Background. Many studies have noted a strong association
between poor social support and
premature mortality. A limitation of such studies has been their failure
to control adequately for
confounders that damage both social supports and physical health.
Methods. A 50-year prospective multivariate study of 223 men
was used to examine the possible
causal relationships between social supports and health. Alcohol abuse,
prior physical health and
mental illness prior to age 50 were controlled. Relative social supports
quantified over the period from age 50 to 70.
Results. Adequacy of social supports from age 50 to 70 was
powerfully correlated with physical
health at age 70 (P<0·001). However, such social
supports were also powerfully predicted by
alcohol abuse (P<0·001), smoking (P<0·001)
and indicators of major
depressive disorder (P<0·01) assessed at age 50. When
depression and alcohol abuse were controlled, then
the association of physical health with social supports was very
much attenuated. Some facets of
social support like religion and confidantes were unassociated with
health even at a univariate level.
Surprisingly, in this sample friends seemed more important for sustained
physical health than
closeness to spouse and to children.
Conclusions. While social supports undoubtedly play a significant
role in maintaining physical well-being in late life, much of the
association between poor social supports and mortality may be
mediated by alcoholism, smoking and pre-morbid psychopathology.