Satisfaction with social relationships and accumulation of chronic illness and multimorbidity: a national cohort of Australian women. Summary Background Social relationships are associated with mortality and chronic conditions. However, little is known about the effects of social relationship satisfaction on multiple chronic conditions (multimorbidity). Goals To examine whether satisfaction with social relationships is associated with the accumulation of multimorbidity. Methods Data were analyzed from 7,694 Australian women who were free of 11 chronic diseases between the ages of 45 and 50 in 1996. Approximately five types of satisfaction in social relationships (partner, family, friends, work, and social activities) were measured. every 3 years and were scored from 0 (very dissatisfied) to 3 (very satisfied). Scores for each relationship type were summed to provide an overall satisfaction score (range: ≤5–15). The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions. Results Over a 20-year period , 4,484 (58.3%) women reported multimorbidities. In general, the level of satisfaction with social relationships had a dose-response relationship with the accumulation of multimorbidities. Compared with women who reported the highest satisfaction (score 15), women with the lowest satisfaction (score ≤5) had the highest odds of accumulating multimorbidity (odds ratio (OR) = 2.35, confidence interval (95% CI: 1.94 to 2.83) in the adjusted model. Similar results were observed for each type of social relationship. Other risk factors, such as socioeconomic, behavioral, and menopausal status, together explained 22.72% of the association. Conclusions Social relationship satisfaction is associated with the accumulation of multimorbidity, and the relationship is only partly explained by socioeconomic, behavioral, and reproductive factors. Social connections (e.g., satisfaction with social relationships) should be considered a public health priority in chronic disease prevention and intervention. |
Comments
Findings are only partially explained by income, education and health behaviors
Satisfying relationships in midlife with partners, friends or co-workers are linked to a lower risk of accumulating multiple long-term conditions in old age, at least among women, suggests research published in the open access journal BMJ General Psychiatry .
The less satisfying these relationships were, the higher the risk, and the findings were only partially explained by influential factors such as income, education and health behaviors, the study shows.
There is growing evidence indicating a link between strong social networks and good health/well-being in later life, but it is not known whether these connections could reduce the risk of multiple long-term conditions (multimorbidity), which many older women face. in particular.
In an attempt to assess the extent to which a woman’s level of satisfaction with her relationships (partner, family, friends, coworkers, and other social connections) might influence this risk individually and collectively, researchers turned to 13,714 participants of the Australian Longitudinal Study of Women’s Health (ALSWH).
The ALSWH is an ongoing population-based study examining factors associated with the health and well-being of women who were ages 18 to 23, 45 to 50, and 70 to 75 in 1996. All women in the study current were between 45 and 50 years old in 1996. Their health and well-being was tracked approximately every three years via questionnaire until 2016.
They were asked to rate their levels of satisfaction with each of their 5 relationship categories on a 4-point scale, with each response scored up to a maximum of 3 points. And they were asked to indicate whether they developed any of the following: diabetes; hypertension; heart disease; stroke; Chronic Obstructive Pulmonary Disease (COPD); asthma; osteoporosis; arthritis; cancer; depression; and anxiety. Accumulation of 2 or more of these from a starting point of none, or additional conditions of only 1, or 2 or more, was defined as having multiple conditions (multimorbidity).
Information was collected on potentially influential demographic, lifestyle, and hormonal factors: country of birth, marital status, area of residence, educational level, and ability to manage income; weight (BMI), physical activity, alcohol consumption and smoking; and menopausal status.
The final analysis included 7694 women, 58% (4484) of whom accumulated multiple long-term conditions over 20 years of follow-up.
Those who did were more likely to have a lower educational level, find it difficult to live on their income, be overweight/obese, not be physically active, smoke, and have had a surgically induced menopause.
Overall, relationship satisfaction was associated with the accumulation of multiple long-term conditions: the higher the levels of satisfaction, the lower the risks .
Compared with women who reported the highest level of satisfaction (score of 15), those who reported the lowest (score of 5 or less) were more than twice as likely to accumulate multiple long-term conditions after fully adjusting potentially influential factors. The strength of the association was comparable to that of well-established risk factors such as overweight/obesity, physical inactivity, smoking and alcohol consumption, the researchers say.
When all 5 relationship types were included in the analysis, the association weakened but remained significant for all except friendships. Similar results were observed when individual conditions were analyzed separately.
Well-established risk factors, such as socioeconomic position, health behaviors, and menopausal status, together explained less than one-fifth of the observed association.
This is an observational study and as such cannot establish cause. It also relied on personal recall and did not capture information about social relationships in early adulthood. And because it only included Australian women, the findings might not be applicable to men or other cultures, the researchers say.
More research is needed to explore other relationship-specific effects on the accumulation of multiple long-term conditions, such as intimacy, quantity, and emotional and practical support, they emphasize.
- However, they conclude: “Our findings have significant implications for chronic disease management and intervention. First, at the individual level, these implications can help counsel women about the benefits of initiating or maintaining diverse, high-quality social relationships throughout middle to early old age.
- “Second, at the community level, interventions that focus on the satisfaction or quality of social relationships may be particularly effective in preventing the progression of chronic diseases.
- “Third, at the national and global levels, social connections (e.g., satisfaction of social relationships) should be considered a public health priority in chronic disease prevention and intervention.”
What does this study contribute?
We demonstrate a dose-response relationship between social relationship satisfaction and the accumulation of multimorbidity in women from midlife to early old age, which is only partly explained by sociodemographic, health behavior, and reproductive factors.
How it can affect clinical practice and health policy
Social connections must be integrated into the prevention and intervention of chronic diseases and multimorbidity.
