How Relationships and Life Events
Affect Health: Human Studies
Lynda W. Freeman
We all pass through a series of life challenges. These challenges may include learning to cope with social networks or enduring periods of loneliness, depression, or emotional isolation. Challenges are often presented during a series of events called relationship passages. Relationship passages include (1) newlywed and marital adaptation period; (2) disruption of the marital state (e.g., separation, divorce, bereavement); and (3) caregiving when a spouse or family member becomes chronically ill. We can also experience chronic stressors (e.g., job-related stress, fear from a nuclear accident) and acute, short-term stressors (e.g., academic stress) not necessarily related to family or friends. All these events have important health consequences. This chapter provides information on how these challenges affect health on both a short- and long-term basis. It also provides information on what can be done to manage the emotional challenges that affect our health.
Most critical is the realization that if health care dollars are to be managed, the psychosocial aspects of life cannot be overlooked. It is hoped that this literature will serve as a wake-up call to health care professionals and a reminder that psychosocial interventions and support systems are not luxuries; rather, they are necessities in a comprehensive health care program.
Research on the effects of relationships and social support began in the 1970s and evolved around the concept of social support, the belief that one "is cared for and loved, esteemed, and a member of a network of mutual obligotions." 18 These early retrospective and prospective epidemiologic studies strongly suggested that the quantity and quality of relationships—marriage and friends—and social interaction—church and social activities—have powerful implications for morbidity and mortality.
Later research emphasized the assessment of biomedical variables (e.g., uric acid, cholesterol, and immune function [lymphocyte count, mitogen response, antibody titers]) and hormonal response (e.g., cortisol, norepinephrine [NEPI], epinephrine [EPI], growth hormone [GH], odrenocorticotropic hormone [ACTH]) as they relate to relationship passages (i.e., marital adaptation and disruption, spousal conflict, caregiving, bereavement). Psychologic mood state (i.e., depression, loneliness, hostility) was found to be correlated with immunologic and hormonal changes and health status, implicating a bi-directional response between mind and body. The biochemical, hormonal, and health effects of chronic stressors during relationship passages (e.g., coring for patients with Alzheimer's disease, bereavement, and fear of a nuclear accident) were topics of extensive research. Research on potential interventions was also conducted.
Acute stressors were assessed, in part, because researchers wanted to identify pathways by which biochemical and hormonal changes, if chronic, might alter health on a long-term basis. Academic stress and job-related stress were two areas of intense review because of the easy access to subjects and the ease of the study design.