Social support

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Old man at a nursing home in Norway.

Social support is the perception and actuality that one is cared for, has assistance available from other people, and that one is part of a supportive social network. These supportive resources can be emotional (e.g., nurturance), tangible (e.g., financial assistance), informational (e.g., advice), or companionship (e.g., sense of belonging)and intangible (e.g. personal advice). Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated in a social network. Support can come from many sources, such as family, friends, pets, neighbours, coworkers, organizations, etc. Government provided social support is often referred to as public aid.

Social support is studied across a wide range of disciplines including psychology, medicine, sociology, nursing, public health, and social work. Social support has been linked to many benefits for both physical and mental health, but social support is not always beneficial.

Two main models have been proposed to describe the link between social support and health: the buffering hypothesis and the direct effects hypothesis.[1] Gender and cultural differences in social support have also been found.

Categories and definitions[edit]

Distinctions in measurement[edit]

Social support can be categorized and measured in several different ways.

There are four common functions of social support:[2][3][4]

  • Emotional support is the offering of empathy, concern, affection, love, trust, acceptance, intimacy, encouragement, or caring.[5][6] It is the warmth and nurturance provided by sources of social support.[7] Providing emotional support can let the individual know that he or she is valued.[6] It is also sometimes called esteem support or appraisal support.[2]
  • Tangible support is the provision of financial assistance, material goods, or services.[8][9] Also called instrumental support, this form of social support encompasses the concrete, direct ways people assist others.[5]
  • Informational support is the provision of advice, guidance, suggestions, or useful information to someone.[2][10] This type of information has the potential to help others problem-solve.[5][11]
  • Companionship support is the type of support that gives someone a sense of social belonging (and is also called belonging).[2] This can be seen as the presence of companions to engage in shared social activities with:[12]

Researchers also commonly make a distinction between perceived and received support.[7][13] Perceived support refers to a recipient’s subjective judgment that providers will offer (or have offered) effective help during times of need. Received support (also called enacted support) refers to specific supportive actions (e.g., advice or reassurance) offered by providers during times of need.[14]

Furthermore, social support can be measured in terms of structural support or functional support.[15] Structural support (also called social integration) refers to the extent to which a recipient is connected within a social network, like the number of social ties or how integrated a person is within his or her social network[2] Family relationships, friends, and membership in clubs and organizations contribute to social integration.[16] Functional support looks at the specific functions that members in this social network can provide, such as the emotional, instrumental, informational, and companionship support listed above.[17]

These different types of social support have different patterns of correlations with health, personality, and personal relationships.[13][18] For example, perceived support is consistently linked to better mental health whereas received support and social integration are not.[13][18] Some have suggested that "invisible support," a form of support where the person has support without his or her awareness, may be the most beneficial.[19][20]

Sources[edit]

Social support can come from a variety of sources, including (but not limited to): family, friends, romantic partners, pets, community ties, and coworkers.[7] Sources of support can be natural (e.g., family and friends) or more formal (e.g., mental health specialists or community organizations).[21] Support from a romantic partner is associated with health benefits, particularly for men.[22] Early familial social support has been shown to be important in children’s abilities to develop social competencies,[23] and supportive parental relationships have also had benefits for college-aged students.[24]

Links to mental and physical health[edit]

Benefits[edit]

Mental health[edit]

In stressful times, social support helps people reduce psychological distress (e.g., anxiety or depression).[7] Social support has been found to promote psychological adjustment in conditions with chronic high stress like HIV,[25] rheumatoid arthritis,[26] cancer,[27] stroke,[28] and coronary artery disease.[29]

People with low social support report more sub-clinical symptoms of depression and anxiety than do people with high social support.[13][30] In addition, people with low social support have higher rates of major mental disorder than those with high support. These include post traumatic stress disorder,[31] panic disorder,[32] social phobia,[33] major depressive disorder,[34] dysthymic disorder,[35] and eating disorders.[36][37] Among people with schizophrenia, those with low social support have more symptoms of the disorder.[38] In addition, people with low support have more suicidal ideation,[39] and more alcohol and drug problems.[40] Similar results have been found among children.[41]

Published in 2013 in the Journal of Affective Disorders, Jessica E. Akey, Lance S. Rintamaki, and Tera L. Kane did a qualitative study of 34 men and women diagnosed with an eating disorder and used the Health Belief Model (HBM) to explain the reasons for which they forgo seeking social support. Many people with eating disorders have a low perceived susceptibility which can be explained as a sense of denial about their illness. Their perceived severity of the illness is affected by those to whom they compare themselves too, often resulting in people believing their illness is not severe enough to seek support. Due to poor past experiences or educated speculation, the perception of benefits for seeking social support is relatively low. The number of perceived barriers towards seeking social support often prevents people with eating disorders from getting the support they need to better cope with their illness. Such barriers include fear of social sigma, financial resources, and availability and quality of support. Self-efficacy may also explain why people with eating disorders do not seek social support, because they may not know how to properly express their need for help. This research has helped to create a better understanding of why individuals with eating disorders do not seek social support, and may lead to increased efforts to make such support more available. Eating disorders are classified as mental illnesses but can also have physical health repercussions. Creating a strong social support system for those affected by eating disorders may help such individuals to have a higher quality of both mental and physical health.[42]

Physical Health[edit]

Social support has numerous ties to physical health, including mortality. People with low social support are at a much higher risk of death from a variety of diseases (e.g., cancer, cardiovascular disease).[17][18] Numerous studies have shown that people with higher social support have an increased likelihood for survival.[43]

Individuals with lower levels of social support have: more cardiovascular disease,[18] more inflammation and less effective immune system functioning,[44][45] more complications during pregnancy,[46] and more functional disability and pain associated with rheumatoid arthritis,[47] among many other findings. Conversely, higher rates of social support have been associated with numerous positive outcomes, including faster recovery from coronary artery surgery,[48] less susceptibility to herpes attacks,[49] a lowered likelihood to show age-related cognitive decline,[50] and better diabetes control.[51] People with higher social support are also less likely to develop colds and are able to recover faster if they are ill from a cold.[52]

Costs[edit]

Although there are many benefits to social support, it is not always beneficial. It has been proposed that in order for social support to be beneficial, the social support desired by the provider has to match the support given to him or her; this is known as the matching hypothesis.[30][53][54] Psychological stress may increase if a different type of support is provided than what the recipient wishes to receive (e.g., informational is given when emotional support is sought).[55][56] Additionally, elevated levels of perceived stress can impact the effect of social support on health-related outcomes.[57]

Other costs have been associated with social support. For example, received support has not been linked consistently to either physical or mental health;[13][18] if anything, received support has surprisingly been linked to worse mental health.[20] Additionally, if social support is overly intrusive, it can increase stress.[58]

Two Dominant Models[edit]

There are two dominant hypotheses addressing the link between social support and health: the buffering hypothesis and the direct effects hypothesis.[30] The main difference between these two hypotheses is that the direct effects hypothesis predicts that social support is beneficial all the time, while the buffering hypothesis predicts that social support is mostly beneficial during stressful times. Evidence has been found for both hypotheses.[7]

In the buffering hypothesis, social support protects (or "buffers") people from the bad effects of stressful life events (e.g., death of a spouse, job loss).[30] Evidence for stress buffering is found when the correlation between stressful events and poor health is weaker for people with high social support than for people with low social support. The weak correlation between stress and health for people with high social support is often interpreted to mean that social support has protected people from stress. Stress buffering is more likely to be observed for perceived support than for social integration[30] or received support.[13]

In the direct effects (also called main effects) hypothesis, people with high social support are in better health than people with low social support, regardless of stress.[30] In addition to showing buffering effects, perceived support also shows consistent direct effects for mental health outcomes.[34] Both perceived support and social integration show main effects for physical health outcomes.[18] However, received (enacted) support rarely shows main effects.[13][18]

Theories to Explain the Links[edit]

Several theories have been proposed to explain social support’s link to health. Stress and coping social support theory;[13][30][53][56] dominates social support research[59] and is designed to explain the buffering hypothesis described above. According to this theory, social support protects people from the bad health effects of stressful events (i.e., stress buffering) by influencing how people think about and cope with the events. According to stress and coping theory,[60] events are stressful insofar as people have negative thoughts about the event (appraisal) and cope ineffectively. Coping consists of deliberate, conscious actions such as problem solving or relaxation. As applied to social support, stress and coping theory suggests that social support promotes adaptive appraisal and coping.[30][56] Evidence for stress and coping social support theory is found in studies that observe stress buffering effects for perceived social support.[30] One problem with this theory is that, as described previously, stress buffering is not seen for social integration,[61] and that received support is typically not linked to better health outcomes.[13][18]

Relational regulation theory (RRT)[59] is another theory, which is designed to explain main effects (the direct effects hypothesis) between perceived support and mental health. As mentioned previously, perceived support has been found to have both buffering and direct effects on mental health.[62] RRT was proposed in order to explain perceived support’s main effects on mental health which cannot be explained by the stress and coping theory.[59] RRT hypothesizes that the link between perceived support and mental health comes from people regulating their emotions through ordinary conversations and shared activities rather than through conversations on how to cope with stress. This regulation is relational in that the support providers, conversation topics and activities that help regulate emotion are primarily a matter of personal taste. This is supported by previous work showing that the largest part of perceived support is relational in nature.[63]

Life-span theory[18] is another theory to explain the links of social support and health, which emphasizes the differences between perceived and received support. According to this theory, social support develops throughout the life span, but especially in childhood attachment with parents. Social support develops along with adaptive personality traits such as low hostility, low neuroticism, high optimism, as well as social and coping skills. Together, support and other aspects of personality influence health largely by promoting health practices (e.g., exercise and weight management) and by preventing health-related stressors (e.g., job loss, divorce). Evidence for life-span theory includes that a portion of perceived support is trait-like,[63] and that perceived support is linked to adaptive personality characteristics and attachment experiences.[18]

Biological Pathways[edit]

Many studies have tried to identify biopsychosocial pathways for the link between social support and health. Social support has been found to positively impact the immune, neuroendocrine, and cardiovascular systems.[64] Although these systems are listed separately here, evidence has shown that these systems can interact and affect each other.[18]

  • Immune system: Social support is generally associated with better immune function.[44][65] For example, being more socially integrated is correlated with lower levels of inflammation (as measured by C-reactive protein, a marker of inflammation),[66] and people with more social support have a lower susceptibility to the common cold.[52]
  • Neuroendocrine system: Social support has been linked to lower cortisol ("stress hormone") levels in response to stress.[67] Neuroimaging work has found that social support decreases activation of regions in the brain associated with social distress, and that this diminished activity was also related to lowered cortisol levels.[68]
  • Cardiovascular system: Social support has been found to lower cardiovascular reactivity to stressors.[44] It has been found to lower blood pressure and heart rates,[69] which are known to benefit the cardiovascular system.

Though many benefits have been found, not all research indicates positive effects of social support on these systems.[7] For example, sometimes the presence of a support figure can lead to increased neuroendocrine and physiological activity.[22]

Support Groups[edit]

Social support groups can be a source of informational support, by providing valuable educational information, and emotional support, including encouragement from people experiencing similar circumstances.[70][71] Studies have generally found beneficial effects for social support group interventions for various conditions,[72] including Internet support groups.[73]

Providing Support[edit]

There are both costs and benefits to providing support to others. Providing long-term care or support for someone else is a chronic stressor that has been associated with anxiety, depression, alterations in the immune system, and increased mortality.[74][75] However, providing support has also been associated with health benefits. In fact, providing instrumental support to friends, relatives, and neighbors, or emotional support to spouses has been linked to a significant decrease in the risk for mortality.[76] Also, a recent neuroimaging study found that giving support to a significant other during a distressful experience increased activation in reward areas of the brain.[77]

Gender and Culture[edit]

Gender Differences[edit]

Gender differences have been found in social support research.[14] Women provide more social support to others and are more engaged in their social networks.[61][78][79] Evidence has also supported the notion that women may be better providers of social support.[61] In addition to being more involved in the giving of support, women are also more likely to seek out social support to deal with stress.[80] Additionally, social support may be more beneficial to women.[81] Shelley Taylor and her colleagues have suggested that these gender differences in social support may stem from the biological difference between men and women in how they respond to stress (i.e., flight or fight versus tend and befriend).[79] Married men are less likely to be depressed compared to non-married men after the presence of a particular stressor because men are able to delegate their emotional burdens to their partner, and women have been shown to be influenced and act more in reaction to social context compared to men.[82] It has been found that men’s behaviors are overall more antisocial, with less regard to the impact their coping may have upon others, and women more prosocial-active with importance stressed on how their coping affects people around them.[83][84] This may explain why women are more likely to experiences negative psychological problems such as depression and anxiety based on how women receive and process stressors.[82]

Cultural Differences[edit]

Although social support is thought to be a universal resource, cultural differences exist in social support.[14] For example, European Americans have been found to call upon their social relationships for social support more often than Asian Americans or Asians during stressful occasions,[85] and Asian Americans expect social support to be less helpful than European Americans.[86] These differences in social support may be rooted in different cultural ideas about social groups.[85][86] Additionally, ethnic differences in social support from family and friends have been found.[87]

See also[edit]

References[edit]

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