title: The mediating effects of social support and self-efficacy on the relationship between social distress and emotional distress in head and neck cancer outpatients with facial disfigurement.
abstract: OBJECTIVE
  Although social support has been recognized as an important factor in the quality of life of head and neck cancer patients, there has been little investigation of the buffering effect of social support on these patients' social distress or of the coping skill of self-efficacy. The aim of this study was to examine how social support and self-efficacy mediate the relationship between social distress and emotional distress in head and neck cancer patients.
  
  
  METHODS
  Two hundred twenty-five head and neck cancer patients completed our questionnaire (effective response rate, 92.2%). Of these, 129 (57.3%) had facial disfigurement. These participants responded to questions about perception of social distress, social support, self-efficacy, and emotional distress (depression and anxiety). We used structural equation modeling for statistical analysis.
  
  
  RESULTS
  The fit indices of this model were excellent (χ2 (7) = 9.147, p = 0.242, goodness of fit index (GFI) = 0.981, adjusted goodness of fit index (AGFI) = 0.922, comparative fit index (CFI) = 0.993, root mean square error of approximation (RMSEA) = 0.049). Self-efficacy strongly buffered the negative influence of social distress on emotional distress. Social support from family members did not have a direct or indirect influence on emotional distress. Social support from friends was related to lower social distress and higher emotional distress.
  
  
  CONCLUSIONS
  Our findings suggest that self-efficacy might confound the relationship between social support and emotional distress, and that different sources of social support might play different roles in the mediation of social distress on emotional distress.
authors.affiliation: Keio Advanced Research Centers, Keio University, Minato-ku, Tokyo, Japan. denominako@a5.keio.jp
authors.forename: Minako
authors.initials: M
authors.lastname: Deno
authors.forename: Mie
authors.initials: M
authors.lastname: Tashiro
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Takahiro
authors.initials: T
authors.lastname: Asakage
authors.forename: Koji
authors.initials: K
authors.lastname: Takahashi
authors.forename: Kenich
authors.initials: K
authors.lastname: Saito
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Busujima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Mori
authors.forename: Hiroto
authors.initials: H
authors.lastname: Saito
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ichikawa
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001828:Body Image; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D006258:Head and Neck Neoplasms / Q000523:psychology*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011788:Quality of Life; D020377:Self Efficacy; D012934:Social Isolation; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires