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7/26/2019 Factors Affecting Illness -- Social Support (Self Help)
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http://www.personalityresearch.org/papers/clark.html
Social support is one of most important factors in predicting the physical health and well-
being of everyone, ranging from childhood through older adults. The absence of social support
shows some disadvantage among the impacted individuals. In most cases, it can predict the
deterioration of physical and mental health among the victims. The initial social support given isalso a determining factor in successfully overcoming life stress. The presence of social support
significantly predicts the individuals ability to cope with stress. !nowing that they are valued by
others is an important psychological factor in helping them to forget the negative aspects of their
lives, and thinking more positively about their environment. Social support not only helps
improve a persons well-being, it affects the immune system as well. Thus, it also a ma"or factor
in preventing negative symptoms such as depression and an#iety from developing.
The social support and physical health are two very important factors help the overall
well-being of the individual. $ general theory that has been drawn from many researchers overthe past few decades postulation that social support essentially predicts the outcome of physical
and mental health for everyone. There are si# criteria of social support that researchers use tomeasure the level of overall social support available for the specific person or situation %&utrona,'ussell, ( 'ose, )*+. irst, they would look at the amount of attachment provided from a
lover or spouse. Second, measuring the level of social integration that the individuals involved
with, it usually comes from a group of people or friends. Third, the assurance of worth fromothers such as positive reinforcement that could inspires and boosts the self-esteem. The fourth
criterion is the reliable alliance support that provided from others, which means that the
individual knows they can depend on receiving support from family members whenever it was
needed. ifth, the guidance of assurances of support given to the individual from a higher figureof person such as a teacher or parent. The last criterion is the opportunity for nurturance. It
means the person would get some social enhancement by having children of their own and
providing a nurturing e#perience.
This paper organies studies of social support into three age-appropriate categories-adolescents, middle-aged adults, and older adults. or e#ample, an e#periment related to social
support and physical health that empathies cancer is assigned to the older adult category. If the
specific area of concern can be applied to everyone, then it is placed into middle-aged adultgroup for generaliation purpose. $fter reviewing those studies and e#periments, it should be
clearly shown that social support is very important factor in determining the status of physical
health, mental health, and immune system functioning for everyone.
$dolescents
$dolescents could develop some kinds of sensitive feelings, which may impact on their health if
they do not get ade0uate social attention from others. They may become involved in an
unfortunate situation that makes them feel overwhelmed or awkward. The adolescent is stilldeveloping, could easily e#perience some strain to their emotion if no help is immediately
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available. $n#iety and depression are two main psychological disorders that often can be seen
among the adolescents.
amily and 1eer Support
or adolescents, family support is the most important element in their lives. $s part of theirgrowth e#perience, adolescents usually e#pect a lot of things from their parents. Inade0uate
support from the parents will likely increase the chance of getting depression among adolescents
who get into unfortunate situation with their parents. This occurs because adolescent usuallybecome confused when they e#pect to get plenty of help and positive reinforcement from their
parents, but it does not happen %Stice, 'agan, ( 'andall, 2334.
5eside family support, peer support also is very important factor for adolescents. &hildren can
e#pect a lot from their friends. 1eer support can be considered as an alternate method of gettingsocial support if the adolescents receive inade0uate attention from their parents. This social
support method is not as reliable as family support because young children could easily withdraw
from their own friends if they become depressed. $nother problem arises in this area, when thedepressed students isolate themselves from public gatherings. This would prevent those suffering
adolescents from getting any social support at all %Stice et al., 2334. 'eceiving social support is
very essential for adolescents to become successful with themselves and achieve a satisfactory
level at school.
6ifted $dolescents
6ifted adolescents also can encounter plenty of problems if they do not get ade0uate social
support. In some cases, intelligent students are sent to residential schools that offer special
programming for students who are gifted in math and science. 7ftentimes, the family support
would be severely limited for those adolescents, because the residential school usually lies faraway from home. This kind of schooling is a totally new e#perience for gifted students, because
they are living in the dormitory. 8ormally, students would e#perience the dormitory living forthe first time when they go to college. $t those ages, students are looking forward to seeking
independence from their parents. This usually leaves a hole for those adolescents with reduced
social support, whereas they have to rely on some people from the residential school %9unn,
1utalla, Sheppard, ( indstrom, )*+;.
6ifted adolescents usually have to rely on counselors and peers at the school. The counselors
usually help those students to ease the transition from home to a residential living situation. In
contrast to students who attend regular school, there is a better chance for those gifted students to
e#perience emotional well-being, be in a good physical health, and have a good immune systemas long as ade0uate social support can be provided at the school to prevent or lessen the chance
for those people from getting depressed %9unn et al., )*+;.
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stress. or e#ample, the cardiovascular system would function much better in those adults who
have better social support %=chino, &acioppo, ( !iecolt-6laser, )**. The social contact,
familial support, and involvement with leisure activities have significantly demonstrated arelationship with lowering of blood pressure. &ontact among family members is the best method
of reliving stress. The fellowship among friends is ade0uate, but not as powerful as family.
Strangers have a negative effect on reducing blood pressure. In one study cited in =chinosarticle, the individual with many siblings and e#periencing low stress was found to be the best
possible combination for lowering the blood pressure.
>ealth
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of the low socioeconomic status. $s e#pected, anyone who comes from a lower socioeconomic
class would be more likely to receive less social support. They basically do not have enough
resources in their environment available to assist with social support. The individuals with lowsocioeconomic status also tend to have less self-control. &onse0uently, they become more
sensitive to stressors in their environment and less able to control their reactions. It means those
adults would trigger some frustrations when they face any kind of stress. =nfortunately, thesocial strain, which is common in their daily lives, increases the risk for lower social class
individuals to develop some kinds of physical and mental illness or a lower sense of well-being.
This should not come to surprise that adults who have higher socioeconomic status tend toreceive more social support %6allo, 5ogart, @ranceanu, (
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displaced workers are likely to develop some problems that could influence their physical or
mental health. or e#ample, those affected workers normally report the loss of self-esteem and
locus of control. This spikes the chance of those workers becoming depressed. The depressionitself could signal the beginning of deterioration in health and well-being among those displaced
workers %
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deteriorating effect of their physical and mental health. =nfortunately, there is no relationship
found between social support and ma"or life events. Bhatever happens to older adult as they
nearing to their death, it will happen, regardless the amount of social support available in theenvironment %'ussell ( &utrona, )**).
&ancer
The spouses of older adults who are fighting cancer usually get overwhelmed with all of the
demands and stressors. They often worry about their loved ones prognosis with cancer. 7n apositive side, social support is said to be a huge psychological factor for these affected spouses.
$s more social support becomes available to those victims, the better the individuals immune
system and well-being will become. This should improve the bodily function of those impactedspouses and allow them to be able to handle the stress much more efficiently. It is very important
for those impacted individuals being able to switch back and forth between two different worlds:
the world of their ill spouses and the real world outside of the house or nursing home. Social
support is widely known to buffer the stress level among those impacted spouses. !nowing that
others are there to help makes the big difference. or those caring for spouses with cancer whohave low social support usually report a deterioration in their general health. $s widely known,
low social support available usually means the impacted spouses have to rely on themselvesmore than usual. It is essentially focusing attention between the stressful spouses and their loved
ones. The unfortunate situation often comes to impair the function of those affected spouses
when they become overwhelmed with their stress, along with the deteriorating conditions amongthe cancer patients they are caring for. It is evident here that the spouses usually cannot handle
taking care of the cancer patients by themselves. This is the primary reason why plenty of social
support should be given to those impacted families. If the immediate family members or relatives
are not available to help the burdened spouses, outside help should be immediately givenD thiscan be someone who are nurses, counselors, or social workers. It should be marked clearly that
social support is only a psychological factor because the cancer patients usually progresses ase#pected toward the end regardless of all of the hopes %5aron, &utrona, >icklin, 'ussell, (ubaroff, )**3.
Stress
Initial mental health is a very important predictor for all older adults at the time they enter their
retirement ages. 6ood mental health would predict a healthy social support and fairly goodphysical health for the years to come %&utrona et al., )*+. 7nce an individuals mental health
declines at any point during their retirement ages, it would increases the likehood for negative
elements to persist with the impacted individuals. It has been found that it will be very difficult
for those older adults to get out of the slump and have a positive perspective in their life onceagain. !nowing that they are valued by others makes a big difference in predicting the outcome
of mental health for those older adults. If the impacted individuals demonstrate negative life
events such as divorces, or any other kinds of daily stress, it becomes obvious to outsiders thatinade0uate social support is available for those people.
&onclusion
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There is evidence that social e#perience is very essential in predicting the well-being for
everyone, ranging from childhood through older adults %&ohen ( Billis, )*+A. $fter a few
decades of studying, the researchers have finally gained some understanding about therelationship between social support and physical health. 8onetheless, some areas of research still
face some problems because they sometimes focus too specify on one population, ignoring the
generaliation rules for using the random samples to generalie the result to a whole population.
The continuity of research on the relation between social support and physical health will enableus to understand better about the effect of good social support toward physical and mental health,
along with a general well-being.
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6ormans peer commentary filled in some information that I failed to discuss in my paper. I
e#plained the transition of older adults from work into retirement. 6ormans peer commentary
added information about the decision-making steps necessary before moving on into retirement,
such as the types of residence to live in. 5ecause this topic has been widely discussed, I could
not put all of the information and e#amples into this paper. &onse0uently, I never include the
life-threatening conditions of middle-aged adulthood as an e#ample of the relation betweensocial support and physical health. 6ormans peer commentary provided a great e#ample of
recovering from life-threatening conditions by being involved in the community and support
groups that share common interests and problems.
!ilpatrick was concerned about the missing discussion of negative relations between social
support and physical health in my paper. $s she pointed out, I basically discussed only the
positive aspects of this topic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292!/
Social Support and 'esilience to Stress
Introduction
Social support is e#ceptionally important for maintaining good physical and mental health.
7verall, it appears that positive social support of high 0uality can enhance resilience to stress,
help protect against developing trauma-related psychopathology, decrease the functional
conse0uences of trauma-induced disorders, such as posttraumatic stress disorder %1TS9, and
reduce medical morbidity and mortality.)>owever, despite strong evidence demonstrating the
beneficial effects of social support on medical and psychological wellbeing, the field of
psychiatry has contributed relatively little to developing, testing, and implementing effective
evidence-based interventions aimed at increasing social support for patients and at-risk
populations. In this review article, we aim to summarie key studies on social support in the
conte#t of resilience to stress and e#plore possible brain mechanisms mediating social supports
positive influence on mental health outcomes. Be will begin with a brief overview of the
neurochemistry of the stress response and resilience to stress. Bithin this framework, we will
then review the emerging literature on the neurobiology and the behavioral mediators of social
support. 8e#t, we will review studies that have investigated the effects of social support on
medical illness, and finally, conclude with a discussion on social supports clinical significancefor psychiatry.
6o to:
"esilience to Stress: Putative Mechanisms
1sychological resilience represents a process of adapting well in the face of adversity. The
psychosocial and neurobiologic characteristics of resilience to stress are e#tremely comple#, and
their discussion is beyond the scope of this article %for a thorough review see Southwick, et al. ).
>owever, the literature suggests the sympathetic nervous system and hypothalamic-pituitary-
adrenocortical %>1$ system are e#tensively involved in stress response and resilience.2
The sympathetic nervous system %S8S responds to stress by increasing heart rate, constricting
blood vessels, increasing blood pressure, and slowing digestion. 8umerous lines of evidence
from psychophysiology and neuroendocrine studies indicate that the noradrenergic system is
often dysregulated in 1TS9. or e#ample, chronic 1TS9 is associated with high baseline
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B2http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B27/26/2019 Factors Affecting Illness -- Social Support (Self Help)
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cerebrospinal fluid 8? concentrations.E
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Social support has been described as Gsupport accessible to an individual through social ties to
other individuals, groups, and the larger community.H)4The 8ational &ancer Institutes
9ictionary of &ancer Terms defines social support as Ga network of family, friends, neighbors,
and community members that is available in times of need to give psychological, physical, and
financial helpH %www.cancer.gov. Theoretical models of social support specify the followingtwo important dimensions: %) a structural dimension, which includes network sie and
fre0uency of social interactions, and %2 a functional dimension with emotional %such as
receiving love and empathy and instrumental %practical help such as gifts of money or assistance
with child care components.2
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rate increases during separation and isolation but returns to normal when monkeys are reunited
with their social groupD2)cortisol rises in s0uirrel monkeys22and wild baboons2Eduring isolationD
at postmortem e#amination, atherosclerosis has been significantly greater in swine24and in
female monkeys2)living alone vs those living in social groups. urther, evidence suggests
chronic stress and lack of social support increases cardiac risk %e.g., endothelial in"ury, increasesplatelet accumulation, in part, through prolonged sympathetic activation.2A
In human studies, low social support has been associated with physiological and neuroendocrine
indices of heightened stress reactivity, including elevated heart rate,2increased blood
pressure,2;and e#aggerated cardiovascular and neuroendocrine responses to laboratory stressors.
or e#ample, in laboratory studies mental arithmetic2+and public speaking tasks2*,E3cause
significantly smaller rises in heart rate, blood pressure, and cortisol among sub"ects supported by
another person compared to sub"ects who are alone. These findings are consistent with the results
of a study conducted by Steptoe, et al., who reported an overall increased noradrenergic and >1$
reactivity in lonely individuals.E)
The brain mechanisms, including the neural circuits and neurotransmitter systems, that underlie
the ac0uisition and processing of social information are e#tremely comple# and far from being
completely understood. >owever, animal studies indicate that the regulation of social attachment
and promotion of positive social interactions may be heavily dependent on two neuropeptides
known as o#ytocin and vasopressin.E27#ytocin is critical for learning social cues and has been
shown to enhance maternal care in rats.EE9ifferential o#ytocin and vasopressin receptor
e#pression patterns in specific areas of the brain %ventral pallidum and medial amygdala have
been shown to influence the type and duration of social attachments formed by voles. ore#ample, montane voles typically avoid social contact e#cept while matingD they have lower
levels of o#ytocin receptors in the nucleus accumbens compared to prairie voles, which are
highly social and typically monogamous.E47#ytocin also e#erts an#iolytic effects that are
associated with attenuated secretion of corticosterone in lactating rodents.EA
The role of o#ytocin in human social behavior has been investigated as well. The Trier Social
Stress Test is a laboratory stressor that involves simulation of an aversive "ob interview and
public speaking with negative feedback, resulting in a robust increase in an#iety and salivary
cortisol. 5oth o#ytocin and social support reduced an#iety in healthy men undergoing this
procedure.EInterestingly, the same study showed that sub"ects who received the combination of
o#ytocin and social support had the least amount of an#iety and lowest cortisol responses to
stress. Taken together, these results suggest that o#ytocin promotes social behavior and may
inhibit the >1$ a#is reactivity to stress.
6o to:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B21http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B22http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B23http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B24http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B21http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B26http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B27http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B28http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B29http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B29http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B31http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B32http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B33http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B33http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B34http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B34http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B35http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B36http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B21http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B22http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B23http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B24http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B21http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B26http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B27http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B28http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B29http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B30http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B31http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B32http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B33http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B34http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B35http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B36http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/7/26/2019 Factors Affecting Illness -- Social Support (Self Help)
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%he Impact o' Social Support on (ealth )utcomes
Social isolation and low levels of social support have been shown to be associated with increased
morbidity and mortality in a host of medical illnesses. or e#ample, in the well-known $lameda
&ounty Studies, men and women without ties to others were ).* to E times more likely to die
from ischemic heart disease, cerebral vascular disease, cancer, or a host of other diseases within a
nine-year period compared to individuals with many more social contacts. E;The effect of social
support on life e#pectancy appears to be as strong as the effects of obesity, cigarette smoking,
hypertension, or level of physical activity.2A
8umerous epidemiological studies have reported that poor social support is associated with the
onset and relapse of depression,E+negative treatment response to dysthymia,E*seasonality of
mood disorder,43and the presence of depression comorbid in several medical illnesses, such as
multiple sclerosis,4)cancer,42and rheumatoid arthritis.4E
The @ietnam Bar may serve as an important e#ample of failed social support during times of
high stress and trauma. ohnson and colleagues found that many @ietnam veterans e#perienced
homecoming as a highly stressful e#perience.44These veterans reported Gbeing insulted, feeling
angry, resentful, and alone.H In this cohort of treatment-seeking, outpatient veterans with 1TS9,
homecoming stress was the strongest predictor of the fre0uency and intensity of their 1TS9
symptoms. The authors concluded that the lack of social support confirmed the veterans
perception of re"ection and lead to feelings of detachment.44
In contrast to low social support, high levels appear to buffer or protect against the full impact of
mental and physical illness. The relationship between good social support and superior mental
and physical health has been observed in diverse populations, including college students,
unemployed workers, new mothers, widows, and parents of children with serious medical
illnesses.4A
Strong social support has been shown to be an important factor in decreasing functional
impairment in patients with depression4and in increasing the likelihood of recovery.4;urther,
the risk of developing 1TS9 upon e#posure to combat trauma is inversely correlated with social
support. or e#ample, 5oscarino, et al.,4+after controlling for trauma e#posure, found that
@ietnam veterans with high levels of social support were )+3-percent less likely to develop
1TS9 as compared to those with low levels of social support.
6o to:
Conclusion
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B37http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B38http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B39http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B41http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B41http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B42http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B43http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B45http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B47http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B37http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B25http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B38http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B39http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B40http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B41http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B42http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B43http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B44http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B45http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B46http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B47http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B48http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/7/26/2019 Factors Affecting Illness -- Social Support (Self Help)
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The literature reviewed above clearly demonstrates the harmful conse0uences of poor social
support and the protective effects of having access to rich and functional social networks on
maintaining physical and psychological health. The e#act biopsychosocial mechanisms
underlying the positive influence of social support on resilience to stress are unknown. There is
undoubtedly a comple# interplay of various environmental and genetic factors that mediate theeffects of social support on health outcomes. ?vidence for such a gene-environment interaction
involving social support comes from a pioneering study by !aufman and her colleagues who
have shown that social support may confer resilience to stress by moderating genetic risks for
depression in maltreated children.4*In this study, the combination of the met allele of the brain-
derived neurotrophic factor %598 gene and the two short alleles of the serotonin transporter
%A->TT gene predicted the highest depression scores in maltreated childrenD and this
vulnerability was moderated by the presence of social support.4*This important finding
demonstrates that an individuals environment may be modified to attenuate his or her genetic
risk for developing mental illness even in the presence of environmental stressors, possibly by
modifying gene e#pression. In fact, animal studies suggest maternal care can alter the e#pression
of the glucocorticoid receptor gene via affecting 98$ methylation and chromatin structure.A3
9ampening >1$ activity may be another ma"or mechanism through which social support
enhances resilience to stress. In fact, findings from animal and translational studies reviewed
above show that social support reduces stress-induced cortisol release. It is possible that stress-
induced o#ytocin release augments social affiliation, which in turn reduces negative appraisals
and arousal. It is open to speculation whether social support affects 9>?$ and/or 81F levels,
which may then help to regulate >1$ and noradrenergic systems, respectively.
In summary, social support seems to moderate genetic and environmental vulnerabilities for
mental illness, possibly by effects through other psychosocial factors, such as fostering effective
coping strategies, and through effects on multiple neurobiological factors. It will be important for
psychiatric researchers to conceptualie, test, and apply effective interventions specifically aimed
at increasing social support for psychiatrically ill or at-risk populations. This represents an
important challenge for our field.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B50http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B49http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/#B507/26/2019 Factors Affecting Illness -- Social Support (Self Help)
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http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-to-eliminate-
cardiovascular-health-disparities/about/influences_on_health/family_social_support.html
Family and Social Support
1ositive social support %family or friends plays an important role in oneJs ability to makehealthier choices. Social support means being able to access people that a person can rely upon if
needed.
The support of family and friends during a crisis has long been seen to have a positive emotional
effect on people. >owever, this support also has a physical benefit as well. 9uring stressful
times, people tend to e#perience higher blood pressure and heart rates. >owever, the presence of
friends or family members has been shown to reduce these rates among people during difficult
periods.
In terms of chronic disease, the support of family or friends has been shown to lessen the chance
that one will become sick or die from heart disease. 'esearch conducted at 5righam Foung
=niversity and the =niversity of 8orth &arolina showed that people who did not have strong
social support were A3K more likely to die from illness than those who had such support.)
amily and friends are also important for those who have been diagnosed with chronic disease
such as heart disease, high blood pressure and diabetes.2 >aving such support systems is
beneficial in helping patients follow a physicians recommendations. Strong social support will
help patients adhere to their medical regimen by reminding them to:
!eep their medical appointments
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?at healthier foods
inally, family and friends can also provide practical support, such as rides to the doctor or
pharmacy, going to the supermarket, and offering childcare during health care visits. The
encouragement of friends and co-workers can motivate people who have been ill to take steps to
be more active and get back to work more 0uickly than those who do not have a strong supportsystem.
http://www.ncbi.nlm.nih.gov/pmc/articles/1
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typesL for instance instrumental support and emotional supportMas often people have
preferences for different types of aid depending on the circumstances. This diversity of ways in
which support is defined is important and can provide greater specificity %conte#t to research
findings.
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MORBIDITY AND MORTALITY STUDIES
$n important line of research in this area centers on e#tending our understanding of links
between social support in its various forms and morbidity and mortality. or instance, social
integration has been shown to affect mortality from diseases such as diabetes,+while belonging
support %characteried by interaction with friends, family, and other groups was a consistent
predictor of self-reported disease outcomes %included diabetes, hypertension, arthritis and
emphysema in an elderly population*.
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to patients restricting negative emotions. $dditionally, in one prospective study social support
did not e#plain risk of stroke beyond established risk factors)E. >owever, support was not a ma"or
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)4.
7ne interesting trend to emerge recently is the importance of being a support provider on health
and well-being)A. or instance, one study found that feelings of social usefulness in the elderly
predicted lower disability and mortality). Similarly, a study on church-based support showed that
providing support, not receiving it, reduced the effects of oneJs financial strain on mortality);.
These findings are consistent with a recent ambulatory study4that 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 uni0ue 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 uni0ue about giving support. It may be that
people e#perience positive affect while helping others, which may improve their health)+, or it
may suggest that it is in the conte#t of a high-0uality relationship in which one feels valued and
can reciprocate by providing support that benefits occur. uture research will be needed to
e#amine these intriguing findings in the recent literature.
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FOCUS ON POTENTIAL PATHWAYS
owever, research on such outcomes has thus far produced inconsistent findings. 'esearchers in
the ramingham >eart Study attempted to correlate social integration with serum markers of
inflammation %i.e., monocyte chemo-attractant protein-), &-reactive proteins %&'1, I-,
soluble intercellular adhesion molecule-)23. &ontrolling for age and potential confounders %some
of which may be mechanisms such as health behaviors, see below, only I- was found to be
inversely associated with social integration in men. $n association with I- was not shown in a
study of pregnant mothers, although &'1 levels were lower as a function of support during the
third trimester of pregnancy2). $nother study found that aspects of social support predicted lower
stimulated levels of I-+, I-, and T8-alpha, >owever, statistically controlling for standard
risk factors %including health behaviors, showed that only the link between support and I-+ was
still significant22. inally, the &hicago >ealth, $ging, and Social 'elations Study did not find a
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R13http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R14http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R16http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R17http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R18http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R19http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R20http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R21http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R22http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R13http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R14http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R15http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R16http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R17http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R4http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R18http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R19http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R20http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R21http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/#R227/26/2019 Factors Affecting Illness -- Social Support (Self Help)
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link between perceived support and &'1 levels while statistically controlling for demographics
and health behaviors2E.
The inconsistencies in these findings may be due to a variety of issues including sample
demographics %ranging from young pregnant women to a mi#ed 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 %8Js ranging from ); to NE333. The study with the most
consistent evidence that social support predicts inflammation had the largest sample of older
adults23, 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 individuals24.
$dditionally, this is a newer area of research and cytokines often have comple# effects on the
regulation of inflammation. 'ecent research aimed at e#amining links between social support
and f
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$s we learn more about the effectiveness of social support in affecting health outcomes, it
becomes appealing to use this information to directly help clinical populations. This may e#plain
why the largest proportion of recent research in social support and health involved interventions,
with many focused on chronic disease populations such as cancer patients.
There are different types of interventions being implemented, many of which include elements of
education and understanding, such as within a conte#t of a support group. Support groups may
be particularly useful because of the gaps they may fill in the support needs of patients and the
e#periential similarity within the group. or instance, one 0ualitative study in cancer support
groups identified the uni0ue role of such groups to be sources of available community,
information, and acceptanceD in contrast to waning support from overburdened family and
friends. $dditionally, these are situations in which patients can offer support to others and
patients report that belonging to these groups provided an element of support that augmented
other-network supportEE.
In addition to support groups, some interventions focus on teaching general psychosocial skills
and capitaliing on support within e#isting networks %e.g., cognitive behavioral therapy. In one
study, caregivers of $9 patients were enrolled in a randomied intervention trial designed, in
part, to teach support seeking skills. In comparison to a usual-care control group, those who were
in the treatment group were better at fostering their emotional ties and were more satisfied with
supportE4. This type of intervention has also been shown to work in child patient populations. or
instance, children with cystic fibrosis were involved in a randomied intervention trial that
educated the children about their disease and taught them relevant social skills. Those in the
treatment group improved their 0uality of life and peer relationships, and decreased theirloneliness and the perceived impact of the diseaseEA. These findings are especially important due
to the potential isolation faced by children in some chronic disease conte#ts. In another
intervention, Type 2 diabetes patients improved their use of social resources and social
integration %though perceived support did not change compared to usual careE.
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older caregivers compared to no-intervention control group caregivers. These data suggest the
potential usefulness of alternative support interventions which may be especially important for
those with practical %e.g., transportation, physical %e.g., disability, or social %e.g., an#iety
barriers.
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CONCLUSION
The literature on social support and health is robust and continues to be an active area of
research. >owever, the ne#t generation of studies must be able to e#plain the conte#ts and
mechanisms for why such associations e#ist. Such research is in its infancy but is currently being
fostered by increasing interdisciplinary perspectives on social support and health. Be believe that
such approaches will be crucial in order to better tailor primary or secondary support
interventions that have beneficial influences on physical health outcomes
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729718/