Social support
From The Art and Popular Culture Encyclopedia
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Social support is important to many people interested in physical (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. There are three distinct sub-types of social support, and each has different links to health: A support recipient’s perception of social support, the specific supportive actions received, and the extent to which a person is integrated within a social network. In addition, there are three main types of causes of social support: the personality of the support recipient, the objectively supportive aspects of support providers, as well as the relationships between specific support recipients and providers. A variety of theories of social support have been proposed. For example, one theory describes how social support helps people cope with stressful events. Another theory describes how social support maintains well being in the absence of stress. A third theory describes how social support becomes part of an adaptive personality profile throughout a person’s life.
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Important subtypes
There are three subtypes of social support: perceived support, enacted support, and social integration (Barrera, 1986). Perceived support refers to a recipient’s subjective judgment that providers will offer (or have offered) effective help during times of need. Enacted support (also called received support) refers to specific supportive actions (e.g., advice or reassurance) offered by providers during times of need. Social integration refers to the extent to which a recipient is connected within a social network. Family relationships, friends, and membership in clubs and organizations contribute to social integration. Surprisingly, these three forms of social support are not strongly related to each other and each has different patterns of correlations with health, personality, and personal relationships (Barrera, 1986; Uchino, 2009). For example, perceived support is consistently linked to better mental health whereas enacted support and social integration are not (Barrera, 1986; Uchino, 2009). In contrast, social integration has been linked consistently to physical health outcomes (e.g., mortality, heart disease) (Uchino, 2009). Enacted support has not been linked consistently to either physical or mental health (Barrera, 1986; Uchino, 2009). If anything, enacted support has been linked to worse mental health (Bolger, Zuckerman & Kessler, 2000).
Perceived support
There are three main types of causes of perceived support: recipient trait influences, provider influences, and relational influences (Lakey, 2010; Lakey, McCabe, Fisicaro & Drew, 1996). These can be defined and their strength can be measured when the same set of support recipients rate the same set of providers on supportiveness. Recipient influences reflect differences among recipients in their perceptions of providers, averaged across providers. For example, Recipient A might see all providers as more supportive than Recipient B. Because recipients are rating the same providers, we know that average differences among recipients do not reflect the characteristics of providers, but instead reflect the trait-like personality characteristics of recipients. Provider influences reflect differences among providers, averaged across recipients. Provider influences reflect agreement among recipients that some providers are more supportive than other providers. As such, these influences reflect the extent to which providers are objectively supportive (i.e., recipients agree on who is most supportive). Relational influences reflect systematic disagreement among recipients about the relative supportiveness of providers. For example, Recipient A might see Provider A as more supportive than Provider B, but Recipient B might see Provider B as more supportive than Provider A. This is the aspect of support that is a matter of personal taste, in the same way that different people have different opinions about which works of art are better or worse.
A recent meta-analysis (Lakey, 2010) of the strength of recipient, provider and relational influences, derived from 5 studies in the US and Europe indicate that relational influences are strongest, accounting for about 60% of perceived support. Recipient trait influences are next strongest, accounting for about 25% of perceived support. Provider influences are small, accounting for only 5 – 10%. Thus, there is relatively little in the way of objectively supportive providers. Part of perceived support reflects the personality of recipients, but the largest part reflects the personal tastes of recipients.
Link to health
There are two key ways by which social support is linked to health: stress buffering and main effects (Cohen & Wills, 1985). In stress buffering, social support protects 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 bad events and poor mental or physical 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. In main effects, people with high social support are in better health than people with low social support regardless of stress. Stress buffering is more likely to be observed for perceived support than for social integration (Cohen & Wills, 1985) or enacted support (Barrera, 1986). Perceived support also shows consistent main effects for mental health outcomes (Lakey & Cronin, 2008) and both perceived support and social integration show main effects for physical health outcomes (Uchino, 2009). Enacted support rarely shows main effects (Barrera, 1986; Uchino, 2009).
Mental and physical health
Many people are interested in social support because social support has been consistently related to mental and physical health. With regard to mental health, people with low social support report more sub-clinical symptoms of depression and anxiety than do people with high social support (Barrera, 1986; Cohen & Wills, 1985). 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 (Brewin, Andrews, & Valentine, 2000), panic disorder (Huang, Yen & Lung, 2010), social phobia (Torgrud, Walker, Murray, Cox, Chartier, Kjernisted, 2004), major depressive disorder (Lakey & Cronin, 2008), dysthymic disorder (Klein, Taylor, Dickstein & Harding, 1988), and eating disorders (Stice, 2002; Grisset & Norvell, 1992). Among people with schizophrenia, those with low social support have more symptoms of the disorder (Norman et al., 2005). In addition, people with low support have more suicidal ideation (Casey et al., 2006) and more alcohol and drug problems (Stice, Barrera & Chassin, 1998; Wills & Cleary, 1996). Similar results have been found among children (Chu, Saucier & Hafner, 2010). Regarding physical health, people with low social support die sooner than people with high support (Holt-Lunstad, Smith & Layton, 2010; Uchino, 2009), have more cardiovascular disease (Uchino, 2009), inflammation and less effective immune system functioning (Uchino, 2006; Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002).
Health theories
Several theories have been proposed to explain social support's link to health. The dominant theory is stress and coping social support theory (Cohen & Wills, 1985), which is designed to explain stress buffering effects. Life-span theory (Uchino, 2009) is designed to explain how the trait-like aspect of social support is linked to physical health. Relational regulation theory (Lakey & Orehek, 2011) focuses on the relational aspect of perceived support and is designed to explain the main effect between perceived support and mental health.
Stress and coping social support theory (Barrera, 1986; Cohen & Wills, 1985; Cutrona & Russell, 1990; Thoits, 1986) dominates social support research. 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 (Lazaraus & Folkman, 1984) 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, enacted support promotes adaptive appraisal and coping. Perceived support reflects a history of receiving effective enacted support. Evidence for stress and coping social support theory is found in studies that observe stress buffering effects for social support (Cohen & Wills, 1985). One problem with this theory is that, as described previously, enacted support is typically not linked to better health outcomes (Barrera, 1986; Uchino, 2009).
Life-span theory (Uchino, 2009) focuses on how trait-like aspects of perceived support and social integration can explain links to physical health. According to this theory, social support develops throughout the life span, but especially in childhood attachment with parents. Social support develops in tandem with adaptive personality characteristics 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 (Lakey, 2010), and that perceived support is linked to adaptive personality characteristics and attachment experiences (Uchino, 2009).
Relational regulation theory (RRT; Lakey & Orehek, 2011) is designed to explain main effects between perceived support and mental health that result from relational influences. As described previously, perceived support is primarily relational (Lakey, 2010). Other research has shown a weaker than expected correlation between perceived support and enacted support (Barrera, 1986). Lakey and Orehek (2011) interpreted this weaker link to mean that perceived support's correlation with mental health is based on processes other than stress and coping. Thus, RRT hypothesizes that people regulate their emotions through ordinary conversations and shared activities. Yet, this regulation is relational in that the providers, conversation topics and activities that help regulate emotion are primarily a matter of personal taste.
