Findings are only partially accounted for by factors such as income, education, and health behaviors.
According to a study published in the open-access journal General Psychiatry, women in their mid-life who have fulfilling relationships with partners, friends, or work colleagues may have a reduced risk of developing multiple long-term health conditions in old age. The findings suggest that the more unsatisfying these relationships are, the higher the risk becomes. While factors such as income, education, and health behaviors partially contribute to the results, the findings are not fully explained by these factors.
There is increasing evidence pointing to a correlation between robust social networks and overall health and well-being in older age, but it remains unclear if these connections can reduce the risk of multiple long-term conditions (multimorbidity), which is a common issue faced by many elderly women.
In a bid to assess to what extent a women’s level of satisfaction with their relationships—partner, family, friends, work colleagues, and other social connections—singly and collectively might influence this risk, the researchers drew on 13,714 participants of the Australian Longitudinal Study on Women’s Health (ALSWH).
The ALSWH is an ongoing population-based study looking at factors associated with the health and well-being of women who were aged 18–23, 45–50, and 70–75 in 1996. All the women in the current study were aged 45-50 in 1996. Their health and well-being was tracked roughly every three years via questionnaire up to 2016.
They were asked to rank their levels of satisfaction with each of their 5 categories of relationships on a 4-point scale, with each response scored up to a maximum of 3 points. And they were asked to indicate if they developed any of the following: diabetes; high blood pressure; heart disease; stroke; chronic obstructive pulmonary disease (COPD); asthma; osteoporosis; arthritis; cancer; depression; and anxiety.
Accumulating 2 or more of these from a starting point of none, or additional conditions from just 1, or from 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 attainment, and the ability to manage income; weight (BMI), physical activity, alcohol intake, and smoking; and menopausal status.
The final analysis included 7694 women, 58% (4484) of whom accumulated multiple long-term conditions over 20 years of monitoring. Those who did so were more likely to have lower educational attainment, find it difficult to live off their income, be overweight/obese, physically inactive, smokers and to have had a surgically induced menopause.
Overall, relationship satisfaction was associated with the accumulation of multiple long-term conditions: the greater the levels of satisfaction, the lower the risks. Compared with women reporting 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 for potentially influential factors.
The strength of the association was comparable with that of well-established risk factors, such as overweight/obesity, physical inactivity, smoking, and alcohol intake, say the researchers. When all 5 types of relationships were included in the analysis, the association weakened but still 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, can’t establish cause. It also relied on personal recall and didn’t capture information on social relationships in early adulthood. And as it included only Australian women, the findings might not be applicable to men or other cultures, say the researchers. Further research is needed to explore other specific effects of relationships on the accumulation of multiple long-term conditions, such as intimacy, quantity, and emotional and practical support, they emphasize.
Nevertheless, they conclude: “Our findings have significant implications for chronic disease management and intervention. First, at the individual level, these implications may help counsel women regarding the benefits of starting or maintaining high-quality and diverse social relationships throughout middle to early old age. Second, at the community level, interventions focusing on social relationship satisfaction or quality may be particularly efficient in preventing the progression of chronic conditions. Third, at the country and global levels, social connections (eg, social relationship satisfaction) should be considered a public health priority in chronic disease prevention and intervention.”
Reference: “Social relationship satisfaction and accumulation of chronic conditions and multimorbidity: a national cohort of Australian women” by Xiaolin Xu, Gita D Mishra, Julianne Holt-Lunstad and Mark Jones, 21 February 2023, General Psychiatry.
The study was funded by the National Health and Medical Research Council and the Australian Department of Health.