Reconsidering the effects of poverty and social support on health: a 5-year longitudinal test of the stress-buffering hypothesis

Abstract

Prior research in the general population has found that social support can buffer the adverse effects of stressors on health. However, both stressors and social support may be qualitatively different for those living in urban poverty. We examined the effects of social support and poverty-specific stressors on self-rated health. We used data from the Welfare Client Longitudinal Survey (WCLS), a 5-year longitudinal study of 718 public aid recipients. We measured received social support and "net social support," defined as the difference between support received and that given to others. We used restricted cubic splines to model the stress-buffering effects of social support on self-rated health as a function of stressful life events and neighborhood disorder. Increased exposure to stressors was associated with poorer self-rated health. Evidence of stress buffering was confined to those with the heaviest exposure to stressors, and its effects decreased across increasing levels of social support. Analyses using net social support had generally more modest effects than those using received social support. Social support does not buffer the effects of stressors on health uniformly for individuals living in conditions of urban poverty. Researchers and policymakers should be cautious in overestimating the beneficial effects that social support may have on health for marginalized populations.

Figure 1.

Regression curves estimating percent risk of fair/poor self-rated health by stressor and social support. a Stressful life events and received social support, b neighborhood disorder and received social support, c stressful life events and net social support, d neighborhood disorder and net social support. Adjusted for self-rated health at t−1, age, sex, race, education, and income. Data are weighted to account for sampling and non-response. Negative values of net social support represent giving more support than receiving, zero represents reciprocity, positive values represent receiving more than giving.