The Impact of Personal-Level Social Networks on Treatment Adherence, Depression, Anxiety, and Perceived Stigma Among Adults with Cystic Fibrosis: An Egocentric Network Analysis.

Background: Among people with cystic fibrosis (CF), health behaviors and mental health have been associated with general social support. We used egocentric network analysis to assess the specific impact of social network variables on treatment adherence, depression, anxiety, and perceived stigma among adults with CF. Our goal is to identify the social network factors which may be driving adherence, anxiety, depression, and perceived stigma among adults with CF toward developing targeted network-based interventions.

Method: Our primary outcome, adherence to individual-level treatment regimens, was assessed using composite prescription refill history (cMPR), self-reported airway clearance therapy (ACT), and consumption of all prescriptions. Secondary outcomes were assessed via patient completion of the Patient Health Questionnaire-9 (PHQ-9) for depression, the General Anxiety Disorder-7 (GAD-7) for anxiety, and the CF Stigma Scale for perceived stigma. Participants also completed a social network interview to collect data on personal-level networks. Controlling for participant age, sex, race, relationship status, work status, and CF disease severity, we explored the impact of network variables on our primary and secondary outcomes using regression analysis. All models were run twice to assess both core and strong network ties.

Results: Regression analysis of 104 participants showed that strong network ties serving as health discussants and health regulators were positively associated with stronger adherence, while financial dependence and network density were associated with decreased adherence. Network alters having higher education levels, strong trust in doctors, and support for daily activities were associated with lower depression, anxiety, and perceived stigma. Participants having a higher proportion of network members who hassled them and had lower trust and/or greater variability in trust in doctors experienced higher depression, anxiety, and perceived stigma.

Conclusion: Findings show that network-based variables including close ties to health discussants, network members' education levels, and health beliefs, as well as having network members providing support for daily activities may be driving specific aspects of adherence, symptoms of depression and anxiety, and perceived stigma among adults with CF. These findings may thus allow us to leverage social networks in the development of novel interventions to improve adherence and mental health and reduce perceived stigma for people with CF.