The structure of the Beck Hopelessness Scale: A confirmatory factor analysis in UK students

The aim of this paper was to confirm the factor structure of the 20-item Beck Hopelessness Scale in a non-clinical population. Previous research has highlighted a lack of clarity in its construct validity with regards to this population.

Based on previous factor analytic findings from both clinical and non-clinical studies, 13 separate confirmatory factor models were specified and estimated using LISREL 8.72 to test the one, two and three-factor models.

Psychology and medical students at Queen's University, Belfast (n = 581) completed both the BHS and the Beck Depression Inventory (BDI).

All models showed reasonable fit, but only one, a four-item single-factor model demonstrated a nonsignificant chi-squared statistic. These four items can be used to derive a Short-Form BHS (SBHS) in which increasing scores (0-4) corresponded with increasing scores in the BDI. The four items were also drawn from all three of Beck's proposed triad, and included both positively and negatively scored items.

This study in a UK undergraduate non-clinical population suggests that the BHS best measures a one-factor model of hopelessness. It appears that a shorter four-item scale can also measure this one-factor model. (C) 2011 Elsevier Ltd. All rights reserved.

Depression, family support and hopelessness: a correlated study

This study aimed to verify the relationship between depression, hopelessness and family support. to this aim, were applied the Escala Baptista de Depressão-Adulto EBADEP- A, The Beck Hopelessness Scale –BHS, Inventário de Percepção de Suporte Familiar- IPSF and a sociodemographic questionnaire on a sample of 198 undergraduate of Pharmacy and Psychology courses of a particular university at São Paulo state (Brazil) with mean age of 23.44 years (SD = 6.8), and with a prevalence of women (80.7%). Results showed significant and positive correlations between EBADEP- A and BHS and significant and negative correlations between EBADEP- A/ BHS and IPSF, indicating that the higher perception of family support the fewer depressive symptoms and hopelessness, agreeing with literature.

An exploration of the relationship between social support and depressive symptoms in schizophrenia

Objective: Depressive symptoms in schizophrenia have previously been associated with a perceived lack of social support. The aim of this study was to explore the relationship between perceived social support and depressive symptoms in schizophrenia; to assess the psychological wellbeing of their carers; and to examine the quality of the relationship between the patients and their carers. Method: Individuals with schizophrenia (n = 17) were assessed on the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), a measure of perceived social support, the Significant Others Scale (SOS) and the Quality of Relationship Inventory (QRI). Results: The mean score on the BDI for patients fell within the moderate-severe range and the mean range on the BHS fell within the moderate range. Family and friends were perceived as supportive resources by patients. There was no significant relationship between patient epressive symptoms or hopelessness and perceived social support. Carers of patients did not report high rates of depressive symptoms or hopelessness. Conclusions: These findings do not support the previous finding of an association between depressive symptoms and a perceived lack of social support in schizophrenia.

Apoyo social e ideación suicida en pacientes con cáncer

El diagnóstico de cáncer ha sido asociado con un alto riesgo de presentar ideación suicida en comparación con la población no oncológica, sin embargo se ha considerado al apoyo social como un factor protector para la ocurrencia de esta conducta. La presente investigación tuvo como objetivo identificar la relación entre el apoyo social percibido y la ideación suicida en 90 pacientes oncológicos adultos en Bogotá, bajo la hipótesis de que a mayor apoyo social percibido, menor presencia de ideación suicida. Se midió la variable de apoyo social a través del cuestionario Duke UNC y la ideación suicida a través de cuatro instrumentos: Escala de Ideación Suicida (SSI), Escala de Desesperanza de Beck (BHS), el ítem 9 del Inventario de Depresión de Beck (BDI-IA) y una entrevista semiestructurada. Los resultados mostraron que no existe relación entre el apoyo social percibido y la ideación suicida. Por otro lado se identificó una prevalencia de suicidio entre 5,6% y 22,77%, confirmando que el paciente con cáncer considera el suicidio y es fundamental evaluar esta variable en esta población. Se considera importante continuar con la realización de investigaciones que permitan generalizar los resultados a la población oncológica colombiana.

Obesidade e sintomas de depressão, ansiedade e desesperança em mulheres sedentárias e não sedentárias

The aim of this field study was to verify if there is a relation between obesity and symptoms of depression, anxiety and hopelessness in 40 women aged 30,35 on average (± 8,60), divided into two groups: non-sedentary ones, characterized for doing a physical activity at least three times a week for three weeks in a row and sedentary ones, characterized by not practicing any type of regular physical activity when recruited. The method consisted of: objective evaluations of humor, through Beck Inventories of Anxiety (BAI), Depression (BDI) and Hopelessness (BHS) and Physical Evaluation, including total body mass, height, waist and hip circumferences and skin folds thickness. Calculations of the body mass index (BMI), of the waist/hip index (WHI) and of the percentage of corporal fat (%F) were performed in order to evaluate the presence and level of obesity. Results of the analysis of regression to square minimum supported the initial hypothesis concerning the existence of a relation between obesity and psychic symptoms only in sedentary women (BDI/WHI, p=0,035, BDI/BMI, p=0,009, BDI/%G, p=0,019, BAI/BMI, p=0,009, BAI/%G, p=0,037, BHS/WHI, p=0,025, BHS/BMI, p=0,041), once the relation of dependency could not be confirmed in non-sedentary women BDI/WHI, p=0,750, BDI/BMI, p=0,141, BDI/%G, p=0,064, BAI/WHI, p=0,729, BAI/BMI, p=0,384, BAI/%G, p=0,246, BHS/WHI, p=0,491, BHS/BMI, p=0,986, BHS/%G, p=0,322) and the greater the level of obesity, the greater the level of psychic symptoms in both groups. These observations seem to point out that the practice of physical activities was a factor of minimization of presence and intensity of psychic symptoms in non-sedentary women.

Sexual abuse and suicidality: gender differences in a large community sample of adolescents

Objective: A cross-sectional study of gender specific relationships between self-reported child sexual abuse and suicidality in a community sample of adolescents. Method: Students aged 14 years on average (N = 2,485) from 27 schools in South Australia completed a questionnaire including items on sexual abuse and suicidality, and measures of depression (Centre for Epidemiological Studies Depression Scale), hopelessness (Beck Hopelessness Scale), and family functioning (McMaster Family Assessment Device General Functioning Subscale). Data analysis included logistic regression. Results: In boys, self-report sexual abuse is strongly and independently associated with suicidal thoughts, plans, threats, deliberate self-injury, and suicide attempts, after controlling for current levels of depression, hopelessness, and family dysfunction. In girls, the relationship between sexual abuse and suicidality is mediated fully by depression, hopelessness, and family dysfunction. Girls who report current high distress about sexual abuse, however, have a threefold increased risk of suicidal thoughts and plans, compared to non-abused girls. Boys who report current high distress about sexual abuse have 10-fold increased risk for suicidal plans and threats, and 15-fold increased risk for suicide attempts, compared to non-abused boys. Fifty-five percent (n = 15) of sexually abused boys attempted suicide versus 29% (n = 17) girls. Conclusions: A history of sexual abuse should alert clinicians, professionals and caters in contact with adolescents, to greatly increased risks of suicidal behavior and attempts in boys, even in the absence of depression and hopelessness. Distress following sexual abuse, along with depression and hopelessness indicate increased risk of suicidal behavior in girls, as well as boys. (C) 2004 Published by Elsevier Ltd.

Ideación suicida y desesperanza en pacientes con cáncer

El objetivo de la presente investigación fue identificar la relación entre ideación suicida y desesperanza en 160 pacientes con cáncer. La ideación suicida se midió a través de dos ítems de una entrevista semiestructurada, la escala de ideación suicida (ISS), el ítem 9 del inventario de depresión de Beck (BDI-IA). La desesperanza se midió con la escala de desesperanza de Beck (BHS). Los resultados obtenidos indicaron una relación significativa (p=.000) entre ideación suicida y desesperanza; una prevalencia de ideación suicida en los pacientes con cáncer entre 4.4% y 13.8% y de riesgo de suicidio entre 5.6% y 30.6%; y algún grado de desesperanza en 31.9 % de los participantes. De acuerdo con lo anterior, se confirma que existe relación entre la desesperanza y la ideación suicida en pacientes oncológicos adultos. Adicionalmente, que estas variables están presentes en los pacientes y que ameritan atención en la intervención interdisciplinaria.

Moderating effects of gender in the relationships between daily stress, coping styles and hopelessness depression in adolescents

The hopelessness depression (HD) theory assumes a number of contributing factors to the development of hopelessness expectations and HD symptoms. Studies carried out to test HD theory have generally supported the prediction that a negative attributional style contributes to the development of hopelessness expectations and HD symptoms, although the evidence is less consistent for adolescents. Due to these inconsistent results, as well as the assumption advanced by HD theory that other factors aside from attributional style may contribute to the development of HD, in this study we examined the potential role of adolescents’ daily stress and coping styles as contributing factors to HD at these ages, and the effects of gender on these relationships. Seiffge-Krenke (1995) showed that stress in daily life plays a particularly relevant role during adolescence and described three coping styles used by adolescents to face daily stress: active and internal approach-oriented styles, which are considered functional and complementary, and avoidant style, considered dysfunctional. In this study, secondary students (N = 480; aged 13–17) completed the Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974), the Hopelessness Depression Symptoms Questionnaire (Metalsky & Joiner, 1997), the Problem Questionnaire ((Seiffge-Krenke, 1995) and the Coping Across Situations Questionnaire (Seiffge-Krenke, 1995). To test the role of daily stress and coping styles in the prediction of hopelessness expectations and HD symptoms, two four-step hierarchical multiple regression analyses were conducted. In these analyses, gender was introduced first, daily stress was introduced second, the three coping styles were entered in a third step, and the moderating effects of gender on the associations of the predictor variables (daily stress and each coping style) with the criterion variables (hopelessness expectations or HD symptoms) were introduced in a fourth step. Results showed a moderating effect of gender on the relationship between daily stress and hopelessness expectations, which revealed a significant effect for boys despite the fact that girls experienced more daily stress than boys, thus suggesting an inoculation effect in girls. It was also found a gender-dependent role of coping styles in the prediction of HD symptoms, revealing a protective effect for the active style in girls and for the internal style in boys. This suggests that girls would benefit from being more action-prone and boys more reflection-prone in order to prevent HD. These findings indicate that programmes aimed to promote coping skills in adolescents would benefit from being gender-adapted.

Prevalencia de ideación suicida y factores de riesgo para el suicidio en pacientes adultos con diagnóstico de cáncer.

determinar la prevalencia de ideación suicida y factores asociados en una muestra voluntaria de 114 pacientes oncológicos adultos. Método: Se entrevistaron los pacientes y se evaluó la presencia de ideación suicida (Escala de ideación suicida), depresión (Inventario de Depresión de Beck) y desesperanza (Escala de desesperanza de Beck). Resultados: La prevalencia de ideación suicida fue de 23,7%, se observaron altos niveles de depresión y desesperanza; así como asociación estadísticamente significativa entre ideación suicida y depresión. Conclusión: Se identificó la importancia de la intervención psicológica en los pacientes oncológicos.

Diseño de un modelo de intervención del suicidio en niños y adolescentes

Resumen El objetivo de este estudio fue el de diseñar un modelo de intervención para la prevención del suicidio en la población escolar de niños y adolescentes, con 72 participantes de un colegio público y un colegio privado de la ciudad de Bogotá. Se caracterizó el suicidio en la ciudad de Bogotá en los últimos nueve años, los aspectos legales, se analizaron algunos modelos de prevención, se identificaron los principales factores de riesgo y factores protectores y se propusieron estrategias para su prevención. Este modelo está basado en la administración social del riesgo y los factores protectores y de riesgo, susceptibles de modificación. Se realizó una prueba de tamizaje y fueron utilizados: el Inventario de depresión infantil (CDI de Kovacs), la escala de desesperanza de Beck y la escala de ansiedad para niños y adolescentes de Spence, validadas a nivel internacional. Se observó una correlación positiva (0.490) mediante el coeficiente de rangos de Spearman, con una significación de 0,01 (bilateral) para los tres factores de riesgo. Se hace entrega de un manual de instrucción para la intervención temprana del suicidio en esta población y un folleto informativo dirigido a padres de familia sobre los factores de riesgo y factores protectores. A partir de esto se plantean implicaciones futuras.

Central poststroke pain: somatosensory abnormalities and the presence of associated myofascial pain syndrome

Background: Central post-stroke pain (CPSP) is a neuropathic pain syndrome associated with somatosensory abnormalities due to central nervous system lesion following a cerebrovascular insult. Post-stroke pain (PSP) refers to a broader range of clinical conditions leading to pain after stroke, but not restricted to CPSP, including other types of pain such as myofascial pain syndrome (MPS), painful shoulder, lumbar and dorsal pain, complex regional pain syndrome, and spasticity-related pain. Despite its recognition as part of the general PSP diagnostic possibilities, the prevalence of MPS has never been characterized in patients with CPSP patients. We performed a cross-sectional standardized clinical and radiological evaluation of patients with definite CPSP in order to assess the presence of other non-neuropathic pain syndromes, and in particular, the role of myofascial pain syndrome in these patients. Methods: CPSP patients underwent a standardized sensory and motor neurological evaluation, and were classified according to stroke mechanism, neurological deficits, presence and profile of MPS. The Visual Analogic Scale (VAS), McGill Pain Questionnaire (MPQ), and Beck Depression Scale (BDS) were filled out by all participants. Results: Forty CPSP patients were included. Thirty-six (90.0%) had one single ischemic stroke. Pain presented during the first three months after stroke in 75.0%. Median pain intensity was 10 (5 to 10). There was no difference in pain intensity among the different lesion site groups. Neuropathic pain was continuous-ongoing in 34 (85.0%) patients and intermittent in the remainder. Burning was the most common descriptor (70%). Main aggravating factors were contact to cold (62.5%). Thermo-sensory abnormalities were universal. MPS was diagnosed in 27 (67.5%) patients and was more common in the supratentorial extra-thalamic group (P <0.001). No significant differences were observed among the different stroke location groups and pain questionnaires and scales scores. Importantly, CPSP patients with and without MPS did not differ in pain intensity (VAS), MPQ or BDS scores. Conclusions: The presence of MPS is not an exception after stroke and may present in association with CPSP as a common comorbid condition. Further studies are necessary to clarify the role of MPS in CPSP.

FADIGA E DEPRESSÃO NO IDOSO

A fadiga é um sintoma inespecífico, encontrado com freqüência na população. Ela é definida como sensação de cansaço físico profundo, perda de energia ou mesmo sensação de exaustão, e é importante a sua diferenciação com depressão ou fraqueza. Os transtornos depressivos e ansiosos constituem os transtornos psiquiátricos mais freqüentes no idoso, e quase sempre dão lugar a conseqüências graves neste grupo etário. Este estudo visa avaliar a influência da ansiedade e depressão sobre o desencadeamento de fadiga e evolução de problemas de saúde e de comportamentos peculiares ao processo de envelhecimento. Trata-se de um estudo, do tipo caso-controle investigando ansiedade, depressão e fadiga. Foram avaliados 61 indivíduos com 60 anos de idade ou mais. Um grupo controle constituído por 60 indivíduos jovens (idade até 35 anos), foram selecionados entre estudantes do Centro Universitário de Santo André que responderam um Questionário de Características Gerais, um Inventário de Ansiedade traço-estado, um Inventário de Depressão de Beck e uma Escala de Severidade de Fadiga. O grupo de idosos apresentou um escore significativamente maior em relação ao grupo controle na escala de severidade de fadiga. O grupo de idosos apresentou escore médio de 36,87 ± 14,61 enquanto o grupo controle apresentou escore médio de 31,47 ± 12,74 (t = 2,167; df = 119; p = 0,032). No entanto, o grupo de idosos apresentou escores significativamente maiores na escala de Beck (10,54 ± 8,63) em relação aos controles (6,83 ± 7,95); t = 2,455; df = 119; p = 0,016). Analisando-se apenas o grupo de indivíduos idosos, observou-se uma correlação significativa entre os escore da escala de severidade de fadiga e a escala de depressão de Beck (correlação de Pearson = 0,332; p = 0,009). Ainda trabalhando apenas com o grupo de indivíduos idosos, observou-se um escore significativamente maior da escala de severidade de fadiga naqueles indivíduos que praticavam atividade física regular, sendo, escore médio de 31,55 ± 13,36; (t = 2,203; df = 58; p = 0,032). A partir da análise dos resultados deste estudo pôde-se concluir que o grupo de indivíduos idosos apresentam estatisticamente significante escore maior, quando comparado com o grupo controle, apresentando mais sintomas de fadiga e depressão. Estes sintomas de fadiga ocorreram em conjunto com sintomas depressivos sugerindo uma possível correlação entre estes. Quando se observou apenas os idosos, esta correlação foi confirmada. Analisado-se ainda somente o grupo de indivíduos idosos observa-se que o grupo de idosos que praticam atividade física regularmente apresentam menos sintomas fadiga que o grupo que não pratica atividade física.(AU)

FADIGA E DEPRESSÃO NO IDOSO

A fadiga é um sintoma inespecífico, encontrado com freqüência na população. Ela é definida como sensação de cansaço físico profundo, perda de energia ou mesmo sensação de exaustão, e é importante a sua diferenciação com depressão ou fraqueza. Os transtornos depressivos e ansiosos constituem os transtornos psiquiátricos mais freqüentes no idoso, e quase sempre dão lugar a conseqüências graves neste grupo etário. Este estudo visa avaliar a influência da ansiedade e depressão sobre o desencadeamento de fadiga e evolução de problemas de saúde e de comportamentos peculiares ao processo de envelhecimento. Trata-se de um estudo, do tipo caso-controle investigando ansiedade, depressão e fadiga. Foram avaliados 61 indivíduos com 60 anos de idade ou mais. Um grupo controle constituído por 60 indivíduos jovens (idade até 35 anos), foram selecionados entre estudantes do Centro Universitário de Santo André que responderam um Questionário de Características Gerais, um Inventário de Ansiedade traço-estado, um Inventário de Depressão de Beck e uma Escala de Severidade de Fadiga. O grupo de idosos apresentou um escore significativamente maior em relação ao grupo controle na escala de severidade de fadiga. O grupo de idosos apresentou escore médio de 36,87 ± 14,61 enquanto o grupo controle apresentou escore médio de 31,47 ± 12,74 (t = 2,167; df = 119; p = 0,032). No entanto, o grupo de idosos apresentou escores significativamente maiores na escala de Beck (10,54 ± 8,63) em relação aos controles (6,83 ± 7,95); t = 2,455; df = 119; p = 0,016). Analisando-se apenas o grupo de indivíduos idosos, observou-se uma correlação significativa entre os escore da escala de severidade de fadiga e a escala de depressão de Beck (correlação de Pearson = 0,332; p = 0,009). Ainda trabalhando apenas com o grupo de indivíduos idosos, observou-se um escore significativamente maior da escala de severidade de fadiga naqueles indivíduos que praticavam atividade física regular, sendo, escore médio de 31,55 ± 13,36; (t = 2,203; df = 58; p = 0,032). A partir da análise dos resultados deste estudo pôde-se concluir que o grupo de indivíduos idosos apresentam estatisticamente significante escore maior, quando comparado com o grupo controle, apresentando mais sintomas de fadiga e depressão. Estes sintomas de fadiga ocorreram em conjunto com sintomas depressivos sugerindo uma possível correlação entre estes. Quando se observou apenas os idosos, esta correlação foi confirmada. Analisado-se ainda somente o grupo de indivíduos idosos observa-se que o grupo de idosos que praticam atividade física regularmente apresentam menos sintomas fadiga que o grupo que não pratica atividade física.(AU)

FADIGA E DEPRESSÃO NO IDOSO

A fadiga é um sintoma inespecífico, encontrado com freqüência na população. Ela é definida como sensação de cansaço físico profundo, perda de energia ou mesmo sensação de exaustão, e é importante a sua diferenciação com depressão ou fraqueza. Os transtornos depressivos e ansiosos constituem os transtornos psiquiátricos mais freqüentes no idoso, e quase sempre dão lugar a conseqüências graves neste grupo etário. Este estudo visa avaliar a influência da ansiedade e depressão sobre o desencadeamento de fadiga e evolução de problemas de saúde e de comportamentos peculiares ao processo de envelhecimento. Trata-se de um estudo, do tipo caso-controle investigando ansiedade, depressão e fadiga. Foram avaliados 61 indivíduos com 60 anos de idade ou mais. Um grupo controle constituído por 60 indivíduos jovens (idade até 35 anos), foram selecionados entre estudantes do Centro Universitário de Santo André que responderam um Questionário de Características Gerais, um Inventário de Ansiedade traço-estado, um Inventário de Depressão de Beck e uma Escala de Severidade de Fadiga. O grupo de idosos apresentou um escore significativamente maior em relação ao grupo controle na escala de severidade de fadiga. O grupo de idosos apresentou escore médio de 36,87 ± 14,61 enquanto o grupo controle apresentou escore médio de 31,47 ± 12,74 (t = 2,167; df = 119; p = 0,032). No entanto, o grupo de idosos apresentou escores significativamente maiores na escala de Beck (10,54 ± 8,63) em relação aos controles (6,83 ± 7,95); t = 2,455; df = 119; p = 0,016). Analisando-se apenas o grupo de indivíduos idosos, observou-se uma correlação significativa entre os escore da escala de severidade de fadiga e a escala de depressão de Beck (correlação de Pearson = 0,332; p = 0,009). Ainda trabalhando apenas com o grupo de indivíduos idosos, observou-se um escore significativamente maior da escala de severidade de fadiga naqueles indivíduos que praticavam atividade física regular, sendo, escore médio de 31,55 ± 13,36; (t = 2,203; df = 58; p = 0,032). A partir da análise dos resultados deste estudo pôde-se concluir que o grupo de indivíduos idosos apresentam estatisticamente significante escore maior, quando comparado com o grupo controle, apresentando mais sintomas de fadiga e depressão. Estes sintomas de fadiga ocorreram em conjunto com sintomas depressivos sugerindo uma possível correlação entre estes. Quando se observou apenas os idosos, esta correlação foi confirmada. Analisado-se ainda somente o grupo de indivíduos idosos observa-se que o grupo de idosos que praticam atividade física regularmente apresentam menos sintomas fadiga que o grupo que não pratica atividade física.(AU)

Mulheres com lúpus eritematoso sistêmico: sintomas depressivos e apoio social percebido

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, rare, multisystem, with a very heterogeneous clinical and serological manifestations standard. The patient, in addition to suffering injuries on his physical and physiological functioning, may also face a number of psychosocial problems. Research indicates that SLE can cause significant damage to the psychological realm, especially with the presence of anxiety and depression. In 1999, the American College of Rheumatology (ACR), proposed the establishment of 19 neuropsychiatric clinical syndromes attributed to SLE. Depression lies between mood disorders and is one of the most common psychiatric manifestations in this group, being found more frequently in these patients than in the general population. Studies also suggest that social support plays an important role in the development of coping strategies, in SLE management and depression. This study has as main objective verify the association between depressive symptoms and perceived social support in patients with SLE. The specific objectives turned to: investigte the prevalence of depressive symptoms; investigate the perceived social support and verify if there is an association between depression, social support and sociodemographic variables. We used a sociodemographic questionnaire, the Beck Depression Scale, and the Perceived Social Support Scale. The analysis was performed through descriptive and inferential statistics. The final sample could count with 79 SLE women, with an average age of 35.7 years. 44 (55.7%) of the participants were married. Only 6 (7.59%) had completed higher education and 32 (40.51%) have not finished high school. Seventy-one (89.87%) had an income below three minimum salaries and 71 (89.87) practiced a religion, and the Catholic (67.71%) was the most mentioned by them. Of the total sample, 37 (46.74%) had been diagnosed SLE more than 7 years before, and 25 (31.65%) had the disease for more than 10 years. Only 19 (24.05%) had some work activity. Forty-two of them (53.17%) had depressive symptoms levels from mild to severe, and 51 (64.46%) reported pain levels of 5, or above. The study found a significant association between depressive symptoms and pain (p = 0.013) and depressive symptoms and work activity (p = 0.02). When we examined the perception of social support, the results showed high levels among participants. Using the Spearman correlation test we found a strong correlation between depressive symptoms and social support (p= 0,000037). It means that the higher the frequency of support, the lower the score of depression. These findings are relevant because depressive symptoms in patients with SLE have a multicausal and multifactorial character and may remain unnoticed, since many of them are confused with the manifestations of the disease. This fact requires a careful assessment from professionals, not only in the clinical setting, but also considering other psychosocial reasons, that may be influencing the emergence or worsening of symptoms. These results also corroborate other studies, which not only confirm the predictive role of social support in the physical wellbeing, but also in the psychological.