Chapter 36 - Close Relationships and Immunity

Abstract

Our lives tend to be centered around close relationships with significant others, family, and friends. It is increasingly apparent that the existence and quality of such relationships and the support they provide have a strong impact not only on our psychological wellbeing (Glenn and Weaver, 1981) but also our physical health. A number of prospective studies have reported remarkably similar patterns of increasing risk for allcause mortality with a decreasing number of social ties, even after controlling for sociodemographic characteristics and health (e.g.. Berkman and Syme, 1979; House et al., 1982; Kaplan et al., 1988). The existence and quality of key close relationships, such as marriage, are also predictive of morbidity and mortality from a range of chronic and acute conditions (Johnson et al., 2000; Kiecolt-Glaser and Newton, 2001; Verbrugge, 1979). One key pathway underlying the association between social relationships and health outcomes appears to be changes in immune function (Kiecolt-Glaser, 1999), an area of research which holds great promise for further clarifying the role of close relationships and health and which will be the focus of this chapter. The current review is organized around three aspects of close relationships: social integration, social support, and negative aspects of social ties. These topics map relatively well onto three models by which social relationships can affect health in relation to psychological stress: the main effects model, the stressbuffering model, and the social strain model (Cohen, 2004; Orth-Gomer, 2000; Rook, 1990). In this literature, psychological stress is most often determined by selfreported perceived stress, as well as by objective indicators of life stress and reports of life events. We first present work on social integration, including in this category broad measures of network size as well as studies focused on marital status, a key social tie. In line with the main effects model (Lazarus and Folkman, 1984), measures of social integration are typically associated with health benefits independent of stress (Cohen, 1988; Cohen, 2004). Next, we review literature focused on social support. In contrast to quantitative measures of network size, social support is typically defined as the perception that assistance would be available if and when it is needed, as well as the receipt of assistance during such times. Such assistance can include, but is not limited to, the provision of material aid, assistance with tasks, information, or emotional support. In line with the stress-buffering model, the benefits of perceived social support are frequently seen only (or primarily) when a person encounters stress of a sufficient magnitude (Cohen, 1988). Relevant work on the related constructs of loneliness and intimacy is also covered briefly in this section. Finally, we review work that best fits with the social strain model, which holds that relationships can sometimes serve as a source of stress