Jul 27, · Results. Across studies (, participants), the random effects weighted average effect size was OR = (95% CI to ), indicating a 50% increased likelihood of survival for participants with stronger social relationships We value excellent academic writing and strive to provide outstanding essay writing service each and every time you place an order. We write essays, research papers, term papers, course works, reviews, theses and more, so our primary mission is to help you succeed academically Get to know your Apple Watch by trying out the taps swipes, and presses you'll be using most. Here are some helpful navigation tips and features
Social Relationships and Mortality Risk: A Meta-analytic Review
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality. This meta-analytic review was byu latex dissertation to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
This finding remained consistent across age, sex, byu latex dissertation, initial health status, cause of death, and follow-up period. The influence of social relationships on risk for mortality is comparable with well-established risk factors byu latex dissertation mortality.
Citation: Holt-Lunstad J, Smith TB, Layton JB Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7 7 : e Received: December 30, ; Accepted: June 17, ; Published: July 27, Copyright: © Holt-Lunstad et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted byu latex dissertation, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This research was generously supported by grants from the Department of Gerontology at Brigham Young University awarded to JHL and TBS and from TP Industrial, Inc awarded to TBS.
The funders had no role byu latex dissertation study byu latex dissertation, data collection and analysis, decision to publish, byu latex dissertation, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Abbreviations: CI, confidence interval; CVD, cardiovascular disease; OR, odds ratio, byu latex dissertation.
Humans are naturally social. Yet, the modern way of life in industrialized countries is greatly reducing the quantity and quality of social relationships. Many people in these countries no longer live in extended families or even near each other. Instead, they often live on the other side of the country or even across the world from their relatives, byu latex dissertation.
Many also delay getting married and having children. Likwise, more and more people of all ages in developed countries are living alone, and loneliness is becoming increasingly common.
Similarly, across the Atlantic, over the past two decades there has been a three-fold increase in the number of Americans who say they have no close confidants. There is reason to believe that people are becoming more socially isolated, byu latex dissertation. Some experts think that social isolation is bad for human health. They point to a review of five prospective studies investigations in which the characteristics of a population are determined and then the population is followed to see whether any of these characteristics byu latex dissertation associated with specific outcomes that showed that people with fewer social relationships die earlier on average than those with more social relationships.
But, even though many prospective studies of mortality death have included measures of social relationships since that first review, byu latex dissertation, the idea that a lack of social relationships is a risk factor for death is still not widely recognized by health organizations and the public.
In this study, therefore, the researchers undertake a systematic review and meta-analysis of the relevant literature to determine the extent to which social relationships influence mortality risk and which aspects of social relationships are most predictive of mortality.
A systematic review uses predefined criteria to identify all the research on a given topic; a meta-analysis uses statistical methods to combine the results of several studies. An effect size quantifies the size of a difference between two groups—here, the difference in the likelihood of death between groups that differ in terms of their social relationships.
They report that the average OR was 1. Put another way, an OR of 1. Importantly, the researchers also report that social relationships were more predictive of the risk of death in studies that considered complex measurements of social integration than in studies that considered simple evaluations such as marital status.
These findings indicate that the influence of social relationships on the risk of death are comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceed the influence of other risk factors such as physical inactivity byu latex dissertation obesity.
Furthermore, the overall effect of social relationships on mortality reported in this meta-analysis might be an underestimate, byu latex dissertation, because many of the studies used simple single-item measures of social isolation rather than a complex measurement, byu latex dissertation.
Although further research is needed to determine exactly how social relationships can be used to reduce mortality risk, physicians, health professionals, educators, byu latex dissertation, and the media should now acknowledge that social relationships influence the health outcomes of adults and should take social relationships as seriously as other risk factors that affect mortality, the researchers conclude. Two decades ago a causal association between social relationships and mortality was proposed after a review of five large prospective studies concluded that social relationships predict mortality [1].
Following the publication of this provocative review, byu latex dissertation, the number of prospective studies of mortality that included measures of social relationships increased exponentially. Although the inverse association between social relationships and nonsuicide mortality has received increased attention in research, neither major health organizations nor the general public recognize it as a risk factor for mortality. This may be due in part to the fact that the literature has become unwieldy, with wide variation in how social relationships are measured across a large number of studies and disappointing clinical trials [2].
Thus, the large corpus of relevant empirical research is in need of synthesis and refinement. For instance, trends reveal reduced intergenerational living, greater social mobility, delayed marriage, dual-career families, increased single-residence households, and increased age-related disabilities [3][4], byu latex dissertation.
More specifically, over the last two decades there has been a three-fold increase in the number of Americans who report having no confidant—now the modal response [3].
Such findings suggest that despite increases in technology and globalization that would presumably foster social connections, people are becoming increasingly more socially isolated. Given these trends, understanding the nature and extent of the association between social relationships and mortality is of increased temporal importance.
There are two general theoretical models that propose processes byu latex dissertation which social relationships may influence health: the stress buffering and main effects models [5]. The buffering hypothesis suggests that social relationships may provide resources informational, emotional, or tangible that promote adaptive behavioral or neuroendocrine responses to acute or byu latex dissertation stressors e.
The aid from social relationships thereby moderates or buffers the deleterious influence of stressors on health. From this perspective, the term social support is used to refer to the real or perceived availability of social resources [6].
The main effects model proposes that social relationships may be associated with protective health effects through more direct means, such as cognitive, emotional, behavioral, byu latex dissertation, and byu latex dissertation influences that are not explicitly intended as help or support.
For instance, social relationships may directly encourage or indirectly model healthy behaviors; thus, being part of a social network is typically associated with conformity byu latex dissertation social norms relevant to health and self-care. In addition, being part of a social network gives individuals meaningful roles that provide self-esteem and purpose to life [7][8].
Social relationships have been defined and measured in diverse ways across studies. Despite striking differences, byu latex dissertation, three major components of social relationships are consistently evaluated [5] : a the degree of integration in social networks [9]b the social interactions that are intended to be supportive i.
The first subconstruct represents the structural aspects of social relationships and the latter two represent the functional aspects. While all three components have been shown to be associated with morbidity and mortality, it is thought that each may influence health in different ways [11] byu latex dissertation, [12].
Because it is presently unclear whether any single aspect of social relationships is more predictive than others, synthesis of data across studies using several types of measures of social relationships would allow for essential comparisons that have not been conducted on such a large scale. Empirical data suggest the medical relevance of social relationships in improving patient care [13]increasing compliance with medical regimens [13]byu latex dissertation, and promoting decreased length of hospitalization [14][15].
Likewise, social relationships have been linked to the development [16][17] and progression [18] — [21] of cardiovascular disease [22] —a leading cause of death globally. Therefore, synthesis of the current empirical evidence linking social relationships and mortality, along with clarifications of potential moderators, byu latex dissertation be particularly relevant to public health and clinical practice for informing interventions and policies aimed at reducing risk for byu latex dissertation. To address these issues, byu latex dissertation, we conducted a meta-analysis of the literature investigating the association between social relationships and mortality.
Specifically, we addressed the following questions: What is the overall magnitude of the association between social relationships and mortality across research studies? Do structural versus functional aspects of social relationships differentially impact the risk for mortality? Is the association moderated by participant characteristics age, gender, health status, cause of mortality or by study characteristics length of clinical follow-up, inclusion of statistical controls? Is the influence of social relationships on mortality a gradient or threshold effect?
To identify published and unpublished studies of the association between social relationships and mortality, byu latex dissertation, we used three techniques.
To capture the broadest possible sample of relevant articles, we used multiple search terms, including mortalitydeathdecease ddieddead byu latex dissertation, and remain ed alivewhich were crossed with search words related to social relationships, including the terms social and interpersonal linked to the following words: supportbyu latex dissertation, networkintegrationparticipationcohesionbyu latex dissertation, relationshipcapitaland isolation To reduce inadvertent omissions, we searched databases yielding the most citations Medline, PsycINFO two additional times.
Next, we manually examined the reference sections of past reviews and of studies meeting the inclusion criteria to locate articles not identified in the database searches. Finally, we sent solicitation letters to authors who had published three or more articles on the topic. We included in the meta-analysis studies that provided quantitative data regarding individuals' mortality as a function of social relationships, including both structural and functional aspects [23].
Because we were interested in the impact of social relationships byu latex dissertation disease, we excluded byu latex dissertation in which mortality was a result of suicide or injury. We also excluded studies in which the only measurement of social support was an intervention provided within the context of the study e. We coded studies that byu latex dissertation participant marital status as one of several indicators of social support, but we excluded studies in which marital status was the only indicator of social support.
We also excluded studies in which the outcome was not explicitly and solely mortality e. Reports with exclusively aggregated data e.
See Figure 1 for additional details. To increase the accuracy of coding and data entry, each article was initially coded by two raters. Subsequently, byu latex dissertation, the same article was independently coded by two additional raters, byu latex dissertation. Coders extracted several objectively verifiable characteristics of the studies: a the number of participants and their composition by age, gender, marital status, distress level, health status, and pre-existing health conditions if anyas well as the percentage of smokers and percentage of physically active individuals, and, of course, byu latex dissertation cause of mortality; b the length of follow up; c the research design; and d the aspect of social relationships evaluated.
Data within studies were often reported in terms of odds ratios ORsthe likelihood of mortality across distinct levels of social relationships. Because OR values cannot be meaningfully aggregated, all effect sizes reported within studies were transformed to the natural log OR lnOR for analyses and then transformed back to OR for interpretation.
When effect size data were reported in any metric other than OR or lnOR, we transformed those values using statistical software programs and macros e. In some cases when direct statistical transformation proved impossible, we calculated the corresponding effect sizes from frequency data in matrices of mortality status by social relationship status. When frequency data were not reported, we recovered the cell probabilities from the reported ratio and marginal probabilities. When survival analyses i.
Across all studies we assigned OR values less than 1, byu latex dissertation. When multiple effect sizes were reported within a study at byu latex dissertation same point in time e. In such cases, the aggregate standard error value for the lnOR were estimated on the basis of the total frequency data without adjustment for possible correlation among the averaged values.
Although this method was imprecise, the manuscripts included in the meta-analysis did not report the information necessary to make the statistical adjustments, and we decided not to impute values given the wide range possible. In analyzing the data we used the shifting units of byu latex dissertation approach [25] which minimizes the threat of nonindependence in the data while at the same time allowing more detailed follow-up analyses to be conducted i.
When multiple reports contained data from the same participants publications of the same databasewe selected the report containing the whole sample and eliminated reports of subsamples. When multiple reports contained the same whole sample, we selected the one byu latex dissertation the longest follow-up duration. When multiple reports with the same whole sample were of the same duration, byu latex dissertation, we selected the one reporting the greatest number of measures of social relationships.
In cases where multiple effect sizes were reported across different levels of social relationships i. When a study contained multiple effect sizes across time, we extracted the data from the longest follow-up period. If a study used statistical controls in calculating an effect size, we extracted the data from byu latex dissertation model utilizing the fewest statistical controls so as to remain as consistent as possible across studies and we recorded the type and number of covariates used within each study to run post hoc comparative analyses.
We coded the research design used rather than estimate risk of individual study bias. The coding protocol is available from the authors. The majority of information obtained from the studies was extracted verbatim from the reports. Discrepancies across coding pairs were resolved through further scrutiny of the manuscript until consensus was obtained.
Aggregate effect sizes were calculated using random effects models following confirmation of heterogeneity.
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