Social Relationships and Mortality

Elucidating the genetic basis of social interaction and isolation

The negative impacts of social isolation and loneliness on health are well documented. However, little is known about their possible biological determinants. In up to 452,302 UK Biobank study participants, we perform genome-wide association study analyses for loneliness and regular participation in social activities. We identify 15 genomic loci (P < 5 × 10⁻⁸) for loneliness, and demonstrate a likely causal association between adiposity and increased susceptibility to loneliness and depressive symptoms. Further loci were identified for regular attendance at a sports club or gym (N = 6 loci), pub or social club (N = 13) or religious group (N = 18). Across these traits there was strong enrichment for genes expressed in brain regions that control emotional expression and behaviour. We demonstrate aetiological mechanisms specific to each trait, in addition to identifying loci that are pleiotropic across multiple complex traits. Further study of these traits may identify novel modifiable risk factors associated with social withdrawal and isolation.

Little is known about the genetic determinants of social isolation and loneliness despite their well-established importance for health. Here, using multi-trait GWAS, Day et al. identify 15 genomic loci for loneliness and further show a bidirectional causal relationship between BMI and loneliness by MR.

Well-Being Correlates of Perceived Positivity Resonance: Evidence From Trait and Episode-Level Assessments

Positivity resonance is a type of interpersonal connection characterized by shared positivity, mutual care and concern, and behavioral and biological synchrony. Perceived positivity resonance is hypothesized to be associated with well-being. In three studies ( N = 175, N = 120, N = 173), perceived positivity resonance was assessed at the trait level (Study 1) or the episode level, using the Day Reconstruction Method (Studies 2 and 3). Primary analyses reveal that perceived positivity resonance is associated with flourishing mental health, depressive symptoms, loneliness, and illness symptoms. These associations largely remain statistically significant when controlling for daily pleasant emotions or social interaction more generally. Ancillary analyses in Studies 2 and 3 support the construct validity of the episode-level assessment of perceived positivity resonance. The overall pattern of results is consistent with Positivity Resonance Theory. Discussion centers on avenues for future research and the need for behavioral interventions.

"I've got somebody there, someone cares": what support is most valued following a stroke?

PURPOSE

There is often a need for increased support following a stroke. This study explored what types of support are provided by different network members and what support functions are most valued.

METHODS

Adults with first stroke were recruited from a stroke unit and participated in in-depth interviews 8-15 months poststroke. Framework Analysis was used to build thematic and explanatory accounts of the data.

RESULTS

Twenty-nine participants took part. Main themes to emerge were as follows: the spouse was the most important provider of support; children were a relatively stable source of support, although many participants expressed reservations about worrying a child; relatives and friends typically provided social companionship and emotional support rather than on-going practical support. The only universally valued support function was the sense that someone was concerned and cared. Other valued functions were as follows: social companionship including everyday social "chit chat"; practical support provided sensitively; and, for many, sharing worries and sensitive encouragement. The manner and context in which support was provided was important: support was easiest to receive when it communicated concern, and was part of a reciprocal, caring relationship.

CONCLUSIONS

As well as measuring supportive acts, researchers and clinicians should consider the manner and context of support. Implications for rehabilitation The manner in which support was provided mattered: support was easier to receive when it communicated concern. The spouse was the most important source of all support functions; children, relatives and friends were important providers of emotional and social companionship support. Researchers and clinicians should not only focus on what support is received, but also the context (e.g., contribution, reciprocity, quality of relationship) and manner (e.g., responsiveness, sensitivity) of the support.

Multidimensional social support is associated with healthcare utilization among older Mexican adults

In this study, we aimed to estimate the association between social support and healthcare utilization among older Mexican adults. We conducted a prospective study with 4027 older adults aged 65-74 in rural areas in seven Mexican states. Data were collected at baseline (2007) and 14 months later (2009). Healthcare utilization was defined as number of visits to a physician for preventive or curative purposes in the last 6 months. Multidimensional social support was operationalized into two components: structural (living arrangements, marital status and network size) and functional (perceived availability of support; and perceived support across emotional, instrumental, economic and information domains). Mixed-effects regression models were used to estimate the probability of healthcare use and to examine the association between social support and the number of visits to a physician. Results showed that perceived availability of social support was associated with the probability of visits to a physician (OR 1.44; p < .01). Meanwhile, the following domains of functional component of social support were associated with the probability of visits to a physician: instrumental (OR 1.55; p < .01), economic (OR 1.19; p = .03) and informational (OR 1.39; p < .01); and also with the number of visits to a physician: instrumental (e ^β  = 1.27; p < .01), economic (e ^β  = 1.14; p = .01) and informational (e ^β  = 1.12; p < .10). Our findings suggest that a significant association exists between social support, measured from a multidimensional viewpoint, and healthcare utilization, in which greater social support was related to a greater extent of use of health services.

Relationship of Psychosocial Resources With Allostatic Load: A Systematic Review

OBJECTIVE

Allostatic load (AL) represents cumulative wear-and-tear on the body and is operationalized as a multisystem index of biomarkers. Allostatic load is associated with morbidities and mortality, leading to a growing body of literature that uses AL as an outcome in its own right. Psychosocial resources (PSRs), such as mastery and social support, may influence health outcomes in part via AL, and the current review seeks to characterize the relations between PSRs and AL.

METHODS

A systematic review was conducted by searching PubMed, CINAHL Plus, PsycINFO, Scopus, and Embase for studies examining the relation between PSR(s) and AL in humans. From 1,417 abstracts screened, 60 full-text articles were reviewed, and 24 studies met inclusion criteria.

RESULTS

Mixed evidence exists for a relationship between PSRs and AL. Most (14/24) studies used a cross-sectional design, and only one study investigated whether a PSR predicted change in AL. Compared to cross-sectional studies, longitudinal studies were more likely to report a significant relationship (8/14 versus 8/10, respectively). Studies with statistically significant main or moderated effects had larger sample sizes than those reporting null effects. Whether a study reported a significant main or moderated relationship did not differ by whether psychological (8/11) or social (10/16) resources were assessed.

CONCLUSIONS

Evidence for a relationship between PSRs and AL is equivocal, and obtained significant relationships are generally small in magnitude. Gaps in the current literature and directions for future research are discussed. Longitudinal studies are needed that repeatedly assess PSRs and AL.

Valued Activities among Individuals with and without Cognitive Impairments: Findings from the National Health and Aging Trends Study

Purpose of the study

Using the National Health and Aging Trends Study (NHATS), we examined activity preferences and participation among individuals with and without cognitive impairments.

Design and methods

Respondents were classified as having No Dementia (n = 5,264), Possible Dementia (n = 893), or Probable Dementia (n = 518). Respondents rated importance of and actual participation (yes/no) in four activities (visiting friends/family, religious services, clubs/classes, going out for enjoyment). We also examined whether transportation or health limited participation.

Results

Overall, visiting friends/family was most important (64.03%); although relative importance of activities varied with cognitive status. Compared to cognitively healthy individuals, those with possible and probable dementia were less likely to indicate activities were important and engage in valued activities (ps < .0001). Additionally, poor health limited participation in activities for those cognitively intact or with possible dementia; this was not true for those with probable dementia. Transportation difficulty limited going out for enjoyment for a greater percentage of those with cognitive impairment than those without impairment.

Implications

Regardless of cognitive level, older adults highly value activities; however, actual participation may decrease with greater impairment in cognitive and physical health and with transportation challenges. Developing tailored interventions for specific populations to achieve desired activity goals is needed.

Causal conditions for loneliness: a set-theoretic analysis on an adult sample in the UK

While age has been identified as a risk factor for loneliness, whether it is a necessary or sufficient condition for loneliness has never been examined. This is the first study that applies fuzzy-set QCA, a special type of set-theoretic method, to discover the necessary and sufficient causal conditions for loneliness, respectively, among adults in the UK, analysing the data collected from the UK sample of Round 6 of the European Social Survey (ESS, 2012, n = 2163). It firstly examines the configurations of five conditions: being female, old age, not living with spouse/partner, bad health, and not being frequently social with others. Gender was found neither a necessary nor a sufficient condition for loneliness, and old age was close to being a necessary condition and became necessary when united with any of the other conditions; the configuration of not living with spouse/partner and not healthy and not frequently social with others is a sufficient condition. Robustness of results was tested with two different conditions (a limiting illness and a confidante), and a separate analysis on the absence of loneliness was conducted. The effect of the unbalanced distribution of cases across different values of the outcome was highlighted as a source of uncertainty, and the results on the absence of loneliness are different from those on its presence.

What Factors Predict Who Will Have a Strong Social Network Following a Stroke?

PURPOSE

Measures of social networks assess the number and nature of a person's social contacts, and strongly predict health outcomes. We explored how social networks change following a stroke and analyzed concurrent and baseline predictors of social networks 6 months poststroke.

METHOD

We conducted a prospective longitudinal observational study. Participants were assessed 2 weeks (baseline), 3 months, and 6 months poststroke. Measures comprised the Stroke Social Network Scale (Northcott & Hilari, 2013), Medical Outcomes Study Social Support Survey (Sherbourne & Stewart, 1991), National Institutes of Health Stroke Scale (Brott et al., 1989), Frenchay Aphasia Screening Test (Enderby, Wood, Wade, & Langton Hewer, 1987), Frenchay Activities Index (Wade, Legh-Smith, & Langton Hewer, 1985), and Barthel Index (Mahoney, Wood, & Barthel, 1958). Analyses of variance and standard multiple regression were used to analyze change and identify predictors.

RESULTS

Eighty-seven participants (37% with aphasia) were recruited; 71 (16% with aphasia) were followed up at 6 months. Social network scores declined poststroke (p = .001). Whereas the Children and Relatives factors remained stable, the Friends factor significantly weakened (p < .001). Concurrent predictors of social network at 6 months were perceived social support, ethnicity, aphasia, and extended activities of daily living (adjusted R2 = .42). There were 2 baseline predictors: premorbid social network and aphasia (adjusted R2 = .60).

CONCLUSIONS

Social networks declined poststroke. Aphasia was the only stroke-related factor measured at the time of the stroke that predicted social network 6 months later.

Affectionate Touch to Promote Relational, Psychological, and Physical Well-Being in Adulthood: A Theoretical Model and Review of the Research

Throughout the life span, individuals engage in affectionate touch with close others. Touch receipt promotes well-being in infancy, but the impacts of touch in adult close relationships have been largely unexplored. In this article, we propose that affectionate touch receipt promotes relational, psychological, and physical well-being in adulthood, and we present a theoretical mechanistic model to explain why affectionate touch may promote these outcomes. The model includes pathways through which touch could affect well-being by reducing stress and by promoting well-being independent of stress. Specifically, two immediate outcomes of affectionate touch receipt—relational-cognitive changes and neurobiological changes—are described as important mechanisms underlying the effects of affectionate touch on well-being. We also review and evaluate the existing research linking affectionate touch to well-being in adulthood and propose an agenda to advance research in this area. This theoretical perspective provides a foundation for future work on touch in adult close relationships.

Recent Developments in the Study of Social Relationships, Stress Responses, and Physical Health

This selective review aims to highlight some of the most recent empirical or theoretical advancements in the study of social relationships as buffers against stress and as protective factors against risk for disease, focusing on articles published between 2013 and 2015. The review summarizes novel findings showing that social relationships can protect individuals against negative health outcomes associated with chronic adversity and can be associated with reduced cumulative physiological damage (allostatic load). There is also evidence that some relationships can be a source of stress. Additionally, recent findings concerning the psychological and neurobiological mechanisms of action for social support, the developmental patterning of social stress-buffering and recent experimental studies attempting to change relationships to affect health are also reviewed.

A systematic review of the impact of stroke on social support and social networks: associated factors and patterns of change

OBJECTIVE

Identify what factors are associated with functional social support and social network post stroke; explore stroke survivors' perspectives on what changes occur and how they are perceived.

DATA SOURCES

The following electronic databases were systematically searched up to May 2015: Academic Search Complete; CINAHL Plus; E-journals; Health Policy Reference Centre; MEDLINE; PsycARTICLES; PsycINFO; and SocINDEX.

REVIEW METHODS

PRISMA guidelines were followed in the conduct and reporting of this review. All included studies were critically appraised using the Critical Appraisal Skills Program tools. Meta-ethnographic techniques were used to integrate findings from the qualitative studies. Given the heterogeneous nature of the quantitative studies, data synthesis was narrative.

RESULTS

Seventy research reports met the eligibility criteria: 22 qualitative and 48 quantitative reporting on 4,816 stroke survivors. The qualitative studies described a contraction of the social network, with non-kin contact being vulnerable. Although family were more robust network members, significant strain was observed within the family unit. In the quantitative studies, poor functional social support was associated with depression (13/14 studies), reduced quality of life (6/6 studies) and worse physical recovery (2/2 studies). Reduced social network was associated with depression (7/8 studies), severity of disability (2/2 studies) and aphasia (2/2 studies). Although most indicators of social network reduced post stroke (for example, contact with friends, 5/5 studies), the perception of feeling supported remained relatively stable (4/4 studies).

CONCLUSION

Following a stroke non-kin contact is vulnerable, strain is observed within the family unit, and poor social support is associated with depressive symptoms.

Aging, health, and identity in Ecuador's indigenous communities

Middle-income countries like Ecuador are in the process of demographic and epidemiological transitions, and their populations are aging. The challenges associated with providing services to growing numbers of citizens who experience the inevitable deterioration associated with aging are mirrored by the manner in which aging is perceived in a culturally heterogeneous society. This paper presents the results of qualitative research conducted among older men and women in indigenous communities in the Ecuadorian highlands in order to investigate the perceptions regarding the ability of family and community networks to provide adequate and appropriate support for older persons in the context of their perceptions of health, health care, and aging. The principal findings are that: (i) perceptions of aging are shaped by chronic illness, fatigue, deteriorating sensory capacities, and vulnerability to accidents; (ii) barriers to health care are exacerbated among aging members of indigenous communities, although in some cases they can be addressed through traditional alternatives; (iii) the sense of identity shifts as aging people are increasingly unable to work the land and participate in community activities; and (iv) family and community support networks for older adults are not as strong as is generally thought. These findings represent the context within which issues related aging in a culturally heterogeneous society can be best understood and addressed.

Group Ties Protect Cognitive Health by Promoting Social Identification and Social Support

OBJECTIVE

Social relationships are protective of cognitive health as we age and recent findings show that social group ties (e.g., with community and peer groups) are especially important. The present research examines this relationship further to explore (a) the contribution of group, relative to interpersonal, ties and (b) underlying mechanism.

METHOD

Two cross-sectional survey studies were conducted. Study 1 was conducted online (N = 200) and Study 2 involved face-to-face interviews (N = 42).

RESULTS

The findings confirmed group ties as a stronger predictor of cognitive health than individual ties. It also supported our proposed sequential mediation model suggesting that the benefits of group ties arise from their capacity to enhance a sense of shared social identification and this, in turn, provides the basis for effective social support.

DISCUSSION

Both studies provided evidence consistent with claims that group ties were especially beneficial because they cultivated social identification that provided the foundation for social support.

A new look at social support: a theoretical perspective on thriving through relationships

Close and caring relationships are undeniably linked to health and well-being at all stages in the life span. Yet the specific pathways through which close relationships promote optimal well-being are not well understood. In this article, we present a model of thriving through relationships to provide a theoretical foundation for identifying the specific interpersonal processes that underlie the effects of close relationships on thriving. This model highlights two life contexts through which people may potentially thrive (coping successfully with life's adversities and actively pursuing life opportunities for growth and development), it proposes two relational support functions that are fundamental to the experience of thriving in each life context, and it identifies mediators through which relational support is likely to have long-term effects on thriving. This perspective highlights the need for researchers to take a new look at social support by conceptualizing it as an interpersonal process with a focus on thriving.

"The we's have it": evidence for the distinctive benefits of group engagement in enhancing cognitive health in aging

Aligned with research in the social capital and general health literature, a large body of evidence shows that older people who are more socially active have better cognitive integrity and are less vulnerable to cognitive decline. The present research addresses the question of whether the type of social engagement (group-based vs. individual) has differential effects on these cognitive health outcomes. Drawing on population data (N=3413) from three waves (i.e., Waves 3, 4 and 5) of the English Longitudinal Study of Ageing, we investigated the independent contribution of group and individual engagement in predicting cognitive functioning four years later. Hierarchical linear regression was used entering age, gender, socioeconomic status, ethnicity, and physical health as covariates. The final model, controlling for initial cognitive function and social engagement (both group and individual) showed that only group engagement made a significant, sustained, and unique contribution to subsequent cognitive function. Furthermore, the effects of group engagement were stronger with increasing age. These findings extend previous work on the social determinants of health by pinpointing the types of relationships that are particularly beneficial in protecting cognitive health. The fact that group engagement optimized health outcomes, and that this was especially the case with increasing age, has important implications for directing community resources to keep older adults mentally active and independent for longer.

Purpose in life as a predictor of mortality across adulthood

Having a purpose in life has been cited consistently as an indicator of healthy aging for several reasons, including its potential for reducing mortality risk. In the current study, we sought to extend previous findings by examining whether purpose in life promotes longevity across the adult years, using data from the longitudinal Midlife in the United States (MIDUS) sample. Proportional-hazards models demonstrated that purposeful individuals lived longer than their counterparts did during the 14 years after the baseline assessment, even when controlling for other markers of psychological and affective well-being. Moreover, these longevity benefits did not appear to be conditional on the participants' age, how long they lived during the follow-up period, or whether they had retired from the workforce. In other words, having a purpose in life appears to widely buffer against mortality risk across the adult years.

Support groups and cardiac rehabilitation: effects of partner participation on anxiety and depression

This study analyzes the effect on levels of patient anxiety and depression of a partner joining a cardiac rehabilitation program support group, also taking into account the sex of the patient. The study was undertaken using a two-group comparison design with pre-and post-test measures in non-equivalent groups. The sample comprised patients in the cardiac rehabilitation program (CRP) at the Ramón y Cajal Hospital, Madrid (Spain). Analysis of covariance (ANCOVA) showed direct effects of sex and partner participation in support groups on the anxiety trait. Similarly, interaction effects were observed between the sex variable and partner participation. These results indicate the pertinence of designing separate groups for patients and partners.

Religion, spirituality, and health: the research and clinical implications

This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

Loneliness in care homes: a neglected area of research?

Approximately 5% of older people, those aged 65 years and over, in developed countries live in care homes and these represent the frailest and most vulnerable members of this population group. Levels of morbidity, especially dementia and cognitive impairment, are high, making it challenging to conduct research with these population groups. Loneliness is a debilitating condition with important negative outcomes in terms of both quality of life and wider health outcomes. The prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations: 22–42% for the care population compared with 10% for the community population. However, the evidence-base for the care home group is tentative as it is based upon a very limited empirical base of only five studies. This review failed to identify compelling evidence for the effectiveness of interventions to remediate loneliness in care home populations.