Sm. Sci. Med. Vol. 25, No. I, pp. 849-859, 1987 0277-9536/87 $3.00 + 0.

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Printed in Great Britain. All rights reserved Copyright 0 1987 Pergamon Journals Ltd

DIFFERENT SOCIAL NETWORK AND SOCIAL SUPPORT

CHARACTERISTICS, NERVOUS PROBLEMS AND
INSOMNIA: THEORETICAL AND METHODOLOGICAL
ASPECTS ON SOME RESULTS FROM THE POPULATION
STUDY ‘MEN BORN IN 1914’, MALMij, SWEDEN
B. S. HANSON and P.-O. ~STERGREN
Department of Community Health Sciences, Lund University, Bangatan 5, S-214 26 Malmii, Sweden

Abstract-A representative sample of 68-year-old men in the Swedish city of MalmB, were interviewed
in detail regarding their social network, social support and social influence as a part of an extensive
examination of their health status. Emphasis in this paper is put on the definition and operationalization
of different social network, social support and social influence characteristics included in a tentative model.
The reliability and validity of the different social network, social support and social influence indices are
analyzed and discussed. The relation between the different indices and marital status and social class are
analyzed implying that men living alone and men in the lowest social class have the most insufficient social
network, social support and social influence. The indices were then used in an analysis of nervous problems
and insomnia. Social anchorage, social participation and contact frequency, all subconcepts of social
network, had independent associations with mental health in this cross-sectional study. The addition of
the social network, social support and social influence indices to social class and marital status gives a
more differentiated and thereby a more valid picture of the association between the psychosocial
environment and this type of mental health problems.
Key words-social network, social support, social class, marital status, epidemiology, mental health
problems

BACKGROUNb social network and to measure social support. In spite

of this, results from studies on various social network
In the discussion of health differences between indi- and social support characteristics and morbidity/
viduals and groups of individuals, much attention has mortality are rather consistent, at least for men,
lately been drawn to the concepts of social network implying an inverse relation [22].
and social support. This tradition of research in the Social network and social support are important
medical field springs mainly from the research into resources enabling a person to cope with different
stress and stressful life events [I, 21. In 1976 Cassel situations in daily life, something which can be
presented his “theory of general susceptibility”, regarded as another aspect of the discussion concern-
which emphasized the presence of factors in the social ing living conditions [23]. Stimuli or stressors in the
environment that could influence the resistance of environment cause emotional and physiological reac-
man against different pathogenic agents [3]. tions in man which can lead to negative health effects.
Many studies have shown associations between an If the stimulus is undesirable, the individual can
insufficient social network and inadequate social sup- theoretically act in different ways to modify or re-
port, and an increased morbidity and mortality from move the factors in the environment causing the
many different conditions [4-151. stimulus [24]. An individual’s relation to his environ-
Individuals with a low level of education or be- ment, biologically as well as psychologically and
longing to the lower social classes have a higher socially, can thereby be viewed as a dynamic process,
mortality in many diseases [16, 171. These differences i.e. the environment is by no means static and thus
can only partly be explained by the fact that indi- requires a continuous adaptation by the individual.
viduals in lower social classes have more of the The social network and social support of the indi-
traditional coronary risk factors, worse living con- vidual represent principally an expansion of his
ditions, a worse working environment, a higher un- individual resources, by means of which he can
employment rate or less access to medical services handle major and minor stressful situations in daily
[l&19]. The finding that individuals in lower social life and possibly prevent negative health effects [25].
classes also are more likely to have an insufficient A theoretical model integrating different social
social network and inadequate social support could network and social support characteristics ought
perhaps be of importance in this context [20,21]. therefore to include the concept of the ‘decision
It is, however, difficult to fit present knowledge into latitude’ of the individual, i.e. his ability to control
a coherent theoretical model in order to discuss the circumstances permitting a choice of alternative
the mechanisms behind these associations. Different actions in order to change and manipulate his en-
theoretical frameworks have been used, the concepts vironment [26], since this seems to be of great im-
have often been unprecisely defined and a large portance for the individual’s ability to cope with
number of instruments have been used to describe the different stressful events.

849
850 B. S. HANKINand P.-O. &ERGREN

There are three main purposes of this paper. First lation studies [37,38]. The questions on health care
of all, to present an instrument based on a theoretical utilization were asked in the same interview. The
model with well defined concepts, easy to oper- questions on consumption of hypnotics and sedatives
ationalize, in order to describe and measure different were asked during the first home visit, when the total
social network and social support characteristics. drug consumption was meticulously penetrated by
Secondly, to analyze these characteristics in associ- looking at all the medicines at home. The questions
ation to marital status and social class, two important on nervous problems and insomnia were asked in a
variables in social epidemiology, known to be associ- questionnaire administered during the visit at the
ated, with both social network and social support Department of Community Health Sciences. At the
[20,21], as well as morbidity and mortality same time a questionnaire was completed on alcohol
[16, 17,27,28]. Thirdly, in order to test our model consumption and alcohol habits.
and instrument, to analyze which of the different In order to assess the reliability of the questions, 30
social network and social support characteristics that of the participants, chosen at random, were re-
are associated with nervous problems and insomnia, examined with the same methods and instruments
since such mental health problems have been shown three weeks after the first examination.
to be associated with insufficient social network and The validity of the marital status variable assessed
social support [ 12,29-341. in the interview was analyzed by comparison with the
population register in Malmii.
MATERIAL Definitions
Malmo is a city in southern Sweden with about After assessment of the currently available litera-
230,000 inhabitants. The population of this study ture, a tentative model (Fig. 1) comprising three main
consists of all men in Malmo, born in even months concepts, namely social network, social support and
in 1914, a total of 621 men. The cohort was defined social influence, was set up [39].
four times (every three months) from 1 hugust 1982, Firstly, social network of the individual has been
in order to reduce the risk of inviting newly deceased defined with three qualitatively different aspects,
men. Out of the 621 men, 466 belonged to a cohort namely as a strictly quantitative concept, as social
chosen in the same way in 1969, who participated in anchorage and as social participation.
a cross-sectional study 1969-70 on the risk factors for
-Social network as a quantitative concept is
arteriosclerosis of the arteries of the legs [35].
considered a strictly structural entity that can be
Five hundred (80.5%) men participated in the
described in different ways, e.g. by noting the number
study 1982283. A further 94 out of the 121 non-
of individuals within the network, divided into kin,
participants participated in a short interview by
friends, work mates, neighbours etc., by identifying
phone or in connection with a home visit. Direct
clusters of individuals in the netwrok, or by calcu-
information has thus been obtained from 594
lating the density and the geographical distribution of
(95.7%) of the invited 621 men. Eleven (1.8%) men
the social network. Aspects such as frequency and
had died and 16 (2.6%) did not want to be inter-
duration of the contacts with the members of the
viewed or were impossible to reach.
network can also be described.
The analysis of the non-participant group showed
-Social anchorage describes to what degree in
that they differed from the participants in some
a structural sense the individual belongs to and is
aspects [36]. A greater number of the non-partici-
anchored within formal and informal groups in the
pants were unmarried or divorced. Men living alone
social network, and in a more functional sense, the
and belonging to the lowest social class were more
degree of feeling of membership in these groups.
often found among the non-participants. Their sub-
-Social participation describes how actively the
jective health was worse and they had been hospi-
individual takes part in activities of formal and
talized more often. Relatively more non-participants
informal groups in society.
had visited the alcohol clinic and had been registered
with the Temperance Board in Malmo. Secondly, social support is regarded as a function
of the individuals’ interactions within their social
network, and reflects social anchorage and social
METHODS AND DEFINITIONS
participation. Using the personal interview method,
The cross-sectional study 1982-83 was accom- this can only be measured as the individuals’ own
plished at the Departments of Clinical Physiology subjective perception of the different items.
and Community Health Sciences, and in the homes of Social support has usually been classified under
the men, on a total of four occasions. Interviews, three headings: emotional support, reflecting the
questionnaires, physical and physiological examin- individuals’ opportunity for care, encouragement of
ations were used to obtain information about health personal value, feelings of confidence and trust; infor-
status, life style and different social network and mational support, reflecting the individuals’ access to
social support characteristics of the individual. An guidance, advice and information and material sup-
important part of the data collection concerned the port reflecting the individuals’ access to practical
examination of heart function and peripheral circu- services and material resources.
lation including assessment of carotid and lower limb Thirdly, social influence is considered a socio-
blood flow. political concept describing to what degree the indi-
Social network and social support characteristics vidual is able to control and manipulate his environ-
were surveyed in a separate interview. Most of the ment, using his own resources and the resources to
questions have earlier been used in Swedish pop- which he is given access through his social network
 Social network and support characteristics 851

,- anchorage -,

SOClfll Social network-

- Contactfrequency
participatton ,.ZSOWC=S

Fig. 1. A tentative model illustrating the relationships between the various concepts and their relation to
non-social network resources.

and social support. It thus includes a dimension of Since our theoretical considerations of the concepts
‘decision latitude’. were finalized during the collection of data, we were
Each of these concepts could be said to include the restricted to the items already included in the ques-
aspects aoaifabilit~ and adequacy [40]. Availability of tionnaire. Therefore we were unable to construct
social support, for example, designates the individ- indices of all concepts and their respective aspects of
ual’s own account of his opportunities of getting availability and adequacy. All the items used in the
advice, information and help. Adequacy of social questionnaire, were classified according to the
support, on the other hand, designates the level of the different concepts defined above. Then the following
individual’s satisfaction with his social support. eight indices were formed:
Social anchorage is thought to be a basic concept
(Fig. 1). It is most probably the result of many -Contact frequency (as a quantitative measure
factors, for example social class, education, financial of social network).
resources and other social network factors like -Social anchorage.
contact frequency and social participation. Social -Social participation.
anchorage can be seen as a proxy variable for avail- -Adequacy of social participation.
ability of social roles, which also constitutes an
assessment of the potential of social acts of the -Availability of material and informational
individual. We consider all these factors to be im- support.
portant resources of the individual and the basis of -Availability of emotional support.
his social support. -Adequacy of emotional support.
The social influence of the individual determines
his ability to manipulate and control his environ- -Adequacy of social influence.
ment, by utilizing his own resources and those added
by his social support derived from his social network.
In our opinion, this model (Fig. I), implies a The reliability of the contact frequency items (Table 1)
dynamic process in which the structure of the social was better than the reliability of the items measuring
network is built and maintained through its func- number of individuals of the social network. Accord-
tions, and that the relation between structure and ing to a covariance analysis there was also a close
function is a dialectic one. Structure then sets the association between items measuring number of indi-
limits for prevailing functions but functional pro- viduals of the social network and contact frequency.
cesses could change the structure, as in every open This indicated that the latter was the quantitative
system in a cybernetical interpretation. social network variable of choice.
852 B. S. HANSONand P.-O. &TERGREN

Table I. Reliability (%) referring to the items of respective index Multiple logistic regression analysis was used to
Reliability Number of analyze associations between the eight indices, mari-
Index (%) questions tal status, social class, health care utilization, alcohol
contact frequency 91-74 6 consumption and nervous problems and insomnia
Availability of emotional support 93 I [43]. The indices which did not appear to be normally
Adequacy of emotional support 83 I distributed were dichotomized at the median before
Social anchorage 91-79 3
Social participation 97-79 3
introduction into the analysis. The odds ratio have
Marital status 100 I been calculated from the regression coefficient (e’““).
Comparison between base line findings and findings three weeks
P-values < 0.05 are considered statistically
later in a random sample of 30 men. significant.

RESULTS
The items belonging to these eight indices are
shown in the Appendix. The distribution of the score At the re-examination a number of selected ques-
of each item has been dichotomized at the median. tions from the respective indices were asked in the
The 50% of the men with the highest score on an item same way. Table 1 shows the range of the reliability
were given one point and the others zero points. The of items of each index.
points of the items of each index have been sum- Marital status reliability was 100% and the re-
marized for each individual to form his score of the liability of both insomnia and nervous problems was
index in question [41]. 93%.
Marital status has not been included in any of the Marital status validity as assessed in the interview
indices. In this way it has been possible to analyze was 97.8% in the four groups: married, never mar-
associations between marital status on one hand and ried, divorcied and widowed, compared to the popu-
different social network and social support character- lation register.
istics on the other. In order to study the importance
of spousal support and to avoid too small groups in Distributions of the indices
the analysis, marital status has only been divided into The three social network indices; contact fre-
two main groups; men living alone and men co- quency, social anchorage and social participation, are
habiting with a woman, either wife or a woman in a almost normally distributed (Fig. 2A-C). The distri-
corresponding relationship. butions of the indices measuring availability of social
The classification of social class is based on the support (Fig. 2D, E) are skewed to the right. When
individual’s former profession, his working tasks and measuring adequacy of emotional support and social
position. Social class III corresponds to ‘blue-collar participation (Fig. 2F, G) this tendency is even more
workers’, social class II to ‘white-collar workers’ on pronounced. The distribution of the index adequacy
a low and medium level and social class I to persons of social injluence (Fig. 2H) is also skewed to the
in leading positions, professionals with university right.
degrees and owners of business enterprises with em-
ployees [42]. Marital status and social class
Men with nervous problems are defined as men Table 2 presents the marital status of the
who have used sedatives during the last two weeks 68-year-old men, 20.4% lived alone and 79.6% co-
and/or gave an affirmative answer to the question habited with a woman, the majority were married.
‘Have you within the last three months had nervous Seventy (14.1%) men belonged to social class I, 177
problems?‘. In the same way, men with insomnia are (35.8%) to social class II and 248 (50.1%) to social
defined as men who have used hypnotics during the class III.
last two weeks and/or gave an affirmative answer to In social class I 10.0% lived alone, in social class
the question ‘Have you within the last three months II 16.5% and in social class III 26.1% (P = 0.003).
suffered from insomnia?‘. There were no statistically significant social class
differences in the proportion of men that had been
Statistical methods divorced, had become a widower or had never been
Chi-square analysis was used to analyze differences married. Thus it seems as though men in social class
in marital status between the social classes and to III have had more difficulties in finding a new woman
analyze differences in nervous problems and in- after a separation or death of spouse. This could to
somnia between the social classes, the marital status
groups and three different groups of the eight indices.
Kruskal-Wallis’ analysis was used to analyze Table 2. Marital status of 68-year-old men
differences in the distribution of the number of Marital status % n
individuals of the social network between the social
Never married 6.7 33
classes. Differences in the proportion of kin in the Divorced, living alone 6.3 31
social network between the social classes, were ana- Widower, living alone 1.5 31
lyzed by a multiple regression method with WLS [43]. Divorced, cohabiting 7.1 35
Loglinear analysis was utilized to analyze the eight Widower, cohabiting 5.3 26
Married, cohabiting 61.3 333
different indices concerning differences in marital
100 495
status and social class [43].
Social network and support characteristics 853
 ‘b
100

90

80 80

70 70

60 50

50 50

40 40

30 30

20 20

10 10

I u.mlh+s
a-

Fig. 3. A comparison of the proportion of scores above the median in the eight indices between the social classes and the marital status groups.
 Social network and support characteristics 855

a certain degree be explained by the fact that the consumption nor utilization of the health care system
social network in social class III usually consists of recorded. The eight indices were as far as possible
fewer people with a larger proportion consisting of divided into three by number equal groups (high,
kin [20]. In this study the proportion of kin in social medium, low). The number and proportion of men
class III was 53.3% and in social class I 36.6% with nervous problems in these three different groups
(P < 0.001). The number of persons within the social of the eight indices are shown in Table 3. Men with
network of these men, with whom they personally low social anchorage, low social participation, less
associate with at least once a year, was 16.0 (median adequate social participation and emotional support
value) in social class I and 12.0 in social class III were significantly more likely to have nervous
(P = 0.012). problems.
One hundred and forty-two (29.2%) men reported
The indices and marital status insomnia. No social class differences were found,
Figure 3 presents the proportion of men having a neither were any differences recorded in alcohol
score above the median of each index and living alone consumption. Forty-three (43.9%) men of those liv-
or living with a woman, respectively. There were ing alone reported insomnia, compared to 99 (25.4%)
statistically significant differences between these two of those men cohabiting (P < 0.001). One hundred
groups, as regards social anchorage (P <O.OOl), social and fifteen (32.5%) men who had utilized the health
participation (P =0.020), availability of material and care system during the last year reported insomnia
informational support (P = 0.007) adequacy of emo- compared to 27 (20.3%) of those who had not
tional support (P < 0.001) and adequacy of social utilized the health care system (P = 0.01). The num-
participation (P = 0.002). The same trend was shown ber and proportion of men with insomnia in the three
in the other indices, i.e. of the men living alone, a groups (low, medium, high) of the eight indices are
smaller proportion had a high score. In the index shown in Table 4. Men with a low contact frequency
delineating availability of emotional support, no and less adequate emotional support were more likely
question regarding emotional support of the wife is to suffer from insomnia.
included. This may explain why the men living with Because of the previously shown interactions be-
their wives did not express a greater availability of tween the eight indices, marital satus and social class
emotional support than the men living alone. a logistic regression analysis was performed with
nervous problems and insomnia as the dependent
The indices and social class variables. The odds ratio for nervous problems was
There were no social class differences as regards 8.8 (95% confidence interval: 1.745.4) for men with
contact frequency or social anchorage (Fig. 3). Indi- a weak social anchorage (0 points) compared to those
viduals in social class III, however, had a lower with a strong social anchorage (8 points) and 4.2
social participation score (P < O.OOl), a lower avail- (95% confidence interval: 1.O-18.1) for men with low
ability of both material and informational support social participation (0 points) compared to men with
(P = 0.007) emotional support (P = 0.017) and high social participation (6 points). The odds ratio of
also a lower adequacy of social influence score insomnia was 2.4 (95% confidence interval: 1.4-3.9)
(P < 0.001). for men living alone compared to men cohabiting and
A multivariate analysis, performed in order to 3.3 (95% confidence interval: 1.1-9.7) for men with
analyze differences of the indices with both marital a low contact frequency (0 points) compared to men
status and social class taken into account, did not with high contact frequency (6 points).
alter this pattern.

D@erent social network and social support character- DISCUSSION

istics and nervous problems and insomnia The population consisted of 68-year-old men in an
In order to test the usefulness of the eight indices, urban area of Sweden. Analysis of the non-
nervous problems and insomnia were chosen as de- participant group revealed that there were more men
pendent variables, since mental health problems have living alone in social class III among the non-
in several publications been shown to be associated participants and more of the non-participants were
with weak social network and social support ill. However, considering the high participation rate
[12,29-341. (80.5%) and the relative small difference in registered
An important aim of this analysis was also to seen variables between the participants and the non-
which of the social network, social support and social participants the participants could be regarded repre-
influence characteristics were independently associ- sentative of all men born in 1914 in Malmii [36].
ated with nervous problems and insomnia. The utilization of a population in this age group
The following available variables were considered appears advantageous in several aspects. 68-year-old
to influence the mental health of the individuals and men have been exposed for many years to a number
the use of sedatives and hypnotics: marital status, of social and medical risk factors. At this age there
social class, the eight indices, alcohol consumption is also a rather high, and progressive morbidity and
(grammes of alcohol per week during the last year) mortality, of particular interest in the prospective
and utilization of the health care system during the part of the study.
previous year. In any cross-sectional study the possibility of selec-
Eighty-five (17.6%) men had nervous problems. By tion bias must be considered. Many men have already
comparison with men without nervous problems, no died, and they may have been the most vulnerable
social class or marital status differences were found. ones of the cohort, i.e. those with the least sufficient
Neither were any differences with regard to alcohol social network and social support. In this population
856 B. S. HANSONand P.-O. ~TERGREN

Table 3. Men with nervous problems, number and proportion (%), in different
E~OUDS(high, medium. low) of the eight indices

Total 85 17.6
Social anchorage High 10 10.3
Medium 39 15.5
Low 30 24.0
(Missing) (6)
Contact frequency High I4 12.2
Medium 43 18.0
Low 26 20.6
(Missing) (2)
Social participation High 9 10.5
Medium 36 15.7
Low 36 22.8
(Missing) (4)
Adequacy of social participation High 50 14.2
Medium 21 22.6
Low IO 31.3
(Missing) (4)
Availability of material and High 22 12.4
informational support Medium 21 16.5
Low 36 21.2
(Missing) (6)
Availability of emotional support High 40 14.9
Medium 19 15.4
Low I9 24. I
(Missing) (7)
Adequacy of emotional support High 27 13.1
Medium 20 II.8
Low 32 34.0
(Missing) (6)
Adequacy of social influence High 38 15.0
Medium 33 17.9
Low 28.6
(Missing)

Table 4. Men with insomnia, number and proportion (%). in different groups (high,
medium, low) of the eight indices
n % P-value
Total 142 29.2
Social anchorage High 25 25.8
Medium 66 26.2 0.08
Low 46 36.5
(Missing) (5)
Contact frequency High 23 20.0
Medium 69 28.8 0.01
Low 47 37.0
(Missing) (3)
Social participation High 23 26.7
Medium 64 27.7 0.54
Low 51 32.3
(Missing) (4)
Adequacy of social participation High 93 26.3
Medium 31 33.3 0.08
Low 14 42.4
(Missing) (4)
Availability of material and High 49 27.7
informational support Medium 34 26.8 0.55
Low 55 32.0
(Missing) (4)
Availability of emotional support High 73 27.0
Medium 34 27.6 0.45
Low 27 34.2
(Missing) (8)
Adequacy of emotional support High 44 21.4
Medium 51 30.0 0.003
Low 38 40.0
(Missing) (9)
Adequacy of social influence High 71 28.0
Medium 54 29.3 0.75
Low IO 34.5
(Mwng) (7)
 Social network and support characteristics 857

small health differences between the social classes
were found. This is in line with results from other
studies on men of this age [17]. Health differences
between the social classes seem to be largest in middle
age. Selection bias cannot be ruled out.
A central point of this paper is the discussion of
methods. The fact that a multitude of different con-
cepts and instruments have been used to describe and
assess social network and social support is generally
recognized to be a problem [14]. Despite this, rather
consistent results have been reported for men as
regards the association between weak social networks
and social support and morbidity and mortality [22].
With more specific and differentiated concepts and
instruments it should be possible to refine and specify
these associations as a step towards a better under-
standing of the underlying process. This is un-
doubtedly of great importance in the discussion of
health promotion strategies in the field of psycho-
social factors and disease.
In this paper our explicit attempts to move towards
this goal have consisted of the definition of significant
variables in order to reach a higher degreee of
construct validity, their operationalization and based
on this, the testing of a tentative model.
In this particular study all interviews were carried
out by one person. They were very easy to accom-
plish. Very few men questioned the relevance of these
questions on social network and social support in
connection with a conventional health control. The
re-examination demonstrated a good reliability.
The social network indices-social anchorage, con-
tact frequency and social participation-were almost
normally distributed. On the other hand, the distri-
butions of the indices measuring availability of social
support were skewed to the right, and those of
adequacy even more so. The greater the subjectivity
in the index items, the more the distributions were
skewed to the right. It has been argued that factors
called ‘social desirability’ and ‘need for approval’
could at least partly explain this, i.e. the interviewed
men tended to answer in a socially desirable way and
to win approval from the interviewer [44,45].
Interview questions can be assigned different levels
of validity [15,46]. The most valid questions refer to
facts with minimum of interpretation on the part of
the respondent, e.g. ‘How often in the last year have
you been to church? A lower level of validity is
represented by questions referring to individually
interpreted facts, e.g. ‘Do you have any really close
friends with whom you feel intimate and with whom
you can discuss anything?’ A still lower level of
validity is represented by hypothetical questions, e.g.
‘If you need help with something for 24 hours, do you
have anyone you can ask?’
Hence, questions on the lower level of validity
could be more sensitive to factors such as ‘social
desirability’ and ‘need for approval’. In our study the
items making up the social support scales are gener-
ally on a lower level of validity. It is thus extremely
important to study the true validity of these items.
This could be done by using more qualitative meth-
ods such as in-depth interviews and participant ob-
servation. But also by analyzing, in the prospective
part of the study, which of the indices that best
predicts morbidity and mortality.
However, there is no evident reason why the true
distributions of all these indices should be normal
ones. The individual could have low social network
resources, e.g. low social anchorage, and in spite of
this be satisfied both with the availability and the
adequacy of the social support yielded by his social
network resources. This is in line with the theoretical
position in the research field of living conditions,
which argues that the subjective experience of
the needs of an individual depends on the existing
opportunities at hand to satisfy them [47].
From a community medicine point of view, we
consider it important to use items measuring concepts
on a structural level, i.e. social network variables. The
use of such indices as those assessing social anchor-
age, contact frequency and social participation, may
facilitate a deeper and mote valid understanding on
a structural level of the mechanisms behind the
associations. This should in turn facilitate the real-
ization of goals in the field of health promotion.
An important hypothesis is that differences in
morbidity and mortality between social classes and
the marital status groups could be specified, at least
partly, by differences in social network and social
support characteristics [ 121.
In our study a larger proportion of men in social
class III lived alone. Individuals in social class III had
a smaller social network with a larger proportion of
kin. This type of network is probably mote vulner-
able for permanent losses of members. These results
are in agreement with those from other studies [20].
Furthermore, individuals in social class III had lower
social participation, less availability of social support
and a less satisfactory adequacy of social influence
than individuals in social class I. Men in social class
III, especially those living alone, could therefore
according to Cassel’s theory of general susceptibility
be more vulnerable to different illnesses’ producing
factors [3].
Our intention in analyzing the associations be-
tween the indices and nervous problems and in-
somnia, was mainly to see if we, with our new indices,
could reproduce results found by others. We did not
include an assessment of relevant stressors in the
analysis, which requires a special mention. The indi-
vidual’s relation to his environment is regarded as a
dynamic one, with more or less rapid change com-
prising major and minor events in the environment
and thus a varying but never ceasing demand for
more ot less daily adaptation and action on the part
of the individual. This means that nervous problems
and insomnia, at least to a certain degree, could be
regarded as the outcome of such a process, and thus
we actually analyze the associations between the
indices and the outcome of this process and not only
the specific level of sttessors.
Our analysis showed that the men with nervous
problems had a weaker social anchorage, a lower
social participation score and a mote inadequate
social participation and emotional support compared
to the men without nervous problems. In the multi-
variate analysis, however, only social anchorage and
social participation were independently associated to
netvous problems.
More of the men with insomnia lived alone and
had utilized the health care system during the last
858 B. S. HANSON and P.-O. &TERGREN

year. These men also had a lower contact frequency tality: prospective evidence from the Tecumseh commu-
and a more inadequate emotional support. In the nity health study. Am. J. Epidem. 116, 123-140, 1982.
multivariate analysis, only marital status and contact 9. Blazer D. G. Social support and mortality in an elderly
frequency had an independent association to in- community population. Am. J. Epidem. 115, 684694,
somnia. 1982.
10. Welin L., Svlrdsudd K., Ander-Perciva S. et al. Pro-
These findings are also in agreement with those of
spective study of social influences on mortality. Lancer
a number of other studies [29-341. It is however not i, 915-918, 1985.
easy to compare the results in detail, because both the 11 Reed D., McGee D., Yano K. and Feinleib M. Social
social network and social support variables and also networks and coronary heart disease among Japanese
the mental health variables have been defined and men in Hawaii. Am. J. Epidem. 117. 384-396, 1983.
measured differently. 12 Mueller D. P. Social networks: a promising direction for
Persons with neurotic or psychological symptoms research on the relationship of the social environment to
have fewer persons in their social network [29,30]. In psychiatric disorder. Sot. Sci. Med. 14A, 147-161, 1980.
13. Berkman L. F. Social networks, support and health:
our study such persons have a lower contact fre-
taking the next step forward. Am. J. Epidem. 123,
quency. Persons active in society (high social par-
559-562, 1986.
ticipation) have fewer mental problems [31, 321. 14. Cohen S. and Syme S. L. Social Support and Health.
Many studies have shown that people living in a local Academic press, Orlando, Fla, 1985.
community characterized by social disintegration 15. Berkman L. F. Assessing the physical health effect of
(high migration, skewed age distribution, lack of social networks and social support. A. Rev. publ. Hlth
individual and collective resources etc), i.e. persons 5, 413432, 1984.
with weak social anchorage, have social networks 16. Marmot M. G., Rose G. and Shipley M. Inequalities
of lower quality and an increased risk of mental in death-specific explanations of a general pattern?
disorders [33, 341. Lancer ii, 100331006, 1984.
17. Antonovsky A. Social class, life expectancy and overall
The fact that only the social network indices, i.e.
mortality. Milbank Meml Fund. 0. 45, 31-73, 1967.
social anchorage, contact frequency and social par- 18. Holme I., Helgeland A., Hjermann I., Lund-Larsen
ticipation, and not the social support indices, showed P. G. and Lcren P. Coronary risk factors and socio-
an independent association to mental health, sup- economic status. The Oslo study. Lancer ii, 13961398,
ports the model in Fig. 1. The social network vari- 1978.
ables underlie the social support variables. 19. Syme S. L. and Berkman L. F. Social class, sus-
The addition of the social network, social support ceptibility and sickness. Am. J. Epidem. 104, 1-8, 1976.
and social influence indices to social class and marital 20. Pool I. de S. and Kochen M. Contacts and influence.
status variables, thus yielded a more differentiated, Sot. Networks 1, 5551, 1978.
21. Hammer M. ‘Core” and “extended” social networks
profound and thereby more valid awareness of the
in relation to health and illness. Sot. Sci. Med. 17,
associations between the psychosocial environment 405541 I, 1983.
and this type of mental health problem. 22. Syme S. L. Social network and its relation to morbidity
Since these results emanate from a cross-sectional and mortality. In Proceedings of the Berzelius symposia
study, no definite conclusions can be drawn regarding Social Support and Health in Malmd 1985 (Edited by
causality. Data from the prospective part of the study Isacsson S.-O. and Janzon L.). Almqvist & Wiksell,
will hopefully further illuminate this area. Stockholm, 1986.
23. Titmuss R. A. Essays on the WelJare State. Unwin
Acknowledgements-This study has been supported by University Books, London, 1958.
The Bank of Sweden Tercentenery Foundation and The 24. Diderichsen F. and Janlert U. A theory of psychosocial
Delegation for Social Research. causes of disease-a contribution from the school of
materialistic psychology. Socialmedicinsk. tidskr. 59,
296301, 1982.
25. Cobb S. Social support as a moderator of life stress.
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Millan A. M. and Leighton A. H. The Character of -Do you feel that you are of great importance to other
Danger. Basic Books, New York, 1963. people and that you have a useful function in society?
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37. The National Central Bureau of Statistics. Living Con- appealed against a decision, contacted a consumers’ associ-
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Central Bureau of Statistics,.Stockholm, 1980. -How often in the last year have you been to parties at
38. Rinder L., Roupe S., Steen B. and Svanborg A. your friends’, relatives’ or neighbours’?
Seventy-year-old people in Gothenburg. A population -How often in the last year have you been to church?
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397407, 1975.
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44. Crowne D. P. and Marlowe D. The new scale of social -Do you have any really close friends with whom you
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47. Biichert E. Welfare, Living Conditions, Quality of Life. -How often do you feel lonely?
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Conditions. Universitetsforlaaet, Oslo, 1981 (Nord you do?
REFO 3-4). -Do you have enough good friends to be with?
-Do you think that you see your children too often or
APPENDIX too rarely?

Contact frequency Adequacy of social participation

-How often do you meet any of these persons at your -Are you satisfied with your opportunities of par-
or at their homes? (children, kin, neighbours, friends, close ticipating in different activities?
friends, work-mates) -How important do you think that your activities are to
you?
Social anchorage -How often do you find it a problem to occupy yourself?
-Would you say that you are rooted and have a feeling
of familiarity with your neighbourhood? Adequacy of social influence
-How many years have you lived in your neigh- -Would you be able to write an official letter or appeal
bourhood? against a decision?
-If you were able to move now, would you do so? -Are you satisfied with your opportunities of influencing
-Do you belong to a group of friends which does things decisions concerning yourself in Malmii?
together, i.e. play cards, listen to music, go on picnics etc? -Do you have a feeling of full control over your life?
--In your daily life, do you have use for the knowledge --If you had the chance today, would you like to get a
.^
and skills you have acquired during your life? Job’!