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

Focus on Potential Pathways

More recently, researchers have also been working on elucidating the potential mechanisms that might explain how social support can influence such noteworthy health outcomes. One area of particular interest is related to biological mechanisms, especially inflammatory processes.[19] Research on such outcomes has thus far produced inconsistent findings. Researchers in the Framingham Heart Study attempted to correlate social integration with serum markers of inflammation [i.e. monocyte chemo-attractant protein-1, C-reactive protein (CRP), and interleukin (IL)-6 and, soluble intercellular adhesion molecule-1].[20] Controlling for age and potential confounders (some of which may be mechanisms such as health behaviors, see later), only IL-6 was found to be inversely associated with social integration in men. An association with IL-6 was not shown in a study of pregnant mothers, although CRP levels were lower as a function of support during the third trimester of pregnancy.[21] Another study found that aspects of social support predicted lower stimulated levels of IL-8, IL-6, and tumor necrosis factor (TNF)-alpha. Statistically controlling for standard risk factors (including health behaviors), however, showed that only the link between support and IL-8 was still significant.[22] Finally, the Chicago Health, Aging, and Social Relations Study did not find a link between perceived support and CRP levels while statistically controlling for demographics and health behaviors.[23]

The inconsistencies in these findings may be due to a variety of issues, including sample demographics (ranging from young pregnant women to a mixed sample of the very old), the different types of support measures (ranging from structural measures to functional measures), or the differences in power within studies (numbers ranging from 17 to more than 3000). The study with the most consistent evidence that social support predicts inflammation had the largest sample of older adults.[20] This study had the most statistical power and is consistent with data indicating that psychosocial influences on immune function may be more apparent in older individuals.[24] Additionally, this is a newer area of research and cytokines often have complex effects on the regulation of inflammation. Recent research aimed at examining links between social support and fMRI activation of specific brain regions that may orchestrate these biological response, may also help clarify these results.[25]

A second potential pathway of interest relates to the influence of social support on health behaviors.[26] Although many prior studies treat such health behaviors as confounds (see above), recent models of support emphasize its potential role as mechanisms.[19] For instance, support can be seen as an encouragement to engage in health behaviors. Conversely, the lack of support or isolation can become a barrier to health-behavior adherence or adherence more generally, as was reported in a qualitative study of cancer survivors[27] and patients with HIV.[28] Social support is also related to broader types of health behavior, including fruit and vegetable consumption, exercising,[29] and smoking cessation.[30] This beneficial support may also come in a health context, such as one's physician, as those who viewed the patient-provider bond as one characterized by collaboration, liking and trust were more likely to adhere to treatment for various long-term medical issues.[31]

In addition to the positive influence of social support on health behaviors and adherence, better relationship quality has also been shown to have a positive effect on long-term married couples' health promotion behaviors.[32] These data suggest that the dyadic context may be an important area that needs additional emphasis in future work. Furthermore, one study contrasted partner support (aiding and reinforcing a partner's own efforts) with partner control behaviors (inducing change in one's partner). Results showed that supportive behaviors predicted better mental health, while control behaviors predicted worse mental health and health behavior in their partners.[5] Consistent with social control models, these data suggest that effective support may need to act as a more gentle guiding force that will motivate behavioral change for the better.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....