Social Support

September 28, 2011

Social support is the help and assistance or exchange of resources that is given by others within a person’s social network (i.e., a person’s web of social relationships) with the intent to enhance the recipient’s well-being. Social support was first identified as a protective factor against deleterious effects of stress on health by Cassel in 1976. He suggested furthermore that social support was important in the etiology of many diseases. Since this time, many studies have confirmed the association between the lack of social ties or social networks and mortality for almost every cause of death. It is thought that social support provides a basic human need, namely, the need for companionship, intimacy, and reassurance of self-worth. Furthermore, social support is thought to increase one’s sense of personal control by providing information, new contacts, and new ways to solve problems.

While many types of social support have been identified, social support is generally divided into four categories: instrumental support, emotional support, informational support, and appraisal support. Instrumental support includes tangible actions that directly aid the person in need, such as getting groceries, helping someone to an appointment, cooking, cleaning, etc. Emotional support is often the support given by an intimate partner or confidant, although it can be given by others. It includes support that provides love, understanding, trust, sympathy, and/or caring. Informational support is the provision of advice or aid that a person can use to address their problem(s). one segment of this support has been to referred to as “weak ties,” which have shown to be quite powerful for activities such as finding a job or health care provider. Finally, appraisal support is communications related to the provision of advice or dialogue useful for self-evaluation.

In general, the association between social support and health does not follow a dose-response effect, but rather low levels of social support are most harmful with a leveling-off of the effect at some threshold level. Furthermore, the type of social support that is most helpful may vary by age or stage of development. For example, after the passing of a spouse, close dense networks have been found to be important (i.e., emotional support), but later in the process, more diffuse networks with access to new social ties and information are more helpful (i.e., informational support). In addition, not all support given is equally effective. In general, those who have experienced the same stressor and are at the same social position are thought to provide the most effective social support because they would likely be more empathic and more likely to provide relevant support regardless of type (i.e., emotional, information, appraisal, or instrumental).

Social support can influence health in at least three ways. First, it may facilitate health-promoting behaviors. Second, it may give an individual a sense of meaning in their lives, and third, it may produce feelings and thoughts that promote health (i.e., reduction in stress). Several specific research studies on social support are worth noting. First, several animal studies have shown the negative effect of isolation on health. Specifically, female monkeys housed alone developed more atherosclerosis than female monkeys housed in small groups. Furthermore, monkeys caged alone had higher heart rates under average conditions compared to those that lived in groups.

In an interesting human study, participants were asked to give a public talk. Half of the participants (randomly assigned) were told that there would be someone available to them before they presented in case they needed any help (although in reality no help was provided nor asked for). The other half of the participants were not offered this avenue of support. The researchers found that systolic and diastolic pressure were higher both before the public talk and during the talk in the group that was not offered any support when compared to the group that was told there would be someone there to help them if they needed it.

Social isolation has been shown to be related to all-cause mortality across 13 cohort studies in many countries. Specifically, in Alameda County, those who did not have many social ties to others were 2-3 times more likely to die during the follow-up period (9 years) compared to those with many social ties. The risk for dying was not associated with any one disease but rather a multitude of different diseases including: ischemic heart disease, cancer, and circulatory disease. Other conflicting studies have shown this risk for men but not for women.

The role of social support and specific diseases has not shown a consistent effect across studies. However, over the last several years there have been several studies that have shown social ties have a protective effect on survival after myocardial infarction and for those with serious cardiovascular disease. Similarly, social support has been shown to be important for those recovering from stroke. Finally, having social contact may provide resistance against the development of infection including the common cold. In a study where participants were given nasal drops with rhinovirus, those with more social ties were less likely to develop a cold, had less mucus associated with the cold, and shed less virus even after controlling for virus-specific antibody, virus type, age, gender, season, BMI, education, and race. Furthermore, there was a dose-response of decreased colds to increased diversity of social network.

The earliest literature for social support focused on the association between social relations and health for men. As the research expanded to include women, many studies found that the same associations were not found for women or the associations were weaker, although some studies have shown similar effects for men and women. The health benefits of marriage, a potential form of social support, have been the subject of many research studies. Studies have consistently shown that married persons have better health outcomes than divorced or separated persons and that single men have poorer health outcomes than married persons, although single women do not have poorer health outcomes than married persons. While several theories have been advanced to explain why married women could have poorer health relative to single women, it has been hypothesized that as women gain increasing opportunities in the workforce and with changes in marital roles, these differences will disappear.

Men and women may also differ in the types and quantity of social support received and given. Women tend to have both larger and more varied social networks. Furthermore, they are more likely to report having a close confidant who is not their spouse. They generally spend more time than men giving and receiving support and are said to have a wider range of opportunities for emotional support. On the other hand, women are more likely to have negative interactions with those members of their network and have more negative effects from marital conflict relative to men. It is important to consider these gender differences when trying to examine the association between support and health, as different ways of quantifying support may lead to different conclusions. For example, researchers found that when information from up to four close people was used to describe support, gender differences was attenuated, and in some cases eliminated when examining physical and psychological health.

When conceptualizing social support, it is important to view social support within the broader spectrum of the social relationships in which social support exists. Social support is provided by one’s social network, which is one’s web of personal social relationships. Social networks can vary by size, density, boundedness, and homogeneity. They have also been described by intensity and complexity. Size in a social network represents the number of members in one’s network; density is the extent to which members know and interact with one another; boundedness is the degree to which the relationships are based on traditional group structures; homogeneity is the extent to which they are similar. Intensity in a social network is the extent to which the relationship offers emotional closeness, and complexity is the extent to which the relationship serves different functions. Social relationships also vary in the extent of frequency of contact, duration, and reciprocity.

While one’s social network provides the opportunity for social support, it also provides opportunities for social influence or norms, social engagement, person-to-person contact, and access to resources and material goods. Within a network, the existence of normative behavior has an important influence on the behaviors of others. In particular for adolescents, peer behavior is one of the best predictors for behavior. So, for example, if a large percentage of people within a network smoke, the nonsmokers may be more likely to take up the habit. Norms can affect various health behaviors such as smoking, alcohol use, and eating patterns as well as health utilization patterns.

In addition to social support and social norms, social networks also provide opportunities for social engagement or social participation, including such activities as social functions, church-going, getting together with friends, and the like. These activities help define and reinforce one’s social role in both the family and community, which provides a sense of belonging and attachment. It is believed that this sense of belong-ingness can give meaning to one’s life, which results in longevity. Person-to-person contact can influence disease directly via contact with others who are infectious. Finally, social networks can influence access to material goods and resources, such as job opportunities and quality health care.

These five mechanisms through which social networks can influence disease in turn can affect health behavior, psychological pathways, and physiologic pathways. Health behaviors do not appear to explain a large amount of the relationship between social networks and mortality, although methodological difficulties may be in part to blame. Psychological mechanisms

including self-efficacy, self-esteem, depression, and coping styles are influenced by social networks generally and social support specifically. Social support has been shown to influence smoking cessation and depression through enhanced self-efficacy. Furthermore, it is thought that self-efficacy mediates the relationship between social networks and engaging in health-promoting behaviors such as exercise. In addition to self-efficacy, social support is associated with emotional states including depression, and has been shown to moderate the effect of stress on depression. Finally, the pathway between social networks and disease can also be physiological, via immune system functioning, allostatic load, transmission of infectious disease, and cardiovascular reactivity to name a few. Unfortunately, this is the least researched aspect of social networks and social support and much of the work that has been done in this area is in animal studies only.

The pathway from social networks to the subsequent five psychosocial mechanisms (social support, social influence, social participation, person-to-person contact, and access to resources) as well as the specific pathways to illness (i.e., health behaviors, psychological pathways, and physiological pathways) are all preceded by larger social forces including culture, socioeconomic factors, historic social change, politics, and policies. This results in a complex framework of pathways and mechanisms through which social networks and social support influences health. The challenge is to develop better measures and utilize causal modeling to elucidate these pathways and mechanisms in order to better understand these important relationships.

See Also: Marital status, Stress

Suggested Reading

  • Arber, S., & Khlat, M. (2002). Introduction to “social and economic patterning of women’s health in a changing world.” Social Science and Medicine, 54, 643-647.
  • Berkman, L. F. (1995). The role of social relations in health promotion. Psychosomatic Medicine, 57(3), 245-254.
  • Berkman, L. F., & Glass, T. (2000). Social integration, social networks, social support, and health. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology. New York: Oxford University Press.
  • Callaghan, P., & Morrissey, J. (1993). Social support and health: A review. Journal of Advanced Nursing, 18, 203-210.
  • Fuhrer, R., & Stansfeld, S. A. (2002). How gender affects patterns of social relations and their impact on health: A comparison of one or multiple sources of support from “close persons.” Social Science and Medicine, 54, 811-825.
  • Heaney, C. A., & Israel, B. A. (1997). Social networks and social support. In K. Glanz, F. M. Lewis, & B. K. Rimer (Eds.), Health behavior and health education: Theory, research and practice (2nd ed.). San Francisco: Jossey-Bass.
  • House, J. S. (1981). Work stress and social support. Reading, MA: Addison-Wesley.
  • House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.
  • Israel, B. A. (1982). Social networks and health status: Linking theory, research and practice. Patient Counselling and Health Education, 4, 65-79.
  • Turner, H. A. (1994). Gender and social support—taking the bad with the good. Sex Roles, 30(7-8), 521-541.

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