Mental Health

The Stress-Buffering Effect of Social Support on Socio-Economic Disparities in Mental Health among Cancer Survivors.

TL;DR

High social support buffered the negative effect of low socio-economic status on mental health among cancer survivors, reducing SES-related disparities in psychological distress, mental well-being, and depression, though this buffering effect was less evident among women.

Key Findings

Mental health vulnerability was highest among cancer survivors with low levels of social support, where no SES-related differences in mental health were observed.

  • Study used two nationally representative surveys conducted in Spain in 2017 (n = 1,143) and 2023 (n = 980)
  • Participants were cancer survivors identified from these surveys
  • At low social support levels, mental health was poor across all SES groups, meaning low SES did not further differentiate outcomes
  • This pattern was observed across three mental health outcomes: psychological distress, mental well-being, and depression

Under medium levels of social support, low SES was associated with significantly higher psychological distress, lower mental well-being, and higher rates of depression among cancer survivors.

  • Low SES linked to higher psychological distress under medium social support: B = 0.24, 95% CI [0.05, 0.42]
  • Low SES linked to lower mental well-being under medium social support: B = -6.08, 95% CI [-1.98, -10.18]
  • Low SES linked to higher rates of depression under medium social support: OR = 2.78, 95% CI [1.52, 5.00]
  • These findings suggest that medium social support is sufficient to reveal, but not eliminate, SES-related mental health inequalities

High social support buffered the negative effect of low SES on mental health, improving mental health among low-SES cancer survivors and reducing SES-related disparities.

  • High social support attenuated SES disparities across all three mental health outcomes: psychological distress (GHQ-12), mental well-being (WHO-5 Index), and depression (PHQ-8)
  • The buffering effect was consistent across both the 2017 and 2023 survey samples
  • Social support was measured using both the Duke-UNC questionnaire and the Oslo Social Support Scale
  • Multiple regression framework was complemented by generalized additive models to capture potential non-linear effects of social support

The stress-buffering effect of social support on SES-related mental health disparities was less evident among women, for whom inequalities persisted regardless of social support levels.

  • Sub-group analyses by sex revealed that the buffering effect differed by gender
  • Among women, SES-related mental health inequalities persisted even at high levels of social support
  • The buffering effect was described as 'less evident among women' rather than absent
  • This sex-based difference was observed consistently across the mental health outcomes examined

SES was identified as a major chronic stressor frequently associated with worse mental health among cancer survivors, motivating investigation of social support as a potential moderator.

  • SES was measured using the social class index of the Spanish Society of Epidemiology
  • The study examined whether social support could 'mitigate the negative impact of low SES on the mental health of individuals with a history of cancer'
  • Low SES is framed as a 'major chronic stressor' in the context of cancer survivorship
  • The stress-buffering hypothesis provided the theoretical framework for the study

What This Means

This research examined whether having strong social support could help protect the mental health of cancer survivors who face economic disadvantages. Using data from two large, nationally representative surveys conducted in Spain in 2017 and 2023, researchers looked at over 2,000 cancer survivors and measured their socioeconomic status, levels of social support, and three aspects of mental health: psychological distress, mental well-being, and depression. The study found that social support plays a complex but important role in shaping mental health inequalities among cancer survivors. When social support was low, mental health was poor across all income and social class groups — meaning that lacking social connections was so harmful that it erased any differences between wealthier and poorer survivors. At medium levels of social support, economic disadvantages became more visible: lower-SES survivors had significantly worse mental health, including nearly three times the odds of depression compared to higher-SES survivors. Importantly, when social support was high, these economic gaps in mental health narrowed substantially, suggesting that strong social networks can act as a buffer against the mental health toll of financial hardship during cancer survivorship. However, this protective effect was weaker for women, who continued to show mental health inequalities by socioeconomic status even when they had high social support. This research suggests that efforts to improve social connectedness — such as peer support programs, community networks, or social prescribing — could help reduce mental health inequalities among cancer survivors, particularly those from lower socioeconomic backgrounds. The finding that women benefit less from social support as a buffer points to the need for gender-sensitive approaches in cancer survivorship care, as women may face additional stressors or barriers that social support alone does not address.

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Citation

Petrova D, Redondo-Sánchez D, Madrid Pérez-Esparza B, Fernández-Navarro P, Blakoe M, Luque Caro R, et al.. (2026). The Stress-Buffering Effect of Social Support on Socio-Economic Disparities in Mental Health among Cancer Survivors.. Psychosocial intervention. https://doi.org/10.5093/pi2026a9