Social and Emotional Support and its Implication for Health

Maija Reblin; Bert N Uchino

Disclosures

Curr Opin Psychiatry. 2008;21(2):201-205. 

In This Article

Morbidity and Mortality Studies

An important line of research in this area centers on extending our understanding of links between social support in its various forms and morbidity and mortality. For instance, social integration has been shown to affect mortality from diseases such as diabetes,[8] while belonging support (characterized by interaction with friends, family, and other groups) was a consistent predictor of self-reported disease outcomes (including diabetes, hypertension, arthritis and emphysema) in an elderly population.[9] Most research in this area, however, has focused on links between structural aspects of support and cardiovascular disease outcomes. In one longitudinal study, social participation was shown to predict incidence of first-time acute myocardial infarction, even after adjusting for demographic and health variables. In this study, those who had lower social involvement were 1.5 times more likely to have a first myocardial infarction.[10] Other studies also found support for the protective effect of social integration on cardiovascular morbidity, though the relationship of integration and all-cause mortality was not significant.[3] These researchers found that those with moderate or low social integration were almost twice as likely to be readmitted to hospital post-myocardial infarction than those with high social integration. In fact, social integration showed a positive dose-response association that was equivalent to other known predictors of re-hospitalization.[3] Another study also showed an association between integration (conceptualized by living alone) and mortality after hospital release post-myocardial infarction, even after controlling for basic health and clinical care variables.[11] There was also an interaction with gender in that men who lived alone were at the greatest risk.

Beyond cardiovascular disease, other studies have taken a less structural approach and focused on perceived and received support, particularly emotional support. One such population survey showed that, for elderly women, low perceived emotional support predicted higher mortality, controlling for baseline demographics and health.[6] In addition, larger discrepancies between perceived and received support were found to predict mortality in patients undergoing dialysis.[7] These studies suggest that emotional support, in addition to structural aspects of support, may reduce mortality.

Although these results are consistent with a large prior body of epidemiological research, there have been some studies that have shown inconsistent associations. In the context of breast-cancer survival, higher perceived support availability in tandem with low anxiety-what would appear to be a positive state-actually predicted higher mortality.[12] The authors suggest that this may be due to patients restricting negative emotions. Additionally, in one prospective study, social support did not explain risk of stroke beyond established risk factors.[13] Support was not, however, a major focus of this study and was assessed only at work. This is important as prior studies suggest familial sources of support have stronger associations to health outcomes.[14]

One interesting trend to emerge recently is the importance of being a support provider on health and well being.[15] For instance, one study found that feelings of social usefulness in the elderly predicted lower disability and mortality.[16] Similarly, a study on church-based support showed that providing support, not receiving it, reduced the effects of one's financial strain on mortality.[17] These findings are consistent with a recent ambulatory study[4] that showed giving support was related to lower systolic and diastolic blood pressure. Interestingly, those who reported giving more support also reported getting more support. The authors postulate that giving and receiving support have unique pathways to stress: giving is mediated by increased efficacy, leading to lower stress, while receiving support has a direct effect on stress. Taken together, studies such as these suggest that there is something potentially unique about giving support. It may be that people experience positive affect while helping others, which may improve their health,[18] or it may suggest that it is in the context of a high-quality relationship in which one feels valued and can reciprocate by providing support that benefits occur. Future research will be needed to examine these intriguing findings in the recent literature.

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