If you had a mom like mine she probably told you to be nice to your friends, but did she tell you not to be mean? You may be wondering what is the difference; don’t they mean the same thing? Well, not exactly. Studies among healthy teens identified that negative interactions within friendships predict a break up of these friendships by the end of the school year. More importantly, even if you have more frequent positive interactions with the same friend these did not compensate for negative ones. Negative interactions appear to be more detrimental to social relationships.
Individuals with chronic conditions, especially those who have chronic conditions that are not understood within society (such as chronic pain and mental health conditions) have a history of experiencing negative interactions with family, friends, and from the general public. Stigma has long been identified as consequence of having a chronic health condition. Goffman first identified stigma in 1963 and defined it as a process through which the reactions of others spoils another’s normal identity, which results in an individual being disqualified from normal social acceptance. Even when negative interactions are not meant to be stigmatizing they may still have a negative effect on one’s health. Recent studies suggest that unsupportive interactions with even close friends are viewed more negatively by teens with chronic pain compared to healthy teens and that these teens may isolate themselves from even their closest friends to protect themselves from negative social situations. Similar findings have been found in adults with chronic pain. By staying home and not engaging with others, people with chronic conditions are at risk of decreasing the strength of their social relationships.
Weak social relationships are a risk factor for poor health outcomes including death and poor social relationships. Weak social relationships are comparable to other well-established risk factors such as smoking and obesity (see Holt-Lunstand et al., 2010 for a meta review (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.100036)
Social relationships benefit mental and physical health. There does not appear to be an age (adult studies), illness, or gender effect. Strong social relationships are protective for everyone’s health and perhaps more so for those who already have a chronic condition.
Research into how social relationships improve health have been conducted. Overall there is no one social relationship factor that is protective. It is more complex than whether we live with someone or live alone. The number of social relationships one has, the quality of those relationships, if one perceives their social relationships as providing social support, the amount of received social support, and combinations of all of these factors have been shown in varying degrees to impact health outcomes.
Social relationships are thought to improve health by one of two ways. The first way social relationships are thought to improve health is by buffering the negative effects of stress and illness. For example, positive social relationships can provide one with emotional support (willingness to discuss difficulties and express caring), appraisal support (provide one with information that is useful for self-evaluation), instrumental support (tangible aid), and informational support (advice, suggestions, information) and therefore help someone adhere to positive health behaviors when they need help. The second way social relationships are thought to improve health are through main effects, which means the benefits of social relationships are always present. For example, by having positive social relationships one has companionship, one is part of a social network in which they feel a purpose in their life and fulfill meaningful roles, which improves self-esteem. Therefore individuals are more likely to conform to social health norms and take better care of themselves. It remains unclear, which one of these two ways of thinking about social relationships, or perhaps a combination of both, is more likely to improve health outcomes.
Although studies have found links between positive health outcomes and social relationships there is much we still don’t know. We don’t know if the support provided by non-friends or non-family members is as helpful or more helpful. Adult peer support groups, for example, have been shown to provide emotional, informational, and appraisal support to others but they don’t provide much instrumental support. We also don’t know if peer support groups are linked to positive health outcomes for teens or for all health conditions. We don’t know if health professionals or paraprofessional can provide some forms of social support for those with weaker social relationships. We also don’t know if peer support is better or even needed if one has positive social relationships.
More research is needed to understand the function of different social relationships on health and how best to maintain and strengthen the forms of social relationships and functions of those relationships that are linked to positive health outcomes. We need to invest in this type of research as not only do the interventions have the potential to make positive impacts on mental and physical health but also the interventions are most likely inexpensive. Additionally, not all help is the same and there is potential for the wrong social support or relationship to lead to poorer health outcomes. Until then remember be nice to your friends and others and if you can’t be nice at the very least don’t be mean.