HLTH200 Lecture Notes - Lecture 8: Twin Study, Shopping Cart, Body Image
28 May 2018
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HLTH200 Week 8 Lectures
The Social Cure
Overview –
• Widening gaps in health, related to disadvantage.
o This can be somewhat depressing, and may seem like there is little that
can bedone at an individual level.
• Health professionals can make an impact
o Some earlier work on social support
o Types of social support
o Group memberships
Social support and health
• It has long been known that social support is related to mental wellbeing
o For instance, various studies have found evidence for the significance
of friendship for the wellbeing of older people providing:
▪ Companionship and pleasure
▪ Support in situations that are problematic and stressful
▪ The sustainment of identity and meaning
• The way social support is measured varies greatly from number of
friends/family, to feelings of available help
o One novel measures asks participants how many people that they could
just ‘drop in and visit unannounced’
• Growing evidence that social support is important for physical health
Living alone and mortality
• Social support and survival after heart attack.
• 880 patients discharged with a primary diagnosis of AMI in a major urban
center during the 1998–1999.
• Living alone (as measure of social support) was determined by a combination
of:
o marital status (single, divorced, or widowed)
o absence of a key contact with the same address, phone number or
postal code
o any notes about the patient’s living arrangements.
o E.g., Lodge, assisted-living, and long-term-care-facility residents were
categorized as living with others.
• Living with others predicted survival. The risk of death was 1.6 times worse
for those living alone compared to those living with others. It was worse for
men → men living alone had the lowest survival rate (twice the risk) than men
living with others
Social support (types of support)
• Emotional or esteem support:
• empathy
• caring
• concern
• positive regard
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o provides comfort and reassurance with a sense of belonging and of
being loved in times of stress
• encouragement (esteem support).
o expressions of confidence or encouragement
o pointing out personal strengths
o letting someone know you believe in them
• Tangible or instrumental support:
o direct assistance, e.g.:
▪ giving or lending money
▪ helping with childcare/housework in times of stress
▪ providing transport
▪ bringing meals
• Informational support
o Advice
o Directions
o Suggestions
o Feedback
• Companionship support
o Availability of others to spend time with person
▪ Giving a feeling of membership in group of people who share
interests or activities
Social relationships and mortality
• Do social relationships influence risk for mortality?
• Which aspects of social relationships are most predictive of mortality?
• Meta-analysis of 148 studies (308,849 participants)
• Highest odds of survival for social integration
• Results
o 50% increased likelihood of survival for participants with stronger
social relationships.
o This finding remained consistent across age, sex, initial health status,
cause of death, and follow-up period.
o Depended on the type of social measurement evaluated. The
association:
▪ strongest for complex measures of social integration (OR =
1.91; 95% CI 1.63 to 2.23)
▪ lowest for binary indicators of residential status (living alone
versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Social support and health
• social support covers three domains: the extent to which idnividuals are
attached to others, the individuals cognitive appraisal of the support, and the
response of others in the provision of support
• so what is important?
o Liking the person or feeling connected to them
o Perceiving that they are offering support
o The type of support offered
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find more resources at oneclass.com
Social support and mortality
• Social support in 206 Finnish men and women
• Participants aged 80 years old
• Using the Social Provision Scale:
o Attachment
o Social integration
o Opportunity for nurturance
o Reassurance of worth
o Reliable alliance
o Guidance
Perceived social support and mortality
• Dividing perceived social support into assistance-related and non-assistance
related support
• Non-assistance related:
o emotional closeness
o sense of belonging
o experiences of reassurance of worth
o opportunity for nurturance
• risk of death → almost 2.5 times higher in women with the lowest non-
assistance-related social support i.e. women with the least ‘emotional
integration’
Relationship quality
• Of middle aged men and women with low symptoms of heart disease
o found low rates of atherosclerosis in people with a spouse/partner
o but high rates for living alone, single or widowed
• But this depends on people perceiving relationship quality as high (Gallo et
al., 2003; Umberson et al., 2006)
• Married people show lower blood pressure than single people, but people in
unhappy marriages show higher blood pressure than single individuals (Holt-
Lunstad et al., 2009)
• Frequent contact with spouse, can protect against worsening atherosclerosis
over time, unless the marriage is perceived as low in quality (Janicki et al.,
2005).
• Good quality social support is important for health (not marriage per se) with
loneliness a predictor of poor health and mortality
Types of support
• Of patients participating in cardiac rehab
o Examined spouses’ provision of health-related support and control
o As predictors of health behaviour and mental health
• Health related support vs. health-related control
• At T1, spouses' health-related support was positively associated with patient
health behavior.
• Change over 6 months revealed:
o spouses‘ health -related support predicted increased patient mental
health,
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
The risk of death was 1. 6 times worse for those living alone compared to those living with others. It was worse for men men living alone had the lowest survival rate (twice the risk) than men living with others. Informational support: advice, directions, suggestions, feedback, companionship support, availability of others to spend time with person, giving a feeling of membership in group of people who share interests or activities. The association: strongest for complex measures of social integration (or = 1. 91; 95% ci 1. 63 to 2. 23) lowest for binary indicators of residential status (living alone versus with others) (or = 1. 19; 95% ci 0. 99 to 1. 44). Social support and mortality: social support in 206 finnish men and women, participants aged 80 years old, using the social provision scale, attachment, social integration, opportunity for nurturance, reassurance of worth, reliable alliance, guidance.
