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NIH Record

Bonds that Heal?
Seminar Series Examines Social Relationships, Health

By Sophia P. Glezos

People who are more likely to maintain health or survive severe illness are those who have one or more intimate and supportive relationships, or otherwise gain a sense of belonging through several but less close relationships. Conversely, those at increased risk for mortality from a broad spectrum of illnesses are socially isolated -- without close relationships or a feeling of social connectedness.

These findings -- which add to mounting scientific evidence that biology often interacts with behavior and social factors to affect health or illness -- emerged from preliminary results of new studies and from a literature review of population-based, mortality-risk research published in the last two decades.

Dr. Lisa F. Berkman, chair of the department of health and social behavior at Harvard School of Public Health, recently discussed her findings at a lecture that was part of a monthly seminar series sponsored by the NIH Office of Behavioral and Social Sciences Research.

"The extent to which we maintain close personal relationships, or the degree to which we feel rooted in our community or have deep, abiding social and psychological resources, help to determine how protected we are against biological, environmental, or interpersonal assaults," she said.

Recent studies conducted by Berkman and colleagues, as well as research published between 1976 and 1994 that she examined, have led her to conclude that illness and death rates reflect social patterns and are in need of more scrutiny.

"Once we recognize the social patterning of the distribution of diseases," she said, "it seems incumbent upon us to explore what it is about people's social circumstances that relates to disease risk. In order to make meaningful medical advances, we have to acknowledge that health exists in a social context...when we remove it from that context -- which is composed of other factors such as social class, economic status, race and ethnicity -- we become removed from something that...may be a significant cause of disease."

Biomedical research that Berkman examined in her effort to learn how social experience can get "under the skin and inside the body" suggests that multiple biologic pathways, such as the neuroendocrine or immune systems, may be involved. One study she reviewed focused on cardiovascular reactivity; volunteers were required to complete two laboratory tasks. Half of the subjects worked alone, the other half worked with an accompanying friend or "supportive partner." In the end, those in the latter group showed beneficially reduced heart rate and blood pressure. The researchers suggested the "friend's presence may have acted as a conditioned stimulus or a 'safety signal,' altering neural input to the heart during challenge."

Another mechanism of influence on the body may be more indirect. "When someone is socially isolated and has little or no sense of belonging," Berkman said, "he or she may drink more, smoke more, eat more, and so on, in an effort to fill the space."

Some populations Berkman highlighted as being at-risk for social isolation are the widowed whose main source of support was their spouse; people who have moved away from their families and close friends; immigrants; and those whose jobs relocate them frequently. In the latter two groups, although many of them may have tight family connections, she said, they are typically missing the kinds of extended relationships and contacts that would help them negotiate life in their new surroundings.

Berkman also discussed current research on social factors that transcend the individual's immediate surroundings. Harvard's Dr. Ichiro Kawachi asked participants in a national survey to agree or disagree with the following: "Most people would take advantage of you if they got the chance." In preliminary results, the researcher found that states whose residents felt confident about people's trustworthiness had the lowest death rates, and those who believed people are exploitative whenever possible had the highest mortality rates.

Berkman described two of her NIH-funded studies that are testing whether psychosocial prevention interventions can reduce morbidity and mortality rates. One 6-month study, supported by NINDS and NIA, is looking at people who have had a stroke. Based on findings from earlier research, she hypothesized that early social-network interventions might favorably influence health outcomes.

While Berkman expects that future studies will continue to confirm the relationship between social ties and health status, much remains unknown about how these factors interact.

"Since we have mostly mortality data," Berkman concluded, "we have very little understanding of where within the disease process these factors have their greatest effects. This would be very important to know in terms of prevention education campaigns, whether we should be focusing on primary prevention or whether our efforts should be secondary."

The next OBSSR seminar will feature Dr. James S. House of the University of Michigan on "Social Inequalities in Aging and Health," Friday, July 11, from 10 to 11 a.m. in Natcher Conference Center, E1-E2.

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