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
Abstract
Distinctions among concepts and approaches to assessing
social support are made, and published generic and specialized
measures of social support are reviewed. Depending on study
aims, investigators may be interested in assessing perceived or
received support from the perspective of the provider, the
recipient, or both. Whereas some measures inquire about the
availability or mobilization of several kinds of supportive
Keywords: Measures; Social network; Social support, social resources
Social support, social networks, and social integration are
three terms that designate three different perspectives on the
resources that may lie in the personal communities we
inhabit. Regrettably, the three terms are often confused
because they have some degree of overlap and mutual
influence. Yet a fourth term is commonly employed by
practitioners in the health and human services field, namely,
support system, a term that blends the function and the
structural context of social ties, romantically suggesting that
people's social ties are unconditionally supportive. Since
social support is in fact highly contingent on numerous
personal, environmental, and cultural factors, it cannot be
assumed to permanently reside in social networks. Nor can it
be assumed to be available and adequate in quantity and
quality at times when people appraise the resources at their
disposal. For these reasons, among others, the measurement
of social support requires clarity about the aspects of the
social surround that are most relevant to the aims and context
of research, and precision in their measurement.
⁎ Corresponding author. Psychology Department, University of Guelph,
Guelph, Ontario, Canada N1G 2W1. Tel.: +1 519 824 4120x54577; fax: +1
519 837 8629.
E-mail address: bgottlie@uoguelph.ca (B.H. Gottlieb).
0022-3999/09/$ – see front matter © 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.jpsychores.2009.10.001
resources, others seek supplemental information about the
membership and structural properties of the social network as
well. Observational and self-reported measures of support are
presented, along with brief and extensive measures. A final set of
three support measures is highlighted, including their psycho-
metric properties.
© 2010 Elsevier Inc. All rights reserved.
After distinguishing among the three preceding perspec-
tives on the resources that arise from people's social ties, we
concentrate on the many support-related concepts that can be
measured empirically and which are listed and defined in
Table 1. We then present a number of assessment tools that
variously measure these concepts, spotlighting three mea-
sures of social support that are likely to be of particular
interest to investigators. This is followed by a discussion of
customized support measures for distinct populations and
cultures, followed by a consideration of different methods of
documenting social support, such as diary and observational
studies. Our primary goal is to inform decisions about what
to measure and how it can best be measured in basic and
intervention studies aimed to sensitively capture the
proximal social network's support-related functions.
The social sphere: social integration, network,
and support
In the natural environment, social support arises from the
conduct of personal relationships. Indeed, the relationship
itself gives supportive meaning to behavior and, conversely,
supportive behaviors can bring relationship meaning to
interactions. Witness the deterioration of close relationships
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
strengthening of social bonds when unexpected support
materializes. It follows that social support is not a
commodity that resides in the provider and passes to the
recipient, but that it is an expression of the mutuality and
affection characteristic of the relationship between the
parties. Close relationships tend to generate a wider range
of types of support than casual acquaintances, and social ties
that are more strictly defined by normative role definitions
tend to provide more specialized support. Recognizing this,
any sensitive and comprehensive inquiry into social support
must first map the participants' larger social field to ensure
that all potentially relevant sources of support are taken into
account. The social network is a unit of social structure that
affords a vantage point for such an account because it
consists of an individual's ties and the ties among them.
A network perspective can provide instruction about
social integration and social support. Structural properties of
the network provide information about social integration
because the number of ties, their density or interconnected-
ness, and the number of different roles that the central person
(often referred to as “ego”) occupies in relation to the ties all
indicate the extent to which the person is enveloped in the
social fabric [1,2]. The greater the number and diversity of
private and public social ties, the greater the social
integration. By shifting attention to the resources and
influences that are carried across the ties between ego and
network members, social support comes into bold relief.
Generally, close ties with romantic partners and other
nuclear family members provide bonding, specializing in
the most intimate expressions of support such as listening,
caregiving, and affection. The more distant, role-defined ties
provide bridging, specializing in practical assistance and a
variety of novel information and advice [3]. This is because
the network's weak ties branch outward into other
information environments, whereas the strong ties tend to
share and recirculate the same information [4]. In short,
sources and types of support are interrelated, but, empirical-
ly, it has been found that the closer the relationship, the
greater the correlation among the several types of support,
reflecting sentiment override; people we feel close to are
perceived to be repositories of all types of support.
Testimony to the longevity of research on social support,
in 1986 Barrera [5] authored a review of the varied structural,
functional, and evaluative aspects of social support that can
be assessed, a review that was followed by a spate of new
support measures. Specifically, Barrera [5] noted that,
depending on the study's purpose, it could be important to
identify the sources of support in terms of different
categories of social ties with lay people (e.g., family
members, friends, neighbors), and the types of support,
including emotional, instrumental, companionship, informa-
tional, and esteem support. He also distinguished between
measurement of perceived vs. actual or enacted support, a
distinction that has proved critical because perceived
support, not its actual materialization, has been found to be
largely responsible for the much-heralded buffering effects
of support [6]. It appears that people who have a strong
psychological sense of support fare better in the face of
adversity than those who are less sanguine about the support
they can garner. Paradoxically, a strong sense of support
seems to give people the confidence to cope without needing
to marshal their network's resources. Hence, perceived
support is essentially the belief or faith that support is
available from network members, whereas actual support is
its mobilization and expression. Taking into account this
distinction, Cohen et al. [7] defined social support as “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” (p. 4).
Another aspect of support that may be relevant to certain
investigations is measurement of its quantitative and
qualitative adequacy from the recipient's perspective. The
former evaluates the amount of support provided, ranging
from too little to too much, whereas the latter inquires about
the quality of support, including the manner and covert
message associated with its delivery. For example, the
provider may have tendered support in a grudging way,
attached strings that limit the recipient's freedom of action,
or made the recipient feel indebted or incompetent. Indeed,
more recent studies suggest that well-intentioned but clumsy,
unsuitable, or overcontrolling support renders it neutral or
even psychologically damaging [8,9]. For example, it has
 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520
often been noted that men provide advice and recommend
action to their wives when the wives disclose an emotionally
upsetting problem. Such support does not meet the wives'
needs to vent and think out loud about the problematic
situation, but robs them of their sense of competence and
agency. Similar findings are reported by Coyne and Smith
[10] in the context of men recovering from a heart attack, but
in that context the wives showed overinvolvement and
overprotectiveness of their partners. Qualitative evaluation
of support also reveals that different psychological con-
sequences arise for the recipient when needed support is not
spontaneously mobilized by network members but must be
actively solicited [11,12].
An additional measurement option is to obtain informa-
tion about the extent of bi-directionality in the support
exchanged with network members. Bi-directionality means
that support flows back and forth between two parties, each
taking turns over time in providing and receiving support.
Ongoing unidirectional support, such as the support
provided by family members to a relative afflicted with
dementia, can be highly burdensome depending on the
history of the relationship; if the support is viewed as
reciprocity for past support rendered by the relative, then it is
far less burdensome than if such support had not been
provided in the past. It is noteworthy that the psychological
appeal of many mutual-aid, self-help (MASH) groups is
predicated on the principle that “helping you helps me”
because members are at once supporters and supported,
thereby epitomizing the ethic of mutuality. Moreover, when
support is measured bi-directionally, it is possible to
determine whether greater mental health benefits accrue to
its provider or its recipient.
It is noteworthy that measures of support can be
customized to the research context of interest, by focusing
on either certain relationships, stressors, or age groups. There
are measures of parental support for children [13],
interspousal support [14], and support among employed
coworkers and between them and their supervisors [15].
These measures and the generic network measures tend to
have a common core of items tapping emotional support, but
relationship-specific items tapping practical and esteem
support. The same applies to support measures tailored to
particular stressors; they too will include the widely
applicable emotional support items, but the informational,
instrumental, esteem, and companionship dimensions of
support will be closely tied to the focal stressor. Typically,
the items that gauge these latter dimensions are drawn from
qualitative interviews with a diverse sample of people who
are experiencing the stressor and then converted into
declarative statements that can be rated by a new sample.
Factor analysis is then conducted to assess the dimension-
ality and internal consistency of the subscales that emerge.
Good examples of such work are the development of support
measures for diet and exercise behaviors by Sallis et al. [16],
the study of the support needs and preferences of cancer
patients by Rose [17], and the measure of perceived support
513
for work stressors by Lawrence et al. [18]. Wills and Shiner
[19] present an appendix with a more complete list of studies
of social support for specific medical conditions.
Measures of support have been created for adolescents
and older adults, as well as for diverse cultural groups. Wills
and Cleary [20] adapted the emotional and practical support
dimensions of the Interpersonal Support Evaluation List
(ISEL) for use with adolescents, who were asked to rate the
support available from the parent with whom they talked the
most. The practical support items referred to help with
transportation, school work, and other demands typically
faced by teenagers. For younger children, Dubow and
Ullman [13] developed the Survey of Children's Social
Support (SOCSS), which solicits both support and network
information. Specifically, it contains 38 items that gauge
emotional, informational, tangible, and esteem support
provided by the child's network, 31 items tapping the
child's subjective evaluations of the support available from
family members, teachers, and peers, and one question about
the size of the child's network of supporters. Although the
SOCSS is both lengthy and blurs important distinctions
between emotional support and both informational and
esteem support, its items are both developmentally and
contextually relevant to elementary school children. At the
other end of the life course, Krause [21] has designed a short
measure of enacted or actually received support for older
adults. Although the emotional and informational support
subscales are highly generic in nature, the instrumental
support is tailored to the typical needs of older adults, such as
help with shopping, yard work, transportation, and house-
hold chores. Krause [21] also included three additional items
tapping the perceived availability of emotional, tangible, and
informational support. This made it possible for him to
determine that the belief that support was available had a
greater impact on older adults' sense of meaning in life than
the receipt of certain supportive provisions. It also allowed
him to determine the contribution of received support to
perceived support. Finally, Dehle et al. [14] have developed
a questionnaire that captures 48 types of enacted support
behaviors of a romantic/marital partner.
Several very brief measures of social support in networks
trade off their usefulness for field research purposes against
their relative superficiality. These measures can certainly be
productive as screening tools for social isolation, but do not
yield much information about the nature and extent of
people's social integration and receipt or provision of
support. Some of the brief measures are short versions of
longer scales, such as the abbreviated six-item version of the
Lubben Social Network Scale [22]. It contains three items
about family support and three identical items about friends'
support, the items tapping the number of people in each
relationship category with whom there is at least monthly
contact, the number to whom the respondent feels close
enough to request help, and the number with whom the
respondent feels enough at ease to talk to about private
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
measure is best used as a screening tool for social isolation.
The same applies to the measure developed by Undén and
Orth-Gomér [23] but it contains double the number of items.
It too contains a set of items tapping social integration
without always specifying the sources of contact, as well as a
set of items tapping “availability of attachment” which,
translated, means the presence of a confidant. The former
items assess broader and less profound forms of support,
such as network members with whom the respondent can
talk frankly and share interests, and who can be asked for
small favors and invited for a home visit. The response
formats vary across the items, some receiving ratings and
some categorical (e.g., yes/no) responses.
A final short support measure that concentrates on
emotional, tangible, and informational support was expressly
developed for the study of patients who had incurred a
myocardial infarction but applies equally well to patients
with other chronic illnesses. The ENRICHD Social Support
Inventory (ESSI) has seven items that ask “how much of the
time” emotional, informational, and practical support are
available from (unspecified) network members plus a single
item that calls for a categorical response about the existence
of a romantic partner [24]. Individually, these aspects of
support were previously found to predict mortality in
cardiovascular patients. A five-item version of the ESSI
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
tapping emotional support from a close associate. Its brevity
and strong psychometric properties commend the ESSI as an
excellent screening tool for perceived social support (see
Table A1 and Appendix). It could be employed, for example,
to determine who is likely to benefit most from interventions
that augment support, such as support groups [25].
Cultural variations in the behaviors and activities that
signify support have been investigated quite extensively.
Measures of perceived and received support cannot be
assumed to be equivalent cross-culturally, precluding simple
translation. In a fascinating chapter, Weisner [26] reports on
the meaning and expressions of support among Kenyan
children in a tribe called Abaluyia. Employing local children
as observers and recorders, Weisner [26] describes the
example of a distressed child who is supported by being
given a job to do without verbal interaction about the child's
feelings or cause of the distress. Other observations revealed
that dominance and teasing often accompany acts of support.
Support measures for Asian populations have also been
created, including measures for Korean adults [27] and
Chinese people [28–30].
Researchers interested in the acculturation of newcomers
will find an excellent measure that contains both generic
items and items unique to the experience of immigration and
adjustment in the Index of Sojourner Social Support (ISSS)
[31]. The development of this measure is exemplary.
Beginning with a diverse sample of 54 participants from
Asia, Europe, North America, and Oceania, Ong and Ward
[31] generated a set of perceived support items based on the
participants' answers to questions about their current social
network, differences in the types of support provided by
local vs. overseas ties, difficulties experienced in the host
country they entered, and the help they received in coping
with those difficulties. This was followed by validation
studies that examined the ISSS's correlation with measures
of received support, anomie, mastery, interpersonal trust,
locus of control, depression, and social desirability. A third
study then examined and confirmed the cross-cultural
stability of the two dimensions of support identified in the
second study with samples of international students in New
Zealand and England. The strong psychometric properties of
the ISSS commend it while the substantive findings reveal
that sojourners rely on their weaker, local ties for
instrumental and informational support, and perceive
emotional support to be mainly available from their stronger,
overseas ties to family and friends. Equally interesting, the
practical and informational support perceived to be available
from their host country network had a stronger bearing on
their (lower) level of depressive affect than the emotional
support available from the ties in their country of origin. This
demonstrates that emotional support is not always the
panacea in stress-related contexts nor is its meaning and
value culturally universal.
Methods of documenting support
The social support concepts that we have introduced are
variously represented in the several measures we now touch
upon. Of these measures, we have singled out three that have
earned our confidence because of their strong psychometric
properties and their probable usefulness and appeal to
investigators. One is a short-form gauge of perceived
support, another a comprehensive assessment of perceived
support, and the third a measure of received support (please
see Table 2 and Appendix A).
The vast majority of support measures have been based
on self-reports that are gained from survey tools or
interviews. The typical generic perceived support survey
lists sets of items that fall into the various classes of support
and inquires about the extent of their availability. Measures
like the ISEL begin with a stem that refers to any one
network member who can provide a given type of support
[32]. An example is, “When I need suggestions for how to
Table 2
Comparison of three recommended social support self-report measures
Name of Number Studies using
measure of items method Reliability Validity
ISSB 40 Many ++ ++
SPS 24 Many ++ ++
ESSI 7 Few + +
 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520
deal with a personal problem, I know there is someone I can
turn to.” This measure makes it possible for people to obtain
a high score if they have only one source of support such as a
confidant. In contrast, the Social Support Questionnaire
(SSQ) requests information about the number and initials or
first names of network members who would provide given
types of support (up to a maximum of 9), followed by a
single evaluation of satisfaction “with the extent to which
you are supported in this way” [33]. Hence, the SSQ can gain
information about several network members, but its reliance
on a single evaluation of their collective adequacy blurs
important differences among them. A third variant is
Procidano and Heller's [34] two measures of perceived
support, one inquiring about available support from family
members and one tapping perceived support from friends.
These two measures illustrate that investigators need not
focus on the entire network, but can concentrate on particular
classes of relationships or particular sources. Measures can
also inquire into only one or two types of support.
One perceived support measure differs from the rest by
virtue of its derivation from Weiss's [35] theoretical
formulations about the resources provided by social
relationships. The Social Provisions Scale (SPS) includes
24 items tapping six types of provisions available from the
general social network, including reliable alliance (practical
help), guidance (informational support), attachment (emo-
tional support), social integration (belonging to a group of
similar peers), reassurance of worth (esteem support), and
opportunity to provide nurturance (providing support) [36].
The latter type of support rests on the premise that
relationships offer opportunities to render, not just receive
support, and suggests that there may be distinct benefits
from being useful to others. This notion is captured by the
motto of many mutual aid and support groups, to the effect
that “helping you helps me.” As displayed in Appendix A,
the SPS has received a commendable amount of psycho-
metric evaluation and is recommended when a comprehen-
sive assessment of perceived support is needed without
identifying particular sources.
Perhaps because the kinds of support people receive
depend largely on the stressful demands they are coping
with, there are few generic measures of received support.
The most widely used measure is the Inventory of Socially
Supportive Behaviors (ISSB; please see Appendix A). It
contains 40 items inquiring about the frequency of recent
receipt of emotional, informational, and practical support,
along with companionship, from any (unspecified) network
members [37]. However, the ISSB is vulnerable to problems
of over- and underinclusion of types of support; it may
contain items that are irrelevant to the stressor context and
therefore should not be included in the total score, and it may
not contain items that could be relevant forms of support for
the context. Hence, if used, the ISSB should be carefully
customized to the situation and then validated, perhaps by
checking with the support providers. It is also noteworthy
that it is inappropriate to determine the internal consistency
515
of received support in whole or by subscale because the
receipt of one type of support does not necessarily imply
receipt of other types of support, nor does the receipt of one
emotionally supportive behavior imply that other types of
emotional support will be tendered.
Finally, researchers interested in gaining a comprehensive
assessment of social support are advised to consider
Krause's [38] battery of support measures. It consists of
several short but psychometrically acceptable scales includ-
ing frequency of contact with family members and friends
(two scales, each composed of three items); practical,
emotional, and informational support received from network
members in general as well as the provision of the same three
types of support to associates (six scales, each composed of
three items); and a single perceived network support scale
composed of three items, one for each of the preceding types
of support.
Observational and daily diary methodologies
Although most widely used because of their convenience
and brevity, self-report measures are not the only method-
ology employed to assess support. Cutrona and Suhr [39]
have developed a coding scheme for capturing support
transactions between spouses that contains 23 “support-
intended communication behaviors” (p. 120) that cover five
dimensions and were derived in part from couples'
descriptions of the support they wanted to receive from
their partners upon the occurrence of stressful events. All
but one of the codes are based on the couples' oral support
communications, the exception being physical affection. In
fact, this coding scheme includes five items that do not tap
support, but assess negative verbalizations such as criticism
and complaints about the partner. Otherwise, the scheme
contains the familiar quartet of emotional, esteem, informa-
tional, and practical support along with companionship. A
second coding scheme that has been developed to observe
social support between romantic partners contains 48 items
and has been productively employed by Dehle et al. [14] in
a daily diary study. Married partners completed the SIRRS
on seven consecutive evenings, making two ratings for each
of the 48 support items. One rating documented the
frequency that the partner engaged in each supportive
behavior and the other reflected how much of each the
participant preferred to receive. Not surprisingly, spouses
who received less support than they wanted had higher
levels of depressive affect and lower marital adjustment
even after controlling for social desirability.
A somewhat different daily diary methodology was
employed by Bolger et al. [40] in a study of spousal support.
With the aim of understanding why actual/enacted support
does not have the buffering effects produced by perceived
support, the authors tested the proposition that the explicit
expression of support incurs “…a cost to self-esteem because
it makes salient to recipients that they are having difficulties
coping with a stressor” (p. 953). However, if the support is
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“invisible” to the recipient, it is more likely to preclude any
adverse effect on self-esteem and serve a stress-moderating
function. Invisible support can either be indirect and
unobserved by the recipient, an example being that the
provider speaks to someone on behalf of the recipient, or
behavior that is not interpreted as help by the recipient, such
as the provider sharing his or her way of coping with an
identical or similar stressor. Procedurally, over a period of 32
evenings before and three evenings after the major scheduled
stressor of writing a bar examination, the examinees
indicated whether their partners had provided emotional
support involving listening to and comforting the examinees,
while their partners reported on their daily provision of this
emotional support. Although the participants responded only
to this single item that called for only a categorical response,
the analysis showed that the examinees' depressive symp-
tomatology declined on days when they reported not having
received emotional support but their partners reported having
provided support. Conversely, the examinees' adjustment
declined on days when both parties agreed that emotional
support had been provided. As the authors conclude,
supportive transactions may be optimal when “… the
recipient reaps the benefits of support provision without
incurring the cost of support receipt” (p. 958).
Concurrent or convergent validation of perceived
support measures has typically been based on their
correlations with constructs deemed to be related to them.
Examples include received support since it should have
some bearing on people's beliefs about the availability of
support; social skills, sociability, and extraversion because
more outgoing people are more likely to form more
relationships from which they can gain support; and
measures of interpersonal trust and relationship warmth
and closeness, including marital adjustment and satisfaction
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
validate measures of perceived support [41]. Adults with a
history of secure attachment do indeed report having more
and longer-lasting close relationships, viewing network
members as more reliable and responsive during times of
need, and assigning greater value to emotional intimacy.
However, these findings are largely based on retrospective
studies whose fallibility stems from influences of current
mood and social experiences on reports and, therefore,
await confirmation by prospective inquiries. Social desir-
ability can also bias reports of perceived support because
self-presentational needs may conspire to sway people
toward more sanguine accounts. Few of us would be
willing to project an image of ourselves as deficient in
social ties and impoverished in the help and support we can
secure from our associates. Moreover, if we are asked to
report on the support we can gain at a time when we are
suffering the ill effects of a stressful event, it is likely that
we will attribute our plight to a network that has left us
bereft of support.
Conclusion
As a focus for interdisciplinary research, the measurement
of social support has been enriched by the contributions of
epidemiologists, health psychologists, sociologists, and
investigators in the fields of human communication, nursing,
and medicine. There are manifold off-the-shelf checklists
and rating scales with acceptable psychometric properties
[42], some that yield information about the composition and
morphology of the social networks from which support
arises. With a clear understanding of the concepts spotlighted
in Table 1, researchers can also customize support
measurement to the particular stressors and samples of
interest. Qualitative interviews with key informants can
produce knowledge of culturally- and developmentally
specific expressions and perceptions of support that are
invaluable for both basic and intervention research. Howev-
er, the application or development of support measures must
be predicated on a sound grasp of study aims and objectives:
Is support an end in itself or a means to other ends, such as
adherence to medical regimens? Is received or perceived
support of most interest? Is it important to capture the
support provided by or available from particular network
members or can the inquiry focus on the network as the unit
of analysis? Are certain types of support of special interest
because of the demands of the stressor or the paucity of
certain social provisions in the lives of the participants? Is the
amount of support, its quality, and its sustainability vital to
the planning of community programs and to an understand-
ing of its effects? Consideration of these questions will help
to align measurement with the purposes set out for study.
Equally important, these questions can alert investigators to
the kaleidoscopic character of the resources that reside in the
social ecology.
Appendix A. Inventory of Socially Supportive Behaviors
Purpose
The Inventory of Socially Supportive Behaviors (ISSB) is
a measure of the frequency of receipt of a wide variety of
verbal and behavioral expressions of social support,
designed for use in the general population [43].
Conceptual basis
The ISSB was designed on the basis of evidence from
empirical research [44] and literature reviews regarding the
types of help and support people receive from members of
their social networks. Items gleaned from previous research
were rewritten to maximize behavioral specificity, avoid
wording applicable only to specific populations, and omit
references to psychological adjustment. The authors pro-
duced 40 items believed to tap the range of important
supportive functions [37]. The 40 socially supportive
 B.H. Gottlieb, A.E. Bergen / Journal of Psychosomatic Research 69 (2010) 511–520
behaviors reflect six main functions of support: material aid,
behavioral assistance, intimate interaction, guidance, feed-
back, and positive social interaction [43].
Description
The ISSB is a self-administered survey, which takes 10–
15 min to complete. Each item is a statement describing a
particular expression of support (e.g., “Did some activity
together to help you get your mind off of things”). The 40
items are scored using a five-point ordinal response format
reflecting the frequency of receipt of each supportive
behavior during the previous month (1=not at all, 2=once
or twice, 3=about once a week, 4=several times a week,
5=about every day). ISSB scores are calculated by summing
or averaging responses to individual items. The ISSB can be
administered to assess support from particular types of
relationships, such as family or friends [37]. In addition, the
ISSB can be customized by adding items that are unique to a
particular stressor and by removing irrelevant items [45,46].
Reliability
Based on an initial sample of 71 undergraduate students,
the ISSB showed 2-day test–retest reliability ranging from
.44 to .91 across the 40 items [37]. The average 2-day test–
retest reliability coefficient was good, with r=.88. The item-
total correlation coefficients ranged from −0.82 to .69,
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
coefficients between .93 and .94 for the first and second
testing sessions, respectively [37]. Evidence from factor
analysis suggests that the ISSB is not a unidimensional
measure and that ISSB subscales should be scored individ-
ually [46]. In addition, overall reliability is not necessarily a
useful indicator of the utility of the ISSB, as individuals may
not necessarily receive all kinds of support in a given
situation. Exploratory factor analysis of revised ISSB items
identified a four-factor solution, the first factor comprising
Guidance and Feedback, the second Nondirective Support,
the third Positive Social Interaction, and the fourth Tangible
Assistance [43]. Confirmatory factor analysis based on 30
items from the ISSB found that a four-factor model was a
better fit than either a three-factor or a unidimensional
solution [46]. In spite of the multidimensionality of the ISSB,
there is evidence that it has good internal consistency in
samples from other cultures. For example, a study of 200
Chinese university students in Beijing and Nanjing yielded a
Cronbach's alpha of .94 for a translated ISSB [45].
Validity
Evidence for the validity of the ISSB comes from its
moderate direct correlation with social support network size
(r=.32 to r=.42), as assessed by the Arizona Social Support
517
Interview Schedule [37]. In addition, when participants were
instructed to respond to the ISSB items in terms of their
family support, ISSB scores were directly related (r=.36) to
scores on Moos's [47,48] Family Environment Cohesion
Subscale [37]. Received social support, as assessed by the
ISSB, is directly related to the occurrence of physical
symptoms (r=.22) and with the frequency of both positive
(r=.28) and negative (r=.28) life events [49]. Thus, as a
measure of received social support, the ISSB is able to assess
the mobilization of support upon the occurrence of physical
symptoms and/or life events. There is evidence that ISSB
subscales are differentially related to depression and life
satisfaction, such that tangible assistance and direct guidance
show only a slight correlation with depression scores (r=.16
and r=.09, respectively), whereas positive social interaction
has a moderate negative relationship with depression (r=
−.29). Only the positive social interaction subscale is directly
related to life satisfaction (r=.27); the other three subscales
are unrelated [46]. Thus, use of composite ISSB scores (i.e.,
40 item totals) may obscure researcher's efforts to
understand the relationship between received social support
and other factors such as depression and life satisfaction.
Evidence for the divergent validity of the ISSB comes from
its differentiation from perceived support measures. A meta-
analysis examining the relationship of the ISSB with various
perceived support measures across 24 studies found an
average correlation of r=.32, suggesting that received
support is a distinct construct from perceived support [50].
Social Provisions Scale
Purpose
The Social Provisions Scale (SPS) is a measure of six
perceived support functions, designed for use in the general
population [36].
Conceptual basis
The SPS is based on Weiss's [35] model of social
provisions, which distinguishes the assistance-related func-
tions of social ties (i.e., reassurance of worth, guidance, and
reliable alliance) from their non–assistance-related functions
(i.e., opportunity for nurturance, attachment, and social
integration) [36]. Construction of the SPS began with 12
statements reflecting positive and negative phrasing of
Weiss's six provisions of social relationships. To increase
the reliability of the measure, the SPS was expanded to 24
items, with four items for each of the six subscales.
Description
The SPS is a self-administered perceived support survey,
consisting of 24 items which respondents rate on a four-point
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
subscales are scored by summing responses to individual
items, after reverse coding negatively worded items.
Similarly, a total SPS score is calculated by summing all
items after appropriate reverse scoring.
Reliability
Based on samples of 1792 respondents across several
studies, including students, nurses, and public school
teachers, the SPS showed excellent overall internal consis-
tency, with a combined Cronbach's alpha of .92 [36]. The
internal consistency of subscales is adequate, ranging from
.65 to .76. Age and sex differences were found in SPS scores,
but these accounted for less than 7% and 4% of the variance
in SPS scores, respectively. Confirmatory factor analysis
indicated that a six-factor oblique model was a better fit to
the data than a single-factor model. High intercorrelations
among subscales (r=.54 to r=.99) indicate the presence of a
second-order factor.
Validity
Convergent and divergent validity of the SPS have been
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
measures of social desirability, psychological distress,
personality factors, and social skills were lower than
correlations between SPS scores and other validated social
support measures, including satisfaction with support,
number of supportive persons, number of helping behaviors,
and attitudes towards support. Even after controlling for the
nonsupport measures, the other social support measures still
predict SPS scores in a regression model [36]. In addition,
after controlling for the other social support measures, SPS
scores together with stress effects and the SPS by stress
interaction still predict depression [36].
Comments from the author of the SPS, Carolyn Cutrona
The SPS [36] has been translated into several languages
(e.g., French, Portuguese) and several variations on the scale
have been developed. The Source-Specific Social Provisions
Scale [51] was developed to allow the assessment of
perceived social support from specific members of the social
network. The published version was developed for use with
adolescents and assessed perceived support from parents,
male partner, and friends. It has a simplified three-point
response scale (1=no; 2=sometimes; 3=yes). Reliability for
the Source-Specific SPS was .78 among childbearing
adolescents [51].
A short version of the SPS has also been developed. This
10-item measure includes one positively worded and one
negatively worded item from each of five subscales. The
Opportunity to Provide Nurturance subscale was omitted in
the short version because it taps perceptions that one
provides support to others rather than perceptions of
receiving support. Reliability of the 10-item scale among
community adults is .83.
The short version of the SPS has also been validated for
use with African-American samples. In a sample of over
600 African-American adults, reliability was .81 and test–
retest reliability was .48 over 2 years. Validity was
evidenced by significant correlations with relationship
quality and stability.
Caution should be exercised when using the SPS to assess
individual components of social support. Confirmatory factor
analyses on data from the full 24-item scale have supported
the hypothesized six-factor structure for the measure, with a
large second-order factor reflecting overall level of support.
However, it is clear that several of the first-order factors
reflecting different types of support are highly intercorre-
lated. Specifically, correlations among the five provisions
that reflect receiving support from others (i.e., Guidance,
Reassurance of Worth, Social Integration, Attachment, and
Reliable Alliance) are correlated from .70 to .99 with one
another. The provision that reflects providing support to
others (i.e., Opportunity to Provide Nurturance) is less highly
correlated with the other five provisions (r=.56 to .64).
ENRICHD Social Support Inventory
Purpose
Originally designed for use with patients recovering from
myocardial infarction [24], ESSI is a seven-item measure
that assesses the availability of support from any network
member plus a single item inquiring about the existence of a
marital/partner.
Conceptual basis
The authors created items by searching the literature for
evidence of the types of structural, instrumental, and
emotional support that predict lower mortality in myocar-
dial infarction patients [24]. The measure was designed to
avoid assessing network morphology, based on evidence
from the literature that network structural properties are less
important than emotional support for survival after
myocardial infarction.
Description
The ESSI is a self-administered survey, consisting of
seven items. For six of the items, respondents rate the
availability of a network member to provide emotional (four
items), informational (one item), and practical (one item)
support. Availability is rated on a five-point Likert-type
response format that ranges from none of the time to all of
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
Table A1
Comparison of the quality of social support measures
Studies
Name of Number Administered using
the scale of items by (time) method Reliability Validity
ISSB 40 Self (10–15 min) Many ++ ++
SPS 24 Self (5 min) Many ++ ++
ESSI 7 Self (5 min) Few + +
+, some information; ++, excellent psychometric properties.
question, “Are you currently married or living with a
partner?” and is scored such that an affirmative response is
worth 4 points and a negative response 2 points. The ESSI
yields a single summed score and takes 5 min to complete.
Reliability
Based on a sample of 196 pilot participants, the ESSI
shows good internal consistency, with a Cronbach's alpha of
.86 [24]. If Items 5 and 7 are dropped, the internal
consistency coefficient increases to .87; this minimal
increase in internal consistency suggests that the seven-
item scale should be used. A modified version of the ESSI
(with revision of one emotional support item) was used with
a sample of 200 Chinese immigrants with hypertension and
showed excellent internal consistency, with a Cronbach's
alpha of .91 and item-total correlations ranging from .70 to
.84 [52]. These results suggest that the ESSI can be
successfully modified for use with non-Western participants.
Validity
In the pilot study, evidence for convergent validity comes
from the moderate correlation of ESSI scores with the
Perceived Social Support Scale, a measure of available
emotional support (r=.62), although this relationship was
attenuated for males and minorities (r=.41 and r=.42,
respectively) [24]. ESSI scores showed lower correlations
with Social Network Questionnaire scores (r=.20) and
overall ISSB scores (r=.25). ESSI scores were related to all
ISSB subscales (r=.26 to .34), except for tangible assistance
[24]. Because the ESSI is designed to measure different
aspects of support than the ISSB (i.e., perceived, not
received, support) and the Social Network Questionnaire
(functional, not structural, aspects of the social network), this
is evidence for its discriminant validity.
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