Should social disconnectedness be included in primary-care screening for cardiometabolic disease? A systematic review of the relationship between everyday stress, social connectedness, and allostatic load

Autoři: Anders Larrabee Sonderlund aff001;  Trine Thilsing aff001;  Jens Sondergaard aff001
Působiště autorů: The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Copenhagen, Denmark aff001
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article


In the present review, we argue that social disconnectedness could and should be included in primary-care screening protocols for the detection of cardiometabolic disease. Empirical evidence indicates that weak social connectedness represents a serious risk factor for chronic diseases, including cardiovascular disease, diabetes, and various cancers. Weak social connectedness, however, is largely regarded as a second-tier health-risk factor in clinical and research settings. This may be because the mechanisms by which this factor impacts on physical health are poorly understood. Budding research, however, advances the idea that social connectedness buffers against stress-related allostatic load–a known precursor for cardiovascular disease and cancer. The present paper reviews the empirical knowledge on the relationship between everyday stress, social connectedness, and allostatic load. Of 6022 articles retained in the literature search, 20 met predefined inclusion criteria. These studies overwhelmingly support the notion that social connectedness correlates negatively with allostatic load. Several moderators of this relationship were also identified, including gender, social status, and quality of social ties. More research into these factors, however, is warranted to conclusively determine their significance. The current evidence strongly indicates that the more socially connected individuals are, the less likely they are to experience chronic stress and associated allostatic load. The negative association between social connectedness and various chronic diseases can thus, at least partially, be explained by the buffering qualities of social connectedness against allostatic load. We argue that assessing social connectedness in clinical and epidemiological settings may therefore represent a considerable asset in terms of prevention and intervention.

Klíčová slova:

Cortisol – Emotions – Cholesterol – Interpersonal relationships – Mental health and psychiatry – Psychological stress – Social networks – Social research


1. WHO. Noncommunicable diseases country profiles 2018. Geneva; 2018.

2. Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Preventive medicine. 2012;55(3):163–70. doi: 10.1016/j.ypmed.2012.06.017 22735042

3. Holt-Lunstad J. The potential public health relevance of social isolation and loneliness: Prevalence, epidemiology, and risk factors. Public Policy & Aging Report. 2017;27(4):127–30.

4. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS medicine. 2010;7(7):e1000316. doi: 10.1371/journal.pmed.1000316 20668659

5. Haslam C, Jetten J, Cruwys T, Dingle G, Haslam SA. The New Psychology of Health. Unlocking the Social Cure. 2018:2018.

6. Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N, et al. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157–71. doi: 10.1016/j.puhe.2017.07.035 28915435

7. Haslam SA, Haslam C, Jetten J, Cruwys T, Bentley S. Group life shapes the psychology and biology of health: The case for a sociopsychobio model. Social and Personality Psychology Compass. 2019:e12490.

8. Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. Journal of behavioral medicine. 2006;29(4):377–87. doi: 10.1007/s10865-006-9056-5 16758315

9. Uchino BN, Cacioppo JT, Kiecolt-Glaser JK. The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychological bulletin. 1996;119(3):488. doi: 10.1037/0033-2909.119.3.488 8668748

10. Uchino BN, Smith TW, Carlisle M, Birmingham WC, Light KC. The Quality of Spouses’ Social Networks Contributes to Each Other’s Cardiovascular Risk. PLoS ONE. 2013;8(8):1–7.

11. Kivimäki M, Jokela M, Nyberg ST, Singh-Manoux A, Fransson EI, Alfredsson L, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet. 2015;386 North American Edition(10005):1739–46. doi: 10.1016/S0140-6736(15)60295-1 26298822

12. Kivimäki M, Nyberg ST, Batty GD, Fransson EI, Heikkilä K, Alfredsson L, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. The Lancet. 2012;380(9852):1491–7.

13. Kivimäki M, Steptoe A. Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology. 2018;15(4):215. doi: 10.1038/nrcardio.2017.189 29213140

14. Evans GW, Kim P. Childhood poverty and health: cumulative risk exposure and stress dysregulation. Psychological Science. 2007;18(11):953–7. doi: 10.1111/j.1467-9280.2007.02008.x 17958708

15. Dimsdale JE. Psychological stress and cardiovascular disease. Journal of the American College of Cardiology. 2008;51(13):1237–46. doi: 10.1016/j.jacc.2007.12.024 18371552

16. Geronimus AT, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among blacks and whites in the United States. American journal of public health. 2006;96(5):826–33. doi: 10.2105/AJPH.2004.060749 16380565

17. Troxel WM, Matthews KA, Bromberger JT, Sutton-Tyrrell K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychology. 2003;22(3):300. doi: 10.1037/0278-6133.22.3.300 12790258

18. Chae DH, Lincoln KD, Adler NE, Syme SL. Do experiences of racial discrimination predict cardiovascular disease among African American men? The moderating role of internalized negative racial group attitudes. Social Science & Medicine. 2010;71(6):1182–8.

19. Forsyth J, Schoenthaler A, Chaplin WF, Ogedegbe G, Ravenell J. Perceived discrimination and medication adherence in black hypertensive patients: the role of stress and depression. Psychosomatic Medicine. 2014;76(3):229–36. doi: 10.1097/PSY.0000000000000043 24677163

20. Brondolo E, Love EE, Pencille M, Schoenthaler A, Ogedegbe G. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. American journal of hypertension. 2011;24(5):518–29. doi: 10.1038/ajh.2011.9 21331054

21. Batten SV, Aslan M, Maciejewski PK, Mazure CM. Childhood maltreatment as a risk factor for adult cardiovascular disease and depression. Journal of Clinical Psychiatry. 2004;65(2):249–54. doi: 10.4088/jcp.v65n0217 15003081

22. Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & behavior. 2012;106(1):29–39.

23. Scott KM, Von Korff M, Angermeyer MC, Benjet C, Bruffaerts R, De Girolamo G, et al. Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Archives of general psychiatry. 2011;68(8):838–44. doi: 10.1001/archgenpsychiatry.2011.77 21810647

24. Logan JG, Barksdale DJ. Allostasis and allostatic load: expanding the discourse on stress and cardiovascular disease. Journal of clinical nursing. 2008;17(7b):201–8. doi: 10.1111/j.1365-2702.2008.02347.x 18578796

25. Low CA, Salomon K, Matthews KA. Chronic life stress, cardiovascular reactivity, and subclinical cardiovascular disease in adolescents. Psychosomatic medicine. 2009;71(9):927. doi: 10.1097/PSY.0b013e3181ba18ed 19737856

26. McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Neuropsychopharmacology. 2000;22(2):108–24. doi: 10.1016/S0893-133X(99)00129-3 10649824

27. Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences. 2001;98(8):4770–5.

28. Tiedt JA, Brown LA. Allostatic load: The relationship between chronic stress and diabetes in Native Americans. Journal of Theory Construction & Testing. 2014;18(1):22.

29. Vines AI, Ward JB, Cordoba E, Black KZ. Perceived racial/ethnic discrimination and mental health: A review and future directions for social epidemiology. Current epidemiology reports. 2017;4(2):156–65. doi: 10.1007/s40471-017-0106-z 28920011

30. McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Archives of internal medicine. 1993;153(18):2093–101. 8379800

31. Beckie TM. A systematic review of allostatic load, health, and health disparities. Biological research for nursing. 2012;14(4):311–46. doi: 10.1177/1099800412455688 23007870

32. Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annual review of public health. 2013;34:337–54. doi: 10.1146/annurev-publhealth-031912-114452 23297662

33. Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nature Reviews Cardiology. 2012;9(6):360. doi: 10.1038/nrcardio.2012.45 22473079

34. Hostinar CE. Recent developments in the study of social relationships, stress responses, and physical health. Current opinion in psychology. 2015;5:90–5. doi: 10.1016/j.copsyc.2015.05.004 26366429

35. Wiley JF, Bei B, Bower JE, Stanton AL. Relationship of psychosocial resources with allostatic load: a systematic review. Psychosomatic medicine. 2017;79(3):283. doi: 10.1097/PSY.0000000000000395 27768647

36. Mauss D, Li J, Schmidt B, Angerer P, Jarczok MN. Measuring allostatic load in the workforce—a systematic review. Industrial Health. 2014.

37. Thomas B, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews on Evidence‐Based Nursing. 2004;1(3):176–84. doi: 10.1111/j.1524-475X.2004.04006.x 17163895

38. Yang YC, Li T, Frenk SM. Social network ties and inflammation in US adults with cancer. Biodemography and social biology. 2014;60(1):21–37. doi: 10.1080/19485565.2014.899452 24784985

39. Yang YC, McClintock MK, Kozloski M, Li T. Social isolation and adult mortality: the role of chronic inflammation and sex differences. Journal of health and social behavior. 2013;54(2):183–203. doi: 10.1177/0022146513485244 23653312

40. Brody GH, Lei M-K, Chen E, Miller GE. Neighborhood poverty and allostatic load in African American youth. Pediatrics. 2014;134(5):e1362–e8. doi: 10.1542/peds.2014-1395 25311604

41. Brody GH, Lei MK, Chae DH, Yu T, Kogan SM, Beach SR. Perceived Discrimination Among A frican A merican Adolescents and Allostatic Load: A Longitudinal Analysis With Buffering Effects. Child development. 2014;85(3):989–1002. doi: 10.1111/cdev.12213 24673162

42. Sotos-Prieto M, Bhupathiraju SN, Falcón LM, Gao X, Tucker KL, Mattei J. A healthy lifestyle score is associated with cardiometabolic and neuroendocrine risk factors among Puerto Rican adults. The Journal of nutrition. 2015;145(7):1531–40. doi: 10.3945/jn.114.206391 25948783

43. Rosal MC, King J, Ma Y, Reed GW. Stress, social support, and cortisol: inverse associations? Behavioral Medicine. 2004;30(1):11–22. doi: 10.3200/BMED.30.1.11-22 15473629

44. Brooks KP, Gruenewald T, Karlamangla A, Hu P, Koretz B, Seeman TE. Social relationships and allostatic load in the MIDUS study. Health Psychology. 2014;33(11):1373. doi: 10.1037/a0034528 24447186

45. McClure HH, Snodgrass JJ, Martinez CR, Squires EC, Jiménez RA, Isiordia LE, et al. Stress, place, and allostatic load among Mexican immigrant farmworkers in Oregon. Journal of immigrant and minority health. 2015;17(5):1518–25. doi: 10.1007/s10903-014-0066-z 25724150

46. Seeman T, Glei D, Goldman N, Weinstein M, Singer B, Lin Y-H. Social relationships and allostatic load in Taiwanese elderly and near elderly. Social science & medicine. 2004;59(11):2245–57.

47. Seeman TE, Gruenewald TL, Cohen S, Williams DR, Matthews KA. Social relationships and their biological correlates: Coronary Artery Risk Development in Young Adults (CARDIA) study. Psychoneuroendocrinology. 2014;43:126–38. doi: 10.1016/j.psyneuen.2014.02.008 24703178

48. Seeman TE, Singer BH, Ryff CD, Love GD, Levy-Storms L. Social relationships, gender, and allostatic load across two age cohorts. Psychosomatic medicine. 2002;64(3):395–406. doi: 10.1097/00006842-200205000-00004 12021414

49. Yang YC, Boen C, Mullan Harris K. Social relationships and hypertension in late life: evidence from a nationally representative longitudinal study of older adults. Journal of aging and health. 2015;27(3):403–31. doi: 10.1177/0898264314551172 25253728

50. Miller GE, Cohen S, Ritchey AK. Chronic psychological stress and the regulation of pro-inflammatory cytokines: a glucocorticoid-resistance model. Health psychology. 2002;21(6):531. doi: 10.1037//0278-6133.21.6.531 12433005

51. Hawkley LC, Lavelle LA, Berntson GG, Cacioppo JT. Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS). Psychophysiology. 2011;48(8):1134–45. doi: 10.1111/j.1469-8986.2011.01185.x 21342206

52. Maselko J, Kubzansky L, Kawachi I, Seeman T, Berkman L. Religious service attendance and allostatic load among high-functioning elderly. Psychosomatic Medicine. 2007;69(5):464–72. doi: 10.1097/PSY.0b013e31806c7c57 17567709

53. Weinstein M, Goldman N, Hedley A, Yu-Hsuan L, Seeman T. Social linkages to biological markers of health among the elderly. Journal of Biosocial Science. 2003;35(3):433–53. doi: 10.1017/s0021932003004334 12887222

54. Gersten O. Neuroendocrine biomarkers, social relations, and the cumulative costs of stress in Taiwan. Social Science & Medicine. 2008;66(3):507–19.

55. Glei DA, Goldman N, Chuang Y-L, Weinstein M. Do chronic stressors lead to physiological dysregulation? Testing the theory of allostatic load. Psychosomatic Medicine. 2007;69(8):769–76. doi: 10.1097/PSY.0b013e318157cba6 17942833

56. Gruenewald TL, Karlamangla AS, Hu P, Stein-Merkin S, Crandall C, Koretz B, et al. History of socioeconomic disadvantage and allostatic load in later life. Social science & medicine. 2012;74(1):75–83.

57. Friedman EM, Karlamangla AS, Gruenewald T, Koretz B, Seeman TE. Early life adversity and adult biological risk profiles. Psychosomatic medicine. 2015;77(2):176. doi: 10.1097/PSY.0000000000000147 25650548

58. Brook AT, Garcia J, Fleming MA. The effects of multiple identities on psychological well-being. Personality and Social Psychology Bulletin. 2008;34(12):1588–600. doi: 10.1177/0146167208324629 19050334

59. Iyer A, Jetten J, Tsivrikos D, Postmes T, Haslam SA. The more (and the more compatible) the merrier: Multiple group memberships and identity compatibility as predictors of adjustment after life transitions. British Journal of Social Psychology. 2009;48(4):707–33.

60. Sønderlund AL, Morton TA, Ryan MK. Multiple group membership and well-being: Is there always strength in numbers? Frontiers in psychology. 2017;8:1038. doi: 10.3389/fpsyg.2017.01038 28680414

61. Gerin W, Pieper C, Levy R, Pickering TG. Social support in social interaction: a moderator of cardiovascular reactivity. Psychosomatic medicine. 1992;54(3):324–36. doi: 10.1097/00006842-199205000-00008 1620808

62. Grant N, Hamer M, Steptoe A. Social isolation and stress-related cardiovascular, lipid, and cortisol responses. Annals of Behavioral Medicine. 2009;37(1):29–37. doi: 10.1007/s12160-009-9081-z 19194770

63. Lepore SJ. Cynicism, social support, and cardiovascular reactivity. Health Psychology. 1995;14(3):210. doi: 10.1037//0278-6133.14.3.210 7641661

64. Lepore SJ, Allen K, Evans GW. Social support lowers cardiovascular reactivity to an acute stressor. Psychosomatic Medicine. 1993;55(6):518–24. doi: 10.1097/00006842-199311000-00007 8310112

65. Townsend KC, McWhirter BT. Connectedness: A review of the literature with implications for counseling, assessment, and research. Journal of Counseling & Development. 2005;83(2):191–201.

66. Jetten J, Branscombe NR, Haslam SA, Haslam C, Cruwys T, Jones JM, et al. Having a lot of a good thing: Multiple important group memberships as a source of self-esteem. PloS one. 2015;10(5):e0124609. doi: 10.1371/journal.pone.0124609 26017554

67. Haslam C, Jetten J, Alexander SH. The Social Cure: Identity, Health and Well-being: Psychology Press; 2012.

68. Jetten J, Haslam C, Alexander SH. The social cure: Identity, health and well-being: Psychology Press; 2012.

69. Jones JM, Jetten J. Recovering from strain and enduring pain: Multiple group memberships promote resilience in the face of physical challenges. Social Psychological and Personality Science. 2011;2(3):239–44.

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2019 Číslo 12
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