title: The social environment and illness uncertainty in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Illness uncertainty is associated with worse outcomes in patients with chronic health conditions. Research on social factors associated with uncertainty has focused on the beneficial role of social support. The goal of this study was to develop a more nuanced understanding of the social factors that are associated with uncertainty.
  
  
  METHODS
  Four hundred sixty-two individuals with alpha-1 antitrypsin deficiency (AATD)-associated chronic obstructive pulmonary disease (COPD) completed a mailed questionnaire. Measures of the social environment included general family functioning, perceived criticism from family members, whether the participant had family members with AATD or COPD, and participation in support groups. Uncertainty was measured using the Mishel Uncertainty in Illness Scale including subscales for ambiguity (uncertainty about physical cues and symptoms) and complexity (uncertainty about treatment and the medical system). Hierarchical regression was used to identify social correlates of ambiguity and complexity while adjusting for demographic and medical characteristics and psychological distress.
  
  
  RESULTS
  Perceived criticism was associated with more complexity (b = 0.21, SE = 0.09, p = 0.015) and ambiguity (b = 0.40, SE = 0.12, p = 0.001). Having a family member with AATD or COPD was associated with more ambiguity (b = 3.28, SE = 1.00, p = 0.001). Participation in support groups was associated with less ambiguity. Individuals who attended three or more support groups in the prior year reported less ambiguity than individuals who had not attended any (b = -3.31, SE = 1.29, p = 0.010).
  
  
  CONCLUSIONS
  The social environment is complex and encompasses more than social support. Multiple aspects of the social environment are associated with uncertainty, including perceived criticism, having a family member with a similar illness, and participation in support groups.
authors.affiliation: Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, W278GH, Iowa City, IA, 52242, USA, karin-hoth@uiowa.edu.
authors.forename: Karin F
authors.initials: KF
authors.lastname: Hoth
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Wamboldt
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sandhaus
authors.forename: Charlie
authors.initials: C
authors.lastname: Strange
authors.forename: David B
authors.initials: DB
authors.lastname: Bekelman
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Holm
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D012931:Social Environment; D012944:Social Support; D011795:Surveys and Questionnaires; D035501:Uncertainty; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications*