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Social support. Kristina Orth-Gomér. Internal medicine Social medicine/Public health Karolinska institutet, Sthlm + Psykosomatisk medicin Charit é Universit ä tsmedizin Berlin. A lonely man is a strong man. Social support - definition.

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Social support
Social support

Kristina Orth-Gomér


Social support
Internal medicineSocial medicine/Public healthKarolinska institutet, Sthlm+Psykosomatisk medicinCharité Universitätsmedizin Berlin



Social support definition
Social support - definition

  • Social support is the resource provided by other people (S Cohen, L Syme 1985)

  • Social networks - structure

  • Social supports - function

  • Social relations may have negative and positive effects on health


Social networks and health
Social networks and health

”the patterns of prospective association between social integration (that is the number and frequency of social relationships and contacts) and mortality are remarkably similar, with some variations by race, sex and geographic locale.”

House et al., Science, 1988


Age adjusted relative mortality risk rr low vs high social network index
Age adjusted relative mortality risk (RR) low vs high social network index

menwomen

Alameda county (CA)2.44*2.81*

Techumseh (MI)3.87*1.97

Evans county (GEO)

whites1.83*1.07

blacks1.081.59

North Karelia (SF)2.63*1.92

Gothenburg (S)4.00*-

Swedish survey of 1.50*1.50*

living coditionsHouse et al., Science, 1988


Swedish survey of living conditions
Swedish Survey of Living Conditions

  • 17 400 men and women, age 15 to 65

  • Representative of the Swedish population

  • Followed for 6 years

  • Low Social network interaction predicted mortality in men of all ages

  • Excess risk 50%, controlling for other risk factors


Men aged 50 born in g teborg
Men, aged 50, born in Göteborg

  • 741 men, born in 1933

  • Followed for 6 years and 15 years

  • Attachment - close emotional ties

  • Social integration - help with appraisal and coping, tangible support, belonging


Social inegration avsi
Social inegration (AVSI)

  • How many people do you know?

  • How many people do you have regular contact with?

  • How many friends do you have who can come to visit any time?

  • How many people can you trust?

  • How many people can you ask for small favors?

  • How many people can you turn to in difficulties and expect real help?



Attachment avat
Attachment (AVAT)

  • Is there anyone you can lean on?

  • Is there anyone who feels very close to you?

  • Is there anyone you can share happiness with, who would also feel happy ?

  • Is there anyone you can share most private feelings with ?

  • Is there anyone to hold and comfort you?

  • Do people really appreciate what you do for them?




Controlling for life style
Controlling for life style

Protective effects on CVD incidence

social integration = .45

P=.014

attachment = . 58

P=.019

Rosengren A Wilhelmsen L

Orth-Gomer K, 2003


Conclusions
Conclusions

  • Socially integrated men have half the risk of getting a myocardial infarction over 15 yrs

  • Attachment is also protective

  • Both effects are independent of other risk factors



Social support
Attachment did not significantly affect prognosis in women.Are close emotional ties stressful rather than protective in women?

Negative effects of social ties?


Social support
Aim

To evaluate the impact of stress from social relations on prognosis in women CHD patients - controlling for both disease severity, standard risk factors and work stress as measured at baseline.


The stockholm marital stress scale
The Stockholm Marital Stress Scale

Is the relationship with your spouse loving?

Is the relationship with your spouse friendly?

Is the relationship with your spouse routine-like ?

Is the relationship with your spouse problematic?

Do you engage in leisure activities together with your spouse?

Do you have your own private life outside the relationship with your spouse?

Is your spouse your closest confidant?

Are there things you can’t talk openly about with each other?

Have you had serious problems in the relationship with your spouse previously?

Have you had serious problems in the relationship with your spouse currently?

Have you had serious crises in your relationhip?

Have you solved problems actively together?

Do you have a sexual relationship with your spouse?

Do you find the sexual relationship with your spouse satisfactory?

Has your sexual relationship been affected by your heart disease?

Has your sexual relationship ceased due to your heart disease?


Depressive symptoms
Depressive symptoms

  • Lack enthusiasm

  • Poor appetite

  • Feel lonely

  • Feel bored

  • Troubled sleep

  • Cry easily

  • Feel downhearted

  • Low in energy

  • Feel hopeless

Pearlin, J Health Soc Behav 22:337-356 1981


Social support

BUFFER EFFECT

STRESSOR

DISEASE

SOCIAL SUPPORT

MAIN EFFECT

SOCIAL ISOLATION

DISEASE



Mediating mechanisms
Mediating Mechanisms

Atherogenic

Thrombotic

Autonomic imbalance



The metabolic syndrome
The metabolic syndrome

  • Defined according to WHO

  • Fasting plasma glucose > 7.0 mmol/l

  • Blood pressure > 160/90 mmHg

  • Central obesity ( w/h >.85 or BMI>30 kg/m2)

  • Fasting TG >1.7mmol/l or HDL<1.0 mmol/l


Social support and the metabolic syndrome in middle aged swedish women
Social support and the Metabolic Syndrome in middle-aged Swedish women

Adjusted for age, menopausal status, educational level, smoking,

exercise and alcohol consumption



Methods
Methods Swedish women

  • All female patients, aged 65 or under who wereadmitted with an acute coronary syndrome between 1991 and 1994 in Stockholm (n=292)

  • Diagnosis at baseline: Acute Myocardial Infarction (n=110) or unstable Angina Pectoris (n=182)

  • followed for five years for recurrent event

  • sleep complaints were measured at baseline using a standardized questionnaire

  • 283 women answered the sleep questionnaire


The sleep questionnaire
The Sleep Questionnaire Swedish women

  • Have you perceived any of the following

  • complaints during the last time?

  • Difficulties falling asleep

  • Disturbed/restless sleep Sleep quality

  • Premature awaking index

  • Heavy snoring

  • Not feeling refreshed


Recurrent cardiac events and subjective sleep quality
Recurrent cardiac events and subjective sleep quality Swedish women

Sleep qualitynScoresHR (95% CI)* p

good740-31

average1414-61.97 (1.01-3.85).047

poor687-92.55 (1.24-5.24).011

*Hazards ratio, adjusted for age, BMI, symptoms of heart failure, hypertension, diagnosis at index event, diabetes, HDL-cholesterol, triglyderides, smoking, and education


Controlling for work stress did not change the results
Controlling for work stress did Swedish womennot change the results!


Depressive symptoms1
Depressive symptoms Swedish women

  • Lack enthusiasm

  • Poor appetite

  • Feel lonely

  • Feel bored

  • Troubled sleep

  • Cry easily

  • Feel downhearted

  • Low in energy

  • Feel hopeless

Pearlin, J Health Soc Behav 22:337-356 1981


Results
Results Swedish women

Poor sleep quality and not feeling well-rested are associated with poorer prognosis in women with a prior cardiac event.


Are variations in heart rate and rhythm autonomic imbalance a mediating mechanism
Are variations in heart rate and rhythm - autonomic imbalance a mediating mechanism?


Heart rate variability
HEART RATE VARIABILITY imbalance a mediating mechanism?

Derived from 24-hour Holter recordings:

SDNN index Total power

Low Frequency power (LF)

High Frequency power (HF)

Very Low Frequency power (VLF)

SDNN index:

average of the standard deviations of all normal to normal

intervals for each 5-minute interval of the entire recording

(ms)


Hrv high healthy low unhealthy
HRV - high (healthy) imbalance a mediating mechanism?low (unhealthy)

Heart rate variability =

ability ofthe heart to react to stressors


Differences in sdnn index msec between standard risk factor groups adjusted for age controls n 249
Differences in SDNN index (msec) between standard risk factor groups, adjusted for age (controls, N=249).

Standard risk factors MeanSEMP

Smoking

No42.9.83

Yes40.01.21.05

Sedentary lifestyle

No42.7.77

Yes 39.41.48.05

Obesity (kg/m2)

BMI28.643.2.76

BMI>28.637.61.43 .001

Systolic blood pressure (mmHg)

14043.0.72

>14036.11.75 .001


Conclusions1
Conclusions factor groups, adjusted for age (controls, N=249).

Social supports affect men and women differently

Men benefit from both social integration and attachment

Women´s close emotional ties -sometimes stressful


Cognitive group based one year educational program friskare kvinnohj rtan
Cognitive group based one year educational program factor groups, adjusted for age (controls, N=249).”Friskare Kvinnohjärtan”

Increased social support

Increased self esteem

Improved communication skills


Topics discussed in the groups
Topics discussed in the groups factor groups, adjusted for age (controls, N=249).

  • Atherosclerosis and its risk factors

  • Psychological consequences of clinical CHD

  • Stress physiology. Recognizing multiple sources of stress - at work at home, elsewhere

  • Indivdual standard risk factor profile


Topics continued
topics continued factor groups, adjusted for age (controls, N=249).

Positive/negative emotions

Exercise book with daily concrete reports

Maintained throughout the course


Exercises
exercises factor groups, adjusted for age (controls, N=249).

Daily practice of altered behavior:

”Choosing the longest line”

”Driving in the right lane”

”Avoid getting angry”

”Every patient needs to talk at least once every session”


Continued
continued factor groups, adjusted for age (controls, N=249).

  • Roles/”strong and weak legs to stand on” ”parent ” child” ”professional pride”…

  • ”avoid standing on just one leg”

  • adaptation to specific social conditions (work, professional,family life)

  • general life situation- how is life? How wouls I like it?What is important in life?


The end
The end factor groups, adjusted for age (controls, N=249).


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