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The concept of social support has both scientiﬁc and popular appeal. The topic has received attention as the important inﬂuence of psychological and interpersonal factors on the health and well-being of individuals has increasingly been recognized.
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Early research in this ﬁeld was characterized by vague deﬁnitions, poor and inadequate samples, and inappropriate generalizations. Psychologists have long recognized the importance of the association between social support and health generally, and interpersonal factors and individual mental health speciﬁcally. It was only when the importance of these factors on physical health was documented that the research became of interest to a broader array of scientists, researchers, and clinicians. This turning point can perhaps be best identiﬁed with the early work of Berkman (Berkman and Syme 1979). Using the Alameda county longitudinal epidemiological data which followed a large representative sample of residents from the California county, Berkman and Syme were able to document that people reporting social ties with friends and organizations were more likely than people without such ties to be alive nine years later. Other studies essentially replicated these ﬁndings with respect to mortality in Tecumseh, Michigan (House et al. 1982) and Evans County, Georgia (Blazer 1982, see also Bowling and Grundy 1998 for a recent review). This began a series of studies documenting the association between social support and numerous aspects of physical and mental health, including depression, recovery from disease and medical procedures, cancer, heart disease, experience of pain, and adherence to a medical regimen (Antonucci 1990, Berkman 1985, Holahan et al. 1995).
While the term social support was initially used as a nonspeciﬁc, generalized term, experts have now come to recognize the importance of providing more detailed deﬁnitions and, more importantly, of distinguishing between diﬀerent related concepts. We propose the generalized term social relations to describe the broad array of factors and interpersonal interactions that characterize social exchanges and social support between people. Under this rubric we ﬁnd it is useful to distinguish three critical terms: social network, social support, and support satisfaction.
Social networks can best be understood as the objective characteristics that describe the people with whom an individual maintains interpersonal relations. Thus, one can describe one’s social network members in terms of age, gender, role relationship, years known, residential proximity, frequency of contact, and the like. Describing a social network tells you about the people with whom an individual has relationships but not about the exchange that takes place within those social relations. To describe this aspect of social relations, the term social support is used.
Social support refers to the actual exchange of support. Social support has been described as an interpersonal transaction involving the exchange of one of three key elements: aid, aﬀect, and aﬃrmation (Kahn and Antonucci 1980). Aid refers to instrumental or tangible support such as lending money, helping with chores, or providing sick care. Aﬀect refers to emotional support such as love, aﬀection, and caring. Aﬃrmation refers to agreement or acknowledgment of similarities or appropriateness of one’s values or point of view. Other terms have also been used, e.g. informational and appraisal support.
The third term often used in this literature is evaluative support or support satisfaction. This term refers to the assessment individuals make about the support they receive. It is an evaluative reﬂection of a combination of both social network and social support characteristics as well as more idiosyncratic characteristics such as perceived and expected support. Since individuals are fundamentally psychological beings, every individual does not experience the objective receipt of support in the same way. Thus, a support provider might say to a support recipient ‘I love you’, which might be heard by one person as a pledge of lifelong romantic love and by another as a passing sign of aﬀection—an indication of platonic, brotherly love, or even a sarcastic statement of disdain. Support satisfaction refers to how individuals evaluate or assess the support they receive. They might feel support is adequate, that it meets their needs. Some individuals will be satisﬁed with the support they receive, i.e. positively evaluate the support they receive, and others will not—even when an observer would report that the two individuals have received the same support.
Recognition of these diﬀerent concepts and the distinctly diﬀerent deﬁnitions associated with them leads directly to the recognition of the problems associated with measuring these constructs. Measurement has evolved signiﬁcantly over the last several years. Diﬀerent types of measures have been used such as open-ended questions and structured interviews. Also interesting is the fact that many diﬀerent methods have now been used to study social support speciﬁcally and social relations more generally. These include indepth ethnographic studies, laboratory studies, as well as large representative, epidemiological studies. When assessing primary sources in this ﬁeld it is important to be cognizant of the speciﬁc deﬁnitions and consequent measures which have been used to assess the social relations characteristics of interest since these facts fundamentally inﬂuence the kind of information obtained.
4. Theoretical Perspectives
Several theoretical conceptualizations relating to social support have been oﬀered such as attachment across the lifespan, socioemotional development, family systems, and developmental aspects of friendships (see Levitt 2000 for an overview). It is now generally recognized that a lifespan perspective provides a critical underlying base upon which to study social relations. The most important exchanges of social support and social relations usually involve long-lasting, close relationships such as those between parent and child, siblings, husband and wife. Interpersonal relationships are lifespan in nature either because they have existed across the lifespan or because they are built on interpersonal relationships that have been experienced over the individual’s lifetime. To understand how an individual experiences a relationship at any one point in time, it is most useful to understand the history of that speciﬁc relationship as well as other relationships in the person’s life. Thus, the study of a 50-year-old woman and her 70-year-old mother is best conceptualized as a relationship that has continued from when the 50-year-old was an infant through her early childhood, adolescence, young adulthood into the current state of middle age. Similarly, her mother was at one time a young 20-year old mother who loved and cared for her child then and throughout the next 50 years. The resultant mother– child relationship is likely to be understood very diﬀerently depending on these lifetime-accumulated experiences. One might even argue that a speciﬁc negative experience could and would be forgiven because of a lifetime of positive experiences. Or, on the contrary, a contemporary supportive interaction may be unable to make up for a lifetime of disappointment or neglect.
4.1 Convoy Model
The convoy model of social support is actually a model of social relations more generally (Antonucci 1990, Kahn and Antonucci 1980). It conceptualizes the longitudinal nature of these relations: the convoy is a structural concept shaped by personal (age, gender, personality) and situational (role expectations, resources, demands) factors which inﬂuence social support and support satisfaction. Changes in the convoy over time critically aﬀect individual health and wellbeing.
4.2 Theoretical Work
Recent theoretical work has focused on explaining how social support positively aﬀects the health and well-being of the individual. Antonucci and Jackson (1987) oﬀer the support eﬃcacy model. This model suggests that it is not only the exchange of speciﬁc support that accomplishes these eﬀects but the cumulative expression by one or several individuals to another that communicates to the target person that he or she is an able, worthy, capable person. Assuming that the support recipient perceives the support provided as accurate and altruistically motivated, the support recipient will come to internalize this same belief communicated by the supportive other. Thus, with multiple and repeated exchanges of this type, the supported person accumulates a belief in his or her own ability which will enable that person to face and succeed in the multiple goals and challenges of life, i.e., to cope with problems across the lifespan. Not all people receive support from those who surround them and not all support is positive (Rook 1992). Thus, some people, instead of being told that they are competent, capable, and worthy, may be led to believe that they are incompetent, incapable, and unworthy. Just as the cumulative eﬀect of positive exchanges can have a positive aﬀect on an individual’s health and well-being, so the opposite can have a devastating and cumulative negative eﬀect on health and well-being. Some support networks can have a negative eﬀect by supporting or encouraging behaviors detrimental to health and well-being. Drug buddies, drinking buddies, eating buddies, and buddies who discourage exercise are all examples of people who help or ‘support’ behaviors that simply are not good for you.
Other theoretical perspectives have been oﬀered. For example, some scholars (e.g., Thoits 1995, Pearlin et al. 1996) consider social support a coping mechanism. They argue that as people are confronted with stress, the receipt of social support from important close others is a critical and signiﬁcant coping strategy. Sarason et al. (1990) have taken a more personalitybased perspective, arguing that individuals with speciﬁc personality characteristics will seek and beneﬁt from diﬀerent types of social relations including speciﬁc types of social support exchanges. Carstensen et al. (1999) have suggested an interweaving of social relationships, emotional development, and lifespan experiences. Although not technically a theory of social support, Carstensen has oﬀered a perspective which argues that at younger ages people are more likely to seek out and be advantaged by numerous exchanges and social contacts, whereas as they age people reduce the number of exchanges in which they engage to only those which are perceived as most close. Finally, two other perspectives on social relationships have focused on intergenerational solidarity (Bengtson et al. 1996) and adult friendships (Blieszner and Adams 1992). Bengtson has documented the unique perspective of each generation towards intergenerational support. Older people of the more senior generations are likely to report that they provide a great deal of instrumental and aﬀective support to their younger, junior generational family members. Younger people, while often agreeing to feelings of solidarity with older generations, report fewer support exchanges than their senior generation relatives. Bengtson et al. explained this as important diﬀerences in developmental stake in family, generational, and close social relationships. Finally, Blieszner and Adams note the unique supportive nature of adult relationships, recognizing that adult friendships serve an important function because, unlike family relationships, they are nonobligatory, most often among peers, and therefore on an equal or nonhierarchical basis.
5. Support Findings
While there is still much to learn about the way in which social relations and, speciﬁcally social support, operates, there is quite a bit that is already known. There are both sociodemographic and cultural similarities and diﬀerences in social relations (Jackson and Antonucci 1992). It is known, for example, that most people report immediate family, mother, father, spouse, child, and siblings as their closest relationship (e.g., Antonucci and Akiyama 1995). It is known that people diﬀerentiate their relationships from very close to much less close. While all these relationships can be important, it is clear that the closest relationships have the biggest eﬀects in most circumstances. However, it is worth noting that there can be special circumstances where a person generally not considered very close can have a signiﬁcant eﬀect on the individual. A supervisor not considered a friend but who goes out of his/her way to extend praise or deliver criticism is an example. It is also known that social relations vary by age, gender, socioeconomic status (SES), race, ethnicity, culture, and other sociodemographic characteristics. The number of close social relationships and amount of emotional support is relatively stable across the lifespan until very old age (Due et al. 1999), when a signiﬁcant decline occurs (Baltes and Mayer 1999). This seems true in most countries for which we currently have data. Although men and women seem to have the same general structure to their social networks and very little diﬀerence in the size of their networks, it does seem to be the case that men have fewer close relationships than women. Men seem to maintain a signiﬁcant, close, and high-quality relationship with their spouse, while women maintain this type of relationship with several people. On the other hand, men seem to be less burdened by their relationships and to feel less responsible for solving the problems of people in their networks. They also have fewer people they feel they can turn to in times of trouble and feel less comfortable seeking and obtaining support from others.
The data on SES indicates that the social networks, support exchanges, and support satisfaction of people from diﬀerent SES levels vary considerably. To put it succinctly, people at lower SES levels have smaller networks which tend to be sex segregated and to consist mainly of family members. They exchange support with fewer people and are often, though not always, less satisﬁed with the support they receive. Race, ethnicity, and culture have been shown to aﬀect social relationships although there appears to be some fundamental characteristics of social relationships that transcend group membership. Thus, for example, most support networks consist of family members but diﬀerent groups have diﬀerent customs and sometimes diﬀerent characteristics, which inﬂuence support relationships. So, for example, the church is a formal group that provides signiﬁcant support to most members of the African-American community. On the other hand, Hispanics place a particularly high value on family relationships which are characterized by large, densely knit support groups. In the United States, the daughter is often the most signiﬁcant support provider and caregiver for older parents. However, in Japan, daughters-in-law more often provide support than daughters because the traditional living arrangements in Japan require daughters-in-law to live with her husband’s parents. It is nevertheless important to remember that structure and culture do not always predict perception, expectation, and/or quality of support. A recent study (Tilburg et al. 1998) comparing older people in the Netherlands who often live alone with older people in Italy who often live with their children, found the Italians reporting less social integration and more loneliness than the Dutch. It may be that Italians expect more, perceive less, and therefore are more likely to downgrade the quality of the support they receive. These are important distinctions of which we are aware but about which we understand little. An additional perspective is oﬀered by research now available which demonstrates, at the psychoimmunological level, that people who are lonely or have more hostile interactions with others are much more likely to become ill, develop heart disease, cope less well with stress, and take longer to recover from health problems (Uchino et al. 1996).
6. Future Directions
Future programs designed to improve social relations and social support need to be sensitive to individuals and yet not encourage or induce dependence (Silverstein et al. 1996). Social support can be most useful when it instills in the individual a feeling of being valued and competent, of being worthy and capable. We are just beginning to understand how this might happen. Acknowledged possibilities include the exchange of support, which involves both receiving and providing support, reciprocity in social relations, and the convergence of expectations, perceptions, and receipt of support. Simply stated, identify ways to maximize positive support and minimize negative support. The next important challenge in this area is ﬁnding ways to incorporate what we know about social support speciﬁcally and social relations more generally into prevention and intervention programs that will improve the physical and mental health of people of all ages.
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