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From the Department of Psychiatry and Behavioral Science, Duke University Medical Center, Durham, North Carolina.
Address correspondence to Heather S. Lett, Psychology Service 116B, VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304. E-mail: heather.lett{at}alumni.duke.edu
Objective: The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD).
Methods: Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966–2004) and PsychINFO (1872–2004). Reviews of bibliographies also were used to identify relevant articles.
Results: In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support.
Conclusions: Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events.
Key Words: social support • depression • coronary heart disease • physiological mechanisms
Abbreviations: AMI = acute myocardial infarction; ANS = autonomic nervous system; CHD = coronary heart disease; ENRICHD = Enhancing Recovery in Coronary Heart Disease; HPA = hypothalamic pituitary adrenal; SES = socioeconomic status; SNS = sympathetic nervous system.
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