Scientists have long known that the support of friends and family plays a key role in protecting people's physical health.
But a new study suggests that the benefits don't go to people who may really need it - those with low self-esteem.
Results showed that perceived social support didn't help people with low self-esteem when it came to one measure of physical health: inflammation. But it did assist those with a more positive attitude about themselves.
"People with high self-esteem already have advantages compared to those with low self-esteem, and social support only helps them more," said David Lee, lead author of the study and a postdoctoral fellow in psychology at The Ohio State University.
"It's a case of the rich getting richer."
Lee conducted the study with Baldwin Way, professor of psychology at Ohio State. Their research appears online in the journal Health Psychology and will be published in a future print edition.
Previous research has shown that chronic inflammation is a potent driver of diseases, including cancer and heart disease. This research examined one marker of inflammation - a protein in the blood called C-Reactive Protein (CRP) - to determine how it was related to levels of self-esteem and perceived social support. Higher levels of CRP indicate higher levels of dangerous inflammation.
Data from the study came from the Survey of Midlife Development in the United States and included 1,054 healthy adults.
Participants rated how much support they felt from those closest to them, including family, friends and spouse. They also completed a 7-item questionnaire that measured their levels of self-esteem.
About two years after the survey, the same participants gave a blood sample in which they were measured for levels of CRP, the marker of inflammation.
Results showed that increased levels of perceived social support were linked to lower levels of CRP, an indicator of harmful inflammation - but only in people with higher self-esteem.
People with low self-esteem did not get the expected health boost from more perceived social support.
Way said that social support may not work in the same positive way for people with low self-esteem as it does in those with a healthy view of themselves.
"People with a negative self-view may actually feel more stress when people try to help them," Way said.
"They may feel they don't deserve the help or they worry that they're asking for too much from their friends and family. The result is that they may not get the benefits of social support."
These findings could contribute to developing more effective intervention strategies to reduce stress-related inflammation in those who have low self-esteem, the researchers said.
Lee will be an assistant professor of communication at the University of Buffalo, State University of New York, beginning this fall.