Social support
Encyclopedia
Social support can be defined and measured in many ways. It can loosely be defined as feeling that one is cared for by and 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). 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, organizations, coworkers, etc.
Social support is important to many people interested in physical health (e.g., mortality) and mental health
(e.g., depression). As a result, there have been over 45,000 articles, chapters, and books published on social support across a wide range of disciplines including psychology
, medicine
, sociology
, nursing
, public health
, and social work
. In general, 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 main effects hypothesis. Additionally, several theories and biological pathways for the link between social support and health have been proposed. Gender
and cultural
differences in social support have also been found.
There are four common functions of social support:
Researchers also commonly make a distinction between perceived and received support. 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.
Furthermore, social support can be measured in terms of structural support or functional support. 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.
like HIV
, rheumatoid arthritis
, cancer
, stroke
, and coronary artery disease.
People with low social support report more sub-clinical symptoms of depression
and anxiety
than do people with high social support. 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, panic disorder
, social phobia
, major depressive disorder, dysthymic disorder, and eating disorders . Among people with schizophrenia
, those with low social support have more symptoms of the disorder. In addition, people with low support have more suicidal ideation
, and more alcohol and drug problems
. Similar results have been found among children.
. People with low social support are at a much higher risk of death from a variety of diseases (e.g., cancer, cardiovascular disease). Numerous studies have shown that people with higher social support have an increased likelihood for survival.
Individuals with lower levels of social support have: more cardiovascular disease
, more inflammation
and less effective immune system
functioning, more complications during pregnancy
, and more functional disability and pain associated with rheumatoid arthritis, among many other findings. Conversely, higher rates of social support have been associated with numerous positive outcomes, including faster recovery from coronary artery surgery, less susceptibility to herpes attacks, a lowered likelihood to show age-related cognitive decline, and better diabetes control. 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.
Other costs have been associated with social support. For example, received support has not been linked consistently to either physical or mental health; if anything, received support has surprisingly been linked to worse mental health. Additionally, if social support is overly intrusive, it can increase stress.
. Evidence has been found for both hypotheses.
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) . 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 or received support.
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. In addition to showing buffering effects, perceived support also shows consistent direct effects for mental health outcomes. Both perceived support and social integration show main effects for physical health outcomes. However, received (enacted) support rarely shows main effects.
with the events. According to stress and coping theory, 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 . Evidence for stress and coping social support theory is found in studies that observe stress buffering effects for perceived social support. One problem with this theory is that, as described previously, stress buffering is not seen for social integration, and that received support is typically not linked to better health outcomes.
Relational regulation theory (RRT) 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. 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. 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.
Life-span theory 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, and that perceived support is linked to adaptive personality characteristics and attachment experiences.
pathways for the link between social support and health. Social support has been found to positively impact the immune
, neuroendocrine, and cardiovascular systems. Although these systems are listed separately here, it should be noted that evidence has shown that these systems can interact and affect each other.
Though many benefits have been found, it should be noted that not all research indicates positive effects of social support on these systems. For example, sometimes the presence of a support figure can lead to increased neuroendocrine and physiological activity.
or support for someone else is a chronic stressor that has been associated with anxiety, depression, alterations in the immune system, and increased mortality. 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. 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.
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
).
Social network
A social network is a social structure made up of individuals called "nodes", which are tied by one or more specific types of interdependency, such as friendship, kinship, common interest, financial exchange, dislike, sexual relationships, or relationships of beliefs, knowledge or prestige.Social...
. 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). 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, organizations, coworkers, etc.
Social support is important to many people interested in physical health (e.g., mortality) and mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
(e.g., depression). As a result, there have been over 45,000 articles, chapters, and books published on social support across a wide range of disciplines including psychology
Psychology
Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...
, medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, sociology
Sociology
Sociology is the study of society. It is a social science—a term with which it is sometimes synonymous—which uses various methods of empirical investigation and critical analysis to develop a body of knowledge about human social activity...
, nursing
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
, public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
, and social work
Social work
Social Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
. In general, 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 main effects hypothesis. Additionally, several theories and biological pathways for the link between social support and health have been proposed. Gender
Gender
Gender is a range of characteristics used to distinguish between males and females, particularly in the cases of men and women and the masculine and feminine attributes assigned to them. Depending on the context, the discriminating characteristics vary from sex to social role to gender identity...
and cultural
Culture
Culture is a term that has many different inter-related meanings. For example, in 1952, Alfred Kroeber and Clyde Kluckhohn compiled a list of 164 definitions of "culture" in Culture: A Critical Review of Concepts and Definitions...
differences in social support have also been found.
Distinctions in Measurement
Social support can be categorized and measured in several different ways.There are four common functions of social support:
- Emotional support is the offering of empathy, concern, affection, love, trust, acceptance, intimacy, encouragement, or caring. It is the warmth and nurturance provided by sources of social support . Providing emotional support can let the individual know that he or she is valued. It is also sometimes called esteem support or appraisal support.
- Tangible support is the provision of financial assistance, material goods, or services . Also called instrumental support, this form of social support encompasses the concrete, direct ways people assist others.
- Informational support is the provision of advice, guidance, suggestions, or useful information to someone. This type of information has the potential to help others problem-solve.
- Companionship support is the type of support that gives someone a sense of social belonging (and is also called belonging). This can be seen as the presence of companions to engage in shared social activities with:
Researchers also commonly make a distinction between perceived and received support. 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.
Furthermore, social support can be measured in terms of structural support or functional support. 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.
Mental Health
In stressful times, social support helps people reduce psychological distress (e.g, anxiety or depression) . Social support has been found to promote psychological adjustment in conditions with chronic high stressChronic stress
Chronic stress is the response to emotional pressure suffered for a prolonged period over which an individual perceives he or she has no control. It involves an endocrine system response in which occurs a release of corticosteroids...
like HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
, cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
, and coronary artery disease.
People with low social support report more sub-clinical symptoms of depression
Depression
Depression or depress may refer to:-Medicine:* Depression , a state of low mood and aversion to activity** Mood disorder, a class of mental illnesses featuring depressed mood...
and anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
than do people with high social support. 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, panic disorder
Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
, social phobia
Social phobia
Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...
, major depressive disorder, dysthymic disorder, and eating disorders . Among people with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, those with low social support have more symptoms of the disorder. In addition, people with low support have more suicidal ideation
Suicidal ideation
Suicidal ideation is a common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, some go on to make suicide attempts...
, and more alcohol and drug problems
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
. Similar results have been found among children.
Physical Health
Social support has numerous ties to physical health, including mortalityMortality
Mortality is the condition of being mortal, or susceptible to death; the opposite of immortality.It may also refer to:* Mortality rate, a measure of the number of deaths in a given population...
. People with low social support are at a much higher risk of death from a variety of diseases (e.g., cancer, cardiovascular disease). Numerous studies have shown that people with higher social support have an increased likelihood for survival.
Individuals with lower levels of social support have: more cardiovascular disease
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
, more inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
and less effective immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
functioning, more complications during pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
, and more functional disability and pain associated with rheumatoid arthritis, among many other findings. Conversely, higher rates of social support have been associated with numerous positive outcomes, including faster recovery from coronary artery surgery, less susceptibility to herpes attacks, a lowered likelihood to show age-related cognitive decline, and better diabetes control. People with higher social support are also less likely to develop colds
Common cold
The common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
and are able to recover faster if they are ill from a cold.
Costs
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. 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).Other costs have been associated with social support. For example, received support has not been linked consistently to either physical or mental health; if anything, received support has surprisingly been linked to worse mental health. Additionally, if social support is overly intrusive, it can increase stress.
Two Dominant Models
There are two dominant hypotheses addressing the link between social support and health: the buffering hypothesis and the direct effects hypothesis. 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 timesStress (psychological)
Stress The word stress is used in many different contexts. However, psychological stress is not as vague and all-encompassing as most people believe it to be...
. Evidence has been found for both hypotheses.
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) . Evidence for stress buffering is found when the correlation
Correlation
In statistics, dependence refers to any statistical relationship between two random variables or two sets of data. Correlation refers to any of a broad class of statistical relationships involving dependence....
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 or received support.
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. In addition to showing buffering effects, perceived support also shows consistent direct effects for mental health outcomes. Both perceived support and social integration show main effects for physical health outcomes. However, received (enacted) support rarely shows main effects.
Theories to Explain the Links
Several theories have been proposed to explain social support’s link to health. Stress and coping social support theory; dominates social support research 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 copeCoping
Coping may refer to:* Coping consists of the capping or covering of a wall* Coping is the process of managing stressful circumstances* Coping , a woodworking technique...
with the events. According to stress and coping theory, events are stressful insofar as people have negative thoughts about the event (appraisal
Appraisal theory
Appraisal theory is the idea that emotions are extracted from our evaluations of events that cause specific reactions in different people. Essentially, our appraisal of a situation causes an emotional, or affective, response that is going to be based on that appraisal. An example of this is going...
) 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
Adaptation
An adaptation in biology is a trait with a current functional role in the life history of an organism that is maintained and evolved by means of natural selection. An adaptation refers to both the current state of being adapted and to the dynamic evolutionary process that leads to the adaptation....
appraisal and coping . Evidence for stress and coping social support theory is found in studies that observe stress buffering effects for perceived social support. One problem with this theory is that, as described previously, stress buffering is not seen for social integration, and that received support is typically not linked to better health outcomes.
Relational regulation theory (RRT) 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. 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. RRT hypothesizes that the link between perceived support and mental health comes from people regulating their emotions
Emotional self-regulation
Emotional self-regulation, also known as Emotion Regulation or simply ER, is being able to properly regulate one's emotions. It is a complex process that involves the initiating, inhibiting, or modulating the following aspects of functioning:...
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.
Life-span theory 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
Attachment theory
Attachment theory describes the dynamics of long-term relationships between humans. Its most important tenet is that an infant needs to develop a relationship with at least one primary caregiver for social and emotional development to occur normally. Attachment theory is an interdisciplinary study...
with parents. Social support develops along with adaptive personality traits
Trait theory
In psychology, Trait theory is a major approach to the study of human personality. Trait theorists are primarily interested in the measurement of traits, which can be defined as habitual patterns of behavior, thought, and emotion. According to this perspective, traits are relatively stable over...
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, and that perceived support is linked to adaptive personality characteristics and attachment experiences.
Biological Pathways
Many studies have tried to identify biopsychosocialBiopsychosocial model
The biopsychosocial model is a general model or approach that posits that biological, psychological , and social factors, all play a significant role in human functioning in the context of disease or illness...
pathways for the link between social support and health. Social support has been found to positively impact the immune
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
, neuroendocrine, and cardiovascular systems. Although these systems are listed separately here, it should be noted that evidence has shown that these systems can interact and affect each other.
- Immune system: Social support is generally associated with better immune function. For example, being more socially integrated is correlated with lower levels of inflammation (as measured by C-reactive proteinC-reactive proteinC-reactive protein is a protein found in the blood, the levels of which rise in response to inflammation...
, a marker of inflammation), and people with more social support have a lower susceptibility to the common cold. - Neuroendocrine system: Social support has been linked to lower cortisolCortisolCortisol is a steroid hormone, more specifically a glucocorticoid, produced by the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat,...
(“stress hormone”) levels in response to stress. NeuroimagingNeuroimagingNeuroimaging includes the use of various techniques to either directly or indirectly image the structure, function/pharmacology of the brain...
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. - Cardiovascular system: Social support has been found to lower cardiovascular reactivity to stressors. It has been found to lower blood pressureBlood pressureBlood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
and heart ratesHeart rateHeart rate is the number of heartbeats per unit of time, typically expressed as beats per minute . Heart rate can vary as the body's need to absorb oxygen and excrete carbon dioxide changes, such as during exercise or sleep....
, which are known to benefit the cardiovascular system.
Though many benefits have been found, it should be noted that not all research indicates positive effects of social support on these systems. For example, sometimes the presence of a support figure can lead to increased neuroendocrine and physiological activity.
Support Groups
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. Studies have generally found beneficial effects for social support group interventions for various conditions, including Internet support groups.Providing Support
There are both costs and benefits to providing support to others. Providing long-term careLong-term care
Long-term care is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time....
or support for someone else is a chronic stressor that has been associated with anxiety, depression, alterations in the immune system, and increased mortality. 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. Also, a recent neuroimaging study found that giving support to a significant other during a distressful experience increased activation in reward
Reward system
In neuroscience, the reward system is a collection of brain structures which attempts to regulate and control behavior by inducing pleasurable effects...
areas of the brain.
Gender Differences
Gender differences have been found in social support research. Women provide more social support to others and are more engaged in their social networks. Evidence has also supported the notion that women may be better providers of social support. 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. Additionally, social support may be more beneficial to women. Shelley TaylorShelley Taylor
Shelley Elizabeth Taylor is a distinguished professor of psychology at the University of California, Los Angeles. She received her Ph.D. from Yale University, and was formerly on the faculty at Harvard University...
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
Tend and befriend
Tend and befriend is a behavior exhibited by some animals, including humans, when under threat. It refers to protection of offspring and seeking out the social group for mutual defense . The tend-and-befriend idea was originally developed by Dr. Shelley E...
).