Bert N. Uchino

The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health.

In this review, the authors examine the evidence linking social support to physiological processes and characterize the potential mechanisms responsible for these covariations. A review of 81 studies revealed that social support was reliably related to beneficial effects on aspects of the cardiovascular, endocrine, and immune systems. An analysis of potential mechanisms underlying these associations revealed that (a) potential health-related behaviors do not appear to be responsible for these associations; (b) stress-buffering effects operate in some studies; (c) familial sources of support may be important; and (d) emotional support appears to be at least 1 important dimension of social support. Recommendations and directions for future research include the importance of conceptualizing social support as a multidimensional construct, examination of potential mechanisms across levels of analyses, and attention to the physiological process of interest.

Social support and health: A review of physiological processes potentially underlying links to disease outcomes

Social support has been reliably related to lower rates of morbidity and mortality. An important issue concerns the physiological mechanisms by which support influences such health endpoints. In this review, I examine evidence linking social support to changes in cardiovascular, neuroendocrine, and immune function. Consistent with epidemiological evidence, social support appears to be related to more positive “biological profiles” across these disease-relevant systems. Recent research on immune-mediated inflammatory processes is also starting to provide data on more integrative physiological mechanisms potentially linking social support to health. The implications of these links, along with future research directions are discussed.

The problem of equivalent models in applications of covariance structure analysis

For any given covariance structure model, there will often be alternative models that are indistinguishable from the original model in terms of goodness of fit to data. The existence of such equivalent models is almost universally ignored in empirical studies. A study of 53 published applications showed that equivalent models exist routinely, often in large numbers. Detailed study of three applications showed that equivalent models may often offer substantively meaningful alternative explanations of data. The importance of the equivalent model phenomenon and recommendations for managing and confronting the problem in practice are discussed.

Social and Emotional Support and its Implication for Health

Purpose of review Recent research findings from selected publications focusing on links between social support and physical health are summarized. Recent findings Current research is extending our understanding of the influences of social support on health. Many epidemiological studies have concentrated on further linking measures of social support to physical health outcomes. A few studies are now moving into newer areas, such as emphasizing health links with support receipt and provision. Researchers are also interested in outlining relevant pathways, including potential biological (i.e. inflammation) and behavioral (i.e. health behaviors) mechanisms. Interventions attempting to apply basic research on the positive effects of social support are also widespread. Although the longer term effects of such interventions on physical health remain to be determined, such interventions show promise in influencing the quality of life in many chronic disease populations. Summary Recent findings often show a robust relationship in which social and emotional support from others can be protective for health. The next generation of studies must explain, however, why this relationship exists and the specificity of such links. This research is in its infancy but will be crucial in order to better tailor support interventions that can impact on physical health outcomes.

Heterogeneity in Neuroendocrine and Immune Responses to Brief Psychological Stressors as a Function of Autonomic Cardiac Activation

Human responses to brief psychological stressors are characterized by changes and large individual differences in autonomic, neuroendocrine, and immune function.The authors examined the effects of brief psychological stressors on cardiovascular, neuroendocrine, and cellular immune response in 22 older women to investigate the common effects of stress across systems. They also used interindividual variation in heart rate reactivity, cardiac sympathetic reactivity (as indexed by preejection period reactivity in their reactivity paradigm), and cardiac vagal reactivity (as indexed by respiratory sinus arrhythmia reactivity) to explore the heterogeneity in human responses to brief psychilogical stressors. The results revealed that brief psychological stressors heightened cardiac activation, elevated plasma catecholamine concentrations, and affected the cellular immune response. It was also found that individuals characterized by high, relative to low, cardiac sympathetic reactivity showed higher stress-related changes in adrenocorticotropic hormone and cortisol plasma levels but comparable changes in epinephrine and norepinephrine concentrations. These data suggest that the effects of psychological stressors on cardiovascular and cellular immune response are governed by coordinated regulatory mechanism(s) and that going beyond the simple notion of heart rate reactivity to examine neural substrates may shed light on the interrelationships among and the regulatory mechanisms for the autonomic, endocrine, and immune responses to stressors.

Psychological pathways linking social support to health outcomes: A visit with the “ghosts” of research past, present, and future

Contemporary models postulate the importance of psychological mechanisms linking perceived and received social support to physical health outcomes. In this review, we examine studies that directly tested the potential psychological mechanisms responsible for links between social support and health-relevant physiological processes (1980s-2010). Inconsistent with existing theoretical models, no evidence was found that psychological mechanisms such as depression, perceived stress, and other affective processes are directly responsible for links between support and health. We discuss the importance of considering statistical/design issues, emerging conceptual perspectives, and limitations of our existing models for future research aimed at elucidating the psychological mechanisms responsible for links between social support and physical health outcomes.

Social Support, Physiological Processes, and Health

Social relationships serve important functions in peoples everyday lives. Epidemiological research indicates that supportive relationships may also significantly protect individuals from various causes of mortality, including cardiovascular disease. An important issue is how social support influences such long-term health outcomes. In this article, we review evidence indicating that social support may influence mortality via changes in the cardiovascular, endocrine, and immune systems. These data suggest that it may be worthwhile to incorporate social-support interventions in the prevention and treatment of physical health problems.

Heterogeneity in the social networks of young and older adults: prediction of mental health and cardiovascular reactivity during acute stress.

We examined the utility of a broad framework that separated positive, negative, and ambivalent social network members. One hundred thirty-three young and older participants completed the social relationships index, measures of mental health, and a cardiovascular reactivity protocol. Results replicated prior research on the beneficial influence of positive (supportive) ties on psychological outcomes. More important, analyses also revealed that the number of ambivalent network ties predicted age-related differences in depression and sympathetic control of heart rate reactivity during stress. The statistical interactions between age and ambivalent ties on cardiovascular responses during stress were not changed when statistically controlling for other social network categories, demographic variables, and various personality factors. These data suggest that social network ambivalence was a relatively unique predictor of cardiovascular reactivity and highlight the utility of separating the variance due to positive, negative, and ambivalent network ties. Implications for the study of social relationships, physiological processes, and health outcomes are also discussed.

Age-related changes in cardiovascular response as a function of a chronic stressor and social support.

The effects of aging, chronic stress, and social support on cardiovascular functioning were examined using a cross-sectional design. Thirty-six family caregivers of Alzheimers disease victims and 34 control Ss performed 2 active coping tasks while continuous noninvasive measures of cardiovascular activity were monitored. Results revealed that caregivers high in social support displayed typical age-related decreases in heart-rate reactivity, whereas caregivers low in social support displayed age-related increases in heart-rate reactivity. Analyses further indicated that only Ss with low social support were characterized by age-related increases in systolic blood pressure. These results suggest that social support can moderate age-related changes in cardiovascular functioning, particularly in Ss exposed to a chronic stressor.

Close relationship processes and health: implications of attachment theory for health and disease.

OBJECTIVES Health psychology has contributed significantly to understanding the link between psychological factors and health and well-being, but it has not often incorporated advances in relationship science into hypothesis generation and study design. We present one example of a theoretical model, following from a major relationship theory (attachment theory) that integrates relationship constructs and processes with biopsychosocial processes and health outcomes. METHOD We briefly describe attachment theory and present a general framework linking it to dyadic relationship processes (relationship behaviors, mediators, and outcomes) and health processes (physiology, affective states, health behavior, and health outcomes). We discuss the utility of the model for research in several health domains (e.g., self-regulation of health behavior, pain, chronic disease) and its implications for interventions and future research. RESULTS This framework revealed important gaps in knowledge about relationships and health. Future work in this area will benefit from taking into account individual differences in attachment, adopting a more explicit dyadic approach, examining more integrated models that test for mediating processes, and incorporating a broader range of relationship constructs that have implications for health. CONCLUSIONS A theoretical framework for studying health that is based in relationship science can accelerate progress by generating new research directions designed to pinpoint the mechanisms through which close relationships promote or undermine health. Furthermore, this knowledge can be applied to develop more effective interventions to help individuals and their relationship partners with health-related challenges.