Review
Psychological pathways linking social support to health outcomes: A visit with the “ghosts” of research past, present, and future

https://doi.org/10.1016/j.socscimed.2011.11.023Get rights and content

Abstract

Contemporary models postulate the importance of psychological mechanisms linking perceived and received social support to physical health outcomes. In this review, we examine studies that directly tested the potential psychological mechanisms responsible for links between social support and health-relevant physiological processes (1980s–2010). Inconsistent with existing theoretical models, no evidence was found that psychological mechanisms such as depression, perceived stress, and other affective processes are directly responsible for links between support and health. We discuss the importance of considering statistical/design issues, emerging conceptual perspectives, and limitations of our existing models for future research aimed at elucidating the psychological mechanisms responsible for links between social support and physical health outcomes.

Highlights

► Reviews almost 30 years of research that directly examined the evidence for models that propose psychological pathways linking social support and health. ► No evidence was found that psychological factors were mediators of links between social support and biological outcomes. ► Future research avenues are suggested to test these models (e.g., expanded set of mediators). ► Raises the possibility that our existing theoretical models are wrong or in need of important modifications.

Section snippets

Psychological mechanisms potentially linking social support to health

Perceived social support is one of the most well-documented psychosocial factors influencing physical health outcomes (see reviews by Berkman et al., 2000, Cohen, 1988, Holt-Lunstad et al., 2010, House et al., 1988, Pinquart and Duberstein, 2010, Uchino, 2004). Epidemiological studies indicate that individuals with low levels of social support have higher mortality rates; especially from cardiovascular disease (Barth et al., 2010, Berkman et al., 1992, Orth-Gomér et al., 1993). Although more

The ghosts of research past and present: testing psychological processes as confounds or mechanisms

A starting point for examining psychological mechanisms linking social support to health occurred in the 1980s to mid-1990s. Many of the early health models which postulated psychological mechanisms were meant to guide future work (Cohen, 1988, Cohen and Wills, 1985). However, as is typical with emerging potential risk factors, there was a concern that social support might be confounded with other factors, especially those related to mental health. For instance, it was shown that depression

The ghost of research yet to come: learning from the past for a more optimistic future?

The tale thus far does not inspire confidence in finding answers to this important theoretical question. Although social support has proven to be a robust predictor of future morbidity and mortality (Holt-Lunstad et al., 2010), decades of research have consistently been unable to demonstrate the psychological mechanisms directly responsible for such links. We believe we are at a point where staying the present course is unlikely to lead to answers to this question and indeed may sidetrack us

How will this story end?

Contemporary models clearly postulate psychological mechanisms as theoretically important pathways linking social support to health (Berkman et al., 2000, Cohen, 1988, Cohen, 2004, Thoits, 2011, Uchino, 2004). However, decades of research have failed to directly document these mechanisms. While none of us have self-identified as “Scrooges,” the current state of the literature is at best discouraging in terms of direct answers to this crucial question. It is always difficult to forecast the

Acknowledgments

This research was supported by grant number R01 HL085106 from the National Heart, Lung, and Blood Institute. We would like to thank Dr. Peggy Thoits and Dr. Thomas Kamarck for their helpful suggestions on a draft of this paper.

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