what statement is true according to research on social support

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9 Social Support: A Review

Shelley E. Taylor, Department of Psychology, University of California at Los Angeles, Los Angeles, CA, USA

• Published: 18 September 2012
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Social support, which is the perception or experience that one is cared for, esteemed, and part of a mutually supportive social network, has beneficial effects on mental and physical health. We review the psychobiological pathways whereby these effects may occur and detail the circumstances under which socially supportive efforts may misfire. Origins of social support include genetic factors and the early environment. We examine gender and cultural differences in how social support is experienced. Under some circumstances, providing social support confers the same benefits as receiving it. A myriad number of social support interventions, including those delivered via the internet, have been evaluated and have the potential to provide emotional and informational support to people who might otherwise lack social support.

Group living is perhaps the most significant adaptation of primate species, including human beings. Whereas other animals are armed with weapons, such as sharp teeth or claws, and defensive resources, such as thick skin and speed, primate species depend critically on group living for survival (Caporeal, 1997 ; Dunbar, 1996 ). This tendency to come together is especially great under threat. Even chimpanzees, known for their solitary behavior, may abandon this style in favor of group activity when an enhanced risk of predation exists (Boesch, 1991 ). In times of intense stress, humans are much the same. Following the September 11 terrorist attacks, some of the most common methods people reported using to cope with this threatening event involved turning to others, including family, friends, and even strangers (Galea et al., 2002 ). There are, of course, tangible benefits to social affiliation under threat. For example, following a disaster, such as a fire, a flood, or a bombing, the presence of many hands can locate survivors and get them to safety. But the presence of others has long been known to foster adjustment to threatening events in other ways, specifically by protecting against adverse changes in mental and physical health that may otherwise occur in response to stress. Social support is now so widely acknowledged as a critical resource for managing stressful occurrences that over 1,100 articles on the topic appear in the research and clinical literatures each year.

What Is Social Support?

Social support is defined as the perception or experience that one is loved and cared for by others, esteemed and valued, and part of a social network of mutual assistance and obligations (Wills, 1991 ). Social support may come from a partner, relatives, friends, coworkers, social and community ties, and even a devoted pet (Allen, Blascovich, & Mendes, 2002 ). Taxonomies of social support have usually classified support into several specific forms. Informational support occurs when one individual helps another to understand a stressful event better and to ascertain what resources and coping strategies may be needed to deal with it. Through such information or advice, a person under stress may determine exactly what potential costs or strains the stressful event may impose and decide how best to manage it. Instrumental support involves the provision of tangible assistance such as services, financial assistance, and other specific aid or goods. Examples include driving an injured friend to the emergency room or providing food to a bereaved family. Emotional support involves providing warmth and nurturance to another individual and reassuring a person that he or she is a valuable person for whom others care. But as the definition makes clear, social support can also involve simply the perception that such resources are available, should they be needed. For example, knowing that one is cared for and/or that one could request support from others and receive it is comforting in its own right. Thus, social support may involve specific transactions whereby one person explicitly receives benefits from another, or it may be experienced through the perception that such help and support is potentially available.

Social support is typically measured either in terms of the structure of socially supportive networks or the functions that network members may provide (e.g., Wills, 1998 ). Structural social support, often referred to as social integration, involves the number of social relationships in which an individual is involved and the structure of interconnections among those relationships. Social integration measures assess the number of relationships or social roles a person has, the frequency of contact with various network members, and the density and interconnectedness of relationships among the network members. Functional support is typically assessed in terms of the specific functions (informational, instrumental, and emotional) that a specific member may serve for a target individual and is often assessed in the context of coping with a particular stressor. Thus, an individual might be asked how much of different kinds of support each member of a supportive network provided during a stressful event.

An early debate in the social support literature centered on the circumstances under which social support may be beneficial. One hypothesis, known as the direct effects hypothesis, maintains that social support is generally beneficial to mental and physical health during nonstressful times as well as during stressful times. The other hypothesis, known as the buffering hypothesis, maintains that the health and mental health benefits of social support are chiefly evident during periods of high stress; when there is little stress, social support may have few physical or mental health benefits. According to this hypothesis, social support acts as a reserve and resource that blunts the effects of stress or enables an individual to deal with stress more effectively, but otherwise is less consequential for mental and physical health (Cohen & Wills, 1985 ). After decades of research, evidence for both types of effects have emerged. Measures of social integration typically show direct associations with mental and physical health, but not buffering effects (Thoits, 1995 ). In contrast, the perception that emotional support is available is associated both with direct benefits to physical and mental health and also with buffering effects (e.g., Wethington & Kessler, 1986 ).

Benefits of Social Support and Reasons for the Benefits

Mental and physical health benefits.

Research consistently demonstrates that social support reduces psychological distress such as depression or anxiety during times of stress (e.g., Fleming, Baum, Gisriel, & Gatchel, 1982 ; Lin, Ye, & Ensel, 1999 ; Sarason, Sarason, & Gurung, 1997 ). It has been found to promote psychological adjustment to chronically stressful conditions, such as coronary artery disease (Holahan, Moos, Holahan, & Brennan, 1997 ), diabetes, HIV (Turner-Cobb et al., 2002 ), cancer (Penninx et al., 1998 ; Stone, Mezzacappa, Donatone, & Gonder, 1999 ), rheumatoid arthritis (Goodenow, Reisine, & Grady, 1990 ), kidney disease (Dimond, 1979 ), childhood leukemia (Magni, Silvestro, Tamiello, Zanesco, & Carl, 1988 ), and stroke (Robertson & Suinn, 1968 ), among other disorders. Social support also protects against cognitive decline in older adults (Seeman, Lusignolo, Albert, & Berkman, 2001 ), heart disease among the recently widowed (Sorkin, Rook, & Lu, 2002 ), and psychological distress in response to traumatic events, such as 9/11 (Simeon, Greenberg, Nelson, Schmeider, & Hollander, 2005 ).

Social support also contributes to physical health and survival (e.g., Rutledge et al., 2004 ). In a classic study that documented this point, epidemiologists Lisa Berkman and Leonard Syme ( 1979 ) followed nearly 7,000 California residents over a 9-year period to identify factors that contributed to their longevity or early death. They found that people who lacked social and community ties were more likely to die of all causes during the follow-up period than were those who cultivated or maintained their social relationships. Having social contacts predicted an average 2.8 years increased longevity among women and 2.3 years among men, and these differences persisted after controlling for socioeconomic status (SES), health status at the beginning of the study, and health habits (Berkman & Syme, 1979 ). Of particular significance is the fact that the positive impact of social ties on health is as powerful, and in some cases, more powerful a predictor of health and longevity than well-established risk factors for chronic disease and mortality, with effect sizes on par with smoking, blood pressure, lipids, obesity, and physical activity (House, Landis, & Umberson, 1988 ).

These benefits are realized in part by the fact that social support appears to help people to stave off illness altogether. For example, Cohen and associates ( 1997 ) intentionally infected healthy community volunteers with a cold or flu virus by swabbing the inside of their nasal passages with virus-soaked cotton swabs. They found that people experiencing a high level of stress were more likely to develop infections than were people under less stress, and the colds and flus they developed were more serious as well. However, those with more social ties were less likely to become ill following exposure to the virus, and if they did, they were able to recover more quickly than were those with fewer social ties (Cohen, Doyle, Skoner, Rabin, & Gwaltney, 1997 ).

On the whole, though, evidence for the impact of social support on the likelihood of becoming ill is not as consistently positive as evidence for its impact on course of illness or recovery (Seeman, 1996 ; Taylor & Seeman, 2000 ). It may be that social contacts both contribute to illness likelihood, as through contagion or the creation of stress (e.g., Hamrick, Cohen, & Rodriguez, 2002 ), but also promote health via social support, leading, on balance, to the only moderately positive net effect on illness likelihood.

Social support has been tied to a variety of specific health benefits among individuals sustaining health risks. These include fewer complications during pregnancy and childbirth (Collins, Dunkel-Schetter, Lobel, & Scrimshaw, 1993 ), less susceptibility to herpes attacks among infected individuals (VanderPlate, Aral, & Magder, 1988 ), lower rates of myocardial infarction among individuals with diagnosed disease, a reduced likelihood of mortality from myocardial infarction (Kulik & Mahler, 1993 ; Wiklund et al., 1988 ), faster recovery from coronary artery disease surgery (King, Reis, Porter, & Norsen, 1993 ; Kulik & Mahler, 1993 ), better diabetes control ( Marteau, Bloch, & Baum, 1987 ), better compliance and longer survival in patients with end-stage renal disease (Cohen et al., 2007 ), and less pain among arthritis patients (Brown, Sheffield, Leary, & Robinson, 2003 ).

The impact of social support on mortality is also clearly established, as the seminal study by Berkman and Syme ( 1979 ) suggests. In prospective studies controlling for baseline health status, people with a higher quantity and quality of social relationships have consistently been shown to be at lower risk of early death (Herbst-Damm & Kulik, 2005 ; Seeman, 1996 ), and in studies of both humans and animals, social isolation has been found to be a major risk factor for early mortality (House et al., 1988 ).

Pathways Linking Social Support to Health

Considerable effort has gone into exploring the pathways whereby social support is beneficial to health. Early research examined the possibility that social support may be associated with good health habits which, in turn, beneficially affect health. For example, family living has been tied to a broad array of good health habits, including a lower likelihood of drug or alcohol abuse and smoking, and an enhanced likelihood of a balanced diet and good sleep habits (e.g., Umberson, 1987 ). Social isolation has been tied to unhealthy responses to stress, such as smoking and alcohol abuse, which can adversely affect health (Broman, 1993 ). However, although social support may be helpful to people initially in developing or changing health habits, such as stopping smoking, it may have less consistent effects on maintenance (Carlson, Goodey, Bennett, Taenzer, & Koopmans, 2002 ). If the social support network itself is engaged in a behavior change program, social support may beneficially affect ongoing maintenance. In one study (Fraser & Spink, 2002 ), for example, women for whom exercise had been prescribed for medical problems were less likely to drop out if they experienced social support in the group. Similarly, when families are engaged in behavior change programs (such as dietary change following diagnosis of cardiovascular disease), such involvement may promote better adherence to an otherwise taxing set of changes (Wilson & Ampey-Thornhill, 2001 ). Social support may also increase commitment to medical regimens because it enhances feelings of self-efficacy (DiMatteo, 2004 ; Resnick, Orwig, Magaziner, & Wynne, 2002 ) or because it affects responsiveness to social influence efforts by others (Cohen & Lemay, 2007 ). But some social networks may also promote unhealthy behaviors, such as smoking, drug abuse, and drinking (Wills & Vaughan, 1989 ). On the whole, the impact of social support on health appears to exist over and above any influence it exerts on health habits.

Accordingly, researchers have focused heavily on potential physiological, neuroendocrine, and immunologic pathways by which social support may achieve its health benefits. What are these pathways? During times of stress, the body releases the catecholamines epinephrine and norepinephrine with concomitant sympathetic nervous system (SNA) arousal and may also engage the hypothalamic-pituitary-adrenocortical (HPA) axis, involving the release of corticosteroids including cortisol. These responses have short-term protective effects under stressful circumstances, because they mobilize the body to meet the demands of pressing situations. However, with chronic or recurrent activation, they can be associated with deleterious long-term effects, with implications for health (e.g., Seeman & McEwen, 1996 ; Uchino, Cacioppo, & Kiecolt-Glaser, 1996 ). For example, excessive or repeated discharge of epinephrine or norepinephrine can lead to the suppression of cellular immune function, produce hemodynamic changes such as increases in blood pressure and heart rate, provoke abnormal heart rhythms such as ventricular arrhythmias, and produce neurochemical imbalances that may relate to psychiatric disorders (McEwen & Stellar, 1993 ). Intense, rapid, and/or long-lasting sympathetic responses to repeated stress or challenge have been implicated in the development of hypertension and coronary artery disease.

Recently, evidence for these pathways has been found at the neural level (Eisenberger, Taylor, Gable, Hilmert, & Lieberman, 2007 ). In a study in which participants kept daily social support diaries, participated in a functional magnetic resonance imaging (fMRI) task assessing neurocognitive reactivity to a social stressor, and participated in laboratory stress tasks during which neuroendocrine responses were assessed, those who interacted regularly with supportive individuals across a 10-day period showed diminished cortisol reactivity to a social stressor. Moreover, greater social support and diminished cortisol responses were associated with diminished activity in the dorsal anterior cingulate cortex (dACC) and Brodmann area 8, brain regions whose activity has previously been tied to social distress. Differences in this neurocognitive reactivity mediated the relationship between social support and low cortisol reactivity. Thus, this study helps to identify the pathways whereby social support affects neural regulation of neuroendocrine processes in response to stress, and this may contribute to health outcomes.

Social support may also protect against immune-related disorders and promote healthy responses to influenza vaccine (Pressman et al., 2005 ). Stress may increase the risk for adverse health outcomes by suppressing the immune system in ways that leave a person vulnerable to opportunistic diseases and infections. Corticosteroids have immunosuppressive effects, and stress-related increases in cortisol have been tied to decreased lymphocyte responsivity to mitogenic stimulation and to decreased lymphocyte cytotoxicity. Such immunosuppressive changes may be associated with increased susceptibility to infectious disorders and to destruction of neurons in the hippocampus as well (McEwen & Sapolsky, 1995 ).

An immunosuppression model does not explain how stress might influence diseases whose central feature is excessive inflammation, however; such diseases include allergic, autoimmune, rheumatologic, and cardiovascular disorders, among other disorders that are known to be exacerbated by stress. Miller, Cohen, and Ritchey ( 2002 ) hypothesized that chronic stress may diminish the immune system’s sensitivity to glucocorticoid hormones that normally terminate the inflammatory cascade that occurs during stress. In support of their hypothesis, they found a clear buffering effect of social support on this process, such that among healthy individuals, glucocorticoid sensitivity bore no relation to social support; however, among parents of children with cancer (a population under extreme stress), those who reported receiving a high level of tangible support from others had higher glucocorticoid sensitivity. Relatedly, social integration has been tied to lower levels of C-reactive protein, a marker of inflammation (Loucks, Berkman, Gruenewald, & Seeman, 2006 ).

Extensive evidence suggests that all these systems—the HPA axis, the immune system, and the SNA—influence each other and thereby affect each other’s functioning. For example, links between HPA axis activity and SNA activity suggest that chronic activation of the HPA axis could potentiate overactivation of sympathetic functioning (Chrousos & Gold, 1992 ). Proinflammatory cytokines, which are involved in the inflammatory processes just noted, can activate the HPA axis and may contribute not only to the deleterious effects that chronic activation of this system may cause, but also, potentially to depressive symptoms, which have previously been tied to HPA axis activation (Maier & Watkins, 1998 ; Capuron, Ravaud, & Dantzer, 2000 ). To the extent, then, that social support can keep SNA or HPA axis responses to stress low, it may have a beneficial impact on other systems as well (Seeman & McEwen, 1996 ; Uchino et al., 1996 ). In turn, these benefits may affect health in a positive direction.

A variety of empirical studies has yielded evidence consistent with these hypotheses. For example, a considerable experimental literature demonstrates that the presence of a supportive person when one is going through a stressful task can reduce cardiovascular and HPA axis responses to stress; these benefits can be experienced whether the supportive person is a partner, a friend, or a stranger (e.g., Christenfeld et al., 1997 ; Gerin, Milner, Chawla, & Pickering, 1995 ; Gerin, Pieper, Levy, & Pickering, 1992 ; Kamarck, Manuck, & Jennings, 1990 ; Kors, Linden, & Gerin, 1997 ; Lepore, Allen, & Evans, 1993 ; Sheffield & Carroll, 1994 ; see Lepore, 1998 for a review).

Not all research shows beneficial effects of social support in challenging circumstances, however. Sometimes the presence of a friend or stranger actually increases sympathetic reactivity among those undergoing stress (e.g., Allen, Blascovich, Tomaka, & Kelsey, 1991 ; Mullen, Bryant, & Driskell, 1997 ). For example, Allen et al. ( 1991 ) found that relative to a control condition in which they remained alone, women who completed a stressful task in the presence of a female friend had higher physiological reactivity and poorer performance (see also Kirschbaum, Klauer, Filipp, & Hellhammer, 1995 ; Smith, Gallo, Goble, Ngu, & Stark, 1998 ). Whereas the presence of a partner seems to reduce stress-related physiological and neuroendocrine reactivity among men, the presence of a male partner more reliably enhances reactivity among women (Kiecolt-Glaser & Newton, 2001 ). The presence of a friend or partner may increase evaluation apprehension over whether important others’ perceptions of the self may decline, and so this apprehension may eliminate any effect of support (Lepore, 1998 ).

Other biological processes may underlie the benefits of social support as well. A growing literature suggests a potential role for oxytocin in the neuroendocrine and physiological benefits of social support. In response to stress, animals and humans experience a cascade of hormonal responses that begins, at least in some stressors, with the rapid release of oxytocin. Consistent evidence suggests that (1) oxytocin is associated with affiliative activities in response to stress, (2) oxytocin is released in response to stress, and (3) oxytocin is associated with reduced SNS and HPA axis responses to stress (see Taylor, Dickerson, & Klein, 2002 ).

Research from both animal (e.g., Grippo et al., 2007 ) and human (e.g., Taylor, Gonzaga et al., 2006 ) studies has found that, in response to the social stressor of social isolation, oxytocin levels rise; one possible explanation for this effect is that oxytocin acts as a biological signal to the organism to seek social company. Indeed, the relation of oxytocin to affiliative activity is very strong. Exogenous administration of oxytocin reliably leads to increases in a broad array of prosocial activities, including seeking proximity, grooming, and mothering, and has been tied to empathy and trust in humans. Both animal (e.g., Witt, Carter, & Walton, 1990 ; McCarthy, 1995 ) and human (e.g., Grewen, Girdler, Amico, & Light, 2005 ) studies have found that oxytocin is consistently associated with signs of relaxation, including an increase in social contact and in grooming in animals (e.g., Carter, DeVries, & Getz, 1995 ), and relaxation and calm in humans (e.g., Uvnäs-Moberg, 1996 ), and lower blood pressure and heart rate (Light, Grewen, & Amico, 2005 ). Oxytocin appears to inhibit the secretion of adrenocorticotropin (ACTH) hormone and cortisol in humans as well (Chiodera & Legros, 1981 ; Legros, Chiodera, & Demy-Ponsart, 1982 ).

The potential roles of oxytocin, both in the down-regulation of SNS and HPA axis responses to stress and in the tendency to turn to others, at present, are hypotheses with a great deal of animal evidence to support them, but less evidence from human studies. Consequently, this issue represents a direction for research, rather than an established biological pathway by which social support may exert protective effects on health. Moreover, there may be roles for other hormones both in promoting social support initially and in regulating its biological effects, which include vasopressin, norepinephrine, serotonin, prolactin, and endogenous opioid peptides (Nelson & Panksepp, 1998 ; Taylor et al., 2002 ).

Why is Social Support Beneficial?

Much early research on social support took for granted that its impact on mental and physical health came largely from the specific benefits furnished by social support transactions. That is, when one person helps another, that other is benefited tangibly or emotionally in ways that can contribute to the well-documented beneficial outcomes described. A variety of observations, however, have led researchers to rethink whether all the benefits, or indeed, the primary benefits of social support come from its actual utilization.

The fact that structural measures of social support are associated with mental and physical health benefits is implicit support for questioning this account. If merely knowing the number of social ties an individual has leads to insights about that individual’s health, then it would appear that the activation of those ties may not be essential for benefits to be experienced. Research suggests that the mere perception of social support, whether or not it is actually utilized, can be stress-reducing with concomitant benefits for well-being. For example, Broadwell and Light ( 1999 ) brought married men and women into the laboratory and had them fill out a questionnaire about how much support they felt they had at home (or a questionnaire assessing matters unrelated to support). Each person was then put through several stressful tasks such as computing difficult arithmetic problems in his or her head. The men who reported a lot of support from their families had lower blood pressure responses to the stressful tasks than did those who had less social support, suggesting that their families were providing support to them even though they were not physically present; the effect was not significant for women. In fact, beliefs about the availability of emotional support actually appear to exert stronger effects on mental health than the actual receipt of social support does (e.g., Wethington & Kessler, 1986 ; Dunkel-Schetter & Bennet, 1990 ; see Thoits, 1995 for discussion).

This point suggests that the receipt of social support may have costs. Consistent with this idea, Bolger, Zuckerman, and Kessler ( 2000 ) documented that actually making use of one’s social support network can be associated with enhanced rather than reduced stress. In their studies, couples completed daily diaries regarding the stressors they experienced, how distressed they were in response to them, and whether they had provided or received support from their partner. Supportive acts that were reported by the support recipient did not promote adjustment to stress, but rather, were associated with poorer adjustment, suggesting that when explicit support efforts are recognized, there can be emotional costs to the recipient. However, when supportive acts were reported by the support provider, but were unrecognized by the recipient, stress-protective effects were found (Bolger & Amarel, 2007 ). The results suggest that the most effective support is “invisible” to the recipient; that is, it occurs without his or her awareness. Thus, it may be that one set of benefits that social support confers is the availability of a supportive network that may act in a supportive manner without one’s realization, thereby reducing distress in response to threatening events. Indeed, merely thinking about one’s supportive ties can reduce stress (Smith, Ruiz, & Uchino, 2004 ).

An important implication of results such as these is that, at least under some circumstances, people can carry their social support networks around in their heads to buffer them against stress without ever having to recruit their networks in active ways that may produce the costs just noted. Findings like these suggest that it is important to distinguish exactly when supportive efforts from others may be beneficial for mental and physical health and when they may not show these benefits (Bolger & Amarel, 2007 ).

When is Social Support Beneficial?

Whether social contacts are experienced as supportive may depend on several factors. These include how large or dense one’s social support networks are, whether the support provided is appropriate for meeting the stressor, and whether the right kind of support comes from the right person.

Considerable research has explored the characteristics of socially supportive networks. As noted, people who belong to more formal and informal organizations in their communities, such as church groups, the PTA, clubs, and the like, enjoy the health and mental health benefits of social support. This may be because such people are more socially skilled to begin with and thus seek out contacts from others, or it may be a direct consequence of participation in supportive networks. Social networks may also be important for accessing specific types of assistance during times of stress (such as social services) (Lin & Westcott, 1991 ). However, the beneficial effects of social support are not cumulative in a linear fashion. It is clear that having a confidant (such as a spouse or a partner) may be the most effective social support (Collins & Feeney, 2000 ; Cohen & Wills, 1985 ), especially for men (e.g., Broadwell & Light, 1999 ; Wickrama, Conger, & Lorenz, 1995 ). Accordingly, married people report higher perceived support than unmarried people do (Thoits, 1995 ). With respect to friends, research documents the benefits of at least one close friend, but having a dozen or more close friends may be little more beneficial for health and mental health than having a few close friends (Langner & Michael, 1960 ). Indeed, one of the risks of social support networks is that overly intrusive social support may actually exacerbate stress (Shumaker & Hill, 1991 ). People who belong to dense social networks of friends or family who are highly interactive may find themselves overwhelmed by the advice and interference that is available to them in times of stress. As comedian George Burns noted, “happiness is having a large, loving, caring, close-knit family in another city.”

Sometimes support providers give poor advice, fail at providing tangible assistance, or provide inappropriate or too little emotional support, thereby reducing or eliminating the effectiveness of the effort (Bolger, Foster, Vinokur, & Ng, 1996 ; Burg & Seeman, 1994 ). Social support efforts, too, may be well-intentioned, but perceived as controlling or directive by the recipient. For example, when a spouse is pulled into the management of a chronic disease, such as coronary artery disease, the “support” of encouraging exercise and changing a partner’s diet may be perceived as interference by the patient (Franks et al., 2006 ). Although such well-intentioned support may achieve some benefits in modifying behaviors in a healthy direction, the potential to produce interpersonal conflict and psychological distress is clearly present as well (e.g., Fisher, La Greca, Greco, Arfken, & Schneiderman, 1997 ; Lewis & Rook, 1999 ; Wortman & Lehman, 1985 ). Socially supportive efforts may misfire for other reasons. When significant others’ responses to a person’s expression of symptoms or distress is contingent on that expression, such “support” may unwittingly reinforce symptom experiences and actually enhance emotional distress (Itkowitz, Kerns, & Otis, 2003 ).

Effective social support may depend on an appropriate balance between the needs of the recipient and what that recipient gets from those in the social network (Cohen & McKay, 1984 ; Cohen & Wills, 1985 ). This “matching hypothesis” suggests that, to be supportive, the actions of the provider must meet the specific needs of the recipient (Thoits, 1995 ). Thus, for example, if a person needs emotional support but receives advice instead, the misfired effort at support may actually increase psychological distress (Horowitz et al., 2001 ; Thoits, 1986 ). Research generally supports this hypothesis. Different kinds of support, for example, may be valued from different members of a social support network. Emotional support may be most helpful from intimate others and actually resented when casual friends attempt to provide it, whereas information and advice may be especially valuable from experts but regarded as inappropriate from well-intentioned friends or family with questionable expertise (e.g., Benson, Gross, Messer, Kellum, & Passmore, 1991 ; Dakof & Taylor, 1990 ). Consistent with this perspective, Helgeson and Cohen ( 1996 ) reviewed research on the impact of social support on adjustment to cancer. They found that emotional support was most desired by patients and appeared to have the greatest beneficial influence on adjustment. However, peer support group interventions whose goal was providing emotional support did not, for the most part, have benefits; rather, educational groups that provided information were perceived more positively. Although there are several possible interpretations of these findings, it may be that emotional needs were best met by those close to cancer patients, rather than by the relative strangers in the peer group, and that educational interventions in peer groups better met the cancer patients’ specific informational needs.

Other threats to obtaining social support may come from the support recipient. People who are under extreme stress often express their distress to others and over time, can drive their social support networks away (Matt & Dean, 1993 ; McLeod, Kessler, & Landis, 1992 ). For example, depressed, disabled, or ill people can inadvertently repel their families and friends by persistently expressing their negative emotions (Alferi, Carver, Antoni, Weiss, & Duran, 2001; Coyne et al., 1987 ; Fyrand, Moum, Finset, & Glennas, 2002 ). In a longitudinal investigation of 405 elderly individuals, Gurung, Taylor, and Seeman ( 2003 ), found that men and women who were depressed or who had cognitive dysfunction reported more problems with social relationships at follow-up several years later (see also Honn & Bornstein, 2002 ; Alferi et al., 2001 ). They concluded that those most in need for social support were potentially less likely to receive it and to instead experience gaps in their social support.

The positive impact of social support on adjustment to stressful events may be attenuated in especially high-stress environments. For example, Ceballo and McLoyd ( 2002 ) found that the usually positive impact of social support on parenting behavior was attenuated in high-stress neighborhoods. Gurung, Taylor, Kemeny, and Myers ( 2004 ) found that, although high levels of social support were associated with lower levels of depression in a sample of low-income HIV-seropositive women, social support resources were not sufficient to moderate the relation between chronic burden and high levels of depression. Thus, like most resources, the effectiveness of social support in reducing distress due to stressful circumstances may have its limits at especially high levels of stress. Related to these observations is the fact that the perception of social support as available is positively correlated with SES (Taylor & Seeman, 2000 ; Thoits, 1984 ).

A New Yorker cartoon shows one woman enthusiastically telling another woman that what she likes best about their friendship is that they never have to see each other or talk. Indeed, many relationships may be better for the having of them than for the using of them. Social relationships are fraught with the potential for discord as well as support, and so relationships are a potential double-edged sword. In a study of 120 widowed women, Rook ( 1984 ) found that negative social interactions were consistently and more strongly related (negatively) to well-being than were positive social interactions. Having one’s privacy invaded by family and friends, having promises of help not come through, and being involved with people who provoked conflict or anger were among the events that worsened adjustment in this vulnerable sample. Similarly, Schuster, Kessler, and Aseltine ( 1990 ) found that negative interactions with a spouse or close friends augmented depression more than positive, supportive interactions reduced it. Research examining the neuroendocrine correlates of marital relationships likewise reveal that conflict can lead to elevated cortisol levels (Heffner et al., 2006 ), to delayed wound healing, and to a lower cytokine response at wound sites (Kiecolt-Glaser et al., 2005 ). Negative social interactions also contribute to negative self-rated health and to more adverse health conditions as well (Newsom, Mahan, Rook, & Krause, 2008 ). These findings not only underscore the double-edged nature of social relationships, but also imply that avoiding social relationships or situations that actually tax well-being may be helpful for managing stress.

Origins of Social Support

Who gets social support.

The fact that social relationships can be either supportive or unhelpful, and the fact that support recipients substantially affect which outcome occurs raises an intriguing issue. Is social support largely “outside” in the social environment or “inside” the person, in the form of abilities to extract support from the environment or construe support as available? Although social support no doubt involves aspects of both, attention to the qualities of the support recipient has yielded some important findings.

Research has suggested that there may be heritable aspects of social support. Specifically, research using twin-study methodology has uncovered a moderately high degree of heritability, either in the ability to construe social support as available or in the ability to experience one’s network of friends and relatives as supportive (Kessler, Kendler, Heath, Neale, & Eaves, 1992 ). Similarly, heritability estimates suggest that genetic factors may account for about 50% of the variance in loneliness (Boomsma, Willemsen, Dolan, Hawkley, & Cacioppo, 2005 ). Although there are a number of potential interpretations of these findings, at the very least, they suggest that genes may play a role in some of the benefits of social support.

Some of these heritable factors may involve social competence. Some people are more effective than others in extracting the social support that they need, suggesting that social support involves a considerable degree of skill. People who have difficulty with social relationships, those who are chronically shy (Naliboff et al., 2004 ) or who anticipate rejection from others (Cole, Kemeny, Fahey, Zack, & Naliboff, 2003 ), are at risk for isolating themselves socially, with concomitant risks for health. Being a socially competent individual appears to be especially important for getting emotional support, but it may not predict as strongly the ability to get tangible assistance or information (Dunkel-Schetter, Folkman, & Lazarus, 1987 ).

Researchers are beginning to identify some of the specific genes that may be involved in the development (or not) of social skills. This work is in its infancy, and so some caution regarding these points is warranted. The µ-opioid receptor gene ( OPRM1 ) appears to be implicated in the experience of social support. Specifically, people with the G allele of the polymorphism (A118G) appear to be more sensitive to potential rejection and also experience greater increases in salivary cortisol during laboratory stress tasks (Way, Taylor, & Eisenberger, 2009). Carriers of the G allele, relative to individuals with two copies of the A allele, also exhibit greater activity in the dACC during a social exclusion fMRI task. Thus, across multiple measures of social sensitivity, the G allele is associated with the potential for greater social distress. Recent research with monkeys shows similar findings (Barr et al., 2008 ; Miller et al., 2004 ).

Similarly, within the gene coding for monoamine oxidase (MAOA), the low expression variants of MAOA-uVNTR are tied to activation in the dACC in response to a social exclusion fMRI task; that activation is correlated with self-reported distress in response to social exclusion (Eisenberger, Way, Taylor, Welch, & Lieberman, 2007 ). Thus, it appears that the MAOA gene also influences distress experienced in response to social exclusion or rejection.

Other genes that contribute to social support (or its absence) are also likely to be uncovered. For example, genes that help to regulate the dopamine system may also be involved in the experiences of social support or social rejection (Way & Taylor, 2011 ). In addition, carriers of the A allele of the oxytocin receptor gene are less likely to show sensitive parenting (Bakermans-Kranenburg & van IJzendoorn, 2008 ), thereby pointing in a preliminary way to a gene that may be implicated in maternal nurturance. A polymorphism within the vasopressin 1A receptor (AVPR1A) has been tied to empathy and altruistic behavior, and may thereby contribute to social support processes (Bachner-Melman et al., 2005 ; Knafo et al., 2008 ). (For a review of genetic factors in social distress/social support, see Way & Taylor, 2011).

A Developmental Approach to Social Support

The fact that social support may have heritable aspects and that it may depend, in part, on social skills, suggests that focusing on its early familial antecedents may also be enlightening regarding why this vital resource seems to come so easily to some people and more rarely to others. The thesis to be offered here is that (a) the beneficial effects of social support on physical and mental health begin with supportive familial contact; (b) these contacts, in turn, lay the groundwork for the development of social competencies and corresponding abilities to enlist and provide social support and/or construe social support as available; and (c) these skills are transferred intergenerationally, through both genomic and nongenomic pathways.

Evidence that socially supportive contacts in early life have beneficial effects on responses to stress, mental health, and health is manifold and may be readily seen in both human and animal studies. In some of the earliest work on this topic, Harlow and Harlow ( 1962 ) found that monkeys who were raised with an artificial terrycloth mother and who were isolated from other monkeys during the first 6 months of life showed disruptions in their adult social contacts. They were less likely to engage in normal social behavior, such as grooming, their sexual responses were inappropriate, mothering among the females was deficient, and they often showed either highly fearful or abnormally aggressive behavior toward their peers. Not surprisingly, these social behaviors led to peer rejection. In sum, a broad array of social skills were compromised by the absence of early nurturant contact with the mother.

Building on work like this, Meaney and colleagues (Francis, Diorio, Liu, & Meaney, 1999 ; Liu et al., 1997 ) explicitly linked early nurturant maternal contact to the development of stress responses in offspring and showed that these contacts affect emotional and neuroendocrine responses to stress across the lifespan. In their paradigm, infant rats are removed from the nest, handled by a human experimenter and then returned to the nest. The response of the mother to this separation and reunification is intense licking and grooming and arched-back nursing, which provides the pup with nurturant and soothing immediate stimulation. On the short term, this contact reduces SNS and HPA axis responses to stress in the pups (and in the mother as well). Over the long term, this maternal behavior results in a better regulated HPA axis response to stress and novelty, and better regulation of somatic growth and neural development, especially hippocampal synaptic development in the pup. These rat pups also showed more open field exploration, which suggests lower levels of fear. This compelling animal model suggests that nurturant stimulation by the mother early in life modulates the responses of offspring to stress in ways that have permanent effects on the offspring’s HPA axis responses to stress, on behavior suggestive of anxiety/fearfulness, and on cognitive function (see also Suomi, 1999 ).

Warm, nurturant, and supportive contact with a caregiver affects physiological and neuroendocrine stress responses in human infants and children, just as in these animal studies. Early research on orphans reported high levels of emotional disturbance, especially depression, in infants who failed to receive nurturant stimulating contact from a caregiver (Spitz & Wolff, 1946 ). More recent findings from Eastern European abandoned infants confirm that, without the affectionate attentions of caregivers, infants may fail to thrive, and many die (Carlson & Earls, 1997 ).

Not surprisingly, attachment processes are implicated in these relations. Gunnar and her associates, studying 15-month-old children receiving well-baby examinations, found that securely attached infants were less likely to show elevated cortisol responses to normal stressors, such as inoculations, than were less securely attached infants (Gunnar, Brodersen, Krueger, & Rigatuso, 1996 ; see also Nachmias, Gunnar, Mangelsdorf, Parritz, & Buss, 1996 ). The protective effects of secure attachment were especially evident for socially fearful or inhibited children (see also Levine & Wiener, 1988 ; Hart, Gunnar, & Cicchetti, 1996 ; see Collins & Feeney,   2000 , for a discussion of attachment in adult supportive relationships).

Research also consistently suggests that families characterized by unsupportive relationships have damaging outcomes for the mental, physical, and social health of their offspring, not only on the short term, but across the lifespan. Overt family conflict, manifested in recurrent episodes of anger and aggression, deficient nurturing, and family relationships that are cold, unsupportive, and/or neglectful have been associated with a broad array of adverse mental and physical health outcomes long into adulthood (Repetti, Taylor, & Saxbe, 2007 ; Repetti, Taylor, & Seeman, 2002 ). The chronic stress of unsupportive families produces repeated or chronic SNS activation in children, which, in turn, may lead to wear and tear on the cardiovascular system. Over time, such alterations may lead to pathogenic changes in sympathetic or parasympathetic functioning or both. Such changes may contribute to disorders such as essential hypertension (e.g., Ewart, 1991 ) and coronary heart disease (e.g., Woodall & Matthews, 1989 ).

As appears to be true in the animal studies previously described, early nurturant and supportive contacts appear to be important for human offspring’s emotional responses to stress as well, especially those involving anxiety or fear. Infants begin life with emergent abilities to monitor the environment, especially for potential threats. The amygdala is activated any time there is something new or unexpected in the environment, especially if it involves suggestions of danger. Early in life, the amygdala sends off many messages of alarm. Any loud noise, for example, will alarm an infant, and a few months later, strangers typically provoke distress. Through the comforting attentions of parents, infants begin to learn about and adjust to the social world. Over time, they learn that strangers are not necessarily threatening and that loud noises are not inevitably associated with danger, among other moderations of automatic responses to threat. As the prefrontal cortex develops, children learn additional ways to moderate the signals that they get from the amygdala, storing information about both the threatening and the comforting aspects of the social world.

The development of this system is critically affected by early nurturant contact. Infants form comforting bonds with others and, in turn, give rise to the emotion regulation skills and social skills that ultimately enable children to manage potentially threatening events autonomously, skills that become vital to managing stress across the lifespan (Taylor, 2002 ). That is, a broad array of evidence demonstrates that children from supportive families are more likely than those from unsupportive families to develop effective emotion regulation skills and social competencies (Repetti et al., 2002 ), as judged, for example, by teachers and peers. Similarly, adults whose interpersonal styles are marked by hostility and cynicism, a style that has been tied to an unsupportive or conflict-ridden early family environment, are less likely to report having social support (e.g., Smith, 1992 ) and/or support may be a less effective buffer against stress (e.g. Lepore, 1995 ).

Epigenetic factors appear to be involved in these pathways. That is, maternal nurturance can induce long-lasting changes in the function of genes, which is an additional mechanism by which experiences of early social support can induce long-term behavioral alterations in emotional and social functioning.

Meaney and colleagues have shown that rat pups exposed to highly nurturant mothering show less emotionality to novel circumstances and more normative social behavior, including mothering in adulthood, compared to recipients of normal mothering (Francis et al., 1999 ; Weaver et al., 2004 ). Studies with monkeys have shown similar effects. For example, Suomi ( 1987 ) reports that highly reactive monkeys cross-fostered to nurturant mothers develop good socioemotional skills and achieve high status in the dominance hierarchy, whereas monkeys with reactive temperaments who are peer-raised develop poor socioemotional skills and end up at the bottom of the dominance hierarchy.

Such long-term effects of maternal care appear to be a result of epigenetic structural alterations (methylation) to the glucocorticoid receptor gene that occur in the first week after birth and affect its expression throughout the lifespan (Meaney & Szyf, 2005 ). This process is affected by each of the neurochemical systems discussed in this chapter, and thus polymorphisms in these systems that affect signaling are likely to have downstream effects upon this process. Mothers showing high levels of nurturant behavior exhibit greater increases in oxytocin receptors during pregnancy, which is thought to trigger maternal responsivity (Meaney, 2001 ), and they have higher levels of dopamine release when caring for their pups (Champagne et al., 2004 ). This more nurturant mothering triggers greater increases in serotonin turnover in the pup, which initiates the cascade leading to the altered glucocorticoid receptor expression that affects adulthood reactivity to stress (Meaney & Szyf, 2005 ).

Related evidence has been uncovered with humans. For example, the harshness or nurturance of the early environment is implicated in the expression of the serotonin transporter gene ( 5-HTTLPR ). People with two copies of the 5-HTTLPR short allele (short/short) who have experienced childhood maltreatment are more likely to be diagnosed with major depressive disorder than are individuals with one or two copies of the long allele who have experienced similar environments (Caspi et al., 2003 ; Kaufman et al., 2004 ). A study from our laboratory (Taylor et al., 2006 ) suggests that the short allele may not only function as a risk allele for depression in the face of an adverse environment, but as an allele reflecting general sensitivity to the environment, providing protection from symptoms of depression when the environment is nurturant. Using a nonclinical sample of 118 adult men and women, we assessed nurturance of the early family environment, depressive symptomatology, and 5-HTTLPR genotype. As expected, a stressful early family environment by itself was significantly related to depressive symptomatology. However, a significant gene-by-environment interaction between 5-HTTLPR and the nurturance of the early family environment qualified the risk for depression. Specifically, individuals with two copies of the short allele had greater depressive symptomatology if they had experienced early familial adversity compared with participants with the short/long or long/long genotypes, but significantly less depressive symptomatology if they reported a supportive early environment. Notably, the adverse early family environments studied were ones in which the degree of social pain was fairly mild, consisting of some conflict, moderate household chaos, and/or cold, unaffectionate, and distant behaviors, rather than explicit maltreatment in the form of physical or sexual abuse.

Of interest, this differential sensitivity to the environment does not appear to be limited to childhood, but is present in adulthood as well. Thus, people with the short/short genotype who reported being in a currently highly stressful environment had higher levels of depressive symptomatology, relative to those with short/long or long/long variants, whereas those who reported currently being in a low-stress environment had significantly lower levels of depressive symptomatology (Taylor, Way et al., 2006 ). Reports of the early and current environment were only modestly correlated with each other, and so these results are fairly independent of each other. Thus, with respect to depressive symptoms, the short/short genotype of the serotonin transporter gene appears to be risky in harsh environments but protective in nurturant environments. Consistent with this latter point, short/short individuals have been found to be more responsive to the protective effects of social support as well (Kaufman et al., 2004 ; Kilpatrick et al., 2007 ).

In essence, then, the early family environment may provide the groundwork for social competence and the abilities to enlist social support across the lifespan. In families that are warm and nurturant, children learn to manage threat effectively with a lesser physiological/neuroendocrine toll, and through exposure to good models, they may develop social skills of their own. If they are raised in cold, non-nurturant, or conflict-ridden families, children instead experience threatening events more commonly and learn fewer social competencies, with the result that social support networks may be difficult to develop or use effectively. As such, early nurturance of offspring in response to stress might be thought of as a prototype for social support, which is mirrored throughout life in the many more modest supportive contacts a person encounters across the lifespan.

Are the benefits of being raised in a socially supportive environment conferred genetically or through the environment? In other words, do particularly nurturant parents have particularly socially skilled offspring by virtue of their shared genetic heritage, or does nurturance itself play a role in the acquisition of social skills? Both mechanisms appear to be involved. On the one hand, certain species show genetically based high levels of “licking and grooming” in response to stress (Liu et al., 1997 ), which are transmitted to offspring as styles that appear in the offspring’s nurturant behavior. On the other hand, by cross-fostering offspring to high- or low-nurturant caretakers, the impact of the behavior itself on physiological and social functioning becomes clear. For example, Suomi ( 1987 ) assigned rhesus monkeys selectively bred for differences in temperamental reactivity to foster mothers who were either unusually nurturant or within the normal range of mothering behavior. Highly reactive infants cross-fostered to normal mothers exhibited deficits in social behavior, and in adulthood, they tended to drop and remain low in the dominance hierarchy (Suomi, 1991 ). Highly reactive infants cross-fostered to exceptionally nurturant females, in contrast, showed higher levels of social skills, and in adulthood were more likely to rise to the top of the dominance hierarchy. When highly reactive females became mothers, they adopted the maternal style of their foster mothers, independent of their own reactivity profile (Suomi, 1987 ). Studies such as these provide evidence of the behavioral intergenerational transfer of nurturance over and above genetic predispositions (see also Francis et al., 1999 ).

These studies are significant for several reasons. First, they suggest clear developmental origins for social competencies that may affect social support availability across the lifespan. Second, they provide clear evidence that maternal nurturance can moderate genetic risks typically associated with the potential for maladaptive social behavior. Third, they demonstrate the nongenomic intergenerational transfer of social skills via exposure to nurturant supportive behavior. In short, then, whereas genetic factors may contribute to whether or not an individual is able to develop social competence, early nurturant experience can also be a contributing factor that may extend not only across one’s own lifespan, but to one’s offspring as well. Although the evidence for such a model is primarily from animals, one would expect that genomic and nongenomic factors may be involved in the intergenerational transfer of social skills and deficits in humans as well.

Gender, Culture, and Social Support

Gender and social support.

The previous discussion places a heavy role on mothering, at least in the animal studies implicating nurturance in offspring’s social and physiological behavior. This raises the question of whether there are gender differences in the ability to provide social support to others, in its extraction from others, and in its benefits. The research evidence suggests that women provide more social support to others, draw on socially supportive networks more consistently in times of stress, and may be more benefited by social support (e.g., Taylor, Klein, Lewis, Gruenewald, Gurung, & Updegraff, 2000 ).

Although men typically report larger social networks than women do, in part because of men’s historically greater involvement in employment and in community organizations, studies find that women are consistently more invested in their relationships and that their relationships with others are more intimate (Belle, 1987 ). Women are more involved in both the giving and receiving of social support than are men (Thoits, 1995 ). Across the lifecycle, women are more likely to mobilize social support, especially from other women, in times of stress. Adolescent girls report more informal sources of support than do boys, and they are more likely to turn to their same-sex peers than are boys (e.g., Copeland & Hess, 1995 ; see Belle, 1987 for a review). College student women report more available helpers and report receiving more support than do college men (e.g., Ptacek, Smith, & Zanas, 1992 ; see Belle, 1987 for a review). Adult women maintain more same-sex close relationships than do men, they mobilize more social support in times of stress than do men, they turn to female friends more often than men turn to male friends, they report more benefits from contacts with their female friends and relatives (although they are also more vulnerable to psychological stress resulting from stressful network events), and they provide more frequent and more effective social support to others than do men (Belle, 1987 ; McDonald & Korabik, 1991 ; Ogus, Greenglass, & Burke, 1990 ).

Women are also more invested in their social networks than are men. They are better at reporting most types of social network events, and they are more likely to report getting involved if there is a crisis in the network (Wethington, McLeod, & Kessler, 1987 ). In an extensive study of social networks, Veroff, Kulka, and Douvan ( 1981 ) reported that women were 30% more likely than men to have provided some type of support in response to network stressors. These findings appear to generalize across a number of cultures as well (Edwards, 1993 ; Whiting & Whiting, 1975 ).

Studies of caregiving also bear out these observations. Over 80% of this care is provided by mothers, daughters, and wives. For example, in the United States, the typical caregiver is a 60-year-old, low-income woman with a disabled or ill spouse. However, daughters care for aging parents (sons are only one-fourth as likely to give parental care), mothers care for disabled children, and a growing number of caregivers are grandmothers caring for the offspring of their own children who may have drug or alcohol problems or HIV infection (Taylor, 2002 ). Several studies suggest that men, in contrast, are more likely to institutionalize their wives in response to common causes of the need for caregiving, such as stroke or Alzheimer disease (Freedman, 1993 ; Kelly-Hayes et al., 1998 ).

As the previous analysis suggests, women are not only disproportionately the providers of social support, they are also more likely to seek social support in response to stress. Two meta-analyses (Luckow, Reifman, & McIntosh, 1998 ; Tamres, Janicki, & Helgeson, 2002 ) examined gender differences in coping with stress and found that women were significantly more likely to seek and use social support to deal with a broad array of stressors. For example, in the Luckow et al. review, of the 26 studies that tested for gender differences in coping via social support, one showed no differences and 25 showed that women favored social support more. These gender differences are more apparent in the domain of seeking emotional support than for other types of social support.

One might expect that if women seek social support more, are more invested in their social support networks, and report that social support is more important to them than is the case for men, they might be benefited more by social support. A meta-analysis conducted by Schwarzer and Leppin ( 1989 ) found support for this hypothesis. Across many investigations, the correlation between social support and good health was approximately .20 for women, but for men, the correlation was only .08.

Women may be somewhat more effective providers of social support than men are as well. For example, Wheeler and colleagues (Wheeler, Reis, & Nezlek, 1983 ) studied students who remained at college during the December holidays to see who became depressed and lonely in response to this stressful circumstance. The students kept track of how they spent their days, with whom they spent them, and what emotions they experienced during that period. The strongest determinant of how lonely the students were was how much contact they had each day with women. The more time a student, whether man or woman, spent with women, the less lonely he or she was. The amount of time spent with other men, for the most part, did not affect mental health.

Research consistent with this point has also come from studies of the differences between men’s and women’s abilities to provide social support for each other in times of stress and the protective effects of such efforts. An array of evidence suggests that women may be better providers of social support to men than men are to women (Thoits, 1995 ). For example, when men are asked where their emotional support comes from, most men name their wife as their chief source of social support and many name her as the only person to whom they confide their personal problems or difficulties (see Glaser & Kiecolt-Glaser, 1994 ; New England Research Institutes, 1997; Phillipson, 1997 ); women report that they are likely to turn to a female friend or relative, as well as to their spouse.

These differences appear to translate directly into health benefits. Although marriage benefits both men and women, it benefits men more (Chesney & Darbes, 1998 ). Thus, for example, the health of married men is better than that of single men, but the health of women is less strongly influenced by marital status. Mortality rates among widowed men are higher than among widowed women, and widowed men who remarry die later in life than those who do not remarry; among widowed women, remarrying has no effect on age of death (Helsing, Szklo, & Comstock, 1981 ; Stroebe & Stroebe, 1983 ). As noted earlier, in experimental studies, when women and men are asked to bring their partner with them when they undergo stressful laboratory tasks, men’s SNS and HPA axis responses to stress tend to be buffered by the presence of a female partner, but females’ responses to stress are often stronger in the presence of a partner than when alone (see Kiecolt-Glaser, & Newton, 2001 ). Moreover, the downside of social contacts discussed earlier, namely the potential for conflict and other negative interactions, appear to weigh more heavily on women than on men. Specifically, in a large-scale review, Kiecolt-Glaser and Newton ( 2001 ) report that wives show stronger heart rate, blood pressure, and HPA axis changes during marital conflict than do husbands.

In a theoretical model that provides a framework for these observations, Taylor and colleagues ( 2000 ) suggested that gender differences in the seeking and giving of social support may reflect, in part, a robust and biologically based difference in how men and women cope with stress. They suggested that, whereas the behaviors of fight-or-flight, namely aggression or withdrawal in response to stress, may be especially characteristic of men, a pattern termed tend-and-befriend may be more characteristic of women in response to stress. Tending involves nurturant activities designed to protect the self and offspring that may promote safety and reduce distress. Befriending is the creation and maintenance of social networks, especially those involving other women, that may aid in this process. Their argument is predicated on the evolutionary assumption that, during human prehistory, men and women faced somewhat different adaptive challenges, and as a result may have developed different stress responses to meet those different challenges. Specifically, females of most species, including humans, have primary responsibility for the early nurturing of offspring through pregnancy, nursing, and care in early life. Stress responses in females, then, are likely to have evolved in such a way as to simultaneously protect mothers and offspring. Whereas fight and flight constitute responses to stress that can protect an individual well, tending to offspring and befriending others in a social group may facilitate the joint protection of self and offspring.

Taylor and colleagues suggested that these stress responses may be influenced, in part, by neuroendocrine underpinnings, such as the release of oxytocin and endogenous opioid peptides. As noted earlier, oxytocin is thought to be an affiliative hormone that may underlie at least some forms of maternal and social contact. Because the impact of oxytocin is enhanced by the effects of estrogen, oxytocin’s effects are thought to be stronger in females than in males and may be implicated in the maternal tending of offspring seen in response to stress (Taylor et al., 2000 ).

In summary, then, although both men and women benefit from social support, women tend to give and receive social support from different sources. Women are disproportionately the support providers to children, to men, and to other women. The support that they provide also appears to translate directly into health benefits. When men seek social support, on the other hand, they are most likely to do so from a partner, and they show clear health benefits from having a marital partner. Overall, women are somewhat more likely to give social support, seek it out in times of stress, and benefit from it, patterns that may have evolutionary significance and biological underpinnings (Taylor et al., 2000 ; Taylor, 2002 ).

Culture and Social Support

Culture is another variable that may moderate how social support is perceived or received. On the one hand, there is a large literature to suggest that the benefits of social support for mental and physical health extend across many cultures. On the other hand, the possibility that support is experienced differently in different cultures is an important issue that has not been widely addressed. Is there any reason to believe that particular cultural dimensions might be related to how and whether social support is experienced or used in response to stress?

Considerable research suggests that people from East Asian cultural contexts view the maintenance of harmony within the social group as an overarching goal. Any effort to bring personal problems to the attention of others to enlist their help may be seen as undermining that harmony or making inappropriate demands on the social group. Accordingly, the appreciation of these norms may lead people to avoid taxing the system by bringing their problems to the attention of others for the purpose of enlisting social support. By contrast, European Americans tend to see ongoing relationships as resources for helping to meet personal needs (Kim, Sherman, & Taylor, 2008 ). To the extent that social support is seen as a resource, Western Europeans may seek the explicit help of family and friends to help themselves cope more successfully with stressful events. In a series of three studies, Taylor, Sherman, Kim, Jarcho, Takagi, and Dunagan ( 2004 ) found evidence consistent with these points. Across multiple studies, European Americans, relative to Asian Americans and Asians, reported drawing on their social relationships more to help them cope with stressful events. Concern over disrupting the harmony of the group, concern over social criticism or losing face, and the belief that one should be self-reliant in solving one’s personal problems were found to mediate the nonuse of social support among those of Asian background.

Social support is thought to be a universally helpful resource, however, which suggests that there may be cultural differences in the ways that it is used or experienced. Forms of social support that do not risk disturbing relationships may be more sought out and be more beneficial for those from Asian cultural backgrounds. Thus, implicit social support, similar to perceived support, may be commonly experienced by East Asians; it refers to the comfort provided through the awareness of a support network rather than through the use of a support network. By contrast, explicit social support, which is used by European Americans, may correspond more closely to the conventional Western definition of a social support transaction; that is, as the use of social networks that involve solicitation of advice, instrumental aid, and emotional support.

The utility of this distinction was demonstrated in an experimental study (Taylor, Welch, Kim, & Sherman, 2007 ) in which Asian Americans and European Americans were primed with either an implicit or explicit support manipulation. Participants in an implicit support condition thought about a group they were close to and wrote about the aspects of the group that were important to them, whereas participants in the explicit support condition were told to think about people they were close to and to write a letter asking for advice and support during upcoming stressful tasks. Subsequently, participants went through several laboratory stressors. Asian Americans who had completed the implicit support task experienced less stress and had lower cortisol responses to stress compared with those who completed the explicit support task, whereas the reverse was found for European Americans.

Like the research on perceived support noted earlier, implicit social support may have many of the same mental health and health benefits as social support that is explicitly drawn on in times of stress. There is a potential broader lesson to be learned from these beginning studies of cultural differences in the experience of social support. As research has clarified the ways in which extracting support from others may be costly, the benefits of just knowing that others care for you have come into view.

Providing Social Support

Costs and benefits of providing social support.

Conceptualizations of social support have been guided by the implicit assumption that support is beneficial for the recipient but costly for the provider. On the surface, this is a fairly sensible assumption. The provision of advice, emotional support, or tangible assistance can be costly to a support provider, at least in time, and potentially in resources as well. Virtually all acts of social support, ranging from listening to a friend’s woes about her marriage to taking in family members who are out of work, involve an outlay of at least some resources.

This viewpoint may also have been shaped by evolutionary perspectives on altruism, which encompasses some of the actions usually construed as social support. Altruistic behavior has presented something of a problem for traditional evolutionary theory. Put in its simplest form, the paradox is, how do we pass on our altruistic genes to future generations if those very genes can put us at risk, thereby reducing the probability that we will pass on our genes at all? The warning cry of the sentinel, common to some rodent species, is often presented as an example. On the lookout for danger, the sentinel sees a predator such as a hawk and then lets out a loud and distinctive warning cry that not only sends his companions scampering for safety, but attracts the attention of the predator, increasing the likelihood that the sentinel itself will be the predator’s meal. Although the kinds of social support that we commonly find in contemporary society do not typically put people at potentially fatal risk, in our early prehistory, giving aid to another person facing a severe threat (such as a predator) may well have done so, under at least some circumstances, and thus the question is a fair one.

Altruism has largely been rescued by the concept of reciprocal altruism (Hamilton, 1963 ; Trivers, 1971 ), which maintains that altruists do not dispense altruism at random but are more likely to aid genetically related others and behave altruistically toward others when there is some expectation of reciprocity. Providing social support is normative, and to the extent that people typically spend their time in the company of familiar social networks of mutual obligation, there is every reason to expect that a favor done by one person may be reciprocated by another at another time. 1

The idea that support provision is inherently costly is also given credence by research on caregiving. Many people are involved in giving care to elderly parents, spouses, and disabled children. The costs of caregiving can be substantial, as it can be a difficult, grinding, chronic stressor. Over half of contemporary caregivers work outside the home, and many need to modify their job or reduce their hours to accommodate their caregiving. For older people, such caregiving can be a fatal undertaking, with caretakers at high risk for physical and mental health problems. Nearly 60% of elderly caregivers show signs of clinical depression. Evidence of immunocompromise is often present in caregivers, which can leave them vulnerable to flu and respiratory disorders, and they show a poorer response to the influenza vaccine as well (Kiecolt-Glaser, Glaser, Gravenstein, Malarkey, & Sheridan, 1996 ; Newsom & Schulz, 1998 ; see also Esterling, Kiecolt-Glaser, & Glaser, 1996 ). Other studies have found that the stress of caregiving can have adverse effects on wound repair (Kiecolt-Glaser, Marucha, Malarkey, Mercado, & Glaser, 1995 ), on the regulation of SNS responses to stress (Mills et al., 1997 ), and on declines in natural killer (NK) cell function (Esterling et al., 1996 ). Moreover, these immune alterations can persist well after caregiving activities have ceased (Esterling, Kiecolt-Glaser, Bodnar, & Glaser, 1994 ). Caregivers shake off infectious disease very slowly and are at heightened risk for death. Schulz and Beach ( 2000 ), for example, found that the chances of dying in a given 4-year period for an elderly person involved in stressful caregiving were 63% higher than for elderly people without these responsibilities (see also Cacioppo, et al., 2000 ; King, Oka, & Young, 1994 ; Spitze, Logan, Joseph, & Lee, 1994 ; Wu, Wang, Cacioppo, Glaser, Kiecolt-Glaser, & Malarkey, 1999 ).

Evidence like this would seem to bear out the viewpoint that giving social support is costly. However, the majority of these studies have focused on populations in which any adverse effects of providing care would be expected to be seen. A number of the situations studied involve particularly burdensome caregiving. A number of the samples involved the elderly, who are at particular risk for health problems. Many others have focused on samples with extreme demands on their time. It is reasonable to think that, although caregiving may provide a glimpse into the extremes of social support provision, it may not characterize support provision generally.

In recent years, the potential benefits of giving social support have become better understood. There are a number of reasons to believe that providing social support to another might be stress reducing for the provider, as well as for the recipient. As the reciprocal altruism perspective just described suggests, providing support to others, as in the form of specific aid, increases the likelihood that there will be people there for you when your needs arise, a perception that can be comforting in its own right, as the perceived social support literature shows. Giving support to others may cement a personal relationship, provide a sense of meaning or purpose, and signify that one matters to others, all of which have been found to promote well-being (e.g., Batson, 1998 ; Taylor & Turner, 2001 ). Empirical research suggests that helping others may reduce distress and contribute to good health (Brown, Brown, House, & Smith, 2008 ; Li & Ferraro, 2005 ; Schwartz, Meisenhelder, Ma, & Reed, 2003 ). A study by Brown, Nesse, Vinokur, and Smith ( 2003 ) assessed giving and receiving social support in an older married sample and related it to mortality over a 5-year period. Death was significantly less likely for those people who reported providing instrumental support to friends, relatives, and neighbors and to those who reported providing emotional support to their spouses. Receiving support did not affect mortality, once giving support was statistically controlled. The study also statistically controlled for a wide variety of potential contributors to these effects, and the relationships held. This study thus provides important evidence that the giving of support can promote health and/or retard illness progression.

Although the exact mechanisms underlying the benefits of support provision are not yet understood, the animal studies on the impact of nurturant behavior on offspring that were described earlier may be instructive. These studies found that, not only were offspring soothed by nurturant contact, but also the animal providing the nurturant contact was benefited as well. Specifically, benefits to offspring were mirrored in the nurturers in the form of reduced sympathetic arousal and higher observed calm (Wiesenfeld, Malatesta, Whitman, Grannose, & Vile, 1985 ; Uvnäs-Moberg, 1996 ; see also Adler, Cook, Davison, West, & Bancroft, 1986 ; Altemus, Deuster, Galliven, Carter, & Gold, 1995 ). Thus, it is possible that the benefits of providing social support operate through some of the same physiological and neuroendocrine pathways whereby the receipt of support from others seems to achieve its benefits. In addition, if oxytocin and other hormones are implicated in the provision of social support, the anxiolytic properties of oxytocin, coupled with its established role in down-regulating SNS and HPA axis responses to stress, may provide a second potential point of departure for understanding the health benefits of providing social support, as well as receiving it.

Social Support Interventions: Clinical Implications

The implications of social support research for clinical practice and interventions are substantial. As one of the best established resources contributing to psychological well-being and health, clinical efforts to enhance or improve social support are well-placed. Moreover, when people are experiencing intensely stressful events, social support is not inevitably forthcoming. Even when people in a social network make efforts to provide social support, those efforts may not always be effective, as noted earlier. Consequently, a broad array of clinical support interventions have arisen to augment social support, especially for those experiencing gaps in the support they receive from others.

Some of these are family support interventions. For example, when a person has been diagnosed with a chronic condition or illness, the family’s participation in an intervention may be enlisted to improve the diagnosed patient’s adjustment to the condition. In addition, as noted earlier, involving the family in health behavior change programs may be beneficial for effective management of the disorder (see Taylor, 2008 ).

Family support interventions may also be emotionally soothing to family members as well, in part by alleviating anxiety that may be generated by incomplete understanding or misinformation. Explaining exactly what the patient’s condition is, what treatments will be needed, and how the family can help can mean that support provided by family members may be more forthcoming and effective. In addition, family members may receive guidance in well-intentioned actions that should nonetheless be avoided because they are experienced as aversive by patients (e.g., Dakof & Taylor, 1990 ; Martin, Davis, Baron, Suls, & Blanchard, 1994 ).

For the most part, people who need help managing stressful events turn to their family, to friends, and to experts, such as medical caregivers, for the support that they need in times of stress. In some cases, however, that support is not forthcoming. Family and friends may be ill-equipped to provide the kind of support that a person needs for any of several reasons. Some conditions for which a person may require social support are stigmatizing ones, such as HIV, cancer, or epilepsy, and stigmatizing conditions can drive friends and family away (Wortman & Dunkel-Schetter, 1979 ). In other cases, a person’s particular problems, such as the discovery of a chronic disease, can lead to questions and concerns that can be answered only by people with similar problems. Consequently, social support groups have arisen, as potential low-cost and efficient vehicles for meeting unmet social support needs. As of 1979, over 15 million Americans were using social support groups as a primary vehicle for their mental health services (Evans, 1979 ), and those numbers have grown over the past 25 years. Recent studies estimate that about 25 million individuals participate in support groups at some point during their life (Kessler, Mickelson, & Zhao, 1997 ), with whites and women more likely to participate than nonwhites and men (Davison, Pennebaker, & Dickerson, 2000 ).

Social support groups were originally conceived of as small, face-to-face voluntary groups of individuals who came together to solve a problem or help each other cope with handicaps or illnesses, especially through the provision of emotional support (Katz & Bender, 1976 ). Some of these groups originally were grass-roots organizations formed by patients themselves, but more commonly, these support groups included a professional clinician, either as an initiator and organizer, or as an ongoing counselor who facilitated group interaction. Self-help groups, a particular type of social support group, do not include the participation of a trained professional, once the group is established (Katz & Bender, 1976 ). Originally, social support groups developed to treat a broad array of problems, disorders, and disabilities, including alcoholism, drug abuse, chronic diseases, loss of a partner through divorce or death, and most commonly, obesity (see Taylor, Falke, Shoptaw, & Lichtman, 1986 for an early review).

Social support groups continue to be a vital resource for the chronically ill and to people managing problems, such as obesity and alcoholism. These groups provide a format for discussions of mutual concern that arise as a result of illness, provide specific information about how others have dealt with similar problems, and provide people with the opportunity to share their emotional responses with others sharing the same problem (Gottlieb, 1988 ). Such groups can potentially fill gaps in social support not filled by family and friends or may act as an additional source of support provided by those going through the same event.

How effective are these groups? A large number of studies have evaluated the efficacy of social support groups by comparing people who have actually participated in such groups with those who have been waitlisted for participation and/or with non-participants, and these studies have generally found beneficial effects (see Hogan & Najarian, 2002 for a review). For example, social support groups have been found to reduce psychological distress for rheumatoid arthritis patients (e.g., Bradley, et al., 1987 ), cancer patients (e.g, Telch & Telch, 1986 ), and patients who have had a myocardial infarction (e.g., Dracup, 1985 ), among many others. As noted, self-help groups may especially benefit those with disorders that are stigmatizing, such as AIDS, alcoholism, breast and prostate cancer, and epilepsy (Davison, Pennebaker, & Dickerson, 2000 ; Droge, Arntson, & Norton, 1986 ).

Other benefits include helping patients to develop the motivation and techniques to adhere to complicated treatment regimens (Storer, Frate, Johnson, & Greeenberg, 1987 ). Support groups may encourage adherence for several reasons. In the course of interacting with others, a participant may learn techniques that others have used successfully to maintain adherence or to cope effectively with a disorder, and adopt those techniques to combat his or her particular barriers to adherence. Because people may commit themselves to change their behavior in front of others in the support group, they may be especially motivated to maintain adherence (e.g., Cummings, Becker, Kirscht, & Levin, 1981 ). Emotional support and the encouragement that others with similar problems provide can also encourage adherence to treatment.

Although social support groups have the potential to provide both emotional and informational support to participants, they may be better at providing educational than emotional benefits. In a review of cancer support groups described earlier, Helgeson and Cohen ( 1996 ) found that educational groups were more effective in meeting patients’ needs than were support groups specifically aimed at the provision of emotional support. As noted, because relationships among support group members may seem artificial or not as intimate as “natural” relationships, relations in the support group may be more appropriate for providing information about the target problem or for managing it, whereas family or close friends may be better sources of emotional support.

A controversial issue in the support group literature has been whether participation in support groups among the chronically or terminally ill may promote better health and long-term survival. An early study of advanced breast cancer patients in a weekly cancer support group provided evidence that participants survived longer than nonparticipants (Spiegel, Bloom, Kraemer, & Gottheil, 1989 ). However, a follow-up investigation was unable to replicate this finding (Spiegel et al., 2007 ), and so whether the benefits of support group participation include the slowing of disease progression remains at issue.

Social support groups were widely heralded early in their history because they presaged a low-cost, convenient treatment option for people who might otherwise not have a therapeutic venue for their problems. Some studies, however, suggested that self-help groups actually reach only a small proportion of potentially eligible members (Taylor, Falke, Shoptaw, & Lichtman, 1986 ), appealing disproportionately to well-educated, middle-class white women. Not only is this the segment of the population that is already served by traditional treatment services, but at least one study (Taylor et al., 1986 ) suggested that participants in self-help groups were actually the same individuals who were using support services of all kinds, including therapists, ministers, family, friends, and medical experts.

Other factors can limit the effectiveness of support groups as well. In an evaluation of sources of satisfaction and dissatisfaction among members of cancer support groups, reported difficulties included logistical problems of getting to the face-to-face support group on a regular basis, irritation or annoyance over a particular individual or individuals in the group, concerns that meetings were too large, and concern that topics were too narrow and did not cover the issues in which prospective participants were interested (Taylor, Falke, Mazel, & Hilsberg, 1988 ).

The limited appeal of face-to-face groups has been somewhat offset by the rise of formal and informal internet support groups (Davison, Pennebaker, & Dickerson, 2000 ). Social networks are clearly expanding. MySpace and other social networking sites have more than 90 million members (Hulbert, 2006 ), indicating shifting patterns in social ties. In addition to these networking ties, informal social support groups have increased substantially in number over the past decade. While not providing the benefit of face-to-face social contact, they are logistically much easier to access, they are inexpensive (once one has a computer and an internet connection), they provide opportunities to come and go at will and at times of personal need, and they may be a more acceptable mode of help-seeking for men than traditional support groups have been (e.g., Bunde, Suls, Martin, & Barnett, 2006 ; Fogel, Albert, Schnabel, Ditkoff, & Neugut, 2002 ). The wealth of information that is now available on the web also means that answers to many specific questions can be answered without long-term participation in a support group.

Because internet-based support groups are a rapidly growing means of providing social support, especially for individuals with chronic illnesses or other stressful conditions, efforts have now gone into evaluating their effectiveness. For example, in one study (Barrera, Glasgow, McKay, Boles, & Feil, 2002 ), 160 type II diabetes patients were randomized into one of four conditions: diabetes information only; a personal self-management coach; a social support intervention; or a personal self-management coach coupled with the social support intervention. All four conditions were implemented via the internet. After 3 months, individuals in the two social support conditions (both with and without the personal coach) reported significant increases in perceived support, both with respect to their disease specifically and in general.

Internet social support can be useful with children as well. For example, STARBRIGHT World is a computer network that serves hospitalized children, providing interactive health education and opportunities to meet online with children in other hospitals who have similar disorders (Hazzard, Celano, Collins, & Markov, 2002 ). In one study evaluating the effectiveness of this program, children who participated reported more support, were found to be more knowledgeable about their illness, and were rated as lower in negative coping.

To date, a large-scale evaluation of internet social support resources has not been undertaken, largely because it is difficult to identify all of the sources that are available and all of the ways in which people distinctively use them. What research literature there is, however, suggests that these internet resources are used for many of the same purposes as face-to-face groups are (Davison et al., 2000 ), and that, as such, they can be a valuable source of both informational and emotional support.

Across the lifespan, nurturant, supportive contact with others, a sense of belonging or mattering to others, and participation in social groups have been tied to a broad array of mental health and health benefits. Indeed, the social environment appears to be instrumental in helping people develop the abilities to build emotionally supportive ties with others and to construe social support as available.

Socially supportive ties are clearly beneficial in times of stress and may achieve these benefits in large part by helping individuals to control their emotional responses to stressful situations, such as anxiety and depression, and by keeping physiological, neuroendocrine, and immunologic responses to stress at low levels or by promoting faster recovery of these systems following stress. As such, social support has translated into mental and physical health benefits across numerous studies.

Social relationships are inherently double-edged, and so ties with others are not inevitably supportive; gaps in support, misfired efforts at support, and blatantly unsupportive behavior from others in times of stress are well-documented. In part because of these observations, researchers and practitioners are increasingly recognizing that the perception of social support, even in the absence of its utilization, may account for many of its benefits.

Many important issues remain for investigation. Among the most important conceptual issues is the integration of social support into our understanding of the psychological and biological concomitants of relationships more generally. The growing literature on developmental antecedents of social support may be especially helpful in building such an integrative model. The biological mechanisms underlying the benefits of social support also merit continued investigation. In particular, animal studies have been very useful for identifying underlying mechanisms relating social contacts to health outcomes, and this rich source of insights should continue to be mined. Much emphasis has been placed on SNS and HPA axis responses to stress as primary pathways affected by social support. Continued exploration of the possible roles of oxytocin, endogenous opioid peptides, and other hormones is warranted.

Why the mere perception of support has such strong effects on well-being and health merits continued consideration. Does perceived support operate through similar mechanisms as actual social support, or are other factors, such as genetic predispositions, more significant influences? Some issues that will merit additional research are only just being recognized, and these include cultural differences in the experience of social support and the psychological/biological benefits of providing support to others.

On the clinical side, perhaps the most compelling and provocative issues center on the potential health benefits of social support interventions, social support groups, and the enormous role that internet support increasingly plays in people’s lives. Targeting people who otherwise may lack sufficient or effective social support, such as patients with stigmatizing conditions and their families and the isolated and/or infirm elderly (Weber, Roberts, Yarandi, Mills, Chumbler, & Wajsman, 2007 ; Winningham & Pike, 2007 ), needs to assume high priority.

What is, perhaps, most striking about social support research is the astonishing expansion of contexts and vehicles that have arisen to provide support and to address potentially unmet support needs. Once the value of social support for health and mental health was identified, it became understood for the valuable resource it is. As such, social support is a cornerstone of the important insights that health psychology has yielded.

Acknowledgments

Preparation of this manuscript was supported by grants from the NSF (SES-0525713 and BCS-0729532).

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Of interest in this context is the observation that, in communal relationships, there are norms explicitly against reciprocity (Clark & Mills, 1979 ), favoring instead the notion that a communal relation with another transcends what would otherwise be obligations for reciprocity.

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In This Article Expand or collapse the "in this article" section Social Support

Introduction, overview and history.

• Theoretical Perspectives
• Social Support and Physical Health
• Social Support and Mental Health
• Mechanisms and Pathways
• Moderating and Mediating Factors in Social Support
• Receiving and Providing Support: Costs and Benefits
• Interventions
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Social Support by Robert G. Kent de Grey , Bert N. Uchino , Ryan Trettevik , Sierra Cronan , Jasara Hogan LAST REVIEWED: 11 January 2018 LAST MODIFIED: 11 January 2018 DOI: 10.1093/obo/9780199828340-0204

Social support is a broad construct comprising both the social structure of an individual’s life and the specific functions served by various interpersonal relationships. Structural aspects of support are often measured by assessing social integration, indicating the extent to which an individual is a part of social networks. Researchers usually divide functional support into two domains: perceived support, or people’s subjective construal of the support they believe to be available to them, and received (or enacted) support, which is aid actually rendered by other persons. Perceived and received support take a number of forms. Informational support involves the provision of recommendations, advice, and other helpful information. Tangible (or instrumental) support is the furnishing of financial, material, or physical assistance, such as the provision of money or labor. Emotional (or appraisal) support involves the expression of affection, empathy, caring, and so on. Belonging (or companionship) support creates a sense of belonging and can involve the presence or availability of others for social engagement. The different facets of social support often have distinct implications for psychological well-being and physical health. For example, higher perceived support is usually associated with preferable mental and physical health outcomes, including lower risk of cardiovascular disease (an association for which the evidence is particularly robust) and all-cause mortality. The proposed mechanisms by which social support influences health typically fall into one of two theoretical frameworks: the buffering model, which contends that support protects against the negative impacts of stressors, and the direct effects model, which holds that social support can also be beneficial in the absence of stressors. Not all support is beneficial; links between received support and health are fraught with complex moderators, such that received support that is beneficial in one circumstance may be ineffective or even detrimental under other conditions. More recent research has examined the factors that determine the direction and magnitude of the effects of received social support. Some evidence suggests support may be most beneficial when it is unobtrusive and matches the receiver’s needs. In contrast, unhelpful or unsolicited received support may feel controlling, frustrate receivers, or lower self-esteem and self-efficacy. Research has also started to consider the costs and benefits of providing social support, especially in the context of serving as a caregiver for a family member with chronic disease. Intervention attempts, especially for caregivers and individuals with unmet needs, increasingly recognize the importance of social support. A more recently emerging literature explores the ways in which computer-mediated communication and online social networks relate to social support.

Thoits 1995 provides a classic overview of the study of social support and the direction of the field at that time. A thorough and more current presentation of the development of social support and its implications for individuals is given by Taylor 2011 . Ditzen and Heinrichs 2014 provides a concise, more recent introduction. Cohen and Wills 1985 presents the two main competing hypotheses on how social support may influence health outcomes, and House, et al. 1988 uses relevant literature to establish a causal link between social support and health. Gottlieb 1985 expands the construct of social support to include the transactional process of giving and receiving support that occurs in interpersonal relationships. This bidirectional process is further discussed in Sarason and Sarason 2009 , with particular emphasis on the fit of an individual to his or her social support environment. Explorations of the potential pathways through which social support affects physiology and health are found in Uchino 2006 .

Cohen, S., and T. A. Wills. 1985. Stress, social support, and the buffering hypothesis. Psychological Bulletin 98.2: 310–357.

DOI: 10.1037/0033-2909.98.2.310

A seminal work examining the potential mechanisms through which social support influences physical health. Authors provide a thorough review of the literature on how social support is conceptualized and measured, as well as support for and against both the main effect and buffering hypotheses of social support.

Ditzen, B., and M. Heinrichs. 2014. Psychobiology of social support: The social dimension of stress buffering. Restorative Neurology and Neuroscience 32.1: 149–162.

DOI: 10.3233/rnn-139008

A brief but broad introduction to various subtopics in social support research. The structured organization renders this paper accessible to nonexperts, though the emphasis on health may make it more suitable for advanced readers. Includes citations of many classic papers in the field.

Gottlieb, B. H. 1985. Social support and the study of personal relationships. Journal of Social and Personal Relationships 2.3: 351–375.

DOI: 10.1177/0265407585023007

An exploration of the form and function of social support in both initiating and maintaining relationships. The author posits an expansion of the idea of social support from an intrapersonal, psychological construct to an interpersonal interaction, with an emphasis on the ways in which social support influences primary and secondary appraisals and coping processes. Additionally, the author provides a unique discussion of unintentional and indirect forms of social support.

House, J. S., K. R. Landis, and D. Umberson. 1988. Social relationships and health. Science 241.4865: 540–545.

DOI: 10.1126/science.3399889

A causal analysis of the association between low levels of social relationships and negative health outcomes. The authors argue that low-quality social support is a risk factor for, rather than a consequence of, poor health.

Sarason, I. G., and B. R. Sarason. 2009. Social support: Mapping the construct. Journal of Social and Personal Relationships 26.1: 113–120.

DOI: 10.1177/0265407509105526

This article provides a discussion on how social support is and should be both conceptualized and operationalized. Particular attention is paid to the bidirectional perspective of social support wherein an individual’s level of social support is the result of an interaction between the individual and his or her environment. The relative importance of fit in supportive relationships is discussed, and suggestions for future directions are given.

Taylor, S. E. 2011. Social support: A review. In The Oxford handbook of health psychology . Edited by H. S. Friedman, 189–214. Oxford: Oxford Univ. Press.

Comprehensive overview of social support. The author details the forms of social support and its benefits, as well as potential negative responses to social support efforts. Particular attention is paid to pathways by which social support influences health. Key factors that influence who receives social support and how it is received are discussed, as are implications for social support interventions.

Thoits, P. A. 1995. Stress, coping, and social support processes: Where are we? What next? In Special issue: Forty years of medical sociology: The state of the art and directions for the future . Edited by Mary L. Fennell. Journal of Health and Social Behavior 35 (extra issue): 53–79.

DOI: 10.2307/2626957

Comprehensive overview of previous literature examining social support in the context of coping with stress, for which a general introduction is also given. Summarizes then-current innovations in the field and suggests future directions.

Uchino, B. N. 2006. Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine 29.4: 377–387.

DOI: 10.1007/s10865-006-9056-5

Thorough review of relevant literature examining which physiological mechanisms may bridge the relationship between social support and health outcomes. The author discusses differential functioning as a result of social support across the cardiovascular, neuroendocrine, and immune systems. Literature supports better functioning in all three systems in individuals with higher levels of social support.

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REVIEW article

Social support and longevity: meta-analysis-based evidence and psychobiological mechanisms.

• Human Psychophysiology and Health Laboratory, Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain

Over the past 60 years, evidence has accumulated on the fundamental role of supportive social relationships in individual health and longevity. This paper first summarizes the results of 23 meta-analyses published between 1994 and 2021, which include 1,187 longitudinal and cross-sectional studies with more than 1,458 million participants. The effect sizes reported in these meta-analyses are highly consistent with regard to the predicted link between social support and reduced disease and mortality; the meta-analyses also highlight various theoretical and methodological issues concerning the multi-dimensionality of the social support concept and its measurements, and the need to control potential confounding and moderator variables. This is followed by an analysis of the experimental evidence from laboratory studies on psychobiological mechanisms that may explain the effect of social support on health and longevity. The stress-buffering hypothesis is examined and extended to incorporate recent findings on the inhibitory effect of social support figures (e.g., the face of loved ones) on fear learning and defensive reactions alongside evidence on the effect of social support on brain networks that down-regulate the autonomic nervous system, HPA axis, and immune system. Finally, the paper discusses the findings in the context of three emerging research areas that are helping to advance and consolidate the relevance of social factors for human health and longevity: (a) convergent evidence on the effects of social support and adversity in other social mammals, (b) longitudinal studies on the impact of social support and adversity across each stage of the human lifespan, and (c) studies that extend the social support framework from individual to community and societal levels, drawing implications for large-scale intervention policies to promote the culture of social support.

Introduction: Historical Background

Evolutionary biologists did not anticipate the continuing rise in life expectancy in high-income countries ( Kirkwood, 2017 ). Assuming that the aging process is a non-malleable biological phenomenon, they expected that a reduction in early- and mid-life-mortality to minimal levels, thanks to advances in preventive and therapeutic medicine, would simply result in a larger number of older people dying at the same ages as in previous generations. However, death rates at advanced ages continue to fall in these countries, where the elderly are living longer and generally enjoying better health ( Kirkwood, 2017 ). This surprising phenomenon is attributed to non-genetic factors that affect the aging and longevity of individuals, including environmental contamination, socioeconomic status, smoking, alcohol consumption, body weight, physical activity, and social support ( Rizzuto and Fratiglioni, 2014 ; Stringhini et al., 2017 ; Chowdhury et al., 2018 ). Among these, social support-related factors have recently attracted considerable attention across numerous disciplines, including biology, epidemiology, medicine, paleo-anthropology, demography, sociology, and psychology ( Snyder-Mackler et al., 2020 ).

The survival of humans depends on their effective social functioning ( Guerra et al., 2012 ). Caregiving and attachment are key elements of parental love that are essential not only for survival during infancy and childhood but also for physical and psychological well-being throughout life ( Taylor, 2010 ). The relevance of social bonds for health and longevity was first documented over a century ago by the French sociologist Emile Durkheim in Suicide ( Durkheim, 1897 ). He examined the different rates of suicide in Europe and found them to be more prevalent among people with fewer social ties, concluding that a lack of social connections (low social integration) was responsible for the higher suicide rates.

The literature on social support and its influence on physical and mental health can be traced back to the publication by Maslow (1943) of his theory of human needs and motivations and to the writings of Bowlby (1969) on his theory of attachment. Maslow postulated a hierarchy of five classes of needs that people are motivated to satisfy for their healthy functioning. These range from the most basic (e.g., food and drink) to the most complex requirements (self-actualization and full potential achievement). Maslow placed social needs (social relationships, love, and friendship) at the middle level of this hierarchy. Bowlby developed his attachment theory, influenced by the work of the ethologist Lorenz (1935) , to explain early social development through the formation by children of close relationships with familial caregivers. Conceived as an innate biological system, attachment protects individuals from danger by establishing emotional security through contact and reassurance with an attachment figure, who functions as a safety signal.

However, the idea that social and psychological factors can protect from physical disease and mortality did not fit well with the predominant medical model of the time, based on Cartesian mind-body separation ( Uchino, 2004 ). By the middle of the twentieth century, three new scientific societies helped to promote a shift in the dominant biological paradigm: the American Psychosomatic Society (1942), the Society for Psychophysiological Research (1960), and the Society of Behavioral Medicine (1978). These associations endorsed the “biopsychosocial model” of disease and health, which assumes that social, psychological, and biological factors operate interactively across the life-span to preserve human health ( Engel, 1977 ). Being interdisciplinary in nature, these societies welcomed the idea that social relationships can influence health and longevity and fostered research on the neurophysiological mechanisms that might underlie this influence.

In 1976, two seminal reviews were published on the concept of social support and its effects on health and mortality ( Cassel, 1976 ; Cobb, 1976 ). The epidemiologist John Cassel centered his review on social support as an example of a social environmental factor, focusing on its capacity to change human susceptibility to disease agents. Social support is defined in terms of the presence of other members of the same species, with the strongest support being provided by the primary groups of greatest importance to the individual . According to Cassel, this type of social support acts as a protective factor that buffers the individual from the physiological or psychological consequences of exposure to stressful situations. For his part, the psychiatrist Sydney Cobb, centered his review on the concept of social support, which he defined as information that leads subjects to believe: (a) they are cared for and loved, (b) they are esteemed and valued, and/or (c) they belong to a network of communication and mutual obligation. Both Cobb and Cassel considered that social support protects people by buffering the health consequences of life stresses.

Three years later, in 1979, the epidemiologists Berkman and Syme (1979) published one of the most influential and cited longitudinal studies on social relationships and mortality, the Alameda County study. They surveyed a random sample of 6,928 adults from Alameda County in California with a subsequent 9-year follow-up. They measured all-cause mortality and a social network index made up of four sources of social contact: (1) marriage, (2) close friends and relatives, (3) religion, and (4) informal and formal group/associations. The findings showed that those who had more social and community ties at the outset were less likely to die during the follow-up than were those with fewer social contacts. The link between social ties and mortality was independent of initial health status and health practices, including smoking, alcohol consumption, obesity, and physical activity.

Over the next two decades, there was an explosion of interest in the topic of social support and health, with an exponential increase in the number of scientific articles and academic works. Between 1980 and 2000, no fewer than 13 academic books were published in English on social support and health ( Gottlieb, 1981 , 1983 ; Whittaker and Garbarino, 1983 ; Cohen and Syme, 1985 ; Litwak, 1985 ; Sarason and Sarason, 1985 ; Sauer and Coward, 1985 ; Lin et al., 1986 ; Vaux, 1988 ; Sarason et al., 1990 ; Shumaker and Czajkowski, 1994 ; Cohen et al., 2000 ). It soon became evident that it was necessary to clarify concepts and methods and construct a coherent theory of social support to guide future research and applications. The hundreds of new empirical studies claiming evidence of an association between social support and health markedly differed not only in their definition of social support and its measurement but also in their research strategy and in the strength and direction of reported evidence. Terms such as social support, social relationships, social ties, social connection, social integration, social capital, social networks, were all used interchangeably with little critical examination. The multiple interpretations of the same concept of support led to a variety of typologies and classifications: instrumental, emotional, informational, financial, tangible, perceived, received, objective, and subjective, among others. The studies also differed in research design, ranging from ecological to case-control, cross-sectional, retrospective, longitudinal, and randomized controlled studies. The main problem with the human studies was the causal interpretation of the results, which was always in favor of the social causation hypothesis, i.e., differences in social support were the cause of the differences in health. The correlational nature of most of these studies meant that they could not rule out the reverse causation hypothesis, i.e., differences in health may be responsible for differences in social support.

However, by the final decade of the twentieth century, researchers began to agree on the main conceptual and methodological frameworks in which studies on social support and health should be conducted and evaluated. First, studies were classified according to two general ways of measuring social support: structural measures and functional measures. Structural measures refer to the characteristics of the social network around the individual. These include marital status, number of social relationships, frequency of contacts, or membership of community groups. Terms such as social ties, social connections, isolation, social integration, and social networks would fit the category of structural support. Functional measures refer to the characteristics of the support provided by social networks, including emotional, instrumental, informational, and/or financial support. Terms such as perceived support, received support, tangible support, and objective and subjective support would fall into the category of functional support. Second, evidence from studies should not be evaluated individually. Proper evaluation of the scientific evidence involves the application of quantitative analytic methods to a large number of independent studies, preferably in meta-analyses. Finally, advances in our understanding of the beneficial effects of social support on health and longevity require experimental evidence on the neurophysiological mechanisms involved in the association.

The present paper was designed in accordance with these three conceptual and methodological frameworks. It first offers an initial summary of evidence on the association of functional and structural measures of social support with individual health and longevity, drawn from the results of 23 meta-analyses selected from articles published in the English language between 1994 and 2021. Next, it examines experimental evidence on the neurophysiological mechanisms that may explain this association. Finally, it discusses the findings in the context of three emerging research areas that consolidate and expand the role of social support in health and longevity by incorporating new research perspectives (evolutionary, lifespan, and systemic).

Human Social Support as Predictor of Individual Health and Longevity

Evidence from published meta-analyses.

Two electronic databases (Scopus and Web of Science) were searched for meta-analysis studies using the following combination of terms: (social support or social engagement or social isolation or social relationship or social network or marital status) and (longevity or mortality or death or disease or health). The electronic searches were restricted to studies published in English with adolescent or adult human participants. They had to include at least one measure of social support as independent variable and at least one outcome measure of longevity/mortality/health/disease as dependent variable. Additional complementary search strategies were used by checking cross-references between the meta-analyses and relevant systematic reviews.

A total of 23 meta-analyses published between 1994 and 2021 complied with the inclusion criteria. They were checked to ensure that they followed the PRISMA protocol and that the final list of primary studies across the 23 meta-analyses did not include duplicate studies or participants. The 23 meta-analyses covered 1,187 non-duplicate primary studies with more than 1,478 million participants. Tables 1 – 3 summarize the results of the 23 meta-analyses, reporting authors and year of publication, number of published/unpublished primary studies, total participants, design, social support measures, outcome measures, heterogeneity test, publication bias test, effect size measure, and effect size results. The meta-analyses are distributed in the Tables according to type of effect size (correlation vs. risk ratio, odds ratio, or hazard ratio) and outcome measure (health/disease vs. longevity/mortality).

Table 1 . Summary of Meta-analyses on social support and health/disease using correlation as effect size measure.

Table 2 . Summary of Meta-analyses on social support and mortality using risk, odds, and hazard ratios as effect size measure.

Table 3 . Summary of Meta-analyses on social support and health/disease using risk and odds ratio as effect size measure.

Six meta-analyses used correlation as effect size measure, and the remaining 17 used proportion ratios (risk ratio, odds ratio, or hazard ratio). In the six meta-analyses with effect sizes based on correlation (see Table 1 ), the outcome measures were health/disease variables assessed as continuous data by means of self-report questionnaires or scales. The social support measures were also assessed as continuous data by means of self-report questionnaires or scales.

Tables 2 , 3 exhibit the 17 meta-analyses with proportion ratios (risk, odds, and hazard ratios). The outcome measure of the meta-analyses in Table 2 was mortality (all-cause mortality, cancer mortality, or coronary heart disease mortality). The outcome measure of those in Table 3 was a disease (drug-resistant tuberculosis, depression, Alzheimer disease, dementia, and coronary heart disease). Only one meta-analysis in Table 3 used a positive health variable (mental health) as outcome measure. The social support measures in these 17 meta-analyses were dichotomous variables (e.g., married vs. single people) or dichotomized data from continuous variables (e.g., people with high vs. low scores in social support scales).

The 23 meta-analyses displayed in the three tables obtained highly consistent results, with significant effect sizes confirming the association between social support (regardless of the type of social support measure) and individual health/longevity (regardless of the type of outcome measure). However, as also observed in these tables, the strength of the association depends on numerous factors, including type of effect size, type of outcome, type of social support, and type of moderator variable. In this section, the results are discussed in relation to the type of effect size and type of outcome. The impact of the social support measures and moderator variables are discussed in the following two sections.

The six meta-analyses in Table 1 used correlation as effect size measure. The first three meta-analyses ( Smith et al., 1994 ; Wang et al., 2003 ; Harandi et al., 2017 ) examined physical and mental health in adult populations, while the other three ( Guilaran et al., 2018 ; Schiller et al., 2021 ; Zalta et al., 2021 ) examined psychological outcomes in disaster responders, depression in family caregivers of autistic children, and post-traumatic stress disorder (PTSD) symptom severity, respectively. The overall effect sizes reported in these meta-analyses ranged from 0.15 to 0.41 for health variables (+) and from −0.20 to −0.63 for disease variables (–). Interestingly, the meta-analysis with lowest effect size (0.15) corresponds to the first published meta-analysis ( Smith et al., 1994 ). The authors concluded that this small effect size, based on 60 primary studies, does not support the assumption that there are strong, consistently positive relationships between social support and health outcome measures . They stressed the need for further refinement of social support measures in future research. It is also noteworthy that the most recently published meta-analysis also used correlation as effect size measure ( Zalta et al., 2021 ). The latter meta-analysis was based on almost three-fold more primary studies ( n = 176) across five continents, used functional and structural measures of social support, analyzed multiple moderator variables, and obtained markedly higher effect sizes (−0.27 in cross-sectional studies and −0.25 in longitudinal studies).

The 10 meta-analyses in Table 2 were based on longitudinal studies (although 5 of them also included cross-sectional studies), and they used risk, odds, or hazard ratios as effect size measures and mortality as outcome measure. All-cause mortality was considered by eight of these meta-analyses, all-cause mortality plus coronary heart disease mortality by one, and cancer mortality by the other. The overall effect size reported for all-cause mortality ranged from 1.11 to 1.53, indicating that the incidence of the outcome was between 11 and 53% more likely in people without social support. The smallest overall effect sizes were obtained by the two meta-analyses that used strength of family ties (1.11) and frequency of contacts (1.13) as social support measures ( Shor et al., 2013 ; Shor and Roelfs, 2015 ). The largest overall effect size (1.53) corresponded to the meta-analysis that used both structural and functional measures of social support ( Holt-Lunstad et al., 2010 ). Meta-analyses that used structural measures related to marital status (single, divorced-separated, widowed, and living alone) yielded effect sizes between 1.20 and 1.32 ( Roelfs et al., 2011 , 2012 ; Sbarra et al., 2011 ; Shor et al., 2012 ; Holt-Lunstad et al., 2015 ). However, as indicated in the table, these effect sizes varied widely when moderator variables such as gender or age were taken into account. With regard to specific types of mortality, effect sizes between 1.15 and 1.25 were obtained for the meta-analysis on cancer mortality ( Pinquart and Duberstein, 2010 ) and an effect size of 1.56 for the one on coronary heart disease mortality ( Barth et al., 2010 ).

The seven meta-analyses in Table 3 used the odds ratio or risk ratio as effect size measure and health or disease as outcome measure, describing effect sizes that ranged from 1.23 to 6.27, indicating that the incidence of the outcome was between 23% and over six-fold more likely in people without social support. The two meta-analyses with the largest effect sizes were related to drug-resistant tuberculosis ( Wen et al., 2020 ), reporting an overall effect size of 5.88 for loss to follow-up in patients without vs. with social support, and to post-partum depression ( Desta et al., 2021 ), finding an overall effect size of 6.27 for women without vs. with adequate social support. The remaining meta-analyses reported statistically significant but more moderate effect sizes (1.23–1.82) for mental health ( Gilbert et al., 2013 ), coronary heart disease ( Valtorta et al., 2016 ), and dementia or Alzheimer disease ( Kuiper et al., 2015 ; Penninkilampi et al., 2018 ) in adults and psychological disorders in young people ( Heerde and Hemphill, 2018 ).

Social support emerges in these meta-analyses as a significant predictor of health and longevity regardless of its conceptualization and measurement. However, this evidence is based on correlational data, i.e., the covariation between observed phenomena. Neither cross-sectional nor longitudinal studies allow causality to be inferred when based on this type of data. It may be suggested by longitudinal studies if one phenomenon precedes the other, but only when all variables affecting the covariation are controlled for, and this is never guaranteed in correlational studies. Two problems arise: the presence of third variables that totally or partially explain the observed association (confounding and moderator variables), and the heterogeneity of effect sizes for primary studies, weakening, or extinguishing the strength of a true association. However, both problems can be addressed and evaluated by applying meta-analysis methodology.

Sub-Group Differences: The Multidimensionality of the Social Support Concept and Its Measurement

Examination of the social support measures listed in the three tables illustrates the conceptual and methodological diversity described in the Introduction. Twenty-six different social support measures are reported, including: quantitative and qualitative social support; received and perceived social support; enacted social support; network social support; material, informational, and emotional social support; social engagement; and social integration. Only two of these meta-analyses used the recommended functional-structural classification ( Cohen and Wills, 1985 ; Uchino, 2004 ).

The meta-analysis by Holt-Hunstad and colleagues, published in 2010, was the first to use this classification to examine the risk of mortality associated with three functional measures (received support, perceived support, and loneliness), six structural measures (marital status, social networks, living alone, social isolation, social integration, and a complex measure of social integration), and a combination of both types of measure. Among the structural measures, the complex measure of social integration was the most highly predictive of the mortality risk, with an effect size of 1.91, whereas living alone was the least predictive, with an effect size of 1.19. Among the functional measures, perceived social support and loneliness were the most predictive measures, with effect sizes of 1.35 and 1.45, respectively, whereas received social support did not even reach statistical significance.

The relevance of perceived social support as a predictor of health and longevity is confirmed in five additional meta-analyses in Tables 1 , 2 on: health risk in disaster responders ( Guilaran et al., 2018 ), depression in caregivers of autistic children ( Schiller et al., 2021 ), PTSD symptom severity ( Zalta et al., 2021 ), cancer mortality ( Pinquart and Duberstein, 2010 ), and coronary heart disease mortality ( Barth et al., 2010 ). Likewise, the relevance of loneliness (i.e., the perception of inadequate social networks and relationships) as a predictor of disease and mortality was confirmed in the second meta-analysis by Holt-Lundstad and colleagues (in Table 2 ) on all-cause mortality ( Holt-Lunstad et al., 2015 ) and in two meta-analyses (in Table 3 ) on dementia ( Kuiper et al., 2015 ) and coronary heart disease ( Valtorta et al., 2016 ).

In general, these data show that the measures that best reflect the multidimensionality of the social support concept (complex measures of social integration or combined measures of functional and structural social support) are the most accurate predictors of a reduced risk of disease and mortality.

Confounding and Moderator Variables

Correlational studies are based on a non-randomized selection of participants. Evidently, people cannot be randomly assigned to groups for social isolation or divorce. In both cross-sectional and longitudinal studies, the non-randomized selection of participants involves the presence of third variables that can make the association spurious. It is well-known that age, socio-economic status, or physical and mental health at the initial evaluation can influence health status and longevity. Age is by far the most important risk factor for many chronic diseases and disabilities ( Kirkwood, 2017 ), and sociologists have described socio-economic gradients in disease and mortality as a function of income since more than 120 years ago ( Snyder-Mackler et al., 2020 ). Reduced physical and mental health can also hinder the formation of new social ties and lead to the loss of existing relationships, including marriage. Age, socio-economic status, and health can act as confounders in the so-called reverse causation or selection model, which offers an alternative explanation for the association observed between social support and health. According to this type of model, it is the decline in health that explains poor social support, not the other way round.

Moderator variables are those that do not challenge the validity of an association but can affect its strength. They can be methodological (e.g., sample size, study design, or follow-up time) or substantive (e.g., gender, source of social support, or geographical location). In meta-analyses, the influence of these variables is evaluated and controlled by means of sub-group analysis and meta-regression. Overall effect sizes are usually adjusted for the influence of these variables (covariates) or reported separately for specific sub-groups of interest. Tables 1 – 3 summarize the main moderators controlled in each meta-analysis and the main results of sub-group analyses. In relation to social support and longevity ( Table 2 ), two moderators, besides the aforementioned social support measure, show consistent results: gender and age. The effect of social support, especially in the unmarried, divorced, or widowed, appears to be greater in males than in females and in younger than older individuals. However, there is an interaction between gender and age, observing a decrease in the gender effect at older age, especially in men. Consistent results have not been obtained for the source of social support (e.g., family, friends, or others) or the geographical location of studies, suggesting that the positive effects of social support on health and longevity transcend family, national, and cultural contexts.

The evidence provided by the 23 meta-analyses remains consistent after controlling for confounders and mediators, thereby conferring convergent validity to the predictive role played by supportive social relationships in health and longevity. However, while confounding variables may reverse the causal pathway between social support and longevity, and moderator variables can modify its strength, other variables affecting the causal pathway play a different role acting as mediators between social support and outcome. This is the case of psychobiological mechanisms and, in particular, of the variables involved in dampening the stress response according to the stress-buffering hypothesis.

Psychobiological Mechanisms Underlying the Association Between Social Support and Longevity

Multiple pathways may link social support with health and longevity. Informational and instrumental support, including financial and material assistance, can help individuals to cope with health problems. Likewise, integration within a supportive social network can prevent health problems by providing positive health role models and reinforcing healthy behaviors ( House et al., 1988 ; Lepore, 1998 ). These are examples of alternative explanations to the stress-buffering hypothesis. However, neurophysiological and neuroendocrine pathways have been highlighted by researchers ever since the two seminal papers of Cassel (1976) and Cobb (1976) . They are involved in mediating activation and inhibition of the stress response in accordance with the so-called the stress-buffering hypothesis.

The Stress-Buffering Hypothesis

This hypothesis has been defined as the process by which the presence of a conspecific reduces the activity of stress-mediating neurobiological systems ( Gunnar and Hostinar, 2015 ). The concept of stress has been extensively analyzed and investigated since the pioneering studies of Cannon (1929) and Selye (1950) (see International Encyclopedia of Stress ; Fink, 2007 ). There is broad consensus across health-related disciplines that three main elements are implicated in stress: (a) a specific type of environmental stimulus, (b) a specific type of biological response, and (c) a specific type of cognitive evaluation of the stimulus and response. From the stimulus perspective, stress requires the presence of a real or interpreted threat to the physical or psychological integrity of an individual ( McEwen, 2000 ). From the response perspective, stress requires the sustained activation of the brain's defense motivational system ( Vila et al., 2007 ). Finally, from the cognitive evaluation perspective, stress requires appraisal of a stimulus as truly threatening and an assessment of defense responses as ineffective to cope with the threat ( Lazarus and Folkman, 1984 ).

The neurobiology underlying the stress response involves a chain of brain activations, starting from the sensory input, proceeding through cortical and subcortical connecting structures (with the amygdala and hypothalamus as critical centers), and ending in autonomic, endocrine, and motor effectors whose function is to protect the organism from the threat (fight-or-flight response). The result is a state of maintained or intermittent activation of physiological and endocrine responses that can, over the long term, compromise the normal functioning of the organs involved and increase the risk of disease and mortality. Two neurobiological subsystems are especially relevant in the above sequence: the hypothalamic-pituitary-adrenocortical (HPA) axis and the sympathetic-adreno-medullar (SAM) axis. Activation of both axes in response to a stressor increases the circulation of glucocorticoids (cortisol) and catecholamines (adrenaline) in the bloodstream to allow energy to be released for the fight-or-flight response, even after the stressor has disappeared.

According to the stress-buffering hypothesis, social support is beneficial for health and longevity because the presence of a bond with social partners attenuates or eliminates the adverse consequences of prolonged HPA and SAM activation. This hypothesis was first formulated by Bovard (1959 , 1961 , 1962) and was developed in his subsequent publications. Bovard was a neurobiologist interested in the reciprocal inhibition of two zones of the hypothalamus: the posterior zone with catabolic function (via activation of the pituitary- and the sympathetic-adrenal arms of the stress response); and the anterior zone with anabolic function (via parasympathetic activation and growth hormone production). Based on evidence from stimulation and lesion studies in animals and humans, Bovard postulated that social support inhibits the stress response by activating the anterior hypothalamic zone, which inhibits the activity of the posterior zone in a reciprocal manner.

Experimental investigation of the stress-buffering hypothesis in humans has been particularly intensive over the past two decades. The experimental tasks have usually employed laboratory-based stressors, such as public speech, threat of mild electric shock, or exposure to painful stimuli. In children, the tasks may consist in natural stressors such as vaccination injections or exposure to clowns or toys ( Gunnar and Hostinar, 2015 ). Social support manipulation is usually investigated by performance of the task alone or accompanied by an attachment figure or stranger. Two sets of human studies can be differentiated: those focused on the HPA stress response (cortisol reactivity) and those focused on the SAM stress response (cardiovascular reactivity).

The evidence provided by the first set of studies is highly consistent. It was reviewed by Hostinar et al. (2014) , Gunnar and Hostinar (2015) , and Hostinar and Gunnar (2015) , who confirmed the cortisol dampening effect of attachment figures during different developmental stages. They describe a potent parent-child stress buffering during infancy and childhood that becomes less effective in adolescence, when parental buffering starts to switch to friends, followed by a new and powerful romantic partner buffering effect in adulthood. It is noteworthy that the high consistency of these studies may be in part attributable to employment of the Trier Social Stress Test, a well-established stress paradigm to examine cortisol reactivity ( Kirschbaum et al., 1993 ). In this test, the cortisol response appears to be unaffected by the motor components of the stress task (speech and mental arithmetic) and is significantly reduced when the task is performed in the presence of a supportive partner.

The second set of studies offers less consistent evidence, and mixed results have been obtained for cardiovascular stress reactivity in experimental studies testing the stress-buffering hypothesis ( Lepore, 1998 ; Uchino et al., 2011 ). The reviews by Lepore and Uchino et al. highlight major problems in relation to: social support manipulation (received vs. perceived and passive vs. active), induced stress levels (high vs. low), and conceptual issues related to the match between the stressor demands and the type of support provided (the stress-matching hypothesis). The inconsistent results may also be explained by another important problem in cardiovascular reactivity studies that is not mentioned in the reviews. Unlike in the case of cortisol, autonomic responses are highly sensitive to the interference of motor responses and effort during performance of the task ( Gunnar and Hostinar, 2015 ). Hence, the key issue may not be whether the support provider is active or passive but whether the supported person (participant) is active or passive, and all experimental tasks used in these studies (speech, mental arithmetic, controversial discussion, video game, or Stroop task) require the participant to be highly active.

The Inhibitory Role of Social Support Figures in Defense Reactions and Fear Learning

There are two well-established paradigms to examine autonomic reactivity to stress-related stimuli without requiring an active participant: Lang's startle probe paradigm and Pavlov's classical conditioning. The startle probe paradigm, developed by Lang and colleagues (see Lang et al., 1990 , Lang, 1995 , and Lang and Davis, 2006 ), uses a passive picture-viewing procedure to examine the capacity to potentiate or inhibit defensive responses (e.g., startle reflex) of positive and negative emotions elicited by pleasant, neutral, and unpleasant pictures selected from the International Affective Picture System (IAPS; Bradley and Lang, 2007 ). The paradigm also includes the recording of a wide set of peripheral and central physiological measures (autonomic, somatic, and brain responses) while the participant passively views the pictures. Taken together, these responses make it possible to trace not only the neurobiological circuits underlying the activation of positive and negative emotions but also the brain circuits involved in the emotional potentiation and inhibition of defense reactions.

In the past decade, various studies have applied the startle probe paradigm to investigate the stress-buffering hypothesis by replacing the IAPS pictures with images of attachment figures (face of romantic partner, father, mother, and/or best friend) and comparing with control pictures (face of unknown people, famous people, and/or mutilated faces from the IAPS). The first three studies used the standard startle probe paradigm to confirm that attachment figures elicit a genuine positive emotional response that is not confounded by familiarity or undifferentiated emotional arousal ( Vico et al., 2010 ; Guerra et al., 2011 ) and is capable of inhibiting the startle reflex ( Guerra et al., 2012 ). The last two studies ( Sánchez-Adam et al., 2013 ; Vila et al., 2019 ) used an adaptation of the paradigm to examine the brain structures involved in these responses with functional magnetic resonance imaging (fMRI). The results of the first three studies were highly consistent: the same pattern of peripheral and central physiological responses was elicited by faces of attachment figures (in black and white with no emotional expression) as was elicited by the most pleasant IAPS pictures, i.e., intense startle inhibition accompanied by a brief heart rate acceleration, higher skin conductance, greater zygomaticus muscle activity, and increased event-related potentials (P300 and LPP). The last two studies revealed that attachment faces activate brain areas related to the processing of positive emotions (medial orbitofrontal cortex), empathy and subjective happiness (anterior cingulate), and autobiographical memories and identity recognition (posterior cingulate and precuneus).

Eisenberger et al. (2011) recently investigated the face of an attachment figure as inhibitor of stress-related responses in studies on pain perception and fear learning ( Hornstein et al., 2016 , 2018 ; Hornstein and Eisenberger, 2017 ). Using a passive picture viewing procedure within an fMRI scanner, female participants received painful thermal stimulation of two intensities (moderate and high) at regular intervals while viewing pictures of their romantic partner or of a stranger or object. Participants reported reduced subjective pain when viewing the partner vs. stranger or object, showing increased activity in safety-signal brain areas (ventromedial prefrontal cortex) and reduced activity in pain-related brain areas (dorsal anterior cingulate and anterior insula). In addition, neural activity in the safety-signal area was negatively correlated with neural activity in the pain-related areas and with self-reported pain.

Studies by Eisenberger on social support figures during fear learning used a Pavlovian shock conditioning procedure to condition the skin conductance response to faces of social support figures (“ the two individuals that give you the most social support on a daily basis ”) in comparison to faces of strangers or known people or neutral objects. The results obtained demonstrate that in comparison to faces of strangers and neutral objects, social support faces, either presented alone or paired with control faces, act as safety signals with the following capacities: (a) to inhibit their own fear conditioning ( Hornstein et al., 2016 ), (b) to inhibit the expression of fear toward previously conditioned stimuli ( Hornstein et al., 2016 ), (c) to inhibit the fear conditioning of new stimuli ( Hornstein and Eisenberger, 2017 ), and (d) to enhance the extinction of conditioned fear responses and prevent the return of fear after a fear reinstatement procedure with additional shocks ( Hornstein et al., 2018 ). Based on this evidence, Eisenberger and colleagues suggested that social support figures have become biologically prepared safety stimuli, analogous to biologically prepared fear stimuli ( Seligman, 1971 ; Öhman, 1986 ), because over the course of evolutionary history they have provided individuals with protection, care, and resources, which has ultimately promoted survival ( Hornstein et al., 2016 , p. 1,051).

Neurobiological Pathways Involved in the Influence of Social Support on Health and Disease

As already commented, the neurobiological mechanisms underlying the social support effect on health and disease processes are directly linked to activation and inhibition of the defense motivational system by danger and safety signals. Interestingly, the main sources of danger and safety for humans, and probably for other social mammals, are not physical but social stimuli, i.e., the “other.” In 1986, Arne Öhman described fear of the predator (the beast) and fear of social rejection (the other) as the two main ancestral fears. Likewise, the main safety signals with capacity to inhibit fear and defense reactions are also other people: attachment and loved figures.

The brain structures at the core of the defense motivational system are two subcortical areas within the temporal lobes: the amygdala and the bed nucleus of stria terminalis (part of the so-called extended amygdala). Knowledge of these structures derives from animal and human studies on defense reactions and fear conditioning ( LeDoux, 1996 ; Lang et al., 2000 ; Lang and Davis, 2006 ). The amygdala receives danger-related sensory information from cortical structures via its lateral and basolateral nuclei, which project to the central nucleus of the amygdala and from there to the bed nucleus of stria terminalis. These two last structures have similar efferent connections to the hypothalamus and to other brainstem areas that directly control specific defense reactions such as freezing (central gray), the startle response (nucleus reticularis pontis caudalis), or the fight-flight response (lateral and paraventricular nuclei of the hypothalamus). The hypothalamic defense areas are of special interest because they mediate activation of the sympathetic branch of the autonomic nervous system (lateral hypothalamus) and the neuroendocrine system (paraventricular nucleus), which play a key role in sustaining activation of the defense system and stress response. In fact, it is chronic activation of the defense system, also called the “default stress response” ( Brosschot et al., 2018 ; Thayer et al., 2021 ), which transforms the fight-or-flight response from an adaptive response that allows survival to a maladaptive response that promotes disease and mortality. Three subsystems are involved in this transformation and its potential reversal by social support.

The Cardiovascular System and Heart Rate Variability

Prolonged activation of the defense system leads to a cardiovascular and autonomic imbalance in which the sympathetic tone is high and the parasympathetic tone is low, a condition associated with increased morbidity and mortality ( Thayer et al., 2010 , 2021 ). Inhibition of the defense system by safety signals is accomplished through structural and functional inhibitory connections between areas of the prefrontal cortex (orbitofrontal cortex and medial prefrontal cortex) and amygdala ( Thayer and Lane, 2009 ). Julian Thayer and coworkers recently reported that the autonomic imbalance produced by prolonged activation of the defense system and the inhibitory control of the prefrontal cortex on the amygdala were linked to the aging process, describing a deterioration in both phenomena (greater sympathetic dominance and lower prefrontal inhibition) with increasing age but only up to around 70–80 years ( Zulfiqar et al., 2010 ; Almeida-Santos et al., 2016 ). Above this age, there is an increase in parasympathetic dominance, measured using indices of vagally-mediated heart rate variability (high frequency variability associated with respiratory sinus arrhythmia), to levels typical of younger individuals. Consequently, it has been suggested that heart rate variability can be used not only as an index of health but also as an index of biological age and longevity ( Zulfiqar et al., 2010 ; Thayer et al., 2021 ).

Two influential theories, Porges's polyvagal theory ( Porges, 2009 ) and Thayer's neurovisceral integration theory ( Thayer and Lane, 2000 ), uphold that safe environments promote parasympathetic dominance, leading to increased health and longevity. The polyvagal theory posits that when the environment is perceived as safe there is an increased parasympathetic control by the mammalian myelinated vagus, slowing the heart, inhibiting the fight-or-flight response, dampening activity of the HPA axis, and reducing inflammation by modulation of the immune system. This effect is accompanied by activation of an integrated social engagement system via neural links with the face and head muscles that control eye gaze and facial expression, thereby promoting supportive social connection and communication ( Porges, 2009 ). Thayer's neurovisceral integration theory assumes a reciprocal interconnection between the brain and the heart via a complex neural network that comprises the prefrontal cortex, anterior cingulate, amygdala, hypothalamus, and vagus nerve as key structures. This network integrates cognitive, affective, and autonomic systems in a dynamic model that explains emotion and stress regulation/dysregulation ( Thayer and Lane, 2000 ). In this model, heart rate variability is seen as a marker of stress (low variability) and health (high variability), as supported by neuroimaging studies that have revealed associations between heart rate variability and specific brain regions in the prefrontal cortex and anterior cingulate in response to perceptions of safety and threat ( Thayer et al., 2012 ).

The HPA Axis and Oxytocin

Similar brain structures to those involved in regulation of the cardiovascular system participate in regulation of the HPA axis. Activity of this axis originates in the parvocellular neurons of the paraventricular nucleus of the hypothalamus by secreting corticotropin-releasing hormone (CRH), which stimulates production of adrenocorticotropic hormone (ACTH) by the anterior pituitary and its release into the general circulation. The ACTH then stimulates the production and release of glucocorticoids (cortisol) by the adrenal cortex, whose main function is the mobilization of energy to cope with environmental challenges. Brain control of the HPA axis uses the same structures as those involved in cortical and subcortical regulation of the cardiovascular system: orbitofrontal and medial prefrontal cortex, anterior cingulate, amygdala, and bed nucleus of stria terminalis ( Hostinar et al., 2014 ). As in the cardiovascular system, these integrated structures mediate activation and inhibition of the HPA axis in response to the perception of threat and safety, thereby contributing to explain the stress-buffering effect of social support.

Another neuroendocrine system that contributes to the social buffering effect is the oxytocin system. The neuropeptide oxytocin is mainly produced by magnocellular neurons of the paraventricular nucleus of the hypothalamus and is released into the circulation by the posterior pituitary. Oxytocin was first recognized for its role in parturition and lactation ( Freund-Mercier et al., 1988 ), while its release in the brain was later found to be responsible for promoting the formation of mother-offspring bonds ( Carter, 1998 ). More recent research, both in animals and humans, has described a role for oxytocin in the regulation of HPA activity, both in direct response to a stressor and in response to a supportive conspecific ( Heinrichs et al., 2003 ; Crockford et al., 2018 ). Crockford and colleagues have suggested that the release of oxytocin in response to a stressor may facilitate the activation of social-support-seeking behavior. Indeed, finding social support may reduce the threat for an individual, as when chimpanzees face a predator or an aggressive conspecific. In the absence of a stressor, the social support effect may be mediated by the oxytocin-induced downregulation of the HPA axis. Chimpanzee studies have shown that grooming or food sharing is associated with higher urinary oxytocin and lower urinary glucocorticoids when done with bonded vs. non-bonded partners ( Wittig et al., 2016 ; Samuni et al., 2017 ). These findings confirm that being in a supportive social environment per se , without exposure to a stressor, is a health promotion mechanism.

The Immune System and Inflammation

Inflammation is the defensive response of the immune system to protect the organism from injury and infection. Eisenberger et al. (2017) recently reviewed evidence that proinflammatory cytokines, immune system markers, have a profound influence on the brain, altering social behavior in opposite directions: (a) increasing sensitivity to negative social experience (e.g., social exclusion) and (b) increasing sensitivity to positive social experience (e.g., viewing pictures of loved ones). Both influences affect sickness behavior, either by withdrawing people from social contacts that may represent an additional threat to well-being or by bringing them closer to attached individuals who may provide support and care to recover from sickness. Eisenberger and coworkers also reviewed evidence that negative social experience has a strong influence on the immune system by increasing proinflammatory cytokines in various social adverse conditions, including real-world social stressors (e.g., parental separation in early life or bereavement in later life), laboratory stressors (e.g., the Trier Social Stress Task), and social disconnection (e.g., social isolation and loneliness).

The association between low social support and inflammation was confirmed in a recent meta-analysis published by Uchino et al. (2018) , based on 41 studies with over 73,000 participants. They found a significant negative correlation effect size (Fisher Zr transformation) of −0.073, indicating that low social support is a significant predictor of inflammation. Three types of social support measure were analyzed: social integration (a complex measure including such aspects of the social network as marriage and volunteer organizations), perceived support, and received support. Although no significant differences were found between the three measures, the largest effect size was for social integration (−0.076), followed by perceived support (−0.054) and then by received support (−0.040), which was not statistically significant. These results are consistent with the findings of the present 23 meta-analyses on the superiority of complex social integration measures and perceived support over received support as predictors of health and longevity. The authors acknowledged that the overall effect size was low and that sample sizes were low for the subgroup, calling for further research. This is a highly relevant issue, given that chronic inflammation associated with low social integration and social support can impact on multiple diseases that represent the leading causes of disability and mortality worldwide, including cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic liver disease, and autoimmune and neurodegenerative disorders ( Furman et al., 2019 ).

Discussion and Conclusions

Highly consistent evidence has accumulated over the past 60 years on the significant association of functional and structural measures of social support with health and longevity. The strength of the association varies widely according to the type of social support measure and the type of health outcome. The strongest association has been observed for structural-type complex social integration measures and functional-type perceived support measures and for outcome measures of specific or all-cause mortality. The strength of this association is equivalent to that documented for other well-documented risk factors such as smoking or obesity.

There has also been highly consistent experimental evidence, especially from the past two decades, on three neurobiological pathways that link social support with health and longevity: the autonomic nervous system, the neuroendocrine system, and the immune system. These systems are all sensitive to environmental social cues that activate or inhibit defensive responses. Threatening social cues activate responses in the three systems to protect the organism by increasing cardiovascular activity, cortisol production, and inflammation. However, if sustained for prolonged periods, these same responses can increase the risk of disease and mortality. Conversely, safety social cues induce the inhibition of defense responses, promoting homeostatic levels and social bond formation through parasympathetic dominance, HPA regulation, and oxytocin production, contributing to a reduction in the risk of disease and mortality.

The strongest evidence on the role of social support as safety cues derives from human experimental studies that tested the stress buffering hypothesis using attachment figures (romantic partner, parents, and friends). The results highlighted the emotional component of social support, principally from family and friends, which is identified as love. Love is embedded in the first and most cited definition of social support proposed in 1976: Information leading to believe that one is loved and cared, esteemed and value, and part of a social network of mutual obligation ( Cobb, 1976 ). Social psychologists were the first to study romantic and non-romantic love ( Mikulincer and Goodman, 2006 ), describing three basic components: attachment (connection), care giving-receiving (protection), and attraction (sexual attraction in romantic love and positive affect in non-romantic love). Indeed, the concept of love includes the notions of aid (care giving) and connection (attachment) that are inherent to the concept of social support. Moreover, focusing on the emotional component of social support can help to advance knowledge on the brain mechanisms that mediate the longevity effect ( Bartels and Zeki, 2004 ; Vila et al., 2019 ). Importantly, it can lead to a reorientation of intervention research toward fostering emotions that strengthen collaboration between individuals and groups.

Nevertheless, research on social support and longevity needs to incorporate recent developments within the field that are helping to expand evidence on the link between social support and health/longevity, to advance knowledge on its underlying neurobiological mechanisms, and to translate this knowledge into the design and implementation of large scale preventive public health interventions that increase the culture of social support. These new developments derive from three different perspectives: the evolutionary, the life span, and the systemic.

The Evolutionary Perspective: Convergent Evidence From Other Social Mammals

Recent comparative studies between human and non-human social mammals have demonstrated that measures of social support and integration in non-human social mammals are strong predictors of health and survival, as observed in humans, with odds ratios between 1.23 and 1.72 ( Snyder-Mackler et al., 2020 ), highly similar to those obtained in the present review of 23 meta-analyses. This association has been demonstrated in at least four mammalian orders: primates, rodents, ungulates (wild horses), and whales. The bulk of the evidence comes from primate studies, which also provide the strongest backing for the social causation hypothesis and, in particular, for biological processes that explain the stress-buffering effect of close social partners. In male Barbary macaques, for example, the company of bond partners (friends) was found to attenuate the stress response to social (received aggression) and environmental (cold temperature) stressors, as reflected in lower fecal glucocorticoids ( Young et al., 2014 ). Similar findings have been reported in chimpanzees ( Crockford et al., 2018 ). The advantage of non-human animal research on the social determinants of health and survival is the possibility to experimentally control the sources of both social adversity and social support. An additional benefit of findings in primates is their close evolutionary proximity to humans. As extensively documented by the primatologist Frans de Waal in Mama's last hug ( de Waal, 2019 ), primates share all social emotions with humans, including love, empathy, gratitude, and a sense of justice, the pillars that sustain supportive social relationships.

The Lifespan Perspective: The Effect of Social Support From Childhood to Late Adulthood

The developmental approach to the stress buffering hypothesis adopted by Gunnar and Hostinar (2015) represents the first effort to apply the lifespan perspective to social support research, with special emphasis on infancy and childhood. A vast amount of evidence has subsequently accumulated from animal and human studies on the negative and positive health consequences of early life experiences. The magnitude of this effect is illustrated by two studies in animals and humans. In the animal study, the lifespan was around 10 years shorter in yellow baboon females who had experienced early life maternal loss or maternal social isolation than in those who had not ( Tung et al., 2016 ). In the human study, living in a loving and caring family was found to reverse the expected negative effects of the short/short polymorphism in the serotonin transporter gene, which is associated with depression and other psychopathologies ( Taylor, 2010 ). More recent research has gone beyond infancy and childhood, focusing on social support effects from adolescence to young, middle, and late adulthood. Yang et al. (2016) combined data from a set of extensive longitudinal studies and demonstrated that indices of social integration exert a differential impact on biomarkers of inflammation, cardiovascular risk, and obesity according to the lifespan stage. This new approach to understanding how the link between social support and longevity unfolds over the lifespan has practical implications for the design of effective intervention policies adjusted to developmental changes.

The Systemic Perspective: From the Individual to Society

The systemic approach to social support and longevity, recently defended by Holt-Lunstad et al. (2010 , 2015) and Holt-Lunstad (2018) , represents a means of broadening the social support field through recognition of its multidisciplinary and multilevel character. In common with all social phenomena, social relationships are embedded in four interrelated dimensions: the individual, the family and close relationships, the community, and society. Application of the systemic perspective to research on social support yields two concrete benefits. First, the multiple causal pathways by which social relationships become a risk or a protective factor can be reorganized into a hierarchy of levels of influence, i.e., the individual (e.g., factors related to biological predispositions), the family and close relationships (e.g., factors related to attachment bond formation and early life experiences), the community (e.g., neighborhood and local environmental factors), and society (e.g., factors related to social and cultural norms). Second, application of this approach can support the implementation of more effective preventive interventions analogous to other well-established public health interventions for risk factors such as smoking or obesity. To date, intervention studies designed to increase social relationships have not yielded convincing results ( Hogan et al., 2002 ; Fakoya et al., 2020 ), which is likely due, at least in part, to their limitation to the individual or family level.

Conclusions: Toward a Culture of Global Social Support

Loneliness, the perception of social isolation, is reaching epidemic proportions among the elderly in developed countries and is expected to increase further over the next few decades ( Cigna, 2020 ). Social adversity is also increasing in many underdeveloped countries due to war, social conflict, or poverty, mainly affecting children and younger adults ( Pettersson and Öberg, 2020 ). The key question is whether social support interventions can help to reduce the disease and mortality risk associated with such extreme adverse social conditions. Love is the positive emotion that connects people. Attachment, care giving-receiving, and positive affect always have others as the reference point. The feeling of belonging to a social group or community is based on socio-emotional relationships of love and support. Research on social support intervention may need to explore strategies for expanding and strengthening a global rather than merely local or national sense of belonging to a community ( de Rivera and Carson, 2015 ). Raising awareness that we are all one people and that we are all interdependent and connected worldwide requires work to shift prevailing societal norms and values, which focus so narrowly on individualism and local or national group identities. The need for efforts in this direction is the implicit message conveyed by the three research areas emerging in the social support literature. Finally, the widespread utilization of internet-based social networks is a novel phenomenon that warrants future in-depth research to address their role in providing individuals with positive or negative social support.

Author Contributions

The author confirms being the sole contributor of this work and has approved it for publication.

Conflict of Interest

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

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Acknowledgments

I wish to thank Pilar Aranda, our university chancellor, Camila Molina, our faculty librarian, and the senior and junior members of my research group (Junta de Andalucía code HUM-388) for their constant support.

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Wittig, R. M., Crockford, C., Weltring, A., Langergraber, K. E., Deschner, T., and Zuberbühler, K. (2016). Social support reduces stress hormone levels in wild chimpanzees across stressful events and everyday affiliations. Nat. Commun. 7:13361. doi: 10.1038/ncomms13361

Yang, Y. C., Boen, C., Gerken, K., Li, T., Schorpp, K., and Harris, K. M. (2016). Social relationships and physiological determinants of longevity across the human life span. Proc. Natl. Acad. Sci. U.S.A. 113, 578–583. doi: 10.1073/pnas.1511085112

Young, C., Majolo, B., Heistermann, M., Schülke, O., and Ostner, J. (2014). Responses to social and environmental stress are attenuated by strong male bonds in wild macaques. Proc. Natl. Acad. Sci. U.S.A. 111, 18195–18200. doi: 10.1073/pnas.1411450111

Zalta, A. K., Tirone, V., Orlowska, D., Blais, R. K., Lofgreen, A., Klassen, B., et al. (2021). Examining moderators of the relationship between social support and self-reported PTSD symptoms: a meta-analysis. Psychol. Bull. 147, 33–54. doi: 10.1037/bul0000316

Zulfiqar, U., Jurivich, D. A., Gao, W., and Singer, D. H. (2010). Relation of high heart rate variability to healthy longevity. Am. J. Cardiol. 105, 1181–1185. doi: 10.1016/j.amjcard.2009.12.022

Keywords: social support, social relationships, health, longevity, meta-analysis, stress, stress-buffering

Citation: Vila J (2021) Social Support and Longevity: Meta-Analysis-Based Evidence and Psychobiological Mechanisms. Front. Psychol. 12:717164. doi: 10.3389/fpsyg.2021.717164

Received: 30 May 2021; Accepted: 17 August 2021; Published: 13 September 2021.

Reviewed by:

Copyright © 2021 Vila. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jaime Vila, jvila@ugr.es

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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How Social Support Contributes to Psychological Health

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Amy Morin, LCSW, is a psychotherapist and international bestselling author. Her books, including "13 Things Mentally Strong People Don't Do," have been translated into more than 40 languages. Her TEDx talk,  "The Secret of Becoming Mentally Strong," is one of the most viewed talks of all time.

 JGI / Tom Grill / Getty Images

• Why It's Important

Social Support vs. Integration

Types of social support, examples of social support, health benefits of social support.

Social support is often identified as a key component of solid relationships and strong psychological health, but what exactly does it mean? Essentially, social support involves having a network of family and friends that you can turn to in times of need.

Whether you are facing a personal crisis and need immediate assistance, or you just want to spend time with people who care about you, these relationships play a critical role in how you function in your day-to-day life.

It is social support that builds people up during times of stress and often gives them the strength to carry on and even thrive.

But social support is certainly not a one-way street. In addition to relying on others, you also serve as a form of support for many people in your life. 

Why Strong Social Support Is So Important

Psychologists and other mental health professionals often talk about the importance of having a strong social support network. When trying to reach our goals or deal with a crisis, experts frequently implore people to lean on their friends and family for support.

Research has also demonstrated the link between social relationships and many different aspects of health and wellness.  Poor social support has been linked to depression and loneliness and has been shown to alter brain function and increase the risk of the following:

• Alcohol use
• Cardiovascular disease

In one study of middle-aged men over a seven-year period, those with strong social and emotional support were less likely to die than those who lacked such relationships.

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at 988  for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our  National Helpline Database .

So, which aspects of our social environments are so vital to health? And how exactly do our social environments impact our overall well-being? There are two essential aspects of our social worlds that contribute to health: social support and social integration.  

Social Support

Social support refers to the psychological and material resources provided by a social network to help individuals cope with stress. Such social support may come in different forms, and might involve:

• Helping a person with various daily tasks when they are ill or offering financial assistance when they are in need
• Giving advice to a friend when they are facing a difficult situation
• Providing caring, empathy , and concern for loved ones in need

Social Integration

Social integration is the actual participation in various social relationships, ranging from romantic partnerships to friendships. This integration involves emotions , intimacy, and a sense of belonging to different social groups, including being part of a:

• Partnership
• Religious community
• Social activity

Experts suggest that being integrated into such social relationships confers a protective benefit against maladaptive behaviors and damaging health consequences.

Supportive social networks can come in different forms and play different roles in your life. Three of the main types of social support are emotional support, instrumental support, and informational support.

Emotional Support

Sometimes the people in your life provide emotional support. They back you up when you need it and are there with a shoulder to cry on when things don't go your way. This type of support can be particularly important during times of stress or when people are feeling lonely.  

Instrumental Support

In other cases, the people in your social network might provide instrumental support. They take care of your physical needs and offer a helping hand when you need it.   This might involve bringing you a hot meal when you are sick or giving you a ride when your car is in the shop. Such support is important when people have immediate needs that must be addressed.

Informational Support

People can also provide what is known as informational support. This can involve providing guidance, advice, information, and mentoring. Such support can be important when making decisions or big changes in one's life.  

By having this form of support, people may feel less anxious and stressed out about the problems they are trying to solve thanks to the advice of a trusted friend, mentor, or loved one.

As you might imagine, people in your social networks may take on different roles. A teacher might provide informational support, while a parent might provide all three types. By having a solid social support network, you are more likely to receive the type of support that you need when you really need it.

Social support can occur in many forms and from many different people in your life. Co-workers may offer support in the workplace, while friends and family may provide emotional or practical support in other areas of your life.

A few examples of social support include:

• Listening to a friend talk about a stressful situation
• Validating another member of a support group when they talk about their feelings
• Cooking meals for a neighbor who has been feeling ill
• Praising an employee for doing a good job
• Providing constructive feedback on someone's work to help them improve
• Helping someone with housework when they are struggling with feelings of depression

So now that we understand that our social support systems involve both different types of social support as well as integration into different social groups, it is time to take a closer look at exactly how these social relationships influence both physical and mental health.

Healthy Choices and Behaviors

Participation in social groups has a normative influence on behaviors, often influencing whether people eat a healthy diet, exercise, smoke, drink, or use illegal substances.  

Clearly, social groups can sometimes have a negative influence in this regard when peer pressure and influence leads to poor or even dangerous health choices . However, group pressure and support can also lead people to engage in healthy behaviors as well. 

If you have ever tried to give up a bad habit, such as smoking, you probably realize just how important social support can be. If your social connections do not support you, it can make success much more difficult. If your friends and family offer support and encouragement, you may find achieving your goal much more possible.

Coping With Stress

Social support also helps people to cope with stress. Stress has been shown to have serious health consequences ranging from reduced immunity to increased risk of heart disease.

Being surrounded by people who are caring and supportive helps people to see themselves as better capable of dealing with the stresses that life brings.

Research has also shown that having strong social support in times of crisis can help reduce the consequences of trauma-induced disorders including PTSD.

Improves Motivation

Social relationships can also help people to stay motivated when trying to achieve their goals. People who are trying to lose weight or quit smoking, for example, often find that it helps to connect with people who are actively trying to attain those same goals.

Talking to people who are going through the same experience can often be a source of support, empathy, and motivation.

A Word From Verywell

Every once in a while, it can be important to assess your relationships:

• Do you have enough social support?
• Would you benefit from deepening your current relationships?
• Could you use some new social contacts or social outlets?

You might decide to get more proactive about giving and getting emotional support. It could greatly improve the quality of your life.

And if you're struggling to make friends or keep them, you might reach out to a therapist. A mental health provider may be able to assist you in managing your relationships in a healthy way so you can have the social support you need to be your best.

American Psychological Association. Manage Stress: Strengthen Your Support Network .

Grav S, Hellzèn O, Romild U, Stordal E. Association between social support and depression in the general population: The HUNT study, a cross-sectional survey . J Clin Nurs . 2012;21(1-2):111-20. doi:10.1111/j.1365-2702.2011.03868.x

Cohen S, Janicki-Deverts D. Can we improve our physical health by altering our social networks? .  Perspect Psychol Sci . 2009;4(4):375–378. doi:10.1111/j.1745-6924.2009.01141.x

Baumgartner JN, Susser E. Social integration in global mental health: What is it and how can it be measured? .  Epidemiol Psychiatr Sci . 2013;22(1):29–37. doi:10.1017/S2045796012000303

Pejner MN, Ziegert K, Kihlgren A. Trying to cope with everyday life--emotional support in municipal elderly care setting .  Int J Qual Stud Health Well-being . 2012;7:1–7. doi:10.3402/qhw.v7i0.19613

Morelli SA, Lee IA, Arnn ME, Zaki J. Emotional and instrumental support provision interact to predict well-being .  Emotion . 2015;15(4):484–493. doi:10.1037/emo0000084

Ko HC, Wang LL, Xu YT. Understanding the different types of social support offered by audience to A-list diary-like and informative bloggers .  Cyberpsychol Behav Soc Netw . 2013;16(3):194–199. doi:10.1089/cyber.2012.0297

Crookes DM, Shelton RC, Tehranifar P, et al. Social networks and social support for healthy eating among Latina breast cancer survivors: Implications for social and behavioral interventions .  J Cancer Surviv . 2016;10(2):291–301. doi:10.1007/s11764-015-0475-6

Gros DF, Flanagan JC, Korte KJ, Mills AC, Brady KT, Back SE. Relations among social support, PTSD symptoms, and substance use in veterans .  Psychol Addict Behav . 2016;30(7):764–770. doi:10.1037/adb0000205

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Social support as a comfort or an encouragement: A systematic review on the contrasting effects of social support on cardiovascular reactivity

Affiliations.

• 1 Heriot-Watt University Malaysia, Putrajaya, Malaysia.
• 2 James Cook University Singapore, Singapore.
• 3 North Dakota State University, Fargo, North Dakota, USA.
• PMID: 30084181
• DOI: 10.1111/bjhp.12337

Purpose: The stress-buffering hypothesis (Cohen & McKay, 1984, Handbook of psychology and health IV: Social psychological aspects of health (pp. 253-256). Hillsdale, NJ: Lawrence Erlbaum) suggests that one way social support enhances health is by attenuating cardiovascular reactivity (CVR) to stress. Research that has tested this hypothesis has reported inconsistent findings. In this review, we systematically reviewed those findings and proposed a dual-effect model of social support and CVR as a potential explanation for the inconsistency in the literature. Specifically, we proposed that when participants are more engaged during a stressor, social support acts primarily as social comfort, attenuating CVR; and when participants are not engaged, social support acts primarily as social encouragement, elevating CVR.

Methods: We reviewed 22 previous studies that (1) empirically manipulated social support in a stressful situation, (2) measured CVR, and (3) tested a moderator of social support effects on CVR.

Results: Although a majority of studies reported a CVR-mitigating effect of social support resulting in an overall significant combined p-value, we found that there were different effects of social support on CVR when we considered high- and low-engagement contexts. That is, compared to control conditions, social support lowered CVR in more engaging situations but had no significant effect on CVR in less engaging situations.

Conclusion: Our results suggest that a dual-effect model of social support effects on CVR may better capture the nature of social support, CVR, and health associations than the buffering hypothesis and emphasize a need to better understand the health implications of physiological reactivity in various contexts. Statement of contribution What is already known on this subject? According to the stress-buffering hypothesis (Cohen & McKay, ), one pathway social support benefits health is through mitigating the physiological arousal caused by stress. However, previous studies that examined the effects of social support on blood pressure and heart rate changes were not consistently supporting the hypothesis. Some studies reported that social support causes elevations in cardiovascular reactivity (CVR) to stress (Anthony & O'Brien, ; Hilmert, Christenfeld, & Kulik, ; Hilmert, Kulik, & Christenfeld, ) and others showed no effect of social support on CVR (Christian & Stoney, ; Craig & Deichert, ; Gallo, Smith, & Kircher, ). What does this study add? When participants were in more engaging conditions, social support decreased CVR relative to no support. When participants were in less engaging conditions, social support did not have a significant effect on CVR. Provide an alternative way to explain the ways social support affects cardiac health.

Keywords: cardiovascular reactivity; social encouragement; social support; stress; stress-buffering hypothesis.

© 2018 The British Psychological Society.

Publication types

• Systematic Review
• Blood Pressure / physiology*
• Heart Rate / physiology*
• Social Support*
• Stress, Psychological / physiopathology*

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Social Support and Resilience to Stress

Steven southwick.

Drs. Ozbay, Johnson, Dimoulas, Morgan, and Southwick are from Yale University School of Medicine, New Haven, Connecticut, and the National Center for PTSD, Clinical Neurosciences Division, VA Medical Center, West Haven, Connecticut; and Dr. Charney is from the Mount Sinai School of Medicine, New York, New York.

Numerous studies indicate social support is essential for maintaining physical and psychological health. The harmful consequences of poor social support and the protective effects of good social support in mental illness have been well documented. Social support may moderate genetic and environmental vulnerabilities and confer resilience to stress, possibly via its effects on the hypothalamic-pituitary-adrenocortical (HPA) system, the noradrenergic system, and central oxytocin pathways. There is a substantial need for additional research and development of specific interventions aiming to increase social support for psychiatrically ill and at-risk populations.

Introduction

Social support is exceptionally important for maintaining good physical and mental health. Overall, it appears that positive social support of high quality can enhance resilience to stress, help protect against developing trauma-related psychopathology, decrease the functional consequences of trauma-induced disorders, such as posttraumatic stress disorder (PTSD), and reduce medical morbidity and mortality. 1 However, despite strong evidence demonstrating the beneficial effects of social support on medical and psychological wellbeing, the field of psychiatry has contributed relatively little to developing, testing, and implementing effective evidence-based interventions aimed at increasing social support for patients and at-risk populations. In this review article, we aim to summarize key studies on social support in the context of resilience to stress and explore possible brain mechanisms mediating social support's positive influence on mental health outcomes. We will begin with a brief overview of the neurochemistry of the stress response and resilience to stress. Within this framework, we will then review the emerging literature on the neurobiology and the behavioral mediators of social support. Next, we will review studies that have investigated the effects of social support on medical illness, and finally, conclude with a discussion on social support's clinical significance for psychiatry.

Resilience to Stress: Putative Mechanisms

Psychological resilience represents a process of adapting well in the face of adversity. The psychosocial and neurobiologic characteristics of resilience to stress are extremely complex, and their discussion is beyond the scope of this article (for a thorough review see Southwick, et al. 1 ). However, the literature suggests the sympathetic nervous system and hypothalamic-pituitary-adrenocortical (HPA) system are extensively involved in stress response and resilience. 2

The sympathetic nervous system (SNS) responds to stress by increasing heart rate, constricting blood vessels, increasing blood pressure, and slowing digestion. Numerous lines of evidence from psychophysiology and neuroendocrine studies indicate that the noradrenergic system is often dysregulated in PTSD. For example, chronic PTSD is associated with high baseline cerebrospinal fluid NE concentrations. 3 McFall, et al., demonstrated that subjects with combat-related PTSD had greater increases in plasma epinephrine, pulse, and blood pressure in response to viewing a combat movie. 4 Notably, the heightened autonomic activity of PTSD patients peaked during the resting period after the combat film, and the authors argued that an impairment of the mechanisms involved in terminating the noradrenergic response to stressors was implicated in the pathophysiology of PTSD. When the SNS is strongly activated, neuropeptide Y (NPY) and galanin are released with norepinephrine to maintain SNS activity within an optimal activation range (reviewed by Southwick, et al. 5 ). Indeed, highly resilient special operations soldiers tend to have high levels of NPY 6 , 7 in contrast to combat veterans diagnosed with PTSD who have reduced levels. 8 The overall net effects of NE hyperactivity thus may depend on the balance between NE, NPY, and galanin. This supports the notion that resilience to stress is associated with the regulation of noradrenergic activity within an optimal window.

In response to acute and chronic stress, the hypothalamus secretes corticotropin-releasing factor (CRF), which in turn induces the release of adrenocorticotropin hormone (ACTH). ACTH stimulates the synthesis and release of cortisol and dehydroepiandrosterone (DHEA) from the adrenal gland. In the short run, cortisol mobilizes and replenishes energy stores and contributes to increased arousal. 9 However, if stress remains chronic, prolonged elevations of glucococorticoids may cause serious adverse effects, such as immunosuppression, hypertension, dyslipidemia, and osteoporesis. 10 In contrast to cortisol, DHEA exerts antiglucocorticoid and antiglutamatergic activity in the brain and may confer neuroprotection (reviewed by Charney 2 ). For example, a negative correlation has been demonstrated between DHEA levels and PTSD symptom severity in women. 11 Morgan, et al., found a positive correlation between DHEA/cortisol ratio and performance among special forces soldiers during high stress training. 12 Similarly, allopregnalolone, another neuroactive steroid, dampens the HPA activity. Rasmusson, et al., has reported lower cerebrospinal fluid levels of allopregnanolone in those diagnosed with PTSD compared to controls. 13 In conclusion, DHEA and allopregnalolone may confer resilience to stress by helping to terminate HPA-activation and preventing harmful effects of prolonged exposure to glucocorticoids.

In summary, stress resilience seems to be associated with an ability to keep the HPA-axis and noradrenergic activity within an optimal range during stress exposure and terminate the stress response once the stressor is no longer present. Based on these findings, we may postulate that for social support to increase stress resilience, it should enhance the ability to optimize the neurochemical stress response summarized above.

What is Social Support?

Social support has been described as “support accessible to an individual through social ties to other individuals, groups, and the larger community.” 14 The National Cancer Institute's Dictionary of Cancer Terms defines social support as “a network of family, friends, neighbors, and community members that is available in times of need to give psychological, physical, and financial help” ( www.cancer.gov ). Theoretical models of social support specify the following two important dimensions: (1) a structural dimension, which includes network size and frequency of social interactions, and (2) a functional dimension with emotional (such as receiving love and empathy) and instrumental (practical help such as gifts of money or assistance with child care) components. 2 Most research has found that quality of relationships (functional dimension) is a better predictor of good health than quantity of relationships (structural dimension), although both are important. 1

It should be noted that the optimal source of social support may depend on the developmental stage of the person who is receiving the support. For example, parental support seems to be more valuable in early adolescence than it is in late adolescence. 15 It has been shown that the perception of social support is associated with the degree of social interaction in the elderly and with instrumental support in younger adults. 16 Moreover, the type of social support seems to be important in conferring resilience to stress. In a sample of childhood sexual abuse survivors, a combination of self-esteem support (the individual perceives that he or she is valued by others) and appraisal support (the individual perceives that he or she is capable of getting advice when coping with difficulties) was most useful in preventing the development of PTSD. 17

The Psychobiological Mediators of Social Support

Investigators have explored the ways in which social support may enhance mental and physical health. It has been argued that rich social networks may reduce the rate at which individuals engage in risky behaviors, 18 prevent negative appraisals, 19 and increase treatment adherence. In general, resilient or hardy individuals are thought to use active coping mechanisms when dealing with stressful life situations. 20 Using a time lag model for the prediction of depression, Holohan, et al., 21 found that high social support predicted less subsequent depression in patients with acute and chronic cardiac illness and that this relationship was partly mediated by the use of an active coping style. Importantly, in this cohort, social support preceded and facilitated the use of active coping mechanisms.

There is an emerging literature on social support and the neurobiological pathways through which it acts to foster resilience and reduce the risk for developing mental illness. In preclinical studies, social isolation has been associated with increased heart rate and blood pressure, hypercortisolemia, and atherosclerosis. For example, among cynomolgus monkeys, resting heart rate increases during separation and isolation but returns to normal when monkeys are reunited with their social group; 21 cortisol rises in squirrel monkeys 22 and wild baboons 23 during isolation; at postmortem examination, atherosclerosis has been significantly greater in swine 24 and in female monkeys 21 living alone vs those living in social groups. Further, evidence suggests chronic stress and lack of social support increases cardiac risk (e.g., endothelial injury, increases platelet accumulation), in part, through prolonged sympathetic activation. 25

In human studies, low social support has been associated with physiological and neuroendocrine indices of heightened stress reactivity, including elevated heart rate, 26 increased blood pressure, 27 and exaggerated cardiovascular and neuroendocrine responses to laboratory stressors. For example, in laboratory studies mental arithmetic 28 and public speaking tasks 29 , 30 cause significantly smaller rises in heart rate, blood pressure, and cortisol among subjects supported by another person compared to subjects who are alone. These findings are consistent with the results of a study conducted by Steptoe, et al., who reported an overall increased noradrenergic and HPA reactivity in lonely individuals. 31

The brain mechanisms, including the neural circuits and neurotransmitter systems, that underlie the acquisition and processing of social information are extremely complex and far from being completely understood. However, animal studies indicate that the regulation of social attachment and promotion of positive social interactions may be heavily dependent on two neuropeptides known as oxytocin and vasopressin. 32 Oxytocin is critical for learning social cues and has been shown to enhance maternal care in rats. 33 Differential oxytocin and vasopressin receptor expression patterns in specific areas of the brain (ventral pallidum and medial amygdala) have been shown to influence the type and duration of social attachments formed by voles. For example, montane voles typically avoid social contact except while mating; they have lower levels of oxytocin receptors in the nucleus accumbens compared to prairie voles, which are highly social and typically monogamous. 34 Oxytocin also exerts anxiolytic effects that are associated with attenuated secretion of corticosterone in lactating rodents. 35

The role of oxytocin in human social behavior has been investigated as well. The Trier Social Stress Test is a laboratory stressor that involves simulation of an aversive job interview and public speaking with negative feedback, resulting in a robust increase in anxiety and salivary cortisol. Both oxytocin and social support reduced anxiety in healthy men undergoing this procedure. 36 Interestingly, the same study showed that subjects who received the combination of oxytocin and social support had the least amount of anxiety and lowest cortisol responses to stress. Taken together, these results suggest that oxytocin promotes social behavior and may inhibit the HPA axis reactivity to stress.

The Impact of Social Support on Health Outcomes

Social isolation and low levels of social support have been shown to be associated with increased morbidity and mortality in a host of medical illnesses. For example, in the well-known Alameda County Studies, men and women without ties to others were 1.9 to 3 times more likely to die from ischemic heart disease, cerebral vascular disease, cancer, or a host of other diseases within a nine-year period compared to individuals with many more social contacts. 37 The effect of social support on life expectancy appears to be as strong as the effects of obesity, cigarette smoking, hypertension, or level of physical activity. 25

Numerous epidemiological studies have reported that poor social support is associated with the onset and relapse of depression, 38 negative treatment response to dysthymia, 39 seasonality of mood disorder, 40 and the presence of depression comorbid in several medical illnesses, such as multiple sclerosis, 41 cancer, 42 and rheumatoid arthritis. 43

The Vietnam War may serve as an important example of failed social support during times of high stress and trauma. Johnson and colleagues found that many Vietnam veterans experienced homecoming as a highly stressful experience. 44 These veterans reported “being insulted, feeling angry, resentful, and alone.” In this cohort of treatment-seeking, outpatient veterans with PTSD, homecoming stress was the strongest predictor of the frequency and intensity of their PTSD symptoms. The authors concluded that the lack of social support confirmed the veterans' perception of rejection and lead to feelings of detachment. 44

In contrast to low social support, high levels appear to buffer or protect against the full impact of mental and physical illness. The relationship between good social support and superior mental and physical health has been observed in diverse populations, including college students, unemployed workers, new mothers, widows, and parents of children with serious medical illnesses. 45

Strong social support has been shown to be an important factor in decreasing functional impairment in patients with depression 46 and in increasing the likelihood of recovery. 47 Further, the risk of developing PTSD upon exposure to combat trauma is inversely correlated with social support. For example, Boscarino, et al., 48 after controlling for trauma exposure, found that Vietnam veterans with high levels of social support were 180-percent less likely to develop PTSD as compared to those with low levels of social support.

The literature reviewed above clearly demonstrates the harmful consequences of poor social support and the protective effects of having access to rich and functional social networks on maintaining physical and psychological health. The exact biopsychosocial mechanisms underlying the positive influence of social support on resilience to stress are unknown. There is undoubtedly a complex interplay of various environmental and genetic factors that mediate the effects of social support on health outcomes. Evidence for such a gene-environment interaction involving social support comes from a pioneering study by Kaufman and her colleagues who have shown that social support may confer resilience to stress by moderating genetic risks for depression in maltreated children. 49 In this study, the combination of the met allele of the brain-derived neurotrophic factor (BDNF) gene and the two short alleles of the serotonin transporter (5-HTT) gene predicted the highest depression scores in maltreated children; and this vulnerability was moderated by the presence of social support. 49 This important finding demonstrates that an individual's environment may be modified to attenuate his or her genetic risk for developing mental illness even in the presence of environmental stressors, possibly by modifying gene expression. In fact, animal studies suggest maternal care can alter the expression of the glucocorticoid receptor gene via affecting DNA methylation and chromatin structure. 50

Dampening HPA activity may be another major mechanism through which social support enhances resilience to stress. In fact, findings from animal and translational studies reviewed above show that social support reduces stress-induced cortisol release. It is possible that stress-induced oxytocin release augments social affiliation, which in turn reduces negative appraisals and arousal. It is open to speculation whether social support affects DHEA and/or NPY levels, which may then help to regulate HPA and noradrenergic systems, respectively.

In summary, social support seems to moderate genetic and environmental vulnerabilities for mental illness, possibly by effects through other psychosocial factors, such as fostering effective coping strategies, and through effects on multiple neurobiological factors. It will be important for psychiatric researchers to conceptualize, test, and apply effective interventions specifically aimed at increasing social support for psychiatrically ill or at-risk populations. This represents an important challenge for our field.

Social Support, Student Outcomes and Teaching Strategies

• First Online: 20 December 2018

Cite this chapter

• Bick-har Lam 2  

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• The original version of this chapter was revised: Belated corrections have been incorporated. The correction to this chapter is available at https://doi.org/10.1007/978-981-13-3577-8_8

Social support is a topic of study related to the link between psychological processes and health. Social support can be explained as the type of communication between support recipients and providers that reduces uncertainties, and enables relationships and functions that enhance support recipients’ perception of personal control in their life experience (Adelman & Albrecht in Communicating social support. Sage Publications, 1987 ). Teaching is an interactional process between learners and teachers in the school environment. Teachers, as more knowledgeable others, give support to students in order to master a certain amount of content knowledge of a discipline, which demonstrates their role as a nurturer (Lam in There is no fear in love: The giving of social support to students enhances teachers’ career development, 2017 ). In the classroom, student peers’ scaffoldings and social interaction involve learners in a community for friendship and academic learning, and the school as a whole creates an environment to foster learners’ social and academic development. Learning in school largely relies on different sources of social support. This chapter investigates the potential of social support in teaching and learning contexts. It attempts to explore teachers’ supportive behaviours and other support sources in the classroom environment and the corresponding outcomes on student learning, to draw implications from theory and practice in teaching. The current chapter seeks to accomplish the following:

Identify the theoretical reasons behind the link between social support and education, especially related to teaching and learning in the classroom;

Explore the support documented in the literature mainly related to teacher social support, and generally about other support sources;

Related to the above, what impact social support behaviours and practice from teachers and other support sources could have on students in terms of educational outcomes;

Identify exemplary teaching strategies that utilise social support;

Discuss implications from the above and further research directions.

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Lam, Bh. (2019). Social Support, Student Outcomes and Teaching Strategies. In: Social Support, Well-being, and Teacher Development. Springer, Singapore. https://doi.org/10.1007/978-981-13-3577-8_4

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