Review of the Association Between Number of Social Roles and Cardiovascular Disease: Graded or Threshold Effect?

Psychosomatic Medicine
Brian Chin, Sheldon Cohen

Abstract

There is increasing evidence for an inverse association between the number of social roles (e.g., spouse, friend, and neighbor) we engage in and our risk of disease, especially cardiovascular disease (CVD). Two mechanistic models have been proposed to explain this association. The social integration model refers to a graded association where every additional social role is associated with an increase in resistance to disease. The social isolation model refers to a threshold effect where the lack of a minimal criterion number of roles increases risk of disease. We conducted a systematic review of prospective studies examining the association between number of social roles and CVD risk. When we include all studies assessing number of social roles, irrespective of whether associations are attributable to graded effects (social integration) and threshold effects (social isolation) or cannot be determined by the data presented, those holding fewer social roles were found to be at greater risk of CVD incidence, CVD mortality (evidence stronger for men than women), and greater progression of disease (only for short [≤5 years] follow-ups). However, closer analyses indicate that the association between a greater number of social roles a...Continue Reading

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Citations

Jul 9, 2020·Perspectives on Psychological Science : a Journal of the Association for Psychological Science·Sheldon Cohen
Dec 25, 2021·Stress and Health : Journal of the International Society for the Investigation of Stress·Eunjin L TracyMartica H Hall

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