On the positive relation between received social support and negative affect: a test of the triage and self-esteem threat models in women with breast cancer

Objective: There is a seemingly paradoxical positive relation between received social support and psychological distress in cancer patients. This study evaluates two models that explain this positive relation: (a) the triage model, which argues that more distressed people receive more support and (b) the self-esteem threat model, which argues that receiving support increases distress by undermining self-esteem. Methods: Longitudinal survey data were collected from 71 women treated for breast cancer at 3- (T1) and 18-months (T2) post-diagnosis Results: Analyses did not disconfirm either model. Consistent with the triage model, there was a marginally significant (p 5 0.052) positive relation between T1 negative affect and T2 received support, controlling for T1-received support. Consistent with the self-esteem threat model, a significant positive relation between T1 received support and T2 negative affect, controlling for T1 negative affect, appeared to be mediated by T2 self-esteem. Conclusions: These findings suggest that people with cancer who are most distressed may receive the most social support, but the conveyance of support can have negative consequences for self-esteem and affect. Copyright r 2008 John Wiley & Sons, Ltd.