As you learn more about and incorporate relational health in your practice, you might want to refer to the science. The following is a curated library of scientific resources by topic.
Child and Adolescent Relational Health and Child Health Outcomes
Adult Relational Health and Adult Health Outcomes
Mechanistic Pathways:
How Relational Health Improves Health Outcomes
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Social Influence and Healthy Behaviors:
Social relationships can exert social influence leading to positive or negative health behaviors, increasing adherence to medical treatment, instilling a sense of responsibility, motivating or pressuring someone to take care of oneself, and increasing the likelihood a person will adopt the health behaviors and status of those around them. -
Services and Resources: Relationships can provide material, concrete, tangible, and instrumental support which can then lead to decreased stress and improved health outcomes.
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Information: Social relationships can improve health by providing information that is needed to solve problems and challenges that arise, and that teach skills and key capacities such as the ability to regulate behavior, plan, and adapt.
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Positive Psychological States and Calmed Stress Response System: Healthy Social Relationships can induce positive psychological states and calm the stress response system. This can lead to health-promoting behaviors and physiological responses including improved neurologic, endocrine, immune and cardiovascular effects as well as improved health outcomes.
Child and Adolescent Relational Health and Child Health Outcomes
ASTHMA AND IMMUNE RESPONSE
- Bellis MA, Hughes K, Ford K, et al. Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance. BMC Public Health. 2018;18(1):792. doi:10.1186/s12889-018-5699-8
- Yang YC, Boen C, Gerken K, Li T, Schorpp K, Harris KM. Social relationships and physiological determinants of longevity across the human life span. Proc Natl Acad Sci U S A. 2016;113(3):578-583. doi:10.1073/pnas.1511085112
- Marin TJ, Chen E, Munch JA, Miller GE. Double-exposure to acute stress and chronic family stress is associated with immune changes in children with asthma. Psychosom Med. 2009;71(4):378-384. doi:10.1097/PSY.0b013e318199dbc3
- Chen E, Chim LS, Strunk RC, Miller GE. The role of the social environment in children and adolescents with asthma. Am J Respir Crit Care Med. 2007;176(7):644-649. doi:10.1164/rccm.200610-1473OC
- Miller GE, Gaudin A, Zysk E, Chen E. Parental support and cytokine activity in childhood asthma: the role of glucocorticoid sensitivity. J Allergy Clin Immunol. 2009;123(4):824-830. doi:10.1016/j.jaci.2008.12.019
- Manczak EM, Levine CS, Ehrlich KB, Basu D, McAdams DP, Chen E. Associations between spontaneous parental perspective-taking and stimulated cytokine responses in children with asthma. Health Psychol. 2017 Jul;36(7):652-661.
- Chen E, Brody GH, Miller GE. Childhood close family relationships and health. Am Psychol. 2017;72(6):555-566. doi:10.1037/amp0000067
- Chen E, Miller GE, Kobor MS, Cole SW. Maternal warmth buffers the effects of low early-life socioeconomic status on pro-inflammatory signaling in adulthood. Mol Psychiatry. 2011;16(7):729-737. doi:10.1038/mp.2010.53
BEHAVIORAL CONCERNS
- Masud, Hamid, et al. "Parenting styles and aggression among young adolescents: A systematic review of literature." Community mental health journal 55.6 (2019): 1015-1030.
- Bellis MA, Hughes K, Ford K, et al. Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance. BMC Public Health. 2018;18(1):792. doi:10.1186/s12889-018-5699-8
- Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One. 2017;12(7):e0181442. Published 2017 Jul 17. doi:10.1371/journal.pone.0181442
BROAD REVIEWS
- National Scientific Council on the Developing Child. (2015). Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper 13. http://www.developingchild.harvard.edu
- Shonkoff JP. Breakthrough Impacts: What Science Tells Us About Supporting Early Childhood Development. YC Young Child. 2017;72(2):8-16.
- Sege R, Linkenbach J. Essentials for childhood: promoting healthy outcomes from positive experiences. Pediatrics. 2014;133(6):e1489-e1491. doi:10.1542/peds.2013-3425
- Wölfer, R, Bull, HD, & Scheithauer, H. Social integration in youth: Insights from a social network perspective. Group Dynamics: Theory, Research, and Practice. 2012; 16(2), 138–147. https://doi.org/10.1037/a0024765
CHOLESTEROL LEVELS
DEPRESSION
- Liu Y, Merritt DH. Examining the association between parenting and childhood depression among Chinese children and adolescents: A systematic literature review. Child Youth Serv Rev. 2018;88:316-332. doi:10.1016/j.childyouth.2018.03.019
- Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One. 2017;12(7):e0181442. Published 2017 Jul 17. doi:10.1371/journal.pone.0181442
DIABETES
- Young MT, Lord JH, Patel NJ, Gruhn MA, Jaser SS. Good cop, bad cop: quality of parental involvement in type 1 diabetes management in youth. Curr Diab Rep. 2014;14(11):546. doi:10.1007/s11892-014-0546-5
- Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One. 2017;12(7):e0181442. Published 2017 Jul 17. doi:10.1371/journal.pone.0181442
MEDICAL ADHERENCE
OBESITY
OVERALL REPORTED HEALTH AND RESILIENCE
- Bellis MA, Hughes K, Ford K, et al. Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance. BMC Public Health. 2018;18(1):792. doi:10.1186/s12889-018-5699-8
- Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One. 2017;12(7):e0181442. Published 2017 Jul 17. doi:10.1371/journal.pone.0181442
- Ashton K, Davies AR, Hughes K, Ford K, Cotter-Roberts A, Bellis MA. Adult support during childhood: a retrospective study of trusted adult relationships, sources of personal adult support and their association with childhood resilience resources. BMC Psychol. 2021;9(1):101. doi:10.1186/s40359-021-00601-x
SELF-REGULATION
SOMATIC CONCERNS
Adult Relational Health and Adult Health Outcomes
BROAD REVIEWS
- Cacioppo JT, Cacioppo S, Capitanio JP, Cole SW. The neuroendocrinology of social isolation. Annu Rev Psychol. 2015;66:733-767. doi:10.1146/annurev-psych-010814-015240
- Cacioppo, S., Capitanio, J. P., & Cacioppo, J. T. (2014). Toward a neurology of loneliness. Psychological bulletin, 140(6), 1464–1504. https://doi.org/10.1037/a0037618
- Cohen S, Janicki-Deverts D, Miller GE. Psychological Stress and Disease. JAMA. 2007;298(14):1685–1687. doi:10.1001/jama.298.14.1685
- Ertel KA, Glymour MM, Berkman LF. Social networks and health: A life course perspective integrating observational and experimental evidence. Journal of Social and Personal Relationships. 2009;26(1):73-92. doi:10.1177/0265407509105523
- Holt-Lunstad J. Why Social Relationships Are Important for Physical Health: A Systems Approach to Understanding and Modifying Risk and Protection. Annu Rev Psychol. 2018;69(1):437-458. doi:10.1146/annurev-psych-122216-011902
- Luanaigh CO, Lawlor BA. Loneliness and the health of older people. Int J Geriatr Psychiatry. 2008;23(12):1213-1221. doi:10.1002/gps.2054
- Miller G, Chen E, Cole SW. Health psychology: developing biologically plausible models linking the social world and physical health. Annu Rev Psychol. 2009;60:501-524. doi:10.1146/annurev.psych.60.110707.163551
- Pietromonaco PR, Collins NL. Interpersonal Mechanisms Linking Close Relationships to Health. Am Psychol. 2017;72(6):531-542. doi:10.1037/amp0000129
- Robles TF, Kiecolt-Glaser JK. The physiology of marriage: pathways to health. Physiol Behav. 2003;79(3):409-416. doi:10.1016/s0031-9384(03)00160-4
- Seeman TE. Health Promoting Effects of Friends and Family on Health Outcomes in Older Adults. American Journal of Health Promotion. 2000;14(6):362-370. doi:10.4278/0890-1171-14.6.362
- Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006;29(4):377-387. doi:10.1007/s10865-006-9056-5
- Umberson D, Karas Montez J. Social Relationships and Health: A Flashpoint for Health Policy. J Health Soc Behav. 2010;51(1_suppl):S54-S66. doi:10.1177/0022146510383501
- Wright K (2016) Social Networks, Interpersonal Social Support, and Health Outcomes: A Health Communication Perspective. Front. Commun. 1:10. doi: 10.3389/fcomm.2016.00010
CANCER PROGRESSION
CARDIOVASCULAR
- Cacioppo JT, Hawkley LC, Crawford LE, et al. Loneliness and health: potential mechanisms. Psychosom Med. 2002;64(3):407-417. doi:10.1097/00006842-200205000-00005
- Hawkley LC, Masi CM, Berry JD, Cacioppo JT. Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychol Aging. 2006;21(1):152-164. doi:10.1037/0882-7974.21.1.152
- Masi CM, Chen HY, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev. 2011;15(3):219-266. doi:10.1177/1088868310377394
- Yang YC, Boen C, Gerken K, Li T, Schorpp K, Harris KM. Social relationships and physiological determinants of longevity across the human life span. Proc Natl Acad Sci U S A. 2016;113(3):578-583. doi:10.1073/pnas.1511085112
- Everson-Rose SA, Lewis TT. Psychosocial factors and cardiovascular diseases. Annu Rev Public Health. 2005;26:469-500. doi:10.1146/annurev.publhealth.26.021304.144542
- Sorkin D, Rook KS, Lu JL. Loneliness, lack of emotional support, lack of companionship, and the likelihood of having a heart condition in an elderly sample. Ann Behav Med. 2002;24(4):290-298. doi:10.1207/S15324796ABM2404_05
- Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009-1016. doi:10.1136/heartjnl-2015-308790
- Richard A, Rohrmann S, Vandeleur CL, Schmid M, Barth J, Eichholzer M. Loneliness is adversely associated with physical and mental health and lifestyle factors: Results from a Swiss national survey. PLoS One. 2017;12(7):e0181442. Published 2017 Jul 17. doi:10.1371/journal.pone.0181442
COGNITIVE ABILITY AND ALZHEIMER'S DISEASE
- Wilson RS, Krueger KR, Arnold SE, et al. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry. 2007;64(2):234-240. doi:10.1001/archpsyc.64.2.234
- Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English Longitudinal Study of Ageing. Psychosom Med. 2013;75(2):161-170. doi:10.1097/PSY.0b013e31827f09cd
DIABETES
EPIGENETICS AND GENE EXPRESSION
- Cole SW. Social Regulation of Human Gene Expression: Mechanisms and Implications for Public Health. Am J Public Health. 2013;103(Suppl 1):S84-S92. doi:10.2105/AJPH.2012.301183
- Cole SW, Levine ME, Arevalo JM, Ma J, Weir DR, Crimmins EM. Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. Psychoneuroendocrinology. 2015;62:11-17. doi:10.1016/j.psyneuen.2015.07.001
- Cole, SW, Capitanio, JP, Chun, K, Arevalo, JMG, Ma, J, & Cacioppo, JT. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. Proceedings of the National Academy of Sciences of the United States of America. 2015. 112(49), 15142–15147. https://www.jstor.org/stable/26466538
- Cole SW, Hawkley LC, Arevalo JM, Sung CY, Rose RM, Cacioppo JT. Social regulation of gene expression in human leukocytes. Genome Biol. 2007;8(9):R189. doi:10.1186/gb-2007-8-9-r189
- Cole SW, Hawkley LC, Arevalo JM, Cacioppo JT. Transcript origin analysis identifies antigen-presenting cells as primary targets of socially regulated gene expression in leukocytes. Proc Natl Acad Sci U S A. 2011;108(7):3080-3085. doi:10.1073/pnas.1014218108
HYPOTHALAMIC PITUITARY ADRENOCORTICAL ACTIVITY
- Adam EK, Hawkley LC, Kudielka BM, Cacioppo JT. Day-to-day dynamics of experience--cortisol associations in a population-based sample of older adults. Proc Natl Acad Sci U S A. 2006;103(45):17058-17063. doi:10.1073/pnas.0605053103
- Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L. Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology. 2004;29(5):593-611. doi:10.1016/S0306-4530(03)00086-6
IMMUNE FUNCTION
- Kiecolt-Glaser JK, Garner W, Speicher C, Penn GM, Holliday J, Glaser R. Psychosocial modifiers of immunocompetence in medical students. Psychosom Med. 1984;46(1):7-14. doi:10.1097/00006842-198401000-00003
- Pressman SD, Cohen S, Miller GE, Barkin A, Rabin BS, Treanor JJ. Loneliness, social network size, and immune response to influenza vaccination in college freshmen [published correction appears in Health Psychol. 2005 Jul;24(4):348]. Health Psychol. 2005;24(3):297-306. doi:10.1037/0278-6133.24.3.297
- Yang YC, Boen C, Gerken K, Li T, Schorpp K, Harris KM. Social relationships and physiological determinants of longevity across the human life span. Proc Natl Acad Sci U S A. 2016;113(3):578-583. doi:10.1073/pnas.1511085112
- Uchino BN, Trettevik R, Kent de Grey RG, Cronan S, Hogan J, Baucom BRW. Social support, social integration, and inflammatory cytokines: A meta-analysis. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2018;37(5):462-471. doi:10.1037/hea0000594
- Cole SW, Levine ME, Arevalo JM, Ma J, Weir DR, Crimmins EM. Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. Psychoneuroendocrinology. 2015;62:11-17. doi:10.1016/j.psyneuen.2015.07.001
- Cole, SW, Capitanio, JP, Chun, K, Arevalo, JMG, Ma, J, & Cacioppo, JT. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. Proceedings of the National Academy of Sciences of the United States of America. 2015. 112(49), 15142–15147. https://www.jstor.org/stable/26466538
- Cole SW. Social regulation of leukocyte homeostasis: the role of glucocorticoid sensitivity. Brain Behav Immun. 2008;22(7):1049-1055. doi:10.1016/j.bbi.2008.02.006
MENTAL HEALTH
- Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry. 2018;18(1):156. Published 2018 May 29. doi:10.1186/s12888-018-1736-5
- Li, F., Luo, S., Mu, W. et al. Effects of sources of social support and resilience on the mental health of different age groups during the COVID-19 pandemic. BMC Psychiatry 21, 16 2021. https://doi.org/10.1186/s12888-020-03012-1
- Chang Q, Peng C, Guo Y, Cai Z, Yip PSF. Mechanisms connecting objective and subjective poverty to mental health: Serial mediation roles of negative life events and social support. Social Science & Medicine (1982). 2020; Nov;265:113308. DOI: 10.1016/j.socscimed.2020.113308. PMID: 32905965.
- Catabay CJ, Stockman JK, Campbell JC, Tsuyuki K. Perceived stress and mental health: The mediating roles of social support and resilience among black women exposed to sexual violence. J Affect Disord. 2019;259:143-149. doi:10.1016/j.jad.2019.08.037
MORTALITY
- Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci J Assoc Psychol Sci. 2015;10(2):227-237. doi:10.1177/1745691614568352
- Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. doi:10.1371/journal.pmed.1000316
- Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012;74(6):907-914. doi:10.1016/j.socscimed.2011.11.028
- Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A. 2013;110(15):5797-5801. doi:10.1073/pnas.1219686110
- Chiang JJ, Chen E, Miller GE. Midlife Self-Reported Social Support as a Buffer Against Premature Mortality Risks Associated with Childhood Abuse. Nat Hum Behav. 2018;2(4):261-268. doi:10.1038/s41562-018-0316-5
OBESITY
- Lauder W, Mummery K, Jones M, Caperchione C. A comparison of health behaviours in lonely and non-lonely populations. Psychol Health Med. 2006;11(2):233-245. doi:10.1080/13548500500266607
- Yang YC, Boen C, Gerken K, Li T, Schorpp K, Harris KM. Social relationships and physiological determinants of longevity across the human life span. Proc Natl Acad Sci U S A. 2016;113(3):578-583. doi:10.1073/pnas.1511085112
RECURRENT STROKE
SLEEP
- Cacioppo JT, Hawkley LC, Crawford LE, et al. Loneliness and health: potential mechanisms. Psychosom Med. 2002;64(3):407-417. doi:10.1097/00006842-200205000-00005
- Pressman SD, Cohen S, Miller GE, Barkin A, Rabin BS, Treanor JJ. Loneliness, social network size, and immune response to influenza vaccination in college freshmen [published correction appears in Health Psychol. 2005 Jul;24(4):348]. Health Psychol. 2005;24(3):297-306. doi:10.1037/0278-6133.24.3.297
TEAM SPORTS
