Group life shapes the psychology and biology of health: The case for a sociopsychobio model

On social health: history, conceptualization, and population patterning

We propose a psychologically-informed concept of social health to join physical and mental components in a more comprehensive assessment of human health. Although there is an extensive literature on the importance of social relationships to health, a theoretical framework is needed to coalesce this work into a codified conceptualisation of social health, defined here as adequate quantity and quality of relationships in a particular context to meet an individual's need for meaningful human connection. Informing this novel conceptualisation, we outline eight key propositions to guide future research and theory on social health, including five propositions focused on the conceptualisation of social health and three focused on its population patterning. The former five propositions include that social health is an outcome in its own right, that health interventions can have divergent effects on social versus physical and mental aspects of health, that social health has independent effects on quality of life, that it is a dynamic and contextual construct, and that it is embedded and encoded in the human body (and mind). The utility of the social health concept is further revealed in its significance for understanding and addressing population health concerns, such as health inequalities experienced by marginalised groups.

The effectiveness of social-support-based weight-loss interventions-a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity.

METHODS

We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up.

RESULTS

Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up.

CONCLUSIONS

There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions.

TRIAL REGISTRATION

PROSPERO 2020 CRD42020173696.

Disciplinary differences in the study of the relationship between social variables and mental health: A systematic mapping review

There has been sustained interest in the intersection between social constructs and mental health from diverse disciplines including psychiatry, sociology and public health. However, no systematic attempt has been made to catalogue what is meant by 'social' by different researchers, how variables deemed 'social' constructs are linked to mental health, nor whether these patterns differ by academic discipline. Understanding interdisciplinary differences and commonalities may reveal opportunities for interdisciplinary collaboration to enhance our understanding of how social factors relate to mental health. This article presents a prospectively registered systematic map of social approaches to mental health using an innovative synthesis methodology (coding all sentences from a random selection of N = 287 articles). Results indicated that although approaches are diverse, disciplinary overlap is substantial. Psychology and psychiatry led articles tend to focus on social skills or emotions as features of mental (ill-)health, while public health and social sciences led articles tend to focus on social relationships, status or context as determinants of mental (ill-)health. Medicine led articles were most likely to focus on social outcomes of mental (ill-)health. Potential growth areas are noted, particularly the relative dearth of intervention research drawing upon social approaches. The findings are discussed with a view towards enabling more effective interdisciplinary collaboration.

The role of social support and social identification on challenge and threat cognitive appraisals, perceived stress, and life satisfaction in workplace employees

There is an emergent literature highlighting the positive role of social support and social identification in buffering against the deleterious effects of psychological stressors. Yet, we have limited understanding of how exactly these social factors fit within contemporary stress and coping theory. To advance and gain a greater understanding of these social factors, we explore the associations of social support and social identification on individuals' challenge and threat cognitive appraisals and how this then relates to perceived stress, life satisfaction, turnover intentions, and job performance. A total of 412 workplace employees from private and public sector occupations completed state measures around a recent most stressful experience at work. Results revealed atemporal associations between cognitive resource appraisals with both social support and social identification. Specifically, greater identification with colleagues and lower threat were related to less perceived stress, while having greater social identification (with colleagues and organisation), social support, and lower threat, were related to greater life satisfaction. Greater perceived stress, and lower social identification and life satisfaction, were also related to greater turnover intentions. While greater identification with the organisation and life satisfaction, along with lower perceived stress were related to greater job performance. Taken together, this research provides evidence that social support and social identification play a positive role when trying to promote more adaptive responses to stressful situations.

A Model of Triage of Serious Spinal Pathologies and Therapeutic Options Based on a Delphi Study

Background and Objectives: The relevance of red flags in serious spinal pathology (SSP) has evolved throughout the last years. Recently, new considerations have been proposed to expand the consideration of red flags. The purpose of this study was to determine, approve and test a model for the triage and management process of SSPs based on the latest data available in the literature. Materials and Methods: The SSP model was initially built on the basis of a literature review. The model was further determined and approved by an expert panel using a Delphi process. Finally, clinical scenarios were used to test the applicability of the model. Results: After three rounds of the Delphi process, panellists reached a consensus on a final version of the model. The use of clinical scenarios by experts brought about reflexive elements both for the determined model and for the SSPs depicted in the clinical cases. Conclusions: The validation of the model and its implementation in the clinical field could help assess the skills of first-line practitioners managing spinal pain patients. To this end, the development of additional clinical scenarios fitting the determined model should be further considered.

Diving into Health: A Mixed Methods Study on the Impact of Scuba Diving in People with Physical Impairments

The impacts of scuba diving on people with physical impairments are unknown. Grounded on the social identity approach to health, the aim of this study was to test and describe the relationships between scuba diving social identity, self-efficacy, social health, psychological health, physical health, health-related quality of life (HRQOL), and disability level among recreational scuba divers with physical impairments. A mixed methods explanatory sequential design was employed. The quantitative strand used an 80-item cross-sectional survey, with the data analyzed via a path analysis. The qualitative strand used 1:1 interviews across 3 case study groups; the data were analyzed using deductive and inductive analyses. Mixing occurred via a joint display with meta-inferences. The quantitative results (n = 78) indicated that self-efficacy was a significant predictor of social health, psychological health, physical health, HRQOL, and disability level. The qualitative findings (n = 15) consisted of six themes, whereby participants described scuba as a positive social identity that provides them with meaning, purpose, and belonging. Furthermore, they described scuba diving as a positive contributor to their self-efficacy, social health, psychological health, physical health, and quality of life. During the mixing of data, the quantitative and qualitative results did not match on the influence of scuba diving social identity on self-efficacy, social health, psychological health, physical health, HRQOL, and disability level. A further analysis revealed that the range restriction impaired the conclusive quantitative evidence on the scuba diving social identity variable. The meta-inferences derived from the data integration suggest that scuba diving plays a role in the self-efficacy, health, HRQOL, and disability level among scuba divers with physical impairments. The findings point to the potential of scuba diving as a health promotion recreational activity and rehabilitation modality for people with physical impairments.

To alleviate group members’ physiological stress, supervisors need to be more than polite and professional

Although stressors are common in group life, people cope better when group authorities treat them with care/concern. However, it remains unclear whether such treatment affects individuals’ physiological stress. In this experiment, individuals engaged in an interview known to increase cortisol (stress biomarker). Surrounding the interview, an ingroup supervisor treated them with standard professionalism (politeness [control]), explicit care/concern (high-quality treatment), or disregard (poor-quality treatment). While those in the control condition experienced a spike in cortisol, individuals in the high-quality treatment condition did not experience this physiological stress (cortisol). Those given poor-quality treatment also did not exhibit stress, suggesting the explicit disregard for them may have undermined the interview’s legitimacy, thereby removing social evaluative threat. Paralleling past research, self-reported stress did not reflect individuals’ physiological stress (cortisol). Overall, results suggest that to alleviate group members’ physiological stress, supervisors need to be more than polite and professional–also demonstrating care/concern for them as individuals.

Exploring links between social identity, emotion regulation, and loneliness in those with and without a history of mental illness

OBJECTIVE

Emotion regulation and social identity theorizing provide two influential perspectives on loneliness. From an emotion regulation perspective, loneliness is understood as a negative emotional state that can be managed using emotion regulation strategies. A social identity perspective views loneliness as resulting from a loss or lack of important social groups and related identities. This study aimed to explore the relationships between key constructs drawn from both perspectives, with a view to understanding loneliness in adults with and without a history of mental illness.

DESIGN AND METHODS

Participants (N = 875) with a mental illness history (MH Hx, n = 217; M_age  = 45 years, 59% female) and without a mental illness history (No MH Hx, n = 658; M_age  = 47 years, 48% female) completed a survey comprising measures of group membership and connectedness, emotion regulation strategies, and loneliness.

RESULTS

The MH Hx group reported higher internal affect worsening strategy use and loneliness than those No MH Hx. Hierarchical regressions indicated that the unique contributions of emotion regulation strategies and social identity factors to loneliness were equivalent between the groups. Together, social identity and emotion regulation explained 37% of the variance in loneliness in the No MH Hx subsample and 35% in the MH Hx subsample.

CONCLUSION

These findings suggest that both emotion regulation and social identity had significant unique contributions to the reported loneliness of people when controlling for demographics and each other in those with and without a history of mental illness. Integration of the two frameworks may provide novel avenues for the prevention and management of loneliness.

PRACTITIONER POINTS

Individuals with a history of mental illness report more use of internal emotion worsening regulation strategies and greater loneliness than those with no such history, but there were no differences in social identity factors. Internal emotion worsening strategies and social support received from others explained the variance in reported loneliness for both those with and without a history of mental illness. Internal emotion improving strategies were significant for those with a history of mental illness, while social support given was significant for those without a history of mental illness. Screening clients for emotion regulation difficulties, social disconnectedness, and loneliness may provide clinicians with an indication of risk for developing psychological distress/disorders.

The biopsychosociotechnical model: a systems-based framework for human-centered health improvement

The biopsychosocial model is among the most influential frameworks for human-centered health improvement but has faced significant criticism- both conceptual and pragmatic. This paper extends and fundamentally re-structures the biopsychosocial model by combining it with sociotechnical systems theory. The resulting biopsychosociotechnical model addresses key critiques of the biopsychosocial model, providing a more "practical theory" for human-centered health improvement. It depicts the determinants of health as complex adaptive system of systems; includes the the artificial world (technology); and provides a roadmap for systems improvement by: differentiating between "health status" and "health and needs assessment", [promoting problem framing]; explaining health as an emergent property of the biopsychosociotechnical context [imposing a systems orientation]; focusing on "interventions" vs. "treatments" to modify the biopsychosociotechnical determinants of health, [expanding the solution space]; calling for a participatory design process [supporting systems awareness and goal-orientation]; and including intervention management to support the full lifecycle of health improvement.

Multiple group membership, social network size, allostatic load and well-being: A mediation analysis

OBJECTIVES

This study examined whether social network size and allostatic load (AL) mediated the association between multiple group membership (MGM) and future physical and psychological well-being.

METHODS

A longitudinal design was used and data from 1026 healthy participants on the relevant variables was extracted from Wave 2(2010-12), Wave 3 (2011-2013) (for baseline MGM, social network size and AL) and Wave 9 (2017-19) (for well-being at follow-up) of the Understanding Society UK population-based dataset.

RESULTS

MGM was not directly associated with future well-being, but both social network size, β = 0.06, t = 2.02, p = .04, and AL, β = -0.06, t = -2.05, p = .04, were associated with physical but not psychological well-being at follow-up. Those who had higher numbers of friends had better physical well-being, and those who had lower AL risk scores had better physical well-being at follow-up. However, MGM was indirectly associated with physical well-being through social network size, and AL such that those reporting higher MGM, reported a greater number of friends which was associated with a lower AL and then future physical well-being, β = 0.004, CI [0.001., 0.0129]. This was not evident for psychological well-being. This mediation withstood adjustment for confounding factors (e.g. age, gender, marital status lifestyle factors).

CONCLUSION

The present study extends findings on the existing social relationships and social cure literature and our findings are discussed in relation to the social cure hypothesis.

Rethinking the nature of the person at the heart of the biopsychosocial model: Exploring social changeways not just personal pathways

Karunamuni et al.'s (2020) biopsychosocial-pathways (BPS-P) model provides an important framework for elaborating on Engel's (1977) biopsychosocial (BPS) model of health. In particular, the BPS-P model improves on Engel's by articulating and evidencing the multiple pathways between biological, psychological, and social influences on health and identifying mechanisms that might be implicated in these pathways. Yet its analytic treatment of these influences as "separate systems" means that, as with Engel's model, the BPS-P model is more a list of ingredients than an integrated whole. In this commentary, following Haslam et al.'s (2019) specification of a sociopsychobio model, we underscore the value of a synthetic appreciation of biology, psychology, and society as dynamically interdependent aspects of an integrated whole which is more than just the sum of its parts and the pathways between them. In particular, our alternative framework centres on an appreciation of people as social beings whose group memberships and associated social identities open up 'changeways' (not just pathways) that, as we have seen during the COVID-19 pandemic, can fundamentally restructure biology, psychology and society.