American Journal of Community Psychology, Vol. 14, No.

4, 1986

Distinctions Between Social Support Concepts,

Measures, and Models I

Manuel Barrera, J r . 2

Arizona State University

The thesis o f this review is that the global concept o f social support should
be abandoned in favor o f more precise concepts that fit narrower models
o f stress-distress relationships. Distinctions between measures o f social
embeddedness, perceived support, and enacted support are consistent with
studies that find they are related only mildly. Literature is reviewed to deter-
mine which social support concepts show positive or negative relationships
to life stress and distress. Six models are presented to illustrate important
findings and to demonstrate how specific support concepts may fit unique
models. The issue o f confounds and future research directions are also
discussed.

Important advances have been made in social support research since the ap-
pearance of seminal works by Caplan (1974, 1976), Cassel (1976), and Cobb
(1976). Literature reviews have already surveyed an impressive accumula-
tion of studies on social support's relationship to physical illness and
psychological disorder (Broadhead et al., 1983; Cohen & Wills, 1985; Got-
tlieb, 1983; Kessier & McLeod, 1985; Kessler, Price, & Wortman, 1985;
Leavy, 1983; Mitchell, Billings, &Moos, 1982; Wallston, Alagna, DeVellis,

~Dr. Barrera completed this paper during his sabbatical stay at the University of California,
San Francisco. His sabbatical was partially funded by a National Research Council postdoc-
toral fellowship sponsored by the Ford Foundation. The author gratefully acknowledges the
assistance of John Dignam, Ricardo Munoz, Jane Norbeck, Diana Oxley, and Lonnie Snowden
who provided critical comments on a preliminary version of the manuscript.
2All correspondence should be sent to Manuel Barrera, Jr., Department of Psychology, Arizona
State University, Tempe, Arizona 85287.
413
0091-0562/86/0800-0413505.00/0 1986 Plenum Publishing Corporation
414 Barrera

& DeVellis, 1983). The array of problems that have been studied includes
depression, cancer, birth complications, psychological distress, job dissatisfac-
tion, child maltreatment, and numerous others. Adults have been the primary
subjects of this research, but children (Sandier, Wolchik, & Braver, 1985)
and the elderly (Fiore, Becker, & Coppel, 1983; Rook, 1984a; Weeks &
Cuellar, 1981) also have been studied. A number of social support in-
struments have been developed since Dean and Lin (1977) first drew atten-
tion to their need (for reviews see Heitzman & Kaplan, 1985; House & Kahn,
1985; Tardy, 1985; Wood, 1984). Critical conceptual papers have even ap-
peared to untangle troublesome complexities or to identify problem areas
that are in need of further research (Barrera & Ainlay, 1983; Broadhead et
al., 1983; Cohen & McKay, 1984; Gottlieb, 1983; Henderson, 1984; House,
1981; Kaplan, Cassel, & Gore, 1977; Shinn, Lehmann, & Wong, 1984;
Shumaker & Brownell, 1984; Thoits, 1982). Finally, research designs have
advanced from the cross-sectional correlational research that characterized
early studies (Heller & Swindle, 1983) to longitudinal designs that have ap-
peared in recent studies (Aneshensel & Frerichs, 1982; Billings & Moos, 1982;
P. Cohen et al., 1982; Dean & Ensel, 1982; Holahan & Moos, 1981; Lin &
Ensel, 1984; Norbeck & Tilden, 1983).
Despite these advances there have been some consistent criticisms of the
social support literature. First, definitions of social support are often so vague
or so broad that the concept is in danger of losing its distinctiveness (Cohen
& McKay, 1984; Heller, 1979; Heller & Swindle, 1983; Shumaker & Brownell,
1984). Some have observed that there is little consensus on how social sup-
port should be defined (Broadhead et al., 1983; Carveth & Gottlieb, 1979;
LaRocco, House, & French, 1980; Rook, 1984b; Tardy, 1985). In addition,
there is great diversity in approaches to measure social support (Barrera, 1981;
Shumaker & Brownell, 1984; Tardy, 1985; Turner, Frankel, & Levin, 1983),
approaches that often appear to have little relationship to each other. Final-
ly, there is a dissappointing lack of consistency in research findings
(Broadhead et al., 1983; S. Cohen & McKay, 1984; Mitchell et al., 1982;
Sandier & Barrera, 1984). This paper examines the basis of these criticisms,
proposes guidelines for studying social support concepts that will reduce some
sources of confusion, and challenges some issues that have been raised in
earlier critiques of the field.
A major thesis of this review is that the term social support is insuffi-
ciently specific to be useful as a research concept. Clarifying the confusion
among concepts and reconciling inconsistencies in findings can be facilitated
by abandoning global references to social support in favor of more specific
terminology. More refined language could then reflect critical differences
that distinguish social support concepts and the operationalization of those
concepts. Rather than striving to identify a single model that represents the
Social Support Models 415

influence of global social support, researchers could develop more precise

models that depict the linkages between specific support concepts, life stress
variables, and indicators of distress.
In the following sections specific social support concepts are identified
and contrasted with each other. This is followed by a review of some studies
that have examined the relationships between operationalizations of these
concepts. Findings from the literature are organized around four simple rela-
tionships that have been observed: Social support is positively related to stress,
negatively related to stress, positively related to distress, and negatively related
to distress. For each of these relationships, special attention is given to the
nature of the social support concept that produces these effects. The paper
closes by examining the assertion that social support is often confounded
with stress and distress.

SOCIAL SUPPORT CONCEPTS

The great diversity in social support concepts and measures is readily

apparent even to the casual reader of the social support literature. For ex-
ample, it is difficult to read Cobb's (1976) classic article without being struck
by the variability in social support indicators that are represented in the studies
he reviewed. Gottlieb (1983) noted the proliferation of social support con-
cepts by observing that "With each new study a new definition of support
surfaces" (p. 50). Despite this diversity, social support concepts and their
operationalizations can be organized into three broad categories: social
embeddedness, perceived social support, and enacted support (Barrera, 1981;
Barrera, Sandler, & Ramsey, 1981; Gottlieb, 1983; Heller & Swindle, 1983).

Social Embeddedness

Social embeddedness is that social support concept that refers to the

connections that individuals have to significant others in their social en-
vironments. Being socially connected is a central element in one's
"psychological sense of community" (S. B. Sarason, 1974) and constitutes
the flip side of social isolation and alienation (Gottlieb, 1983), terms that
historically have figured prominently in psychosocial theories of psychological
disorder (Rook, 1984a, Thoits, 1982).
There have been two prevalent approaches to measuring social embed-
dedness. One approach consists of using broad indicators of the presence
of social ties such as marital status (Eaton, 1978; Thoits, 1982), participa-
tion in community organizations (Andrews, Tennant, Hewson, & Vaillant,
416 Barrera

1978; Berkman & Syme, 1979; Lin, Simeone, Ensel, & Kuo, 1979), presence
of older siblings (Sandier, 1980), and contact with friends (Silberfeld, 1978).
Although these indicators are not perceived as direct measures of social sup-
port, they are used with the rationale that available social ties could poten-
tially serve as "social support resources" (Sandier, 1980, p. 43) and potentially
"provide...support during a crisis period" (Eaton, 1978, p. 231).
A second approach is reflected in the use of social network analysis
(d'Abbs, 1982; Mitchell & Trickett, 1980; Wellman, 1981). Social network
analysis often involves structured procedures for identifying individuals who
have important relationships with the focal subject. Sophisticated methods
are available for characterizing the structural properties of networks such
as density, multiplexity, and reachability (d'Abbs, 1982).
A shortcoming of social embeddedness measures is that they often fail
to illuminate the mechanism of social support's hypothesized influence on
stress or psychological distress (Barrera, 1981; Gore, 1981; Gottlieb, 1983).
Wellman (1981) correctly pointed out that when social network analysis iden-
tifies important social relationships, it is erroneous to assume that all such
linkages involve the provision of social support. However, some network
measures have been specifically developed to identify just those network
members who provide social support exchanges such as personal advice, non-
directive support, material assistance, and information (Barrera, 1980;
Norbeck, Lindsey, & Carrieri, 1981; I. G. Sarason, Levine, Basham, &
Sarason, 1983). These measures begin to move beyond the quantification
of social ties by providing information concerning the content of the linkages.

Perceived Social Support

Perceived social support has emerged as a prominent concept that

characterizes social support as the cognitive appraisal of being reliably con-
nected to others. It is highly consistent with Cobb's (1976) assertion that social
support is information and Cassers (1976) emphasis on the feedback func-
tion of social support. This concept also fits cognitive models of stress and
coping processes (Folkman, Schaefer, & Lazarus, 1979; Lazarus & Launier,
1978) that emphasize the appraisal of potentially threatening situations and
resources that can be enlisted in coping efforts.
Many measures of perceived social support incorporate two dimensions,
perceived availability and adequacy of supportive ties (Cohen & Hoberman,
1983; Holahan & Moos, 1981; Procidano & Heller, 1983; Turner et al., 1983).
These measures differ from measures of social embeddedness in that they
do not quantify the number of supporters or the amount of social contact.
Social Support Models 417

Instead they attempt to capture individuals' confidence that adequate sup-

port would be available if it was needed or to characterize an environment
as helpful or cohesive. Other instruments focus more exclusively on the
perceived adequacy or satisfaction with support (Barrera, 1981; Henderson,
Byrne, & Duncan-Jones, 1981; I. G. Sarason et al., 1983).
There is some concern that perceived social support scales overlap with
measures of perceived stress and self-reported psychological distress (Gore,
1981; Henderson et al., 1978). As Gore (1981) commented, "If the socio-
emotional quality of support is measured through subjective reports.., the
correlations between support, subjective stress, and outcome (mental health)
variables are likely to be spuriously high, with each variable measuring a por-
tion of the same variance, such as variance in well-being" (p. 211). The issue
of confounding social support measurement with that of stress and distress
is addressed in a later section of the paper.

Enacted Support

Social support can also be conceptualized as actions that others per-

form when they render assistance to a focal person. Tardy (1985) referred
to behavioral descriptions of support as "enacted" support to distinguish it
from "available" support that is measured by scales of perceived availability
and even some measures of social embeddedness.
Measures of enacted social support complement other measures by
assessing what individuals actually do when they provide support, a research
question that some have identified as important for understanding coping
and adjustment processes (Cowen, 1980; Gottlieb, 1978; Liem & Liem, 1979).
Since the appearance of these critiques, self-report measures of enacted social
support have figured prominently in several studies (Aneshensel & Frerichs,
1982; Barrera, 1981; Barrera & Balls, 1983; Carveth & Gottlieb, 1979; Lef-
court, Martin & Saleh, 1984; Pearlin & Schooler, 1978; Sandier & Barrera,
1984; Sandler & Lakey, 1982). It could be argued that self-report scales of
enacted support are actually assessing "perceived-received" support because
these measures rely on retrospective evaluations. Behavioral observations of
supportive transactions would provide a more accurate account of received
support than these self-report methods.
Intuitively, the helping behaviors that constitute enacted support are
likely to be provided when individuals face adversity, particularly acute
stressors. In these cases, measures of enacted support are suitable for gaug-
ing the responsiveness of others in rendering assistance when subjects are
confronted with stress.
418 Barrera

Discussion

The emphasis on distinctions among social support concepts was not

intended to deny some meaningful connections between them. Heller and
Swindle (1983) provided a model of social support and coping that depicted
the relationships of social environmental connections, perceived support, and
support seeking/provision. In this model the availability of social connec-
tions contribute to an individual's perception that he or she can rely on others
for aid or emotional sustenance. Furthermore, the perceived availability of
support is related to an individual's decision to seek out support and ultimately
to the provision of support by those individuals who are available and equip-
ped to deliver the needed assistance. This is a useful model for drawing distinc-
tions between social embeddedness, perceived social support, and enacted
support and at the same time depicting their interrelationships.
But despite these hypothesized connections, these concepts are suffi-
ciently different to caution against regarding them as synonymous. Examin-
ing how these measures are empirically related to each other also addresses
the issue of differentiating social embeddedness, perceived social support,
and enacted support.

MEASUREMENT DIVERSITY

Reliable measures of social embeddedness, perceived social support,

and enacted support often show only mild relationships to each other. The
results of studies that examined the correlations between these measures are
summarized in Table I. In several studies by Barrera and his colleagues
(Barrera, 1981; Sandier & Barrera, 1984; Valdenegro & Barrera, 1983),
measures of network size (social embeddedness), support satisfaction (per-
ceived support), and frequency of helping behaviors (enacted support) were
used. Network size was mildly correlated (r = .24-.32) with an enacted sup-
port scale, the Inventory of Socially Supportive Behavior (ISSB; Barrera et
al., 1981). In each of these studies a measure of satisfaction with support
was not related to either social embeddedness or enacted support.
The relationship between the ISSB (enacted support) and a measure
of perceived support, the Interpersonal Support Evaluation List (ISEL), was
examined in two studies (L. H. Cohen, McGowand, Fooskas, & Rose, 1984;
S. Cohen & Hoberman, 1983). In both studies the correlation between these
two instruments was .46. The two scales also showed very different patterns
of relationships to measures of stress and distress.
The development of several perceived social support measures was
described by Turner et al. (1983). These researchers reserved the term social
Social Support Models 419

Table I. Correlations Between Measures of Social Embeddedness, Perceived Social Sup-

port, and Enacted Social Support
Embeddedness Enacted support Embeddedness
with with with
perceived perceived enacted
Study social support social support support
Barrera, 1981 .00 - .13 .24
S. Cohen & Hoberman, .46
1983
L. H. Cohen et al., 1984 .46
Hirsch, 1979 - .10
Sandler & Barrera, 1984 .04 .01 .32
1984
I. G. Sarason et al., .21-.34
1983
Schaefer et al., 1981 .10-.36
Stokes, 1983 -.10 a
Turner et al., 1983 .07-.57
(M = .27)
Valdenegro & Barrera, .00 .02 .27
1983
Vaux & Harrison, 1985 < .10, .18
aStandardized regression coefficient;network sizewas not a significant predictor of support
satisfaction when entered in stepwise regression with three additional network variables.

support for the perceived availability o f social bonds that offered love, esteem,
social affiliation, and other critical provisions. They distinguished social sup-
port f r o m social resources which they regarded as objective indices o f af-
filiation. Social resources were assessed by social n e t w o r k measures and
indicators o f social participation (e.g., frequency o f visiting neighbors, marital
status, n u m b e r o f close friends). Perceived social s u p p o r t scales were cor-
related moderately and consistently with each other over four separate studies.
In contrast, measures o f perceived social support showed only low correla-
tions with indicators o f social resources. These findings led Turner et al. (1983)
to conclude that perceived social support and social resources (social embed-
dedness) are t w o related but otherwise distinct concepts.
The Social S u p p o r t Questionnaire (SSQ) was developed to assess two
social s u p p o r t c o m p o n e n t s , the n u m b e r o f individuals w h o are available to
deliver social support and satisfaction with support (I.G. Sarason et al., 1983).
Each measure proved highly reliable. However, in two separate studies, these
two c o m p o n e n t s showed m o d e s t correlations ranging f r o m .21 to .34. Fur-
thermore, the n u m b e r o f supportive others was related to n u m b e r o f positive
life events but not to negative life events. In contrast, satisfaction with sup-
p o r t was not related to positive events, but it did show an inverse relation-
ship to negative life events. These results p r o m p t e d the authors to conclude
that both measures were reliable indicators o f distinct social support concepts.
420 Barrera

Numerous other researchers have commented on the comparative in-

dependence of different social support concepts (Broadhead et al., 1983; P.
Cohen et al., 1982; Heller & Swindle, 1983; Kobasa & Puccetti, 1983; Pearlin,
Lieberman, Menaghan, & Mullan, 1981; I. G. Sarason et al., 1983; Wilcox,
1981). For example, Broadhead et al. (1983) cited several factor-analytic
studies that found that the quality of social support and the frequency of
social interaction emerged as orthogonal components. Similarly, Heller and
Swindle (1983) described some unpublished data that were collected in the
development of perceived social support scales. They noted that factor
analyses indicated that measures of perceived social support were indepen-
dent of social network characteristics. In their community survey of New
York City residents, P. Cohen et al. (1982) assessed three social support
variables: (a) neighborhood cohesion, a measure of perceived social support
in the neighborhood, (b) frequency of visits to friends or relatives, and (c)
marital status. Neighborhood cohesion and frequency of visiting were not
correlated highly (r = .34); marital status was unrelated to the other social
support variables.

Discussion

The relative independence of social support measures is a source of

despair to those who interpret it as the lack of convergent validity across
measures. However, it can also be interpreted as empirical grounds for draw-
ing clear distinctions between different social support concepts. There are
several implications of this conclusion. First, it seriously questions the value
of a global construct of social support and issues a strong caution against
regarding social support scales as interchangeable. Instead, the independence
of social support measures signals the importance for investigators to carefully
identify the social support concepts that fit their research questions and to
select measures that match these concepts. It also calls for the judicious use
of proxy variables. For example, researchers who use marital status as an
indicator of "social support" have the responsibility of demonstrating that
it is generalizable to other social support measures (cf. P. Cohen et al., 1982).
We do not advance our understanding of social support concepts by using
proxy variables that are not clearly related to these concepts.
Another implication is that individual measures are handicapped when
they include a mixture of distinct social support variables. Internal consistency
should suffer seriously in these cases. This is one possible explanation for
the relatively low internal consistency of a some scales such as that described
by Lin et al. (1979) which appeared to include elements of both perceived
social support (e.g., feelings about people nearby) and social embeddedness
Social Support Models 421

(e.g., frequency of talking with neighbors). It is conceivable that there will

be situations in which otherwise distinct components of social support are
substantially correlated with each other (e.g., Aneshensel & Stone, 1981;
Dignam, Barrera, & West, 1986). But barring strong empirical justifica-
tion for combining support concepts, both the internal consistency of social
support measures and the interpretation of findings based on them will be
facilitated by differentiating between social embeddedness, perceived social
support, and enacted support.

MODELS

Although the stress-buffering model of social support has dominated

social support research, other models of social support's linkages to stress
and distress have been described. As noted by several reviewers (Gore, 1981;
Gottlieb, 1983; Henderson et al., 1981; House, 1981) social support has been
hypothesized to have a diversity of connections to stress, distress, and in-
tervening processes. Furthermore, Gore (1981) and Henderson et al. (1981)
hypothesized reciprocal relationships between social support, stress, and
distress.
If each of these models was interpreted literally, it would appear that
global social support has highly diverse roles in the stress process. But in
light of the conceptual and empirical distinctions that can be drawn between
social support concepts it seems that these composite models are overly com-
plex and imprecise. An alternative approach is to hypothesize narrower
models that indicate the linkages between specific social support concepts
and the variables of stress and distress.
As a way of structuring a review of social support effects, four simple
relationships that involve stress, distress, and social support concepts were
selected:
1. Social support is positively related to stress.
2. Social support is negatively related to stress.
3. Social support is positively related to distress.
4. Social support is negatively related to distress.
Organizing findings around these basic relationships allowed for the inclu-
sions of studies that reported only bivariate correlations, tested simple models,
or did not specifically evaluate nonlinear effects.
In reviewing this research, special attention was given to the types of
social support concepts that were measured in each study. The goal here was
to determine if a particular relationship was found for certain categories of
social support but not for others. For each of the four relationships a table
422 Barrera

Table II. Studies Showin~a Positive Relationship Between Social Support and Stress/Strain
Study Social support Stress/strain

Enacted social support scales

Barrera, 1981 Frequency of help Negative events
Belle, 1982 Frequency of mutual aid & Life conditions
socializing with neighbors stress
S. Cohen & Hoberman, Frequency of help Negative events
1983
Sandler & Barrera, 1 9 8 4 Frequency of help Negative events
Mixed social support scales
Aneshensel & Frerichs, No. of close friends, no. of Loss events
1982 close relatives, frequency of
support provision

(see Tables II-V) lists those studies that found some significant association
(simple correlation, partial correlation, or path coefficient) between a social
support concept and a measure of either stress or distress. 3 Figures 1 to 6
illustrate only those models that have been explicitly tested or that appear
to be consistent with patterns of relationships found in non-path-analytic
studies.
Research on the most prominent nonlinear model of social support ef-
fects, the stress-buffering model, 4 is not covered in the present review. This
literature has been reviewed extensively (S. Cohen & McKay, 1984; S. Cohen
& Wills, 1985; Kessler & McLeod, 1985). The stress-buffering model is omitted
here to avoid redundancy with these previous reviews and to advocate the
consideration of other viable models of social support effects.

Social Support is Positively Related to Stress

The positive linkage between stress and social support has been observed
in only a few studies. As shown in Table II, all of these studies included some

3The tables do not show studies that failed to find particular relationships between social sup-
port and measures of stress and distress. I refrained from interpreting the lack of statistically
significant findings as evidence that relationships, in fact, do not exist. The failure to find
statistically significant effects could be due to a number of factors (such as unreliability, small
samples, biased distributions, data collections procedures) that are not always described fully
in research reports.
4The most prominent version of the stress-buffering model proposes that the relationship bet-
ween stress and distress is greater under conditions of low support than it is for high support.
Alternatively, the shape of this interaction is such that there is little difference between high
and low support groups under conditions of low stress. However, under high stress, individuals
with low support show more distress than individuals with high support.
Social Support Models 423

Stress "J" j, Enacted ~ Distress

Events Support

Fig. 1. Effective support mobilization model.

measure of enacted support that assessed the quantity of support provision.

In fact, three of these studies used the same measure, the ISSB.
One study, a longitudinal path-analytic project (Aneshensel & Frerichs,
1982), found that stressful life events were positively related to a composite
measure of enacted support and social embeddness. Subjects reported not
only the number of close friends and close relatives but also rated how often
there was someone to provide them with various forms of socioemotional
and instrumental aid. These data were consistent with a path model that
showed a positive link between stress events and enacted support/social
embeddedness and a subsequent negative link between support and depres-
sion. A simplified version of Aneshensel and Frerichs (1982) model is shown
in Figure 1 which has been labeled the Effective support mobilization model.
The positive linkage between stress and social support can be interpreted
as evidence that exposure to stressful circumstances triggers the mobiliza-
tion of enacted support (Barrera, 1981; Gore, 1981; Gottlieb, 1983; Lin et
al., 1979). If social support networks are responsive, they will increase their
provisions of supportive actions when network members are confronted with
stressful efents. Schachter's (1959) famous studies on affiliation also suggest
that individuals might have a greater tendency to affiliate when they are con-
fronted with adversity. Thus, stress might result in the mobilization of sup-
port by the spontaneous provisions of significant others and by increases in
affiliation by those who are experiencing stress.
Belle (1982) provided data that were relevant to these observations. Her
study of 43 low-income mothers included measures of stressful life condi-
tions, perceived availability of supports, and various types of aid that were
exchanged between neighbors. Activities such as borrowing material goods,
shopping for each other, and socializing were positively related to stressful
life conditions. Belle interpreted these findings as evidence that mothers who
experienced the greatest strains in day-to-day living relied on their neighbors
as a matter of survival. Stress appeared to increase the need of these women
to engage in mutual exchange with their neighbors.
Previous reviewers have regarded the positive linkage between enacted
social support and stress as problematic, evidence of confounding, and
grounds for questioning the validity of enacted support measures (S. Cohen
& Wills, 1985; Kessler & McLeod, 1985; Wood, 1984). For example, Wood
(1984) wrote this about one measure of enacted support, the ISSB: "there
is some concern regarding what the ISSB actually measures, since it was found
424 Barrera

to be positively correlated with both negative life events and psychiatric symp-
tomatology" (p. 341). Rather than serving as a source of confusion, the
positive relationship between enacted support and stress is quite consistent
with a model of support mobilization such as that shown in Figure 1. This
relationship is only viewed as surprising, problematic, or confusing because
a different model of stress-support relationships has been adopted as the "cor-
rect" representation.
With the exception of the study by Aneshensel and Frerichs (1982), the
studies shown in Table II were cross-sectional. These designs cannot eliminate
the possibility that social support exerts a causal influence on the occurrence
of negative life events. However, inspection of ISSB items (that were used
in three studies) and life event schedules suggests that the support-causes-
stress model is less plausible than the support mobilization explanation.
To further our understanding of support mobilization it would be useful
to differentiate between help seeking (an active coping activity) and help
that is obtained without the assertive actions of the recipient. The distinc-
tion between help seeking and passive help receipt is not captured in some
measures of enacted support (e.g., ISSB). Differentiating between these two
forms of enacted support might further clarify the role of personality fac-
tors in support processes (Kobasa & Puccetti, 1983; Lefcourt et al., 1984;
McFarlane, Norman, Streiner, & Roy, 1983; Sandler & Lakey, 1982). For
example, externally oriented individuals reported recieving more enacted sup-
port than individuals with an internal orientation, but the stress-buffering
effect of enacted support was shown for subjects with an internal locus of
control (Sandler & Lakey, 1982). One possible explanation for these findings
is that internals are more selective in seeking out those forms of social sup-
port that aid in moderating stress. Externals, on the other hand, might passive-
ly receive more assistance, but this assistance might not met the needs
engendered by stress events. To test these hypotheses it is necessary to
distinguish between active coping strategies that involve the solicitation of
aid and enacted support that is passively obtained.

Social Support is Negatively Correlated with Stress

There are at least 17 studies that reported an inverse relationship be-

tween social support variables and measures of life events or perceived strain.
With few exceptions (Aneshensel & Stone, 1982; Mitchell & Hodson, 1983),
these studies have included measures of perceived social support (see Table
III).
There are two obvious mechanisms that would account for this rela-
tionship between perceived social support and stress/strain. The first model
might be described as the stress prevention model in which social support
Social Support Models 425

Table III. Studies Showing a Negative Relationship Between Social Support and Stress/Strain
Study Social support Stress/strain

Perceived social support scales

Barrera, 1981 Support satisfaction Negative events
Burke & Weir, 1977 Satisfaction with spouse's help Perceived job and home stress
L. H. Cohen et al., 1984 Perceived support Negative events
Dean & Ensel, 1982 Strong-tie support (perception Life events
of not having close com-
panion or friends)
Goplerud, 1980 Quality of faculty contacts Stress events
Henderson et al., 1981 Perceived adequacy of Life events
support
Kobasa & Puccetti, Perceived work support Life events
1983
McFarlane et al., 1983 Perceived helpfulness of Neutral or undesirable un-
supportive discussions controllable events
Mitchell & Moos, 1984 Perceived family support Chronic stress
Pearlin et al., 1981 Intimacy relationships Economic strain
Procidano & Heller, Perceived friend support Negative life events
1983
I. G. Sarason et al., Support Satisfaction Negative life events
1983
Turner& Noh, 1983" Perceived support Negative life events
Mixed social support scales
Aneshensel & Stone, No. of close relationships, Perceived strain
1981 amount of support
Dignam et al., 1986 Frequency & satisfaction Perceived role ambiguity
with help
Mitchell & Hodson, Contacts with friends and Level of violence from male
1983 family, number of partner
supporters
Schaefer et al., 1981 Perceived information Loss events
support, social embedded-
ness composite
"Only for low social status subsample.

prevents the occurrence of stressful conditions or reduces the likelihood that

events would be perceived as highly stressful (see Figure 2).
The stress prevention modei was illustrated in a study by Dignam et
al. (1986). Correctional officers in county prisons were the subjects of
this cross-sectional study. Supportive transactions between co-workers and
supervisors were hypothesized to prevent job stress by decreasing role am-
biguity and thereby influencing burnout levels. An adaptation of the ISSB
allowed for ratings of both the frequency and quality of supportive behaviors
that were received from fellow correction officers and supervisors. Other
predictors of burnout were role ambiguity, workload, and direct contact with
inmates. Maslach's Burnout Inventory served as the criterion (Maslach &
426 Barrera

Social
Embeddedness
or Enacted
Support

Distress

Perceived Perceived
Support Stress

Fig. 2. Stress prevention model showing several plausible mechanisms.

Jackson, 1981). There was no support for either buffering effects or a direct
pathway between social support and burnout. However, the data fit a model
that linked support with reductions in role ambiguity which led to reduc-
tions in burnout symptoms. Figure 2 is a simplified version of the model
found by Dignam et al. (1986).
An extremely important feature of the stress prevention model is that
social support bears an indirect rather than a direct relationship to distress.
In the Dignam et al. (1986) study, the zero-order correlation between social
support and perceived stress was negative and significant, but social support
was not related to distress (burnout). Some writers have questioned the validi-
ty or meaningfulness of social support measures that show a significant cor-
relation with stress (S. Cohen & Wills, 1985) or that fail to show a negative
relationship to distress (Wood, 1984). However, Dignam et al.'s study
demonstrated that social support measures with these characteristics can fit
a viable model of social support effects.
The stress prevention model actually involves two somewhat different
mechanisms of support that could be untangled in future research. In one
case, the initial occurrence of events is prevented (Pearlin & Schooler, 1978).
For example, the neighborhood cohesion that results from Neighborhood
Block Watch programs are designed to prevent the initial occurrence of stress
events associated with property crimes. A second mechanism is one in which
social support reduces the perceived threat or the appraised stressfulness of
events that have already occurred. Studying these two mechanisms obvious-
ly requires two different approaches to assessing stress.
A second explanation of the negative relationship between perceived
support and stress is that stress deteriorates the perceived availability or ef-
fectiveness of social support. Dean, Ensel, and Lin reported a series of studies
that yielded results consistent with the support deterioration model (Dean
& Ensel, 1982; Lin & Dean, 1984; Lin & Ensel, 1984). In their model, stressful
Social Support Models 427

Perceived
Support

Stress//~_
Events
~ "I-
Distress

Fig. 3. Support deterioration model.

life events had a negative linkage to strong-tie support (perceptions of not

having a close companion or close friends) which, in turn, was related to
depressive symptoms (see Figure 3).
Mitchell and Moos (1984) conducted a longitudinal panel study with
depressed patients that was also consistent with the support deterioration
model. Measures of life events, perceived strain, perceived family support,
and number of close friends were administered to depressed patients in two
assessments over a 1-year period. Mitchell and Moos concluded that perceived
strain lead to less perceived family support; there was no evidence that either
perceived family support or number of close friends prevented the occur-
rence of stressful life events or perceptions of strain.
So what is the causal direction in the linkage between perceived social
support and stress/strain? The short answer is that there are not extensive
data on this question. On the surface, both mechanisms are plausible.
McFarlane et al. (1983) concluded that there is a reciprocal relationship bet-
ween perceived social support and stress. In their longitudinal study,
McFarlane et al. found that one effect of increases in uncontrollable life events
was to decrease the perceived helpfulness of future support transactions. Yet
it also appeared that perceived helpfulness prevented increases in stress events.
It is not clear why there are not more data consistent with the support
deterioration model for measures of social embeddedness. Many forms of
stress (not only social losses) could conceivably precipitate changes in social
network structure. For example, job strains or unemployment could be linked
to marital disruptions which, in turn, could lead to further social embed-
dedness deterioration. Evaluations of this process await further research.
In addition to the mechanisms I have described, some have suggested
that the negative relationship between stress and support is evidence that the
428 Barrera

two concepts overlap (Gore, 1981; Schaefer, Coyne, & Lazarus, 1981; Thoits,
1982). For example, Brown and Harris (1978) acknowledged that if their sub-
jects experienced a provoking agent such as marital difficulties, it was unlikely
that they would name their spouse as a confidant. For the low-income women
in Brown and Harris' sample, provoking agents were highly associated with
the lack of intimate relationships (see chap. 11). Schaefer et al. (1981) reported
results that were consistent with arguments that social support measures can
be confounded with event inventories that include social exit experiences.
Their measure of social loss events was negatively correlated with perceived
informational support and a composite index of social embeddedness but
a measure of nonsocial loss events was not.
Measures o f social embeddedness are particularly vulnerable to the
criticism that they overlap conceptually with social loss events. The most ob-
vious problematic situation is when marital status is used as a proxy variable
for social support and when life event schedules include items such as divorce,
separation, and death of spouse (Thoits, 1982). However, it should not be
assumed that conceptual overlap of this kind automatically occurs in measures
o f social embeddedness or extends to other concepts such as perceived social
support.

Positive Relationships Between Social

Support and Distress

Several studies have shown a positive relationship between social sup-

port and measures of psychological-distress or physical illness (see Table IV).
All the studies shown in Table IV used measures of enacted support with

Table IV. Studies Showing a Positive Relationship BetweenSocial Support and Distress/Illness
Study Social support Distress/Illness

Enacted social support scales

Barrera, 1981 Frequency of help Psychological distress
S. Cohen & Hoberman, Frequency of help Physical symptoms
1983
Coyne et al., 1981 Seeking of emotional support Depression symptoms
Fiore et al., 1983 Frequency of asking for BDI: depression symptoms
support
Mixed social support scales
Carveth & Gottlieb, Amount of contact, frequency Health status, psychiatric
1979 of problem discussions, symptoms, perceived
relationship importance distress
Warheit et al., 1982 Presence of relatives nearby General psychiatric symptoms
for help, help seeking from
relatives, help seeking from
friends
Social SupportModels 429
the exception of two studies that incorporated heterogeneous measures of
support. Even these two studies (Carveth & Gottlieb, 1979; Warheit, Vega,
Shimizu, & Meinhardt, 1982) had scales that included items reflecting enacted
support. These findings are not consistent with the results of Aneshensel and
Frerichs (1982) who found a negative relationship between depression and
a composite measure of enacted support and social embeddedness (see Figure
1). At this point it is not clear how these conflicting models can be resolved.
There are two obvious explanations for the positive relationship between
enacted support and distress. In what might be described as a support seek-
ing~triage model, those individuals who show the greatest symptomatology
should receive and/or seek the most enacted support. This model is analogous
to the medical model of care seeking in which the initial recognition of symp-
tomatology leads to the solicitation of medical services. Because a number
of the enacted support measures shown in Table IV explicitly refer to seeking
aid for problem resolution, this is a plausible model for these relationships.
A variation on the support seeking/triage model depicts the positive
relationship between enacted support and psychological distress as a spurious
effect that results from the relationship of both variables to stress (see Figure
4). A reanalysis of data from the correlation matrices reported by Barrera
(1981) and Sandler and Barrera (1984) showed that the relationship between
enacted social support and symptoms approached zero (.04 and - .01, respec-
tively) when stress was held constant. The observed linkages in these two
studies are consistent with paths A and B shown in Figure 4, but not with
path C.

(A)
/\\\\
Distress

\~1- (C)

Stress
/ ,,, ~ Enacted
Events Support
(B)
.... possible
spurious
path
Fig. 4. Support seeking/triagemodel showingpossible
spurious linkage between psychologicaldistress and
enacted support.
430 Barrera

The studies shown in Table IV cannot rule out the possibility that the
provision of support leads to the exacerbation of symptoms. Adverse effects
of help seeking and receiving could result from several mechanisms. First,
the receipt of aid could be initially experienced as negative. This would be
the case, for example, it advice was delivered in a demeaning or dogmatic
fashion. Alternatively, help could be initially experienced as positive, but
the net effect of receiving aid could be negative. There is a growing apprecia-
tion of the potential adverse effects of help provision (Fisher, Nadler, &
Whitcher-Alagna, 1982). Receiving aid might lower one's sense of self-esteem
if it is interpreted as a sign of personal incompetence or if it triggers social
comparisons with a more able support donor. Receipt of aid might also result
in feelings of indebtedness or obligation to restore equity by repaying aid.

Social Support is Negatively Correlated with Distress

Of all the relationships reviewed here, there is the greatest amount of

evidence for the negative association between social support and distress.
For the most part, these relationships are found for measures of perceived
social support, but in a few studies measures of social embeddedness and
enacted support also show these effects (see Table V). Because a number of
the studies are longitudinal, there is compelling evidence to suggest that social

Table V. Studies Showing a Negative Relationship Between Social Support and Distress/Illness
Study Social support Distress/Illness

Perceived social support measures

Andrews et al., 1978 Perceived availability of
crisis support
Barrera, 1981 Support satisfaction
Belle, 1982 Perceived availability
of child care aid, emotional
support
Billings & Moos, 1981 Perceived family support
Billings & Moos, 1982 Perceived work & family
support
Billings & Moos, 1984 Strength of close ties,
quality of personal
relationships
Burke & Weir, 1977 Satisfaction with spouse's help
L. H. Cohen et al., Perceived support
1984
S. Cohen & Hoberman, Perceived support
1983
Dean & Ensel, 1982 Strong-tie support (perception
of not having close com-
panion or friends)
Psychological distress
Psychological distress
Depressive & anxiety
symptoms, mastery
Depressive, anxiety, &
physical symptoms
Depressive & physical
symptoms
Depressive & physical
symptoms, self-confidence
Variety of symptom & life
satisfaction scales
Depressive & distress
symptoms
Depressive symptoms
Depressive symptoms
Social Support Models
Table V. Continued
Study Social support
Perceived Social Support Measures
Fleming et al., 1982 Perceived support
Frydman, 1981 Perceived availability of
crisis support, neighbor-
hood interaction, com-
munity participation
Habif & Lahey, 1980 Perceived support
Henderson et al., 1981 Perceived adequacy &
availability
Hirsch, 1980 Satisfaction with advice,
socializing
Holahan & Moos, 1981 Perceived family & workplace
support
LaRocco & Jones, 1978 Perceived leader support
and work group coopera-
tion
Lin & Dean, 1984 Strong-tie support (perception
of not having close compa-
nion or friends)
Lin & Ensel, 1984 Strong-tie support
Monroe, 1983 Marital coping resources
Norbeck & Tilden,
1983 Perceived emotional support
Paykel et al., 1980 Adequacy of marital com-
munication, help with
chores, & nonspouse
confidant relationship
Schaefer et al., 1981 Perceived tangible &
emotional support
Turner, 1981 Perceived support
Turner & Noh, 1983 Perceived support
Social embeddedness measures
Bell et al., 1982 Composite measure of social
embeddedness
Berkman & Syme, 1979 Marital status, extent of
contact with friends and
relatives, social participation
Billings & Moos, 1981 No. of friends, organizational
participation, social par-
ticipation
Billings & Moos, 1984 No. of friends, contact with
friends
Brown et al., 1975a Presence of confidant
P. Cohen et al., 1982 Neighborhood cohesion,
marital status
Costello, 1982 Presence of confidant
Goplerud, 1980 Social contacts, faculty
contacts
431
Distress/Illness
Psychological distress
Psychological distress,
well-being
Depressive symptoms
Depressive & distress
symptoms
Psychological distress,
self-esteem
Psychological distress
Job dissatisfaction
Depressive symptoms
Depressive symptoms
Physical symptoms
Psychological distress
Puerperal depression
Depressive symptoms &
negative morale
Distress (anger, anxiety,
depression)
Distress
Depressive symptoms
Mortality rates
Depressive symptoms
(results held for male only)
Depressive & physical
symptoms, self-confidence
Depression
Well-being (composite of
positive and negative states)
Depression
Emotional & health problems
432 Barrera

Table V. Continued
Study Social support Distress/Illness

Social Embeddedness Measures

Mitchell & Hodson, Contacts with friends and Depressive symptoms
1983 family
Monroe et al., 1983 Living at home Depressive symptoms
Rook, 1984a No. of comfortable ties, Well-being, loneliness
frequency of socializing
Surtees, 1980 6-item social embeddedness Depressive symptoms
index
Warheit, 1979 Presence of spouse, Depressive symptoms
friends
Williams et al., 1981 Social participation Psychological distress &
/ positive well-being
Enacted support measures
Belle, 1982 Receipt of help for day-to-day Mastery, self-esteem
tasks
Lefcourt et al., 1984 Frequency of help Mood disturbance
Mixed measures of social support
Aneshensel & Frerichs, No. of close friends, no. Depressive symptoms
1982 of close relatives, frequency
of support provision
Aneshensel & Stone, No. of close friends, Depressive symptoms
1981 no. of close relatives,
frequency of support
provision
Gore, 1978 Perceived support of Depressive & illness
wife, friends, & relatives; symptoms, serum
relatives; socializing; cholesterol, perceived
perceived opportunities economic deprivation
for socializing & problem
discussion
Lin et al., 1979 Social participation, Psychiatric symptoms
organization affiliation, job
satisfaction
aThis result is based on Tennant and Bebbington's (1978) reanalysis of Brown et al.'s (1975) data.

s u p p o r t is p r o s p e c t i v e l y r e l a t e d to p s y c h o l o g i c a l d i s o r d e r a n d / o r p h y s i c a l
illness.
Five o f these studies d e s c r i b e d p a t h m o d e l s ( A n e s h e n s e l & F r e r i c h s ,
1982; P . C o h e n et al., 1982; D e a n & Ensel, 1982; L i n & D e a n , 1984; L i n
& Ensel, 1984). T h e p a t h analyses o f D e a n , Ensel, a n d L i n s h o w e d a negative
r e l a t i o n s h i p b e t w e e n life stress a n d p e r c e i v e d social s u p p o r t t h a t is consis-
tent with the s u p p o r t d e t e r i o r a t i o n m o d e l ; the m o d e l also d e p i c t s a negative
l i n k a g e b e t w e e n p e r c e i v e d social s u p p o r t a n d depressive s y m p t o m s . F o r ex-
Social Support Models 433

ample, Lin and Ensel (1984) reported a two-wave panel study of a random
sample of adults living in the Albany, New York, area. They measured a
perceived social support concept labeled "strong-tie support" which refer-
red to subject's perceptions of lacking a close companion and close friends.
Their path analysis included 1-year change scores on measures of life stress
events, strong-tie support, and depressive symptoms. Results showed that
increases in life stress were related to decreases in perceptions of social sup-
port; deterioration in perceived social support was related to increases in
depressive symptoms.
This model is distinct from one reported by P. Cohen et al. (1982) that
included a measure of social embeddedness (see Figure 5). In this model,
the additive model, stress and social embeddedness were unrelated and made
independent contributions to psychological well-being. These results are
similar to those reported by Williams, Ware, and Donald (1981) in their
longitudinal study of Seattle residents. Change in life stress and social embed-
dedness made unique contributions in the prediction of changes in
psychological well-being measures.
The negative relationships between psychological well-being and both
social embeddedness and perceived support are consistent with attachment
theory. Without enlisting the concept of stressful life changes, there is substan-
tial theoretical basis for arguing that these support concepts are primary re-
quisities for psychological well-being (Bowlby, 1969; Henderson, 1977;
Murray, 1938; Weiss, 1969). The absence of these attachments is seen as a
sufficient explanation for the development of psychological distress. Social
embeddedness measures capture the extensiveness of attachments by assess-

Social
Embecldedness

Distress

Stress
Events

Fig. 8. Additivemodelof stressand socialembed-

dedness.
434 Barrera

ing the quantity of people who are recognized as support providers or by

gauging the frequency of social participation. Perceived social support
measures should be even more sensitive to the basic mechanism of attachment,
that is, the perceived adequacy of support in meeting social needs.
Although social support concepts are commonly modeled as causally
antecedent to psychological distress, it is legitimate to question if psychological
distress can lead to the deterioration of social embeddedness or alter percep-
tions of support. Unfortunately, a number of panel studies have collected
data relevant to this issue but have not fully described tests for possible pro-
spective relationships between psychological distress and social support
measures. The possibility that distress influences social support is most often
regarded as an undesirable effect that should be controlled rather than
studied. How~ever, there are data that demonstrate the detrimental effects
of prior psychological distress on perceived social support.
In a panel study of community residents and alcohol treatment pro-
gram participants, Billings and Moos (1982) found limited evidence that
depressive symptoms can influence subsequent perceptions of support. For
their subsample of employed women, initial depressive symptosm were
negatively related to perceived workplace support 1-year later. This relation-
ship was not found for other subsamples of employed men and alcohol pro-
gram participants.
Turner (1981) obtained measures of perceived support and psychological
well-being in two assessments that were separated by a 6-month interval. An
examination of cross-lagged correlations and multiple regression analyses led
Turner to conclude that there was support for a reciprocal relationship bet-
ween perceived social support and well-being, that is, "some important part
of the causation involved goes from social support to psychological well-being
and that some important part also goes in the opposite direction" (p. 363).
Thus, there is some support for the model shown in Figure 6 that depicts
a reciprocal relationship between stress and perceived social support.
A number of viable mechanisms could account for how psychological
distress causes poor perceptions of social support, poor social embeddedness,
or the failure to mobilize enacted support. First, states of psychological
distress such as depression could lead to a negative distortion of the availabili-
ty or adequacy of social support. Second, individuals who show signs of
psychological destress might be rejected by others (Coyne, 1976), particularly
if the disorder is chronic rather than acute. Finally, personal characteristics
of the distressed individual such as poor social skills (Heller, 1979) or severe
psychiatric disorders (Henderson et al., 1978; Pattison, Defrancisco, Wood,
& Frazier, 1975; Silberfeld, 1978; Tolsdorf, 1976) could result in small net-
works and/or poor quality of relationships. There is a need for more studies
that explicitly examine the causal mechanisms that link psychological distress
Social Support Models 435

Perceived
Support

Distress

Stress
Events

Fig. 6. Reciprocityof stressand perceivedsupport

model.

and illness to social support concepts. This research should address the
developmental changes that might occur in the structure and functioning of
support networks as psychological distress progresses to adjustment or
deteriorates to chronicity.

THE ISSUE OF CONFOUNDS

Social support measures have been criticized for being confounded with
the concepts (measures) of both stress and distress (S. Cohen & Hoberman,
1983; Dohrenwend, Dodson, Dohrenwend, & Shrout, 1984; Gore, 1981;
Heller & Swindle, 1983; Henderson et al., 1981; Thoits, 1982). In these discus-
sions the term confound appears to refer to three separate conditions. First,
there is the problem of conceptual overlap that is reflected when social sup-
port scale items are highly similar to those in a stress or distress measure.
Second, confounding can refer to "the third-variable problem" that occurs
when the relationship between two variables can be explained by their linkages
to a separate variable that causes both of them. Finally some writers have
expressed concern about bias and confounds when, in fact, they appear to
describe simple correlations involving social support concepts and measures
of life stress.
Two articles illustrated interesting approaches to identifying possible
conceptual overlap between social support and psychological distress. Turner
436 Barrera

et al. (1983) used factor analysis to determine if perceived social support and
psychological distress items could be differentiated. Four separate studies
included various measures of social support and psychological distress (BSI,
CESD, scales of anxiety and hostility). In each of these studies, the social
support and distress items separated into remarkably distinct factors. There
was no consistent overlap between the two sets of items. These results are
notable because perceived social support measures are thought to have great
potential for overlap with symptom measures that rely on individuals' percep-
tions of distress (Gore, 1981).
Dohrenwend et al. (1984) were concerned with the overlap between
measures of psychological distress and measures of both life stress and social
support. They noted how previous research with Holmes and Rahe's (1967)
life events scale was crticized because this measure contained many items that
were themselves indicators o f physical or mental illness. Accordingly, the
relationship between life stress and illness could be viewed as spurious because
of the confounding of the two concepts. Dohrenwend et al. (1984) argued
that other measures of life stress and social support could also contain items
that assess psychological disorder.
In Dohrenwend et al.'s (1984) study, members of the clinical psychology
division of the American Psychological Association were asked to judge
whether items from Holmes and Rahe's (1967) Schedule of Recent Experience
(SRE), Kanner, Coyne, Shaefer, & Lazarus's (1981) Hassles Scale, and Lin,
Dean, and Ensel's (1981) Instrumental-Expressive Social Support Scale
assessed symptoms of psychological disorder. Ratings had a possible range
of 1 (almost certainly a symptom of psychological disorder) to 5 (almost cer-
tianly not a symptom of psychological disorder). Five items from Langner's
(1962) 22-item Symptom scale served as reference points for psychological
disorder ratings. Five items from the ISSB served as anchor items for non-
symptom ratings since the developers of this scale designed it to be relatively
unconfounded with references to psychological distress (Barrera et al., 1981).
As predicted, the Langner items were rated at the lowest end of the
rating scale (almost certainly symptoms); Barrera et al.'s items were rated
at the opposite extreme (almost certainly not symptoms). The other three
scales showed a considerable amount of overlap with psychological symp-
tomatology. Lin et al.'s (1981) social support scale contained the greatest
percentage of items that were rated as similar to symptom items. Almost two-
thirds of the scale's items were rated below the neutral point. The scales by
Kanner et al. (1981) and Holmes and Rahe (1967) followed in their degree
of confounding with symptomatolo~5.
The studies by Dohrenwend et al. (1984) and Turner et al. (1983) il-
lustrated two approaches to evaluating the confounding of social support
and psychological distress measures that results from conceptual overlap.
Social Support Models 437

It is critical to note that conceptual confounding was observed for one of

the social support measures, but it was not apparent in either the ISSB items
Dohrenwend et al. selected or the several measures investigated by Turner
et al. Although it is useful to be concerned about the potential overlap be-
tween measures of support and distress, all social support scales should not
be viewed as suspiciously confounded with measures of psychological
symptoms.
Conceptual overlap is also a potential problem for measures of sup-
port and life stress (Eckenrode & Gore, 1981; Gore, 1981; Schaefer et al.,
1981; Shinn et al., 1984; Thoits, 1982). It is easy to agree with the assertion
that some crude indicators of social embeddedness (e.g., marital status) can
overlap with life event scales that refer to losses or gains of supportive rela-
tionships (e.g., marriage, divorce, death of spouse, separation). Although
possible content overlap between life stress and social embeddedness is an
important issue, other measures of support are less susceptible to this
criticism. There is little basis for arguing that a measure of the frequency
of socially supportive behaviors or perceived support are conceptually con-
founded with the occurrence of discrete stress events, even when the stress
measure contains items concerning social exits and entrances.
The problem of confounding can also include the notorious third-
variable problem in which a relationship between two variables results when
they are both causally linked to a third variable (Kenny, 1979). As previous-
ly noted, the positive relationship between enacted support and psychological
distress is consistent with a model in which both of these variables are causally
linked to negative life events. Although complex data-analytic procedures
do not compensate for faulty theoretical specifications, the use of path-
analytic procedures aids in identifying spurious relationships between modeled
variables.
There is the danger that concern for confounding will discourage the
scrutiny of legitimate relationships between social support concepts and
measures of stress or distress. Consider, for example, a statement by S. Cohen
and Wills (1985) in their review o f stress-buffering effects:

We argue that the ISSBconfoundsthe availabilityof support functions and the recent
need for support (i.e., stress), an argument that is supported by the positive cor-
relation between life events and the ISSB. (p. 340)

Although it is not completely clear how Cohen and Wills used the term con-
f o u n d in this quotation it is possible that they regarded a relationship be-
tween support and stress as undesirable (i.e., confounded) because they were
concerned about strong tests of the buffering hypothesis. From this perspec-
tive, it is desirable to demonstrate the relative independence of predictor
variables that are used to create interaction terms. However, the desirability
438 Barrera

of having unrelated support and stress measures in tests of the buffering model
should not be extended to tests of other viable models. Rather than dismiss-
ing potential causal linkages between life stress and social support as evidence
of bias or confounding, these linkages should become the targets of study
(Eckenrode & Gore, 1981; Shinn et al., 1984). For example, the death of
a spouse clearly involves the loss of a critical social relationship and likely
results in additional changes in one's social network. Investigating the
mobilization or withdrawal of enacted support following this event would
be a legitimate topic for study. These effects are distinctly different from
confounded relationships that result from content overlap or third-variable
problems.

CONCLUSIONS

We can reduce some of the confusion in the social support literature

by drawing some clearer distinctions between concepts and measures that
are relatively independent. The term social support is not likely to disappear
totally from our vocabulary, but it has little positive value for clarifying
linkages between stress and disorder. In fact, continued reliance on this
heterogeneous concept presents the great danger of obscuring important dif-
ferences and inhibiting the integration of research findings. There are, no
doubt, other schemes for organizing social support concepts or still finer
distinctions that could be drawn, but the categories of social embeddedness,
perceived social support, and enacted support appear to capture meaningful
similarities and differences that exist among commonly used concep-
tualizations.
"l~hisreview suggests that certain social support concepts fit some models
better than others. Positive relationships between social support and measures
of both stress and distress most often involved the concept of enacted sup-
port. These relationships are compatible with support mobilization and sup-
port seeking/triage models in which stress and the presence of symptoms elicit
the provision of support. The possibility that enacted support causes stress
events and psychological distress cannot be excluded but seems less plausible.
Perceived social support was the most frequently assessed social sup-
port concept in the literature reviewed. Measures of perceived support con-
sistently show negative relationships to distress and often to measures of life
stress and strain. Longitudinal studies provided an impressive accumulation
of evidence demonstrating prospective relationships between perceived sup-
port and subsequent psychological distress. Relationships involving perceived
support have fit several models, most notably the support deterioration model
in which life stress results in the deterioration of perceived support which,
in turn, is related to increased psychological distress.
Social Support Models 439

It is also important to note that some studies have shown reciprocal

relationships between perceived social support and both stress and symp-
tomatology. There is clearly a basis for investigating nonrecursive models
that depict circular paths of causality between perceived support and stress
and between perceived support and psychological disorder.
The support deterioration model has some special implications for in-
tervention strategies and further research. If life events cannot be prevented,
individuals might be protected from the deleterious impact on their percep-
tions of social support. Predictable stressors such as increased work demands
might be accompanied by parallel efforts to prepare significant others for
increased strains and to arrange for positive social interactions. Perhaps
cognitive-behavioral interventions would be useful in preventing distorted
perceptions of available support. Future research should also clarify the
mechanisms whereby stress leads to the deterioration of perceived support.
Does increased life stress alter behavioral transactions that contribute to the
appraisal of social support? Do certain life events substantially increase the
need for support which alters the perceived adequacy of available resources
(Henderson et al., 1981)?
The results for social embeddedness are somewhat sparse, but they are
consistent with the additive model shown in Figure 5. Unlike the models for
perceived social support, social embeddedness measures are more likely to
make contributions to the prediction of psychological distress that are in-
dependent of life stress. These few studies suggest the value of designing
preventive interventions that strengthen social embeddedness, perhaps by pro-
moting participation in community, neighborhood, work or religious
organizations. But here too there is a need for greater explication of the critical
properties of social embeddedness.
One of the models that has not received extensive research, the stress
prevention model, has important implications for preventive interventions.
At present it is not possible to identify the stress prevention model with a
single social support concept. The one study that illustrated this model used
a measure that combined perceived social support and enacted support
(Dignam et al., 1986). Certainly, only some forms of stress are prevent-
able, and only a subset of these could reasonably be prevented through social
interventions. Yet there are occasions when the social environment might
play a part in preventing the occurrence of stress (Dignam et al., 1986).
Future research needs to clarify potential mechanisms. To what extent does
enacted social support or social embeddedness prevent the initial occurrence
of stressful events? How might perceived social support prevent the appraisal
of events as highly aversive or threatening?
Although the emphasis of this paper has been on the distinctions be-
tween social embeddedness, perceived social support, and enacted support,
it is important to understand potential connections between these concepts
440 Barrera

(Heller & Swindle, 1983). A r e l a t e d r e s e a r c h t o p i c involves i d e n t i f y i n g the

causal a n t e c e d e n t s o f these s u p p o r t variables. W h a t leads to the d e v e l o p -
m e n t o f perceived s a t i s f a c t i o n with s u p p o r t (Stokes, 1983; V a u x & H a r r i s o n ,
1985) o r to the m o b i l i z a t i o n o f e n a c t e d s u p p o r t ( E c k e n r o d e , 1983)? W h a t
f a c t o r s t h r e a t e n the d e t e r i o r a t i o n o f social e m b e d d e d n e s s ? H o w d o struc-
tural variables such as the size o f schools, w o r k organizations, or communities
influence the m o b i l i z a t i o n o f e n a c t e d s u p p o r t (Oxley & B a r r e r a , 1984; Ox-
ley, B a r r e r a , & S a d a l l a , 1981; U n g e r & W a n d e r s m a n , 1985)? W h a t are the
social o r c u l t u r a l n o r m s t h a t affect h o w e n a c t e d s u p p o r t is s o u g h t o r p r o -
v i d e d ( N e i g h b o r s & J a c k s o n , 1984; Valle & Vega, 1980)?
D i v e r s i t y in social s u p p o r t is s o m e t h i n g to be a p p r e c i a t e d r a t h e r t h a n
s c o r n e d . But this diversity d e m a n d s w e l l - i n f o r m e d researchers w h o s p e c i f y
the c o n c e p t s o f s u p p o r t t h a t are the subjects o f inquiry, select m e a s u r e s t h a t
m a t c h these c o n c e p t s , a n d i d e n t i f y m o d e l s t h a t d e p i c t the h y p o t h e s i z e d con-
nections b e t w e e n the v a r i a b l e s o f interest.

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