social connectedness & health. disclaimer some say: i’m too cynical i make it too complex i...
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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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Low HighSOCIAL TIES
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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
0.5
1
1.5
2
2.5
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
0
10
20
30
Low High
Emotional Support
Pe
rce
nt
Mo
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
0
1
2
3
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)
4.80
4.85
4.90
4.95
5.00
5.05
5.10
5.15
Low High
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
0
1
2
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
2
2.2
2.4
2.6
2.8
3
3.2
1 Month 4 Months
Lo
g A
nti
bo
dy
Tit
ers
v
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)
1.58
1.27
1.39
10.9
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
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
1
2
3
4
5
6
7
Hig
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
0
0.5
1
1.5
2
2.5
3
-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
9
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
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