Research attention on the role of interpersonal relationships

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Of all the possible strategies for reducing stress and enhancing coping, none have received as much research attention as the role of interpersonal relationships (Mind, 2010). The association between stress and social support has been applied to a hugely diverse range of scenarios, from pregnancy outcome (Peronà, 2009), academic performance (DuBois et al., 2008) and perceived threat of terrorism (Shahar et al., 2009), to unemployment (Ullah, 2009), the management of symptoms in posttraumatic stress disorder (PTSD: Thrasher et al., 2010) and coping with distressing psychotic experience (Hayward, 2007). The considerable and continued fascination with this extensive area attests to its importance in both physical and psychological health outcomes, as well as to the ongoing impetus to clarify the mechanisms through which it exerts its influence.

The concept of interpersonal relationships is multifaceted, encompassing features of SS, personality characteristics, and wider social structures (Pierce et al., 1996). Indeed, one of the single greatest challenges in refining social support as a coping resource is devising a clear, consistent definition of what actually constitutes good interpersonal relationships (Rice, 2000). Weiss (1974) for example, specified nurturance, reliability, attachment, reassurance of worth, and social integration, whereas Barrerea (1981), House (1981) and Norbeck (1984) have all emphasised material and physical aid, social participation, intimacy, feedback, and guidance. Various other conceptualisations have been proposed in the intervening years, although most contemporary definitions accentuate the role of instrumental (practical help), informational (guidance and advice) and emotional (acceptance and nurturance) assistance (Willis, 2008).

According to Diri (2006), evidence for the positive impact of interpersonal alliances on health is sufficiently strong to warrant economic and political initiatives for enhancing social integration. Similarly, the escalatation of digital technology has led some authors to propose the utilisation of internet forums as a social proxy for isolated individuals experiencing specific stressors, including single mothers (Hudson et al., 2008), elderly adults (Cody et al., 1999), cancer sufferers (Beaudoin et al., 2007) and survivors of childhood maltreatment (Rose, 2002). However, as laudable as such intentions are, one limitation of this structural 'embeddedness' approach is that social connections alone do not guarantee adequate supportive functions; rather, it may be the quality of social support, as opposed to quantity, that heightens resistance to stress (Papadimitrou, 2008). A classic study in this domain is the work of Brown and Harris (1978) who retrospectively found that 'close, intimate and confiding' relationships were a significant protective factor against depression following major life events. Studies using prospective methodology have yielded reliably similar findings (e.g., Brown et al., 1986; Chandola et al., 2006; Cooper et al., 2006; DuBois et al., 2008). A recent investigation into the prevalence and correlates of PTSD in veterans (Pietrzak et al., 2009) suggested that intimate, supportive relationships within the military unit, and emotional support and instrumental assistance post-deployment, are a significant protective factor against subsequently developing depression and PTSD. This study assessed perceived social support (i.e., professed satisfaction, adequacy and availability of interpersonal relationships; Jones and Bright, 2001), an important approach for establishing the quality of social currency. In contrast, Pina et al. (2008) found that adolescent survivors of Hurricane Katrina were less likely to develop PTSD symptoms when they had access to instrumental and informational professional support, and emotional familial support. This distinction between different categories of enacted assistance is an interesting and important division, whereby the manner in which help is provided can often prove situationally and temporally distinct. For example, intentions of support providers may be less acceptable to cancer patients if family and friends offer informational/instrumental assistance rather than emotional support (Dakof & Taylor, 1990). In contrast, couples undergoing IVF treatment are more responsive to emotional support from female providers, and instrumental help from males (Knoll et al., 2007). A qualitative study of the social support experiences of 15 adults with chronic disabilities (attention deficit disorder, spina bifida or cerebral palsy) has also reported that emotional, instrumental and informational support is differentially received during different transitions in the individual's life (King et al., 2006).

The question as to how interpersonal relationships reduce susceptibility to stress is an intriguing one. It is also an enquiry of considerable complexity, as examining the mechanisms whereby social support enhances resilience requires (i) transparency in how interpersonal relationships are defined, (ii) appropriate measures and statistical tests for exploring these relationships, and (iii) clarity in explicating possible mechanisms of effect. Nevertheless, it is generally accepted that social support can operate by exerting direct, mediating and moderating influences. The first of these models proposes that social support has a immediate impact on well-being, regardless of whether the recipient is actually experiencing stress, in that "social networks provide…regular positive experiences…positive affect, a sense of predictability…and a recognition of self-worth (Cohen & Wills, 1985, p.31). Numerous studies have endorsed its benefits (e.g., Bolger et al., 2007; Hatchett et al., 1997; Younger et al., 1997). For example, Hoffman and Hatch (2008) report that the direct effects of social support are associated with a significantly lower risk of pre-term birth amongst economically disadvantaged women, whereas Chen et al. (2009) found that objective and subjective measures of direct social support mitigated the depression experienced in relation to job stress amongst a sample of 843 Chinese workers. According to Gluhoski and colleagues (1997), direct social support, in combination with hardiness, was the most powerful determinant of well-being amongst a sample of 598 bereaved gay men.

In contrast, moderating (or 'buffering') effects suggest that social resources increase resistance to stress by influencing both appraisal and coping (Kessler & Essex, 1982); in effect, that social support may interact with the stressor to shape the outcome and render it less threatening (Lazurus & Folkman, 1984). A vast range of experimental work has addressed this issue, and has generally found that buffering can work in ways that are both structural (i.e., the mere existence of interpersonal relationships) and functional (i.e., the quality of these relationships). Although the concept is well supported (e.g., Andersen et al., 2009; Bak, 2008; Kang et al., 1998; Uchino et al., 1996), buffering may be more efficacious when congruence occurs between available support and the type of stress experienced (Cohen & Wills, 1985). Such 'support matching' may be most relevant in terms of social companionship and instrumental assistance (Jones & Bright, 2001), for while emotional and informational support may be more generically appropriate, specific stressors can require more precise matches to be optimally effective. For example, in contrast to other kinds of social support, the presence of other military wives was rated the most significant stress moderator for women whose spouses were deployed in service (Rosen, 1990), whereas Rees et al. (2007) have found that matching instrumental support to different scenarios enhances the buffering effect of social support amongst professional sportspeople.

Finally, interpersonal relationships can also mediate the association between stressors and coping outcomes. According to Quittner et al. (1990), who examined how social support mediates chronic parenting stress, interpersonal relationships can function as an intervening variable that specify how, rather than when, coping effects occur. In this study, for example, social support mediated maternal stress in terms of greater strain being associated with depleted structural social contacts, and the perception of proffered support as critical and suggestive of incompetence. In contrast, Bolger and Amarel (2007) report that supportive acts, which are accomplished with sufficient subtlety to avoid inferring a sense of incapacity to recipients, mediates the relationship between the stress of public speaking and emotional reactivity. Supportive interpersonal relationships have also been found to mediate associations between stress and quality of life for carers of mentally ill relatives (Smith et al., 2010), childhood abuse and adulthood adjustment (Range et al., 2007), and depression and psychosocial functioning following cancer treatment (Carey, 2009).

Despite consistently positive findings, the association between social support and susceptibility to stress (as with so much research within the field) is more complex than it first appears. For instance, interpersonal alliances are not invariably helpful. Indeed, in the case of bereavement (Sorvino, 1987), marital discord (Carter et al., 1990), or serious illness (e.g., Kiecolt Glaser et al., 1995) one's original source of comfort may become the object of distress. A particular social group may also enhance and encourage dysfunctional coping strategies, such as substance use (Levi, 1005), non-compliance with medical advice (e.g., Burg & Seerman, 1994) and risk behaviours like gambling and sexual promiscuity (Hewitt, 2004). Whilst such fraught interactions are intuitively damaging, even sincere and well-meaning attempts at support can have a destructive effect. A frequently-cited example of this are the responses often meted out to cancer patients (Wortman & Dunkel-Shetter, 1987) and individuals with mental health difficulties (Read et al., 2004), which include misplaced attempts at optimism, prohibitions on communicating feelings, and tense, awkward interactions. Similarly, deeply traumatic or stigmatising stressors, such as bereavement or criminal activity within the family, may induce so-called 'support deterioration', whereby interpersonal alliance become fragmented through evasion and avoidance (Barrera, 1988) Finally, individuals enduring chronic stress may ultimately either exhaust their social resources, or experience help-seeking as demoralising in that its receipt exacerbates a sense of hopelessness and inadequacy (Hobfall, 1990).

A second potential difficulty relates less to the actual construct of interpersonal relationships, and more to how they are conceptualised and measured. Applying consistent, congruent assessment tools is vital for preserving conceptual and experimental integrity, yet the construct has been operationalized in so many ways that at present over 50 different measures of social support exist (Dunham, 2007). Many of these are self-report tools, which carry their own set of methodological problems (see Jones & Bright, 2001), not least the likelihood of anxious, strained individuals to evaluate their interpersonal relationships more negatively (Peters, 1999). Furthermore, it is important that proposed models of social support are systematically applied and tested within different populations (e.g., culture, gender, or age relevance) and in response to varied stressors (e.g., chronic, acute, occupational, or familial). Similarly, the influence of personality variables within social relationships is a fruitful avenue for enquiry, including the ways in which features like neuroticism, extraversion and introversion (e.g., Halamandaris & Power, 1999), agreeableness (e.g., Hoth et al., 2007), locus of control (e.g., Lu, 1994), and perceptions of reciprocity (e.g., Schwarzer & Knoll, 2007) determine the use of interpersonal relationships and the benefits derived from them.

Nevertheless, despite the inherent intricacies of the field, research around stress and interpersonal relationships continue to validate the belief that recruitment and receipt of meaningful support yields substantial advantages for coping and well-being. This is both a natural and intuitive finding. At our most basic level, humans are social beings; simultaneously individuals yet members of a group, wherein connecting with other in meaningful ways contributes to the sense of belongingness, comfort, and solidarity that is needed for us to flourish, prosper and thrive.