Category Archives: health benefits

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.

Social Capital Benefits of Choral Singing

Oakland Gospel Choir

Chorus America has a 2009 Chorus report out asserting that choral singing is associated with better outcomes for kids and higher citizenship.  I’m very sympathetic to the claim and suspect it is true — choral societies were after all one of the best predictors in my colleague Robert Putnam’s landmark study on what predicted how well newly formed regional governments worked in Italy.  [see Making Democracy Work.] That said, I don’t find such a single-point-in-time survey like the Chorus America study to be very convincing evidence of this.

It’s just as plausible that good citizenship and choral singing could be linked because good citizenship leads to choral singing or because something like sociability leads to both good citizenship and to choral singing.  Since we can’t randomly assign people to choruses, we really can’t know how the choral singers are different in unobservable ways from the non-singers.

It would be far better to have some sort of panel survey where you track the same people over time and observe some people joining choruses or dropping out of choruses and see how the change in “treatment” (in or out of choruses) affects their social trust or their friendships or their levels of citizenship.

The best evidence I’ve seen on the power of choral singing came from a study done in 2000 by Robert Beck (of U. Cal., Irvine) and others called “Choral Singing, Performance Perception, and Immune System Changes in Salivary Immunoglobulin A and Cortisol” (Music Perception, Fall 2000: 18(1):87-106.) that used saliva swabs before and after rehearsals and performances of a professional choir singing Beethoven’s Missa Solemnis.  He found that immunoglobulin A (which provides immunity and lowers stress) increased 150% during rehearsals and 237% during performances.  Singers self-ratings of various emotional states were highly predictive of the rise in immunoglobulin A.

As a social capital maven, I wondered how much of this was singing or playing music in groups and how much could have been achieved playing or singing alone.    To my knowledge, Robert Beck hasn’t conducted similar research of musicians practicing alone or musicians playing in groups.  [I know he conducted a later study of college solo singers and found similar results but the rehearsals were together with coaches so they were not really singing “alone.”]

One study  found that elderly nursing home residents participating for four weeks  in a choir lowered depression and anxiety and another found  mental and physical health gains from independent elderly people spending one year singing with an established community choir. See Cohen et al. and Houston et. al studies listed at bottom of report.

I haven’t seen any great studies of social capital in choruses, but a bright sociology student at Harvard, Matthew Baggetta, was undertaking a dissertation last year following choral groups in Boston and witnessing how their structure and governance helped influence the civic development of their members since he assumed individuals did not select into choirs based on their administrative structure and hence it was something of a quasi-randomized experiment.  [His dissertation, which I haven’t read was called: “Civic Development in Apolitical Associations.”]

[The Chorus America study can be found here.  Beck et al.’s 2006 study on college “solo” singers, called “Supporting the Health of College Solo Singers: The Relationship of Positive Emotions and Stress to Changes in Salivary IgA and Cortisol during Singing” , Journal for Learning through the Arts, 2(1), available here.]

See also Kreutz, G., Bongard, S., Rohrmann, S., Grebe, D., Bastian, H.G. & Hodapp, V. (2004) “Effects of choir singing or listening on secretory immunoglobulin A, cortisol and emotional state”, Journal of Behavioral Medicine, 27 (6), 623-635.

Kuhn, D. (2002) “The effects of active and passive participation in musical activity on the immune system as measured by salivary immunoglobulin A (SigA)”, Journal of Music Therapy, 39 (1), 30-39.

Cohen, G.D., Perlstein, S., Chapline, J., Kelly, J., Firth, K.M. & Simmens, S. (2006) The impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults, The Gerontologist, 46 (6), 726-734.

Houston, D.M., McKee, K.J., Carroll, L. & Marsh, H. (1998) Using humour to promote psychological wellbeing in residential homes for older people, Aging and Mental Health, 2 (4), 328-332.