Psychosocial models of the role of social support in the etiology of physical disease

Although there has been a substantial effort to establish the beneficial effects of social support on health and well-being, relatively little work has focused on how social support influences physical health. This article outlines possible mechanisms through which support systems may influence the etiology of physical disease. I begin by reviewing research on the relations between social support and morbidity and between social support and mortality. I distinguish between various conceptualizations of social support used in the existing literature and provide alternative explanations of how each of these conceptualizations of the social environment could influence the etiology of physical disease. In each case, I address the psychological mediators (e.g., health relevant cognitions, affect, and health behaviors) as well as biologic links (e.g., neuroendocrine links to immune and cardiovascular function). I conclude by proposing conceptual and methodological guidelines for future research in this area, highlighting the unique contributions psychologists can make to this inherently interdisciplinary endeavor.     

Advances in the conceptualization and measurement of religion and spirituality. Implications for physical and mental health research

Empirical studies have identified significant links between religion and spirituality and health. The reasons for these associations, however, are unclear. Typically, religion and spirituality have been measured by global indices (e.g., frequency of church attendance, self-rated religiousness and spirituality) that do not specify how or why religion and spirituality affect health. The authors highlight recent advances in the delineation of religion and spirituality concepts and measures theoretically and functionally connected to health. They also point to areas for areas for growth in religion and spirituality conceptualization and measurement. Through measures of religion and spirituality more conceptually related to physical and mental health (e.g., closeness to God, religious orientation and motivation, religious support, religious struggle), psychologists are discovering more about the distinctive contributions of religiousness and spirituality to health and well-being.     

Perfectionism and health: a mediational analysis of the roles of stress, social support and health-related behaviours

This study tested a model derived from personality theory in which perceived stress, perceived social support, health-risk and health-promotion behaviours mediate the relationship between perfectionism and perceived physical health. A sample of 538 undergraduate students completed a web-based survey assessing multi-dimensional perfectionism, perceived stress, perceived social support, health behaviours, physical health and a scale tapping elements of the five-factor model of personality. Analyses that account for the effects of traits from the five-factor model (e.g., neuroticism, conscientiousness and extraversion) indicated that socially prescribed perfectionism was associated with poorer physical health and this association was fully mediated by higher levels of perceived stress and lower levels of perceived social support. Self-oriented perfectionism was related complexly to health such that it was related to poorer health via higher levels of perceived stress, but was also related to better health via higher levels of perceived social support. Our findings illustrate the need for considering key mediators of the link between perfectionism and poor health outcomes.     

Perfectionism and health: A mediational analysis of the roles of stress,social support and health-related behaviours

This study tested a model derived from personality theory in which perceived stress, perceived social support, health-risk and health-promotion behaviours mediate the relationship between perfectionism and perceived physical health. A sample of 538 undergraduate students completed a web-based survey assessing multi-dimensional perfectionism, perceived stress, perceived social support, health behaviours, physical health and a scale tapping elements of the five-factor model of personality. Analyses that account for the effects of traits from the five-factor model (e.g., neuroticism, conscientiousness and extraversion) indicated that socially prescribed perfectionism was associated with poorer physical health and this association was fully mediated by higher levels of perceived stress and lower levels of perceived social support. Self-oriented perfectionism was related complexly to health such that it was related to poorer health via higher levels of perceived stress, but was also related to better health via higher levels of perceived social support. Our findings illustrate the need for considering key mediators of the link between perfectionism and poor health outcomes.     

Personality and psychopathology: working toward the bigger picture

There are systematic and meaningful links among normal and abnormal personality traits and Axis I and II constructs from the DSM. Nevertheless, much research in this area focuses on pairs of constructs (e.g., the link between personality traits and a specific Axis I disorder), rather than on the broader multivariate structure of the personality-psychopathology domain. We underscore the need for this broader perspective, a perspective that would transcend largely artificial boundaries between current constructs (e.g., normal and abnormal personality). We outline our approach to research from this perspective and we emphasize the internalizing (mood and anxiety) and externalizing (substance use and antisocial behavior) spectra as promising foci for initial research on the joint structure of personality and psychopathology.     

Profiles of Chronic Illness Knowledge in a Community Sample of American Adults

The author identified profiles of chronic illness knowledge (i.e., heart disease, cancer, diabetes) in a community sample of American adults and examined the effect of sociodemographic influences on relations of illness knowledge to health practices and well-being. Participants were 181 women and 120 men who completed measures of illness knowledge, sociodemographics, personal health practices (e.g., diet, exercise, substance abuse, adaptive healthcare use), well-being (e.g., self-rated physical health, depression, social support), and perceived illness risk. Two-step cluster analyses performed on random subsets of the sample identified three levels of illness knowledge: low, medium, and high. Knowledge groups were differentiated on most measures of health practices, well-being and perceived illness risk. However, effects were substantially attenuated after controlling for differences in age and SES. Findings indicate that age and other sociodemographic factors are related not only to levels of illness knowledge but also to the application of knowledge in relation to health practices and well-being.     

Stress,health, and reciprocity and sufficiency of social support: the case of university students in Japan

The authors examined the effects of reciprocity and sufficiency of social support on the mental and physical health of 488 Japanese university students with different levels of stressors. The questionnaire included items that measured support provided for, requested by, requested of, and received from others. It also addressed negative affect associated with support relationships, as well as the levels of stressors and mental and physical health. The participants' support relationships with others were fairly reciprocal. Although being overbenefited (i.e., receiving more support than one provides) was related to stronger feelings of indebtedness, being underbenefited (i.e., providing more support than one receives) was related to stronger feelings of burden. In sum, when the participants received less support than they requested and when they provided less support than others requested, they tended to become less mentally and physically healthy. Reciprocity of support appeared to have both direct and buffering effects; however, the effects of sufficient support on health did not vary with levels of stressors.     

Quality of Social Support in Mental and Physical Health

The current study investigates the relationship between social support and mental and physical health. Results indicate that poor functional support (or quality of support) is related to physical health problems while structural support (or social network size) is not. Moreover, although both poor functional and structural support are related to depression and anxiety, functional support is more strongly related to these outcome variables, the strongest relationship being associated with depression. Depression and hostility are also related to social isolation, although the relationship is again stronger for depression. The results suggest that the quality of social relationships is more important than quantity for optimal mental and physical health. The clinical relevance of these findings is that the quality of social support in the lives of individuals is central to recovery and should be addressed in medical and mental health treatment planning whenever it is an etiological or maintaining factor. The author dedicates this paper to her beloved father, Charles VanderVoort and her colleagues Dr. Uwe Stuecher and Dr. Gay Barfield whom she describes as “natural altruists, the rarest and most loving type of people in the world.”     

Social support and recovery from sexual assault: A review

This article reviews empirical studies of social support and sexual assault in order to evaluate the empirical evidence for the role of support in recovery from mental health and physical health consequences of this crime. Evidence is mixed with regard to the effect of social support, with some studies showing no significant effect and others showing positive effects of support on postassault recovery. Negative aspects of social relations (e.g., negative social reactions), while less studied, show consistent and strong negative effects on sexual assault victims. Factors that may modify the relationship of support and sexual assault outcomes are reviewed, including: assault characteristics, specific support provider factors, victim coping and functioning, preassault support network, and other postassault experiences, such as criminal justice system involvement. Limitations of existing research are noted. Suggestions for future research on the relationship of social support and sequelae of sexual assault are provided, with a focus on development of support network interventions for victims.     

An Interpersonal Approach to Religiousness and Spirituality: Implications for Health and Well‐Being

The interpersonal tradition (Horowitz & Strack, 2011) provides a rich conceptual and methodological framework for theory‐driven research on mechanisms linking religiousness and spirituality (R/S) with health and well‐being. In three studies, we illustrate this approach to R/S. In Studies 1 and 2, undergraduates completed various self‐report measures of R/S, interpersonal style, and other aspects of interpersonal functioning. In Study 3, a community sample completed a wide variety of R/S measures and a measure of interpersonal style. Many, but not all, aspects of religiousness (e.g., overall religiousness, intrinsic religiousness) were associated with a warm interpersonal style, and most aspects and measures of spirituality were associated with a warm and somewhat dominant style. Spirituality and related constructs (i.e., gratitude, compassion) were associated with interpersonal goals that emphasize positive relationships with others, and with beneficial interpersonal outcomes (i.e., higher social support, less loneliness, and less conflict). However, some aspects of R/S (e.g., extrinsic religiousness, belief in a punishing God) were associated with a hostile interpersonal style. R/S have interpersonal correlates that may enhance or undermine health and emotional adjustment. This interpersonal perspective could help clarify why some aspects of religiousness and spirituality are beneficial and others are not.     

Emotional health,support, and self‐efficacy in young adults with a history of language impairment

Children and adolescents with language impairment (LI) are at risk of emotional health difficulties. However, less is known about whether these difficulties continue into adulthood for this group, or about the potential role of environmental resources (e.g., social support) or internal resources (e.g., self‐efficacy). This study investigates emotional health in 81 adults with a history of developmental LI (aged 24) compared with 87 age‐matched peers (AMPs) using Beck Inventories. Social support and self‐efficacy measures were examined as predictors. The results were fourfold: (1) adults with LI had higher levels of emotional health problems; (2) whilst the availability of social support was similar across groups, people with LI received more help from others compared to peers; (3) social support was not significantly related to emotional health in those with LI – in contrast, for AMPs, uptake of support indicated poorer emotional health; (4) self‐efficacy was the strongest predictor of emotional health in both groups and fully mediated the relationship between language and emotional health (no moderation by group). This cross‐sectional study has implications for concurrent factors that might affect emotional health outcomes for children and young people with and without LI.     

Social Support and Its Relation to Health: A Critical Evaluation

issues and problems related to the view that social support can moderate or reduce the adverse effects of stress on mental and physical health are discussed. Conceptual, methodological, and theoretical shortcomings of this body of research are presented. Research attention is directed toward the interactive process between provider and recipient of social support. Identification of factors involved in the receipt and offering of social support is essential for theory development. Recognition of individual differences in the giving, as well as taking, of social support is needed. The possibility is raised that the persistent belief in the power of social support to reduce stress, despite lack of convincing data, reflects a form of bias due to strong expectancies.     

Community Psychology at the Crossroads: Prospects for Interdisciplinary Research

Effective engagement in interdisciplinary work is critical if community psychology is to achieve its promise as a field of ecological inquiry and social action. The purpose of this paper and special issue is to help make the benefits of interdisciplinary community research clearer and to identify and begin to address its challenges. Although some areas of psychology (e.g., biological, cognitive and health) have made substantial interdisciplinary strides in recent decades, progress in community psychology (and related areas) is more modest. In this article we explore the prospects for expanding and improving interdisciplinary community research. Challenges include designs, measures, and analytical frameworks that integrate multiple levels of analysis from individuals through families, organizations, and communities to policy jurisdictions, and the complexities involved in simultaneously bringing together multiple disciplinary collaborators and community partners. Challenges to interdisciplinary collaboration common to all disciplines include the disciplinary nature of academic culture and reward structures, limited funding for interdisciplinary work and uncertainties related to professional identity and marketability. Overcoming these challenges requires a synergy among facilitative factors at the levels of the interdisciplinary project team (e.g., the framing question; embedded relationships; leadership), the investigators (e.g., commitment to new learning; time to invest), and the external context (e.g., physical, administrative, economic and intellectual resources and support for interdisciplinary work). We conclude by identifying several exemplars of effective interdisciplinary collaborations and concrete steps our field can take to enhance our development as a vibrant community-based, multilevel discipline increasingly devoted to interdisciplinary inquiry and action.     

Agentic and Communal Social Motives

People chart and navigate their social lives along two cardinal axes – agency and communion. The motives to approach communion (e.g., enhance closeness and cooperation), approach agency (e.g., gain status and control), avoid communion (e.g., limit vulnerabilities and obligations), and avoid agency (e.g., limit resentments and rivalries) can each be adaptive, depending on the person and situation. After reviewing common implicit and explicit measures of agentic and communal motives, I describe how these motives together shape (and are shaped by) diverse phenomena, such as individuals' involvements in mating and parenting and, concurrently, their testosterone and oxytocin levels. I also detail how normative models of development and maturation depict a shifting dynamic between communal and agentic motives over the lifespan: In childhood, secure attachments provide foundations for developing agency; in adulthood, the challenge becomes yoking agency (one's accumulated mental, physical, and social resources) to communal aims (nurturing others and prosocial endeavors).     

Gambling, health and age: data from the National Epidemiologic Survey on Alcohol and Related Conditions.

The health effects of recreational gambling are presently unclear, particularly across age groups. Theories of healthy aging suggest that social activities, including gambling, may be beneficial to the health of older adults. Using cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093), the authors examined associations between gambling (categorized as nongambling, recreational gambling, or problem/pathological gambling) and health and functioning measures stratified by age (40-64 years and >/=65). Problem/pathological gambling was uniformly associated with poorer health measures among both younger and older adults. Among younger respondents, poorer health measures were also found among recreational gamblers. However, among older respondents, recreational gambling was associated not only with some negative measures (e.g., obesity) but also with some positive measures (e.g., better physical and mental functioning). Longitudinal studies are needed to clarify the relationship between gambling and health in older adults in the context of healthy aging.     

Dimensionality of the Rosenberg Self-Esteem Scale and Its Relationships With the Three-and the Five-Factor Personality Models

The interpersonal correlates of the Guilt Inventory (Kugler &; Jones, 1992), which yields scores for state guilt, trait guilt, and moral standards, were assessed. Data collection addressed three issues including the relationships among Guilt Inventory scores and measures of: (a) interpersonal emotions and traits (e.g., shyness, self-consciousness, anger, etc.); (b) the social support network; and (c) ratings of trait guilt, moral standards, and relevant adjectives by friends and family members. Results indicated that trait and state guilt scores were significantly related to various interpersonal measures, most particularly, depression, anxiety, shyness, and loneliness, but only modestly related to satisfaction with social support. Moral standards were generally unrelated to these variables. Others tended to rate participants higher on trait guilt negatively (e.g., higher on contemptuous, angry, guilty, etc.), and participants higher on moral standards in socially acceptable terms (e.g., higher on prompt, self-reliant, moral, and religious). Results are interpreted in view of the frequently cited distinction between social and nonsocial emotions.     

Ordinary Social Interaction and the Main Effect Between Perceived Support and Affect

Relational regulation theory hypothesizes that (a) the main effect between perceived support and mental health primarily reflects ordinary social interaction rather than conversations about stress and how to cope with it, and (b) the extent to which a provider regulates a recipient's mental health primarily reflects the recipient's personal taste (i.e., is relational), rather than the provider's objective supportiveness. In three round‐robin studies, participants rated each other on supportiveness and the quality of ordinary social interaction, as well as their own affect when interacting with each other. Samples included marines about to deploy to Afghanistan (N = 100; 150 dyads), students sharing apartments (N = 64; 96 dyads), and strangers (N = 48; 72 dyads). Perceived support and ordinary social interaction were primarily relational, and most of perceived support's main effect on positive affect was redundant with ordinary social interaction. The main effect between perceived support and affect emerged among strangers after brief text conversations, and these links were partially verified by independent observers. Findings for negative affect were less consistent with theory. Ordinary social interaction appears to be able to explain much of the main effect between perceived support and positive affect.     

Social Support in Cardiac Rehabilitation Exercise Maintenance: Associations with Self‐Efficacy and Health‐Related Quality of Life1

This study examined whether cardiac rehabilitation (CR) maintenance exercise participants who were high and moderate in social support (SS) differed in their types of self‐efficacy and health‐related quality of life, and whether SS was related to self‐efficacy. Measures of SS, self‐efficacy (i.e., walking, scheduling, in‐class efficacy), and health‐related quality of life (HRQL) were administered to 64 CR maintenance exercise participants. A one‐way, between‐groups MANOVA was significant (p < .01), indicating that CR participants higher in SS reported significantly greater self‐efficacy and physical HRQL than did their moderate counterparts. In addition, social support predicted significant variance in task self‐efficacy. The findings suggest that differential perceptions of SS are related to differences in walking, in‐class and scheduling self‐efficacy, and the physical component of HRQL among CR exercise maintainers.     

Physical symptoms and the interplay of work and family roles

The paradigm underlying research on the relationship between work and physical-health symptoms in men has focused on workplace stressors and has ignored men's family roles. Research on women, work, and health suggests several necessary additions to this paradigm, including (a) a focus on job rewards and job concerns and (b) attention to the impact of family roles on the relationship between job rewards and concerns and physical health. We included these variables in a study of a disproportionate random sample of 403 employed 25- to 55-year-old women. Major findings are that (a) work rewards (e.g., helping others at work) are related to reports of low levels of physical symptoms; (b) work concerns (e.g., overload) are associated with reports of high levels of physical symptoms; (c) particular work rewards, which may be different for women than for men, mitigate the negative health effects of work concerns; (d) among employed mothers, satisfaction with salary is negatively related to physical-health symptoms; and (e) women in positive marriages or partnerships were more likely to reap physical-health benefits from the rewards of helping others at work and from supervisor support.     

The metabolic mind: A role for leptin and ghrelin in affect and social cognition

Leptin and ghrelin are metabolic hormones central to energy regulation in the body. Theories of allostasis suggest that metabolism could matter for more than just food intake and weight regulation but also ultimately for psychological processes, such as affect and social cognition. Allostasis is the process by which the brain monitors ongoing physiological states and, in turn, regulates physiology based on expectations about how a given situation will impact the self. Motivated by this allostatic perspective, we argue that leptin and ghrelin may be influenced by and even contribute to psychological processes such as affect and social cognition. Specifically, we review literature suggesting that leptin and ghrelin may be sensitive to social affective signals and related contexts (e.g., social status, and social threat vs. support), given that these signals and contexts may represent access to tangible physical and psychological resources that support allostasis and metabolic needs. We then review literature showing that leptin, ghrelin, and associated metabolic states may feed into the construction of social affective states and behaviors (e.g., emotion and risk taking), in order to motivate behaviors in line with allostatic needs. We close by offering guidelines for researchers interested in contributing to this emerging field and highlight opportunities for future research. We believe that leptin and ghrelin offer exciting new directions for social and affective scientists interested in linking the mind, brain, and body.