Social Relations


Article Author:
Elizabeth Cash


Article Editor:
Tammy Toney-Butler


Editors In Chief:
Alexandra Caley
Sameh Boktor


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
5/2/2019 6:14:52 PM

Introduction

Social relations are broadly defined as any relationship or interaction between two or more individuals. Interest in social relationships and resulting support began a century ago when the French sociologist Emile Durkheim postulated that disruptions in social networks could influence psychological health.[1] Consequently, theoretical models have emerged that conceptualize social support as a multifaceted construct. Models typically include the concepts of social integration, or level of involvement in relationships, such as marriage or group membership, and the emotional, tangible or practical support from others that serves a functional purpose.[1][2] An individual’s acknowledgment or fulfillment of social roles may beneficially influence self-esteem and provide a sense of meaning or controllability to life.[3] It is also important to consider the converse, or social conflict, as there are important consequences to emotional and physical health for the socially isolated individual, one who lacks social connections, or those for whom relationships serve as a source of stress.[1][2]

Issues of Concern

Social Relations and Stress

A widely accepted view of psychological stress defines it as the appraisal of an event as taxing or overwhelming one’s resources (Lazarus & Folkman, 1984. Stress, appraisal, and coping. New York, NY, Springer). This theory first proposed that appraisal of an event as threatening or exceeding one’s resources activates physiological stress response systems in the body, including the autonomic (fight or flight) system and hypothalamic-pituitary-adrenal (HPA) axis.[4]

The hypothalamic-pituitary-adrenal (HPA) axis responds to central nervous systems signals that regulate the release of the glucocorticoid hormone, cortisol, from the adrenal gland. In a healthy individual, circulating cortisol levels double within 30 minutes to 45 minutes after awakening and then gradually decrease over the course of the day and subsequent night,[5] reflective of the diurnal slope. As a primary conductor of the physiological stress response, psychological stress also activates the hypothalamic-pituitary-adrenal axis. When a stressor lasts for more than a few minutes, increased levels of cortisol are released from the adrenal cortex. When a stressor or repeated stressors become chronic, lasting for periods of months to years, the over-taxed HPA axis becomes less able to respond flexibly to environmental demands. This results in long-lasting dysregulation of axis functioning, which can manifest as erratic peaks and troughs in diurnal cortisol expression.

Social relationships that are perceived as emotionally supportive have demonstrated their potential to act as a buffer of the effects of stress. Social support makes the demands of a stressor feel more manageable, thereby buffering its impact.[6][7] As such, social support may provide some protection to hypothalamic-pituitary-adrenal axis responsivity. In fact, simply being married may be protective of HPA axis function. In a community sample, married individuals had healthier appearing cortisol rhythms than their never married or previously married counterparts. Interestingly, the relationship between high stress and cortisol disruption appeared to be diminished among married individuals.[8] Marital satisfaction was not assessed. This suggests that even those who are dissatisfied in their marriages may still experience benefit. This may be in part related to increased access to healthcare/insurance or growing social networks, both of which often accompany marriage.

While the size of an individual’s social network, or integration, may not be associated with diurnal cortisol secretion or acute stress responses, supportive relationships have been associated with more rhythmic or healthy-appearing diurnal cortisol expression profiles.[9][10] Alternatively, it has been noted that when one feels isolated or less integrated into social networks, the associated increased psychological stress appears to amplify physiological stress responses.[11] Social isolation has been associated with dysregulation of diurnal cortisol expression in several studies of healthy adults.[12][13]

Clinical Significance

The impact of the social world on physiology and health is a topic of intrigue to scientists in a variety of disciplines. Social interactions may exert direct effects on biological functioning by providing a zeitgeber (i.e., time-giver) to set or reset our biological clocks.[14] Social integration may directly and positively influence health behaviors. Integration also promotes social embeddedness, defined as ongoing social connectedness that facilitates beneficence toward self and others, which may positively affect health.[15]

Societal roles, for example, the social role of mother or spouse, may provide one with a sense of social identity and thereby influence health behaviors, such as exercising or smoking cessation. Provision of information regarding the importance of treatment adherence may be another way in which our social structure exerts a direct impact.

Physiological stress response systems tend to become less efficient with age. Chronic or frequently repeated stress response activation stress may also bring about hypothalamic-pituitary-adrenal dysregulation. This affects the responsivity of the axis, reducing the flexibility of the hypothalamic-pituitary-adrenal stress response mechanism. Chronic dysregulation of these systems may hamper the body’s natural disease defenses. As a result, psychological stress may be implicated in disease onset, development, and course.[16]

Individuals reporting better social support demonstrate preserved hypothalamic-pituitary-adrenal axis efficiency, an association that may be even more pronounced among older males.[17] Greater social integration has also been shown to reduce disease and mortality risk.[18] Supportive relationships may be beneficial for cardiovascular health, endocrine and immune function, and protection from disease development.[19] A recent example highlights these effects: a study utilizing a large epidemiological cancer database (SEER data) revealed that unmarried cancer patients are at greater risk for presentation with metastatic disease, under-treatment of illness, and increased risk of death.[20]

Social Relationship Interventions

Existing social relationships appear to exert a strong impact on the psyche and physiology. Understandably, attempts to increase these factors have garnered significant attention in recent decades. Social support interventions by nature work to "mobilize the social environment" to meet an individual's needs better.[21] Social support interventions typically focus on at least one of three main attributes. They change the structure or composition of the social field, change attitudes or behavior toward the social field, or change the quality and frequency of support received.[22] Promising studies have also demonstrated that these types of interventions may benefit endocrine and immune physiology in patients with cancer.[23] Future research will be useful for better understanding of the mechanisms by which social relationships are most effective at conferring psychological and physiological benefits. Similarly, public health policy initiatives that promote social relationships may beneficially impact health.


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Social Relations - Questions

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At a meal, a patient is observed grabbing condiments from others, chewing with his mouth open, and failing to interact with others at the table. The other patients at the table ignore him. Select the most probable comprehensive deficit.



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Sue is an executive who enjoys interacting with her co-workers. She is also engaged in coaching activities for her children's soccer league, and makes time to volunteer with local organizations. What does the research on social relations indicate as the least likely outcome of Sue's activities?



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Glen has just been diagnosed with cancer. He needs assistance in getting to his appointments, someone to pick up groceries for him, and someone to help care for his dog while he is undergoing treatment. His sister, Sarah, offers to help. This is an example of:



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Theories of social support encompass four constructs, social integration, social isolation, positive social relationships, and negative or detrimental relationships. Each construct has varying effects on physical health. Which of the following is an example of the effect of social support on health?



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According to studies among healthy adults, which of the following is true?



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Families come in a multitude of types with households consisting of children and adolescents under 18 years of age. What are some family types? Select all that apply.



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Social Relations - References

References

Marital status and survival in patients with cancer., Aizer AA,Chen MH,McCarthy EP,Mendu ML,Koo S,Wilhite TJ,Graham PL,Choueiri TK,Hoffman KE,Martin NE,Hu JC,Nguyen PL,, Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013 Nov 1     [PubMed]
Stress, social support, and the buffering hypothesis., Cohen S,Wills TA,, Psychological bulletin, 1985 Sep     [PubMed]
Health psychology: developing biologically plausible models linking the social world and physical health., Miller G,Chen E,Cole SW,, Annual review of psychology, 2009     [PubMed]
Uncoupling of social zeitgebers and diurnal cortisol secretion in clinical depression., Stetler C,Dickerson SS,Miller GE,, Psychoneuroendocrinology, 2004 Nov     [PubMed]
Aging and the HPA axis: Stress and resilience in older adults., Gaffey AE,Bergeman CS,Clark LA,Wirth MM,, Neuroscience and biobehavioral reviews, 2016 Sep     [PubMed]
Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies., Cacioppo JT,Ernst JM,Burleson MH,McClintock MK,Malarkey WB,Hawkley LC,Kowalewski RB,Paulsen A,Hobson JA,Hugdahl K,Spiegel D,Berntson GG,, International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 2000 Mar     [PubMed]
Marital status as a predictor of diurnal salivary cortisol levels and slopes in a community sample of healthy adults., Chin B,Murphy MLM,Janicki-Deverts D,Cohen S,, Psychoneuroendocrinology, 2017 Apr     [PubMed]
Cohen S, Social relationships and health. The American psychologist. 2004 Nov;     [PubMed]
Umberson D,Crosnoe R,Reczek C, Social Relationships and Health Behavior Across Life Course. Annual review of sociology. 2010 Aug 1;     [PubMed]
Stinson DA,Wood JV,Doxey JR, In search of clarity: self-esteem and domains of confidence and confusion. Personality     [PubMed]
Charmandari E,Tsigos C,Chrousos G, Endocrinology of the stress response. Annual review of physiology. 2005;     [PubMed]
Stone AA,Schwartz JE,Smyth J,Kirschbaum C,Cohen S,Hellhammer D,Grossman S, Individual differences in the diurnal cycle of salivary free cortisol: a replication of flattened cycles for some individuals. Psychoneuroendocrinology. 2001 Apr;     [PubMed]
Uchino BN, What a Lifespan Approach Might Tell Us about Why Distinct Measures of Social Support have Differential Links to Physical Health. Journal of social and personal relationships. 2009 Feb 1;     [PubMed]
Stetler CA,Miller GE, Social integration of daily activities and cortisol secretion: a laboratory based manipulation. Journal of behavioral medicine. 2008 Jun;     [PubMed]
Rosal MC,King J,Ma Y,Reed GW, Stress, social support, and cortisol: inverse associations? Behavioral medicine (Washington, D.C.). 2004 Spring;     [PubMed]
Cacioppo JT,Cacioppo S,Capitanio JP,Cole SW, The neuroendocrinology of social isolation. Annual review of psychology. 2015 Jan 3;     [PubMed]
Brown EG,Gallagher S,Creaven AM, Loneliness and acute stress reactivity: A systematic review of psychophysiological studies. Psychophysiology. 2018 May;     [PubMed]
Burt RS,Kilduff M,Tasselli S, Social network analysis: foundations and frontiers on advantage. Annual review of psychology. 2013;     [PubMed]
McEwen BS, The neurobiology of stress: from serendipity to clinical relevance. Brain research. 2000 Dec 15;     [PubMed]
Berkman LF,Syme SL, Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. American journal of epidemiology. 1979 Feb;     [PubMed]
Koopman C,Hermanson K,Diamond S,Angell K,Spiegel D, Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psycho-oncology. 1998 Mar-Apr;     [PubMed]
Cohen S,Gottlieb BH,Underwood LG, Social relationships and health: challenges for measurement and intervention. Advances in mind-body medicine. 2001 Spring;     [PubMed]
Carlson LE, Mindfulness-based interventions for coping with cancer. Annals of the New York Academy of Sciences. 2016 Jun;     [PubMed]

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