Previous Studies on Social Support as Mediating Variable

Social support is considered as a resource of good mental health for adults and caregivers of children (Reich, Lounsbury, Zaid-Muhammad, & Rapkin, 2010). The feeling of being

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connected with others enhances an ability to cope better in stressful situations and individual experience less anxiety and depression. Moreover, lower incidence of disease and faster recovery has been associated with the social connections (Compas et al., 2012). Conversely, low self-esteem and psychological distress are reported to be associated with less social connections (Smith et al., 2015).

For better parental functioning, the interaction of stress and support has received much attention (Kong & You, 2013). In numerous studies, social support has been positively linked with better caregiver mental health and better quality of parenting and parent–child interaction (Casale & Wild, 2012). In turn, good mental health and effective parenting results in better child developmental outcomes (Reich et al., 2010). A few studies in the same analysis by using path modeling have linked caregiver, his/her social support and child outcomes. For example, high level of social support to the parents cause less distress, more self-efficacy and better parenting which ultimately helps a child to better adjust psychosocially (Maulik et al., 2011).

Rosell-Murphy et al. (2014) in collaboration with the ICIAS study protocol found that by increasing the primary caregiver’s social support, the quality of life increases and caregiver burden decreases. Kohlsdorf et al. (2012) in a meta-analysis of studies from 1996-2009 found the significant relationship between social support and mental health of caregivers in various studies while only few showed no relation between caregiver’s mental health and social support.

Kim and Knight (2008) indicated that caregivers who have lower instrumental support have higher cortisol level that indicates a greater psychological stress. Moreover, results

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of analysis of Casale et al. (2013) suggest social support as a constructive resource of mental health by showing direct association between anxiety and social support.

Although coping is not directly affected by social support, still it is seen to be linked with the effects of caregiver strain and coping with strain (Kuo, Fitzgerald, Operario, & Casale, 2012). Regardless of the mediating or moderating role of social support, there are some benefits especially for caregivers. Caregiver stress have been found to be alleviated by social support which in turn, provide more coping strategies to deal with behavioral and emotional problems of child (Strom & Egede, 2013). Munsell, Kilmer, Cook and Reeve (2012) showed a significant relation between caregiver’s social connections and stress with the well-being.

Gariepy, Honkaniemi and Quesnel-Vallee (2016) found that satisfaction with social support of caregivers providing care to the psychiatric patients buffers the effects of stress. The study on influence of social support on self-esteem and psychological outcomes indicated the mediating effect of social support on indicators of well-being (Djundeva, Mills, Wittek, Steverink, 2015). The studies in USA and Taiwan showed inconsistency in buffering effect of social support on stress of caregivers. A study in Taiwan by Huang, Xia, Sun, Zhang and Wu (2009), discovered less depressive symptoms in caregivers with high emotional support.

Previously, Strom and Egede (2012) mentioned that social support may act as a mediator between caregiving demands and depression of a caregiver of cancer patients. Moreover, Pi-Ming Yeh, Mary and Su-Chuan Yuan (2009) examined how support from family influences the health of family caregivers in a Taiwanese hospital. A sample of 91 family

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caregivers of hospitalized cancer patients showed a negative correlation between caregiver’s health and family support.

Moreover, Casale and Wild (2012) in a systematic literature of 20 database groups conducted between May and June 2011 found that four of the 15 studies reviewed did not provide any significant association between the social support and the outcomes of health while ten studies reported direct associations between social support and mental health and three reported indirect association. One of these studies also found that less psychiatric disorder occurs in presence of increased social support.

Further, Navneet kaur (2014) also reported a significant relation between high caregiving stress and low social support. Whereas, Smojver-Azic and Bezinovic (2011) found higher level of social support is reported by females as compared to the males which agree with another research of Sonnenberg, Deeg, Van Tilburg, Vink, Stek and Beekman (2013) and Pfeifer, Silva, Lopes, Matsukura, Santos and Pinto (2014).

In addition, over 2009-2010, a household survey that is cross-sectional in nature was conducted to find stress-buffering effect of social support by Casale, Cluver, Crankshaw, Kuo, Lachman and Wild (2015) with 2,477 South African adolescents of age 10–17 years and their adult caregivers. The results showed that three studies provided evidence of stress buffering of specific stressors.

Findings of a further two studies suggest a stress-buffering effect of social support on mental health. Lakey and Orehek (2011) found that person reporting low social support showed a negative status of health, therefore increasing psychological distress whereas no connection was stated between distress and mental health of the individuals with higher

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level of support. Additionally, no significant correlation was established between distress and size of social network, indicating that quality is more important than quantity of support in moderating psychological distress reactions (Park, Jang, Lee, Ko, & Chiriboga, 2014).

Wang et al. (2014) narrated that parent’s stress gets crucial over the time due to lack of information regarding disease, physical condition of child, treatment procedures and side effects. Social support from family members, colleagues, friends and neighborhood is imperative. Generally, social support is available highly at the time of disclosure of disease and decline over the treatment phase where mothers are in more need of support than fathers (Sonnenberg et al., 2013).

In Western and Eastern families, the prevalence of similar experiences with pediatric cancer is highlighted by various authors. Both groups showed similar changes and responses to domestic and professional routine in company with somatic symptoms (Lima, Cardoso, & Silva, 2016). Regardless of the culture, the initial stages of treatment of cancer require more parental involvement, adaptation to requirements of treatment and social support (Rosell-Murphy et al., 2014).

Hence, the direct and the buffering-effects of social support vary in the structure and function of social support in the caregiving literature which shows its multi-dimensional nature. But for this study, stress buffering-effect of social support is under consideration.

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