Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review

Social support has been reliably related to physical health outcomes. However, the conceptual basis of such links needs greater development. In this article, I argue for a life-span perspective on social support and health that takes into account distinct antecedent processes and mechanisms that are related to measures of support over time. Such a view highlights the need to distinguish measures of perceived and received support and its links to more specific diseases (e.g., chronic, acute) and stages of disease development (e.g., incidence). I discuss both the novel implications of these theoretical arguments for research on social support and physical health, as well as the potential intervention approaches that are apparent from this perspective.

Robert Weiss (1973) conceptualised loneliness as perceived social isolation, which he described as a gnawing, chronic disease without redeeming features. On the scale of everyday life, it is understandable how something as personally aversive as loneliness could be regarded as a blight on human existence. However, evolutionary time and evolutionary forces operate at such a different scale of organisation than we experience in everyday life that personal experience is not sufficient to understand the role of loneliness in human existence. Research over the past decade suggests a very different view of loneliness than suggested by personal experience, one in which loneliness serves a variety of adaptive functions in specific habitats. We review evidence on the heritability of loneliness and outline an evolutionary theory of loneliness, with an emphasis on its potential adaptive value in an evolutionary timescale.

The 35-item Duke Social Support Index (DSSI) measures multiple dimensions of social support and has been used extensively in cross-sectional and longitudinal studies of aging. Epidemiological studies of chronically ill, frail elderly individuals often wish to include a measure of social support. However, most multidimensional measures (including the DSSI) are long and may exhaust the patient, especially when included in an often already congested interview schedule. The authors have developed two abbreviated versions of the DSSI (23-item and 11-item) that capture the essential components of social support related to mental health outcomes and use of health services in treating elderly individuals with nonpsychiatric medical illness.