Social networks,health and aging

Lisa F Berkman Ph.D.Measuring Social Activity and Civic

Engagement among Older Americans

Federal Interagency Forum on Aging-related Statistics

Gerontological Society of AmericaMay 8 2007

Suicide varies inversely with the degree of integration of the social

groups of which the individual forms a part.

Suicide, Durkheim, 1897, 1951, p. 209

Social Network Model

IND. Extended Zone

Nominal Zone

Effective Zone

Intimate Zone B

Intimate Zone A

PersonalCell

Source: Bolssevain, Jeremy: Friends of Friends, 1974

Social Networks • Networks form the web of social relations or ties

that surround us

Intimate ties

Extended ties• They are usually measured in structural ways

– Size: number of contacts– Geographic proximity: how close ties are– Frequency: how often they are seen– Density: how many people know each other– Reciprocity: how people help each other

Conceptual Model of How Social Networks Impact Health

Downstream FactorsUpstream Factors

Condition: the extent, shape, and nature of…

Which provides opportunities for…

Social-Structural Conditions (Macro)

Social Networks (Mezzo)

Behavioral Mechanisms (Micro) Pathways

Culture• Language• Norms and values• Competition/cooperation

Socioeconomic Factors• Inequality• Discrimination• ConflictLabor Market structures

Sociogeographic Factors• Urban/rural• Neighborhood characteristics• Social cohesion• Residential and occupational

segregation

Social Change• Urbanization• War/civil unrest• Economic depression

Network Structure• Size• Density• Reciprocity• Reachability• Proximity• Organizational structure• Social ranking

Network Activation• Frequency of face-to-face

interaction• Frequency of nonvisual contact• Frequency of organizational

participation (attendance)• Duration and intensity of

contacts

Social Support• Instrumental and financial• Informational• Appraisal• Emotional

Access to Resources and Material Goods

• Jobs/economic opportunity• Access to health care• Housing• Human capital• Referrals/institutional contacts

Social Engagement• Physical/cognitive exercise• Reinforcement of meaningful

social role

Social Influence• Constraining/enabling

influences on health behaviors• Attitudes and norms toward

help-seeking• Attitudes and norms toward

treatment adherence

Psychobiological Pathways• Stress-response/allostatic load• Immune system function• inflammatory• Hippocampal atrophy• Blood pressure• Cardiovascular reactivity• Pulmonary function

Health Behavioral Pathways

• Smoking/alcohol consumption• Diet• Exercise• Adherence to medical

treatments• Help-seeking behavior

Psychosocial Pathways• Self-efficacy• Coping effectiveness• Relaxation/stress management• Depression/distress• Sense of well-being/QOL

Which impacts health through the following…

Critical domains of networks or ties

• Summary indicator of social networks:size, ties across domains, density, weak ties

• Quality of ties: negative and positive

• Social engagement or participation

• Caregiving roles and demands

Social Network Items in Alameda county study

• Marital status or living with a partner

• Number of contacts (frequency of contact) with friends

• Number of contact (frequency of contact) with close relatives

• Participation in voluntary and civic organizations

• Membership in religious organization

0

2

4

6

8

10

12

14

16

18

Men Women

High SNIMed-highMed-lowLow SNI

Mortality Rate from All Causes by Social Network Index : Alameda

County 1965-74 (Berkman and Syme AJE, 1979)

Relative Risk of Dying from Specific Causes Based on Age-Adjusted Mortality

Rates

2.12.3

1.7

3.13.2 3.2

2.2

3.0

0

0.5

1

1.5

2

2.5

3

3.5

4

ICD Cerebro CA Other

Specific Cause of Death

Rel

ativ

e R

isk

of D

ying

(%

) Men Women

Social integration and mortality in a French occupational cohort: EDF-GDF employees

Berkman et al AJE 2004

0

0.5

1

1.5

2

2.5

3

men women

high

med/high

med/low

low

Adjusted for age, occupational grade, cigarette smoking, alcohol consumption, BMI, depressive symptoms, self-rated health, and geographical region.

Clinical ColdsClinical Colds

6 Day Quarantine

VIRUSVIRUS

Social RolesSocial Roles

Pittsburgh Common Cold Study N=276 3 Years

1 - 3 4 - 5 6 +

30

40

50

60

# of High-Contact Roles

% w

ith

Co

lds

OR=4.23*

OR=1.87*

OR=1.00

(Odds ratios are adjusted for control variables.)

Cohen et al.; JAMA; 1997

Social Roles and Colds

How do social networks and social integration impact health?

Mean Coronary Artery Atherosclerosis Extent as Measured

by Intimal Area in Females

0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

Dominant in SocialGroups

Subordinate in SocialGroups (Control)

Housed in SingleCages

Intim

al A

rea m

m2

Fibrinogen and Social Isolation in Men

5.5

5.55

5.6

5.65

5.7

5.75

very low low medium high

Social Network Score

ln [f

ibrin

ogen

]unadjusted

adjusted

Natural log (ln) of fibrinogen concentrations in men according to social network score. Error bars represent ln [SEM].

Social Engagement

Social Engagement and the maintenance of good cognitive function

Social engagement is defined as the maintenance of many social connections and a high level of participation in social activities.

Bassuk, SS, Glass, TA, Berkman, LF:Social Disengagement and Incident Cognitive Decline.Annals of Internal Medicine 131(3): 165-173, 1999.

Social engagement and cognitive

declineSocial Engagement

– Marital status– Contact with friends and relatives–Attendance at religious services–Voluntary/civic engagement–Regular social activities

Cognitive decline by social disengagement among older men and

women ( Bassuk, Glass Berkman, AJE)

0

10

20

30

40

50

60

%decline

0 ties

1-2 ties

3-4 ties

5-6 ties

Odd’s ratios of cognitive decline by level of social engagement (multivariate model,1982-1994)

2.37 (CI 1.1-4.9) controlling for age, SPMSQ

sex,ethnicity,education,income, physical disability, cardiovascular risk, depression, smoking ,alcohol,

physical activity and emotional support.

Epidemiology

• Job stress

• Cost of caring

• Work/family demands

Caregiving in the Nurses Health Study.

Lee,Colditz,Berkman,Kawachi, AM J Prev Med 2003:24(2):113-119

• 54,412 women in the Nurses Health Study, ages 46-71 (no documented CHD)

• Information on caregiving in 1992

• CHD follow up 1992-1996

• 321 incident cases

CHD RR: Caregivers of Disabled/Ill Spouse

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Total CHD Nonfatal CHD

0 1-8 >=9Hours of Caregiving Per Week:

214 7 10297 8 16

01 2

3

Executive

Professional/technician

Clerk/Manual worker

0,9 1,22,5

5,34,4

1,3 1,23,0

0,3 0,4 0,60,3

0

2

4

6

8

10

12

14

16

Level of work and family demands

Multiple work and family demands and all-diagnosis psychiatric Multiple work and family demands and all-diagnosis psychiatric sickness absence: GAZEL cohort men.sickness absence: GAZEL cohort men.

Day

s/p-

yr

0 1 2 3

Executive

Professional/technician

Clerk

4,8

2,5

5,2

15,6

4,8

1,9 2,9

12,9

2,61,0

0,8

14,4

0

2

4

6

8

10

12

14

16

Multiple work and family demands and all-diagnosis Multiple work and family demands and all-diagnosis

psychiatric sickness absence: GAZEL cohort women.psychiatric sickness absence: GAZEL cohort women.D

ays/

p-yr

Level of work and family demands

Data needs & resources

• Nat8ional data ( NHANES, NHIS, HRS, GSS) should include common core measures and unique measures relevant to each study- some are already available

• Assessments across multiple domains is essential ( intimate ties, informal ties, voluntary associations)- no single item

• International comparability is valuable