Category Archives: health

How loneliness kills

Flick/cc/ewixx

Flickr/cc/ewixx

Judith Shulevitz, in the May 13, 2013 New Republic has an interesting read “The Lethality of Loneliness.”

Excerpt:

“Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people….

“To the degree that loneliness has been treated as a matter of public concern in the past, it has generally been seen as a social problem—the product of an excessively conformist culture or of a breakdown in social norms. Nowadays, though, loneliness is a public health crisis. The standard U.S. questionnaire, the UCLA Loneliness Scale, asks 20 questions that run variations on the theme of closeness—“How often do you feel close to people?” and so on. As many as 30 percent of Americans don’t feel close to people at a given time….

“What He [God] wanted is for us not to be alone. Or rather, natural selection favored people who needed people. Humans are vastly more social than most other mammals, even most primates, and to develop what neuroscientists call our social brain, we had to be good at cooperating. To raise our children, with their slow-maturing cerebral cortexes, we needed help from the tribe. To stoke the fires that cooked the meat that gave us the protein that sustained our calorically greedy gray matter, we had to organize night watches. But compared with our predators, we were small and weak. They came after us with swift strides. We ran in a comparative waddle.

“So what would happen if one of us wandered off from her little band, or got kicked out of it because she’d slacked off or been caught stealing? She’d find herself alone on the savanna, a fine treat for a bunch of lions. She’d be exposed to attacks from marauders. If her nervous system went into overdrive at perceiving her isolation, well, that would have just sent her scurrying home. [John] Cacioppo thinks we’re hardwired to find life unpleasant outside the safety of trusted friends and family, just as we’re pre-programmed to find certain foods disgusting. “Why do you think you are ten thousand times more sensitive to foods that are bitter than to foods that are sweet?” Cacioppo asked me. “Because bitter’s dangerous!”

The article, well worth a read, discusses issues like that only about half of loneliness is hereditary, what areas of the brain light up when we are socially snubbed (the same portion that registers physical pain, i.e., the dorsal anterior cingulate cortex), what has been learned about the impact of the absence of loving parents on loneliness from the isolating experience of Russian orphans; and how Nobelist James Heckman is finding that many low SES children bear loneliness scars from poor parenting growing up (that is akin to the impact found by Steve Suomi and Harry Harlow on isolated rhesus macaques).

See other posts about the negative health effects and contagion of  loneliness and social isolation here.

Altruism the key to worker productivity and advancement?

The New York Times Sunday magazine (3/31/13) has an interesting long read by Susan Dominus “Is Giving the Secret to Getting Ahead?” focusing on research by Wharton (U. Penn) workplace organization psychologist Adam Grant who believes, originally based on personal experience and later supported by hard-headed quant studies that altruism both motivates workers to work harder and helps them to advance.

Snippet:

“For Grant, helping is not the enemy of productivity, a time-sapping diversion from the actual work at hand; it is the mother lode, the motivator that spurs increased productivity and creativity. In some sense, he has built a career in professional motivation by trying to unpack the puzzle of his own success. He has always helped; he has always been productive. How, he has wondered for most of his professional life, does the interplay of those two factors work for everyone else?

“Organizational psychology has long concerned itself with how to design work so that people will enjoy it and want to keep doing it. Traditionally the thinking has been that employers should appeal to workers’ more obvious forms of self-interest: financial incentives, yes, but also work that is inherently interesting or offers the possibility for career advancement. Grant’s research, which has generated broad interest in the study of relationships at work and will be published for the first time for a popular audience in his new book, “Give and Take,” starts with a premise that turns the thinking behind those theories on its head. The greatest untapped source of motivation, he argues, is a sense of service to others; focusing on the contribution of our work to other peoples’ lives has the potential to make us more productive than thinking about helping ourselves.”

At a university call center, Grant tried reinforcing the ties to needy students to motivate callers and tested its effectiveness.  He found in 6 repeated tests that even a 5 minute speech by a scholarship recipient now working for Teach for America and testifying how the scholarship had changed his life, on average meant that even a month later fundraisers spent 2.5x as much time on the phone, nearly doubled the number of calls made per hour, and average caller brought in 5x as much money per week.  These results were achieved even though workers used the same script and consciously discounted the impact of the student’s talk.   He and others have found other productivity benefits from “gratitude journals” or “thank you notes.”

“Over the years, Grant has followed up that study with other experiments testing his theories about prosocial motivation — the desire to help others, independent of easily foreseeable payback. In one study, Grant put up two different signs at hand-washing stations in a hospital. One reminded doctors and nurses, “Hand hygiene prevents you from catching diseases”; another read, “Hand hygiene prevents patients from catching diseases.” Grant measured the amount of soap used at each station. Doctors and nurses at the station where the sign referred to their patients used 45 percent more soap or hand sanitizer.”

Grant in his forthcoming book divides the world of workers “divides the world into three categories: givers, matchers and takers. Givers give without expectation of immediate gain; they never seem too busy to help, share credit actively and mentor generously. Matchers go through life with a master chit list in mind, giving when they can see how they will get something of equal value back and to people who they think can help them. And takers seek to come out ahead in every exchange; they manage up and are defensive about their turf. Most people surveyed fall into the matcher category — but givers, Grant says, are overrepresented at both ends of the spectrum of success: they are the doormats who go nowhere or burn out, and they are the stars whose giving motivates them or distinguishes them as leaders.”

Grant says that the key to successful givers is being strategic about doing nice things for others — what he calls the “5 minute favor” and asking if you can add unique value to the person requesting your time, and if not, strategically connecting the asker with other givers or with matchers for whom you have done past favors.  One can easily imagine that if one is strategic about doing favors for others, social capital theory would suggest that one builds up an informal “favor bank” that as the askers move up in the world, put you in a much stronger position to request favors of others.  It increases his pool of willing collaborators and puts him in a larger web of information flows in an era where expertise and knowledge is often distributed.  It is interesting that the motivation for Grant at least in being a giver is not at all about advancement — for him it is the key to doing what he can to conquer mortality.  He endorses William James’ view that  ‘The greatest use of a life is to spend it on something that will outlast it.’

Grant also notes that takers succeed in the short-term but don’t do as well over the long-term perhaps because others use online social networks to punish takers [see e.g., Matthew Feinberg, Joey T. Cheng and Robb Willer, "Gossip as an Effective and Low-Cost Form of Punishment", Behavioral and Brain Science 25(1), Feb 2012.]

He talks about his experience with the University of Michigan fundraising call center about 4 minutes into the following video. One person had a depressing sign on his desk saying “Doing a good job here is like wetting your pants in a dark suit.  You get a warm feeling but no one else notices.”:

I wonder whether his strategy is equally effective for all social strata. Jean Rhodes and others found that post-Katrina low SES survivors  who were more connected with others suffered mental health losses in short-term because all their friends were making demands of them [discussed towards bottom of this blog post].  The workers, like Adam Grant, himself may be less surrounded by needy individuals and more likely to be providing favors to students who will go on to higher stations in life, but very interesting food for thought…

Read Susan Dominus “Is Giving the Secret to Getting Ahead?

Read Adam Grant’s new book, “Give and Take: A Revolutionary Approach to Success” (April 2013)

Having few friends predicts early death as much as smoking or alcoholism

“Low social interaction as high a risk factor for early death as smoking 15 cigarettes daily or being an alcoholic, and twice the risk factor of obesity.”

Julianne Holt-Lunstad, a psychologist at BYU, published a recent meta-analysis with Timothy Smith and J. Bradley Layton (that culls from learning across 148 longitudinal health studies covering over 300,000 individuals). They showed that increased involvement in social networks on average reduces one’s chance of mortality over the period of any particular study by 50+%, a greater effect than either stopping smoking or eliminating one’s obesity/physical inactivity.

The study “Social Relationships and Mortality Risk: A Meta-analytic Review” appears in the journal PLoS Medicine.  They controlled for baseline health status,  and found consistent results for friendships with family, friends, neighbors and colleagues across age, gender, initial health status, cause of death, and follow-up period.

The life-protective benefits of friendship were strongest for complex measures of social integration and lowest for simple measures of residential status (e.g., living alone versus with others) .  In studies that had greater dimensions of social involvement (whether one was in a network, the kinds of social support one got, etc.), the life-protecting benefits of friendships were higher, likely corresponding to the multiple pathways through which friendships provide benefits.

Low social interaction, according to the authors, was as high a risk factor for early death as smoking 15 cigarettes a day or being an alcoholic.  Low social interaction was a higher risk factor than not exercising and twice as high a risk factor for early death as obesity.

Co-author Tim Smith noted: “We take relationships for granted as humans – we’re like fish that don’t notice the water….That constant interaction is not only beneficial psychologically but directly to our physical health.”

The longitudinal studies they analyzed tracked health outcomes and social interaction for a period of seven and a half years on average.

The 50% increased survival rate is quite likely an underestimate: these longitudinal studies don’t track relationship quality but only one’s inclusion in a social network, so they include negative relationships as well. Survival benefits of friendships are likely to be much higher if one could isolate only positive and healthy social relationships.

Holt-Lunstad speculated that the pathways of social relationships to improved longevity stem range from  “a calming touch to finding meaning in life.” She believes that those who are socially connected take greater responsibility for others’ and their own lives and take fewer risks.

Here is key Figure 6 from their study:

Unlike some other work, such as Eric Klinenberg’s Heat Wave, where shut-in elderly were especially at risk of death in Chicago’s 1995 heat wave, the findings of Holt-Lunstad are generalizable to all age groups.

Two recent articles on the importance of groups for health

Flickr/EdsonHong

Tina Rosenberg (author of the recently blogged about Join the Club) had two recent opinion pieces in the New York Times in November on how groups play a key role in healthy outcomes.

One “Fixes: For Weight Loss, a Recipe of Teamwork and Trust” (11/15/11) focuses on how patients are much more successful in trying to lose weight when they are in groups.

Another “Fixes: At a Big Church, a Small Group Health Solution”
discusses how Saddleback Church (also featured in Bob Putnam and Lew Feldstein’s Better Together) uses small-groups to encourage more healthy lifestyles of their members.

Tip o’ the hat to Lew Feldstein for these articles.

Social capital can alleviate youthful stressors that predict poor adult health

Flickr/meganskelly

Just finished a very interesting New Yorker article entitled “The Poverty Clinic” by Paul Tough that focuses on Nadine Burke who runs a San Francisco-based low-income health clinic and her conviction, supported by various studies, that youth trauma scars young people’s health for life.

They cite the ACE (Adverse Childhood Experiences) study of 1998 that showed that adults’ retrospective childhood ACE memories were a strong predictor of all kinds of negative adult health outcomes and this exhibited a dose-response linearity — i.e., exposure to more categories of childhood adversity meant both greater likelihood of negative adolescent outcomes (depression, suicide, binge drinking, etc.) and greater likelihood of poor adult health outcomes.

These ACEs measure youth stress in four areas: 1) physical; 2) sexual; 3) psychological; 4) substance abuse; 5) mental illness; and 6) criminal activity.  Actual list of items appended to this post.

While it is possible that these retrospective memories are flawed (i.e., sick adults are more likely to recall childhood stresses), a basically prospective New Zealand Dunedin study is finding the same thing for early trauma.  And Bruce McEwen (Rockefeller Univ.) and Frances Champagne (Columbia Univ.) have shown that “repeated, full-scale activation of this stress system, especially in early childhood…actually alerts the chemistry of DNA in the brain, through a process called methylation….This process disables these genes [methyl groups], preventing the brain from properly regulating its response to stress.”  Even a decade or more after the stress, these teenagers find it harder to sit still, exhibit higher rates of aggression, show weaker brain function, and can’t as adequately distinguish between real and imaginary threats.

While some doctors are looking at whether drugs (psychopharmacology) could have an impact, social capital can often overcome these stressors.

“Other researchers have produced evidence that they can mend children’s overtaxed stress-response systems by changing the behavior of their parents or caregivers.  A study in Oregon drew this conclusion after assessing a program that encouraged foster parents to be more responsive to the emotional cues of the children in their care.  Another study, in Delaware, tracked a program that promoted secure emotional attachment between children and their foster parents.  In each study, researchers measured, at various points in the day, the children’s level of cortisol, the main stress hormone, and then compared these cortisol patterns with those of a control group of foster kids whose parents weren’t in the program.  In both studies, the children whose foster parents received the intervention subsequently showed cortisol patterns that echoed those of children brought up in stable homes.

“In terms of helping older children and adolescents who have experienced early trauma, the research is less solid.  There is evidence that certain psychological regimens, especially cognitive-behavioral therapy, can reduce anxiety and depression in patients who are suffering from the stress of early trauma.  But, beyond that, little is known…”

Kaiser Permanente started asking about these stressors on intake questionnaires, since the were markers of health problems in the same way as say high cholesterol was.  The article points out that eliminating the negative effects of four ACEs would lower the risk of heart attacks as much as lowering cholesterol below the warning threshold.

With regard to work we are currently doing on a growing social class gap among adolescent youth, it is possible that methylation and ACEs might help explain lingering and persistent growing social class gaps that we see among high schoolers over the last several decades.

Read “The Poverty Clinic” (New Yorker, March 21, 2011)

See earlier post “Doctors Prescribing Social Capital

See early article on Childhood stressors and adult health: Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, et al JS. The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine. 1998;14:245-258.

+++

Specifically ACE questionnaire asks whether:  parent or other adult in household (HH) often or very often swore at you, insulted you or put you down; often or very often acted in way that made you afraid that you would be physically hurt;  often or very often pushed, grabbed, shoved, or slapped you; often or very often hit you so hard that you had marks or were injured; person five+ years older than you ever touched or fondled you in a sexual way; had you touch their body in a sexual way; attempted oral, anal, or vaginal intercourse with you; actually had oral, anal, or vaginal intercourse with you; whether you lived with anyone who was a problem drinker or alcoholic; lived with anyone who used street drugs; whether anyone in HH was depressed or mentally ill; whether HH member attempted suicide; whether your mother was treated violently ; whether your mother or stepmother was sometimes, often, or very often pushed, grabbed, slapped, or had something thrown at her; whether mother/stepmother was sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard; whether mother/stepmother was ever repeatedly hit over at least a few minutes; whether mother/stepmother was ever threatened with, or hurt by, a knife or gun; whether HH member ever went to prison.

Doctors prescribing social capital?

Flickr photo by carf

I wrote earlier about some insurers using social capital in making decisions of whom to insure.

That post and a story sent to me by Lew Feldstein about doctors prescribing outdoor time got me thinking about doctors and social capital.  In the same way as doctors ask questions of patients around smoking, exercise, diet, etc., why shouldn’t doctors also ask patients to fill out a short survey about social capital activities they engage in:  number of confidants, how many of their neighbors’ first names they know, how often they go to friends’ houses or entertain others in their home, etc.?

These data could be used for 3 purposes:

1) to track real changes in the patient over time:  e.g., if a patient used to report 2 confidants and now reports zero it would be a chance for the doctor to find out what had triggered this (a friend moving, serious arguments, a close friend dying, etc.) that might help identify patients at risk of being socially isolated or going through stressful times.

2) to benchmark against others of the patients’ education, race and age.  In larger practices, or if this information was aggregated anonymously by affiliated hospitals, the computer could help patients understand the degree to which they far less involved in community or other associations or less trusting than comparable others nationwide or in their area.  If one was significantly below what others were, the doctor might want to bring this to the patient’s attention:  “did you know that most others like you are far more active in their community?”  or “did you know that most others like you volunteer much more their community?”  “This is something that has clear health impacts;  would you like more information about how to get more involved?”

3) to prescribe social capital “treatments”.  We’re far more used to a doctor prescribing an antibiotic or an aspirin than recommending that a patient get actively involved in a group (on a topic he/she cares about).  And some social capital deficits are more easily treated than others — it’s hard to suddenly develop a confidant.  But doctors might note to patients that there are real health consequences of being socially isolated and being socially and civicly uninvolved: i.e., getting sick more often and recuperating more slowly.  If acquiring a confidant in the next year is not a doable goal, maybe deciding which of ones’ friends have the potential to be confidants and taking some steps to start to deepen these relationships might be doable over the next 6-12 months.   Patients might agree to certain steps they want to take and put them on a card in a sealed and addressed letter that gets sent to them in 4 months.  Nudges can also be used to help people keep promises (through ongoing social groups that hold their members accountable for their promises, checks that go to disliked groups if commitments are broken, etc.).

And as to why?  Doctors might point out that they would rather be prescribing social capital now than prescribing hypertension drugs five years down the road.

[Read related story in NY Times about prescribing outdoor time: "Head Out for a Daily Dose of Green Space" (Jane Brody, 11/30, 10]

Happiness: how to increase it, UK Government measurement

Flickr photo by greeneydmantis

Two interesting updates on happiness research:

1) Being in the present increases your happiness.  A somewhat surprising finding since  one would think that daydreaming about a Tahitian vacation, a Carlton Fisk’s memorable 1975 world series home run for the Red Sox, or recalling something hilarious one’s children said, would increase your happiness.  But social psychologists Daniel Gilbert and Matthew Killingsworth (both from Harvard) found, using an iPod app called trackyourhappiness, that the Buddhists were indeed right.  Dwell in the present and be mindful.  Trackyourhappiness beeped 2,200 volunteer subjects at various times of the day and asked them describe what they were doing, with whom, and how happy they were.  The researchers analyzed the quarter of a million datapoints to determine what activities provided the greatest or least happiness.

Excerpt:

When asked to rate their feelings on a scale of 0 to 100, with 100 being ”very good,” the people having sex gave an average rating of 90. That was a good 15 points higher than the next-best activity, exercising, which was followed closely by conversation, listening to music, taking a walk, eating, praying and meditating, cooking, shopping, taking care of one’s children and reading. Near the bottom of the list were personal grooming, commuting and working.

When asked their thoughts, the people in flagrante were models of concentration: only 10 percent of the time did their thoughts stray from their endeavors. But when people were doing anything else, their minds wandered at least 30 percent of the time, and as much as 65 percent of the time (recorded during moments of personal grooming, clearly a less than scintillating enterprise).

On average throughout all the quarter-million responses, minds were wandering 47 percent of the time….

”I find it kind of weird now to look down a crowded street and realize that half the people aren’t really there,” Dr. Gilbert says.

Of course, it might well be that the mind wanders because the underlying activities are less “scintillating”; it’s hard to say whether being in the present for commuting or grooming would dramatically increase the happiness levels of doing those activities, although it might reduce traffic accidents and grooming accidents…

See “When The Mind Wanders, Happiness Also Strays” (NY Times, 11/16/10, by John Tierney)

See here for a recent summary post on happiness research.

2) The British government has followed up on Prime Minister David Cameron’s interest in wellbeing and will begin measurement this year.  The UK government follows countries like Bhutan and Canada in regularly measuring this concept. France has also been recommended to take similar action from a high-powered academic commission advising French President Nicolas Sarkozy; Sarkozy announced in 2009 that he plans to measure happiness and wellbeing as part of France’s economic progress in the near future.

A Guardian piece notes that there is some ” ‘nervousness’… in Downing Street at the prospect of testing the national mood amid deep cuts and last week’s riot in Westminster…”  Cameron has indicated that tracking wellbeing is as important as ever during a downturn, and his commitment to integrate wellbeing centrally into government policy.

The government is charging the national statistician Jil Matheson with crafting the exact happiness questions to add to the Office of National Statistics’ ongoing household survey. Cameron has asked for regular measurement of “subjective wellbeing” (including happiness) and how well Brits are meeting their “life goals”.

The new data, to begin being measured in Spring 2011, may be published quarterly like British crime data, and will be coupled with other social measures like social capital to provide data on Brits’ quality of life.

John Helliwell “told the Guardian: ‘The UK plans are putting into action the two most important elements of the Stiglitz/Sen report: systematically measuring subjective wellbeing as part of a broader national accounting system, and using these data to inform policy choices.’  “

See “Happiness index to gauge Britain’s national mood: Despite ‘nervousness’, David Cameron wants measure of wellbeing to steer government policy” (Guardian, Nov. 14, 2010, by Allegra Stratton)

See David Cameron’s November 25, 2010 transcript regarding UK measurement of wellbeing.

See how UK ranks to other countries in happiness

Datablog: see how our happiness rating compares