How can social support help me manage difficult emotions?

Social support and community, a social determinant of health, plays a critical role in both physical and emotional well-being.^1,2 Social support is divided into four main areas: emotional (understanding, empathy, and comfort), appraisal (self-evaluation and comparison), informational (advice or sharing of helpful and relevant information), and instrumental (help with concrete needs such as material aid or assistance with tasks).³ Numerous studies have found that social support is significantly associated with both mental and physical health.^4,5 One 2009 meta-analysis of 208 studies found that social support was significantly correlated with all health outcome variables (e.g., health status, physical symptoms, psychologic symptoms, depression, stress, quality of life).⁶

A 2006 cross-sectional study of 4,558 middle-aged individuals (aged 40-69) found that social support was associated with lower levels of depression.⁷ Depression was assessed using the Center for Epidemiologic Studies Depression scale (CES-D; scored 0-60 with scores ≥16 considered depressed) and social support using the Measurement of Social Support-Elderly (MOSS-E; scored 0-10 with higher scores indicating higher levels of social support). Among those who had the highest levels of social interaction, the mean CES-D score was 13.05 compared to 17.01 for the lowest levels of social interaction. Similarly, those with higher MOSS-E scores had both higher levels of perceived health (7.20 for very good health vs 5.92 for bad health) as well as fewer illnesses (7.09 for no illnesses, 6.78 for one, 6.05 for two, and 5.8 for three or more).

A study published in 2008 used a random digit telephone survey (n=337,556 adults) to assess the relationship between self-reported social support and mental health.⁸ Overall, receiving social support was common, with 91.4% of respondents reporting that they sometimes, usually, or always receive social/emotional support. Among those with more social support, the mean number of poor mental health days in the past month was lower (2.4 days for always/usually receiving support, 6.2 for sometimes, and 7.3 days for rarely/never), days with depressive symptoms (2.2, 5.5, and 7.3 days, respectively), and days with anxiety symptoms (4.3, 8.0, and 9.0 days respectively). Those with lower social support were also more likely to report being dissatisfied with life (2.1%, 13.9%, and 24.7%, respectively).

The same study found that social support impacted physical health.⁸ Those with less social support reported higher levels of sleep insufficiency (8.1, 10.3, and 12.1 days, respectively), pain (2.4, 3.9, and 4.4 days respectively), and activity limitations (1.7, 3.4, and 4.3 days, respectively). Those with less social support were also more likely to have poorer perceived general health (12.9%, 25.3%, and 33.9%, respectively) and fewer days of vitality defined as feeling very healthy and full of energy (18.7%, 13.2%, and 13.1%, respectively).

Mental Health

Social support is associated with improved mental health. The majority of studies on social support and mental health have examined depression; however, a 2018 systematic review examined 34 studies that found that social support was associated with improved symptoms, recovery, and social functioning for mental health conditions including depression, schizophrenia, schizoaffective disorders, bipolar disorder, anxiety disorders, and patients with multiple conditions.¹² For depression, peer support has been shown to be as effective as cognitive behavioral therapy for reducing depressive symptoms.⁹ A 1992 review of 35 studies found that every one had a clear inverse association between social support and depression.¹⁰ A more recent 2016 meta-analysis of 100 studies found that social support had a protective effect for depression regardless of age, with 90% of studies reporting a significant association.¹¹

Stress

Social support can be especially beneficial in times of stress. According to the stress-buffering hypothesis, social support can mitigate the negative psychological and physiological effects of stress by enhancing coping resources.¹³ When individuals face emotionally challenging situations, such as illness, grief, or life transitions, supportive interactions can help reduce perceived stress and promote emotional resilience. This buffering effect can be particularly effective when the support is perceived as responsive, empathetic, and matched to the individual's needs.¹⁴

Social support is thought to activate the parasympathetic nervous system and reduce physiological arousal associated with stress, such as elevated heart rate and cortisol levels.¹⁵ A 1999 meta-analysis examined 22 studies that tested the effect of social support during an anxiety-provoking situation in a controlled setting.¹⁶ The studies use various stressors, including electric shock, delivering a speech, being verbally accosted, solving a puzzle, and performing mental math. The presence of a friend or loved one decreased heart rate, blood pressure, and cortisol levels.

References

1. Healthy People 2030: Social Determinants of Health. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed July 25, 2023. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
2. Taylor SE. Social Support: A Review. In: Friedman HS, ed. The Oxford Handbook of Health Psychology. Oxford University Press; 2011:189-214:chap 9.
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10. Henderson A. Social support and depression. In: Veil H, Baumann U, eds. The meaning and measurement of social support. Hemisphere Publishing Corp; 1992:85-92.
11. Gariépy G, Honkaniemi H, Quesnel-Vallée A. Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry. Oct 2016;209(4):284-293. doi:10.1192/bjp.bp.115.169094
12. Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry. May 29 2018;18(1):156. doi:10.1186/s12888-018-1736-5
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14. Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. Jun 2011;52(2):145-61. doi:10.1177/0022146510395592
15. Hostinar CE, Sullivan RM, Gunnar MR. Psychobiological mechanisms underlying the social buffering of the hypothalamic-pituitary-adrenocortical axis: a review of animal models and human studies across development. Psychol Bull. Jan 2014;140(1):256-82. doi:10.1037/a0032671
16. Thorsteinsson E, James J. A Meta-analysis of the effects of experimental manipulations of social support during laboratory stress. Psychology & Health. 1999;14(5):869-886. doi:10.1080/08870449908407353