Social Support: The Good, the Bad, and the Ugly

Social support, social strain and inflammation: Evidence from a national longitudinal study of U.S. adults by Yang et. Al focuses on how various types of relationships effect health and what biophysiological mechanisms are at play.  It is widely known that social support is beneficial to long term health.  Having social support has been shown to assist with individual’s mental and physical health, and stress management.   While there are many benefits of social support, there are also social costs as well such as negative and strained relationships.  Both need to be measured to understand more about how social aspects effect one’s health as psychological stress brought on by social strain can cause inflammation and lower immune function. 

The study specifically focuses in on how different types of relationships such as family, friends, and spouses effect the immune system over a period of ten years. Two components that are concentrated on are perceived social support and social strain.  From previous research it is hypothesized that over time, perceived social support will reduce inflammation and social strain will worsen inflammation.  Overall, it is expected that perceived social support will cause a net positive for the individual.     

Wave I data was collected between 1995-96, with 7,108 participants between the ages of 25-74 and were recruited via random dialing.  90 percent of individuals were white and 5 percent were black.  Wave II data was collected between 2004-05 via follow up phone interviews with a retention rate of 75%. The third phase of data collected occurred between 2004-09 with a final sample of 647 individuals all of whom were married.  Overall, the individuals who stayed in the study rated higher on measures of social support, lower social strain, high income, and were more active.  This will cause the relationship between social support and inflammation to be different than if the other individuals were still able to be part of the study.   

Inflammation was measure by five different biological indicators including, C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), E-selectin, and intracellular adhesion molecule 1 (ICAM-1). 

Social support was measured through phone survey by asking participants questions pertaining to how much their friends, family and spouse “care about you”, “understand the way you feel”, “how much you can rely on them”, and “how much you can open up to them”.  Participants were asked to give a rating on a scale from 1-4 with 4 being the highest marker of support. 

Social strain was measured in the same phone survey by asking participants do your family, friends and spouse “make too many demands on you”, “criticize you”, “let you down when you are counting on them” and “get on your nerves”.  The same 1-4 scare was used to rate the answers. 

Additional questions were asked about spouses in regards to social support and social strain. 

The results were analyzed through a multivariate regression model.  Results were examined by looking each social support factor separately (family, friend, and spousal support) as well as all together.  Stronger family support was associated with significantly lower odds of elevated IL-6.  Strong spouse support was associated with significantly lower odd of elevated E-selectin.  Strong total support was associated with a significantly lower risk of elevated ICAM-1.  The results suggest that overall social support is more important that each individual support. 

A higher degree of family strain was associated with elevated odds of high-risk fibrinogen and E-selectin.  Spousal strain was associated with elevated E-selectin.  Total high social strain was  associated with higher levels of E-selectin, fibrinogen, and inflammation burden.

When factoring in social strain and support together, consistent social strain is shown to be a major risk factor for inflammation burden. 

In conclusion, Yang et. Al determined that social strain is a significant indicator of inflammation longitudinally and can override the benefits of social support. 

Yang et. Al’s study focuses in specifically on inflammation and how it is associated with social support and social strain.  This information is extremely important for understanding how one’s social lives effect biology and physiology.  However, that the study misses a few points. Within the 10 year follow up, there were no check ins on the participants.  Therefore, it is possible that the support or strain that in being measured could be really only looking at that moment in time.  This longitudinal study would be much more complete if these factors were examined possibly every two - three years.  This would give a more complete look at how those relationships changed over time and how that influences their inflammation and answers to questions.  It would also be interesting to include measures and other indicators of health as well.  While inflammation is a measure of health, it is only one aspect.  The study could take into account other health related factors and histories to understand more about how social strain and social support effect individuals. 

   Overall, this study helps us to understand more about how social support is helpful but social strain can be an even bigger drain on the body.  This proves that it is not only quantity of social support members but quality of support that is important.