Examines whether the positive association between social support and well-being is attributable more to an overall beneficial effect of support (main- or direct-effect model) or to a process of support protecting persons from potentially adverse effects of stressful events (buffering model). The review of studies is organized according to (1) whether a measure assesses support structure (the existence of relationships) or function (the extent to which one's interpersonal relationships provide particular resources) and (2) the degree of specificity (vs globality) of the scale. Special attention is given to methodological characteristics that are requisite for a fair comparison of the models. It is concluded that there is evidence consistent with both models. Evidence for the buffering model is found when the social support measure assesses the perceived availability of interpersonal resources that are responsive to the needs elicited by stressful events. Evidence for a main effect model is found when the support measure assesses a person's degree of integration in a large social network. Both conceptualizations of social support are correct in some respects, but each represents a different process through which social support may affect well-being. Implications for theories of social support processes and for the design of preventive interventions are discussed.

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Stress, social support, and the buffering hypothesis.

Job Demands, Job Decision Latitude, and Mental Strain: Implications for Job Redesign

The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.

The Multidimensional Scale of Perceived Social Support

Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health. Prospective studies, which control for baseline health status, consistently show increased risk of death among persons with a low quantity, and sometimes low quality, of social relationships. Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes. The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored.

https://science.sciencemag.org/content/sci/241/4865/540.full.pdf

Social relationships and health.

Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

Work stress and social support

This chapter reviews the recent literature on social support and health and its relation to preexisting research and theory in the areas of social networks and social integration. We identify crucial directions for future theoretical and empirical work, focusing on the need to better understand the structures and processes through which social relationships affect human health and well-being. Two elements of social relationship structure are distinguished: (a) social integration, which refers to the existence or quantity of social relationships, and (b) social network structure, referring to the structural properties that characterize a set of relationships. We further identify three social processes through which these structures may have their effects: (i) social support, which pertains to the emotionally or instrumentally sustaining quality of social relationships; (ii) relational demands and conflict, referring to the negative or conflictive aspects of social relationships; and (iii) social regulation...

Structures and Processes of Social Support

Context.— A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income. Objective.— To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and allcause mortality. Design.— Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years. Participants.— A nationally representative sample of 3617 adult women and men participating in the Americans’ Changing Lives survey. Main Outcome Measure.— All-cause mortality verified through the National Death Index and death certificate reviews. Results.— Educational differences in mortality were explained in full by the strong association between education and income. Controlling for age, sex, race, urbanicity, and education, the hazard rate ratio of mortality was 3.22 (95% confidence interval [CI], 2.01-5.16) for those in the lowest-income group and 2.34 (95% CI, 1.49-3.67) for those in the middle-income group. When health risk behaviors were considered, the risk of dying was still significantly elevated for the lowestincome group (hazard rate ratio, 2.77; 95% CI, 1.74-4.42) and the middle-income group (hazard rate ratio, 2.14; 95% CI, 1.38-3.25). Conclusion.— Although reducing the prevalence of health risk behaviors in lowincome populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged.

https://jamanetwork.com/journals/jama/articlepdf/187597/joc72105.pdf

Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults

Studies on the health effects of income inequality have generated great interest. The evidence on this association between countries is mixed,1–4 but income inequality and health have been linked within the United States,5–11 Britain,12 and Brazil.13 Questions remain over how to interpret these findings and the mechanisms involved. We discuss three interpretations of the association between income inequality and health: the individual income interpretation, the psychosocial environment interpretation, and the neo-material interpretation.

#### Summary points

Income inequality has generally been associated with differences in health

A psychosocial interpretation of health inequalities, in terms of perceptions of relative disadvantage and the psychological consequences of inequality, raises several conceptual and empirical problems

Income inequality is accompanied by many differences in conditions of life at the individual and population levels, which may adversely influence health

Interpretation of links between income inequality and health must begin with the structural causes of inequalities, and not just focus on perceptions of that inequality

Reducing health inequalities and improving public health in the 21st century requires strategic investment in neo-material conditions via more equitable distribution of public and private resources

We reviewed the literature through traditional and electronic means and supplemented this with correlational analyses of gross domestic product and life expectancy and of income inequality and mortality trends based on data from the World Bank,14 the World Health Organization,15 and two British sources.16 17

According to the individual income interpretation, aggregate level associations between income inequality and health reflect only the individual level association between income and health. The curvilinear relation between income and health at the individual level 18 19 is a sufficient condition to produce health differences between populations with the same average income but different distributions of income.3 20 This interpretation assumes that determinants …

https://www.bmj.com/content/bmj/320/7243/1200.full.pdf

James S. House

Papers

Social relationships and health.

Work stress and social support

Structures and Processes of Social Support

Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults

Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions