Social Relationships and Psychoneuroimmunology 83especially informative to current approaches to clinical treat-
ment of infectious disease and cancer, by suggesting that psy-
chosocial interventions can promote lower susceptibility and
increased resistance (Andersen, Kiecolt-Glaser, & Glaser,
1994; Glaser, Rabin, Chesney, Cohen, & Natelson, 1999).
One of the “rst studies used an academic examination para-
digm to investigate acute stress, social support, and immune
response to hepatitis B vaccination (Glaser, Kiecolt-Glaser,
Bonneau, Malarkey, & Hughes, 1992). Although no differ-
ences in seroconversion rates were found when comparing
subjects on social support, social support was positively
associated with the immune response to the vaccine as mea-
sured by total antibody titers and T cell responses to the vac-
cine antigen. Similarly, subjects with low social integration
(less diverse social roles) were three times more likely to de-
velop clinical symptoms of cold when infected with a cold
virus compared to subjects with high social integration
(Cohen, Doyle, Skoner, Rabin, & Gwaltney, 1997).
A large number of studies on social support have involved
HIV-positive individuals who had not yet progressed to AIDS
(asymptomatic). Given the positive bene“ts of social support
on immune function, perhaps HIV-positive individuals with
high social support would show a slower decline in immune
competence associated with progression to AIDS. Although
initial studies indicated negative “ndings (Goodkin, Blaney,
et al., 1992; Perry, Fishman, Jacobsberg, & Frances, 1992),
later studies found increased social participation and de-
creased loneliness to be associated with higher CD4+ counts
(Persson, Gullberg, Hanson, Moestrup, & Ostergren, 1994;
Straits-Troester et al., 1994). Moreover, low perceived emo-
tional support was associated with a more rapid decline in
CD4+ cells (Theorell et al., 1995).
Social Support-Immune Pathways
Considerable evidence suggests that social support con-
tributes positively to immune function. The pathways
through which social relationships can in”uence immune
competence appear to be through primarily stress-buffering
effects (Esterling, Kiecolt-Glaser, et al., 1994; Esterling
et al., 1996; Goodkin, Blaney, et al., 1992; Kang et al., 1998;
Kiecolt-Glaser et al., 1991; Theorell et al., 1990), although
ample evidence suggests that immunological regulation is
promoted by the mere presence of supportive others
(S. Cohen et al., 1997; Levy et al., 1990; Linn et al., 1988;
Persson et al., 1994; Theorell et al., 1995; Thomas et al.,
1985). The magnitude of these effects appears to be small
(r.21), as shown in a meta-analysis of the literature up to
1995 (Uchino, Cacioppo, & Kiecolt-Glaser, 1996). However,
these effects may have clinical relevance because social
relationships can be associated with both disease susceptibil-
ity (common cold, hepatitis B studies) and progression
(breast cancer, HIV/AIDS). Moreover, this effect is impres-
sive given the diverse conceptualizations and assessments of
both social support and immune function.Close Personal RelationshipsWhile the previously reviewed studies explored the support
relationships provided by one•s social network (friends, fam-
ily, coworkers, etc.), certain social relationships have greater
psychological and physiological importance than others.
Close personal relationships provide a unique source of
social support, often encompassing all of the four general
components of social support (e.g., emotional support, in-
strumental support, informational support, and appraisal
support). Arguably, the most important close personal rela-
tionship is the marital relationship. Married persons have
lower rates of morbidity and mortality compared to nonmar-
ried persons across a variety of conditions, including
cancer, myocardial infarction, and surgery (Chandra, Szklo,
Goldberg, & Tonascia, 1983; Goodwin, Hunt, Key, & Samet,
1987; Gordon & Rosenthal, 1995; House et al., 1988).
Although healthy marital relationships afford health bene-
“ts, disruptions in the marital relationship are associated with
health risks. Separated or divorced adults have higher rates of
acute illness and physician visits compared to married per-
sons and higher rates of mortality from infectious diseases,
including pneumonia (Somers, 1979; Verbrugge, 1979,
1982). As such, PNI studies in this domain have focused on
disruptive aspects of the marital relationship and their conse-
quences for immune competence.Marital DisruptionInitial studies of marital relationships and immune function
focused on the immune consequences of separation and/or
divorce (Kiecolt-Glaser, Fisher, et al., 1987; Kiecolt-Glaser
et al., 1988). In these studies, married adults were compared
to separated and/or divorced adults on enumerative and func-
tional measures of immune function. Separated/divorced
males and females showed higher IgG antibody titers to
latent EBV, indicative of poorer immune competence in
controlling the latent virus. Separated/divorced males also
showed higher antibody titers to latent HSV, and separated/
divorced females showed poorer blastogenic response to
PHA compared to married counterparts. Poorer psychologi-
cal adjustment to separation, particularly stronger feelings of
attachment and shorter separation periods, were associated
with increased distress, lower helper to suppressor T-cell