December 2003

Grant Results

SUMMARY

Experts from the social, behavioral, physiological and medical sciences developed a plan to study how the extent to which people are socially connected (that is, have relationships with others) affects their physical health.

Between 2001 and 2002, the Mind Brain Body and Health Initiative, at the University of Texas Medical Branch, organized and guided the development of a research plan to address this issue.

Previous research by Lisa F. Berkman, Ph.D., of Harvard University and others has shown that people with a greater number of social relationships live longer and appear to recover more rapidly from illness.

However, little work has been done to describe the physiological mechanisms that lead to these impacts on health or how interventions could be designed to increase people's social relationships and overall health.

Key Results

  • A five-member planning group convened 10 meetings between October 2001 and December 2002 that drew on the knowledge of a multidisciplinary group of experts.

    Early meetings addressed psychological factors in the link between "social connectedness" and health, the physiological means by which this link occurs, and intervention strategies.

Key Findings
During these meetings, participants learned that:

  • There is compelling evidence that individuals with social relationships live longer and are physically and mentally healthier than more isolated individuals.
  • In contrast, the evidence that social interventions are effective in improving health is much weaker.
  • There are multiple problems associated with prior intervention studies; many did not consider the social, cultural and environmental context; the complexity of social relationships; or other aspects of social interaction.

Subsequent meetings included a presentation to RWJF staff and the development of a proposal to RWJF to fund a network of researchers at various institutions to study the relationships between social relationships and health. The proposal recommended the establishment of a research network to study, in tandem, the physiological mechanisms underlying the relationship between social connectedness and health and the social interventions that are effective in promoting health.

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project with a grant of $696,672 from August 2001 to September 2002.

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THE PROBLEM

Individuals with a greater number of social connections — with family, friends and community — live longer and appear to recover more rapidly from illness than do more socially isolated individuals, according to researchers such as Lisa F. Berkman, Ph.D., of Harvard University. Yet, researchers, health care providers and policy-makers have not adequately addressed social "connectedness" and social isolation as important factors in health.

It is clear, from research evidence, that social relationships influence health and disease. However, how this occurs — the physiological mechanisms — remains unclear. Understanding these complex mechanisms and the social interventions that will enhance health status requires research that draws upon perspectives from the social, behavioral, physiological and medical sciences.

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RWJF STRATEGY

This project was an initiative of the RWJF Community Health Team. The overall strategic objective of the Community Health Team was to encourage research and programs aimed at reducing social isolation and its consequences as causes of illness, injury and death.

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THE PROJECT

Staff from the Mind Brain Body and Health Initiative, an initiative of the Institute for the Medical Humanities at the University of Texas Medical Branch, organized meetings of experts in psychology, neuroscience, epidemiology, medicine and other fields to develop a research plan. The plan incorporated two themes:

  • To study the physical and behavioral ways by which social connectedness and social isolation affect the risk and course of medical illness.
  • To identify interventions that will increase social connectedness and have a positive impact on health.

A multidisciplinary planning group of five researchers led the effort. (See the Appendix for a list of planning group members and their fields of study.) RWJF supported the meetings and plan development with a grant of $696,672 to the Mind Brain Body and Health Initiative.

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THE RESULTS

The Meetings

Ten meetings took place between October 2001 and December 2002. The first three meetings (October and November 2001, and January 2002) addressed:

  1. Psychological factors, such as social roles and personality, in the development of social relationships.
  2. Intervention strategies that enhance social connections with family, friends and community.
  3. Biological processes that occur between social interactions and health.

The planning group participated in each meeting, along with a varying group of between 10 and 20 invited experts. A presentation of findings to RWJF staff followed in February 2002. Meetings in April and June 2002 of the planning group and a small number of selected experts focused on how social interventions may impact health.

The Evidence

During these meetings, participants heard the evidence on the links between social connectedness, social isolation and health. This evidence included:

  • Studies of socially integrated people — those deeply involved in multiple social relationships — have found that such people live longer, are less likely to be depressed, are less susceptible to infectious disease and are less likely to suffer severe cognitive decline with aging than are those who are more socially isolated. Even the perception that others will provide support predicts more positive health outcomes in the face of stressful events.
  • The health risks of social isolation are comparable to the health risks of cigarette smoking, high blood pressure and obesity. Those who are socially isolated have two to three times the risk of poor health than those who are most connected with others.
  • Evidence of the effectiveness of social interventions on improving health is much weaker; there are fewer studies and results have often been negative.
  • Design problems have hampered prior intervention studies, including: a neglect of social, cultural and environmental context; a narrow focus that has ignored the complexity of social relationships; failure to assess the effects of an intervention on an individual's perception of his or her social environment; and failure to track the psychological and physiological ways in which changes in the social environment affect health.

The Research Proposal

The planning group, with selected others, convened four more times (July, September, October and December 2002) to review information gathered in the earlier meetings and to develop, draft and review the proposal to RWJF. The group concluded that a research network — conducting multiple, intervention-based studies and bringing diverse perspectives, expertise and strategies — would be the best structure for studying the complex relationship between social connectedness and health.

The group submitted a proposal to RWJF for a research network to study both the physiological mechanisms underlying the relationship between social connectedness and health as well as social interventions that may be effective in promoting health. The proposal integrated the study of physiological mechanisms into the proposed work on social interventions, rather than proposing two separate research networks, as was originally envisioned by the project's organizers. This change was in keeping with RWJF's strategic goals, which evolved over the course of the project.

Communications

Project staff prepared summaries of each meeting for use by the planning group. The project did not result in any published materials.

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AFTER THE GRANT

RWJF did not elect to fund the research network proposal. Improving health by reducing social isolation is no longer a strategic focus of RWJF. The Community Health Team's functions at RWJF have since been taken over by the Vulnerable Populations priority area group, with social connectedness being a minor focus.

The planning group continues to work on its Chicago population-based longitudinal study of social isolation, loneliness and health funded by the National Institutes on Aging. It has been able to collect longitudinal data on more than 90 percent of the original population based sample, with no differences in successful follow-up as a function of ethnicity or gender — exceeding its projections for retention. The team, led by Linda Waite, Ph.D., (University of Chicago) and M.E. Hughes, Ph.D. (Duke University) is looking at Health and Retirement Study data to replicate and extend many of the findings in the original project.

To help flesh out the health implications of the work, the team is now working with Liz Holper, M.D. (head, Cardiac Catheterization Lab, University of Chicago Hospitals); Kellie Brown, M.D. (vascular surgery, Medical College of Wisconsin); Chris Masi, M.D. (internal medicine, University of Chicago Hospitals); Deon Cox-Haley, M.D. (geriatrician, University of Chicago Hospitals); and Andrew Davis, M.D. (internal medicine, University of Chicago Hospitals).

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GRANT DETAILS & CONTACT INFORMATION

Project

Studying the Relationship Between Social Connectedness and Health

Grantee

Mind Brain Body and Health Initiative (Galveston,  TX)

  • Amount: $ 696,672
    Dates: August 2001 to December 2002
    ID#:  040460

Contact

Robert M. Rose, M.D.
(409) 772-9382
brose@urbancom.net

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Planning Group Members and Fields of Study

Lisa Berkman, Ph.D.
Epidemiology
Harvard University

John Cacioppo. Ph.D.
Social neuroscience
University of Chicago

Thomas Cook, Ph.D.
Evaluation research, intervention methodology
Northwestern University

Sheldon Cohen, Ph.D.
Health and social psychology
Carnegie Mellon University

Robert Rose, M.D.
Integrative physiology, medicine
Mind Brain Body and Health Initiative
University of Texas Medical Branch

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Report prepared by: Mary B. Geisz
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Pamela G. Russo