Gender, social relations and mental health: prospective findings from an occupational cohort (Whitehall II study)

https://doi.org/10.1016/S0277-9536(98)00290-1Get rights and content

Abstract

Gender differences in social support tend to suggest that women have larger social networks and both give and receive more support than men. Nevertheless, although social support has been identified as protective of mental health, women have higher rates of psychological distress than men. We examine the prospective association between social support and psychological distress by gender in a cohort study of middle aged British Civil Servants, the Whitehall II study. In this sample we found that women have a larger number of close persons than men although men have larger social networks. We also found that the effects of marital status, social support within and outside the workplace and social networks on subsequent occurrence of psychological distress were similar for men and women independently of baseline mental health status.

Introduction

The relative contribution of social relations to health and mortality has been reported from numerous studies using different definitions of social relations, different health outcomes and diverse samples. The magnitude of the effects varies according to the methodologies employed; nonetheless, there appears to be a consistent association between inadequate levels of social relations and poor physical and mental health. The apparent consistency and magnitude of these findings are such, that House et al. (1988)proposed that `insufficient social support' should be considered an important risk factor for ill-health and mortality.

Many of the early studies were limited to males and some to white males only (Welin et al., 1985). When analyses are performed separately by gender, one often notes a weaker or non-existent association for women. This finding is in contrast to what both popular culture and empirical studies would expect to obtain, given the belief that women have more extensive and better social relations than men. Women, as opposed to men, have larger and more varied networks and are more likely to have a close confidante and report that the confidante is someone other than their spouse (Antonucci, 1994). Women also provide and receive more support and have a wider `net of concern' than men, that is to say, they spend more time involved in responding to requests and support from other people (Kessler and McLeod, 1985). Also, women can more readily mobilise support when in need (Belle, 1989) and men tend to have fewer emotionally intimate relationships than women. All this should mean that women would benefit more in health terms from social support than men. However, although some studies report an equivalent effect of social support on mortality in both men and women (Berkman and Syme, 1979; Orth-Gomer and Johnson, 1987), many studies show an advantage for men that is not observed for women (House et al., 1982; Schoenbach et al., 1986; Kaplan et al., 1988).

In a critical review of social support and physical health, Shumaker and Hill (1991)examined the available evidence for gender differences and discussed the possible factors that may account for the observed differences in associations. They contend that the associated factors are related not only to the definitions of support and health that are used, but also to the possible mechanisms linking social relations to health that may differ for men and women.

The concept of social relations is multifaceted and includes the diverse set of interpersonal relationships and exchanges that people engage in both within and between families, friendships and `group affiliation' (Antonucci, 1994). Kahn and Antonucci (1980)deconstruct social support into three types of support: affect, aid and affirmation. Social relations may include the degree to which an individual's need for affection, esteem or approval, belonging, identity and security are met by significant others (Kaplan et al., 1977). It may also include whether he or she is cared for or loved, that he or she is esteemed or valued, that he or she feels they belong to a network of communication and mutual obligation (Cobb, 1976). When social relations are examined from a life course perspective, some authors (Bandura, 1986; Antonucci and Jackson, 1987) claim that they are effective because they help people develop a feeling of competency or personal efficacy.

Multiple constructs are covered by the term social relations, although the simple proposal by House and Kahn (1985)to differentiate structure and function as the two essential components, is both parsimonious and adequate. The structure of social relations consists of the more objective characteristics of the `social network', i.e. its size, relative composition in terms of gender and family/friend balance, network density, frequency of contacts etc. The support function of social relations, often referred to as social support, is the effective type of support received, provided or exchanged.

While definitions of social support and social networks vary, the measures of these constructs are even more inconsistent (Antonucci, 1985). Some studies ask about availability of support in general terms, others ask about support from specific role-defined persons, i.e. spouse, confidant(e), children, parents, etc., while others ask about support received with no identification of its source. It is assumed that the larger the network, i.e. the structure, the greater the potential for support. Seeman and Berkman (1988)examined this assumption in an urban community sample of older adults (≥65-yr old) and found that network size, number of face-to-face contacts and number of proximal ties were associated with greater availability of both emotional and instrumental support. They also found that the presence of a confidant was associated with both, whereas the presence of a spouse was not.

Many explanations have been proposed to describe how and why social relations impacts upon health. Social support may have both direct effects on health or may buffer the negative effects of life events and chronic stressors (Cohen and Wills, 1985). Directly, social support may increase our sense of control over the environment. In this way, it may dampen physiological arousal, strengthen immune responses and promote healthy (or occasionally unhealthy) behaviour. Indirectly, support may alter the appraisal of threatening events and may provide both emotional support and tangible resources to deal with life crises.

Supportive networks are considered to provide a health benefit and their absence to be detrimental to health, but less is known about the health consequences of negative interactions with network members. Rook (1990)has proposed 3 forms of negative interactions: unwanted or aversive contacts, ineffective support and social control to influence unhealthy behaviour.

While the majority of published reports have examined the effect of social relations on physical health and mortality, an extensive literature also exists on its effects on mental health and well-being. Cross-sectional studies show a clear negative association between levels of support and psychiatric disorders in both men and women, in community and patient samples (Lin et al., 1979; Williams et al., 1981; Aneshensel and Stone, 1982). Longitudinal studies suggest that lack of support while individuals are depressed predicts poor outcome (Fondacaro and Moos, 1987; Brugha et al., 1990; Paykel, 1994). Individuals with better support networks or with larger networks or who are married report better mental health and less psychological distress. The positive effect for marital status is stronger for men than for women. Furthermore, several authors report that network interactions are more strongly associated with women's mental health than with men's. Antonucci and Akiyama (1987)note that for both men and women, quality of social support has a stronger effect than quantity, however the magnitude of the combined effects of quality and quantity is higher for women. Likewise, Kessler et al. (1985)and Schuster et al. (1990)found that depression in women was predicted by both support and negative interaction with partners, relatives and/or friends, while for men only negative interaction was associated with depression. Due to the cross sectional design of most of these studies, the direction of the association cannot be inferred.

In previous longitudinal analyses of the Whitehall II cohort, we found that high levels of confiding/emotional support from the person nominated as closest reduced the risk of psychiatric disorder measured by the general health questionnaire (GHQ) (Goldberg, 1972) in men but not in women (Stansfeld et al., 1998). The absence of a protective factor for women was unexpected. Confiding in the closest person without receiving accompanying emotional support conferred greater risk of psychiatric disorder in women then men and may partly explain the observed gender difference in the effectiveness of confiding/emotional support. However, this seemed unlikely to be the full explanation and thus we extended the analyses to incorporate the effects of support from more than one close person.

The present study examined prospectively the gender specific effects on mental health of several components of social relations. We estimated the effect of each component separately, as well as their combined effects. We further adjusted for mental health at baseline, as psychological distress at baseline might influence the reporting of social relations and because of its cross-sectional association with social support which could confound the association. We also included social support in the workplace as an additional source of support whose absence may be detrimental to health.

Section snippets

Sample

The data presented in the present paper are drawn from the Whitehall II study of London-based British civil servants who completed versions 3 and 4 of the baseline questionnaire (n=7697); the first 2611 of the 10 308 participants completed earlier versions of the questionnaire that did not include several of the social support questions and have therefore been excluded from these analyses. The sample used for the analyses includes 6007 office-based civil servants aged 35 to 55 yr at study entry

Results

At phase 2 follow-up, 6,007 (78.0%) of the baseline sub-sample (n=7697 participants with versions 3 and 4) returned a questionnaire with the GHQ completed. Respondents at follow-up differed from non-respondents by gender, with men having a higher follow-up participation rate (79.9 vs. 74.8, p-value for difference of proportions by gender <0.001). Both men and women respondents differed by employment grade from non-respondents and gender was no longer associated with follow-up participation

Discussion

In this sample of British civil servants, we found that the effects of marital status, social support within and outside the workplace and social networks on subsequent occurrence of psychological distress were comparable for men and women. This finding was independent of baseline mental health status and controlling for mental health showed the same reductions in the associations for both sexes. These results do not replicate those reported by other studies, including our own earlier analyses (

Acknowledgements

We thank all civil service departments and their welfare, personnel and establishment officers; the Civil Service Occupational Health Service Agency, Dr Elizabeth McCloy; the Council of Civil Service Unions, all participating civil servants and all members of the Whitehall II study team. We acknowledge the advice provided by Professor Lisa Berkman in the development of the close persons questionnaire during her sabbatical visit in our department. We would also like to thank Dr Eric Fombonne and

References (47)

  • Bandura, A., 1986. Social Foundations of Thought and Action. Prentice Hall, Englewood Cliffs,...
  • Belle, D., 1989. Gender differences in children's social networks and supports. In: Belle, D. (Ed.), Children's Social...
  • L.F Berkman et al.

    Social networks, host resistance and mortality: a nine-year follow-up of Alameda County residents

    Am. J. Epidemiol.

    (1979)
  • T.S Brugha et al.

    Gender, social support and recovery from depressive disorders: A prospective clinical study

    Psychol. Med.

    (1990)
  • S Cobb

    Social support as a moderator of life stress

    Psychosom. Med.

    (1976)
  • S Cohen et al.

    Stress, social support, and the buffering hypothesis

    Psychol. Bull.

    (1985)
  • C Ernst et al.

    The Zurich study XII: sex differences in depression. Evidence from longitudinal epidemiological data

    Eur. Arch. Psychiatr. Clin. Neurosci.

    (1992)
  • Evandrou, M., 1996. Unpaid work, carers and health. In: Blane, D., Brunner, E., Wilkinson, R. (Eds.), Health and Social...
  • J Fiore et al.

    Social network interactions: a buffer or a stress?

    Am. J. Commun. Psychol.

    (1983)
  • M.R Fondacaro et al.

    Social support and coping: a longitudinal analysis

    Am. J. Commun. Psychol.

    (1987)
  • Goldberg, D.P., 1972. The detection of psychiatric illness by questionnaire. Oxford University Press,...
  • Goldberg, D.P., Blackwell, B., 1970. Psychiatric illness in general practice. A detailed study using a new method of...
  • W.R Gove

    Gender differences in mental and physical illness: the effects of fixed roles and nurturant roles

    Soc. Sci. Med.

    (1984)
  • Cited by (155)

    • Attachment, empathy, emotion regulation, and subjective well-being in young women

      2023, Journal of Applied Developmental Psychology
      Citation Excerpt :

      Young women who were preoccupied with forming and maintaining close relationships with other people or who were reluctant to trust and depend on others reported lower life satisfaction, less positive affect, and more negative affect. The findings offer empirical support for the point that women are strongly affected by negative aspects of relationships (Fuhrer et al., 1999; Hyde, 2014; Turner, 1994). However, contrary to our expectations, this study did not find significant relations between empathy and subjective well-being.

    View all citing articles on Scopus
    View full text