Social support has direct and indirect effects

With respect to health, social support may have direct or indirect (buffer) effects (Cohen & Syme, 1985).

• The direct effect implies that social support has a positive effect on health, irrespective of life situation
• The buffering effect occurs only when the person is exposed to stressors, like negative life events and more lasting adversities. In this instance, social support is supposed to help the person to cope better with the situation, and hence prevent stress. Coping also depends on personal characteristics, and the interplay between social support and personality assets may be crucial for the health effect of stressors.

Social support affects health through different pathways

Social support can affect a person’s health through different pathways: health behavioural, psychological and physiological pathways (Berkman & Glass, 2000).

• In the health behavioural pathway, social support influences a person’s health behaviour. A lack of social support is, for example, associated with excess smoking (to relieve psychological distress?), an unhealthy diet and a lack of exercise, and less use of health services when ill.
• In the psychological pathway social support affects mental health through such factors as self-esteem and self-efficacy.
• The perception of social support strengthens the coping abilities of the person, and hereby reduces stress and it’s negative physiological effects on health, for instance via the immune system or the cardiovascular system.

Poor social support is associated with mental health problems

A large number of studies suggest that poor social support is associated with mental health problems, such as depression (e.g. Brown & Harris, 1978, House, 1981, Schaefer et al., 1981, Dalgard et al., 1995a). In a survey of seventeen EU countries, a lower level of social support (measured by the OSS-3) was strongly associated with an enhanced prevalence of psychological distress: Association between social support and psychological distress. This was observed for all three items of the OSS-3. In all countries the percentage of people reporting psychological distress decreased as the social support increased; the strength of the association was highly significant in 14 of the 17 countries. . Countries with the highest level of social support (i.e. Sweden and Ireland) tend to report the lowest levels of psychological distress and vice versa (EORG, 2003a).It is unknown which dimensions of social support are responsible for the differences between the countries, and it should also be kept in mind that the differences may be influenced by problems in the translation of the questionnaire.

Strong social support is associated with positive mental health

A significant association between strong social support and positive mental health, in the sense of coping resources, like energy and vitality, was found (EORG, 2003a): Age-adjusted EVI-means by perceived social support. The relationship between social support OSS-3 and positive mental health was the same in all participating countries (Lehtinen et al., 2005).

Social support influences somatic health and mortality

Poor social support is associated with higher mortality rates (e.g. House et al., 1982, Berkman & Syme, 1979, Hansson et al., 1989, Dalgard & Haaheim, 1998). An overview of longitudinal studies showing increased mortality associated with a lack of social support and weak social ties is given by Quick et al., 1996. However, it is difficult to untangle the effect of social support from the possible effect of personality factors, since personality factors are seldom included in the studies of social support and mortality (Eriksen, 1994).

For mortality caused by cardiovascular diseases the association is especially strong (Eriksen, 1994, Kuper et al., 2002, Everson-Rose & Lewis, 2005, Luttik et al., 2005).

Emotional support seems to be of particular importance for the etiology and the prognosis of cardiovascular disorders. Not only the positive effect of social support on health, but also the negative effect of critical and/or demanding interactions, has been underlined (Seeman, 2000).