Dr. Dean Ornish

The Karolinska Institute in Stockholm conducted a study to determine the benefit of social support among the elderly and whether it can improve health outcomes. The study involved sixty residents of a retirement community in Stockholm.  At the start of the program, a complete blood count and levels of testosterone, dehydroepiandrosterone, and estradiol were recorded for all sixty subjects. Psychosocial tests were also administered to everyone. Both groups were then tested again at three months and at the end of the study at the six-month mark. One of the findings included statistically significant hormonal increases in the treatment group but none in the controls. The thirty subjects in the control group evidenced a decrease in hemoglobin levels, while these levels were unchanged in the treatment group. This is significant because hemoglobin levels are ordinarily on a steady decline in old age. In addition, height decreased in the controls but not in the treatment group. 

One of the attributes of the healthiest centenarians throughout the world is that they maintained strong social networks throughout life. In addition, their lives have traditionally revolved around family life. Multigenerational families commonly live together. And despite having so much family around, they also made time each day for friends.

Social support at its best includes the opportunity for everyone to experience the deep joy of giving to others in the group. Research psychologists Charlene Depner and Berit Ingersoll-Dayton studied seven hundred elderly adults and discovered that the degree of health and vitality among the elders was directly associated with the personal contributions they made to their social network; it was not based on what they took out of the social network. 

The evidence of a connection between social support and heart disease is compelling. One Swedish study, for example, tracked 736 men over six years and found that those with close friendships had less heart disease. We have all experienced heartwarming feelings when we were with close friends. Such feelings have physiological correlates. They have been traced to relaxation of the smooth muscle in the cardiac arteries, which then triggers other healthy physiological responses including vasodilation (the widening of blood vessels). This allows arteries that may be lined with plaque to open and carry more blood and oxygen to the heart, resulting in fewer and milder cardiac events. The heartwarming feeling itself is the literal result of increased blood flow to the center of the chest. This is probably one of the physiological mechanisms at work in the effects of social support on cardiac health.

Most behavioral medicine studies involving heart patients focus on the efficacy of lifestyle changes to reduce atherosclerosis (hardening of the arteries) and reverse ischemic heart disease (reduced blood supply to the heart muscle). World-renowned cardiologist Dean Ornish’s behavioral medicine program includes weekly psychoeducational group participation, which he initially instigated as a way to promote the healthy lifestyle changes he advocates, especially adherence to a very strict low-fat diet. Doctor Ornish reported that although the researchers in his studies had not previously controlled for the effects of participation in the group, it was his personal belief that the social support aspect of these gatherings might be the single most powerful intervention of the entire program.

When research psychologist Ute Schultz and his team studied the efficacy of the Ornish program, they found the social support aspect to be one of the ingredients that made it a lifesaver for cardiology patients who had failed with previous behavioral medicine interventions.

Prior to the establishment in their city of American fast food outlets and other unhealthy American influences, the residents of Tokyo and other major Japanese cities had one of the lowest rates of heart disease in the world. It was generally accepted in the early 1970s that the differences between US and Japanese incidents of heart disease could be accounted for in two ways: Americans ate a red-meat-based diet and the Japanese ate a fish-based diet and Japanese had a much stronger sense of connectedness to family, friends, and even work associates than Americans.

Despite the exceptional cardiac health of the Japanese in their home country at that time, researchers discovered that Japanese immigrants to San Francisco in the early 1970s were even healthier than their already healthy Tokyo counterparts. These immigrants often ate American food, smoked cigarettes, and had cholesterol levels as high as their American counterparts. The most dramatic finding was that despite their new, unhealthy American lifestyle habits, their cardiac health was not only superior to that of Americans but was even better than the Japanese back home, all of whom at that time were eating a much healthier diet.

Epidemiology researcher Michael Marmot studied these immigrants, controlling for every imaginable variable. They concluded that the reason for this very surprising finding was that the immigrants had become even more involved in the tightly-knit Japanese cultural community of San Francisco than the average Japanese was in Japan. It was social support that allowed them be so healthy despite eating an unhealthy American diet, smoking, and not exercising.

In a study of several hundred cardiac patients in Sweden, Dr. Bertil Hanson wanted to know why some patients had better health outcomes than others. After controlling for all the variables, they discovered that while in the hospital, people with the best outcomes were those whose teams of physicians and nurses were always close by and where there was the most human contact. After returning home, the patients with the best outcomes, again controlling for all the variables, were the ones with the most social support.

Although the psychophysiological mechanisms at work are still a medical mystery, it is now clear that social support not only correlates with lower rates of all-cause morbidity and mortality, but can cure existing disease. In a prospective study from Sweden, physician and medical researcher Kristina Orth-Gomer and her assistant Anna-Lena Unden divided 150 men into three groups. One group was made up of post-MI (myocardial infarct) patients. Men in the second group were relatively healthy except they had risk factors for ischemic cardiovascular (CV) disease. Men in a third group were healthy and had no risk factors for any CV disease. The men in all three groups received identical psychological testing as well as a complete physical at the start of the study. Variables for which the researchers controlled included socioeconomic status, marital status, education, occupation, social class, smoking, alcohol consumption, Type A behavior, social activities, and social integration. All the men in all three groups were then observed for ten years. At the end of that period, thirty-seven of the men had died—twenty of them from ischemic heart disease. After all the data were processed these associations became clear:

  • The men with the most disease or the most risk factors ten years earlier were not necessarily the ones with the highest mortality rates.
  • Social isolation was the single factor above all others that contributed to the highest mortality rates.
  • The men with existing heart disease ten years earlier who had the greatest social support outlived the healthiest men who were the most socially isolated.