Transcript Mechanisms for Health and Well-Being

Social Support: Mechanisms for Health and Well-Being
Briana Vander Wege, Grand Valley State University
What is Social Support?
How Can understanding Social support Help?
Social support looks at the different types of
transactions between individuals, like companionship
and validation as well as informational, emotional and
instrumental support.
Why is Social Support Especially Important in the Aging Population
The elderly population is living longer but not necessarily experiencing better
quality of life:
- Increasing rate of disease: 86% suffer from at least one chronic health
condition
The link between low levels of social support and poor health and wellbeing has fueled the development of interventions designed to improve
social support for those lacking this resource.
- The long-term effects of social support interventions on physical health
are still largely undetermined, but they show promise in increasing the
quality of life in a variety of
populations.
Social support is assessed by looking at the depth of
integration, the number of different social networks
and the number of interconnections within each, and
the types of participation in these social networks
- Low health literacy
- Informal sources of support (family, neighbors, friends etc.) have to
juggle time & energy between the needs of elderly family members & their
own work schedule & family duties
- Formal sources of support (healthcare providers, counselors, etc.) are
often burdened by limited resources & the need to supplement or substitute
informal supports for the elderly
- Interventions like teaching general psychosocial skills have been found to
enhance the ability to foster emotional ties and increase satisfaction with
support
- Support groups may fill in the support needs of patients, and act as a
source of community, information and acceptance
Stress causes
sympathetic nervous system activation, which is
characterized by releasing epinephrine and
norepinephrine into the bloodstream which leads to
increased heart rate and cardiovascular output.
This model draws on stress and coping theory,
which proposes that social support contributes
to health by protecting people from the
adverse effects of stress.
Lower levels of social
participation and
involvement predict
first time acute
myocardial infarction
Low levels of
perceived
emotional
support are
predictive of
higher mortality
in older women
Providing
support leads
to an
increased
sense of
efficacy &
lowers stress
Thus, this model proposes that support is
related to health especially for persons
experiencing high levels of stress and thus are
more at risk for increased cardiovascular
reactivity.
Low social-integration
predicts mortality after
hospital release from
post-myocardial
infarction
Integration into a social
network can affect the
psychological state of the
individual leading to a
generalized positive effect,
which can in turn result in
suppressed
neuroendocrine responses
and enhanced immune
functioning
In this model, integration into a
social network can serve as an
antecedent variable by subjecting
the individual to peer pressure
that may encourage the individual
to conform to certain norms
regarding preventive health
behavior, or may lower the
likelihood that certain stressful
events will occur.
Cardiovascular
Disease
Patients who are low to
moderately integrated in
social networks are
almost twice as likely to
be readmitted after
myocardial infarction
Associations
Between Health &
Social Support
Perceived
Support
and
Provision
of Support
Lower emotional
well-being & more
symptoms of
depression are
more evident in
those receiving
emotional support
in excess
(Roberto & Scott, 1986).
Social
integration
predicts
mortality from
diabetes
Social-usefulness
predicts lower
disability,
mortality, &
systolic & diastolic
blood pressure
Unsupported
individuals recorded
significantly higher
levels of, & more
changes in, measures
of cholesterol, illness
symptoms, and
affective responses
than did supported
individuals
Other
Medical
Conditions
Social networks exert a direct
independent effect on the
reduction of physical
symptoms, including heart
disorder, edema, sleep
disorder, arthritis, stroke,
respiratory problems,
hypertension, cancer, hearing
problems, visual
disorders & other
somatic symptoms
(Reblin & Uchino, 2008)
Normally, when adequate amounts of cortisol are
present a negative feedback system is activated. This
system signals the pituitary gland and hypothalamus to
reduce the output of ACTH and CRH, which leads to the
reduction of cortisol secretion. However, high levels of
cortisol cause gradual damage to the hippocampus,
which leads to hypersecretion of glucocorticoids due to
the disruption of this negative feedback loop.
(Raiber-Kornfeld, 2005; Cohen, Underwood,
& Gottlieb, 2000).
(McEwen & Magarinos, 1997)
Examples:
This model can eliminate or
reduce affective response, thus
dampening any physiological
response.
Perceived support can redefine
the potential for harm posed by a
situation, increasing an
individuals sense of control and
perceived ability to cope therefore
redefining situation as less
stressful
(Knox & Uvnas-Moberg, 1998;
Uchino,
Cacioppo, & Keicolt-Glaser, 1996)
regardless of whether
the person is under
stress or not.
Peer pressure may also be
beneficial with health-care
providers. If one views their
physician in terms of a
patient-provider bond and
has a sense of
collaboration, liking and
trust, this is associated with
being more likely to adhere
to treatment for various
long-term medical issues
The adrenocortical system is also activated by the
hypothalamus, leading to the release of cortisol, which
lingers in the system and causes continued elevation of
peripheral response.
Since cardiovascular reactivity is at the center
of this perspective, cortisol and
dehydroepiandrosterone (DHEA) may be the
first link in the chain of events that connects a
lack of social support to disease.
Main-effect model:
Social support is
beneficial for health
This peer pressure can also
influence health behaviors like:
-Exercising
-Eating a low fat diet
-Smoking.
(Raiber-Kornfeld, 2005).
The StressBuffering Model is
the most widely
accepted model in
the development
of cardiovascular
diseases
(Barnett, Spence, Manuck, &
Jennings, 1997; Lynch,
Everson, Kaplan, Salonen, &
Salonen, 1998).
Many studies show there is an inverse
relationship between DHEA (S)
concentration and cardiovascular disease
(Alexandersen, Haarbo, & Christiansen, 1997).
DHEA and its’ sulfated metabolite DHEAS, together abbreviated as DHEA (S), are
normally secreted synchronously with
cortisol in response to CRH and ACTH
and have antiglucocorticoid effects. These
peak in our mid 20’s though, and
progressively decline, reaching
concentrations of 20-30% of the peak
level by ages 70-80
(Labrie, Belanger, Cusan, Gomez, & Candas, 19987; Sulcova, Hil,
Hakpi, & Starka,1998).
Acute trauma and serious illnesses have
also been shown to be associated with
lower levels of DHEA (S).
the
(Raiber-Kornfeld, 2005; Auslander & Litwin, 1987;
Lin, Ensel, Simeone, & Kuo, 1979; Simons & West,
1985; Wellman & Hall, 1986)
Large discrepancies
between perceived
& received support
are predictive of
lower emotional
well-being and more
symptoms of
depression
Cortisol secretion increases in response to physical
stress like trauma, illness, surgery or extreme
temperature, and to psychological stress such as higher
levels of anxiety, mood disturbance and negative mood
Cortisol is also
associated with the
mobilization of fatty
acids and increased
risk of formation of
arterial plaques or
early cardiovascular
lesions
This model may provide
the individual with
information regarding
access to medical services
or behaviors that positively
influence health.
(Thoits, 1986)
Cardiovascular
Disease
Social support can provide a
solution to the problem, provide
distractions or tranquilize the
neuroendocrine system
(Cohen & Wills, 1985).
Elderly participants perform
more poorly on memory tasks
than younger participants.
(Lovelace, 1990; Park, O’Connel, & Thomson, 2003)
It could also provide the
individual with tangible and
economic services that
result in better health care.
Since working memory also
declines with age, it is especially
vulnerable to divided attention
tasks.
Physical changes:
Age-related declines in
cognitive functioning correlate
with decreased sensory
functioning and thus may be a
consequence of biological
changes in underlying neural
and sensory structures
(Lindenberger & Baltes, 1994)
There are typically losses in
frontal lobe volume, which
could account for difficulty in
integrating information and
remembering efficiently
(West, 1996).
(Lovelace, 1990)
Mechanisms
Connecting Health
& Social Support
Belonging support
predicts selfreported diseases
like diabetes,
hypertension,
arthritis &
emphysema
Depression
VS
Some studies suggest
that depression
negatively impacts social
support
(George, Blazer, & Hughes, 1989; Ezquiaga, Garcia, &
Pallares, 1999; Krause, Liang, & Yatomi, 1999;
Williams, 2004)
Craik & Anderson, 1999)
Cognitive resources decline:
One theory finds that as people age,
certain cognitive processes slow down
and can no longer accomplish
processes in the allotted time, leading to
difficulty coordinating mental processes
that require several streams of input
(Salthouse, 1996)
Another theory finds that difficulties
arise from a deficit in the ability to
initiate memory processes
(Craik, 1986)
Cognitive
Decline
The last theory finds that decreased
efficiency of working memory may be
due to inefficient inhibitory mechanisms,
making it difficult for older adults to
ignore irrelevant stimuli
(Hasher & Zacks, 1988; Hasher,
Zacks, & May, 1999).
Cognitive
activities related to anxiety, like
worrying, also compete with taskrelevant information for attention in the
processing system
Social
causation effect: a
decline in social support
may be the cause for an
increase in depression
(Moos, Cronkite & Moos, 1998).
These cognitive declines may
be because of physical changes
that occur with age or
diminished cognitive resources
(Eyesenk, 1979).
Non-depressed (ND)
patients have lower
Neuroticism &
higher Extraversion,
Openness, &
conscientiousness
scores than depressed
patients suggesting that
ND patients have more
personality traits that
lend towards giving and
receiving social support
Chronic
unmitigated stress leads to high
levels of glucocorticoids, which
can cause damage to the
hippocampus, where learning
and memory of new information
are transferred to long-term
memory.
This damage can further
interfere with the feedback loop
that tells the brain when to “turn
off” the stress response, fueling
the cycle
even further.
Thus, anxiety decreases performance
and hinders working memory.
Therefore, when such affective factors
are considered in light of age-related
cognitive changes, older adults can be
seen at an even higher risk of
processing overload.
Since social support can alleviate
anxiety and depression, this
decreases competition for working
memory and may help deter cognitive
decline
(Williams, 2005).