American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved
Vol. 161, No. 3 Printed in U.S.A.
PRACTICE BOOK REVIEW OF EPIDEMIOLOGY
Social Support and Physical Health: Understanding the Health Consequences of Relationships By Bert N. Uchino ISBN 0-300-10218-6, Yale University Press, New Haven, Connecticut (Telephone: 800-405-1619, Fax: 800-406-9145, E-mail:
[email protected], Website: http://yalepress.yale.edu/yupbooks/), 2004, 240 pp., $35.00 (hardcover) the importance of structure and function in social support measurement. He explains the differences between perceived support, quality of support, received support, emotional support, and structural support. In the third chapter, he explains the two main models for addressing social support—the stress-buffering model and the directeffects model—along with the pathways for potential effects. In the fourth and fifth chapters, he reviews the literature regarding social support and mortality from all causes and specific diseases. In the sixth chapter, he fine-tunes the theoretical models based on existing studies and broadens the existing models for future research. In the seventh chapter, he discusses the implications of improving health by instituting social support interventions based on current research. In the eighth chapter, he summarizes his conclusions and provides guidelines for future research. Dr. Uchino has provided a book that clearly outlines some of the most salient research findings surrounding social support and physical health outcomes and elucidates questions for further research in this field. He objectively reviews the research evidence while clearly stating his own bias that social support is a causal factor influencing mortality. In addition to a detailed review of the literature, two of the major strengths of this book are the clear definitions and descriptions of the complex facets of social support/ networks and the delineation of theoretical pathways linking social support to physical outcomes. These pathways include social, personal, psychological, and biologic characteristics. Why should epidemiologists read this book? Much of the evidence for or against social support’s being related to physical health comes from epidemiologic studies. Epidemiologists, of necessity, often select the shortest assessment instrument available that has some predictive validity for their studies. For the most part, epidemiologic studies of the effects of social and psychological characteristics on physical disease have not focused on theoretical models. However, it is important for epidemiologists to understand the social support instrument they choose and how it fits into a broader picture of personal, social, and physical characteristics regarding the prediction of health or disease. Familiarity with the relevant theoretical models would help epidemiologists to conceptualize research designs and address specific questions that would augment current knowledge. For example, controlling for other variables in analyses to determine the “independence” of an effect may conceal relations that involve mediating effects. This book
The concept of “social support” and its relation to health outcomes has been a focus of study in psychosocial epidemiology for over 25 years. The intuitive sense that high levels of social support protect people from disease and early death has not always been realized in epidemiologic studies. In the history of this research, the goal has generally been to determine whether some measure of social support is an “independent” predictor of all-cause mortality or disease-specific mortality and morbidity. The strongest evidence that social support is related to health or disease comes from studies of large populations demonstrating that social support or social networks are protective against all-cause mortality. It also appears that social support is negatively associated with cardiovascular death and that it protects against recurrent events and death among persons diagnosed with disease. Research involving the predictive relation between social support/social networks and incidence of disease, specifically cardiovascular disease, has been inconclusive and inconsistent. Study results linking social support/networks to cancer and other outcomes, such as survival from human immunodeficiency virus/acquired immunodeficiency syndrome and complications arising during pregnancy, have also been conflicting. Inconsistencies in the findings surrounding social support/ networks and physical health outcomes may result from a number of factors. First, social support/networks are defined and measured differently across studies. Second, the association between social support and health may be not unidirectional but bidirectional; for example, in some circumstances, social support may be counterproductive to healthy outcomes. Third, the effects of social support may vary by characteristics such as age, sex, socioeconomic status, cultural setting, disease, or stage of disease. Fourth, the mechanisms that may explain any associations between social support and health need further elucidation. Fifth, theoretical paradigms need to be clearly defined and utilized in designing studies and analyzing data. Lastly, automatic multivariable adjustment, as practiced in many epidemiologic studies, may not be conducive to understanding the effects of social support on health outcomes. This book includes a general history of the biopsychosocial model of human health and specifically addresses the complexity of the concept of social support. This history is followed in the second chapter by the difficult question of how social support is to be conceptualized and measured. The author, Dr. Bert N. Uchino, differentiates and explains 1 Downloaded from https://academic.oup.com/aje/article-abstract/161/3/297/126972 by guest on 13 August 2018
Am J Epidemiol 2003;158:000–000
Book Reviews 2 will help epidemiologists design studies that are more comprehensive, collect data that broaden the scope of our understanding, and analyze the data in a theoretically sound fashion. While this book is useful and informative, its utility to epidemiologists is somewhat limited by the absence of discussion and illustration of various measures of social support/networks. Dr. Uchino references some appropriate sources, but it would have been useful to see measurement scales appropriate for large-scale studies presented in an appendix. It also would have been helpful if Dr. Uchino had illustrated where the various measures of social support fit into the theoretical frameworks he outlines.
Am J Epidemiol 2003;158:000–000 Downloaded from https://academic.oup.com/aje/article-abstract/161/3/297/126972 by guest on 13 August 2018
Study of the relation between social support and physical illness will depend on psychologists, sociologists, and epidemiologists to test and expand the field. Books like this one inform epidemiologists in useful ways, such as by providing an objective review of the evidence gathered to date and outlining the utility of theoretical models. It would have been even more valuable if the tools for conceptualization and data collection had been explicitly defined and provided. However, this book is an important addition to the literature for its holistic approach to the topic of social support and physical health. Elaine D. Eaker Eaker Epidemiology Enterprises, LLC, Chili, WI 54420
