Social Support , Cardiovascular Disease , and Mortality

This chapter presents a conceptual and selective review of the relationship between social support and cardiovascular illness and death. It is argued that cardiovascular health is not only determined by biological factors but also by social and psychological factors. For decades, epidemiological studies have linked mortality rates to marital status and social networks, thus indicating a beneficial effect of such social factors on longevity. Moreover, studies on cardiac patients have attributed increased survival rates to the existence of close social bonds. In the case of conjugal loss, for example, widowers are at risk of illness and death in the absence of a compensating network of support providers. Health psychology is looking for the mediating mechanisms that help explain such epidemiological associations. For this purpose, social support is distinguished from social integration, and further differentiations are made to better understand the quality and function of interaction processes that result in favorable health outcomes. Physiological, behavioral, and psychological pathways are distinguished in the etiology of disease, signifying differences in how people may respond to stressful encounters and critical life changes. 1. Social integration and social support People can be predisposed to illness by long-term experiences of social isolation, neglect, loneliness, and social stress. Before discussing some current issues in the relationship between social factors (as predictors) and illness and death (as outcomes), the conceptual background of the former needs to be made clear. The term “social support” is often used in a broader sense, including social integration and social networks. In this chapter, too, we will use it as a summary term in the title and headings. However, these three notions should be clearly distinguished. Social networks represent the objective basis for social integration and social support. The latter two are seen as theoretical constructs. They refer to the degree to which individuals are socially embedded, have a sense of belonging and intimacy, and tangible needs are met, such as assistance, guidance, and access to information. Social integration and social support need to be distinguished. Social integration refers to the structure and quantity of social relationships, such as the size and density of networks, frequencies of interaction. but sometimes also to subjective perceptions of embeddedness. Social support, in contrast, refers to the function and quality of social relationships, such as perceived availability of help or actually received support. It occurs through an interactive process and can be related to altruism, a sense of obligation, and the perception of reciprocity [1, 2, 3]. Both constructs have been related to ill health and mortality which represents the topic of the present chapter. 1.1 Social integration Community-based prospective epidemiological studies have documented a link between lack of social integration on the one hand and morbidity and all-cause mortality on the other. Socially isolated persons are at the highest risk for a variety of diseases and fatal health outcomes. Social integration, or the lack of it, can influence the onset, progression, and recovery from illness. This relationship has been shown for diverse physical health problems, such as the common cold, cancer, HIV infection, cardiovascular diseases (CVD), and cardiovascular reactivity [4, 5, 6]. In this chapter, we will focus on CVD for two reasons: (a) Cardiovascular diseases are the leading causes of death in Western societies, with growing incidence rates in Eastern Europe; (b) there is a substantial body of literature examining the linkage of CVD to an array of behavioral and psychological factors. For example, studies have found a link between social embeddedness and survival rates of patients who had experienced a myocardial infarct (MI). Male survivors of an acute MI who were socially isolated were more than twice as likely to die over a three-year period than those who were socially integrated. Diagnosis of coronary artery disease and subsequent death was also linked to marital status. Those who were single or without a confidant were more than three times as likely to die within five years compared with those who had a close confidant or who were married [4,5]. The present chapter will refer to some of these findings in more detail.