Social Networks and Social Support
Thomas Ashby Wills
Marnie Filer Fegan
Ferkauf Graduate School of Psychology and Albert Einstein College of Medicine
This chapter considers how social support is related to physical health, including research on mortality, morbidity, and recovery from illness. During the past 10 years there has been a large amount of research showing measures of social network structure, or measures of available supportive functions, to be related to various outcomes (Belle, 1989; S. Cohen & Syme, 1985; I. G. Sarason, B. R. Sarason, & I. G. Sarason, 1988; Wills, 199Ob). During this time, there have been substantial advances in recognizing how beneficial social support can be; at the same time, this research has raised intriguing questions about how social support works.
The theme of the chapter is how social support works, because at present this question is less understood. A number of different mechanisms have been suggested as the basis for which an abstract social variable, social support, is related to objective physiological intermediaries (e.g., blood pressure) and to disease endpoints (e.g., mortality from myocardial infarction). These suggested mechanisms are most interesting from the standpoint of health psychology because they represent an interface between psychological theories of stress, coping, and affect, as well as physiological models of disease processes. Although a plethora of mechanisms has been suggested, the current evidence on the mechanism of support effects is mixed and sometimes fragmentary, so at present there is no consensus for seeing one particular mechanism as most likely. Hence the goal here is to survey the range of evidence available on social support and to suggest the relevance of possible mechanisms where they are indicated by the evidence.
This chapter is organized first by concepts about social support and then by areas of research. It first defines basic concepts and discusses conceptual issues where debate is still occurring. Then it describes the nature of five groups of mechanisms that have been postulated to account for the relationship between social support and health, and discusses briefly the approach for testing each mechanism. The chapter then covers evidence from several areas of social support research. It begins by surveying epidemiologic studies of morbidity and all-cause mortality, and then considers research on social support effects for three specific disease conditions: cancer, diabetes, and renal failure. The chapter then considers specific topics, such as social support effects among children and adolescents, social support effects during pregnancy, and social support effects in elderly populations. A final section summarizes the current findings and discusses some questions for further research.
Social support is broadly defined as resources and interactions provided by others that may be useful for helping a person to cope with a problem. Under this broad definition, however, several different perspectives on social support are encompassed, and these are reflected in different assessment approaches and research designs. One point of divergence is whether support is conceptualized as the number of persons an individual knows, or whether support should be conceptualized as the amount of effective resources available to an individual, irrespective of the absolute number of friends and acquaintances. Another area of divergence is whether it is adequate to obtain a global assessment of a person's support, or whether it is necessary to measure specific dimensions of support