Social Support and Health: A Theoretical and Empirical Overview

It is generally assumed that social support has a favorable impact on the maintenance of health and on coping with illness. However, results are inconsistent and even conflicting. This is partly due to conceptual and methodological shortcomings. In order to overcome these problems and to guide further research, we present a taxonomy of social relationships and a causal process model. Social integration, cognitive social support and behavioral social support are distinguished and related to personality, stress, coping and the pathogenic process. In the causal model we propose that social support is depicted both as mediating the effects of stress on illness as well as directly affecting illness. A meta analysis was conducted that related social support and social integration to morbidity and mortality based on eighty empirical studies, including more than 60,000 subjects. Data subsets revealed disparate patterns of results that give rise to intriguing theoretical questions. Evidently, social support operates in complex ways. Several causal models are specified which represent alternative pathways of social support processes. Where social support was associated with less illness, a direct effect model was proposed. In cases where more support was seemingly paradoxically associated with illness it is assumed that a mobilization of support has taken place. In conclusion, some recent research examples that help illustrate future directions untangling the social support-illness relationship are presented.