Social status, everyday interpersonal processes, and coronary heart disease: A social psychophysiological view

Abstract

Lower socioeconomic position is associated with increased risk of coronary heart disease. This robust gradient is found across levels of socioeconomic position and after controlling access to health care and traditional biological and behavioral risk factors. Thus, previous theory and research has examined the role of other, relatively static psychosocial factors (e.g., social isolation and negative emotional traits) that may account for this association. Utilizing an interpersonal perspective on psychosocial risk (Smith & Cundiff, ; Smith, Gallo, & Ruiz, ; Smith, Glazer, Ruiz, & Gallo, ), this review examines the role of recurring interpersonal experiences and their physiological effects as a pathway linking socioeconomic position and coronary heart disease. Specifically, we focus on proximal interpersonal experiences that may not only explain the increased prevalence of more chronic psychosocial vulnerabilities in lower socioeconomic environments and individuals but may also link those psychosocial vulnerabilities to the momentary physiological mechanisms (i.e., stress responses) that directly contribute to coronary heart disease. Recurring experiences of reduced support and increased conflict in important personal relationships, work stress, multiple aspects of interactions with higher‐status others, the effects of negative stereotypes about lower socioeconomic groups and individuals, greater use of suppressive strategies for emotion regulation and greater negative consequences for more direct and expressive social behavior, and greater engagement in perseverative cognition all plausibly combine to perpetuate psychosocial risk and produce overall greater physiological burden at lower levels of socioeconomic position.

The Pathway From Social Status to Physical Health: Taking a Closer Look at Stress as a Mediator

“…Along these lines, researchers may want to consider measuring and manipulating experiences that mimic real-world stress exposures known or thought to disproportionately affect individuals of lower social status, thus potentially explaining disparities. For example, individuals of lower social status may be exposed to the following types of objective or perceived stress more frequently or severely compared with higher-status individuals: financial stress; stress associated with actual or perceived social subordination; threats to social status such as being devalued, rejected, or discriminated against; lack of control over one’s environment; and being exposed to more dominance and control from others (Almeida et al, 2005; Cundiff & Smith, 2017; Gallo, Smith, & Cox, 2006; Smith, Cundiff, & Uchino, 2012). Therefore, researchers interested in social-status-related health disparities may find benefit in measuring and manipulating stressors with these characteristics.…”

Trait dominance and cardiovascular functioning during social stress

“…It could be that women with greater dominance simply had to expend less cardiovascular effort to cope with the social stressor. A recent review (Cundiff & Smith, ) argued that individuals with an awareness of lower status (but not higher status) may be more reactive to particular forms of stress, such as those associated with threat of losing status and social‐evaluative threat, and this has been found to be associated with the evocation of momentary increases in psychophysiological stress responses. Thus, social situations may not exert as high as a physiological toll for individuals with greater dominance as it might for individuals lower in dominance.…”

Social inhibition in population-based and cardiac patient samples: Robustness of inhibition, sensitivity and withdrawal as distinct facets

“…Adverse cardiovascular stress responses involving heart rate, ventricular contractility, cardiac output, and total peripheral resistance, are associated with the experience of repeated social threat [7][8][9][10]. Accordingly, recurrent social stress is found to be a risk factor for cardiovascular disease and premature mortality [7,[11][12][13]. Given the difficulties of socially inhibited individuals to deal with everyday social stress and to form stable social relationships, these individuals in particular may have increased risk of adverse cardiovascular outcomes due to recurrent social stress.…”

“…The frequent recurrence of negative interpersonal experiences in everyday life can induce adverse cardiovascular stress responses [7], and increased vulnerability to social threats is characterized by a myriad of cardiovascular stress responses involving heart rate, ventricular contractility, cardiac output, and total peripheral resistance [8][9][10]. Accordingly, researchers qualify dysfunctional relationships, such as recurrent social stress or lacking social connection, as a risk factor for cardiovascular disease and premature mortality [7,[11][12][13]. However, inhibited behavior is a complex phenomenon, and it is still unknown which facets of inhibition are related to cardiovascular health [14].…”