SOCIAL CONNECTEDNESS & HEALTH. DISCLAIMER Some say: I’m too cynical I make it too complex I...

SOCIAL CONNECTEDNESS & HEALTH

DISCLAIMER

Some say:• I’m too cynical

• I make it too complex

• I make it too simple

• I’m just wrong

QUESTIONS

•How do they influence health?

•Can our social environment be destructive to our health?

•Is it really personality?

•What types of relationship constructs matter for health?

•Is marriage a special case?

What kinds of relationship constructs matter for health?

Negative Social Relationships--conflicts, loss, isolation, betrayal, loneliness

Social Integration--Participation in a broad range of social relationships

Social Support--Resources provided by others in the face of adversity; material,

informational, & emotional aid

How do relationships influence health?

Modify the Stress Response--Stress Buffering Hypothesis

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Cohen & Wills, 1985

STRESS

Modify the Stress Response--Partial Stress Buffering

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Cohen & Wills, 1985

STRESS

Acts Directly--Main Effect Hypothesis

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Cohen & Wills, 1985

STRESS

Social Support, Social Integration and Negative Relationships

Influence Health through Different Mechanisms!

When I got my firstTV set I stopped caringabout relationshipswith other people.

Andy Warhol

Quote from famous Pittsburgh Native

MEASURES OF SOCIALINTEGRATION

• Social roles

• Participation

• Perception

• Complex

Social Integration Acts Directly

Social Integration

Psychological Mediators

Sense of Identity

SOCIAL

INTEGRATION

Expectation for Behavior of Others (predictability)

Affect Regulation

Meaning and Purpose to Life

Health Behavior Mediators

SOCIAL

INTEGRATION

Motivation to Care for Oneself

Social Control: Encourages Healthy Life Style

Biologic Mediators

SOCIAL

INTEGRATION

AffectRegulation

Regular Interaction

SNS, HPA Regulation

Maintain Biologic Rhythms

Social Social IntegrationIntegration

At BaselineAt Baseline

Prospective Studies Find SI Predicts Better Health

Morbidity

Mortality

Healthy at Baseline

6 months – 18 years

SOCIALLY INTEGRATED PEOPLE

• Live longer (5-18 yr follow-ups)

• Less coronary heart disease

• Less stroke

• More likely to survive cancer

• Fewer functional limitations (elderly)

• Less Institutionalization (elderly)

BERKMAN & SYME SI INDEX

• Marital status (x 4)

• Friends and relatives (x 4)

• Group membership (x 2)

• Church membership (x 1)

Berkman & Syme; Am J Epid; 1979

Men Women0

5

10

15

20I. LeastII.III.IV. Most

Connections

Gender

% D

ied

fro

m A

ll C

au

ses

Social Isolation and Mortality

0

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1

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2

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3

3.5

4

Alameda E. Finland Gothenberg Tecumseh

House, Landis et al. (1988) Science

RELA

TIV

E R

ISK

Clinical ColdsClinical Colds

6 Day Quarantine

VIRUSVIRUS

Social Network Social Network DiversityDiversity

Pittsburgh Common Cold Study N=276 3 Years

Spouse/partner

Parent

Child

Child-in-law

Close relative

Close friend

Neighbor

Worker

Student

Church member

Group member/ volunteer

SOCIAL ROLES

1 - 3 4 - 5 6 +

30

40

50

60

# of High-Contact Roles

% w

ith

Co

lds

OR=4.23*

OR=1.87*

OR=1.00

(Odds ratios are adjusted for control variables.)

Cohen et al.; JAMA; 1997

Social Roles and Colds

New Scientist6/28/97

Does a spontaneous indicator of

important social relationships predict longevity?

Longevity of Famous (DEAD) Psychologists

96- psychologists included in series:A History of Psychology in Autobiography

Pressman & Cohen, 2007

• Average age ~65 when autobio written

• Computerized text counts of use of social role terms

Examples of Psychologists

Allport Boring Broadbent Cattell Eysenck Guilford Hebb Helson

Hilgard Murray Newcomb Osgood Simon Skinner Terman Tolman

COVARIATES

Demographic Controls Date of birth Sex Age at autobio writing

Examples of Root Words from Social Ties Dictionary (53 roots;103 terms)

Aunt Boyfriend Brother Churchgoer Club Colleague Cousin Dad Daughter

Employee Father Fellow Fiancé Friend Girlfriend Grandchild Grandmother Husband

SNI Social Roles & Longevity in Psychologists

72

74

76

78

80

82

84

86

low mid high

Frequency of Social Network Roles

Ye

ars

Liv

ed

Psychosomatic Medicine, 2007

Marriage and the Substitutability of Social Roles

ALAMEDA COUNTY All of the social roles (marriage, friend, neighbor,

social group, religious group) predicted mortality MIND-BODY COLD STUDY

Marriage, group memberships, volunteers all predict lower cortisol

You can substitute one role for another

Social Support Acts as a Stress-Buffer

Social Support

We all need someone we can lean on…and if you want to, you can lean on me.

Rolling Stones

How Could Stress Get Under the Skin?How Could Stress Get Under the Skin?

Poor Health Practices

Immune Function

Stress Hormones

Cardiovascular Function

Poor Adherence

STRESS

How Could Social Support Protect You?

Provides Coping Resources

Emotional InformationalMaterial

STRESSFULEVENTS

APPRAISAL

Emotional Response

Health Practices

SNS & HPA

STRESSFULEVENTS

APPRAISAL

Emotional Response

ALTERS MEANING

Health Practices

SNS & HPA

STRESSFULEVENTS

APPRAISAL

Emotional Response

PROBLEM-FOCUSEDCOPING

Health Practices

SNS & HPA

STRESSFULEVENTS

APPRAISAL

Emotional Response

EMOTION-FOCUSEDCOPING

Health Practices

SNS & HPA

STRESS-BUFFERING

• Perceived availability

• Received

Measures

PERCEIVED SOCIAL SUPPORT& THE STRESS-BUFFERING HYPOTHESIS

TYPICAL QUESTIONS

• Is there someone you can talk to about intimate problems?

• Is there someone who will loan you money when you are in need?

Emotional support (but not SI) interacts with life events; 7-yr mortality follow-up of Swedish

men

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30

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Emotional Support

Pe

rce

nt

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rta

lity

0 Life Events1 Life Event2 Life Events>2 Life Events

Rosengren et al., BMJ, 1993

Job Strain, Emotional Support and Risk for Mortality (6-7 yrs.) in Elderly Swedish Men

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4

Low High

Emotional Support

Re

lati

ve

Ris

k

No Job StrainJob Strain

Falk et al., Am J Public Health, 1992, 82, 1136-139.

Dependent variables:Concanavalin A (Con A)Phytohemaglutinin (PHA)

Nonstressed Controls(Stable animals)

Stress(Unstable animals)

25 Months WK1 WK2 WK3

0 rotations

25 rotations

AFFILIATION INDEX

% time grooming+

% time in close proximity+

% time body contact

Stress, Affiliation and Immune Response(Proliferation to ConA)

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4.85

4.90

4.95

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5.10

5.15

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Affiliation

Δ C

PM

of

Rad

ioac

tivi

ty (

log

10)

StableUnstable

Cohen et al.; Psych Sci; 1992

Are the effects we attribute to the social environment really just PERSONALITY?

Can Personality Explain Stress-Buffering?

Buffering effects are unaffected by

•Social anxiety

•Social competence

•Self-disclosure

Cohen, Sherrod & Clark JPSP (1986)

25

30

35

40

45

50

Low High

Trait Extraversion

% w

ith

Co

lds OR=2.61*

OR=1.00

Extraversion and Susceptibility to the Common Cold

JAMA (Cohen et al., 1997)

Rates of Colds by SociabilityRates of Colds by Sociability

Lowest Highest10

15

20

25

30

35

Low (N=66)

(N=66)Middle (N=67)

Sociability

(N=66)

High (N=66)

Figure 1. Rates of Colds by Sociability Adjusted for Standard Controls.

Cold Criteria

% C

old

s

Cohen et al. (Psychological Science, 2003)

Can our social environments be destructive to our health?

Destructive with Intent

Social conflict Betrayal Exploitation Hostility and aggression

Destructive without Intent

Promote negative behaviors Clumsy or miscarried support Stress transmission Exposure to infectious agents

Social Conflict & The Common Cold

Clinical ColdsClinical Colds

6 Day Quarantine

VIRUSVIRUS

Psychological Psychological StressStress

Pittsburgh Common Cold Study N=276 3 Years

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1

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3

4

5

None OtherInterpersonal Work

Ad

juste

d O

dd

s R

ati

o

Chronic Stressor Domain

Health Psychology (1998)

All the lonely peopleWhere do they all belong?

Eleanor Rigby/ Beatles

Loneliness and AB response to A/New Caledonia Immunization

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1 Month 4 Months

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ers

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LowLoneliness

MediumLoneliness

HighLoneliness

Ab t

iters

adju

sted f

or

base

line

Marriage as a Special Case

Marriage As A Special Case

Main Effect Intimacy, companionship

Stress-Buffer Mutual support, financial advantage

Negative Interactions Conflict, betrayal

MARITAL STATUS & HEALTH

Overwhelming evidence that married people live longer, and are healthier (more for men than women)

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Married NeverMarried

Divorced/Separated

Widowed

1989 Status

Od

ds

of

Dy

ing

*

*

*

U.S. 1989 National Health InterviewMen & Women 19-85 (N=80,018)

8 Yr Mortality Date

Kaplan & Kronick, JECH, 2006

Is it marriage of self-selection into marriage?

Longitudinal Data It is Self-selection

(1,077 Terman’s Termites:Tucker et al. JPSP, 1996)

It is NOT self-selection (7,735 British Men: Erahim et al. AJE, 1995)

DOES MARITAL QUALITY MATTER?

15-year Follow-Up of 2,502 Men and Women in Kaiser Permanente

Baseline Collected 1970-1971

Baseline Assessment of marriage: Marital quality, equality in decision making, and companionship

For married women: equality in decision making and companionship in marriage are protective against death.

For married men: none of the marriage characteristics predicted health outcomes.

Hibbard & Pope, Soc Sci & Med, 1993

Subclinical CAD in Postmenopausal Women by Marital Satisfaction

10

15

20

25

30

35

% w

ith

pla

qu

e sc

ore >

2

Satisfied Unmarried Low-Satisfied

*

Gallo et al. (2003) Psychosomatic Medicine

Odds of Women Developing Metabolic Syndrome at 3-Yr Follow-up

Adjusted for age, baseline metabolic syndrome status, and duration of follow-up. p. < 05; **p < .01

0

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hly

Sati

sfied

Modera

tely

Sati

sfied

Dis

sati

sfied

Sin

gle

Div

orc

ed

Wid

ow

ed

**

**

Troxel et al. (2005). Archives of Internal Medicine

QUESTIONS and ANSWERS

• What types of relationship constructs matter for health? Many… network, perceived, and personality.

•How do they influence health? Through both main and stress- bufferingand acting as stressors.

•Is it really personality?

There is overlap, but independent effects do exist.

• Can our social environment be destructive to our health?

YES, social conflicts, isolation & loneliness

Dr. Cohen says:

“A friend in need is a friend indeed.”

Winter, spring, summer, or fall, all you

have to do is call and I'll be there, yeah, yeah, yeah. You've got a friend.

Lyrics by Carole King

THE END

SOCIALLY INTEGRATED ARE LESS DEPENDENT OF THEIR SOCIAL

WORLDS…

SOCIAL INTERGATED ARE LESS SUBJECT TO SOCIAL PRESSURES

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-3.4 -1.4 0.6 2.6 4.6 6.6

Daily Total Interaction Partners

Dai

ly N

um

ber

of D

rin

ks

Low SI

High SI

Health Psychology, 2007

AFFECT LEVELS OF THOSE HIGH IN SI LESS INFLUENCED BY #

INTERACTION PARTNERS

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9.5

10

10.5

-3.4 -1.4 0.6 2.6 4.6 6.6

Daily Total Interaction Partners

Da

ily

We

ll-b

ein

g

Low SI

High SI

Health Psychology, 2007