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The author discusses 3 variables that assess different aspects of social relationships—social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from social- connectedness interventions.
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Social Relationships and Health
Sheldon Cohen
Carnegie Mellon University
The author discusses 3 variables that assess different
aspects of social relationships—social support, social
integration, and negative interaction. The author argues
that all 3 are associated with health outcomes, that these
variables each influence health through different
mechanisms, and that associations between these variables
and health are not spurious findings attributable to our
personalities. This argument suggests a broader view of
how to intervene in social networks to improve health. This
includes facilitating both social integration and social
support by creating and nurturing both close (strong) and
peripheral (weak) ties within natural social networks and
reducing opportunities for negative social interaction.
Finally, the author emphasizes the necessity to understand
more about who benefits most and least from social-
connectedness interventions.
There has been much recent emphasis on the role of social
relationships in our physical health (e.g., Cohen, Gottlieb,
& Underwood, 2000; Uchino, Cacioppo, & Kiecolt-Glaser,
1996). The structure of our social networks (Brissette, Co-
hen, & Seeman, 2000), the support we receive from others
(Cohen et al., 2000), the quality and quantity of our social
interactions (Kiecolt-Glaser & Newton, 2001), and our
feelings of isolation and loneliness (Cacioppo et al., 2002)
have all been identified as predictors of health and well-
being. However, the interpretation of this literature is
clouded by an approach that often views effects of differ-
ent social environmental and dispositional variables as if
they all are exemplars of the same underlying concept and
mechanism(s). Yet there is increasing evidence that differ-
ent social variables influence health through entirely differ-
ent and independent mechanisms (Cohen, 1988; Cohen et
al., 2000; Lakey & Cohen, 2000). It is only by understand-
ing the dimensions of our social ties that influence health
and how they “get under the skin” to do so that psycholo-
gists can successfully apply this knowledge to health pro-
moting interventions. In the service of this goal, I address
five questions about the association between social ties and
Which characteristics of the social environment are
beneficial for health?
How do these characteristics of our social environ-
ment improve our health?
Can our social environment be destructive to our
Is it the social environment or our personalities that
really matter?
Can our social environments be changed to improve
our health?
These are complex questions, and each deserves consider-
ably more space than I am allocated. I provide preliminary
answers to each question leaning heavily on research and
theory produced in my own laboratory over the last 25
years. For this reason, what I present represents a limited
(but hopefully insightful) approach. My discussion includes
scattered studies of social relationships and mental health,
but my primary focus has been physical health outcomes.
Which Characteristics of the Social Environment Are
Beneficial for Health?
Sociology and social psychology abound with terms that
refer to different properties of the social environment, and
many of these constructs may have implications for health.
However, for both historical and sometimes arbitrary rea-
sons, the literature on social relationship and physical
health is relatively restricted and addresses only a select
group of social constructs. In this section, I focus on two
of these: social integration and social support. They are of
special interest here because I believe that each promotes
health through different mechanisms.
Social Support
Social support refers to a social network’s provision of
psychological and material resources intended to benefit an
individual’s ability to cope with stress. It is often differen-
tiated in terms of three types of resources: instrumental,
informational, and emotional (e.g., House & Kahn, 1985).
Instrumental support involves the provision of material aid,
for example, financial assistance or help with daily tasks.
Informational support refers to the provision of relevant
information intended to help the individual cope with cur-
rent difficulties and typically takes the form of advice or
Editor’s Note
Sheldon Cohen received the Award for Distinguished Sci-
entific Contributions. Award winners are invited to deliver
an award address at the APA’s annual convention. A ver-
sion of this award address was delivered at the 112th an-
nual meeting, held July 28 –August 1, 2004, in Honolulu,
Hawaii. Articles based on award addresses are reviewed,
but they differ from unsolicited articles in that they are
expressions of the winners’ reflections on their work and
their views of the field.
676 November 2004
American Psychologist
guidance in dealing with one’s problems. Emotional sup-
port involves the expression of empathy, caring, reassur-
ance, and trust and provides opportunities for emotional
expression and venting. Such typologies of support provide
a basis for determining whether the effectiveness of differ-
ent kinds of support differs by the nature of stressful
events or by the characteristics of persons suffering
Social Integration
Social integration is defined as participation in a broad
range of social relationships (Brissette et al., 2000). It is a
multidimensional construct thought to include a behavioral
component—active engagement in a wide range of social
activities or relationships—and a cognitive component—a
sense of communality and identification with one’s social
roles (Brissette et al., 2000). The concept of social integra-
tion is rooted in Durkheim’s (1897/1951) seminal work on
social conditions and suicide. Durkheim proposed that sta-
ble social structure and widely held norms are protective
and serve to regulate behavior.
How Do These Characteristics of Our Social
Environment Improve Our Health?
Social factors can promote health through two generic
mechanisms: stress-buffering and main effects (Cohen,
1988; Cohen & Wills, 1985; House, 1981). Specific pro-
cesses underlying these mechanisms are presented in the
first two rows of Table 1.
Stress Buffering
The primary model considered by psychologists, especially
those interested in intervention, has been stress buffering.
This model asserts that social connections benefit health by
providing psychological and material resources needed to
cope with stress. The model predicts that social support is
beneficial for those suffering adversity but does not play a
role in health for those without highly stressful demands.
Statistically, the stress-buffering model is supported by an
interaction of stress and social support.
Stress is thought to influence health both by promoting
behavioral coping responses detrimental to health (smok-
ing, drinking alcohol, illicit drug use, sleep loss) and by
activating physiological systems such as the sympathetic
nervous system and the hypothalamic-pituitary-adrenal cor-
tical axis (Cohen, Kessler, & Gordon, 1995). Prolonged or
repeated activation of these systems is thought to place
persons at risk for the development of a range of physical
and psychiatric disorders.
The current literature suggests that the critical factor in
social support operating as a stress buffer is the perception
that others (even one reliable source) will provide appropri-
ate aid (Cohen, 1988; Cohen & Wills, 1985; Uchino et al.,
1996). In this view, the belief that others will provide nec-
essary resources may bolster one’s perceived ability to
cope with demands, thus changing the appraisal of the situ-
ation and lowering its effective stress (Cohen & Wills,
1985; Thoits, 1986; Wethington & Kessler, 1986). Belief
that support is at hand may also dampen the emotional and
physiological responses to the event or alter maladaptive
behavioral responses (e.g., Wills & Cleary, 1996).
In our early work, we proposed that social support is
effective in reducing the effects of stressful events only in
so far as the form of assistance matches demands of the
event (Cohen & Wills, 1985; also see Cutrona & Russell,
1990). For example, having someone lend you money may
be useful in the face of a temporary job loss but useless in
the face of the death of a friend.
There is substantial evidence that the perceived avail-
ability of social support buffers the effect of stress on psy-
chological distress, depression, and anxiety (reviewed by
Cohen & Wills, 1985; Kawachi & Berkman, 2001). For
example, we found that both student and adult samples
reported more symptoms of depression and of physical ail-
ments under stress but that these associations were attenu-
ated among those who perceived that support was available
from their social networks (see Figure 1; Cohen, Mermel-
stein, Kamarck, & Hoberman, 1985). When types of per-
ceived support were broken down, emotional support
Table 1
Mechanisms Through Which Different Types of Social Constructs Influence Physical Health
Social construct Mechanism Specific processes
Social support Stress buffering Eliminates or reduces effects of stressful experiences by promoting less threatening
interpretations of adverse events and effective coping strategies.
Social integration Main effect
(independent of
Promotes positive psychological states (e.g., identity, purpose, self-worth, and
positive affect) that induce health-promoting physiological responses. Provides
information and is a source of motivation and social pressure to care for oneself.
Negative interactions Relationships as a
source of stress
Elicits psychological stress and in turn behavior and physiological concomitants that
increase risk for disease.
677November 2004
American Psychologist
worked in the face of a variety of types of stressful events,
whereas other types of support (e.g., instrumental, informa-
tional) responded to specific needs elicited by an event.
The most striking evidence for stress buffering in the
physical health realm is reported in a prospective study of
healthy Swedish men aged 50 years and over (Rosengren,
Orth-Gomer, Wedel, & Wilhelmsen, 1993). Those with
high numbers of stressful life events in the year before the
baseline exam were at substantially greater risk for mortal-
ity over a seven-year follow-up period. However, this ef-
fect was ameliorated among those who perceived that high
levels of emotional support were available to them (see
Figure 2). In contrast, perceived emotional support made
no difference for those with few stressful events. Social
integration did not act as a stress buffer.
Beyond perceptions, the actual receipt of support could
also play a role in stress buffering. Support may alleviate
the impact of stress by providing a solution to the problem,
by reducing the perceived importance of the problem, or
by providing a distraction from the problem. It might also
facilitate healthful behaviors such as exercise, personal hy-
giene, proper nutrition, and rest (cf. Cohen, 1988; House,
1981). My colleagues and I have pursued this issue in an
experimental primate model in which we randomly as-
signed animals to chronically high stress (unstable) or low
stress (stable) social environments and coded their naturally
occurring affiliative behaviors (Cohen, Kaplan, Cunnick,
Manuck, & Rabin, 1992). There, 43 male cynomolgus
monkeys were randomly assigned to stable or unstable so-
cial conditions for 26 months. In the stable condition, ani-
mals remained in a single cage with four other animals. In
the unstable condition, the animals were rotated into cages
with (at least three of the four) different animals on a
monthly basis. The proportion of time spent in affiliative
behaviors was assessed by 30-minute observations of each
group made twice per week. T-cell immune response was
assessed weekly for three weeks immediately following the
26 months of manipulation. That affiliative behavior repre-
sented an attempt to cope with social stress was supported
by greater affiliation among animals in the unstable com-
pared with the stable condition. Although immune response
was suppressed among animals in the unstable social con-
dition, animals in the unstable condition with the highest
levels of affiliation were partly protected from this stress-
induced suppression (see Figure 3).
Main Effect
The main-effect model argues that social connectedness is
beneficial irrespective of whether one is under stress.
There is reason to believe that social integration operates
primarily through main effects. Individuals who participate
in a social network are subject to social controls and peer
pressures that influence normative health behaviors. For
example, their networks might influence whether they exer-
cise, eat low-fat diets, smoke, or take illicit drugs. Integra-
tion may also engender feelings of responsibility for others
resulting in increased motivation to take care of oneself so
that responsibility can be fulfilled.
Social integration is also thought to influence one’s
sense of self and one’s emotional tone. Role concepts that
are shared among a group of people help to guide social
Figure 1
Each Increase in Perceived Availability of Social
Support Is Associated With a Further Reduction in the
Association Between Psychological Stress and
Depressive Symptoms in College Students
Note. CES-D Center for Epidemiologic Study of Depression Scale; ISEL
Interpersonal Support Evaluation List.
Figure 2
Perceived Availability of Emotional Support Buffers the
Association of the Number of Stressful Life Events and
Mortality in Initially Healthy Swedish Men Aged 50
Years and Older
Note. From “Stressful Life Events, Social Support, and Mortality in Men Born in
1933,” by A. Rosengren, K. Orth-Gomer, H. Wedel, and L. Wilhelmsen, 1993,
British Medical Journal, 307, p. 1104. Copyright 1993 by BMJ Publishing
Group. Reprinted with permission.
678 November 2004
American Psychologist
interaction by providing a common set of expectations
about how people should act in different roles. In meeting
normative role expectations, individuals gain a sense of
identity, predictability and stability; of purpose; and of
meaning, belonging, security, and self-worth (Cassel, 1976;
Cohen, 1988; Thoits, 1983; Wills, 1985). Interacting with
others is also thought to aid in emotional regulation in-
creasing positive affect and helping limit the intensity and
duration of negative affective states (Cohen, 1988). These
positive cognitions and emotions are presumed to be bene-
ficial because they reduce psychological despair (Thoits,
1983), result in greater motivation to care for oneself (e.g.,
Cohen, 1988), or result in suppressed neuroendocrine re-
sponse and enhanced immune function (Cohen, 1988;
Uchino et al., 1996). Having a wide range of network ties
also provides multiple sources of information that could
influence health-relevant behaviors, result in more effective
use of available health services, or help one to avoid
stressful or other high-risk situations.
Attention was drawn to social integration as a predictor
of physical health by a report of a prospective study of
residents of Alameda County, California, by Berkman and
Syme (1979). They found that healthy adults who were
more socially integrated (were married, had close family
and friends, belonged to social and religious groups) at
study onset were more likely to still be living at the nine-
year follow-up than their more isolated counterparts (see
Figure 4). The association between social integration and
mortality has since been replicated in over a dozen pro-
spective community-based studies (reviewed by Berkman
& Glass, 2000), whereas other studies have found that
greater integration predicts survival from heart attacks, less
risk for cancer recurrence, less depression and anxiety, and
less severe cognitive decline with aging (see Cohen et al.,
2000). Although both men and women seem to benefit
from social integration, there is evidence that men benefit
more than women (House, Landis, & Umberson, 1988).
This has been attributed to integration having a cost for
women that isn’t experienced by men—the responsibility
that women take for the fate of other network members
(Kessler, McLeod, & Wethington, 1985). However, it
could also be attributable to women being more sensitive
to the quality and content of their relationships than are
men (Coriell & Cohen, 1995). Hence men may benefit
from lower quality relationships, whereas women do not.
I have been particularly interested in the role of social
integration in the body’s ability to fight off infectious dis-
ease. If social integration confers resistance to infectious
illness, this could account for many of the associations dis-
cussed earlier because infections may underlie mortality
and the risk for asthma, certain cancers, and coronary heart
disease. In my studies of the common cold, I assessed psy-
chosocial factors in healthy adults and then experimentally
exposed them to an infectious agent that causes the com-
mon cold. When exposed to such an agent, only about one
third of the subjects developed clinically verifiable disease.
Consequently, I can ask whether a particular psychosocial
factor (in this case, social integration) predicts who is re-
sistant to illness. To investigate this issue, my colleagues
and I (Cohen, Doyle, Skoner, Rabin, & Gwaltney, 1997)
developed a measure of social integration that assessed
active (at least once every two weeks) participation in 11
different social roles including being married, a parent, a
parent-in-law, a child, another close family member, a
close neighbor, a friend, a workmate, a schoolmate, a fel-
Figure 3
Affiliative Animals Are Protected From the Effects of
Chronic Social Stress on Cellular Immune Function
Note. CPM counts per minute. From “Chronic Social Stress, Affiliation, and
Cellular Immune Response in Nonhuman Primates,” by S. Cohen, J. R. Kaplan,
J. E. Cunnick, S. B. Manuck, and B. S. Rabin, 1992, Psychological Science, 3,p.
303. Copyright 1992 by Blackwell Publishing, Inc. Adapted with permission.
Figure 4
Greater Social Integration Is Associated With Lower
Rates of Mortality
Note. From “Social Networks, Host Resistance, and Mortality: A Nine-Year
Follow-Up Study of Alameda County Residents,” by L. F. Berkman and L. Syme,
1979, American Journal of Epidemiology, 109, p. 190. Copyright 1979 by
Oxford University Press. Adapted with permission.
679November 2004
American Psychologist
low volunteer, or a member of groups with or without reli-
gious affiliation. We found that greater social integration as
assessed by the numbers of social roles was associated
with less susceptibility to clinical illness (Figure 5). This
association was confirmed across two viruses and was in-
dependent of demographic factors and of immunity to the
experimental virus at baseline (viral-specific antibody
Although the social integration research I have dis-
cussed is impressive in the reliability of associations with
morbidity and mortality, it does not directly test whether
social integration is operating as a main effect or stress
buffer because none of these studies included measures of
stress. In contrast, the literature on social integration and
psychological well-being indicates that social integration is
associated with better psychological well-being but does
not interact with stress (review by Cohen & Wills, 1985).
A study of stressful life events, social integration, and sur-
vival from breast cancer (Funch & Marshall, 1983) found
that stressful life events were directly associated with lower
rates of survival and social integration was associated with
higher rates. As in the psychological literature, there was
no stress-buffering interaction. Although not reported in the
published work (Cohen et al., 1997), our own research (de-
scribed earlier) similarly failed to find an interaction (or
even a consistent pattern) that would support social integra-
tion operating as a buffer. In sum, existing evidence is gen-
erally supportive of social integration influencing health
independent of whether persons are facing adversity.
Can Our Social Environment Be Destructive to
Our Health?
Social networks provide emotional, informational, and ma-
terial support; regulate behavior; and offer opportunities for
social engagement. They also provide modes of contact to
spread disease and the opportunity for conflict, exploita-
tion, stress transmission, misguided attempts to help, and
feelings of loss and loneliness. These potentially negative
aspects of networks can act as psychological stressors re-
sulting in cognitive, affective, and biological responses
thought to increase risk for poor health. The processes un-
derlying this mechanism are summarized in the third row
of Table 1.
Earlier, I discussed the social integration literature as if
being integrated is beneficial and the more integrated one
is, the better it is for one’s health. This argument is sup-
ported by the graded relation between social integration
and health found in many studies (see Figures 4 and 5). An
alternative argument is that it is social isolation that causes
disease. In this view, isolation could be a stressor in its
own right, increasing negative affect and a sense of alien-
ation, loneliness, and stress while decreasing feelings of
control and self-esteem. In turn, these negative psychologi-
cal states could increase neuroendocrine and cardiovascular
responses, suppress immune function, and interfere with
performance of health behaviors (Cacioppo et al., 2002;
Cohen, 1988; Uchino et al., 1996). The hypothesis that
isolation is what is responsible for the reported associations
between social integration and health suggests that there is
some threshold for social contact below which one is at
risk for disease. Interestingly, the social integration litera-
ture can also be interpreted as supporting this hypothesis.
For example, a close examination of Figures 4 and 5 indi-
cates that the most isolated individuals are at greater risk
than one would expect if the relation between social inte-
gration and health was linear. Hence the reliable and strik-
ing associations between social integration and morbidity
and social integration and mortality may be attributable to
both the health-promoting mechanisms associated with in-
tegration and the disease-promoting mechanism that oper-
ates among the most isolated.
In other work on the negative effects of the social envi-
ronment on health, I have examined the influence of social
conflicts on susceptibility to colds. My colleagues and I
(Cohen et al., 1998) assessed whether subjects were in-
volved in serious, enduring (one month or longer) social
conflicts using an intensive interview technique. We then
exposed each subject to a virus that causes the common
cold. Those with enduring conflicts were more than twice
as likely to develop a cold as persons without any chronic
stressors in their lives. The conflicts contributing to this
relationship included enduring problems with spouses,
close family members, and friends. These associations were
Figure 5
Greater Number of Social Roles Is Associated With
Decreased Susceptibility to the Common Cold
Note. From “Social Ties and Susceptibility to the Common Cold,” by S. Cohen,
W. J. Doyle, D. P. Skoner, B. S. Rabin, and J. M. Gwaltney Jr., 1997, Journal of
the American Medical Association, 277, p. 1943. Copyright 1997 by the
American Medical Association. Reprinted with permission.
680 November 2004
American Psychologist
independent of preexposure immunity to the virus (specific
antibodies), demographics, and a host of other controls.
In sum, social environments and one’s responses to
them can have powerful detrimental effects. It is likely that
these effects are primarily mediated through one’s apprais-
als of social conditions as stressful and the consequential
changes in health behaviors, endocrine, immune, and car-
diovascular response.
Is It the Social Environment or Our Personalities That
Really Matter?
Social personality traits such as attachment, extraversion,
agreeableness, and hostility are thought to play a key role
in molding our social environments. Hence, it is possible
that one or more aspects of these traits account for associa-
tions between social environments and health that I have
discussed earlier. Are social traits responsible (acting as
third or spurious factors) for associations that have tradi-
tionally been attributed to the social environment?
A number of traits that are thought to influence the de-
gree and quality of one’s social relationships have been
implicated in health outcomes. For example, hostile people
are at greater risk for coronary artery disease and possibly
other physical health problems (Smith, 1992), and argu-
ments (but as yet little evidence) have been recently made
that those with more secure attachment styles may be
partly protected from disease risk. My work has focused on
sociability, a disposition that is generally recognized as a
determinant of quality and quantity of social interaction. I
define sociability as “the quality of seeking others and be-
ing agreeable.”
My colleagues and I found that sociability was associ-
ated with greater resistance to developing colds when per-
sons were experimentally exposed to a cold virus (Cohen,
Doyle, Turner, Alper, & Skoner, 2003). That this associa-
tion was found after entering multiple controls (covariates
in the equation) including preexisting immunity (specific
antibody), gender, age, education, season of the year, body
mass index, and type of virus is notable.
If sociability is responsible for our creating and main-
taining of social ties, and sociability is itself directly bene-
ficial to health, then the associations of social ties and
health we discussed earlier may just be a reflection of the
benefits of sociability and not attributable to our social ties
and interactions. This is especially important because it
suggests that changing social ties would not influence
health outcomes. There is limited evidence in regard to this
question. When my colleagues and I controlled for markers
of sociability when predicting health from social integra-
tion or from social conflicts (Cohen et al., 1997, 1998), the
associations between the social environmental variables and
disease susceptibility were reduced but remained substan-
tial and significant.
In an earlier study, we were interested in determining
whether other dispositional factors might account for per-
ceived social support influences in stress buffering (Cohen,
Sherrod, & Clark, 1986). As expected, we found that per-
ceived social support buffered the effects of psychological
stress on depression. This association held up even after
we controlled for both the main effects and interactions
with stress of social competence, social anxiety, and the
tendency to disclose intimate feelings to others. Similarly,
Rook (1984) found that the association between having ties
who were sources of negative interactions and poorer psy-
chological well-being was not altered after controlling for
indices of social competence. In sum, social personality
traits do play a role in health. However, the few studies
that address the overlap of these traits with social integra-
tion, perceived social support, and negative interaction sug-
gest that the trait and environmental effects are at least
partly independent of one another (also see Uchino et al.,
Can Our Social Environments Be Changed to Improve
Our Health?
The provocative and consistent positive associations of so-
cial integration and supports with physical health discussed
in this article are based entirely on the measures of rela-
tionships within natural social networks. In contrast, pub-
lished interventions are based almost entirely on support
provided by strangers. Moreover, evidence of the effective-
ness of social interventions is much weaker than the evi-
dence from correlational studies. There are fewer studies,
and overall their results have been disappointing (Cohen et
al., 2000).
Social support interventions have often been aimed at
improving health outcomes in patients with serious, life-
threatening diseases. Patients are approached after an acute
event (heart attack, stroke) or in the course of a chronic,
debilitating disease (cancer, HIV) and offered an interven-
tion aimed at reducing secondary events and improving
function. Most often, patients are offered peer support
groups. Early studies, though often small, were sometimes
promising (e.g., Fawzy et al., 1993; Frasure-Smith &
Prince, 1989); one showed, for instance, that women with
metastatic breast cancer who were offered group psycho-
therapy lived longer (Spiegel, Bloom, & Kraemer, 1989).
However, as trials became larger, followed more rigorous
protocols, and involved multiple sites and interventionists,
the promising results were not replicated. Recently, for
example, several clinical trials with postmyocardial infarc-
tion patients (e.g., The ENRICHD Investigators, 2003; Fra-
sure-Smith et al., 1997) and metastatic breast cancer pa-
tients (e.g., Cunningham et al., 1998; Goodwin et al.,
2001) have found no effects of social support interventions
on recurrent disease or mortality.
681November 2004
American Psychologist
Our own intervention work similarly failed to support
the effectiveness of providing seriously ill patients with
emotional support provided by a support group of peers. In
a clinical trial led by my colleague Vicki Helgeson (Helge-
son, Cohen, Schulz, & Yasko, 1999), we found that the
provision of information, but not “peer” emotional support,
facilitated psychological and physical adjustment to breast
cancer. More important, the effectiveness of providing dif-
ferent types of support was dependent on individual differ-
ences in the strength and nature of natural support systems
(Helgeson, Cohen, Schulz, & Yasko, 2000). For example,
peer emotional support groups helped women who lacked
support from their partners or physicians but harmed
women who had high levels of natural support.
In sum, the existing intervention literature has been dis-
appointing. In general, investigators have approached a
complex problem with good intentions but often without
deep theoretical analysis or a strong base of prior research.
My intent here is not to suggest that social network and
support interventions are not potentially effective. On the
contrary, it is to encourage the design of interventions that
better reflect what is known from existing research on the
role of social relationships in health.
The work discussed in this article highlights a number
of directions for future interventions. First, it suggests a
special emphasis on intervention in natural social networks.
Emphasis on natural networks is consistent with the corre-
lational evidence presented in this article but is also more
promising than social support groups as a means of making
changes in social relationships that one can rely on months
and years beyond the period of active intervention (see
Gottlieb, 2000, on when to intervene in the natural social
Second, it suggests intervening in several different as-
pects of the social environment. These include (a) increas-
ing the availability of social support within existing social
networks by improving individual social skills or by build-
ing stronger ties to existing network members, (b) increas-
ing social integration by creating and nurturing close and
peripheral ties between an individual and his or her com-
munity, and (c) reducing negative interactions.
Finally, it suggests that researchers need to identify the
characteristics of those who benefit most and least from
social integration and support interventions. For example,
variability in the effectiveness of support may be attribut-
able to differences in the participants’ social skills, social
traits, or network relationships. It is conceivable that only
the most socially isolated individuals reap significant bene-
fits from their contact with new sources of support. Or it
may be that those who feel the greatest emotional isolation,
or experience the most conflict with their existing associ-
ates, are the least able to take advantage of new opportuni-
ties to strengthen their network. As suggested by our work
with breast cancer patients, this may not merely be an is-
sue of identifying who will benefit but also who may be
harmed by interventionists’ positive intentions.
In sum, I have argued that three different social relation-
ship variables—social integration, social support, and nega-
tive interaction—are all associated with health outcomes,
that these variables each influence health through different
mechanisms, and that these associations are not spurious
findings attributable to personality and hence they are
likely subject to intervention. Further, I feel that this litera-
ture suggests a broader view of how to intervene that in-
cludes creating and strengthening a diverse natural social
network, increasing the availability of social support in
natural networks, and reducing negative interactions within
one’s network. Finally, I emphasize the necessity to under-
stand more about who benefits most and least from social
connectedness interventions.
Author’s Note
This research was supported by National Institute of Men-
tal Health (NIMH) Research Scientist Development Awards
K02 MH00721 and K05 MH00721, National Cancer Insti-
tute Grants CA38243 and CA61303, National Institute of
Allergies and Infectious Diseases Grant AI23072, National
Heart Lung and Blood Institute Grant HL29547, and
NIMH Grants MH47234 and MH50429. Preparation of
this article was facilitated by Pittsburgh Mind–Body Center
Grants HL65111 and HL65112.
I thank my colleagues on the Robert Wood Johnson
Planning Group on Social Connectedness and Health, Lisa
Berkman, John Cacioppo, Tom Cook, Robert Rose, and
John Sheridan; my collaborators on an edited volume on
social support, Ben Gottlieb and Lyn Underwood, for stim-
ulating discussions of the status of this research literature
and its implications for intervention; and my fellow mem-
bers of the MacArthur Foundation Network on Socioeco-
nomic Status and Health. I thank Vicki Helgeson, Tamar
Krishnamurti, and Tom Wills for their helpful comments on
an earlier draft.
Correspondence concerning this article should be ad-
dressed to Sheldon Cohen, Department of Psychology, Car-
negie Mellon University, Pittsburgh, PA 15213. E-mail:
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... 행동의 역할을 통해 인과관계를 설명해 왔다 (Lewis et al., 1994;Markey et al., 2005;Repetti et al., 2002, Uchino, 2004 . 중·노년기 인구의 건강상태의 이질성 은 건강을 회복시키고 개선할 수 있는 건강행동으로 설명할 수 있 는데 (Kaplan, 1991;Taylor et al., 2002) (Umberson, 1992 (Cohen, 2004;. 반대로 부부관계가 만족스럽지 않은 경우, 건강 위해행동(예: 흡연, 음주)이 증가하 고 스트레스와 관련된 생리적 변화로 인해 질병에 취약하게 된다 (Kiecolt-Glaser & Glaser, 2002;Nealey-Moore et al., 2007;Slatcher, 2010;Slatcher & Selcuk, 2017;South & Krueger, 2013;Whisman et al., 2010;Wickrama et al., 2001 (Lee et al., 2021;Roberson et al., 2018). ...
This study aimed to examine the actor and partner effects of marital satisfaction on life satisfaction in middle-aged and older couples via their health behavior and health. The study participants included a total of 2,108 couples, aged 57 and over, from the eighth wave of data from the Korean Longitudinal Study of Ageing (KLoSA). The marital satisfaction, health behavior, health, and life satisfaction of the husbands and wives were measured to conduct the analysis. This analysis was conducted based on the Actor-Partner Interdependence Mediation Model (APIMeM) with the bootstrapping technique being used as the mediating effect. The results indicated that there were significant actor and partner direct and indirect effects when it comes to the relationship between the participants’ marital satisfaction and their own life satisfaction, mediated by health behavior and health. However, no significant influences regarding the health of the participants on the life satisfaction of their spouses were found. These results suggest that it is important for middle-aged and older couples to improve their marital relationships in order to promote the health and life satisfaction of both parties. Doing so will help husbands and wives lead healthier lifestyles based on their positive relationships.
... Interpersonal well-being requires coping successfully with two challenges: How to foster positive relationships and how to resolve conflict. Some of the benefits of attaining positive interpersonal relations include physical health, low levels of stress, optimistic outlook on life, resilience, self-efficacy, and a higher likelihood of being happy (Buettner, 2010;Cohen, 2004;Rosenberg, 2012). But not all friendships or associations are good for you. ...
Psychologists have studied certain elements of wellness, and various aspects of fairness, but they have seldom studied the interaction between the two. As a result, it is not surprising that there is a paucity of educational, community, clinical and social interventions to promote wellness and fairness in concert. In this paper I present a framework of justice consisting of substantive and contextual types. Distributive and procedural justice constitute the two main types of justice. Interpersonal, organizational, cultural and communal justice are contextual types which embed within them the two substantive aspects of justice. I explore how these various kinds of justice impact human development across six facets of well-being: interpersonal, communal, occupational, physical, psychological and economic. I claim that for children and adults to achieve optimal human development, these facets of well-being must be supported by various types of justice.
... Humans are social beings and having close and meaningful social relationships is beneficial to mental and physical health (such as reduced depression, general anxiety, stress, and increased longevity; Cohen, 2004;Counts & John-Henderson, 2020). Loneliness refers to a subjectively unpleasant experience that includes feeling empty, not in control, and perceived threat (Cacioppo & Patrick, 2008;Weiss, 1973). ...
Emerging adults frequently report feelings of loneliness and social anxiety owing to changes in their social environment, instabilities, and transitions. One of the risk factors that could contribute to emerging adults’ social well-being is overparenting. We examined the association between overparenting, loneliness, and social anxiety among emerging adults and investigated the potential mediating role of emotion regulation as a mechanism that might account for the association. Overparenting was operationalized as a domain-specific construct comprising various aspects of emerging adults’ lives (i.e., academic, health, financial, and relational). College students (N = 287) participated in a short-term longitudinal study and responded to self-reported measures on overparenting, emotion regulation, loneliness, social anxiety, and demographics. Findings from structural equation modeling suggested that relational overparenting was related to higher levels of loneliness and social anxiety among emerging adults and that this association was mediated by emotion regulation. Implications for future research and practice are discussed.
INTRODUCTION Social connectedness is associated with slower cognitive decline among older adults. Recent research suggests that distinct aspects of social networks may have differential effects on cognitive resilience, but few studies analyze brain structure. METHODS This study includes 117 cognitively impaired and 59 unimpaired older adults. The effects of social network characteristics (bridging/bonding) on brain regions of interests were analyzed using linear regressions and voxel‐wise multiple linear regressions of gray matter density. RESULTS Increased social bridging was associated with greater bilateral amygdala volume and insular thickness, and left frontal lobe thickness, putamen, and thalamic volumes. Increased social bonding was associated with greater bilateral medial orbitofrontal and caudal anterior cingulate thickness, as well as right frontal lobe thickness, putamen, and amygdala volumes. DISCUSSION The associations between social connectedness and brain structure vary depending on the types of social enrichment accessible through social networks, suggesting that psychosocial interventions could mitigate neurodegeneration. HIGHLIGHTS Distinct forms of social capital are uniquely linked to gray matter density (GMD). Bridging is associated with preserved GMD in limbic system structures. Bonding is associated with preserved GMD in frontal lobe regions. Bridging is associated with increased brain reserve in sensory processing regions. Bonding is associated with increased brain reserve in regions of stress modulation.
This article aimed to assess posttraumatic growth among participating and nonparticipating families of organ donors in grief support groups. The program, in the form of both face-to-face and WhatsApp groups, is unique in that it extends over many years without limitation for a predefined period, is open to both immediate and extended family members, and is conducted according to predetermined topics. A questionnaire was completed by 84 participants and 115 non-participant family members. Most participants had attended for between 1 and 5 years (57.2%), although 33.3% had participated for >5 years, including 16.7% who participated for >10 years. All measures of posttraumatic growth were significantly higher in group participants (3.40 [0.75] vs. 3.15 [0.75], p = .010) than non-participants. The often-prolonged participation in the groups suggests there may be an important need for ongoing contact with and support for these families even many years after the loss.
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This chapter aims to provide researchers with the background to makeinformed decisions when selecting measures of social support. The premise isthat these decisions should be informed by theories of how social relationshipsinfluence health and well-being. More generally, social support research shouldhave a basis in theories about how social relationships influence our cognitions, emotions, behaviors, and biology.
Surgery and pharmaceuticals are not the only effective procedures we have to improve our health. The natural human tendency to care for fellow humans, to support them with social networks, has proven to be a powerful treatment as well. As a result, the areas of application for social support intervention have expanded dramatically during the past 20 years. The title is divided into four sections. The first provides some historical context as well as a conceptual overview of how social support might influence mental and physical health. The second discusses techniques for measuring social networks and support, and the third addresses the design of different types of support interventions. The final section presents some general comments on the volume and its implications for social support research and intervention. This resource is meant to aid researchers in understanding the conceptual criteria on which measurement and intervention decisions should be made when studying the relations between social support and health.
In order to test the effect of a psychological intervention on survival from cancer, 66 women with metastatic breast cancer, all receiving standard medical care, were randomly assigned into two groups; one group (n=30) attended the psychological intervention, consisting of 35 weekly, 2 h sessions of supportive plus cognitive behavioral therapy; the control group (n=36) received only a home study cognitive behavioral package. No significant difference was found in survival post‐randomization between the groups as assessed by a log rank test 5 years after the commencement of the study. As expected, several prognostic factors were significant predictors of survival: metastatic site, hormonal receptor status, and chemotherapy prior to randomization. While many personal and demographic variables did not influence survival, there was a significant effect of self‐reported exercise (possibly due to better health). A small subgroup of intervention subjects who attended outside support groups also survived significantly longer than those who did not. The strengths and limitations of the present study are discussed, and the results contrasted with those of a well known study by Spiegel et al. (Spiegel, D., Bloom, J.R., Kraemer, H.C. and Gottheil, E. (1989) Lancet ii, 888–891). We propose that a different experimental design (correlative) may be needed to show any effect of self‐help behaviors and psychological attributes in a small minority of patients. © 1998 John Wiley & Sons, Ltd.
The relationship between social and community ties and mortality was assessed using the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, California and a subsequent nine-year mortality follow-up. The findings show that people who lacked social and community ties were more likely to die in the follow-up period than those with more extensive contacts. The age-adjusted relative risks for those most Isolated when compared to those with the most social contacts were 2.3 for men and 2.8 for women. The association between social ties and mortality was found to be independent of self-reported physical health status at the time of the 1965 survey, year of death, socioeconomic status, and health practices such as smoking, alcoholic beverage consumption, obesity, physical activity, and utilization of preventive health services as well as a cumulative index of health practices.
The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.
This chapter aims to provide guidance to those planning supportinterventions regarding the grounds for selecting the appropriate type of interventionstrategy and regarding the main elements that should be taken intoconsideration in designing such interventions. The chapter addresses the conditions and contexts that call for and precludeparticular support strategies and provides a generic framework for designinginitiatives that marshal or augment social support. The chapter concentrateson person-centered rather than system-centered initiatives.
This paper is different from the others in this volume in that we discuss the health-damaging effects of providing social support rather than the health-promoting effects of receiving it. Our topic has heretofore been neglected. Yet, as we show below, there is good reason to think that there are serious personal costs associated with being a supporter; costs that should be taken into account by those who advocate community interventions to increase access to support.
Recent research has renewed interest in the potential influence of hostility on physical health. This review indicates that the evidence available from prospective studies, although not entirely consistent, suggests that hostile persons may be at increased risk for subsequent coronary heart disease and other life-threatening illnesses. Further, several plausible mechanisms possibly linking hostility and health have been articulated and subjected to initial evaluation. Hostile individuals display heightened physiological reactivity in some situations, report greater degrees of interpersonal conflict and less social support, and may have more unhealthy daily habits. Additional research is needed, and it must address a variety of past conceptual and methodological limitations. Perhaps the most central of these concerns are the assessment of individual differences in hostility and the role of social contexts in the psychosomatic process.