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Journal of Psychosomatic Research 69 (2010) 511 – 520

Social support concepts and measures

Benjamin H. Gottlieb⁎, Anne E. Bergen
Psychology Department, University of Guelph, Guelph, Ontario, Canada
Received 30 April 2009; received in revised form 7 July 2009; accepted 2 October 2009


Distinctions among concepts and approaches to assessing resources, others seek supplemental information about the
social support are made, and published generic and specialized membership and structural properties of the social network as
measures of social support are reviewed. Depending on study well. Observational and self-reported measures of support are
aims, investigators may be interested in assessing perceived or presented, along with brief and extensive measures. A final set of
received support from the perspective of the provider, the three support measures is highlighted, including their psycho-
recipient, or both. Whereas some measures inquire about the metric properties.
availability or mobilization of several kinds of supportive © 2010 Elsevier Inc. All rights reserved.
Keywords: Measures; Social network; Social support, social resources

Social support, social networks, and social integration are After distinguishing among the three preceding perspec-
three terms that designate three different perspectives on the tives on the resources that arise from people's social ties, we
resources that may lie in the personal communities we concentrate on the many support-related concepts that can be
inhabit. Regrettably, the three terms are often confused measured empirically and which are listed and defined in
because they have some degree of overlap and mutual Table 1. We then present a number of assessment tools that
influence. Yet a fourth term is commonly employed by variously measure these concepts, spotlighting three mea-
practitioners in the health and human services field, namely, sures of social support that are likely to be of particular
support system, a term that blends the function and the interest to investigators. This is followed by a discussion of
structural context of social ties, romantically suggesting that customized support measures for distinct populations and
people's social ties are unconditionally supportive. Since cultures, followed by a consideration of different methods of
social support is in fact highly contingent on numerous documenting social support, such as diary and observational
personal, environmental, and cultural factors, it cannot be studies. Our primary goal is to inform decisions about what
assumed to permanently reside in social networks. Nor can it to measure and how it can best be measured in basic and
be assumed to be available and adequate in quantity and intervention studies aimed to sensitively capture the
quality at times when people appraise the resources at their proximal social network's support-related functions.
disposal. For these reasons, among others, the measurement
of social support requires clarity about the aspects of the
The social sphere: social integration, network,
social surround that are most relevant to the aims and context
and support
of research, and precision in their measurement.
In the natural environment, social support arises from the
⁎ Corresponding author. Psychology Department, University of Guelph,
conduct of personal relationships. Indeed, the relationship
Guelph, Ontario, Canada N1G 2W1. Tel.: +1 519 824 4120x54577; fax: +1
itself gives supportive meaning to behavior and, conversely,
519 837 8629. supportive behaviors can bring relationship meaning to
E-mail address: bgottlie@uoguelph.ca (B.H. Gottlieb). interactions. Witness the deterioration of close relationships

0022-3999/09/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
512 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520

Table 1
Support-related concepts and definitions
Support-related concepts Definitions
Social support The social resources that persons perceive to be available or that are actually provided to them by nonprofessionals
in the context of both formal support groups and informal helping relationships.
Social network A unit of social structure composed of the individual's social ties and the ties among them.
Social integration The extent to which an individual participates in private and public social interactions.
Functional support The varied kinds of resources that flow through the network's social ties.
Structural support The number and pattern of direct and indirect social ties that surround the individual.
Types of support Emotional, instrumental, informational, companionate, and esteem support.
Perceived support The individual's beliefs about the availability of varied types of support from network associates.
Received support Reports about the types of support received.
Support adequacy Evaluations of the quantity and/or quality of received support.
Directionality of support Determination of whether support is unidirectional or bidirectional (mutual).

in which emotional support has eroded and the formation and Testimony to the longevity of research on social support,
strengthening of social bonds when unexpected support in 1986 Barrera [5] authored a review of the varied structural,
materializes. It follows that social support is not a functional, and evaluative aspects of social support that can
commodity that resides in the provider and passes to the be assessed, a review that was followed by a spate of new
recipient, but that it is an expression of the mutuality and support measures. Specifically, Barrera [5] noted that,
affection characteristic of the relationship between the depending on the study's purpose, it could be important to
parties. Close relationships tend to generate a wider range identify the sources of support in terms of different
of types of support than casual acquaintances, and social ties categories of social ties with lay people (e.g., family
that are more strictly defined by normative role definitions members, friends, neighbors), and the types of support,
tend to provide more specialized support. Recognizing this, including emotional, instrumental, companionship, informa-
any sensitive and comprehensive inquiry into social support tional, and esteem support. He also distinguished between
must first map the participants' larger social field to ensure measurement of perceived vs. actual or enacted support, a
that all potentially relevant sources of support are taken into distinction that has proved critical because perceived
account. The social network is a unit of social structure that support, not its actual materialization, has been found to be
affords a vantage point for such an account because it largely responsible for the much-heralded buffering effects
consists of an individual's ties and the ties among them. of support [6]. It appears that people who have a strong
A network perspective can provide instruction about psychological sense of support fare better in the face of
social integration and social support. Structural properties of adversity than those who are less sanguine about the support
the network provide information about social integration they can garner. Paradoxically, a strong sense of support
because the number of ties, their density or interconnected- seems to give people the confidence to cope without needing
ness, and the number of different roles that the central person to marshal their network's resources. Hence, perceived
(often referred to as “ego”) occupies in relation to the ties all support is essentially the belief or faith that support is
indicate the extent to which the person is enveloped in the available from network members, whereas actual support is
social fabric [1,2]. The greater the number and diversity of its mobilization and expression. Taking into account this
private and public social ties, the greater the social distinction, Cohen et al. [7] defined social support as “the
integration. By shifting attention to the resources and social resources that persons perceive to be available or that
influences that are carried across the ties between ego and are actually provided to them by nonprofessionals in the
network members, social support comes into bold relief. context of both formal support groups and informal helping
Generally, close ties with romantic partners and other relationships” (p. 4).
nuclear family members provide bonding, specializing in Another aspect of support that may be relevant to certain
the most intimate expressions of support such as listening, investigations is measurement of its quantitative and
caregiving, and affection. The more distant, role-defined ties qualitative adequacy from the recipient's perspective. The
provide bridging, specializing in practical assistance and a former evaluates the amount of support provided, ranging
variety of novel information and advice [3]. This is because from too little to too much, whereas the latter inquires about
the network's weak ties branch outward into other the quality of support, including the manner and covert
information environments, whereas the strong ties tend to message associated with its delivery. For example, the
share and recirculate the same information [4]. In short, provider may have tendered support in a grudging way,
sources and types of support are interrelated, but, empirical- attached strings that limit the recipient's freedom of action,
ly, it has been found that the closer the relationship, the or made the recipient feel indebted or incompetent. Indeed,
greater the correlation among the several types of support, more recent studies suggest that well-intentioned but clumsy,
reflecting sentiment override; people we feel close to are unsuitable, or overcontrolling support renders it neutral or
perceived to be repositories of all types of support. even psychologically damaging [8,9]. For example, it has
B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520 513

often been noted that men provide advice and recommend for work stressors by Lawrence et al. [18]. Wills and Shiner
action to their wives when the wives disclose an emotionally [19] present an appendix with a more complete list of studies
upsetting problem. Such support does not meet the wives' of social support for specific medical conditions.
needs to vent and think out loud about the problematic Measures of support have been created for adolescents
situation, but robs them of their sense of competence and and older adults, as well as for diverse cultural groups. Wills
agency. Similar findings are reported by Coyne and Smith and Cleary [20] adapted the emotional and practical support
[10] in the context of men recovering from a heart attack, but dimensions of the Interpersonal Support Evaluation List
in that context the wives showed overinvolvement and (ISEL) for use with adolescents, who were asked to rate the
overprotectiveness of their partners. Qualitative evaluation support available from the parent with whom they talked the
of support also reveals that different psychological con- most. The practical support items referred to help with
sequences arise for the recipient when needed support is not transportation, school work, and other demands typically
spontaneously mobilized by network members but must be faced by teenagers. For younger children, Dubow and
actively solicited [11,12]. Ullman [13] developed the Survey of Children's Social
An additional measurement option is to obtain informa- Support (SOCSS), which solicits both support and network
tion about the extent of bi-directionality in the support information. Specifically, it contains 38 items that gauge
exchanged with network members. Bi-directionality means emotional, informational, tangible, and esteem support
that support flows back and forth between two parties, each provided by the child's network, 31 items tapping the
taking turns over time in providing and receiving support. child's subjective evaluations of the support available from
Ongoing unidirectional support, such as the support family members, teachers, and peers, and one question about
provided by family members to a relative afflicted with the size of the child's network of supporters. Although the
dementia, can be highly burdensome depending on the SOCSS is both lengthy and blurs important distinctions
history of the relationship; if the support is viewed as between emotional support and both informational and
reciprocity for past support rendered by the relative, then it is esteem support, its items are both developmentally and
far less burdensome than if such support had not been contextually relevant to elementary school children. At the
provided in the past. It is noteworthy that the psychological other end of the life course, Krause [21] has designed a short
appeal of many mutual-aid, self-help (MASH) groups is measure of enacted or actually received support for older
predicated on the principle that “helping you helps me” adults. Although the emotional and informational support
because members are at once supporters and supported, subscales are highly generic in nature, the instrumental
thereby epitomizing the ethic of mutuality. Moreover, when support is tailored to the typical needs of older adults, such as
support is measured bi-directionally, it is possible to help with shopping, yard work, transportation, and house-
determine whether greater mental health benefits accrue to hold chores. Krause [21] also included three additional items
its provider or its recipient. tapping the perceived availability of emotional, tangible, and
It is noteworthy that measures of support can be informational support. This made it possible for him to
customized to the research context of interest, by focusing determine that the belief that support was available had a
on either certain relationships, stressors, or age groups. There greater impact on older adults' sense of meaning in life than
are measures of parental support for children [13], the receipt of certain supportive provisions. It also allowed
interspousal support [14], and support among employed him to determine the contribution of received support to
coworkers and between them and their supervisors [15]. perceived support. Finally, Dehle et al. [14] have developed
These measures and the generic network measures tend to a questionnaire that captures 48 types of enacted support
have a common core of items tapping emotional support, but behaviors of a romantic/marital partner.
relationship-specific items tapping practical and esteem Several very brief measures of social support in networks
support. The same applies to support measures tailored to trade off their usefulness for field research purposes against
particular stressors; they too will include the widely their relative superficiality. These measures can certainly be
applicable emotional support items, but the informational, productive as screening tools for social isolation, but do not
instrumental, esteem, and companionship dimensions of yield much information about the nature and extent of
support will be closely tied to the focal stressor. Typically, people's social integration and receipt or provision of
the items that gauge these latter dimensions are drawn from support. Some of the brief measures are short versions of
qualitative interviews with a diverse sample of people who longer scales, such as the abbreviated six-item version of the
are experiencing the stressor and then converted into Lubben Social Network Scale [22]. It contains three items
declarative statements that can be rated by a new sample. about family support and three identical items about friends'
Factor analysis is then conducted to assess the dimension- support, the items tapping the number of people in each
ality and internal consistency of the subscales that emerge. relationship category with whom there is at least monthly
Good examples of such work are the development of support contact, the number to whom the respondent feels close
measures for diet and exercise behaviors by Sallis et al. [16], enough to request help, and the number with whom the
the study of the support needs and preferences of cancer respondent feels enough at ease to talk to about private
patients by Rose [17], and the measure of perceived support matters. The convergent validity and internal consistencies
514 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520

of the six items have been well established, but again, the Asia, Europe, North America, and Oceania, Ong and Ward
measure is best used as a screening tool for social isolation. [31] generated a set of perceived support items based on the
The same applies to the measure developed by Undén and participants' answers to questions about their current social
Orth-Gomér [23] but it contains double the number of items. network, differences in the types of support provided by
It too contains a set of items tapping social integration local vs. overseas ties, difficulties experienced in the host
without always specifying the sources of contact, as well as a country they entered, and the help they received in coping
set of items tapping “availability of attachment” which, with those difficulties. This was followed by validation
translated, means the presence of a confidant. The former studies that examined the ISSS's correlation with measures
items assess broader and less profound forms of support, of received support, anomie, mastery, interpersonal trust,
such as network members with whom the respondent can locus of control, depression, and social desirability. A third
talk frankly and share interests, and who can be asked for study then examined and confirmed the cross-cultural
small favors and invited for a home visit. The response stability of the two dimensions of support identified in the
formats vary across the items, some receiving ratings and second study with samples of international students in New
some categorical (e.g., yes/no) responses. Zealand and England. The strong psychometric properties of
A final short support measure that concentrates on the ISSS commend it while the substantive findings reveal
emotional, tangible, and informational support was expressly that sojourners rely on their weaker, local ties for
developed for the study of patients who had incurred a instrumental and informational support, and perceive
myocardial infarction but applies equally well to patients emotional support to be mainly available from their stronger,
with other chronic illnesses. The ENRICHD Social Support overseas ties to family and friends. Equally interesting, the
Inventory (ESSI) has seven items that ask “how much of the practical and informational support perceived to be available
time” emotional, informational, and practical support are from their host country network had a stronger bearing on
available from (unspecified) network members plus a single their (lower) level of depressive affect than the emotional
item that calls for a categorical response about the existence support available from the ties in their country of origin. This
of a romantic partner [24]. Individually, these aspects of demonstrates that emotional support is not always the
support were previously found to predict mortality in panacea in stress-related contexts nor is its meaning and
cardiovascular patients. A five-item version of the ESSI value culturally universal.
that omitted the question about a romantic partner and the
single item about the availability of practical help obtained a
higher internal consistency, leaving the measure mainly Methods of documenting support
tapping emotional support from a close associate. Its brevity
and strong psychometric properties commend the ESSI as an The social support concepts that we have introduced are
excellent screening tool for perceived social support (see variously represented in the several measures we now touch
Table A1 and Appendix). It could be employed, for example, upon. Of these measures, we have singled out three that have
to determine who is likely to benefit most from interventions earned our confidence because of their strong psychometric
that augment support, such as support groups [25]. properties and their probable usefulness and appeal to
Cultural variations in the behaviors and activities that investigators. One is a short-form gauge of perceived
signify support have been investigated quite extensively. support, another a comprehensive assessment of perceived
Measures of perceived and received support cannot be support, and the third a measure of received support (please
assumed to be equivalent cross-culturally, precluding simple see Table 2 and Appendix A).
translation. In a fascinating chapter, Weisner [26] reports on The vast majority of support measures have been based
the meaning and expressions of support among Kenyan on self-reports that are gained from survey tools or
children in a tribe called Abaluyia. Employing local children interviews. The typical generic perceived support survey
as observers and recorders, Weisner [26] describes the lists sets of items that fall into the various classes of support
example of a distressed child who is supported by being and inquires about the extent of their availability. Measures
given a job to do without verbal interaction about the child's like the ISEL begin with a stem that refers to any one
feelings or cause of the distress. Other observations revealed network member who can provide a given type of support
that dominance and teasing often accompany acts of support. [32]. An example is, “When I need suggestions for how to
Support measures for Asian populations have also been
created, including measures for Korean adults [27] and
Chinese people [28–30]. Table 2
Researchers interested in the acculturation of newcomers Comparison of three recommended social support self-report measures
will find an excellent measure that contains both generic Name of Number Studies using
items and items unique to the experience of immigration and measure of items method Reliability Validity
adjustment in the Index of Sojourner Social Support (ISSS) ISSB 40 Many ++ ++
[31]. The development of this measure is exemplary. SPS 24 Many ++ ++
ESSI 7 Few + +
Beginning with a diverse sample of 54 participants from
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deal with a personal problem, I know there is someone I can of received support in whole or by subscale because the
turn to.” This measure makes it possible for people to obtain receipt of one type of support does not necessarily imply
a high score if they have only one source of support such as a receipt of other types of support, nor does the receipt of one
confidant. In contrast, the Social Support Questionnaire emotionally supportive behavior imply that other types of
(SSQ) requests information about the number and initials or emotional support will be tendered.
first names of network members who would provide given Finally, researchers interested in gaining a comprehensive
types of support (up to a maximum of 9), followed by a assessment of social support are advised to consider
single evaluation of satisfaction “with the extent to which Krause's [38] battery of support measures. It consists of
you are supported in this way” [33]. Hence, the SSQ can gain several short but psychometrically acceptable scales includ-
information about several network members, but its reliance ing frequency of contact with family members and friends
on a single evaluation of their collective adequacy blurs (two scales, each composed of three items); practical,
important differences among them. A third variant is emotional, and informational support received from network
Procidano and Heller's [34] two measures of perceived members in general as well as the provision of the same three
support, one inquiring about available support from family types of support to associates (six scales, each composed of
members and one tapping perceived support from friends. three items); and a single perceived network support scale
These two measures illustrate that investigators need not composed of three items, one for each of the preceding types
focus on the entire network, but can concentrate on particular of support.
classes of relationships or particular sources. Measures can
also inquire into only one or two types of support. Observational and daily diary methodologies
One perceived support measure differs from the rest by
virtue of its derivation from Weiss's [35] theoretical Although most widely used because of their convenience
formulations about the resources provided by social and brevity, self-report measures are not the only method-
relationships. The Social Provisions Scale (SPS) includes ology employed to assess support. Cutrona and Suhr [39]
24 items tapping six types of provisions available from the have developed a coding scheme for capturing support
general social network, including reliable alliance (practical transactions between spouses that contains 23 “support-
help), guidance (informational support), attachment (emo- intended communication behaviors” (p. 120) that cover five
tional support), social integration (belonging to a group of dimensions and were derived in part from couples'
similar peers), reassurance of worth (esteem support), and descriptions of the support they wanted to receive from
opportunity to provide nurturance (providing support) [36]. their partners upon the occurrence of stressful events. All
The latter type of support rests on the premise that but one of the codes are based on the couples' oral support
relationships offer opportunities to render, not just receive communications, the exception being physical affection. In
support, and suggests that there may be distinct benefits fact, this coding scheme includes five items that do not tap
from being useful to others. This notion is captured by the support, but assess negative verbalizations such as criticism
motto of many mutual aid and support groups, to the effect and complaints about the partner. Otherwise, the scheme
that “helping you helps me.” As displayed in Appendix A, contains the familiar quartet of emotional, esteem, informa-
the SPS has received a commendable amount of psycho- tional, and practical support along with companionship. A
metric evaluation and is recommended when a comprehen- second coding scheme that has been developed to observe
sive assessment of perceived support is needed without social support between romantic partners contains 48 items
identifying particular sources. and has been productively employed by Dehle et al. [14] in
Perhaps because the kinds of support people receive a daily diary study. Married partners completed the SIRRS
depend largely on the stressful demands they are coping on seven consecutive evenings, making two ratings for each
with, there are few generic measures of received support. of the 48 support items. One rating documented the
The most widely used measure is the Inventory of Socially frequency that the partner engaged in each supportive
Supportive Behaviors (ISSB; please see Appendix A). It behavior and the other reflected how much of each the
contains 40 items inquiring about the frequency of recent participant preferred to receive. Not surprisingly, spouses
receipt of emotional, informational, and practical support, who received less support than they wanted had higher
along with companionship, from any (unspecified) network levels of depressive affect and lower marital adjustment
members [37]. However, the ISSB is vulnerable to problems even after controlling for social desirability.
of over- and underinclusion of types of support; it may A somewhat different daily diary methodology was
contain items that are irrelevant to the stressor context and employed by Bolger et al. [40] in a study of spousal support.
therefore should not be included in the total score, and it may With the aim of understanding why actual/enacted support
not contain items that could be relevant forms of support for does not have the buffering effects produced by perceived
the context. Hence, if used, the ISSB should be carefully support, the authors tested the proposition that the explicit
customized to the situation and then validated, perhaps by expression of support incurs “…a cost to self-esteem because
checking with the support providers. It is also noteworthy it makes salient to recipients that they are having difficulties
that it is inappropriate to determine the internal consistency coping with a stressor” (p. 953). However, if the support is
516 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520

“invisible” to the recipient, it is more likely to preclude any Conclusion

adverse effect on self-esteem and serve a stress-moderating
function. Invisible support can either be indirect and As a focus for interdisciplinary research, the measurement
unobserved by the recipient, an example being that the of social support has been enriched by the contributions of
provider speaks to someone on behalf of the recipient, or epidemiologists, health psychologists, sociologists, and
behavior that is not interpreted as help by the recipient, such investigators in the fields of human communication, nursing,
as the provider sharing his or her way of coping with an and medicine. There are manifold off-the-shelf checklists
identical or similar stressor. Procedurally, over a period of 32 and rating scales with acceptable psychometric properties
evenings before and three evenings after the major scheduled [42], some that yield information about the composition and
stressor of writing a bar examination, the examinees morphology of the social networks from which support
indicated whether their partners had provided emotional arises. With a clear understanding of the concepts spotlighted
support involving listening to and comforting the examinees, in Table 1, researchers can also customize support
while their partners reported on their daily provision of this measurement to the particular stressors and samples of
emotional support. Although the participants responded only interest. Qualitative interviews with key informants can
to this single item that called for only a categorical response, produce knowledge of culturally- and developmentally
the analysis showed that the examinees' depressive symp- specific expressions and perceptions of support that are
tomatology declined on days when they reported not having invaluable for both basic and intervention research. Howev-
received emotional support but their partners reported having er, the application or development of support measures must
provided support. Conversely, the examinees' adjustment be predicated on a sound grasp of study aims and objectives:
declined on days when both parties agreed that emotional Is support an end in itself or a means to other ends, such as
support had been provided. As the authors conclude, adherence to medical regimens? Is received or perceived
supportive transactions may be optimal when “… the support of most interest? Is it important to capture the
recipient reaps the benefits of support provision without support provided by or available from particular network
incurring the cost of support receipt” (p. 958). members or can the inquiry focus on the network as the unit
Concurrent or convergent validation of perceived of analysis? Are certain types of support of special interest
support measures has typically been based on their because of the demands of the stressor or the paucity of
correlations with constructs deemed to be related to them. certain social provisions in the lives of the participants? Is the
Examples include received support since it should have amount of support, its quality, and its sustainability vital to
some bearing on people's beliefs about the availability of the planning of community programs and to an understand-
support; social skills, sociability, and extraversion because ing of its effects? Consideration of these questions will help
more outgoing people are more likely to form more to align measurement with the purposes set out for study.
relationships from which they can gain support; and Equally important, these questions can alert investigators to
measures of interpersonal trust and relationship warmth the kaleidoscopic character of the resources that reside in the
and closeness, including marital adjustment and satisfaction social ecology.
as validation for confiding relationships. Since the construct
of secure attachment embraces patterns of behaviors that
bear on support seeking, it too has been employed to Appendix A. Inventory of Socially Supportive Behaviors
validate measures of perceived support [41]. Adults with a
history of secure attachment do indeed report having more Purpose
and longer-lasting close relationships, viewing network
members as more reliable and responsive during times of The Inventory of Socially Supportive Behaviors (ISSB) is
need, and assigning greater value to emotional intimacy. a measure of the frequency of receipt of a wide variety of
However, these findings are largely based on retrospective verbal and behavioral expressions of social support,
studies whose fallibility stems from influences of current designed for use in the general population [43].
mood and social experiences on reports and, therefore,
await confirmation by prospective inquiries. Social desir- Conceptual basis
ability can also bias reports of perceived support because
self-presentational needs may conspire to sway people The ISSB was designed on the basis of evidence from
toward more sanguine accounts. Few of us would be empirical research [44] and literature reviews regarding the
willing to project an image of ourselves as deficient in types of help and support people receive from members of
social ties and impoverished in the help and support we can their social networks. Items gleaned from previous research
secure from our associates. Moreover, if we are asked to were rewritten to maximize behavioral specificity, avoid
report on the support we can gain at a time when we are wording applicable only to specific populations, and omit
suffering the ill effects of a stressful event, it is likely that references to psychological adjustment. The authors pro-
we will attribute our plight to a network that has left us duced 40 items believed to tap the range of important
bereft of support. supportive functions [37]. The 40 socially supportive
B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520 517

behaviors reflect six main functions of support: material aid, Interview Schedule [37]. In addition, when participants were
behavioral assistance, intimate interaction, guidance, feed- instructed to respond to the ISSB items in terms of their
back, and positive social interaction [43]. family support, ISSB scores were directly related (r=.36) to
scores on Moos's [47,48] Family Environment Cohesion
Description Subscale [37]. Received social support, as assessed by the
ISSB, is directly related to the occurrence of physical
The ISSB is a self-administered survey, which takes 10– symptoms (r=.22) and with the frequency of both positive
15 min to complete. Each item is a statement describing a (r=.28) and negative (r=.28) life events [49]. Thus, as a
particular expression of support (e.g., “Did some activity measure of received social support, the ISSB is able to assess
together to help you get your mind off of things”). The 40 the mobilization of support upon the occurrence of physical
items are scored using a five-point ordinal response format symptoms and/or life events. There is evidence that ISSB
reflecting the frequency of receipt of each supportive subscales are differentially related to depression and life
behavior during the previous month (1=not at all, 2=once satisfaction, such that tangible assistance and direct guidance
or twice, 3=about once a week, 4=several times a week, show only a slight correlation with depression scores (r=.16
5=about every day). ISSB scores are calculated by summing and r=.09, respectively), whereas positive social interaction
or averaging responses to individual items. The ISSB can be has a moderate negative relationship with depression (r=
administered to assess support from particular types of −.29). Only the positive social interaction subscale is directly
relationships, such as family or friends [37]. In addition, the related to life satisfaction (r=.27); the other three subscales
ISSB can be customized by adding items that are unique to a are unrelated [46]. Thus, use of composite ISSB scores (i.e.,
particular stressor and by removing irrelevant items [45,46]. 40 item totals) may obscure researcher's efforts to
understand the relationship between received social support
Reliability and other factors such as depression and life satisfaction.
Evidence for the divergent validity of the ISSB comes from
Based on an initial sample of 71 undergraduate students, its differentiation from perceived support measures. A meta-
the ISSB showed 2-day test–retest reliability ranging from analysis examining the relationship of the ISSB with various
.44 to .91 across the 40 items [37]. The average 2-day test– perceived support measures across 24 studies found an
retest reliability coefficient was good, with r=.88. The item- average correlation of r=.32, suggesting that received
total correlation coefficients ranged from −0.82 to .69, support is a distinct construct from perceived support [50].
indicating that not all social support behaviors listed are
assessing the same construct [37]. However, the scale showed
excellent internal consistency overall, with Cronbach's alpha Social Provisions Scale
coefficients between .93 and .94 for the first and second
testing sessions, respectively [37]. Evidence from factor Purpose
analysis suggests that the ISSB is not a unidimensional
measure and that ISSB subscales should be scored individ- The Social Provisions Scale (SPS) is a measure of six
ually [46]. In addition, overall reliability is not necessarily a perceived support functions, designed for use in the general
useful indicator of the utility of the ISSB, as individuals may population [36].
not necessarily receive all kinds of support in a given
situation. Exploratory factor analysis of revised ISSB items Conceptual basis
identified a four-factor solution, the first factor comprising
Guidance and Feedback, the second Nondirective Support, The SPS is based on Weiss's [35] model of social
the third Positive Social Interaction, and the fourth Tangible provisions, which distinguishes the assistance-related func-
Assistance [43]. Confirmatory factor analysis based on 30 tions of social ties (i.e., reassurance of worth, guidance, and
items from the ISSB found that a four-factor model was a reliable alliance) from their non–assistance-related functions
better fit than either a three-factor or a unidimensional (i.e., opportunity for nurturance, attachment, and social
solution [46]. In spite of the multidimensionality of the ISSB, integration) [36]. Construction of the SPS began with 12
there is evidence that it has good internal consistency in statements reflecting positive and negative phrasing of
samples from other cultures. For example, a study of 200 Weiss's six provisions of social relationships. To increase
Chinese university students in Beijing and Nanjing yielded a the reliability of the measure, the SPS was expanded to 24
Cronbach's alpha of .94 for a translated ISSB [45]. items, with four items for each of the six subscales.

Validity Description

Evidence for the validity of the ISSB comes from its The SPS is a self-administered perceived support survey,
moderate direct correlation with social support network size consisting of 24 items which respondents rate on a four-point
(r=.32 to r=.42), as assessed by the Arizona Social Support strength of dis/agreement response format (e.g., “There are
518 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520

people I can depend on to help me if I really need it”). SPS the short version because it taps perceptions that one
subscales are scored by summing responses to individual provides support to others rather than perceptions of
items, after reverse coding negatively worded items. receiving support. Reliability of the 10-item scale among
Similarly, a total SPS score is calculated by summing all community adults is .83.
items after appropriate reverse scoring. The short version of the SPS has also been validated for
use with African-American samples. In a sample of over
Reliability 600 African-American adults, reliability was .81 and test–
retest reliability was .48 over 2 years. Validity was
Based on samples of 1792 respondents across several evidenced by significant correlations with relationship
studies, including students, nurses, and public school quality and stability.
teachers, the SPS showed excellent overall internal consis- Caution should be exercised when using the SPS to assess
tency, with a combined Cronbach's alpha of .92 [36]. The individual components of social support. Confirmatory factor
internal consistency of subscales is adequate, ranging from analyses on data from the full 24-item scale have supported
.65 to .76. Age and sex differences were found in SPS scores, the hypothesized six-factor structure for the measure, with a
but these accounted for less than 7% and 4% of the variance large second-order factor reflecting overall level of support.
in SPS scores, respectively. Confirmatory factor analysis However, it is clear that several of the first-order factors
indicated that a six-factor oblique model was a better fit to reflecting different types of support are highly intercorre-
the data than a single-factor model. High intercorrelations lated. Specifically, correlations among the five provisions
among subscales (r=.54 to r=.99) indicate the presence of a that reflect receiving support from others (i.e., Guidance,
second-order factor. Reassurance of Worth, Social Integration, Attachment, and
Reliable Alliance) are correlated from .70 to .99 with one
Validity another. The provision that reflects providing support to
others (i.e., Opportunity to Provide Nurturance) is less highly
Convergent and divergent validity of the SPS have been correlated with the other five provisions (r=.56 to .64).
comprehensively assessed; details are provided in a review
by Cutrona and Russell [36]. Based on a sample of 242
college students, correlations between SPS scores and ENRICHD Social Support Inventory
measures of social desirability, psychological distress,
personality factors, and social skills were lower than Purpose
correlations between SPS scores and other validated social
support measures, including satisfaction with support, Originally designed for use with patients recovering from
number of supportive persons, number of helping behaviors, myocardial infarction [24], ESSI is a seven-item measure
and attitudes towards support. Even after controlling for the that assesses the availability of support from any network
nonsupport measures, the other social support measures still member plus a single item inquiring about the existence of a
predict SPS scores in a regression model [36]. In addition, marital/partner.
after controlling for the other social support measures, SPS
scores together with stress effects and the SPS by stress Conceptual basis
interaction still predict depression [36].
The authors created items by searching the literature for
Comments from the author of the SPS, Carolyn Cutrona evidence of the types of structural, instrumental, and
emotional support that predict lower mortality in myocar-
The SPS [36] has been translated into several languages dial infarction patients [24]. The measure was designed to
(e.g., French, Portuguese) and several variations on the scale avoid assessing network morphology, based on evidence
have been developed. The Source-Specific Social Provisions from the literature that network structural properties are less
Scale [51] was developed to allow the assessment of important than emotional support for survival after
perceived social support from specific members of the social myocardial infarction.
network. The published version was developed for use with
adolescents and assessed perceived support from parents, Description
male partner, and friends. It has a simplified three-point
response scale (1=no; 2=sometimes; 3=yes). Reliability for The ESSI is a self-administered survey, consisting of
the Source-Specific SPS was .78 among childbearing seven items. For six of the items, respondents rate the
adolescents [51]. availability of a network member to provide emotional (four
A short version of the SPS has also been developed. This items), informational (one item), and practical (one item)
10-item measure includes one positively worded and one support. Availability is rated on a five-point Likert-type
negatively worded item from each of five subscales. The response format that ranges from none of the time to all of
Opportunity to Provide Nurturance subscale was omitted in the time. The seventh item is a dichotomous response to the
B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520 519

Table A1 [5] Barrera M. Distinctions between social support concepts, measures,

Comparison of the quality of social support measures and models. Am J Community Psychol 1986;14:413–45.
[6] Cohen S, Wills TA. Stress, social support, and the buffering
hypothesis. Psychol Bull 1985;98:310–57.
Name of Number Administered using
[7] Cohen S, Gottlieb B, Underwood L. Social relationships and health:
the scale of items by (time) method Reliability Validity
challenges for measurement and intervention. New York: Oxford
ISSB 40 Self (10–15 min) Many ++ ++ University Press, 2000.
SPS 24 Self (5 min) Many ++ ++ [8] Rook KS. The negative side of social interaction: impact on
ESSI 7 Self (5 min) Few + + psychological well-being. J Pers Soc Psychol 1984;46:1097–108.
+, some information; ++, excellent psychometric properties. [9] Steinberg M, Gottlieb BH. Appraisals of social support among women
facing conflicts between work and family. In: Burleson BR, Albrecht
TL, Sarason IG, editors. The communication of social support.
question, “Are you currently married or living with a Newbury Park (Calif): Sage, 1994. pp. 152–72.
[10] Coyne JC, Smith DAF. Couples coping with a myocardial infarction: a
partner?” and is scored such that an affirmative response is
contextual perspective on wives' distress. J Pers Soc Psychol 1991;61:
worth 4 points and a negative response 2 points. The ESSI 404–12.
yields a single summed score and takes 5 min to complete. [11] Eckenrode J, Wethington E. The process and outcome of mobilizing
social support. In: Duck S, Silver RC, editors. Personal relationships
Reliability and social support. London: Sage Publications, 1990. pp. 83–103.
[12] Lawrence E, Bunde M, Barry RA, Brock RL, Sullivan KT, Pasch LA,
et al. Partner support and marital satisfaction: support amount,
Based on a sample of 196 pilot participants, the ESSI adequacy, provision, and solicitation. Pers Relatsh 2008;15:445–63.
shows good internal consistency, with a Cronbach's alpha of [13] Dubow EF, Ullman DG. Assessing social support in elementary school
.86 [24]. If Items 5 and 7 are dropped, the internal children: the survey of children's social support. J Clin Child Psychol
consistency coefficient increases to .87; this minimal 1989;18:52–64.
increase in internal consistency suggests that the seven- [14] Dehle C, Larsen D, Landers JE. Social support in marriage. Am J Fam
Ther 2001;29:307–24.
item scale should be used. A modified version of the ESSI [15] Rooney JA, Gottlieb BH. Development and initial validation of a
(with revision of one emotional support item) was used with measure of supportive and unsupportive managerial behaviors. J Voc
a sample of 200 Chinese immigrants with hypertension and Beh 2007;71:186–203.
showed excellent internal consistency, with a Cronbach's [16] Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The
alpha of .91 and item-total correlations ranging from .70 to development of scales to measure social support for diet and exercise
behaviors. Prev Med 1987;16:825–36.
.84 [52]. These results suggest that the ESSI can be [17] Rose JH. Social support and cancer: adult patients' desire for support
successfully modified for use with non-Western participants. from family, friends, and health professionals. Am J Community
Psychol 1990;18:439–64.
Validity [18] Lawrence SA, Gardner J, Callan VJ. The support appraisal for work
stressors inventory: construction and initial validation. J Vocat Behav
In the pilot study, evidence for convergent validity comes [19] Wills TA, Shinar O. Measuring perceived and received social support.
from the moderate correlation of ESSI scores with the In: Cohen S, Underwood LG, Gottlieb BH, editors. Social support
Perceived Social Support Scale, a measure of available measurement and intervention: a guide for health and social scientists.
emotional support (r=.62), although this relationship was New York: Oxford University Press, 2000. pp. 86–135.
[20] Wills TA, Cleary SD. How are social support effects mediated? A test
attenuated for males and minorities (r=.41 and r=.42,
with parental support and adolescent substance use. J Pers Soc Psychol
respectively) [24]. ESSI scores showed lower correlations 1996;71:937–52.
with Social Network Questionnaire scores (r=.20) and [21] Krause N. Longitudinal study of social support and meaning in life.
overall ISSB scores (r=.25). ESSI scores were related to all Psychol Aging 2007;22:456–69.
ISSB subscales (r=.26 to .34), except for tangible assistance [22] Lubben J, Blozik E, Gillmann G, Iliffe S, von Renteln Kruse W, Beck
[24]. Because the ESSI is designed to measure different JC, et al. Performance of an abbreviated version of the Lubben social
network scale among three European community-dwelling older adult
aspects of support than the ISSB (i.e., perceived, not populations. Gerontologist 2006;46:503–13.
received, support) and the Social Network Questionnaire [23] Undén AL, Orth-Gomér K. Development of a social support instrument
(functional, not structural, aspects of the social network), this for use in population surveys. Soc Sci Med 1989;29:1387–92.
is evidence for its discriminant validity. [24] Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR,
et al. A short social support measure for patients recovering from
myocardial infarction: the ENRICHD social support inventory. J
References Cardiopulm Rehabil 2003;23:398–403.
[25] Gottlieb BH, Wachala ED. Cancer support groups: a critical review of
[1] Cohen S, Lemay EP. Why would social networks be linked to affect empirical studies. Psychooncology 2007;16:379–400.
and health practices? Health Psychol 2007;26:410–7. [26] Weisner TS. Cultural and universal aspects of social support for
[2] Smith KP, Christakis NA. Social networks and health. Annu Rev children: evidence from the Abaluyia of Kenya. In: Belle D, editor.
Sociol 2008;34:405. Children's social networks and social supports. Toronto: Wiley, 1989.
[3] Wuthnow R. Religious involvement and status-bridging social capital. pp. 70–90.
J Sci Study Relig 2002;41:669–84. [27] Oh K, Oh KO, Lee SJ, Kim JA, Jeong CJ, Kim HR, et al. Psychometric
[4] Granovetter M. The strength of weak ties. Am J Sociol 1973;78: evaluation of the Korean social support questionnaire. J Korean Acad
1360–80. Nurs 2008;38:881–90.
520 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520

[28] Taylor SE, Sherman DK, Kim HS, Jarcho J, Takagi K, Dunagan MS. support: messages, interactions, relationships, and community. Thou-
Culture and social support: who seeks it and why? J Pers Soc Psychol sand Oaks (Calif): Sage, 1994. pp. 113–35.
2004;87:354–62. [40] Bolger N, Zuckerman A, Kessler RC. Invisible support and adjustment
[29] Wong ST, Yoo GJ, Stewart AL. An empirical evaluation of social to stress. J Pers Soc Psychol 2000;79:953–61.
support and psychological well-being in older Chinese and Korean [41] Sarason BR, Pierce GR, Sarason IG. Social support: the sense of
immigrants. Ethn Health 2007;12:43–67. acceptance and the role of relationships. In: Sarason BR, Sarason GR,
[30] Yuen-Tsang AWK. Towards a Chinese conception of social support: a editors. Social support: an interactional view. New York: Wiley, 1990.
study on the social support networks of Chinese working mothers in pp. 97–128.
Beijing. Aldershot, England: Ashgate Pub Co, 1997. [42] Wills TA, Filer M. Social networks and social support. In: Baum A,
[31] Ong ASJ, Ward C. The construction and validation of a social support Revenson T, editors. Handbook of health psychology. Mahweh (NJ):
measure for sojourners: the Index of Sojourner Social Support (ISSS) Erlbaum, 2000. pp. 209–34.
scale. J Cross Cult Psychol 2005;36:637–61. [43] Barrera M, Ainlay SL. The structure of social support: a conceptual and
[32] Cohen S, Mermelstein R, Kamarck T, Hoberman H. Measuring the empirical analysis. J Community Psychol 1983;11:133–43.
functional components of social support. In: Sarason IG, Sarason BR, [44] Gottlieb BH. The development and application of a classification scheme
editors. Social support: theory, research and applications. The Hague: of informal helping behaviors. Can J Behav Sci 1978;10:105–15.
Martinus Nijhoff, 1985. pp. 73–94. [45] Liang B, Bogat GA. Culture, control, and coping: new perspectives on
[33] Sarason IG, Levine HM, Basham RB, Sarason BR. Assessing social social support. Am J Community Psychol 1994;22:123–47.
support: the social support questionnaire. J Pers Soc Psychol 1983;44: [46] Finch JF, Barrera MJR, Okun MA, Bryant WHM, Pool GJ, Snow-
127–39. Turek AL. The factor structure of received social support: dimension-
[34] Procidano ME, Heller K. Measures of perceived social support from ality and the prediction of depression and life satisfaction. J Soc Clin
friends and from family: three validation studies. Am J Community Psychol 1997;16:323–42.
Psychol 1983;11:1–24. [47] Moos RH. Evaluating treatment environments: a social ecological
[35] Weiss R. The provision of social relationships. In: Rubin Z, editor. approach. New York: Wiley, 1974.
Doing unto others. New Jersey: Prentice Hall, 1974. pp. 17–26. [48] Moos RH. Evaluating correctional and community settings. New York:
[36] Cutrona CE, Russell DW. The provisions of social relationships and Wiley, 1975.
adaptation to stress. In: Jones WH, Perlman D, editors. Advances in [49] Cohen S, Hoberman HM. Positive events and social supports as buffers
Personal Relationships. A Research Annual. Greenwich (Conn): JAI of life change stress. J Appl Soc Psychol 1983;13:99–125.
Press, 1987. pp. 37–67. [50] Haber MG, Cohen JL, Lucas T, Baltes BB. The relationship between
[37] Barrera M, Sandler IN, Ramsay TB. Preliminary development of a self-reported received and perceived social support: a meta-analytic
scale of social support: studies on college students. Am J Community review. Am J Community Psychol 2007;39:133–44.
Psychol 1981;9:435–47. [51] Cutrona CE. Ratings of social support by adolescents and adult
[38] Krause N. Assessing change in social support during late life. Res informants: degree of correspondence and prediction of depressive
Aging 1999;21:539–69. symptoms. J Pers Soc Psychol 1989;57:723–30.
[39] Cutrona CE, Suhr JA. Social support communication in the context of [52] Li WW, Stewart AL, Stotts N, Froelicher ES. Cultural factors
marriage: an analysis of couples' supportive interactions. In: Burleson associated with antihypertensive medication adherence in Chinese
BR, Albrecht TL, Sarason IG, editors. Communication of social immigrants. J Cardiovasc Nurs 2006;21:354–62.