Now in this section, we're going to consider social supports. By which we mean the way that the person is integrated into the social network, and is that social network emotionally supportive? And is it instrumentally supportive? And these networks differ, actually, a great deal. And one of the most important aspects of the social network is the, the so called confidant. So when you ask a question in the general population survey you ask a question like is there someone that you could talk to about a problem that you might of had no matter what the problem was. this is what I call an intimate confidant. Turns out 85% of the population or 80% of the 75% say yes there is someone. And about 15 or 20% say there is no other person I can talk to. Now it is a little, as an aside it's a little interesting I think that you may be able to guess, the males and females may be able to guess that confidant. For a married person who is a male, who is that confidant. Well, almost all the time it's their wife. For a female who is married, that confidante is usually not their husband. They were often not their husband [LAUGH]. It's usually a sister, or girlfriend, or a female friend. So this confidant is someone you can talk to about, no matter what the problem is. And here we see that interaction of the presence of a confidant with life stress. And we see that if there's no recent life stress confidant doesn't matter too much. And this is what we saw with the genetics too. In the absence of stress the risk for depressive disorder is low. If there is recent life stress and there is a confidant, for that the risk for depression is still relatively low 4%. If there is no confidant, it zooms to 38%, 38% is a huge percent out of the population to be at risk for onset of depressive disorder. And this is sometimes called the stress-buffering hypothesis. That is, social support buffers the effect of stress. And this again is George Brown and it's the, the simplest and clearest demonstration of the stress-buffering hypothesis. So, one other aspect of social support is interesting and again this is our male female difference with regard to depressive disorder. We can measure so called global social support by asking questions about when you think about your family do they help you when you're in trouble. Or does your spouse help you or are your friends there when you need them and so forth, and of course we actually have negative social supports, you ask does your spouse bother you a lot, does she make demands, or he make demands on you. But we have a standardized score for global social support, running from a negative five, to positive three, and negative five is low social support, or even negative social support. And the three is lots of social support. This is the probability of major depressive disorder, and prior to wave two, and this is Ken Kendler's twin sample again, and each of those little Xs represents an individual in these cloud diagrams. You can see several things. One is, for women, social support is terribly important. Those people with negative social support are much more likely to have an episode of depressive disorder. Those people with lots of social support. These are the people with a confidant, or more than one confidant, are much less likely to have an episode of depressive disorder. That's the red cloud going from the way upper left to the lower right. But, for men, social support doesn't matter very much. And so this is a quandary we have. Why is social support more important for women than for men in depressive disorder? And you can see on the right hand side, it's been divided into those with a history of depressive disorder and those without. That is, those with a history of depressive disorder, we're studying the recurrence. Another episode of depression in their course. Those with no history were studying new episodes. And we see the same results, except that those with a history are more likely to have another episode as you might suspect. They have already been through an episode of depressive disorder and they're at higher risk. So now you may want to think about why social support is more important for women and I think we can get into, but I won't, the gender versus sex argument. The gender argument would be well women are trained that way. They're taught to be socially integrated they when they grow up they're supposed to pay attention to other people and be supportive. that's the gender argument I suppose you could say. The sex argument is the biologic argument, a Darwinian argument, and that is that women have hormones that make them pay attention to other people because that is so important after the birth of a baby that they be very concerned about that baby and they want to support that baby and pay attention to it. I don't have the answer for this. But that is the possibility for explaining this differential relationship with social support in women and men. So this is a summary about heredity and stress and support. First thing is, stress increases risk for depressive disorder. Second thing is, social supports are protective from depressive disorder, and the third thing is, stress and social supports interact in affecting risk, and also, we learned that inherited traits like neuroticism interact with stress in raising risk and then finally we learn that low social support is riskier for females. That's our small conclusion about social support. Typically with all these risk factors they,they all are confounded with one another and well see how this works into the social support aspects work, into work and environment and life stage in the next section.
