People with life-threatening conditions and diseases significantly benefit from social support interventions that promote healthy behaviors and may even gain longer life spans as a result, according to a new meta-analysis of health care studies dating back to 1980.
In a paper published Tuesday in PLOS Medicine, psychologists from Brigham Young University analyzed the effectiveness of psychosocial interventions, which encourage healthy behaviors among patients while they undergo medical treatment. They found that the interventions greatly increased odds of survival and relative length of survival compared with controls; notably, interventions focused on patient's health behaviors, such as physical exercise, were apparently quite effective, while those focused on emotional support were apparently only on par with controls. And certain data showed that patients receiving the interventions averaged a 29% increased likelihood of survival over time.
"Providing medical patients with social support can be just as helpful as providing cardiac rehabilitation for someone recovering from heart disease," said Timothy B. Smith, a professor at Brigham Young University and first author of the paper. "It can be just as helpful as a diet or lifestyle program for obese patients or treatment for alcoholism among patients with alcoholism."
Smith told The Academic Times that his past research, which showed that strong social connections predicted a longer life span, informed this meta-analysis. He explained that there is a need for more research on whether emotional and behavioral social support in health care settings can improve the survival rates of medical patients.
Smith said he and his co-authors wanted to see if medical professionals "could intervene to enhance longevity by augmenting social support." They assessed psychosocial interventions that were conducted in patients' homes, in support groups, or through telephone or online conversations. Some interventions they studied focused on behavior, such as supporting patients in changing their health behaviors during treatment, and others focused on emotion, such as supporting patients as they coped with distress. The researchers compared the two categories to see if one type was more effective than the other.
After screening more than 42,000 studies, they zeroed in on 106 randomized controlled trials from around the world that were carried out between 1980 and 2020. These covered more than 40,000 participants, some of whom received interventions and some of whom were in control groups. The studies included patients with a health condition likely to result in death if untreated, such as cardiovascular disease and cancer.
Studies that evaluated outcomes at one time followed up with patients about three months later, on average. Whether or not patients were alive at this stage showed that those who were part of the intervention groups were 20% more likely to be alive. Other studies reported this data in terms of survival time, meaning they tracked patients until their passing rather than at fixed follow-up points.
"We had assumed going into this project that the interventions that involve family members would be the most effective, because a family member is present usually 24/7 in the same household," Smith said. "However, we found that there were very few studies that actually investigated family involvement. So that's an area that will need to be confirmed through future research." He noted that family support is usually the most enduring and impactful type of support medical patients can receive.
"But for now, we're able to say that all interventions are approximately, equally effective," he continued. "It doesn't matter so much if you do home visits, or if you do a survivor support group, or if you do retreat programs. They all work. And they all work about the same, on average."
The findings also suggest that psychosocial interventions can prolong life to roughly the same extent as cardiac rehabilitation programs and treatments for alcoholism or smoking. "That is a truly astounding discovery that has clear implications: medical care and public health can benefit from stronger integration with psychology," Smith said.
Smith explained that the results provide important evidence that health care systems and public health groups, particularly in the U.S., need to develop better mental health support programs for patients and to offer them as supplements to standard medical treatments. And rather than focus solely on emotional and psychological support, interventions should also address and promote health behaviors. Patients need to be made aware that social support options are available to them, and that they can be considered a normal part of treatment and recovery.
"We can do a better job as a health care system, of integrating mental health and physical health care," Smith said. "Patients' apathy, anxiety and uncertainty can prevent them from fully completing recommended medical treatments. Our data indicate that explicitly fostering patients' motivation, coping strategies and social support improves their survival."
According to the authors, the data presented in the paper could be used to recommend protocols for evaluating existing sources of patient support and barriers to treatment completion, as well as to evaluate specific support programs for patients in hospitals and clinics, particularly for those at risk of not completing treatments. They said programs and clinics should also be made more family- and caregiver-friendly to provide patients with additional support and accountability.
Training in medical schools should be improved to address the social, emotional and behavioral needs of patients, and there should be further informed collaboration between medical professionals and mental health professionals, the authors said.
"The more social support we have, the better we are in all areas of life," Smith said.
The study, "Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials," published May 18 in PLOS Medicine, was authored by Timothy B. Smith, Connor Workman, Caleb Andrews, Bonnie Barton, Matthew Cook, Ryan Layton, Alexandra Morrey, Devin Petersen and Julianne Holt-Lunstad, Brigham Young University.