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Co gniti ve Therap y an d Research, Vol. 23, No . 5, 1999, pp .

511-533

Clinical D epression and Perceptions of Supportive Others: A G eneralizab ility A n alysis


Brian Lake y,1,2 Jan a B rittain D rew ,1 an d K im berly Sirl 1

Lo w perceived support is asso ciated w ith emotio nal distu rban ce. Tw o im portan t determ in an ts of social support ju dgm ents are perceptual biases of the perceivers an d the Percei ver 3 Su pporter in teractio n. Recent gen eraliz ab ility studies ha ve found that the Perceiver 3 Su pporter in teractio n is a m uch stronger in uence on support ju dgm ents than the perceptual biases of percei vers. How ever, these recent studies were based on norm al sam ples. The present research in vestigated w hether perceptual biases in support ju dgm ents w ould be stronger for clin ically depressed in patien ts. Patien ts an d con trols view ed four vid eotap ed targets an d rated targets supporti veness. Co m pared to norm al controls, depressed in patien ts did not show a negati ve perceptu al bias that gen eraliz ed acro ss support pro vid ers. Consisten t w ith norm al sam ples, how ever, th e Perceiver 3 Su pporter in teractio n w as m ore im portan t, as patien ts an d controls differed in w hom they saw as suppo rti ve. Controls saw su pporters high on agreeab leness as m ore supportive, but did not rely on extra versio n, conscientio usness, or openness in m akin g support ju dgm ents. The su pport ju dgm en ts of depressed patien ts w ere hard er to ch aracteriz e. Im plicatio ns for in terventio ns w ere discussed.
KE Y WOR DS: depression; cognition; social support.

Cognitive proce sse s are important in both depression and social support. Score s of studie s have be e n publishe d on cognition and depression and succe ssful inte rventions have be e n de velope d from cognitive perspe ctive s ( Barne tt & Gotlib, 1988; Be ck, Rush Shaw, & E mery, 1979; Gotlib & Hammen, 1992; Hammen & Krantz, 1985; Robinson, B e rman, & Neimeye r, 1990) . A lthough cognitive approache s have only recently be e n applie d to unde rstanding social support, the re is now a growing cognitive perspective in social support re se arch (Lakey & Cassady, 1990; Lake y & Drew, 1997; Mankowski & Wyer, 1997; Pie rce, B aldwin, & Lydon, 1997; Sarason, Pie rce, & Sarason, 1990) . Rese arch in both areas has e mphasize d assimilation e ffects in which chronically accessible cognitive cate gorie s bias the processing of ne w inform ation to t e xisting be liefs (c.f. Higgins, 1996) . For example , many studie s
1 2

Wayne State Unive rsity. Corresponde nce should be sent to B rian Lake y, Departme nt of Psychology, 71 W. Warren A ve ., Wayne State Unive rsity, Detroit, Michigan, 48202. E -mail: brian.lakey@wayne .edu 511
0147-5916/99/1000-0511 $16.00/0 1999 Plenum Publishing Corporation

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have e xam ine d de pre ssion and ne gative biase s in atte ntion, judgm e nt, and memory (Gotlib & Hamme n, 1992; William s, Mathe ws, & MacLe od, 1996) . Similarly, cognitive social support re se arch has inve stigate d how individual diffe re nces in pe rceive d support are re late d to the inte rpretation of and me mory for supportive be haviors and people (Lake y & Drew, 1997; Mankowski & Wye r, 1997; Pierce, B aldwin, & Lydon, 1997) . A lthough a large numbe r of studie s indicate that low pe rceived support is associate d with de pre ssion and a wide range of othe r he alth outcom es (B arrera, 1986; Cohe n & Wills, 1985; B arne tt & Gotlib, 1988; Lowe nthal & Have n, 1968; Phife r & Murre ll, 1986; Swindle , Cronkite , & Moos, 1989; Uchino, Cacioppo, Keicolt-Glase r, 1996) , less progre ss has be en made in unde rstanding the dete rminants of support perceptions. Conce ptually, the re are at le ast three important dete rminants: The pe rceive r, the supporte r, and the Perceive r 3 Supporte r inte raction (Lake y, McCabe , Fisicaro, & Drew, 1996) . Social support the ory traditionally has e mphasize d the role of the supporte r. A ccording to this vie w, support pe rceptions ( i.e ., pe rceive d support) are dire ct re e ctions of the amount and quality of the social support actually receive d (i.e ., enacte d support) ( Sarason, Sarason, & Pierce, 1990; Cutrona & Russe ll, 1990; Thoits, 1986) . Howe ve r, the size of the re lation betwe en pe rceive d support and enacte d support is too small ( r # .30) for pe rceive d support to be base d prim arily on the receipt of supportive behaviors (B arre ra, 1986; Lake y & Lutz, 1996; Lakey & Drew, 1997; Dunke l-Sche tter & B e nne tt, 1990; Sarason e t al., 1990; Sarason, She arin, Pie rce, & Sarason, 1987) . Perceive rs contribution to support judgme nts traditionally has be en emphasized by individual-dif ference mode ls of pe rceive d support (Lake y & Cassady, 1990; Sarason et al., 1990; Sarason, Sarason, & She arin, 1986) . A ccording to this vie w, support judgm e nts partly re ect the te nde ncy of pe rceive rs to color new inform ation to t existing beliefs. In fact, the re is substantial e vide nce that high pe rceived support pe ople inte rpre t the same , nove l, supportive be havior and persons more favorably than do low perceive d support individuals. This nding has be e n re plicate d many time s across a wide range of sample characte ristics and measure s (A nan & Barne tt, in pre ss; Lake y & Cassady, 1990; Lake y, Moine au, & Drew, 1992; Pierce, Sarason, & Sarason, 1992; Rudolph, Hamme n, & B urge , 1995; Sarason, Pie rce, She arin, Sarason, Poppe , & Waltz, 1991) . Howe ve r, the size of the Perceive r e ffect is not suf ciently strong to sugge st that support judgme nts can be unde rstood solely on the basis of pe rceptual biase s. B e yond the role of supporte rs and pe rceivers, a re cent se rie s of ge neralizability studie s sugge st that the most important de te rminant of support judgm ents is the Pe rceive r 3 Supporte r inte raction (Lake y, McCabe , e t al., 1996) . For e xample , Pe rceive r A may re liably se e Targe t A as more supportive than Targe t B , whereas Pe rceive r B may re liably show the opposite patte rn. This inte raction can occur through both cognitive and be havioral processes. A s an example of a be havioral proce ss, Perceive r A may e licit more supportive be haviors from Targe t A than from Targe t B , and Perceiver B may e licit more supportive be havior from Targe t B. The Perceive r 3 Supporte r inte raction can also occur through pure ly cognitive mechanisms. E ve n when pe rceive rs are pre se nted with the same information about

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supporte rs, the Perceive r 3 Supporte r inte raction is still obse rved (Lake y, McCabe , et al., 1996, study 3). A n e xam ple of a cognitive proce ss contributing to the Pe rceiver 3 Supporte r inte raction is whe n pe rceivers base support judgme nts on pe rceive rs similarity to supporte rs (Lake y, Ross, B utle r, & B e ntle y, 1996; Suitor, Pille me r, & Keeton, 1995) . The same information that make s Targe t A similar to Pe rceive r A make s Targe t A dissimilar to Perceiver B . A lthough Lake y, McCabe , e t al. (1996) found that the Pe rceive r 3 Supporte r inte raction was a much stronge r in uence on support judgm e nts than the pe rceptual biase s of perceivers, their studie s were base d on norm al sample s. Studie s including clinically de pre sse d patie nts may show important diffe re nce s. Perceptual biase s may be more important for de pre sse d patie nts than for controls. Studie s that include patie nts may show stronge r e ffects for the role of perceive rs than studie s base d on normal sample s. In addition, although the Pe rceive r e ffe ct may be re lative ly small (eve n among clinical sample s), the Pe rceive r effe ct may still be the compone nt that is associate d with disorde r.3 O nly a portion of perceived support variance is associate d with disorde r, and this ove rlap may be share d with the pe rceiver compone nt rathe r than the Pe rceive r 3 Supporte r inte raction. The re is anothe r re ason to study the Pe rceiver 3 Supporte r inte raction in clinical samples. Given the appare nt importance of the Pe rceive r 3 Supporte r inte raction, it will be important to identify groups that diffe r in whom they se e as supportive . Clinical disorde r is one important individual diffe re nce variable that may account for why diffe rent pe ople se e the same supporte rs diffe re ntly. If so, inte rve ntions de signe d to incre ase pe rceive d support among de pressed patie nts must be guide d by knowle dge of what type s of people de pre sse d patie nts se e as supportive . To inve stigate the se que stions, the present study include d both de pre sse d inpatie nts and norm al controls. If clinical de pre ssion is associate d with a bias to see ne arly e ve ryone as unsupportive , the n patie nts should se e a sample of targe ts as le ss supportive than do controls. Howe ve r, if the diffe re nce s be twe en de pre sse d patie nts and controls follow the patte rn of the Pe rceive r 3 Supporte r inte raction, then de pressed patie nts should display a diffe re nt relative orde ring of targe ts on supportive ne ss than do controls. If patie nts and controls diffe r in whom the y se e as supportive , the n the two groups may be responding to diffe rent characte ristics of targe ts in making support judgments. The re fore , patie nts and controls judgm e nts of targe ts were mappe d onto supporte rs pe rsonality characte ristics to see which characte ristics of targe ts were associate d with patie nts and controls support judgme nts.

ME THOD Particip an ts E le ve n clinically de pre sse d inpatie nts and 14 nonde pressed controls from Detroit participate d in the study. The two groups were roughly e quivale nt on age ,
3

We thank Catherine J. Lutz for this insight.

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ethnicity, inte llige nce , and socioe conom ic status (Table I). Hospital diagnose s of depre ssion were veri e d by one of the authors by making RDC diagnose s of Major De pre ssion base d on the Sche dule for A ffe ctive Disorde rs and Schizophre nia (SA DS; E ndicott & Spitze r, 1978) . A ll but one of these inte rviews and diagnose s we re inde pe nde ntly re vie wed by a fully lice nse d clinical psychologist with exte nsive clinical e xpe rie nce in de pre ssion (the audio re cording faile d for one patie nt s inte rvie w) . Participants were include d in the study only if the ir primary diagnosis from all three source s was Major Depre ssion. Four depressed participants had a history of substance abuse or depende nce as well, and all four of the se were abusing at admission. Howeve r, in e ach of these cases, substance abuse followe d the onse t of depre ssion, and patie nts we re fre e of ille gal drugs at the time of the study. Hospital staff also saw the se four patie nts as having de pre ssion as the ir primary diagnosis as none of the patie nts were be ing tre ated spe ci cally for substance abuse . Thre e patie nts also suffere d from anxious symptom atology, but again, the ir primary diagnosis was depre ssion. Controls were solicite d through ye rs adve rtising for participants . Pote ntial participants we re administe red a brie f scree ning que stionnaire to de termine the ir suitability for the study. This scree ning instrum ent include d que stions re garding ethnicity, gende r, socioe conomic status, and past tre atment for psychologic al disorders or substance abuse . Pote ntially suitable participants were the n se en for an individual testing se ssion to comple te the study me asure s. Controls had not be e n hospitalize d in the past for psychologic al disorde rs, and had B e ck Depre ssion Inve ntory scores be low 9.

Procedure The main asse ssment instrum ent was a vide otape that aske d participants to judge the supportive ne ss of four targe ts and re call the targe ts be haviors. A dministration of the vide o asse ssment measure s and the que stionnaire packe t asse ssing depre ssion and pe rceive d support were counte rbalance d. Two ve rsions of the vide o we re pre se nte d that varie d the orde r in which the targe ts appe are d. The re we re no orde r e ffe cts. E xpe rime nters were blind to the hypothe ses of the study.

Table I. De mographic V ariables Depresse d patients Gende r Male Female E thnicity A frican A merican E uropean A merican Hispanic Median SE S Mean age Mean IQ 6 5 6 5 0 26.5 19.1 90.8 Controls 5 9 8 5 1 28.5 19.1 90.6

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ME A SU R E S Intellige nce Inte llige nce was me asure d by the use of a short form of the WA IS-R that consiste d of the V ocabulary and B lock Design subte sts. This short form has be e n shown to correlate with the full scale score at r 5 .90 (Sattle r, 1990) .

So cioeconom ic Statu s Socioe conomic status was measure d by the Hollingshe ad Inde x of Social Position (Hollingshe ad, 1975) , which assigns a classi cation of socioe conom ic status base d on the occupation and educational le ve l of the head( s) of house hold. A ccording to this inde x, de pre sse d participants and controls were typically raise d in le vel IV familie s, characte rized by se miskille d worke rs such as security guards and orde rlie s.

Pe rceiv e d So cial Su pport Perceive d support was me asure d by the Interpersonal Support E valuation List (Cohen, Me rmelste in, Karmarck, & Hobe rman, 1985) . This scale has be e n use d exte nsive ly in social support research and has substantial e vide nce for its re liability and validity. It was modi e d for the pre se nt study by providing a 5-point re sponse scale with ``strongly agre e and ``strongly disagre e as e xtre me re sponse s. This modi cation was made to allow for gre ater variance in re sponse s and has be e n used succe ssfully in prior inve stigations (e .g., Lake y & Cassady, 1990; Lake y e t al., 1992) .

D e pre ssio n Participants comple te d the B eck Depression Inve ntory ( B eck, Stee r, & Garbin, 1988) to provide an inde x of participants current le ve l of de pre ssion. Substantial evide nce e xists for the re liability and validity of this scale .

Su pport-R e late d Cogn itio n To asse ss cognitive proce sse s in support judgme nts, participants were shown a vide otape consisting of four 5-min inte ractions be twee n a targe t and an individual describing a proble m to the targe t. A ctors of age s similar to participants portraye d the role s. Same -se x dyads discusse d family (in two of the vigne tte s), car, or landlord dif cultie s. The came ra was focused on the targe t, who had bee n instructe d to behave in ne ithe r a particularly supportive nor nonsupporti ve fashion, with the hope that more ambiguous response s would allow for gre ater individual diffe rence s in inte rpre tation.

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Characte ristics of V id e otap ed Targe ts The se four conve rsations we re sele cted from the e ight conve rsations use d in study 3 of Lake y, McCabe , e t al. (1996) . We se le cted the se four conve rsations base d on se ve ral conside rations. First, because our sample was expe cted to be roughly eve nly divide d be twee n men and wome n and be twe e n pe ople of both A frican and Europe an ance stry, we sele cted four vide os that repre se nte d all four combinatio ns of ge nde r and e thnicity. Thus we re taine d a black man, a black woman, a white man, and a white woman. B eyond ge nde r and e thnicity, we wante d to se lect conve rsations in which the targe t was within one standard de viation of the me an on supportive ne ss according to the distribution obse rve d in our prior study. O ne targe t s support score was well above one standard de viation above the mean, but she was include d in the nal tape because she was the only A frican-A merican female targe t include d in our prior study. E ach targe t was also rate d on the B ig-5 pe rsonality dime nsions by a se parate group of 19 judge s. The se judge s were unde rgraduate s e nrolle d in psychology classe s at Wayne State Unive rsity. Judge s vie wed the four conve rsations and rated each targe t on a 5-point scale with the 92 adje ctives provide d by Trapne ll and Wiggins (1990) as marke rs of the B ig 5. Inte rrater re liabilitie s ( a) were .92 for e xtrave rsion, .88 for ope nne ss, .89 for agre e able ne ss, .80 for conscie ntiousne ss, and .22 for ne uroticism. B ecause of the low inte rrate r agre e ment for ne uroticism, this variable was not analyze d. To de te rmine how the targe ts pe rsonalitie s diffe re d (as e xpre sse d during the vide o), a re pe ate d-measure s A NOV A was calculate d for e ach personality trait with each targe t represe nting one le ve l of the Targe t factor. The four targe ts diffe re d signi cantly and substantially on all of the traits. The black woman was the most extrave rte d and the white woman and black man were the least e xtrave rte d. The two women were the most agre e able and the two men were the least agre e able . The black woman and the white man were vie wed as the most conscie ntious and the black man and the white woman were see n as the le ast conscie ntious. Finally, the black woman was se en as the most ope n to expe rie nce and the black man was se e n as the le ast ope n. Diffe re nce s in judge s ratings of targe ts pe rsonality characte ristics are pre se nted in Fig. 1. De pre sse d patie nts and controls viewed e ach of the four conve rsations. A fter vie wing e ach conve rsation, participants were aske d (via instructions on the vide o monitor) to think for 1 min about the conve rsation the y had just se e n. This was done be cause prior research had sugge ste d that giving participants additional time to think about be haviors helps consolidate their impre ssions of the pe rsons be ing rate d ( Srull & Wye r, 1989) . Following this delay, participants were pre se nte d with the ne xt conve rsation to vie w. A fte r viewing all four conve rsations, participants rate d e ach targe t on how supportive the targe t would be if the participant were discussing a proble m with that targe t. B e fore rating each targe t, participants were reminde d of the targe t with a 15-se c sile nt clip. Ratings were made on modi e d ve rsions of 10 items from the Procidano and Helle r (1983) Pe rceived Support Scale . The ite m wording was modi e d so that the items aske d participants opinions about e ach spe ci c targe t. This scale is a freque ntly use d measure with e stablishe d

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Fig. 1. Judge s ratings of targets pe rsonality characte ristics.

reliability and validity ( Procidano & Helle r, 1983; Lyons, Pe rrotta, & Hanche r, 1988) . Inte rnal consiste ncy compute d across all four targe ts for this modi e d scale was a 5 .92. A fte r making support judgm ents, participants were aske d to list as many supportive and unsupportive be haviors or state ments as the y re membered from e ach inte raction. The se ratings were include d to te st hypothe ses about the re lation be twe e n support judgm e nts and the re call of supportive be haviors. Howeve r, respondents re calle d ve ry fe w actual e xample s of be haviors and state ments ( M 5 2.64 across all four targe ts). Instead, the ir response s were dominate d by e xam ples of traitlike concepts (e .g., kind, bore d, uninte re sted; M 5 14.24 across all four targe ts). The more fre que nt recall of trait conce pts vs. spe ci c be haviors was signi cant ( t(23) 5 8.23, p , .001) . Thus, because this task e licite d the re call of trait conce pts rathe r than spe ci c supportive be haviors, we were unable to inve stigate the re lation betwe en support judgm e nts and the re call of supportive be haviors.

A ttentio n to an d Mem ory fo r the Task To allow for the control of factors associate d with general me mory ability and atte ntion to the task, participants were presente d with a fth scene afte r the fourth conve rsation, but be fore the supportive ne ss ratings and recall tasks. In this scene , a male speake r de scribe d the activitie s of his day. Following the ratings and re call of supportive ne ss, participants rate d how busy the spe ake r appe are d to be and recalle d the activitie s he de scribe d. A ctivitie s recalle d were summed to create a total score .

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R E SU LTS Pre liminary analyse s focuse d on diffe re nce s betwe e n depressed and control participants on le ve ls of pe rceived support and de pression. A s displaye d in Table II, clinically depre sse d patie nts had highe r de pre ssion and lower pe rceive d support score s than did nonde presse d controls ( t(23) 5 8.22; p , .001, and t(23) 5 5.59; p , .001, respe ctively) . Howeve r, the re were no diffe re nce s in socioe conom ic status, age , or inte llige nce, indicating that the two groups we re comparable on de mographic variable s. A main goal of the prese nt study was to dete rmine whe ther Lake y, McCabe , et al. (1996) unde re stimate d the role of pe rceive rs pe rceptual biase s by studying nonclinical sample s. If so, whe n the pre se nt sample was analyze d as a ge ne ralizability study, the size of the Pe rceive r main e ffe ct should be substantially large r than obse rve d pre viously. Gene ralizability the ory provide s powe rful te chnique s for de te rmining the source s of variance in a group of score s (Cronbach, Gle se r, Nanda, & Rajaratnam , 1972; Shave lson & We bb, 1991; Wiggins, 1973) . Most clinical psychologists are familiar with gene ralizability ( g) the ory s contribution to unde rstanding the inte rnal consiste ncy of te sts. Howeve r, the powe r of g the ory to answe r basic research que stions is less well appre ciated, and g theory has be e n applie d succe ssfully to a number of basic re se arch que stions. For e xam ple , Kenny (1994) deve lope d a unique variant of g the ory methodology to dete rmine the e xtent to which pe rceptions of targe ts pe rsonalitie s re presents characte ristics of the targe t, the perceive r, or the ir unique relationship. E ndle r and Hunt ( 1966, 1969) use d g the ory to analyze the exte nt to which anxie ty was a function of the person, the situation, and the Pe rson 3 Situation inte raction. A more exte nsive discussion of g theory as applie d to social support is provide d in Lake y, McCabe , e t al. (1996) . O ur rst analysis was a dire ct re plication of the ge neralizability studie s pre sente d in Lake y, McCabe , e t al. (1996) . The prese nt study was analyze d as a Pe rceive r 3 Targe t 3 Item, fully crosse d A NO V A with random factors. E ach participant was tre ate d as one le ve l of the Pe rceive r factor, e ach targe t as one le ve l of the Targe t factor, and e ach item as one leve l of the Ite m factor. Thus, this analysis was a 25 3 4 3 10 A NOV A . B e cause e ach re sponde nt was tre ate d as a separate le vel of the Pe rceiver factor, the re was one obse rvation pe r cell. In such designs, the appropriate e rror term is the highe st-orde r inte raction (Pe rceive r 3 Targe t 3 Ite m). Whe n the re is no thre e -way inte raction, this term is an appropriate estimate of random e rror. Whe n such an inte raction is pre se nt, the highe st-orde r

Table II. Comparing Patie nts and Controls on Depression, Perceive d Support, and Memory for Activities Depressed patie nts M Depre ssion Pe rce ived Support Me mory for activities
a

Controls M 5.1 164.1 10.1 SD 2.6 14.2 4.6 t 8.22 a 5.59 a 0.46

SD 8.3 20.8 5.0

26.6 125.0 9.2

p ,

.001.

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Table III. Ge ne ralizability A nalyse s for the E ntire Sample , De pre sse d Patients and Controls E ntire sample E ffect Pe rce iver Targe t Item Pe rce iver 3 Targe t Pe rce iver 3 Ite m Targe t 3 Item 3-way interaction (error) df 24 3 9 72 216 27 648 F 22.09 158.50 a 4.78 a 8.26 a 1.93 a 1.30 Depresse d patients E ffect Pe rce iver Targe t Item Pe rce iver 3 Targe t Pe rce iver 3 Ite m Targe t 3 Item 3-way interaction (error) df 10 3 9 30 90 27 270 F 8.48 a 26.77 a 2.45 b 4.97 a 1.50 b 0.55 Controls E ffect Pe rce iver Targe t Item Pe rce iver 3 Targe t Pe rce iver 3 Ite m Targe t 3 Item 3-way interaction (error)
a b a

E ffect size .11 .21 .01 .25 .08 .00 .34

E ffect size .05 .11 .02 .22 .13 .00 .55

df 13 3 9 39 117 27 351

F 41.03 194.50 a 4.08 a 10.30 a 2.50 a 2.06 a


a

E ffect size .16 .29 .00 .21 .09 .02 .23

p , p ,

.01. .05.

inte raction is an ove re stimate of error, producing more conse rvative signi cance te sts (Cronbach et al., 1972) . Consiste nt with our prior re search, the re were signi cant Pe rceiver, Targe t, and Ite m effe cts, and signi cant Pe rceiver 3 Targe t and Pe rceive r 3 Item inte ractions (Table III). The only nonsigni cant e ffect was the Targe t 3 Ite m inte raction. Howe ve r, it is the siz e of the se e ffects that is most important. E ffe ct sizes were calculate d from formulas provide d by Shave lson & We bb (1991) and are pre sente d in Table III. O f primary inte rest is the variance e stimates for the Perceive r main effe ct and the Pe rceive r 3 Targe t inte raction. 4 The Pe rceive r e ffect accounte d for
4

The size of the Targe t (Supporter) effe ct is not particularly me aningful in studies that re ly on judgme nts of videotaped targe ts be cause the size of the e ffect is largely de te rmined by the particular targe ts that the e xperime nters choose to prese nt. To obtain meaningful estimates of effe cts due to supporters, targets should be e ither se lecte d randomly from some population or chose n for their repre se ntative ne ss of supporters in a give n population (see Lakey, McCabe, et al., 1996) . The purpose of the curre nt study was to inve stigate cognitive proce sses in the Perceive r e ffect and in the Pe rceive r 3 Supporter interaction. Thus, we are unconce rne d with the size of the Supporter effe ct in this study.

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11% of the variance , similar to the e stimate of 8% obtaine d in our prior g studie s with norm al sample s. The Perceiver 3 Targe t inte raction was substantially large r than the Pe rceive r main e ffe ct, accounting for 25% of the variance . The 25% estimate is consiste nt with our prior g study, which also use d vide otape d targe ts ( 21% in Lake y, McCabe , e t al., 1996, study 3) . The g analyse s re plicate d our prior re search in showing that the Pe rceive r 3 Supporte r inte raction is substantially more powe rful than perceive rs pe rceptual biase s. Next, we wante d to de te rmine whe the r any diffe re nce betwe e n patie nts and controls in support judgme nts followe d the patte rn of Pe rceive r e ffe cts or the Pe rceive r 3 Supporte r inte raction. Instead of tre ating e ach responde nt as a se parate le vel of the Perceive r factor (as in the g study) , the next analyse s classi ed re spondents as de pre sse d vs. nonde pre sse d. This re sulte d in a Diagnosis (2) 3 Targe t (4) 3 Item (10) A NOV A . The se analyse s were more conve ntional in the se nse that multiple responde nts pe r cell allowe d the calculation of a within-grou ps error te rm. If the Pe rceive r effe ct in the g study re sulte d from diffe re nces in de pre ssion, the n classifying responde nts according to diagnosis should produce a main e ffe ct for diagnosis. This would indicate that, on ave rage , de pre sse d patie nts saw the targe ts as less supportive than did controls. In contrast, diffe rence s be twe en patie nts and controls may follow the patte rn of the Pe rceive r 3 Supporte r inte raction. Such an inte raction would indicate that patie nts and controls diffe r in whom the y see as supportive . This e ffe ct would be capture d by a Diagnosis 3 Targe t inte raction. To inve stigate these hypothe se s, we conducte d a Diagnosis ( depre sse d vs. control) 3 Targe t 3 Ite m mixed A NO V A , with Targe t and Item as random factors and Diagnosis as a xe d factor. The results re ve ale d no signi cant effe ct for diagnosis ( F (1,23) 5 0.10; n.s.) indicating that depressed patie nts did not vie w targe ts ove rall as less supportive than did controls. Howe ve r, the re was a signi cant Diagnosis 3 2 Targe t inte raction ( F (3,69) 5 3.88, p , .02, v 5 .06) , indicating that de pre sse d patie nts produce d a diffe re nt relative orde ring of targe ts on supportive ne ss than did controls. The re were also Ite m ( F (9,207) 5 2.45, p , .01) and Targe t main e ffects ( F (3,69) 5 21.49, p , .001) accounting for 6% and 42% of the variance , re spe ctive ly. Figure 2 presents graphically how de pre sse d patie nts and controls saw the targe ts diffe re ntly. Compare d to patie nts, norm al controls made more sharp distinctions among the targe ts. Follow-up paire d t-tests re vealed that controls saw the black woman as more supportive than the white woman ( t(13) 5 2.45, p , .05) , the white man ( t(13) 5 6.28, p , .01) , and the black man ( t(13) 5 4.85, p , .01) . Controls also perceive d the white woman as more supportive than the white man ( t(13) 5 4.09, p , .01) and the black man ( t(13) 5 3.27, p , .01) . In contrast, patie nts saw the black woman as more supportive than the white woman ( t(10) 5 2.62, p , .05) and the black man ( t(10) 5 3.85, p , .01) , but unlike controls, patie nts did not se e the black woman as signi cantly more supportive than the white man. A lso, unlike the controls, depre sse d patie nts did not se e the white woman as more supportive than the two me n. In addition to diagnosis, we also e xam ine d whe the r pe rceive rs ge nde r or ethnicity would he lp illuminate the basis of the Pe rceive r 3 Targe t inte raction. Part of the Perceive r 3 Targe t inte raction may re ect a process whe re by pe rsons judge d targe ts of similar ge nde r or e thnicity as more supportive than dissimilar

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Fig. 2. Patients and controls ratings of targets supportivene ss.

targe ts. Thus, paralle l A NOV A s were conducte d in which ge nde r or e thnicity was substitute d for the diagnosis factor, re sulting in a Gende r 3 Targe t 3 Ite m A NO V A and an E thnicity 3 Targe t 3 Ite m A NO V A .5 Howe ve r, the re we re no main e ffects or inte ractions with targe ts involving ge nde r or e thnicity. Thus, the Pe rceiver 3 Targe t inte raction did not re sult from a tende ncy to perceive targe ts as more supportive if the targe ts were similar to pe rceive rs in gender or e thnicity. De pre sse d patie nts and controls diffe re d in whom the y saw as supportive . We re patie nts and controls re sponding to diffe rent targe t characte ristics when making support judgme nts? The ne xt se t of analyse s ide nti e d the targe t characte ristics that were re late d to controls and depressive s pe rceptions of targe ts. The se analyse s re lie d on the judge s ratings of targe ts pe rsonality characte ristics. We compare d targe ts re lative standing on supportive ne ss with the ir re lative standing on a give n personality dime nsion. For e xam ple , if e xtrave rsion showe d the same con guration across targe ts as did support ratings, this would t the hypothe sis that re sponde nts base d support ratings, in part, on e xtrave rsion. Howe ve r, if the con guration across targe ts for e xtrave rsion con icte d with the con guration for supportive ne ss, we could re je ct the hypothe sis that re sponde nts base d the ir support judgme nts on e xtrave rsion. Thus, for the four personality dime nsions for which the re was high inte rrater agre e ment (i.e ., e xtrave rsion, ope nne ss, agre eable ness, and conscie ntiousne ss), we compare d the targe ts re lative standing on supportive ness with the ir relative standing on a give n pe rsonality dime nsion. B e cause
5

In analyse s involving ethnicity, only data from A frican- or E urope an-A me ricans were analyzed. Data from the lone Hispanic re spondent were excluded .

522 Table IV . Te sts of the Rating 3

Lakey, Dre w , and Sirl Target Interactions for De pre sse d Patients and Controls Depre ssed patie nts

Rating 3

Targe t interactions involving

df 3,84 3,84 3,84 3,84

F 1.74 1.62 7.31 0.63 Controls

p, .16 .19 .00 .60

2 v

Agree able ne ss and Supportive ne ss Conscientiousness and Supportiveness Extrave rsion and Supportive ne ss Openne ss and Supportive ne ss

.02 .02 .12 .00

Rating 3

Targe t interactions involving

df 3,93 3,93 3,93 3,93

F 0.41 8.95 8.32 2.74

p, .74 .00 .00 .05

2 v

Agree able ne ss and Supportive ne ss Conscientiousness and Supportiveness Extrave rsion and Supportive ne ss Openne ss and Supportive ne ss

.00 .16 .13 .03

patie nts and controls diffe re d in whom they saw as supportive , se parate analyse s we re conducte d for both patie nts and controls. Controls support ratings were compare d with judge s pe rsonality ratings in a serie s of Rating (2) 3 Targe t (4) mixe d A NO V A s in which Rating was the be twee nsubje cts factor and Targe t was the within-subje cts factor. The pe rsonality ratings provide d by judge s on a give n personality dimension were one le ve l of the Rating factor and the support ratings by controls (in the rst se t of analyse s) or de pre sse d patie nts (in the se cond se t of analyse s) were the othe r le vel of the Rating factor. For example , conside r the de sign use d to te st the hypothe sis that controls support judgme nts paralle le d judge s agre e able ness ratings. The two leve ls of the Rating factor were (1) support judgm e nts by controls and (2) agre e able ne ss ratings by judge s. The four targe ts re pre se nted the four leve ls of the within-subje cts Targe t factor. A signi cant Rating 3 Targe t inte raction would indicate that the support ratings by controls and the agre e able ne ss ratings by judge s did not follow the same patte rn. Such a nding would cast doubt on the hypothe sis that controls use d targe t agre e able ness to infe r targe t supportive ne ss. Howeve r, the abse nce of a Rating 3 Targe t inte raction would indicate that we could not reje ct the hypothe sis that the se two ratings were paralle l, providing support for the infe re nce that controls base d support judgme nts in part on targe t agre e able ne ss. Four analyse s of this kind were run for both the controls and patie nts in which one of the four pe rsonality dime nsions was use d as one le ve l of the Rating factor.6 Neuroticism ratings were not include d in these analysis be cause of unacce ptably low inte rrate r agre e ment. Results comparing controls ratings of support with judge s rating of pe rsonality reve ale d thre e signi cant Rating 3 Targe t inte ractions for e xtrave rsion, conscie n6

In these analyse s, the main e ffects for targe ts are not me aningful because they re e ct a combination of the support judgme nts by controls (or depressives) and the pe rsonality ratings by judge s. The only effe ct of intere st in these analyse s is the Rating 3 Targe t interaction, which mere ly indicates whether targets pro les for a give n personality trait diverges from their pro le on supportivene ss. B ecause variance re sulting from the Rating 3 Targe t interaction can be represe nted as main effects, we ce ntered the personality and support ratings by subtracting the me an of their re spe ctive distributions from e ach Target s rating. This had the e ffect of e liminating main e ffects due to ratings, which were not relevant to the hypothe sis unde r examinati on.

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Fig. 3. Controls ratings of targets supportivene ss and judges ratings of targe ts e xtraversio n.

Fig. 4. Controls ratings of targets supportivene ss and judge s ratings of targets conscie ntiousness.

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Fig. 5. Controls ratings of targe ts supportiveness and judges ratings of targe ts openne ss.

tiousne ss, and ope nne ss (Table IV ; Figs. 3 5). A s shown in Figs. 3 5, controls ratings of supportive ne ss con icte d with judge s ratings of e xtrave rsion, conscie ntiousne ss, and openne ss. Thus, controls appare ntly did not base their support judgm ents on the se thre e traits. Howe ve r, controls support judgme nts closely paralle le d judge s ratings of agre e able ne ss (Fig. 6), sugge sting that controls may have base d the ir support judgme nts on this inform ation. The re sults of the same analyse s using patie nts support ratings reve ale d that the ir judgm ents dive rge d only from judge s e xtave rsion ratings (Table IV ; Fig. 7). A lthough patie nts appare ntly did not base the ir support judgme nts on e xtrave rsion, we could not rule out their use of conscie ntiousne ss, ope nness, or agre e able ness (Figs. 8 10) . We might conclude that patie nts rely on e ach of the se traits in making support judgm e nts. Howeve r, in examining the gure s, we se e that the corresponde nce be twee n agre e able ness /support and conscie ntiousne ss/support for patie nts is not exact, e ven though the hypothe sis that the y corre sponde d could not be re jected at the p , .05 le ve l. E ve n the close st- tting pair for patie nts (ope nne ss/ support) appe are d to re e ct a less pre cise t than the close st- tting pair for controls (agre e able ness/support) . Keeping in mind that signi cance tests re ect both me an diffe rences and random error, we wonde re d whethe r the support judgme nts of patie nts had more random e rror than those of controls. To te st the hypothe sis that the support judgm ents of patie nts had more random error 7 than controls, we conducte d se parate ge ne ralizability analyse s for both groups. A s can be see n in Table II, the re was more than twice as much random
7

Although it is common to refe r to u nexplain ed variance as random error, it is worthwhile to re me mbe r that un exp lained variance is not ne ce ssarily u nexp lainable variance . Unexplained variance may be error only in the sense that we have not mode led it adequate ly.

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Fig. 6. Controls ratings of targe ts supportiveness and judges ratings of targe ts agre eablene ss.

Fig. 7. Depresse d patie nts ratings of targe ts supportivene ss and judge s ratings of targets extraversion.

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Fig. 8. De pre ssed patie nts ratings of targets supportiveness and judge s ratings of targe ts agre eableness.

Fig. 9. Depre ssed patie nts ratings of targets supportivene ss and judges ratings of targe ts conscientiousne ss.

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Fig. 10. De presse d patie nts ratings of targe ts supportiveness and judge s ratings of targe ts ope nness.

error in the support judgme nts of patie nts than in the support judgm ents of controls (55% vs. 23%). Consiste nt with this analysis, patie nts support ratings were le ss inte rnally consiste nt than were controls ( as 5 .88 vs. .98, re spective ly) .8 We re the high leve ls of error variance a result of a fe w outlie rs who were re sponding randomly? We calculate d se parate Targe t 3 Ite m repe ated-measure s A NO V A s for each de pressed patie nt and e xam ine d the distribution of error variance . Eight of 11 de pressed patie nts had comparative ly high le ve ls of error variance , indicating that the outlie rs we re those with low rate s of random ness in their answe rs. Thus, comparative ly high le vels of random ness se eme d to characte rize the majority of the de pre sse d patie nts. To de termine whethe r de pressed patie nts would display highe r leve ls of random ne ss in the ir judgm e nts on the individual-dif fe re nce s measure s of de pre ssion and pe rceive d social support (i.e ., not ratings of targe ts), we calculate d se parate inte rnal consiste ncy analyse s for patie nts and controls on the se measure s. Howe ver, patie nts re sponse s to the se measure s had less e rror variance than the re sponse s of controls (patie nts and controls as were .74 and .41 for depre ssion, re spe ctive ly, and .93 and .83 for pe rceive d support, re spe ctive ly) . D ISCU SSION Two important de terminants of support judgme nts are the pe rceptual biase s of perceive rs and the Pe rceive r 3 Supporte r inte raction. O ur prior ge neralizability
8

Standard internal consistency e stimate s produce a lower e stimate s of error than do full ge ne ralizability analyse s be cause standard internal consistency estimates do not analyze variance due to targets or items (Wiggins, 1973) .

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studie s had indicate d that the Perceive r 3 Supporte r inte raction was much more powerful than pe rceivers biase s (Lake y, McCabe , e t al., 1996) . The curre nt study inve stigate d whe ther the role of perceptual biase s was stronge r in a sample that include d clinically de pre sse d individuals. Howe ve r, the curre nt study con rme d the strong role of the Perceive r 3 Supporte r inte raction. The Pe rceiver main e ffect accounte d for 11% of the variance in the current study, not substantially diffe re nt from the 8% obtaine d in our prior studie s of norm al sample s. In addition, the size of the Pe rceive r 3 Supporte r inte raction in the current sample was ve ry similar to that of our prior g study that used vide otape d targe ts (study 3 of Lake y, McCabe , et al., 1996) . In the curre nt study, the Pe rceive r 3 Supporte r inte raction accounte d for 25% of the variance , where as study 3 of our prior article e stimate d it at 21%. The pre se nt study also found that the diffe re nce s in the support judgm e nts betwe en patie nts and controls followe d the patte rn of the Pe rceive r 3 Supporte r inte raction rathe r than the Pe rceiver e ffe ct. Patie nts and controls diffe red in whom the y saw as supportive , rathe r than de pre sse d patie nts se e ing targe ts ge ne rally as le ss supportive than did controls. Thus, in addition to be ing the single most important dete rminant of support judgme nts, the Pe rceive r 3 Supporte r inte raction appe ars to more ade quate ly re pre sent the diffe rence be twe en de pressed patie nts and controls. None the less, diffe re nces betwe e n patie nts and controls were only part of the Pe rceive r 3 Supporte r inte raction in this study. The e ffe ct size for the Diagnosis 3 Targe t inte raction accounte d for only 6% of the variance , whe re as the Pe rceive r 3 Targe t inte raction accounte d for 25%. E ve n whe n data from the de pre sse d group we re analyze d separate ly, there was a strong e ffe ct for the Perceive r 3 Targe t inte raction (22%). Give n the appare nt importanc e of the Pe rceive r 3 Supporte r inte raction, it is important to ide ntify why pe ople diffe r in whom they se e as supportive . The pre se nt study sugge sts that patie nts and controls may diffe r in the information they use to make support judgm e nts. Controls appe are d to re ly on agre eable ne ss be cause the ir support judgm ents paralle le d judge s ratings on that trait. Howe ver, de pre ssed patie nts judgm ents were less cle arly linke d to a particular trait, although the y did not appe ar to use e xtrave rsion. The re are at le ast three e xplanations for why the support judgme nts of patie nts were le ss cle arly linke d to a single trait. First, patie nts may have base d their support judgm ents on a line ar combination of agre eable ness, ope nne ss, and conscie ntiousne ss, whe re as controls may have re lie d more he avily on a single trait. In fact, Lutz (Lutz, 1997; Lutz & Lake y, 1997) has shown that some individuals base support judgme nts on line ar combinations of multiple traits. Howe ver, in contrast to the hypothe sis that patie nts use d more traits than controls in making support judme nts, Lutz did not nd e vide nce that e motional distre ss was re late d to the use of more traits. Howeve r, Lutz studie d norm al sample s, and he r results may not apply to clinically disorde red individuals. The large r Pe rceive r 3 Targe t 3 Ite m inte raction for patie nts vs. controls sugge sts two othe r explanations for why the support judgm ents of patie nts were harde r to characte rize . First, the support judgme nts of patie nts may be more comple x than those of controls. For example , some patie nts may characte rize diffe re nce s betwe en targe ts by re lying he avily on some ite ms vs. othe rs, where as othe r patie nts characte rize diffe re nce s be twe en targe ts by using a diffe rent se t of items. For

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example , Patie nt A may draw distinctions be twee n Targe ts A and B only with ite ms that re e ct acce ptance , and not with ite ms that re ect good advice . In contrast, Patie nt B may distinguish be twee n Targe ts C and D with ite ms that re e ct good advice , but not with ite ms re ecting acce ptance . Such a patte rn would produce a large Pe rceiver 3 Supporte r 3 Ite m inte raction. We be lieve that this explanation is unlike ly be cause inte ractions involving ite ms have ge ne rally be e n small in all of our ge neralizability studie s, ranging from 1% to 8% of the variance . A se cond explanation for the large r Pe rceiver 3 Supporte r 3 Item inte raction for patie nts vs. controls is that patie nts support judgm ents have more random e rror than do those of controls. In ge ne ralizability de signs of this kind, this inte raction is the appropriate inde x of random error. The re are seve ral pote ntial e xplanations for why depressive s might make support judgm e nts in a more random fashion. O ne possibility is that de pre sse d patie nts have more dif culty e ngaging in effortful vs. automatic cognitive proce ssing ( Har zquez, & Dykman, 1993) . A ccording to this e xplanation, patie nts tlage , A lloy, V a should do le ss well at any task that involve d e ffortful proce ssing (e .g., tasks that require attention and conscious aware ne ss). Howe ve r, this alte rnative has dif culty explaining the obse rvation that patie nts and controls had e quivale nt score s on a measure of inte llige nce and on a me asure of atte ntion to, and me mory for, the vide otape d supportive conve rsations. Furthe rmore , patie nts did not have more dif cultie s making judgme nts about the ir own de pre ssive symptom s or about the supportive ne ss of pe ople in the ir own social ne tworks. Patie nts gre ate r random ness in making judgm ents about the vide otape d supporte rs is dif cult to e xplain by a ge ne ralize d de cit in e ffortful proce ssing or in making social judgme nts. A nothe r possibility is that patie nts may have dif culty making initial social judgme nts. Whe re as nonde pressed people may be able to quickly and e asily de cide who will be supportive , de pre ssive s judgme nts may be shroude d in doubt and unce rtainty. Conside r the situation in which both de pre sse d and nonde pre sse d people e nter a new social ne twork (e.g., a ne w job) . Nonde pre sse d pe ople may be able to disce rn quickly who will be a source of support and who will not. De pre sse d individuals, howe ve r, may have much greate r dif culty identifying supportive othe rs, eve n if the othe rs are pre se nt. If positive thought about social relations helps maintain emotional well-be ing, the n pe rsons who have trouble recognizing supportive othe rs may e xpe rie nce more negative emotion. Se cond, dif culty making support judgme nts could have ne gative in uences on social inte raction. B e cause of a greate r dif culty in making support judgme nts, de pre sse d people may be reluctant to spe ak to othe rs. Furthe rmore , the y may incorre ctly identify who will be supportive and have disappointin g social inte ractions with unsympathe tic othe rs. De pre sse d patie nts may also have le ss well-organize d conce pts of supportive ness than do controls. The personal conce pt of supportive ne ss may be more fuzzy for depre sse d patie nts. This is re e cted in our obse rvation that the inte rnal consiste ncy e stimate s for support ratings of targe ts were lowe r for depressed patie nts than for controls, indicating that the ite ms on the support scale s were not as cohe sive for patie nts. Howe ver, be cause this lack of cohesive ness was not obse rve d in re sponse s to a me asure of perceive d support from e stablishe d relationships, this fuzzy conce pt hypothe sis would only apply to initial support judgme nts.

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O ne limitation of the prese nt study is that it inve stigate d only cognitive processe s in the Pe rceiver 3 Supporte r inte raction. Howe ve r, the re are probably important behavioral proce sse s as we ll. O ne be havioral mechanism may be that certain perceive rs may be have in such a way that they e licit diffe re nt behaviors from a give n supporte r than do othe r pe rceivers. For e xample , one supporte r may be se e n as cool and aloof by most pe rsons in a give n social network. Howe ve r, share d expe rie nce betwe e n a perceive r and supporte r may le ad the supporte r to act diffe rently toward that perceive r than to othe rs. We belie ve that some type of be havioral effe ct must be occurring. Studie s that allow for pe rceivers to in ue nce the be haviors of supporte rs (studie s 1 and 2 of Lake y, McCabe , e t al., 1996) produce much large r effe cts for the Pe rceiver 3 Supporte r inte raction than do studie s that do not pe rmit this type of in ue nce (study 3 of Lake y, McCabe , e t al., 1996, and the current study) . Thinking about pe rceived support as a Pe rceive r 3 Supporte r inte raction has implications for both the ory and inte rvention. First, it sugge sts that prior the ory has ove re mphasize d both the role of pe rceive rs and the role of supporte rs in contributing to the low leve ls of perceived support among de pre sse d patie nts. For example , we had pre viously argue d that low perceived support re presente d cognitive biase s on the part of pe rceivers (Lake y & Cassady, 1990; Lake y et al., 1992) . Similarly, Coyne (1976) had e mphasize d de pre sse d pe ople s own noxious social behavior in their social isolation. Conve rse ly, traditional social support the ory has vie we d the main cause of low pe rceived support as the abse nce of obje ctively supportive people in the social e nvironm e nt (Cutrona & Russe ll, 1990; Sarason e t al., 1990; Thoits, 1986) . Howeve r, in light of the power of the Pe rceiver 3 Supporte r inte raction, focusing e xclusive ly on the role of pe rceive rs or provide rs is too narrow. Conce ptualizing pe rceive d support as a Perceiver 3 Supporte r inte raction encourage s inve stigators and clinicians to think about social support in te rm of person environme nt t (Helle r & Monahan, 1977) . A ccording to this view, pe ople s social adjustme nt is in ue nce d by how well pe ople t within a give n social e nvironm e nt or network. If we thought of the Pe rceive r 3 Supporte r inte raction in te rms of person environme nt t, it would sugge st that low support patie nts are mismatche d to their social e nvironm e nts. What contribute s to this mismatch? Recent re se arch has indicate d that one de terminant of pe rceive r supporte r matching is similarity in attitude s, value s (Lake y, Ross et al., 1996) , life e xpe rience s (Suitor e t al., 1995) , and personality (Lutz, 1997; Lutz & Lake y, 1997) . Similarity be twe e n pe rceive rs and supporte rs re e cts the Perceive r 3 Supporte r inte raction because the characte ristics of Perceive r A that make s he r similar to Supporte r A also make s he r dissim ilar to Supporte r B . Thus, are depre ssive s with low pe rceive d support obje ctive ly less similar than othe rs in their social e nvironm e nts? Do patie nts behave in ways that fail to take advantage of the similarity that doe s exist? A re the re othe r social environme nts in which the y might fare be tte r? The re lative size s of the e ffe cts for Pe rceive rs, Supporte rs, and the Perceive r 3 Supporte r inte raction also have implication s for inte rve ntion. B ecause the size of the Pe rceivers and Supporte rs e ffe cts are smalle r than the Pe rceive r 3 Supporte r inte raction, inte rve ntions pe rhaps should focus on proce sse s associate d with the Pe rceive r 3 Supporte r inte raction. Howe ve r, most social support inte rve ntions have targe te d the Supporte rs e ffect by atte mpting to provide obje ctive ly supportive

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persons or actions to low pe rceive d support pe rsons. A lthough the se inte rve ntions have occasionally produce d change s in mental he alth, the y have only rarely re sulte d in improve d pe rceive d support (Lake y & Lutz, 1996) . With hindsight, this is not surprising if the Pe rceive r 3 Supporte r inte raction is as pote nt as it appe ars. V ie wing perceive d support as an inte raction sugge sts that there is little in the way of obje ctive ly supportive pe rsons or actions. What will be se e n as supportive by some persons will be se e n as obnoxious by othe rs. Similarly, inte rve ntions that focus only on Pe rceiver effe cts by changing the pe rsonal characte ristics of low-suppor t pe rsons will also have only limite d succe ss ( e.g., B rand, Lake y, & B e rman, 1995) . New inte rve ntions are necessary that targe t proce sse s associate d with the Perceive r 3 Supporte r inte raction. We e xpe ct that the Perceive r 3 Supporte r inte raction re sults from a wide range of diffe re nt me chanism s involving both cognitive and behavioral proce sse s. B ecause research to ide ntify the se proce sse s is only just beginning, it is dif cult to spe culate about what form the se ne w inte rve ntions might take . Howeve r, deve loping such inte rve ntions like ly will involve two ste ps: (1) ide ntifying the type s of pe rsons and environme nts that are supportive for spe ci c individuals, and (2) deve loping me chanism s for matching individuals with like ly supportive pe ople and environme nts. The re se arch de scribe d in this article re pre se nts a rst ste p in atte mpting to answe r the rst que stion, although the results sugge ste d that identifying who will be supportive may be more dif cult for de pre sse d patie nts than for controls. O the r recent work indicate s that similarity betwe en pe rceive rs and supporte rs contribute s to the pe rceived supportive ne ss of dyads (Lake y, Ross et al., 1996; Lutz, 1997; Lutz & Lake y, 1997; Suitor e t al., 1995) . If similarity is con rme d as an important dete rminant of supportive ne ss, the n inte rve ntions must match perceive rs and supporte rs on similarity. For example , skills can be taught to he lp patie nts ide ntify and gain e ntry to social se ttings populate d with similar othe rs. Patie nts can be matched with similar the rapists to promote a supportive the rape utic re lationship. Interve ntions mode led after dating se rvice s could he lp similar ye t unmatche d persons nd e ach othe r.

A CK NOWLE D G ME NTS The authors thank two anonym ous re vie wers for helpful comme nts on an earlie r version of this manuscript and the patie nts and staff of A urora Young A dult Hospital, Detroit, Michigan.

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