Presented By: Stacy Jackson March 18, 2008 Social Support Presented By: Stacy Jackson March 18, 2008

Definitions Social Support “ information leading the subject to believe (s)he is cared for and loved, esteemed, and a member of a network of mutual obligation.” – Cobb (1) “perception that one is cared for and loved or has a confident or intimate friend”. – Bloom (2) “ the degree to which a person’s basic social needs are gratified through interaction with others.”- Thoits and Kaplan et al.(3,4) “may be seen as the emotional, instrumental and financial aid that is obtained from one’s social network.”- Berkman (5) - Overall it appears that all the definitions imply some form of positive interaction or helpful behaviour provided to someone in need of support. (7)

Definitions Social Networks Defined as “ the vehicle through which social support is provided.” – Langford (6) Refers to people’s social ties to one another, and the structure of those social ties. (8) Depending on the network, social networks may or may not be supportive or beneficial.

Types of Support Research articles have identified four types of social support: (5,6) Emotional Support: Includes provision of care, love, trust and empathy as well as respect and admiration. This type of support is the most abundant, and far out numbers all other types of support (6). Related to Attachment Theory- that people are the happiest and most effective when that they have one or more trusted persons they can confide in (8). Instrumental Support Includes providing tangible good and services, such as money, groceries, completing work that was assigned to someone else, use of one’s car etc.(6)

Types of Support, cont’d Informational Support Involves providing information or advise to another in a time of need, especially problems solving situations (6). The richest source of this form of support is often from professionals. E.g., Health Professionals, Lawyers, Accountants, etc. (9) However informational support can also be provided by friends and family. (9) Appraisal Support Often included as part of informational support. Involve the communication of key information that is relevant in self-evaluation situations. (6)

Types of Support, cont’d Each of these four types of social support appear to play a role in protecting and helping person who is receiving the support (6). They also enable an exchange of reciprocal supportive actions. This may further increase one’s level of perceived support – the sense that one belongs to a social group and that help will be there if and when it is needed. (5,8) Note – Perceived vs. Received Support Received support refers to support transactions that actually occur. (8)

However, for these support elements to have a positive effect on health and well being it appears 3 additional components are needed (6): Social Networks- previously defined. Social Embeddedness- the connectedness one has with others within their social network (how deep or strong the relationship is). Social Climate- the personality of the environment (is it a supportive type of environment). It is important to note that large social networks does not mean this large network will provide large amounts of support (6).

Measuring Social Support Social support is a difficult commodity to measure, as it cannot be measured by mass or energy. (1) This is because in order to measure social support, individuals have to be aware that they are being supported, however “the affective component of social support, is likely to be influenced by one’s psychological state or social networks functions.” (5) Thus, individuals who have adequate support are more likely to feel that not inadequate social support because they feel lonely, depressed or unhappy (5).

Social Support and Health There is very little doubt that social support and social ties have positive influences on health. (8) The earliest indications that social support and social interaction was related to health was shown by Durkheim’s suicide studies (2). He found that being integrated into a society appeared to be critical to health and well-being individuals who lacked these social ties were likely to be isolated, lonely and in an extreme state of anomie. All of which increased the risk of suicide and premature death – a trend that social epidemiologists would confirm. (2)

Effects of Social Support on Health Studies (1,5) have shown social support has many positive effects on health and well-being, including: Reduced risk of death due to heart attack or other circulatory diseases Men who never married, or live alone, had a higher risk of heart disease. Reduced risk of cancers. Faster recovery. Fewer complications during pregnancy. Keeping patients in medical treatment and increasing compliance with prescribed medications. Increased levels of self-worth and esteem. (1) Facilitates coping and adaptation to change. (1) Reduced anxiety levels. (1) Overall, increased life satisfaction. (6)

Effects of Social Support on Health (2) Studies have shown that social support and networks can predict risk of mortality in all adults. (5) But how does social support prevent disease and promote well-being? Is it: At the biological level? (are social networks intertwined with biological risk factors?) (5) Is it at the recovery level? (5) Or the way social support promotes coping and adaptation to life’s stresses and changes? (1) Or is it through the information that these support systems provide through advice and access to new social contacts? (5) Or does social support act as a buffer? (2)

How Support Works There are many hypotheses on how social support may promote health. One is that social support may have some effect on neuroendocrine pathways - possibly through stress reduction. (1) Or through promoting compliant behaviours in patients, causing them to more diligent with the treatment and medication regimes - by being good patients (1)

How Support Works (2) However, many studies suggest that support may not contribute directly to health outcomes, but rather “buffer” or protect health during times of high stress (2). A study conducted be Cohen and Wills found a relationship between social support and psychological well-being only in the presence of stress. It is believed that social support increases one’s level of psychological well-being by allowing individuals to feel like that have better control over their stress.(2) Social support may be a primary coping mechanism.

How Support Works (3) Social networks may also influence health more directly by providing access to information needed in making decisions regarding health issues (2). In addition, information support may come with some form of advice, especially where information is coming from friends or family members who have been through the same or a similar situation (5).

Quality vs. Quantity of Social Support Is quality or quantity of support more important for health? Although we may like the idea of having many sources of support in times of need, the quality of the support may be more important. In terms of informational and emotional support this is particularly true: Even if you have a lot informational support, it may not be the information needed to make an important decision. And in terms of emotional support, not all support is equally sympathetic and empathetic. A study on the effect of social support in cancer patients revealed that quality may be more important, especially with regard to informational support (9). It was found that the information provided to cancer patients from physicians was much more helpful than information acquired from friends and family or even other patients who participated in a cancer support group.

Quality vs. Quantity of Social Support Cont`d This same study also found that the best source of emotional support for patients was that received from their spouse, family members or close friends (9). This may be because patients would feel the most comfortable disclosing personal feelings and emotions regarding their health condition to these individuals (9). Furthermore, patients also desired instrumental support from family members, even more than friends or health care professionals. They also preferred informational support to come from health professionals, rather than family and friends (9).

Social Networks Affecting Health vs. Health Affecting Social Networks In the previous slides we have seen how social network can influence health. But health can also affect one’s development and maintenance of social networks: In some cases when an individual becomes ill, their social networks may start to constrict, because they are unable to go out an participate in their regular activities. This will decrease an individual’s access to social support, affecting their health (2).

Health Affecting Social Networks This reduced access to social networks and support is often termed ‘Social Breakdown Syndrome’. Social Breakdown Syndrome is most common in individuals who are separated from their normal social networks because of admission to a long-term care facilities or hospital stays of long duration. (1,2) The effects of this syndrome are preventable: through community-oriented services, such as home nursing services etc, which allow minimum hospital stays in some cases. E.g. One study showed that MI patients had no greater risk, and possibly a reduced risk, of death following MI when treated at home rather than in the ICU (when this was an option). (1)

“Friends make good medicine”(5)

“A Friend, Not an Apple a Day Will Keep the Doctor Away”(5)

References 1.Cobb, S. (1976). Social Support as a Moderator of Life Stress. Psychosomatic Medicine 38(5), 300-313. 2. Bloom, J. (1990). The Relationship of Social Support and Health. Social Science Medicine 30(5), 635-637. 3. Kaplan, B.H.,et al. (1977). Social Support and Health. Medical Care 15, 47-58. 4.Thoits, P., et al. (1982). Conceptual methodology, and theoretical problems in studying social supports as a buffer against life stress. Journal of Health Social Behaviour 23, 145-159. 5. Berkman, L. (1984). Assessing the physical health effects of social networks and social support. Annual Reviews 5, 413-432. 6. Langford, C., et al (1997). Social Support: a conceptual analysis. Journal of Advanced Nursing 25, 95-100. 7. Hupcey, J. (1997). Clarifying the social support theory-research linkage. Journal of Advanced Nursing 27, 1231-1241. 8. McDowell, I. (2008). Social Support Notes. Retrieved March 11th, 2008 from http:// www.courseweb.uottawa.ca/epi6181/Course_Outline/Social_Support_2.htm 9. Helgeson, V. & Cohen, S. (1996). Social Support and Adjustment to Cancer: Reconciling Descriptive, Correlation, and Intervention Research. Health Psychology 15(2), 135-148.