Do people with good social support and connections live longer? This was the question investigated by a major study recently published in PLoS Medicine.
The findings showed that social relationships have as much influence on the risk of death as other well-established risk factors, such as smoking and alcohol. They also showed the influence of social relationships may even exceed other significant risk factors, such as physical inactivity and obesity.
Dr Shane Pascoe, Research Fellow at the UNSW Research Centre for Primary Health Care and Equity, considers what the implications might be for primary health care:
This interesting study assesses the quality and quantity of individuals’ social relationships to outcomes in mental health and more importantly for me, mortality. A meta-analytic study, it looked at the results of 148 individual studies and found a 50% increased likelihood of survival for those participants with stronger social relationships across all ages and people.
A meta-analysis is a method combining the results of several studies and is at the top of the hierarchy of evidence. A meta-analysis is, however, really only as good as the studies that it brings together. The authors here use a good level of detail in their methods section so that the reader knows why a given study was rejected and others included. Although heavily weighted to North American and European research, this is often the case in these types of studies and is however useful for the Australian context.
The implications are wide ranging but let’s break it down first.
My interest is in cancer. Social support can be beneficial for the cancer patient in two ways. First the direct effect of being a member of a social network improves adaptive thinking and functional behaviours. This means that social support may encourage a patient to stick to that healthy diet. Take that prescribed medication. Better manage stress.
Secondly the ‘stress buffering’ hypothesis, suggests that social support reduces the threat of a stressor, and therefore its physical response. Social relationships also provide meaning and decrease the likelihood that people would engage in the risky behaviours many of us are prone to.
Within primary care, patients requiring practical support for financial, legal or housing issues are assessed either by their GP or other health provider. For GPs, the provision of information and referral to financial support for their patients are important tasks, and are part of the broader provision of psychosocial support. GPs help patients navigate the complex healthcare system and are instrumental in the choices and therefore outcomes of referral, especially in cancer care.
We are interested in this, and with our study of GPs involved in the referral pathway for colorectal cancer these factors are important. Little research has investigated the role and influence of the GP in referral. We asked GPs about their role as they saw it and they described it as providing long-term support and follow up after all the cancer treatment has been done. A great support.
Patients’ perspectives of the referral system are seldom heard. We have conducted another study of patients involved in the referral pathway for colorectal cancer, and social isolation was also an important psychosocial issue and was recognized as placing a person at risk.
The PLoS study, and the decades of other such work before it, lies on the outskirts of medicine.
Governments provide advertisements but where is the public health policy that is not slotted in a commercial break between a beer or a car commercial?
The importance of social support as recognized by patients and GPs alike is not matched by the frequency by which it is measured. This isn’t surprising.
Health professionals are not supported in assessing social support, providing meaningful intervention and follow up and seldom get the opportunity to see the fruits of their labour; improved longevity and mental health for patients.