Social Integration Ralf Schwarzer by ihuangpingba

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									                                                                                               Concepts of Social Integration and Social Support



                                                                                               Social Support and Mortality

                                                                                               Survival from Chronic Illness and Medical Procedures

       Mortality, Morbidity, and                                                               Conjugal Loss


                Gender
          Ralf Schwarzer, Freie Universität Berlin, Germany
                                                                                               Social Support and Morbidity

                                                                                               Social Support and Recovery from Cardiac Disease
                         http://www.RalfSchwarzer.de
                                                                                               Social Support in the Etiology of Disease




„Social networks function to meet basic
emotional needs for social integration,
reassurance of worth and intimacy as
well as practical needs for assistance,
guidance, advice and access to new
contacts and information. This occurs
through the interactive process of social
support ... “            (p. 935)




Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the
relationship between social network support and mortality:A longitudinal study of an elderly
cohort. Social Science and Medicine, 41, 935-947.
                                                                                               Social Integration


                                                                                                                         Social Support:
                                                                                                                        How does it work?
                                     NACHBAR-
                                     NACHBAR-
                                      SCHAFT                                                   Dunkel-Schetter et al., 1992
                                       UND                                                                                                Gives help
                                     GEMEINDE
                  EHE UND                                   FREUND-
                                                            FREUND-
                  FAMILIE                                   SCHAFT                                            recipient                  provider


                                                  BINDUNG                                                 Needs help
                       BERUFLICHE                    AN
                        BINDUNG                    ORGANI-
                                                   ORGANI-                                                                    observer   Sees it happen
                                                  SATIONEN




                                                                                                                                                          1
Conceptual Issues
Quantitative –               Qualitative – functional:
structural:
                                   Social Support
Social Integration
                         1. Perceived available support
                            (= prospective)
                         2. Actually received support
                            (= retrospective)

                     Emotional, Tangible, Informational, etc.
                                                                Marital Status




                 Very Happy




                                            Peer
                                            Network              Companionship




                                                                                 2
                             Friendship




Soziale Netzwerke im Alter
                                           Social
                                          Support
Berliner Altersstudie,
 Wagner, Schütze &
    Lang, 1996


                                           Schwarzer, 2000




                                                             3
 BEGRIFFLICHE DIFFERENZIERUNG VON SOZIALEM                    Frauen, die im Verlauf ihrer Schwangerschaft besonders starken
                  RÜCKHALT                                    Belastungen unterworfen sind, jedoch emotionale Unterstützung
                                                              genießen, weisen weniger medizinische Komplikationen auf als Frauen
                                                              mit gleich starken Belastungen, aber ohne Unterstützung (Nuckolls, et al.
                                                              1972)
    quantitativ-strukturell    qualitativ-funktional          Bei Anwesenheit und emotionalem Beistand durch eine befreundete Frau
           SOZIALE                  SOZIALE                   während der Geburt vermindert sich die durchschnittliche Geburtszeit um
        INTEGRATION              UNTERSTÜTZUNG                rund die Hälfte; der Geburtsstreß für Mutter und Kind reduziert sich
                                                              erheblich (Sosa).
                              Erwartete Unterstützung
                               •emotionale Unterstützung      Paare, die sich gegenseitig Hilfe bescheinigen, zeigen unter belastenden
                              •instrumentelle Unterstützung   Lebens- und Arbeitsbedingungen ein besseres psychisches Befinden.
                                                              (Burke & Weir, 1977)
                                •informelle Unterstützung

                              Erhaltene Unterstützung
                                                              Personen, die an ihrem Arbeitsplatz emotionale Hilfe durch ihre Kollegen
                               •emotionale Unterstützung      erfahren, zeigen als Folge von Streß weniger psychosomatische
                              •instrumentelle Unterstützung   Beschwerden als Personen ohne Hilfe. (La Rocco, et al. 1980)
                                •informelle Unterstützung




        Social Support                                                      Types of social support
                                                                  Emotional                            caring and sharing
• when people believe they :
   – are cared for and loved                                      Informational                        tips for studying for
                                                                                                       the next exam
   – are respected and valued                                     Tangible                             babysitting for a tired
   – belong                                                                                            Mum
                                                                  Social affiliation                   caring for family
                                                                                                       members
                                                                  Affirmation                          supportive listening




                                                                   Aussagen, die sich auf Gefühle und Erlebnisse beziehen, die in
  How social support may help:                                            Beziehungen zu Freunden vorkommen können.
                                                                    Antwortmöglichkeiten: JA        NEIN      WEISS NICHT
                                                                1. Meine Freunde geben mir die moralische Unterstützung, die ich brauche
• enhances health-seeking behaviours                            2. Die meisten anderen Menschen stehen ihren Freunden näher als ich
                                                                3. Einige meiner Freunde kommen zu mir, wenn sie Probleme haben oder
  – e.g., people alone may not eat proper meals                 einen Rat brauchen
• may encourage people to seek health care                      4. Ich vertraue auf meine Freunde, wenn ich emotionale Unterstützung
                                                                brauche
  – e.g., a man goes to Dr because his wife sent                5. Ich habe einen Freund, zu dem ich gehen kann, wenn ich mich bedrückt
    him                                                         fühle, ohne mich hinterher zu schämen
                                                                6. Meine Freunde sind meinen persönlichen Bedürfnissen gegenüber sehr
• can change a stressor                                         feinfühlig

  – e.g.. losing your job may not be as                         7. Meine Freunde können mir gut helfen, Problem zu lösen

    devastating if friends are there to support you             8.Meine Freunde bekommen von mir gute Ideen darüber, wie einige Dinge zu
                                                                handhaben sind
• softens the impact of disease or life event                   9. Meine Freunde suchen mich auf, wenn sie Gesellschaft brauchen
                                                                10. Ich glaube, meine Freunde fühlen, daß ich ihnen gut helfen kann, Probleme
                                                                zu lösen




                                                                                                                                                4
                                                                                                                                         Freunden,
                                                                             Die Fragen beziehen sich auf die Unterstützung, die Sie von Freunden,
                                                                            Verwandten, Gruppen, Organisationen oder von ihrem Partner im letzten
Haben Sie Kontakte zu Menschen, die vor der Wende Bürger               JA                           Monat erhalten haben:
der alten Bundesländer waren, unabhängig davon, wo diese
Personen jetzt wohnen?                                              NEIN    1.a Wie oft haben Ihnen diese Menschen Ratschläge gegeben oder
                                                                            Informationen übermittelt (egal, ob Sie das wollten oder nicht)?
Denken Sie jetzt bitte nur an diese Personen. Mit welchen dieser Personen
hatten sie zuletzt Kontakt. Sie können an bis zu drei Personen denken.                           Antwortmöglichkeiten von „NIEMALS“ bis „SEHR OFT“
Bitte notieren Sie die Anfangsbuchstaben der Vornamen in den drei
Kästchen.
                                                                              a. Ihre Freunde                              b.Ihre Verwandten                                         c.Ihr(e) Partner(in)
                                                                              d.Gruppen oder Organisationen                                                   (Welche ?                                                     )
In welchem Verhältnis stehen Sie zu den Personen? Bitte kreisen Sie ein.      e.Andere                                                                        (Welche?                                                      )
                            PERSON 1          PERSON 2          PERSON 3
 Ist Partner (in)
 ist Freund (in)                                                            1.b Wie zufrieden oder unzufrieden waren Sie im Allgemeinen mit diesen
 ist guter Bekannter                                                        Ratschlägen oder Informationen im letzten Monat?
 ist flüchtiger Bekannter
 ist Nachbar (in)
 ist Kolleg (in)                                                             Sehr unzufrieden                                                         Weder noch                                                      Sehr zufrieden
 ist Vater, Mutter,
 Schwester, Bruder
 ist Verwandtschaft
 ist anders




   Social Support                                                                                        How do we measure Social
                                                                                                                Support?

   Measurement                                                                        • Social Support Questionnaire
                                                                                        (Sarason et al., 1983)
                                                                                        27 items
                                                                                        e.g. “Who helps you feel that you
                            www.coping.de                                               truly have something positive to
                                                                                        contribute to others?”
                    www.RalfSchwarzer.de




                                                                            3,5
                                                                                           Friends are the most important source of support for gay men

                                                                              3


                                                                            2,5


                                                                              2


                                                                            1,5


                                                                              1
                                                                                                 Advise                                     Assist                                 Reassure                                        Listen

                                                                                                                           Friend                 Relatives                    Partner                 Groups

                                                                              Schwarzer, R., Dunkel-Schetter, C., & Kemeny, M. (1994). The multidimensional nature of received social support in gay men at risk of HIV infection and AIDS.
                                                                              American Journal of Community Psychology, 22, 319-339.




                                                                                                                                                                                                                                              5
                                                                                               4
                                                                                             3,5
                                                                                               3
                                                                                             2,5
                                                                                               2
                                                                                             1,5
                                                                                               1
                                                                                                                    Advise            Assist        Reassure          Listen

                                                                                                                            Friend   Relatives      Partner    Groups


                                                                                           Received social support means by support type and provider source in
                                                                                                    902 Costa Rican workers (Gutierrez-Dona, 2003).




 4,2
                                                                                                                           4,5




 4,0                                                                                                                       4,0
                                                                                                   Receiving Advice




 3,8                                                                                                                       3,5



 3,6
                                                                                                                           3,0



 3,4
                                                                                                                           2,5
                                                                    Men
                                                                                                                                                                       Men
 3,2                                                                Women
       Advise                     Assist   Reassure     Listen                                                             2,0                                         Women
 Sex differences in the amount of received spousal support in 902                                                           < 25      25-34         35-44      > 44

Costa Rican workers. In contrast, sex differences in friend support,
                                                                                                                                              Age
    relatives support, and group support were less significant.




                                 4,2                                                                                       4,5



                                 4,0

                                                                                                                           4,0
                                                                                                   Receiving Reassurance
           Received Assistance




                                 3,8



                                 3,6                                                                                       3,5



                                 3,4

                                                                                                                           3,0

                                 3,2
                                                                                   Men                                                                                 Men

                                 3,0                                               Women                                   2,5                                         Women
                                  < 25          25-34            35-44      > 44                                            < 25      25-34         35-44      > 44


                                                          Age                                                                                 Age




                                                                                                                                                                               6
                                                                                         4,4                                                                                                           3,4
                                            Received Spousal Support: Listening




                                                                                                                                                             Received Friend Support: Sum Score
                                                                                         4,2
                                                                                                                                                                                                       3,3
                                                                                         4,0


                                                                                         3,8
                                                                                                                                                                                                       3,2

                                                                                         3,6

                                                                                                                                                                                                       3,1
                                                                                         3,4


                                                                                         3,2
                                                                                                                                                                                                       3,0
                                                                                         3,0                                                    Men                                                                                         Men

                                                                                         2,8                                                    Women                                                  2,9                                  Women
                                                                                          < 25               25-34          35-44        > 44                                                           < 25   25-34         35-44   > 44


                                                                                                                      Age                                                                                              Age




                                                                                         4,2                                                                                                           4,4
                                            Received Support from Relatives: Sum Score




                                                                                                                                                             Received Spousal Support: Sum Score
                                                                                         4,1                                                                                                           4,2

                                                                                                                                                                                                       4,0
                                                                                         4,0

                                                                                                                                                                                                       3,8
                                                                                         3,9
                                                                                                                                                                                                       3,6
                                                                                         3,8
                                                                                                                                                                                                       3,4
                                                                                         3,7
                                                                                                                                                                                                       3,2

                                                                                         3,6
                                                                                                                                                                                                       3,0

                                                                                         3,5                                                    Men                                                    2,8                                  Men

                                                                                         3,4                                                    Women                                                  2,6                                  Women
                                                                                          < 25               25-34          35-44        > 44                                                           < 25   25-34         35-44   > 44


                                                                                                                      Age                                                                                              Age




                                      4,4                                                                                                                                                              2,6
                                                                                                                                                             Received Support from Groups: Sum Score
Received Spousal Support: Sum Score




                                      4,2
                                                                                                                                                                                                       2,5
                                      4,0
                                                                                                                                                                                                       2,4
                                      3,8

                                      3,6                                                                                                                                                              2,3


                                      3,4
                                                                                                                                                                                                       2,2

                                      3,2
                                                                                                                                                                                                       2,1
                                      3,0

                                                                                                                                    494 Men                                                            2,0                                  Men
                                      2,8

                                      2,6                                                                                           363 Women                                                          1,9                                  Women
                                       < 25                                                    25-34          35-44         > 44                                                                        < 25   25-34         35-44   > 44
                                                                                                                                     For 95% of sample who
                                                                                                       Age                             live with a partner                                                             Age




                                                                                                                                                                                                                                                    7
          Received Spousal Support: Sum Score Wave 2
                                                       4,4



                                                                                                                                                                   4,4                                                                                 4,4




                                                                                                                      Received Support from Relatives: Sum Score
                                                       4,2




                                                                                                                                                                                                                 Received Spousal Support: Sum Score
                                                                                                                                                                   4,2                                                                                 4,2

                                                                                                                                                                   4,0                                                                                 4,0

                                                                                                                                                                   3,8                                                                                 3,8
                                                       4,0
                                                                                                                                                                   3,6                                                                                 3,6


                                                                                                                                                                   3,4                                                                                 3,4

                                                       3,8                                                                                                         3,2                                                                                 3,2

                                                                                                                                                                   3,0                                                                                 3,0

                                                                                                                                                                   2,8                                   Men                                           2,8                                     Men

                                                       3,6                                                                                                         2,6                                   Women                                         2,6                                     Women
                                                                                                                                                                    < 25   25-34         35-44    > 44                                                   < 25     25-34         35-44   > 44
                                                                                                           Men
                                                                                                                                                                                   Age                                                                                    Age
                                                       3,4                                                 Women
                                                        < 25            25-34         35-44         > 44


                                                                                Age




0,4
                                                                                                                                                                    0,4
                                                                                                                                                                   0,35
0,3                                                                                                                                                                 0,3
                                                                                                                                                                   0,25
0,2                                                                                                                                                                 0,2
                                                                                                                                                                   0,15
0,1                                                                                                                                                                 0,1
                                                                                                                                                                   0,05
  0                                                                                                                                                                   0
        Pos Affect                                                 Depression            Qual Psy          Qual Phy                                                        Pos Affect            Depression                                                  Qual Psy              Qual Phy
                                                               Friend     Relatives    Partner   Groups
                                                                                                                                                                                         Friend      Relatives                                               Partner       Groups

                                                                                                                                                   Absolute correlation coefficients between four sources of received overall
 Absolute correlation coefficients between four sources of received overall
                                                                                                                                                    support (sum score of advice giving, assistance, reassurance, listening)
support (sum score of advice giving, assistance, reassurance, listening) by
                                                                                                                                                     by four different provider sources. Subsample of Costa Rican women.
four different provider sources. Subsample of Costa Rican men (n = 515).
                                                                                                                                                            (n= 387). Note: Coefficients for depression are negative.
               Note: Coefficients for depression are negative.




   Social Support Scales at:
                                                                                                                                                                            Deutscher
                                                                                                                                                                           Alterssurvey
                                      www.coping.de
                                                                                                                                                                               DZA
         www.RalfSchwarzer.de




                                                                                                                                                                                                                                                                                                       8
                                                                                         Children as Sources of Emotional Support (N=3,085)
                                                                                    in %
 Spouses as Sources of Emotional Support (N=3,085)
                                                                                    50
in %
80                                                                                  40

70
60                                                                                  30

50
40                                                                                  20

30
20                                                                                  10

10
 0                                                                                   0
         Men         Women          Men          Women         Men         Women           Men       Women            Men         Women            Men      Women

          40 - 54 yrs                     55 - 69 yrs            70 - 85 yrs                 40 - 54 yrs                    55 - 69 yrs              70 - 85 yrs

                                           Age                                                                                Age




         Sisters and Brothers as Sources of Emotional                                    Berlin Social-Support Scales (BSSS)
  in %                 Support (N=3,085)
                                                                                                             Ralf Schwarzer & Ute Schulz, 2000


  20                                                                                1.     Perceived Available Support
                                                                                    2.     Need for Support
                                                                                    3.     Support Mobilization
  10
                                                                                    4.     Actually Provided Support, Provider
                                                                                    5.     Actually Received Support
     0
           Men          Women        Men           Women        Men         Women
               40 - 54 yrs                  55 - 69 yrs              70 - 85 yrs                      Available at www.coping.de
                                             Age




                      Recipient                            Source                                     Recipient                                  Source


               Perceived             Need                                                     Perceived                 Need


                     Mobilization                          Provided                                  Mobilization                           Provided



               Received                                                                          Received


     Social Support in the Context of Dyadic Coping                                      Social Support in the Context of Dyadic Coping




                                                                                                                                                                    9
Perceived Available Emotional Support
                                                                    Recipient              Source
1. There are some people who truly like me.

2. Whenever I am not feeling well, other                        Perceived          Need
people show me that they are fond of me.
                                                                    Mobilization          Provided
3. Whenever I am sad, there are people who
cheer me up.
                                                                Received
4. There is always someone there for me
when I need comforting.
                                                           Social Support in the Context of Dyadic Coping




             Need for Support                                       Recipient              Source

When I am down, I need someone
                                                                Perceived          Need
who boosts my spirits.
                                                                    Mobilization          Provided

It is important for me always to
have someone who listens to me.                                 Received


                                                           Social Support in the Context of Dyadic Coping




       Support Mobilization
           is a coping strategy, e.g.:                              Recipient              Source


In critical situations, I prefer to ask others for their        Perceived          Need
      advice.
Whenever I am down, I look for someone to cheer
                                                                    Mobilization          Provided
      me up again.
When I am worried, I reach out to someone to talk
      to.
If I do not know how to handle a situation, I ask               Received
      others what they would do.
Whenever I need help, I ask for it.                        Social Support in the Context of Dyadic Coping




                                                                                                            10
             Actually Received Support
                                                                           Recipient                       Source
 Think about the person who is closest to you, such
as your spouse, partner, child, friend, and so on.
How did this person react to you during the last
                                                                      Perceived            Need
week?

1. This person showed me that he/she loves and accepts                     Mobilization                   Provided
      me.
3. This person comforted me when I was feeling bad.
8. This person made me feel valued and important.                     Received
9. This person expressed concern about my condition.
10. This person assured me that I can rely completely on
      him/her.                                                   Social Support in the Context of Dyadic Coping




Actually Provided Support by Partner                                       Recipient                      Source
(For a Male Patient)

Now think about the patient. How did you interact with                            .45
him during the past week?
                                                                      Perceived            Need
  I showed him how much I cherish and accept                            .53               .62
      him.(EMO)                                            .49             Mobilization                  Provided
  I was there when he needed me.                                                                ~ .0
      (INSTRUMENTAL)                                                 .28 to .33                 dyadic
  I comforted him when he was feeling bad. (EMO)                      Received
  I did a lot for him. (INSTRUMENTAL)                                                              .22 to .48 dyadic
  I made him feel important and valued. (EMO)
                                                             Social Support Correlations in the Cancer Surgery Study




      How does social support influence
                                                                     Does social support always help?
                  health?
   • The main effect hypothesis: With its very                    • Although support may be offered
     presence reduces the effect of a stressor and
     its absence itself acts as a stressor.                         or available to us, we may not
   • The stress buffering hypothesis: social                        perceive it as supportive.
     support helps individuals to cope with stress
     by buffering the individual from the                         • The type of support we receive
     stressor; social support influences the                        may not match the needs that the
     individual’s appraisal of the potential                        stressor has produced.
     stressor.




                                                                                                                       11
                                                                                                                           Social support and mortality

                                                                                                                • There is a link between mortality
                                                                                                                  risk and social support
                                                                                                                  Berkman and Syme (1979): 4700
                                                                                                                  people. Risk of death for the most
                       Mortality                                                                                  isolated 2-3 times greater than for
                                                                                                                  those individuals with most social
                                                                                                                  contacts.
                                                                                                                    Berkman, 1984
                                                                                                                    Cohen, 1988

 and Social Integration                                                                                             House et al., 1988




            Social support in times of illness                                                                        Social support and non-disclosure

    • Ruberman et al. (1984): men who had                                                                       • Radley (1988): men who were to
      suffered a heart attack and who were                                                                        receive heart surgery, and who, with
      classified as being socially isolated,                                                                      their wives, reported most strain at this
      and having high levels of “life stress”,                                                                    time, not only had fewer contacts, but
      had more than 4 times the risk of dying                                                                     also expressed a wish not to speak to
      as compared with men low on bow of                                                                          others about their condition, or about
      these measures.                                                                                             problems arising from it.




                                                                                                           In healthy populations, 5 out of 8
Prospective cohort studies provide
strong evidence that psychosocial                                                                          prospective cohort studies suggest
factors, particularly depression and                                                                       a possible aetiological role for
social integration, are independent                                                                        social support or social integration.
aetiological and prognostic factors for                                                                    Depression/Anxiety                                               11/11 studies

coronary heart disease (Hemingway                                                                          Type A/ Hostility                                                6/14 studies

& Marmot, 1999, p. 1460).                                                                                  Psychosocial work characteristics                                6/10 studies
                                                                                                           Social integration                                               5/8 studies
Hemingway, H. & Marmot, M. (1999). Psychosocial factors in the aetiology and prognosis of coronary
heart disease: Systematic review of prospective cohort studies. British Medical Journal, 318, 1460-1467.    Hemingway, H. & Marmot, M. (1999). Psychosocial factors in the aetiology and prognosis of coronary
                                                                                                            heart disease: Systematic review of prospective cohort studies. British Medical Journal, 318, 1460-1467.




                                                                                                                                                                                                                       12
                                                                                                                                                                                                                                                                                                                                                                                                                                             Follow up


In coronary heart disease                                                                                            Author, year, country                                                                                                  Total sample (% women)                                                                      Age at entry                       Exposure                                                           (years)



                                                                                                                    Medalie 1976w49 Israel                                                                                                             10 000 (0)                                                                             >40                          Perceived love and support from                                       5

populations, 9 out of 10 prospective                                                                                                                                                                                                                                                                                                                                       spouse




cohort studies suggest a possible                                                                                   House 1982w50 USA                                                                                                                  2754 (52)                                                                              35-69                        Social relationships and activities                                  11



                                                                                                                    Berkman 1983w51 USA                                                                                                                4725 (53)                                                                              30-69                        Social network index                                                  9

prognostic role for social support or                                                                               Reed 1983w52 USA                                                                                                                   4653 (0)                                                                               52-71                        Social network score                                                  6

social integration.                                                                                                 Kaplan 1988w53 Finland                                                                                                              13301                                                                                 39-59                        Social network index                                                  5


Depression/Anxiety                                                                                   6/6 studies    Vogt 1992w54 USA                                                                                                                   2603 (54)                                                                             18-75+                        Network scope, network frequency,                                    15
                                                                                                                                                                                                                                                                                                                                                                           and network size


Psychosocial work characteristics                                                                    1/2 studies    Orth-Gomer 1993w55                                                                                                                  736 (0)                                                                                50                          Emotional support from close                                          6
                                                                                                                    Sweden                                                                                                                                                                                                                                                 people and support from extended
                                                                                                                                                                                                                                                                                                                                                                           network (social integration)
Social integration                                                                                   9/10 studies
                                                                                                                    Kawachi 1996w56 USA                                                                                                                36 624 (0)                                                                             42-77                        Social network index                                                  4
        Hemingway, H. & Marmot, M. (1999). Psychosocial factors in the aetiology and prognosis of coronary
        heart disease: Systematic review of prospective cohort studies. British Medical Journal, 318, 1460-1467.
                                                                                                                    Chandra 1983w57 USA                                                                                                                  1401                                                                            Not stated                        Marital status                                                       10




                                                                                                                                                                                                                   Social Integration and Mortality in the Shye et al. Study
 Social Integration and Mortality in the Shye et al. Study                                                                                                                                                                                                      Relative Hazards for Men
                                                                                                                                                           Odds Ratios & Confidence Intervals




                                                                                                                                                                                                          3
Random sample of persons aged 65 or older
                                                                                                                                                                                                       2,5
209 men and 246 women                                                                                                                                                                                     2
                                                                                                                                                                                                       1,5
15-year follow-up from 1971 to 1986
                                                                                                                                                                                                          1
Marital status                                                                                                                                                                                         0,5
                                                                                                                                                                                                          0
Network size = number of people with whom the
                                                                                                                                                                                                                                                 ed                                                                                          ze                                                                     in
                                                                                                                                                                                                                                                                                                                                                                                                                      g
respondent reported informal social contact in all available                                                                                                                                                                            ar
                                                                                                                                                                                                                                           ri                                                                                           Si                                                                   ok
                                                                                                                                                                                                                                                                                                                                    k
                                                                                                                                                                                                                               nm                                                                  or                                                                                                      Sm
                                                                                                                                                                                                                                                                                               w
categories of social relationships (family, kin, friends,                                                                                                                                                                     U                                                              et
                                                                                                                                                                                                                                                                                            N
                                                                                                                                                                                                                                                                                        w
neighbors, co-workers), low=4-13, medium=14-19                                                                                                                                                                                                                                     Lo

Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the                           Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the
relationship between social network support and mortality:A longitudinal study of an elderly                          relationship between social network support and mortality: A longitudinal study of an elderly
cohort. Social Science and Medicine, 41, 935-947.                                                                     cohort. Social Science and Medicine, 41, 935-947.




                                            Social Integration and Mortality in the Shye et al. Study
                                                                   Relative Hazards for Women
 Odds Ratios & Confidence Intervals




                                       3
                                      2,5
                                                                                                                                                                                                    Social Integration and Mortality in the Shye et al. Study                                                                                 Social Integration and Mortality in the Shye et al. Study
                                       2                                                                                                                                                                                   Relative Hazards for Men                                                                                                                            Relative Hazards for Women
                                                                                                                                                                                                                                                                                               Odds Ratios & Confidence Intervals
                                                                                                                      Odds Ratios & Confidence Intervals




                                      1,5                                                                                                                                                       3
                                                                                                                                                                                                                                                                                                                                          3
                                                                                                                                                                                 2,5
                                       1                                                                                                                                                        2
                                                                                                                                                                                                                                                                                                                                        2,5
                                                                                                                                                                                                                                                                                                                                          2
                                      0,5                                                                                                                                        1,5
                                                                                                                                                                                                                                                                                                                                        1,5
                                                                                                                                                                                                1
                                                                                                                                                                                                                                                                                                                                          1
                                       0                                                                                                                                         0,5
                                                                                                                                                                                                                                                                                                                                        0,5
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Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the                           Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the
relationship between social network support and mortality: A longitudinal study of an elderly                         relationship between social network support and mortality: A longitudinal study of an elderly
cohort. Social Science and Medicine, 41, 935-947.                                                                     cohort. Social Science and Medicine, 41, 935-947.




                                                                                                                                                                                                                                                                                                                                                                                                                                                         13
                                                                                               Men                              Women
Hierarchical
proportional                                                       Age 70 -74                  1.72                             1.97
                                                                                                                                           Social network size provides
hazards                                                            Age 75 - 90                 2.31                             2.45       direct protection from mortality
analysis
between social
                                                                   High Stress                 0.96                             0.75       risk to both men and women but
networks and                                                       Unmarried                   1.34                             0.90
15-year                                                            Low                         1.65                             1.61       men gain protection at a lower
mortality in                                                       Network
                                                                   Size
                                                                                                                                           level of network size then women.
elderly men
and women                                                          Medium                      0.95                             1.47
                                                                   Network
                                                                   Size
Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the                                                Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the
relationship between social network support and mortality: A longitudinal study of an elderly                                              relationship between social network support and mortality: A longitudinal study of an elderly
cohort. Social Science and Medicine, 41, 935-947.                                                                                          cohort. Social Science and Medicine, 41, 935-947.




                                            Social Integration and Mortality in the Shye et al. Study
                                                                   Relative Hazards for Women
                                                                                                                                           Among the elderly, marital status is less predictive
                                                                                                                                           of mortality than in younger ages, in particular in
 Odds Ratios & Confidence Intervals




                                       3                                                                                                   younger men. Widowhood as an expected life event
                                      2,5
                                       2
                                                                                                                                           for the elderly may have fewer negative health
                                      1,5                                                                                                  consequences.
                                       1
                                      0,5
                                                                                                                                           Also, misclassification occurs when changes in
                                       0                                                                                                   marital status are not recorded. Marital status at
                                                            rie
                                                               d                          ze                                       z   e
                                                          ar                        k
                                                                                        Si
                                                                                                                            k
                                                                                                                                Si         baseline may be inaccurate. Transition to
                                                     nm                           or                                      or
                                                                                 w                                    w
                                                 U
                                                                              N
                                                                               et
                                                                                                                   N
                                                                                                                    et                     widowhood or separation might be the true social
                                                                          w                                    m
                                                                        Lo                                   iu
                                                                                                                                           risk factor.
                                                                                                          ed
                                                                                                      M

Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the                                                Shye, D., Mullooly, J. P., Freeborn, D. K., & Pope, C. R. (1995). Gender differences in the
relationship between social network support and mortality: A longitudinal study of an elderly                                              relationship between social network support and mortality: A longitudinal study of an elderly
cohort. Social Science and Medicine, 41, 935-947.                                                                                          cohort. Social Science and Medicine, 41, 935-947.




„Women‘s social network interactions fulfill
feminine social role prescriptions for expressive,                                                                                            Social Integration and
affiliative, supportive behaviors, while men‘s
conform to masculine role norms of independence
                                                                                                                                              Mortality in the Terman
and instrumentality. Women have larger and more                                                                                               Life-Cycle Study
multifaceted networks than men, report having more
friends, and provide and receive more support from
                                                                                                                                              856 men, 672 women
members of their network than men. Women are
                                                                                                                                                                                                          Mortality Data until:
also more likely than men to report having a close
confidante, and to list someone other than a spouse
                                                                                                                                             1910 1921                      1940 1950 1960 1977                               1991
as their confidante. Women‘s friendships focus on
intimacy and disclosure, while men‘s emphasize                                                                                             Birth Begin Study               Measures of Social Ties

sociability and task activity orientation.... (p. 936) “.




                                                                                                                                                                                                                                           14
                                       Social Integration and Mortality in the Terman Life-Cycle Study


                                       Begin: 1921                                                                                                                                                              Mean Year of Birth: 1910
                                       856 men, 672 women
                                       Follow-Ups:
                                                                                               1940, 1950, 1960, 1977 for measures of social ties.
                                       Mortality Data until 1991.
                                       Tucker et al.-Analysis based on 697 men and 544 women.

                                       Source: Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in
                                       the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.




                                                                                 Social Integration and Mortality in the Terman Life-Cycle Study                                                                                                                                                                                                                    Social Integration and Mortality in the Terman Life-Cycle Study
                                                                                                                                                Relative Hazards for Men                                                                                                                                                                                                                     Relative Hazards for Women
                                                                                                                                                                                                                                                                                                                               Odds Ratios & Confidence Intervals
                                          Odds Ratios & Confidence Intervals




                                                                                               3                                                                                                                                                                                                                                                                      3

                                                                                        2,5                                                                                                                                                                                                                                                                          2,5

                                                                                               2                                                                                                                                                                                                                                                                      2

                                                                                        1,5                                                                                                                                                                                                                                                                          1,5

                                                                                               1                                                                                                                                                                                                                                                                      1

                                                                                        0,5                                                                                                                                                                                                                                                                          0,5

                                                                                               0                                                                                                                                                                                                                                                                      0
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                                                                                                                                                                                                                                                             O                                                                                                                                                                                                      O
                                        * = confidence interval excludes 1                                                                                                                                                                                                                                                  * = confidence interval excludes 1

               Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.                                                                                                              Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.




                                                                                                                                                                                                                                                                                                                             For men, a protective effect of social integration, in
                                                                                                                                                                                                                                                                                                                             particular marriage, has been documented
                                                                                                                                                                                                                                                                                                                             repeatedly. Men who are divorced, separated or
                                                                                                                                                                                                                                                                                                                             widowed have a higher mortality risk than those who
                                       Social Integration and Mortality in the Terman Life-Cycle Study
                                                                                                     Relative Hazards for Men
                                                                                                                                                                                                               Social Integration and Mortality in the Terman Life-Cycle Study                                               are consistently married. Even those who are
                                                                                                                                                                                                                                           Relative Hazards for Women

                                                                                                                                                                                                                                                                                                                             remarried have a similarly high mortality risk, i.e.,
                                                                                                                                                                          Odds Ratios & Confidence Intervals
  Odds Ratios & Confidence Intervals




                                         3                                                                                                                                                                       3

                                        2,5

                                         2
                                                                                                                                                                                                                2,5

                                                                                                                                                                                                                 2
                                                                                                                                                                                                                                                                                                                             reestablishing an intimate relationship does not help
                                        1,5

                                         1
                                                                                                                                                                                                                1,5

                                                                                                                                                                                                                 1
                                                                                                                                                                                                                                                                                                                             to reduce the risk. It is possible that not marriage per
                                        0,5

                                         0
                                                                                                                                                                                                                0,5

                                                                                                                                                                                                                 0
                                                                                                                                                                                                                                                                                                                             se but the stressful dissolution of an intimate
                                                                                          d*                 id
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                                                                                                                                                                                                                                                                                                                             relationship represents the main cause for the
                                                                                                                                                                                                                                                                    M                            O
* = confidence interval excludes 1
                                                                                                                                                                        * = confidence interval excludes 1
                                                                                                                                                                                                                                                                                                                             elevated risk. The detrimental effect of social stress
                                                                                                                                                                                                                                                                                                                             might be more important than the protective effect of
               Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.
                                                                                                                                                                                                                                                                                                                             social integration.
                                                                                                                                                                                                                                                                                                                           Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            15
                                                                                                                                                                                                                                                                                Social Integration and Mortality in the Terman Life-Cycle Study
                                                                                                                                                                                                                                                                                                                      Relative Hazards for Women Aged 70 or older

           For women, the protective effect of




                                                                                                                                                                                                                                          Odds Ratios & Confidence Intervals
                                                                                                                                                                                                                                                                                               3

           marriage is less pronounced. Instead,                                                                                                                                                                                                                                      2,5

           they seem to benefit from children and                                                                                                                                                                                                                                              2

                                                                                                                                                                                                                                                                                      1,5
           organizational ties, in particular when                                                                                                                                                                                                                                             1

           they are older.                                                                                                                                                                                                                                                            0,5

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                                                                                                                                                                                                                                        * = confidence interval excludes 1


Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.                    Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.




                                                    Social Integration and Mortality in the Terman Life-Cycle Study
                                                                      Relative Hazards for Women Aged 69 or younger
    Odds Ratios & Confidence Intervals




                                                      3

                                                     2,5                                                                                                                                                                                Social Integration and Mortality in the Terman Life-Cycle Study                                                                                                                       Social Integration and Mortality in the Terman Life-Cycle Study
                                                                                                                                                                                                                                                                                       Relative Hazards for Women Aged 69 or younger                                                                                                              Relative Hazards for Women Aged 70 or older




                                                                                                                                                                                                                                                                                                                                                                                         Odds Ratios & Confidence Intervals
                                                      2
                                                                                                                                                                                                   Odds Ratios & Confidence Intervals




                                                                                                                                                                                                                                             3                                                                                                                                                                                  3

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 * = confidence interval excludes 1

Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.                    Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.




                                                    Social Integration and Mortality in the Terman Life-Cycle Study                                                                                                                                                             Social Integration and Mortality in the Terman Life-Cycle Study
                                                                         Relative Hazards for Men Aged 69 or younger                                                                                                                                                                                                       Relative Hazards for Men Aged 70 or older
               Odds Ratios & Confidence Intervals




                                                                                                                                                                                                                                          Odds Ratios & Confidence Intervals




                                                       3                                                                                                                                                                                                                                       3

                                                     2,5                                                                                                                                                                                                                              2,5
                                                       2                                                                                                                                                                                                                                       2
                                                     1,5                                                                                                                                                                                                                              1,5
                                                       1                                                                                                                                                                                                                                       1
                                                     0,5                                                                                                                                                                                                                              0,5
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   * = confidence interval excludes 1                                                                                                                                                                                                   * = confidence interval excludes 1


Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.                    Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      16
                                                                                                                                                                                                                                                                                          Conjugal Loss
                                                                                                                                                                                                                                                                                          The mortality risk for widows/widowers is increased compared to
                                                                                                                                                                                                                                                                                          those who do not experience this loss. It seems to be greatest for
                                                                                                                                                                                                                                                                                          men during the first six months of bereavement. There may be
                                                                                                                                                                                                                                                                                          several reasons for this gender difference. The social network is
                                       Social Integration and Mortality in the Terman Life-Cycle Study
                                                              Relative Hazards for Men Aged 69 or younger
                                                                                                                                                                                   Social Integration and Mortality in the Terman Life-Cycle Study
                                                                                                                                                                                                          Relative Hazards for Men Aged 70 or older
                                                                                                                                                                                                                                                                                          typically smaller in men than in women, so their loss cuts more
                                                                                                                                                                                                                                                                                          deeply into their network. Also, widowhood occurs at an older
  Odds Ratios & Confidence Intervals




                                                                                                                                              Odds Ratios & Confidence Intervals

                                         3                                                                                                                                           3
                                        2,5

                                         2
                                                                                                                                                                                    2,5
                                                                                                                                                                                                                                                                                          age for men than for women since men, on average, die earlier
                                                                                                                                                                                     2
                                        1,5                                                                                                                                         1,5                                                                                                   than their spouses due to age differences in couples and
                                         1

                                        0,5
                                                                                                                                                                                     1

                                                                                                                                                                                    0,5
                                                                                                                                                                                                                                                                                          biological gender differences in longevity. As a result, the death
                                         0
                                                             d*                     id                       e   n                     s*
                                                                                                                                                                                     0
                                                                                                                                                                                                      d                        id                           n                         s
                                                                                                                                                                                                                                                                                          of a wife leaves a widower who is older and more in need for
                                                       rie                         W                      dr                        Tie                                                            rie                        W                      dr
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                                                                                                                                                                                                                                                                                          support. Moreover, men usually confide in their spouse as their
                                                                                                                     O                                                                                                              M                           O
* = confidence interval excludes 1                                                                                                          * = confidence interval excludes 1                                                                                                            only intimate partner whereas women cultivate a larger network
                                                                                                                                                                                                                                                                                          of family members and friends and find it more easy to turn to
                                                                                                                                                                                                                                                                                          someone in times of need. This higher social integration and
               Tucker, J. S., Schwartz, J. E., Clark, K. M., & Friedman, H. S. (1999). Age-related changes in the associations of social network ties with mortality risk. Psychology and Aging, 14, 564-571.                                                                             support may buffer the stressful experience of the loss.




                                                                                                                                                                                                                                                                                                    Fig. 3     Percent women surviving free of cardiac events according to
                                                                                                                                                                                                                                                                                                              social support and depressive symptoms.

                                                                                                                                                                                                                                                                                                    100                                  Stockholm Female Coronary Risk Study

                                                                                                                                                                                                                                                                                                                                                            91%
                                                                                                                                                                                                                                                                                                                                                                           High support
                                                                                                                                                                                                                                                                                                     90                                                                    & low depression
                                                                                                                                                                                                                                                                                                                                                                           [1]*
                                                                                                                                                                                                                                                                                                                                                            79%
                                                                                                                                                                                                                                                                                                                                                                           Low support
                                                                                                                                                                                                                                                                                                     80                                                                    & low depression
                                                                                                                                                                                                                                                                                                                                                                           [2.4 (.53–10.6)]*
                                                                                                                                                                                                                                                                                                                                                            72%
                                                                                                                                                                                                                                                                                                                                                                           High support
                                                                                                                                                                                                                                                                                                     70                                                                    & high depression
                                                                                                                                                                                                                                                                                          Social                                                                           [3.6 (.81–15.9)]*
                                                                                                                                                                                                                                                                                          support                                                           67%            Low support
                                                                                                                                                                                                                                                                                          and health 60                                                                    & high depression
                                                                                                                                                                                                                                                                                                                                                                           [4.1 (1.0–16.9)]*
                                                                                                                                                                                                                                                                                          Kristina
                                                                                                                                                                                                                                                                                          Orth-
                                                                                                                                                                                                                                                                                          Gomér,     50
                                                                                                                                                                                                                                                                                                        0           12       24          36         48         60
                                                                                                                                                                                                                                                                                          2001
                                                                                                                                                                                                                                                                                                                            Time (months)
                                                                                  Social stress is related to mortality                                                                                                                                                                                * Hazard ratio (95% CI), adjusted for age, P for trend = 0.01.




                                       Conjugal Loss
                                                                                                                                                                                                                                                                                                  Death rates among the widowed by
                                       The mortality risk for widows/widowers is increased compared to
                                       those who do not experience this loss. It seems to be greatest for
                                                                                                                                                                                                                                                                                                    gender, age and type of death
                                       men during the first six months of bereavement. There may be                                                                                                                                                                                                                 Widowed Men                     Widowed Women
                                       several reasons for this gender difference. The social network is                                                                                                                                                                                    Age
                                                                                                                                                                                                                                                                                                             Unexpected       Expected        Unexpected          Expected
                                       typically smaller in men than in women, so their loss cuts more
                                       deeply into their network. Also, widowhood occurs at an older                                                                                                                                                                                        25-49            24.3              0.0                 4.5              4.4
                                       age for men than for women since men, on average, die earlier
                                       than their spouses due to age differences in couples and                                                                                                                                                                                             50-64            81.1             16.0                 9.0              19.5
                                       biological gender differences in longevity. As a result, the death
                                       of a wife leaves a widower who is older and more in need for                                                                                                                                                                                         65+              33.9             64.4               18.2               26.6
                                       support. Moreover, men usually confide in their spouse as their
                                       only intimate partner whereas women cultivate a larger network
                                       of family members and friends and find it more easy to turn to
                                       someone in times of need. This higher social integration and                                                                                                                                                                                       Smith, K. R., & Zick, C. D. Risk of mortality following widowhood: Age and sex
                                                                                                                                                                                                                                                                                          differences by mode of death. Social Biology 43 (1996) 59-71.
                                       support may buffer the stressful experience of the loss.




                                                                                                                                                                                                                                                                                                                                                                                               17
                                                                                                                                                                                  Health Complaints of Men and Women

                                                                        Morbidity                                                                                                 Refugees from East Germany in 1989
                                                                                                                                                                                       Effects of Gender, Age, and Social Support
                                                                                                                                                                                                                            40


                                                                                                                                                                                                                            35


                                                                                                                        and                                                                                                 30




                                                                                                                                                                                                        Health Complaints
                                                                                                                                                                                                                            25


                                                                                                                      Social                                                                                                20


                                                                                                                                                                                                                            15
                                                                                                                                                                                                                                                                               Women

                                                                                                                                                                                                                                                                             age

                                                                                                                     Support                                                                                                10


                                                                                                                                                                                                                             5
                                                                                                                                                                                                                                                                                   14 to 25 yrs

                                                                                                                                                                                                                                                                                   26 to 45 yrs

                                                                                                                                                                                                                             0                                                     46 yrs and older
                                                                                                                                                                                                                                    low                    high

                                                                                                                                                                  Nina Knoll & Ralf Schwarzer, 2000                                 Received Social Support




                              Health Complaints of Men and Women
                              Refugees from East Germany in 1989                                                                                                             Possible Pathways
                                  Effects of Gender, Age, and Social Support
                                      Men                                                                            Women                                                           Social Support                                       Morbidity               Mortality
                    40                                                                                    40

                    35                                                                                    35

                    30                                                                                    30
                                                                                                                                                                      Social Support                                             Behavior          Morbidity                   Mortality
Health Complaints




                                                                                      Health Complaints




                    25                                                                                    25

                    20                                                                                    20

                    15                                                                                    15
                                                             age                                                                         age
                    10                                             14 to 25 yrs                           10                                   14 to 25 yrs
                                                                                                                                                                     Social Support                                         Immune System             Morbidity                Mortality
                     5                                             26 to 45 yrs                            5                                   26 to 45 yrs

                     0                                             46 yrs and older                        0                                   46 yrs and older
                                low                high                                                        low                high

                                Received Social Support                                                        Received Social Support



                                                                                                                                                                      Stress                 Social Support                                    Morbidity                     Mortality
                         Nina Knoll & Ralf Schwarzer, 2000




                                                                                                                                                                                                        Sample                      Number                         Results
                                                                                                                                                                                                                                       of
      A Physiological Pathway: The Buffering Effect                                                                                                                      Type of study                                              studies



                                                                                                                                                                   Correlational Studies              normotensive                    28      Support was associated with better blood pressure
                                                                                                                                                                                                       individuals                            regulation in 23 studies (r = .08)
                                                                                                                                                                                                                                              - no difference between structural and functional
                                                                                                                                                                                                                                              measures => both predict better cardiovascular
                                                                                                                                                                                                                                              regulation



                                                                                                                                                                   Intervention Studies               normotensive                    6       Support was associated with better blood pressure
                                                                                                                                                                                                       individuals                            regulation both in normal (4 of 6 studies) and


                                                                                                                                                                                                                                              -at-risk populations (r = .15).
                                                                                                                                                                                                                                              - strongest association when interventions were
                                                                                                                                                                                                      hypertensive                    8       performed on familial sources of support
                                                                                                                                                                                                       individuals



                                                                                                                                                                   Laboratory Studies                 normotensive                    4       Support reduced cardiovascular reactivity to acute
                                                                                                                                                                                                       individuals                            stress in all 4 studies (r = .28)
                                                                                                                                                                                                                                              - strongest association if supportive function of
                                                                                                                                                                                                                                              social relations is manipulated (instead of taking
                                                                                                                                                                                                                                              naturalistic measures of support)




                                                                                                                                                                                                                                                                                                      18
                                                     Various Pathways




                                                                                                     Recovery
                                                                                                   and Social Support




                                                                                                            Social
                                                                                                           Support

Holahan, C. J., Holahan, C. K., Moos, R. H., & Brennan, P. L. (1997). Psychosocial adjustment in
patients reporting cardiac illness. Psychology and Health, 12 (3), 345-360.




                                                                                                                        19
                                                                                                             Tage im Krankenhaus
  Recovery after bypass surgery:                                                                      10



  Married patients who receive                                                                          9
   frequent visits in the hospital
   do better than married patients                                                                      8
   who don't.
                                                                                                        7
  Kulik, JA and Mahler, HIM. (1989) "Social Support and                                                     wenig Unterstützung            mehr Unterstützung
    Recovery from Surgery," Health Psychology, 8:221-                                                              Verheiratete Männer                                             Ledige Männer
    238.




                                                                Coping with
                                                                    Cardiac
                                                                   Surgery:
                                                                 The Role of
                                                                   Personal
                                                                  and Social
                                                                  Resources
 Schröder, K. E. E., Schwarzer, R., & Konertz, W. (1998). Coping as a mediator in recovery
 from heart surgery: A longitudinal study. Psychology & Health, 13, (1), 83-97.
                                                                                                     Schröder, K. E. E., Schwarzer, R., & Konertz, W. (1998). Coping as a
Schröder, K. E. E., Schwarzer, R., & Endler, N. S. (1997). Predicting cardiac patients' quality of   mediator in recovery from heart surgery: A longitudinal study. Psychology
life from the characteristics of their spouses. Journal of Health Psychology, 2 (2), 231-244.
                                                                                                     & Health, 13, (1), 83-97.




   Patienten mit Lebenspartner lesen früher                                                                                      Successful rehabilitation
           nach der Herzoperation                                                                                                   after cardiac surgery
                                      single     with partner                                                                                was facilitated by
         35
                                                                                                                                            resources such as
         30
         25                                                                                                                             perceived self-efficacy
         20
                                                                                                                                           and social support.
         15
                                                                                                                            Schröder, K. E. E., Schwarzer, R., & Konertz, W. (1998). Coping as a mediator in recovery
         10                                                                                                                 from heart surgery: A longitudinal study. Psychology & Health, 13, (1), 83-97.

           5
                                                                                                                              Schröder, K. E. E., Schwarzer, R., & Endler, N. S. (1997). Predicting cardiac
           0                                                                                                                  patients' quality of life from the characteristics of their spouses. Journal of
                      Day 0                     Day 1                    Day 2                                                Health Psychology, 2 (2), 231-244.




                                                                                                                                                                                                                        20
                                                                                       Interaction
            Worry
                                                                                       between
       8
                                                                                                                                        Men
      7,5
                                                                                       Gender and                                             Women

       7
                                     Low Self-Efficacy
                                                                                       Partner Status
      6,5
                                                                                       on Social                                Women
       6                                                                               Support.
      5,5                           High Self-Efficacy                                                                    Men
     5
  Low Support                                                        High Support      N = 236 Cardiac and Lung
                                      Social Support                                   Patients, 6 Months after
                                                                                       Surgery.
Schröder, K. E. E., Schwarzer, R., & Konertz, W. (1998). Coping as a mediator in
recovery from heart surgery: A longitudinal study. Psychology & Health, 13, (1), 83-                                       Singles      With Partner
                                                                                       Schwarzer, Wolf & Schröder, 2000
97.




                       Patient                               Partner                      Social Support und
                     (Empfänger)                             (Quelle)
                                                                                       Genesung nach Operation
                              .42
               Erwartete U.          Bedürfnis nach U.

                    .51                .66
.15                   Mobilisierung                         Geleistete U.
 -                                       .03 bis .16.
.50          .12 bis .36
              Erhalt von U.
                                         .08 bis .46




      Berlin Social Support Skalen (BSSS)                                                  Wahrgenommene soziale Unterstützung
                                Schwarzer & Schulz (2000)                                                     Perceived available support

 1.    Wahrgenommene Unterstützung
 2.    Erhaltene Unterstützung                                                          Wenn es mir schlecht geht, zeigen andere
 3.    Geleistete Unterstützung                                                        mir, daß sie mich mögen.
 4.    Bedürfnis nach Unterstützung                                                     Wenn ich traurig bin, gibt es Menschen, die
 5.    Suche nach Unterstützung (Mobilisierung)                                        mich aufmuntern.
 6.    Protektives Buffering
                                                                                        Wenn ich Trost und Zuspruch brauche, ist
                                                                                       jemand für mich da.
                Available at: www.coping.de




                                                                                                                                                       21
                                                                                          Geleistete soziale Unterstützung
  Erhaltene soziale Unterstützung
                                       Actually received support                     Denken Sie nun bitte an den Patienten. Wie haben Sie sich in
  Denken Sie nun bitte an Ihre engste Bezugsperson wie                                 der letzten Woche ihm gegenüber verhalten?
         (Ehe)Partner/in, Kind, Freund/in usw.
  Wie hat sich diese Bezugsperson in der letzten                                     Ich habe ihm gezeigt, daß ich ihn mag und akzeptiere.
      Woche Ihnen gegenüber verhalten?                                                  (EMO)
                                                                                     Ich habe ihn getröstet, wenn es ihm schlecht ging. (EMO)
Diese Bezugsperson hat mir gezeigt, daß sie mich mag und                             Ich habe viel für ihn erledigt. (INST)
akzeptiert.                                                                          Ich habe ihm das Gefühl gegeben, wertvoll und wichtig zu
                                                                                        sein. (EMO)
Diese Bezugsperson war für mich da, wenn ich sie
                                                                                     Ich habe meine Sorge um sein Befinden ausgedrückt. (EMO)
gebraucht habe.
                                                                                     Ich kümmerte mich um seine Angelegenheiten, die er nicht
Diese Bezugsperson hat mich getröstet, wenn es mir                                      alleine erledigen konnte. (INST)
schlecht ging.                                                                       Ich war für ihn da, wenn er mich gebraucht hat. (INST)




                                 4,0                                                     Erhaltene emotionale Unterstützung T4
    Received Emotional Support




                                 3,9                                                                       4.0


                                 3,8
                                                                                                           3.8

                                 3,7


                                 3,6                                                                       3.6



                                 3,5
                                                                                                           3.4

                                 3,4                                       PARTNER
                                                                                                                                                        Geschlecht
                                                                                             Mittelwerte




                                                                                                           3.2
                                 3,3                                         No
                                                                                                                                                           männlich
                                 3,2                                         Yes
                                                                                                           3.0                                             weiblich
                                        < 59 yrs     59 - 66    > 66 yrs
                                                                                                                           Single           Partner

                                                   Age Groups                                                    Partnerstatus




 Dyadisches                                                                                                        Dyadisches Coping
                                                                                                                    Helge Streller & Steffen Sameiske




   Coping
    Die Patient-Partner-Dyade
      ist die Analyseeinheit




                                                                                                                                                                      22
                 Drei Ansätze                                            Beziehungsbezogen
                  (nach Bodenmann)
                                                            ...auch Relationship-Focused Coping
                                                            • betrifft neben emotions- und problembezogener
                                                               Bewältigung die Bemühungen, die
                                                               Beziehungsqualität in belastenden Situationen zu
                                                               stärken
                                                            • drei Hauptstrategien (Coyne):
                                                               – Aktives Engagement
                                                               – Beschützendes Abpuffern
                                                               – Überbehütung




            Coping-Kongruenz                                      Zwischenmenschlicher Prozeß

 • Grundidee: Vereinbarkeit (nicht zwingend                 • Systemisch prozessorientierte Sicht auf Krankheit
   Gleichheit) von Copingstrategien sei wichtig für           und Coping
   Beziehungsqualität                                       • Zusammenspiel von Stresssignalen des Patienten
 • Annahme: optimal seien kongruente                          und der Reaktion des Partners
   emotionsfokussierte- und verschiedene                    • Beide Partner aktivieren Ressourcen zur
   problemorientierte Strategien                              Bewältigung, da beider Wohlergehen (individuell
 • Möglicherweise hoher gemeinsamer Mittelwert                und als Paar) stark von der Situation des anderen
   (Bewältigungsfähigkeiten beider Partner                    abhängt
   zusammen) entscheidend für Beziehungsqualität            • Gemeinsames, unterstützendes und delegiertes
                                                              Coping werden unterschieden (Bodenmann)




                                                                      Recipient                           Source
           Recipient                   Source
                                                                             .45

     Perceived           Need                                   Perceived             Need
                                                                   .53               .62
          Mobilization               Provided         .49             Mobilization                       Provided
                                                                                           ~ .0
                                                                .28 to .33
     Received                                                   Received
                                                                                                  .22 to .48

Social Support in the Context of Dyadic Coping




                                                                                                                    23
  Patient T 1    Patient T 2   Patient T 3   Patient T 4         Patient T 1          Patient T 2           Patient T 3          Patient T 4

                                                                                                                                   .29



   3-4 Tage
    vor der
                  1 Woche
                  nach der
                                 1 Monat
                                nach der
                                              6 Monate
                                              nach der
                                                                Erhaltene emo.Unterstützung
   Operation      Operation     Operation     Operation

                                                                         .22                                       .22
                                                                                .22            .30                         .48
  Partner T 1                  Partner T 3                       Partner T 1                                Partner T 3




   3-4 Tage                      1 Monat
    vor der                     nach der
   Operation                    Operation                           Geleistete emotionale Unterstützung




                “Kampfgeist”                                     Patient T 1          Patient T 2           Patient T 3          Patient T 4




Ich versuchte, die Krankheit                                                    „Kampfgeist“
zu bekämpfen.                                                                                                      .22
                                                                 Partner T 1                                Partner T 3   .33

Ich habe versucht, das Beste
aus meiner jetzigen Lage zu
machen.                                                             Geleistete emotionale Unterstützung




         Patienten bewältigen durch:                                                                              Correlations


         Akkommodation                                                                                Provided      Provided     Provided
                                                                                                      Emotional   Informationa Instrumental
                                                                                                       Support      l Support    Support
         Abwärtsvergleiche
                                                           Received emotional support               .52**         .35*             .36*
         Kampfgeist                                        Received informational support           .32           .47**            .16
                                                           Received instrumental support            .27           .27              .61**
         Sinnfindung                                       Accommodation                            .47**         .31              .53**
                                                           Downward comparison                      .49**         .37*             .39*
                                                           Fighting spirit                          .42**         .27              .46**
                                                           Search for meaning                       .25           .14              .52**


                                                            Lagged Correlations Between Provided Male Partner Support (Time 3)
Partner leisten emotionale Unterstützung                      and Female Patient Characteristics (Time 4) for N = 38 Couples




                                                                                                                                               24
                                                                             .59                                                                             .59


                                                        Erhaltene                                                                             Support
                                                      Unterstützung                                                                           Receipt
                                                         nach 6                                                                               (Time 4)
                                                        Monaten                                                          .25
                                                                                                                  Sex
                                .64                                                                                            .64

                                                                                   .85                                                                             .85
                                                     Akkommodation                                                                        Accommodation
                                .39                                                                                            .39
                                                                                   .82                                                                             .82
                                                    Abwärtsvergleiche                                                           .42       Downward Comp.
                                 .42
            Partner-                                                                                          Support
          Unterstützung                                                                                      Provision                                             .79
                                 .46                                               .79                                          .46
          nach 1 Monat                                                                                        (Time 3)                     Fighting Spirit
                                                       Kampfgeist
                                 .42                                                                                            .42
                                                                                   .82                                                                             .82

                                                      Sinnfindung                                                                             Meaning




                                                                                         .59


                                                                  Support
                                                                  Receipt
                                                                  (Time 4)
                                       .25
                          Sex
                                             .64

                                                                                               .85
                                                           Accommodation
                                             .39
                                                                                               .82
                                              .42         Downward Comp.
                   Support
                  Provision                                                                    .79
                                              .46
                   (Time 3)                                    Fighting Spirit
                                              .42
                                                                                               .82
                                                                  Meaning




                                                                                                                                 Brandtstädter, 1992
      Received Emotional Support
4,0



3,9



3,8



3,7



3,6
                                                                                                     Men

3,5                                                                                                  Women     Social Support
      1                     2                              3                             4


                                         TIME
                                                                                                               and Depression



                                                                                                                                                                         25
                                                                                                                    Social Integration and Depression
     Social integration, social
     support and depression




 Schwarzer, R., & Leppin, A. (1989). Sozialer Rückhalt und Gesundheit. Eine Meta-Analyse. Göttingen: Hogrefe.




                                                                                                                            Macrosocial Changes
                                                                                                                Schwarzer, R., Hahn, A. & Schröder, H. (1994). Social integration and social
                                                                                                                support in a life crisis: Effects of macrosocial change in East Germany. American
                    Social stress is related to depression                                                      Journal of Community Psychology, 22(5), 685-706.




 24
       Depressivität (Männer)
                                                                                                                                 Sex differences
 23

 22                                                          keine neuen Freundschaften

 21

 20
                        neue Freundschaften
 19
                             1989                      1990                      1991



Changes in depression levels in men with or without
   new friends within two years after migration




                                                                                                                                                                                                    26
                    Depression of Men and Women Migrating from                                                                                                               Health Complaints of Men and Women
                           East to West Germany in 1989                                                                                                                      Refugees from East Germany in 1989
                             Effects of Gender, Age, and Social Support                                                                                                          Effects of Gender, Age, and Social Support
                                                                                                                                                                                     Men                                                                            Women
                                                                                                                                                                   40                                                                                    40
               32
                                                                                       32
                                                                                                                                                                   35                                                                                    35
               30
                                                                                       30
                                                                                                                                                                   30                                                                                    30
               28
                                                                                                        Women




                                                                                                                                               Health Complaints
                                                                                       28




                                                                                                                                                                                                                                     Health Complaints
               26
                        Men                                                                                                                                        25                                                                                    25
  Depression




                                                                                       26
                                                                          Depression




                                                                                                                                                                   20                                                                                    20
               24                                                                      24
                                                                                                                                                                   15                                                                                    15
                                                                                                                                                                                                            age                                                                         age
               22                                                                      22
                                                 age                                                                  age                                          10                                             14 to 25 yrs                           10                                   14 to 25 yrs
               20                                      14 to 25 yrs                    20                                   14 to 25 yrs                            5                                             26 to 45 yrs                            5                                   26 to 45 yrs

               18                                      26 to 45 yrs                    18                                   26 to 45 yrs                            0                                             46 yrs and older                        0                                   46 yrs and older
                                                                                                                                                                               low                high                                                        low                high
               16                                      46 yrs and older                16                                   46 yrs and older
                       low                high                                              low                high                                                            Received Social Support                                                        Received Social Support

                       Received Social Support                                              Received Social Support
Knoll, N. & Schwarzer, R. (2001-in press). Gender and age differences in social support: A study on East German refugees.
In G. Weidner, M. Kopp & M. Kristenson (Eds.), Heart disease: Environment, stress, and gender. Amsterdam, The
                                                                                                                                                                        Nina Knoll & Ralf Schwarzer, 2000
Netherlands: IOS Press.




                                                                                                                                               It is needed to disentangle diverse
                     Conclusions                                                                                                               facets of social support, make clear
                                                                                                                                               distinction between functions of
                                                                                                                                               support and their sources. Moreover,
                                                                                                                                               the psychometric properties of
                                                                                                                                               support measures call for
                                                                                                                                               improvement. It is more likely to
                                                                                                                                               detect buffering effects of social
                                                                                                                                               support when there is a reasonable
                                                                                                                                               match between the stressor type and
                                                                                                                                               the support function.




      The same conceptual differentiation is
                                                                                                                                               We see two major avenues for a
      needed for cardiovascular reactivity,                                                                                                    better elaboration of this field, one
      CVD, cardiac events, and cardiac death.                                                                                                  being the thorough investigation
      Some indicators are not stable over time,                                                                                                of causal mechanisms in the
      or not accurately documented. It is                                                                                                      etiology of cardiac disease, and
      desirable to examine more closely the                                                                                                    the other being the examination of
      links of the different facets of support to                                                                                              dyadic and communal coping
      specific physiological, psychological, and                                                                                               processes in cardiac patients
      behavioral mechanisms. This includes
                                                                                                                                               which includes the mobilisation,
      the separation of short term from longer
                                                                                                                                               provision, receipt, and evaluation
      term effects of physiological changes.
                                                                                                                                               of support.




                                                                                                                                                                                                                                                                                                                 27
                                                                                                 SOZIALE INTEGRATION
                                                                                                                                                                           PERSÖNLICHKEIT

                                                                                                       Struktur des
                                                                                                   sozialen Netzwerkes                                                    Selbst-         Soziale
  30                                                                                                                                                                     konzept        Kompetenz


  28                                                                                           ERWARTETE UNTERSTÜTZUNG
                                                      h
                                                 uc                                                                                                                                BEWÄLTIGUNGSVERHALTEN
                                        B   es
  26                               n ig                                                                Evaluation
                                                                                                                                                                          ERHALTENE
                                                                                                                                                                                                          GESUNDHEITS-
                              we                                                                                                                                        UNTERSTÜTZUNG
                                                                                                                                                                                                           VERHALTEN

  24                                                                                                                                                                     Mobili-        Unter-
                                                                                                                                                                                                          KRANKHEITS-
                                  viel B                                                                                                                                sierung       stützung
                                                                                                                                                                                                           VERHALTEN
                                         e       such
                                                                                                 STRESSEINSCHÄTZUNG
  22
                                                                                                    Anforderungen vs.                                                   PHYSIOLOGISCHE                    ENTWICKLUNG UND
  20                                                                                                    Optionen                                                          PROZESSE                          VERLAUF VON
                                                                                                                                                                                                             KRANKHEIT
                  Kein Todesfall                          Todesfall
                                                                                                                                                                                                          Schwere-
                                                                                                                                                                                                                     Genesung
                                                                                                                                                                    z.B. Immunkompetenz                    grad




 Gender, Mental Health
Status, And Perceptions of
      Social Support
During a Stressful Event: A
     Study in Dyads
                      Thomas Klauer
                University of Rostock
                                                                                                      Hypothetical stages and components of the dyadic support process by Thomas Klauer
                 Faculty of Medicine
   Department of Psychosomatics and Psychotherapy




              Scale (No. items)                       Item example             alphar alphap
                                            Support Scales
                                                                                                                                                8
           Emotional Support (15) "He expressed a deep understanding of .92           .90                                                            p <.001
                                  my worries"
           Informational Support "I reported to him how other people    .86           .87
                                                                                                          Satisfaction ratings + SE (min = 0)




           (12)                   had managed a similar problem"                                                                                7
           Instrumental Support   "She gave her assistance to me at a   .83           .86                                                                      p <.05
           (7)                    difficult operation"
                                        Mobilization Scales
           Requesting Feedback       "She asked me what she could do           .89    .89                                                       6
           and Advice (12)           next"
           Search for Physical       "I told her to take me tightly into her   .77    .81
           Contact (4)               arms"
           Demanding Help (4)        "She criticized me for always being       .75    .84                                                       5
                                     absent when she needs me"                                                                                                                     Healthy controls
           Emotional Expression      "He openly showed his upsetness"          .76    .72
           (3)                                                                                                                                                                     Psychotherapy controls
                                                                                                                                                4
           Ostentacious              "When she asked me what's wrong           .80    .81
           Withdrawal (3)            with me I didn't answer"                                                                                                                      Depression patients

                                                                                                                                                3
           Note. Item examples were translated from German and differ with regard to
           recipient vs provider perspective and target gender wording; alphar: consistency                                                         Male providers                     Female providers
           for recipient version; alphap: consistency for provider version



           Table 2: Overview of mobilization and support scales




                                                                                                                                                                                                                                28
                                                                                                                                                                     1

                                                                                                                                                                                     Female providers




                                                                                                                                                      Support satisfaction
                                                                   4
                                                                         a                                b                                                                          Male providers




                                                                                                                                                          (z scores)
                         Estimated marginal means + SE (min = 0)




                                                                                       Male providers
                                                                                       Female providers




                                                                   3                                                                                                 0
                                                                                                                                           -1                                0                           1

                                                                                                                                                                                 Received emotional support
                                                                                                                                                                                         (z scores)




                                                                   2
                                                                       Healthy    Psycho- Depres-             Male   Female
                                                                       controls   therapy    sed                                                                  -1
                                                                                  controls patients            Recipients




     References
Barbee, A. P., Gulley, M. R., & Cunningham, M. R. (1990). Support seeking in personal relationships. Journal of Personal and
   Social Relationships, 7, 531-540.
Barbee, A., Cunningham, M. R., Winstead, B. A., Derlega, V. J., Gulley, M. R., Yankeelov, P. A., & Druen, P. B. (1993).
   Effects of gender role expectations on the social support process. Journal of Social Issues, 49(3), 175-190.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press.
Belle, D. (1987). Gender differences in the social moderators of stress. In R. C. Barnett, L. Biener, & G. K. Baruch (Eds.),
   Gender and stress (pp. 257-277). New York: Free Press.
Coyne, J. C. (1976). Toward an interactional description of depression. Psychiatry, 28-40.
Cutrona, C. E., Suhr, J. A., & MacFarlane, R. (1990). Interpersonal transactions and the psychological sense of support. In S.
   Duck & R. C. Silver (Eds.), Personal relationships and the psychological sense of support (pp. 30-45). London: Sage.
Glynn, L. M., Christenfeld, N., & Gerin, W. (1999). Gender, social support, and cardiovascular responses to stress.
   Psychosomatic Medicine, 61, 234-242.
Joiner, T. E., & Coyne, J. C. (Eds.). (1999). The interactional nature of depression. Washington, DC: American Psychological
   Association.
Kirschbaum, C., Klauer, T., Filipp, S. H., & Hellhammer, D. H. (1995). Sex-specific effects of social support on cortisol and
   subjective responses to acute pychological stress. Psychosomatic Medicine, 57, 23-31.
Mickelson, K. D., Helgeson, V. S., & Weiner, E. (1995). Gender effects on social support provision and receipt. Personal
   Relationships, 2, 211-224.
Schwarzer, R., & Leppin, A. (1992). Social support and mental health: A conceptual and empirical overview. In L. Montada, S.-
   H. Filipp, & M. J. Lerner (Eds.), Life crises and experiences of loss in adulthood (pp. 435-458). Hilldale: Erlbaum.
Shumaker, S. A., & Hill, D. R. (1991). Gender differences in social support and physical health. Health Psychology, 10, 102-
   111.
Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological
   processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119, 488-
   531.
Winkeler, M., Klauer, T., Broda, M., & Filipp, S.-H. (1998). Soziale Unterstützung und die Chronifizierung depressiver
   Störungen: Eine Studie an Dyaden [Social support and the maintenance of depressive disorders: A study in dyads]. Zeitschrift
   für Gesundheitspsychologie, 6, 19-32.




                                                                                                                                  Women have larger and more multifaceted
     Sex Differences and                                                                                                          networks than men, and provide and receive
                                                                                                                                  more support from members of their network
      Support Sources                                                                                                             than men.
                                                                                                                                  Women are also more likely than men to have
                                                                                                                                  a close confidante, and to list someone other
                                                                                                                                  than a spouse as their confidante.
                                                                                                                                     The identification of support sources
                                                                                                                                  should precede the analysis of perceived and
                                                                                                                                  received support.




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