Briana Vander Wege, Grand Valley State University

1. Social Support: Mechanisms for Health and Well-Being Briana Vander Wege, Grand Valley State University What is Social Support? Social support looks at the different types of transactions between individuals, like companionship and validation as well as informational, emotional and instrumental support. 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 • 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 • 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 • How Can understanding Social support Help? • The link between low levels of social support and poor health and well-being 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. • 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. 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 (Raiber-Kornfeld, 2005). 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. 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. (McEwen & Magarinos, 1997) Cortisol is also associated with the mobilization of fatty acids and increased risk of formation of arterial plaques or early cardiovascular lesions (Barnett, Spence, Manuck, & Jennings, 1997; Lynch, Everson, Kaplan, Salonen, & Salonen, 1998). 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. 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. 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. (Raiber-Kornfeld, 2005; Cohen, Underwood, & Gottlieb, 2000). Lower levels of social participation and involvement predict first time acute myocardial infarction 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 Many studies show there is an inverse relationship between DHEA (S) concentration and cardiovascular disease (Alexandersen, Haarbo, & Christiansen, 1997). DHEA and its’ sulfated metabolite DHEA-S, 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). 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. This peer pressure can also influence health behaviors like: -Exercising -Eating a low fat diet -Smoking. The Stress-Buffering Model is the most widely accepted model in the development of cardiovascular diseases (Knox & Uvnas-Moberg, 1998; Uchino, Cacioppo, & Keicolt-Glaser, 1996) Cardio- vascular Disease Patients who are low to moderately integrated in social networks are almost twice as likely to be readmitted after myocardial infarction 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 the situation as less stressful (Thoits, 1986) Social support can provide a solution to the problem, provide distractions or tranquilize the neuroendocrine system (Cohen & Wills, 1985). Main-effect model: Social support is beneficial for health regardless of whether the person is under stress or not. (Raiber-Kornfeld, 2005; Auslander & Litwin, 1987; Lin, Ensel, Simeone, & Kuo, 1979; Simons & West, 1985; Wellman & Hall, 1986) Cardio- vascular Disease 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 (Reblin & Uchino, 2008) 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). Associations Between Health & Social Support Unsupported individuals recorded significantly higher levels of, & more changes in, measures of cholesterol, illness symptoms, and affective responses than did supported individuals This model may provide the individual with information regarding access to medical services or behaviors that positively influence health. It could also provide the individual with tangible and economic services that result in better health care. Elderly participants perform more poorly on memory tasks than younger participants. (Lovelace, 1990; Park, O’Connel, & Thomson, 2003) Since working memory also declines with age, it is especially vulnerable to divided attention tasks. (Lovelace, 1990) These cognitive declines may be because of physical changes that occur with age or diminished cognitive resources Craik & Anderson, 1999) Large discrepancies between perceived & received support are predictive of lower emotional well-being and more symptoms of depression Mechanisms Connecting Health & Social Support 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) 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). Low levels of perceived emotional support are predictive of higher mortality in older women Belonging support predicts self-reported diseases like diabetes, hypertension, arthritis & emphysema Other Medical Condit-ions Cognitive Decline Depression Perceived Support and Provision of Support Social integration predicts mortality from diabetes Providing support leads to an increased sense of efficacy & lowers stress Cognitive activities related to anxiety, like worrying, also compete with task-relevant information for attention in the processing system (Eyesenk, 1979). 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). 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 Social-usefulness predicts lower disability, mortality, & systolic & diastolic blood pressure Social causation effect: a decline in social support may be the cause for an increase in depression (Moos, Cronkite & Moos, 1998). VS Some studies suggest that depression negatively impacts social support (George, Blazer, & Hughes, 1989; Ezquiaga, Garcia, & Pallares, 1999; Krause, Liang, & Yatomi, 1999; Williams, 2004) 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. Lower emotional well-being & more symptoms of depression are more evident in those receiving emotional support in excess (Roberto & Scott, 1986). • 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