The role of social relations in health promotion
TL;DR: Acknowledging that health promotion rests on the shoulders not only of individuals but also of their families and communities means that resources must be committed over the next decade to designing, testing, and implementing interventions in this area.
Abstract: In considering new paradigms for the prevention and treatment of disease and disability, we need to incorporate ways to promote social support and develop family and community strengths and abilities into our interventions. There is now a substantial body of evidence that indicates that the extent to which social relationships are strong and supportive is related to the health of individuals who live within such social contexts. A review of population-based research on mortality risk over the last 20 years indicates that people who are isolated are at increased mortality risk from a number of causes. More recent studies indicate that social support is particularly related to survival postmyocardial infarction. The pathways that lead from such socioenvironmental exposures to poor health outcomes are likely to be multiple and include behavioral mechanisms and more direct physiologic pathways related to neuroendocrine or immunologic function. For social support to be health promoting, it must provide both a sense of belonging and intimacy and must help people to be more competent and self-efficacious. Acknowledging that health promotion rests on the shoulders not only of individuals but also of their families and communities means that we must commit resources over the next decade to designing, testing, and implementing interventions in this area.
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TL;DR: In this article, the authors present a conceptual model of how social networks impact health, and argue that networks operate at the behavioral level through four primary pathways: (1) provision of social support; (2) social influence; (3) on social engagement and attachment; and (4) access to resources and material goods.
4,033 citations
TL;DR: The authors found that in ethnically diverse neighbourhoods residents of all races tend to "hunker down" and trust (even of one's own race) is lower, altruism and community cooperation rarer, friends fewer.
Abstract: Ethnic diversity is increasing in most advanced countries, driven mostly by sharp increases in immigration. In the long run immigration and diversity are likely to have important cultural, economic, fiscal, and developmental benefits. In the short run, however, immigration and ethnic diversity tend to reduce social solidarity and social capital. New evidence from the US suggests that in ethnically diverse neighbourhoods residents of all races tend to ‘hunker down’. Trust (even of one's own race) is lower, altruism and community cooperation rarer, friends fewer. In the long run, however, successful immigrant societies have overcome such fragmentation by creating new, cross-cutting forms of social solidarity and more encompassing identities. Illustrations of becoming comfortable with diversity are drawn from the US military, religious institutions, and earlier waves of American immigration.
3,466 citations
TL;DR: Despite some successes reported in social support interventions to enhance mental health, further work is needed to deepen the understanding of the design, timing, and dose of interventions that work, as well as the characteristics of individuals who benefit the most.
Abstract: It is generally agreed that social ties play a beneficial role in the maintenance of psychological well-being. In this targeted review, we highlight four sets of insights that emerge from the literature on social ties and mental health outcomes (defined as stress reactions, psychological well-being, and psychological distress, including depressive symptoms and anxiety). First, the pathways by which social networks and social supports influence mental health can be described by two alternative (although not mutually exclusive) causal models—the main effect model and the stress-buffering model. Second, the protective effects of social ties on mental health are not uniform across groups in society. Gender differences in support derived from social network participation may partly account for the higher prevalence of psychological distress among women compared to men. Social connections may paradoxically increase levels of mental illness symptoms among women with low resources, especially if such connections entail role strain associated with obligations to provide social support to others. Third, egocentric networks are nested within a broader structure of social relationships. The notion of social capital embraces the embeddedness of individual social ties within the broader social structure. Fourth, despite some successes reported in social support interventions to enhance mental health, further work is needed to deepen our understanding of the design, timing, and dose of interventions that work, as well as the characteristics of individuals who benefit the most.
2,989 citations
TL;DR: It is argued that there are two broad types of support, emotional sustenance and active coping assistance, and two broad categories of supporters, significant others and experientially similar others, who specialize in supplying different types ofSupport to distressed individuals.
Abstract: Over the past 30 years investigators have called repeatedly for research on the mechanisms through which social relationships and social support improve physical and psychological well-being, both directly and as stress buffers. I describe seven possible mechanisms: social influence/social comparison, social control, role-based purpose and meaning (mattering), self-esteem, sense of control, belonging and companionship, and perceived support availability. Stress-buffering processes also involve these mechanisms. I argue that there are two broad types of support, emotional sustenance and active coping assistance, and two broad categories of supporters, significant others and experientially similar others, who specialize in supplying different types of support to distressed individuals. Emotionally sustaining behaviors and instrumental aid from significant others and empathy, active coping assistance, and role modeling from similar others should be most efficacious in alleviating the physical and emotional impacts of stressors.
2,510 citations
Cites background from "The role of social relations in hea..."
...The disadvantage of the term is that researcher attention is directed away from the “dark sides” of social relationships....
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TL;DR: This review highlights consistent patterns in the literature associating positive affect (PA) and physical health and raises serious conceptual and methodological reservations, but suggests an association of trait PA and lower morbidity and of state and traitPA and decreased symptoms and pain.
Abstract: This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed.
1,890 citations
Cites background from "The role of social relations in hea..."
...Furthermore, social support is beneficial to survival from life-threatening illnesses (Berkman, 1995; Helgeson, Fritz, & Cohen, 1998; Seeman, 1996) and is associated with improved immune outcomes (Cohen, 1988; Uchino, Cacioppo, & Kiecolt-Glaser, 1996)....
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...Furthermore, social support is beneficial to survival from life-threatening illnesses (Berkman, 1995; Helgeson, Fritz, & Cohen, 1998; Seeman, 1996) and is associated with improved immune outcomes (Cohen, 1988; Uchino, Cacioppo, & Kiecolt-Glaser, 1996)....
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References
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TL;DR: It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome.
Abstract: Social support is defined as information leading the subject to believe that he is cared for and loved, esteemed, and a member of a network of mutual obligations. The evidence that supportive interactions among people are protective against the health consequences of life stress is reviewed. It appears that social support can protect people in crisis from a wide variety of pathological states: from low birth weight to death, from arthritis through tuberculosis to depression, alcoholism, and the social breakdown syndrome. Furthermore, social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimens.
6,113 citations
"The role of social relations in hea..." refers background in this paper
...Received for publication June 21, 1994; revision received November 21, 1994 integrated into their communities and had deep and abiding social and psychological resources (1-4)....
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TL;DR: The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts.
Abstract: The relationship between social and community ties and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California and a subsequent nine-year mortality follow-up. The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. The age-adjusted relative risks for those most isolated when compared to those with the most social contacts were 2.3 for men and 2.8 for women. The association between social ties and mortality was found to be independent of self-reported physical health status at the time of the 1965 survey, year of death, socioeconomic status, and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services as well as a cumulative index of health practices.
4,882 citations
"The role of social relations in hea..." refers background in this paper
...In the first of these studies from Alameda County (6), men and women who lacked ties to others (in this case, based on an index assessing contacts with friends and relatives, marital status, and church and group membership) were 1....
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...Community-Based Alameda County, Berkman and Syme (6) Tecumseh, Michigan, House et al....
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..." Between 1979 with the Alameda County Study and 1994, there have been eight community-based prospective studies that reveal an association between what we have now come to call "social integration" and mortality rates, usually death from all causes (6-13)....
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TL;DR: I count myself honored indeed to be included among those who have been chosen to present this, the Wade Hampton Frost Lecture, and for this I must thank my very wise chief, Dr. Sidney L. Kark, who introduced me to the papers, particularly the section on tuberculosis.
2,051 citations
TL;DR: Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.
2,010 citations
TL;DR: Possible mechanisms through which support systems may influence the etiology of physical disease are outlined and conceptual and methodological guidelines for future research in this area are proposed.
Abstract: Although there has been a substantial effort to establish the beneficial effects of social support on health and well-being, relatively little work has focused on how social support influences physical health. This article outlines possible mechanisms through which support systems may influence the etiology of physical disease. I begin by reviewing research on the relations between social support and morbidity and between social support and mortality. I distinguish between various conceptualizations of social support used in the existing literature and provide alternative explanations of how each of these conceptualizations of the social environment could influence the etiology of physical disease. In each case, I address the psychological mediators (e.g., health relevant cognitions, affect, and health behaviors) as well as biologic links (e.g., neuroendocrine links to immune and cardiovascular function). I conclude by proposing conceptual and methodological guidelines for future research in this area, highlighting the unique contributions psychologists can make to this inherently interdisciplinary endeavor.
1,703 citations
"The role of social relations in hea..." refers background in this paper
...There are several excellent reviews in this field (35-38), and the reader may refer to them for more extensive and detailed discussions....
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