The influence of social support and problematic support on optimism and depression in chronic illness: A prospective study evaluating self-esteem as a mediator

The present study focused on the mechanism through which social and problematic support affects psychological adjustment in chronic illness. The authors hypothesized that self-esteem would mediate the relations between social and problematic support and adjustment. Eighty-six end-stage renal disease patients were assessed twice for social support, problematic support, and self-esteem. Adjustment was assessed twice by depression and optimism. Mediational analyses indicated that social support operated through self-esteem to influence optimism cross-sectionally and prospectively and depression cross-sectionally. Social support was associated with high self-esteem, which in turn increased optimism and was related to decreased depression. Problematic support was unrelated to self-esteem obviating mediational analysis. Disaggregating social support into subscales showed that belonging support predicted decreases in depression, and both tangible and belonging support predicted increases in optimism.