THE ROLE OF SOCIAL SUPPORT IN MENTAL HEALTH

The World Health Organization defines health as more than the absence of disease and, in doing so, it provides for a more inclusive and meaningful definition of health, one that incorporates the physical, mental, economic, and societal contexts. Health, the WHO states, provides people with the ability “to cope with their environment in order to live a long, productive, and fruitful life…Health enables social, economic and personal development fundamental to well-being.” The CDC defines mental health as “emotional, psychological, and social well-being,” and is observed in the psycho-social contexts of resilience, positive relationships, healthy choices, and meaningful societal involvement.

71 billion people worldwide suffer from a mental disorder, approximately 43.8 million in the United States alone. According to the Lancet Global Health, poor mental health costs the world economy approximately US $2·5 trillion per year in poor health and reduced productivity, a cost projected to rise to $6 trillion by 2030. Anxiety and depression, two of the most common disorders, account for 1 trillion of those dollars. Left untreated, mental illness creates widespread disability. According to HealthyPeople.gov, “neuropsychiatric disorders are among the leading causes of disability in the United States.” Moreover, suicide is the 10th leading cause of death in the United States, accounting for the deaths of approximately 43,000.

But the cost and mortality burden are substantially broader when one recognizes the direct and indirect effects of mental health on physical health. Several studies have found that physical and mental health are inextricably linked, with the clearest link between mental and physical health in longevity. Many studies have found that those with mental health challenges, such as schizophrenia or depression, tend to live shorter lives when compared to those who do not have these conditions. In fact, the Mental Health Foundation reported that schizophrenia is associated with a tripled risk of dying from a respiratory disease and a doubled risk of dying from a form of heart disease. Depression has been linked to a 50 percent increase in a person’s risk of dying from cancer and a 67 percent increase from heart disease.

Human beings are social creatures with an ancient story of how the social brain evolved to allow us to interact with each other and how to make predictions during those interactions; to develop groups of belonging for survival; and, eventually, to create civilization through large scale collective behavior. Just as critical today, one’s social and community relational world is a significant determinant of his or her quality of life, health, and longevity. Numerous studies across several research domains (psychology, sociology, and epidemiology) have demonstrated that the quantity and quality of social relationships positively impact mental health, physical health, and mortality risk. Research suggests that loneliness is one of the main indicators of social wellbeing. In addition to increased mortality risk, studies controlling for baseline mental and physical health have found loneliness and social isolation to positively correlate with depression, Alzheimer’s, alcohol abuse, and suicide.

Just as critical today, one’s social and community relational world is a significant determinant of his or her quality of life, health, and longevity.

The importance of healthy, positive social networks is bidirectional; it is both a product of and a primary contributor to health and wellbeing. These networks are the basis of social support, providing a web of physical and emotional resources that an individual experiences as available and reliable. Social support is hypothesized to protect mental health both directly through the benefits of social relationships and indirectly as a buffer against stressful circumstances. Sources of support and psychological resilience are two resources that protect individual mental health in stressful situations. Family and community social supports enhance an individual’s ability to cope and adapt, reducing the risk of depressive and anxious symptoms during times of stress and change.

Social support has been conceptually divided into four domains: informational (information provided to another during a time of stress), instrumental (the provision of tangible goods and services or tangible aid), appraisal (the communication of information which is relevant to self-evaluation rather than problem solving), and emotional support (the provision of caring, empathy, love, and trust). Generally, perceived social support can come from a variety of sources, including, but not limited to, family, friends, romantic partners, pets, community ties, and coworkers. The perception of having accessible social support and the frequency of social support contact is directly connected to mental health and wellbeing, with odds for poor mental health greater when frequency of social contact is low. Individuals who have extensive access to social support from social networks appear to have greater access to beneficial information about mental health and resources and are more likely to have one or more social groups that endorse healthy self-care behaviors.

A wealth of research has demonstrated that different sources and amounts of social support have different influences on mental health relative to age, gender, psychiatric disorder, race, economic status, employment, and living situation. For example, parental support may be more beneficial in reducing depression in early versus later adolescence. Having few friends as an adolescent is associated with greater risk of depression in young adulthood. In college students, positive social interactions with family and friends reduce anxiety and increase feelings of security. In older individuals, those who receive more social support and participate in a variety of social-related activities and interactions, tend to enjoy more favorable mental health, less loneliness, and better physical wellbeing. When comparing gender differences, social support is correlated more heavily with mental health in women than in men. Women tend to have more social support networks than do men, tend to access those networks more frequently, and subsequently reap more mental health benefits from the effects of social support such as reduced risk for depression and anxiety than do men. Conversely, however, more women than men experience significant social and psychological distress as the result of conflicted social interactions.

Research on the association of social support and psychiatric disorders is abundant and suggests that social support plays an important role in functioning across all psychological disorders, though the devil is usually in the details. For example, in PTSD and depressive disorders, social support from family more so than friends is associated with reduced posttraumatic stress disorder severity and fewer depression symptoms. Studies examining the role of social support in community adaptation for psychotic disorders have reported significantly more functional impairment in schizophrenics living alone compared to those who live with a spouse, other family, or rehab centers; with the spousal living arrangement superior to any other living arrangement wherein individuals exhibit fewer symptoms and less functional impairment. While they acknowledge higher functioning could permit better social engagement for marriage, their findings suggest that the social support influence of a spouse enhances the social network in general, thereby increasing psychological support resources.

Gil Choi, Associate Professor College of Social Work at the University of South Carolina, studied depressive disorders in newly immigrated Korean Americans and found that lack of social support is correlated with acculturative stress and that depression was correlated with both, but that increasing social supports moderates the acculturative stress and, in turn, results in fewer reported depressive symptoms. Other research suggests that a sense of belonging moderates the effects of social support on depression, with low sense of belonging accentuating the effects of low social support on depressive symptomatology.

“A defining characteristic of human society is that individual lives are intertwined through social relationships” (Yang, et al.34).

Overall, low levels of social relations are associated with low levels of wellbeing. The frequency of contact with friends and loved ones and the reachability of one’s social network has a significant influence on mental and physical health. As such, the construction of mental health interventions, prevention strategies, and health and wellness related policies may be best served with attention focused on the complexities of social networks.

“A defining characteristic of human society is that individual lives are intertwined through social relationships” (Yang, et al.). Overall, low levels of social relations are associated with low levels of wellbeing. The frequency of contact with friends and loved ones and the reachability of one’s social network has a significant influence on mental and physical health. As such, the construction of mental health interventions, prevention strategies, and health and wellness related policies may be best served with attention focused on the complexities of social networks.

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