Family is all that matters: Prospective associations between structure, function, and quality of social relations and self-rated health in the National Social Life, Health, and Aging Project (NSHAP)

We prospectively examined the association between structure, function, and quality of social relations and selfrated health (SRH) in U.S. adults followed over 10 years in the population-based National Social Life, Health, and Aging Project (NSHAP). Large social network and high positive/negative social support were measured at baseline and defined as the highest quartile. These three binary measures were reported from friends, family, and partner and combined into a multifactorial exposure variable. SRH was measured through a 5-point Likert scale and dichotomised. Odds ratios (OR) for poor SRH were estimated with covariate-adjusted logistic regression. In total, 1,592 participants were included. Based on the combined multifactorial exposure variable as well as independent exposure variables, only lower levels of negative social support were prospectively associated with better SRH (aOR = 0.65; 95%CI 0.44-0.98). From the different social ties, only family-related negative social support was associated with poor SRH (aOR = 0.59; 95%CI 0.39-0.90). This association was similar between genders, but only statistically significant among women. Sensitivity analysis with depressive symptoms as outcome supported the hypothesis that the findings for SRH may be partially driven by mental health (aOR = 0.65; 95%CI 0.48-0.90). Concluding, negative social support particularly from family is prospectively associated with poor SRH.