Health and Social Connection:Are We Born to Bond ?

Mark C. Pettus MD

February 18, 2014

The Assertion

How highly an individual perceives their quality of life appears to be a significant predictor of health

outcomes. While many factors contribute to this, social satisfaction consistently rises to the top of the

pyramid.

…the bottom line: support and connection with others fills a perpetual need for sustaining life satisfaction and

for living well.

Objectives

• To review the importance of social attachment and bonding as a primal human neurobiologic survival system

• To examine the current medical science linking social connection with important health outcomes

• To review strategies for cultivating social connection in one’s life e.g. empathy, conflict management and forgiveness

The System

Social Bonding and Attachment

• The mammalian “Separation Cry”• Cuddling• Oxytocin, dopamine, and endorphins• Reward, attachment, diminished fight-flight tone• Rewards cooperative social connection and inhibits

selfish impulse

The mammalian triune brain

The Prairie Vole and the Montane Vole

OxytocinOxytocin

Robert Sapolsky PhDStanford - Zebras Don’t Get Ulcers

Mirror Neurons

Evidence linking social connection and bonding with important health outcomes

Social Ties and Health

People who lacked social ties include those who:– Were not married– Had little or no contact with family/friends,– Did not belong to or attend church regularly– Were not members of social groups/clubs– Were significantly more likely to die during next 9 years

compared to people with strong social ties– Were more likely to die from heart disease, stroke, cancer,

respiratory diseases, and digestive system diseases.Good Health

Practices Study

A Sampling of the Research

• Carnegie Mellon University- linking strong social supports with more “robust” immune response

• An international study involving more than 50 countries shows worse health outcomes and behaviors in individuals who rate their degree of social satisfaction to be poor.

• Marital conflict and hostile behavior associated with impaired endocrine and immune function.

• 2003 Whitehall Study-social position, satisfaction, perception of connection and control in the workplace associated with markers of inflammation

Social Support and Survival after a Heart Attack

Dr. Lisa Berkman studied survival rates of people suffering a heart attack.

Those with little emotional support were 3 times more likely to die. Of those who survived, after 6 months …

– 53% of those with no social support died, compared to

– Only 36% with 1 person, and

– 23% for those with 2 or more people to provide social support. D

eath

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Social Networks – Swedish Study

This study included 17,000 healthy men and women, followed for 6 yearsPeople who were most isolated and lonely (low social contact) had nearly 4 times the risk of dying during the study.

Relative risk, all cause mortality

Social Network Score

Social Networks – Tecumseh Study

Study included 3,000 men and women for 12 years

Persons with high levels of social contact and relationships had significantly lower mortality levels.

Relative risk, all cause mortality

Social Network Score

Social Networks – GHP Study

Social network factors include:– Marriage– Frequent contact with

family/close friends– Member of a church– Member of a club or other

social group

People lacking these social networks were 2.8 times more likely to die in the next 9-years.

Relative risk, all cause mortality

Social Network Score

Good Health Practices Study

Heart Disease and Social Support Duke Study

Duke University studied 1,400 men and women who had angiograms and found at least one artery severely blocked

Those who were not married or who had no close confidant were over 3 times more likely to die in the next five years

Relative risk, all cause mortality

Social Network Score

Love and Lipids

Social connection decreases stress and depression

Stress and depression are causally associated with

- elevated blood pressure

- elevated triglycerides

- elevated LDL cholesterol

- increased endothelial reactivity

Connection and The Common Cold

•276 healthy volunteers given rhinovirus containing nasal drops

•Questioned about 12 types of social relationships-parental, childhood, groups, etc.

•Those who scored only 3 out of 12 developed cold symptoms 4 times more frequently

•Cohen et al. JAMA 1997

Hostility and Heart Health

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risk

Circulation, Vol. 101(17):2034-39

Duke University studied anger and heart disease in 12,986 people.

Those who scored high in anger had 2.7 times as much heart disease, six years later.

Moderate anger people developed 35% more heart disease than those low in anger or hostility.

Social Support, Religion, and Survival after Heart Surgery

Patients at the U of Texas were asked before surgery:

– Do you participate regularly in church or in a social group?

– Do you draw strength and comfort from your religion?

In the next 6 months, among those:– Without religion to provide comfort or

strength: 3 times as many died.– With no participation in social groups: 4

times as many died.– With neither social support nor religion: 7

times as many died.

Relative risk, all cause mortality

McGowan PO, Sasaki A, D’Alessio AC, Dymov S, Labonte B, Szyf M, Turecki G, Meaney MJ. Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci. 2009;12(3):342-348.

Environmental Programming of Gene Activity- Bonding

Glucocorticoid Receptor Gene

Child Abuse Bonding

GR Gene

GR Receptors

Stress Response

GR Gene

GR ReceptorsStress Response

Obstacles to Connection

• Physical, developmental, or intellectual disabilities

• Behavioral health problems e.g. depression• Personality traits e.g. shyness, hostility• Self-conscious emotional states• Insufficient knowledge, skill, experience, or

resources• Unhealthy behaviors

A Sampling of Forgiveness Research

• Stanford-forgiveness training reduced symptoms of depression, stress, anger, and anxiety and improved appetite, sleep patterns, energy, BP, and general well being

• Duke-lower levels of pain, anger, and emotional distress

• U. Wisconsin-decrease anger, depression, anxiety and improved self-esteem and resilience

• U. Tennessee-improved BP, HR, muscle tension, and skin conduction

Other Strategies for Social Satisfaction• Take a “Meaning Inventory”

• Nurture an important relationship• Write/thank an old friend• Seek treatment for a remediable problem• Support groups• Faith communities• Recreation• Volunteerism• Resolve an ongoing conflict• Forgive an unrelenting act of transgression• Pets

Thank You!