From social integration to health: Durkheim in the new millennium

It is widely recognized that social relationships and affiliation have powe rful effects on physical and mental health. When investigators write about the impact of social relationships on health, many terms are used loosely a nd interchangeably including social networks, social ties and social integr ation. The aim of this paper is to clarify these terms using a single frame work. We discuss: (1) theoretical orientations from diverse disciplines whi ch we believe are fundamental to advancing research in this area; (2) a set of definitions accompanied by major assessment tools; and (3) an overarchi ng model which integrates multilevel phenomena, Theoretical orientations that we draw upon were developed by Durkheim whose work on social integration and suicide are seminal and John Bowlby. a psyc hiatrist who developed attachment theory in relation to child development a nd contemporary social network theorists. We present a conceptual model of how social networks impact health. We envi sion a cascading causal process beginning with the macro-social to psychobi ological processes that are dynamically linked together to form the process es by which social integration effects health. We start by embedding social networks in a larger social and cultural context in which upstream forces are seen to condition network structure. Serious consideration of the large r macro-social context in which networks form and are sustained has been la cking in all but a small number of studies and is almost completely absent in studies of social network influences on health. We then move downstream to understand the influences network structure and function have on social and interpersonal behavior. We argue that networks operate at the behavioral level through four primary pathways: (1) provisio n of social support; (2) social influence; (3) on social engagement and att achment: and (4) access to resources and material goods, (C) 2000 Elsevier Science Ltd. All rights reserved.