Research examining the relationship between social support and psychological well-being has largely ignored the negative side of social interactions. However, empirical evidence suggests that negative interactions can potentially be more harmful than social support is helpful. This article critically reviews the literature investigating the relationship between social support and negative social interactions and their simultaneous effect on psychological well-being. A review of 28 studies revealed that there are conceptual, theoretical, and methodological limitations associated with this body of research. In order to unravel some of these limitations, studies are grouped according to three conceptual models: the additive effects model, the moderator model, and the domain-specific model. Finally, the article discusses directions social work practice research should take to tackle and fully appreciate the complexities of the relationship between social support and psychological well-being.A long tradition of theory and research examines the relationship between social support and health. Research findings have repeatedly shown that people with spouses, family members, and friends who provide psychological and material support have better physical and mental health than those who have fewer resources. Mortality, morbidity, depression, and other undesirable health-related outcomes have been associated with the lack of social relationships (Blazer 1982;Cohen and Wills 1985;House, Umberson, and Landis 1988).Another substantial body of literature has used a stress and coping theoretical framework to examine the role of social factors in health and well-being. The theory posits that adaptation is influenced by the stressful life situations to which a person is exposed, by the appraisal of such stressors, and by the psychological and social resources available to cope with them (Lazarus 1966;Pearlin and Schooler 1978;Billings and Moos 1981;Lazarus and Folkman 1984). Given the importance of social resources, researchers are focusing on understanding the critical components of social networks and identifying their role in the stress and coping process.Most research in the field of social support focuses on its positive aspects, such as instrumental, emotional, esteem, and tangible support. These findings are well established and quite promising. However, the focus on the positive aspects of social support obscures that there are also costs associated with social relations. The negative side of social relationships has received considerably less attention. A small, but growing body of research Abramis, and Caplan 1985;Davis and Rhodes 1994). Other studies, however, report a stronger effect from positive interactions on psychological well-being (e.g., Okun and Keith 1998), whereas still others report equal effects of the two constructs (e.g., IngersollDayton, Morgan, and Antonucci 1997). These conflicting findings suggest that we must take a more balanced approach to investigating the relationship between social tie...

SummaryBackgroundIntrahepatic cholestasis of pregnancy, characterised by maternal pruritus and increased serum bile acid concentrations, is associated with increased rates of stillbirth, preterm birth, and neonatal unit admission. Ursodeoxycholic acid is widely used as a treatment without an adequate evidence base. We aimed to evaluate whether ursodeoxycholic acid reduces adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy.MethodsWe did a double-blind, multicentre, randomised placebo-controlled trial at 33 hospital maternity units in England and Wales. We recruited women with intrahepatic cholestasis of pregnancy, who were aged 18 years or older and with a gestational age between 20 weeks and 40 weeks and 6 days, with a singleton or twin pregnancy and no known lethal fetal anomaly. Participants were randomly assigned 1:1 to ursodeoxycholic acid or placebo, given as two oral tablets a day at an equivalent dose of 500 mg twice a day. The dose could be increased or decreased at the clinician's discretion, to a maximum of four tablets and a minimum of one tablet a day. We recommended that treatment should be continued from enrolment until the infant's birth. The primary outcome was a composite of perinatal death (in-utero fetal death after randomisation or known neonatal death up to 7 days after birth), preterm delivery (<37 weeks' gestation), or neonatal unit admission for at least 4 h (from birth until hospital discharge). Each infant was counted once within this composite. All analyses were done according to the intention-to-treat principle. The trial was prospectively registered with the ISRCTN registry, number 91918806.FindingsBetween Dec 23, 2015, and Aug 7, 2018, 605 women were enrolled and randomly allocated to receive ursodeoxycholic acid (n=305) or placebo (n=300). The primary outcome analysis included 304 women and 322 infants in the ursodeoxycholic acid group, and 300 women and 318 infants in the placebo group (consent to use data was withdrawn for 1 woman and 2 infants). The primary composite outcome occurred in 74 (23%) of 322 infants in the ursodeoxycholic acid group and 85 (27%) of 318 infants in the placebo group (adjusted risk ratio 0·85 [95% CI 0·62–1·15]). Two serious adverse events were reported in the ursodeoxycholic acid group and six serious adverse events were reported in the placebo group; no serious adverse events were regarded as being related to treatment.InterpretationTreatment with ursodeoxycholic acid does not reduce adverse perinatal outcomes in women with intrahepatic cholestasis of pregnancy. Therefore, its routine use for this condition should be reconsidered.FundingNational Institute for Health Research Efficacy and Mechanism Evaluation Programme.

A small but growing literature recognizes the varied roles that clergy play in identifying and addressing mental health needs in their congregations. Although the role of the clergy in mental health services delivery has not been studied extensively, a few investigations have attempted a systematic examination of this area. This article examines the research, highlighting available information with regard to the process by which mental health needs are identified and addressed by faith communities. Areas and issues where additional information is needed also are discussed. Other topics addressed include client characteristics and factors associated with the use of ministers for personal problems, the role of ministers in mental health services delivery, factors related to the development of church-based programs and service delivery systems, and models that link churches and formal services agencies. A concluding section describes barriers to and constraints against effective partnerships between churches, formal services agencies, and the broader practice of social work.

This study examines the relationships among social support, negative interaction, financial strain, traumatic events, personal control, personality, and psychological distress among African American and white adults. These analyses: (1) test the overall adequacy of various models (i.e., main, mediator, and artifactual effects) of these effects, (2) examine the role of social support and negative interaction within the context of financial strain and traumatic events, and (3) verify possible indirect effects of social interaction on distress by assessing their impact on personal control. Data from The National Comorbidity Survey were used to examine these relationships using structural equation modeling techniques. Findings indicated different models of these relationships for African Americans and whites. Overall, personal control mediated the relationship between negative interaction and psychological distress. For whites, negative interaction was an overall stronger predictor of distress and contributed to the impact of financial strain and traumatic events on psychological distress. Among African Americans, social support was a stronger predictor of distress. The findings suggest that the underlying models of these relationships are different for African Americans and whites.Over 20 years of research has verified the importance of positive and negative aspects of personal relationships for health and well-being (Abbey, Abramis, and Caplan 1985;Finch et al.

This study examined demographic predictors of attitudes regarding religious coping (i.e., prayer during stressful times and look to God for support, strength and guidance) within a national sample of African American, Caribbean Blacks and non-Hispanic Whites (National Survey of American Life). The findings demonstrate significant Black-White differences in attitudes regarding religious coping with higher endorsements of religious coping among African Americans and Black Caribbeans (Caribbean Blacks). Comparisons of African Americans and Black Caribbeans revealed both similar and divergent patterns of demographic effects. For both African Americans and Black Caribbeans, women were more likely to utilize religious coping than men and married respondents were more likely than never married respondents to report utilizing prayer when dealing with a stressful situation. Further, for both groups, higher levels of education were associated with lower endorsements of the importance of prayer in dealing with stressful situations. Among African Americans only, Southerners were more likely than respondents who resided in other regions to endorse religious coping. Among Black Caribbeans, those who emigrated from Haiti were more likely than Jamaicans to utilize religious coping when dealing with a stressful episode.