive symptoms.
The Center for Epidemiologic Studies Depression Scale Revised (CESD-R-10; [1]) assessed depressive symptoms.
Alcohol misuse.
Individuals reported on their alcohol use using the Alcohol Use Disorders Identification Test-Consumption/AUDIT-C [2].
To test whether unique or general support factors were associated with outcomes, a bifactor model [10] was fit to the data within the context of a structural equation model. Mental health symptoms (depression, anxiety, and alcohol misuse) were examined as outcomes as associated with each social support factor (‘special person’, family, friend, and general). Covariates (age, race, and sex) were also included.
The final bifactor model, using the Weighted Least Squares with Mean and Variance Adjustments (WLSMV) estimator for a mix of dichotomous and categorical outcomes, showed good fit to the data, CFI: 0.95 and RMSEA: 0.04. Those with higher scores on the broad social support factor reported fewer depressive and anxiety symptoms. None of the specific factors were associated with any of the outcomes. Sex was not associated with any of the outcomes. Race/ethnicity was marginally associated (p < .1) with alcohol misuse, such that White participants reported higher likelihood of alcohol misuse than Black participants. Age was also marginally associated (p < .1) with alcohol misuse such that older individuals reported higher risk. See Figure 1 for full model results.
Fig. 1.
Depiction of associations among study variables.
The current study investigated whether support from a significant other, family, friend, and/or a general support factor were associated with depressive symptoms, anxiety symptoms, and alcohol misuse among young adults who visited the ED for a traumatic injury. The current findings do not suggest that different supports are uniquely associated with mental health symptoms. However, higher levels of general support was significantly associated with anxiety and depressive symptoms, but not alcohol misuse. These results extend the existing literature, by suggesting that within the context of a traumatic injury, cumulative social support is most relevant for mental health outcomes as opposed to a specific relationship. It may be that those with higher levels of cumulative social support from several sources can rely on multiple individuals when they encounter stressors, reducing the likelihood of depressive and anxiety symptoms.
Previous research suggested that more peer support is associated with more alcohol consumption [15]. The current study found no association between peer support, or any support, on alcohol misuse. It is possible that in this sample of emerging adults who experienced traumatic injury that there is variation in peer drinking, which could result in null findings. Further, prior work has found that greater parental monitoring, parent-child relationship quality, and communication are associated with multiple offspring alcohol outcomes, while parental support is associated with fewer outcomes [12]. Parenting/family environment constructs may be more potent predictors of offspring alcohol misuse.
This study should be considered in light of limitations. The sample of this study was small (n = 76), so we may have been under-powered to detect effects and lacked representative diversity in the sample. Further, the cross-sectional design precludes determination of direction of effects. Despite these limitations, this study has many strengths. It is the only study examining social support using a bifactor model to determine correlates of broad support and unique support. It is also one of the only studies examining a sample of young adults after visiting the ED for traumatic injury to examine mental health outcomes and social support. Overall, findings suggest that having more unique social supports may not be as useful as having higher levels of broad social support in reducing risk for anxiety and depressive symptoms following a traumatic injury in young adults.
Acknowldgements
Data collection and manuscript preparation were partially supported by Interdisciplinary Fellowship at the Medical University of South Carolina (MPI: Cohen & Russell), the National Institute of Mental Health ((T32 MH018869, MPI: D. G. Kilpatrick & C. K. Danielson), the National Institute on Drug Abuse (K23DA042935, PI: Gilmore), National Institute on Alcohol Abuse and Alcoholism (1K01AA028058, PI: Bountress) and National Institute of Justice (2018-R2-CX-0022, PI: Cohen).
Contributor Information
Brianna George, Department of Psychology, Virginia Polytechnic Institute and State, University, United States
Alexia Guzman, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, United States.
Joseph R. Cohen, Department of Psychology, University of Illinois at Urbana-Champaign, United States
Amanda K. Gilmore, Mark Chaffin Center for Healthy Development and Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, United States
Kaitlin E. Bountress, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, United States
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