Low Social Support

The reference numbers for this material are from the article: Schnall PL, Landsbergis PA, Baker D. Job strain and cardiovascular disease. Annual Review of Public Health; 15:381-411,1994.

Workplace social support has been added to the job strain model as a third major job characteristic in several studies of CVD (49, 50, Hall, Johnson and Tsou, 1993), all-cause mortality (8, 25), smoking and sedentary behavior (Johannson, Johnson and Hall, 1991), and ambulatory blood pressure (Landsbergis et al., 1994) as well as a number of studies of psychological strain outcomes (e.g., 60, 71).

The main effect of low social support on CVD was examined, with positive associations (25, 49), as well as the interaction between social support and job strain (8, 25, 49). Social support was as an effect modifier in the Swedish study of retired men (25) (increased job strain-mortality risk ratios for those with low social support), in the Swedish factory worker study (8) (reduced high latitude-mortality risk ratios for those with high workplace social support), and in a Swedish national study (49) (increased high demand-low latitude-CVD prevalence ratios with greater workplace social isolation).

One study of CVD risk factors (Johannson, Johnson and Hall, 1991) found an association between smoking and co-worker support, but only for women. While Landsbergis et al. (1994) found no association between social support and ambulatory blood pressure among 262 male employees in New York City, an earlier study found significant associations between a supportive foreman, supportive coworkers and lower casual diastolic blood pressure among 288 male factory workers (79).

The combination of job strain and low social support has been labeled “iso-strain”, or “isolated high strain” work. This approach was proposed since “iso-strain” is a univariate measure, “a more parsimonious instrument for measuring and analyzing workplace conditions” (50, p. 272). Only two studies (50, Landsbergis et al., 1994) directly examined “iso-strain” as a risk factor. Among 7219 employed Swedish men followed for nine years, “iso-strain” was associated with CVD morbidity and mortality (50). Among 262 male employees in New York City, “iso-strain” was associated with work and home ambulatory blood pressure and with risk of hypertension (Landsbergis et al., 1994). Social support and health.

Further study of social support and its effect on stress and health is indicated not only by the job strain studies cited above, but also by the extensive literature of the beneficial effects of both workplace and non-work based social support on cardiovascular and psychological health (20, 42).

Greater social integration is associated with lower mortality (House, Landis and Umberson, 1988) in various population based prospective studies. Positive associations between social support and CHD were found in Alameda County (Berkman and Breslow, 1983), eastern Finland (Kaplan et al., 1988), Sweden (Orth-Gomer and Johnson, 1987; Orth-Gomer, Rosengren and Wilhelmsen, 1993), Denmark (Netterstrom and Juel, 1988) and Tecumseh county, Michigan (House, Robbins and Metzner, 1982), but not in Honolulu (Reed et al., 1983), Evans County, Georgia (Schoenbach et al., 1986) or Framingham (Haynes, Feinleib and Kannel, 1980). [This paragraph is adapted from a review by Lynda Powell.]

However, a nonsupportive boss was associated with CHD among female clerical workers in Framingham (Haynes & Feinleib, 1980). Emotional support has also been associated with lower mortality following a myocardial infarction (Frasure-Smith and Prince, 1989; Berkman, Leo-Summers and Horwitz, 1992).

Dressler (1991) reported that social support moderates the effect of lifestyle incongruity on blood pressure. In laboratory reactivity studies, social support has been found to buffer the effect of stress on diastolic blood pressure responses (Gerin et al., 1995).

Many issues remain to be more fully examined, including: the hypothesized social support “buffering” effect; the respective contributions of work-based vs. non-work-based social support, instrumental vs. emotional support, and quality of support vs. extent of social network; effect modification by gender, race and/or SES; and the effect of social support on CVD risk factors such as blood pressure.


Berkman LF, Breslow L. Health and ways of living: The Alameda County study. New York: Oxford University Press, 1983.

Berkman LF, Leo-Summers L, Horwotz RI. Emotional support and survival after myocardial infarction. Annals of Internal Medicine 1992;117:1003-1009.

Dressler WW. Social support, lifestyle incongruity, and arterial blood pressure in a Southern Black community. Psychosomatic Medicine 1991;53:608-620.

Frasure-Smith N, Prince R.Long-term follow-up of the Ischemic Heart Disease Life Stress Monitoring program. Psychosomatic Medicine 1989;51:485-513.

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Kaplan GA, Salonen JT, Cohen RD, Brand RJ, Syme SL, Puska P. Social connections and mortality from all causes and from cardiovascular disease: Prospective evidence from eastern Finland. American Journal of Epidemiology 1988;128:370-380.

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Netterstrom B, Juel K. Impact of work-related and psychosocial factors on the development of ischemic heart disease among urban bus drivers in Denmark. Scandinavian Journal of Work, Environment and Health 1988;14:231-238.

Orth-Gomer K, Johnson JV. Social network interaction and mortality: A six-year follow-up study of a random sample of the Swedish population. Journal of Chronic Diseases 1987;40:949-957.

Orth-Gomer K, Rosengren A, Wilhelmsen L. Lack of social support and incidence of coronary heart disease in middle-aged Swedish men. Psychosomatic Medicine 1993;55:37-43.

Reed D, McGee D, Yano K, Feinleib M. Social networks and coronary heart disease among Japanese men in Hawaii. American Journal of Epidemiology 1983;117:384-397.

Schoenbach VJ, Kaplan BH, Fredman L, Kleinbaum DG. Social ties and mortality in Evans County, Georgia. American Journal of Epidemiology 1986;123:577-591.

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