60 Coping and Social Support
integration,asks the individual to report how many different
roles he or she has or the degree to which the individual is ac-
tive in different activities (e.g., church). The proposed mech-
anism for this type of support is that a person who has a
greater number of roles or is more active in social activities
has a more differentiated identity and that stressful events in
one area of life, or one role function, would be less likely to
impact the individual because fewer roles and areas of life are
disrupted.
Both perceived and received support have been measured
by assessing the degree to which others would provide per-
ceived support or actually provide (received support) the basic
functions of social support. The key support dimensions
have varied from theorist to theorist (see House, 1981; Weiss,
1974), but the majority of theories have incorporated
emotional, instrumental, informational, companionship, and
validation support (Argyle, 1992; House, 1981). The multidi-
mensional nature of support measures provides a powerful
tool because researchers can investigate the degree to which
different functions of support are helpful for dealing with dif-
ferent types of stressors.
Social Support and Health Outcomes
Cardiovascular Function
The majority of studies examining the role of social support in
physiological processes have focused on aspects of cardiovas-
cular function. One reason investigators are interested in this
area of research is that increased cardiovascular reactivity has
been linked to the development of cardiovascular disease. In-
creased sympathetic nervous system (SNS) responses have
been associated with a number of pathophysiological processes
that may lead to coronary heart disease (see Rozanski,
Blumenthal, & Kaplan, 1999). Differences between individu-
als in terms of their cardiovascular reactivity to stressors are as-
sumed to be markers of increased SNS responsivity, as studies
have shown that individuals who have increased reactivity to
mental stress are at higher risk for hypertension (e.g., Menkes
et al., 1989), arteriosclerosis (Barnett, Spence, Manuck, &
Jennings, 1997), and recurrent heart attacks (Manuck, Olsson,
Hjemdahl, & Rehnqvist, 1992).
A review of the more than 25 studies evaluating the as-
sociation between social support and social context (e.g.,
marital status) and cardiovascular function is beyond the
scope of this chapter (see Uchino, Cacioppo, & Kiecolt-
Glaser, 1996, for a review of this topic). Overall, the major-
ity of the studies examining the association between support
and cardiovascular function indicate that social support is
associated with lower blood pressure, lower systolic blood
pressure (SBP), and lower diastolic blood pressure (DBP)
(e.g., Hanson, Isacsson, Janzon, Lindell, & Rastam, 1988;
Janes, 1990). A small subset of studies reported no relation-
ship between social support and cardiovascular function
(e.g., Lercher, Hortnagl, & Ko”er, 1993), and one study re-
ported that social support was associated with poorer car-
diovascular function (Hansell, 1985). Uchino and colleagues
(1996) conducted a metaanalysis on the studies reporting a
correlation between blood pressure and social support and
found a small but reliable effect size across studies. Several
studies have reported gender differences. Social resources
are a stronger predictor of blood pressure among men, and
instrumental support is a stronger predictor of blood pres-
sure in women (see Uchino and colleagues, 1996, for a re-
view of this topic).
Over the course of the past 10 years, researchers have
begun to use laboratory studies to examine the ways that so-
cial support can in”uence cardiovascular reactivity. The un-
derlying hypothesis of these studies is that higher reactivity
to stressors may be one mechanism whereby cardiovascular
disease develops (see Manuck, 1994, for a review of this
topic). Researchers working in a laboratory setting have used
two basic ways to investigate whether social support can re-
duce reactivity. One approach, labeled the •passiveŽ support
paradigm by Lepore (1998), compares the cardiovascular re-
sponses of a person exposed to a stressor when alone to the
responses when another person is present. A second ap-
proach, labeled the •activeŽ support paradigm by Lepore
(1998), examines the effect of having another person provide
different types and levels of support. Some experiments com-
bine both types of manipulations or compare the effects of
the provision of supportive feedback versus nonsupportive or
evaluative feedback. One early study by Kamarck, Manuck,
and Jennings (1990) compared cardiovascular reactivity dur-
ing two tasks. Half of the subjects completed the tasks with-
out social support, and half of the subjects brought a friend
who provided support by touching the subject on the wrist
during the task. Results indicated a signi“cant reduction in
cardiovascular response when the friend was present. Edens,
Larkin, and Abel (1992) found that, during a mental arith-
metic task, the presence of a friend resulted in lower heart
rate (HR), SBP, and DBP than when a friend was not present
during the task. A second study evaluated the potential
buffering effects of social support in stress reactivity among
women under conditions of high or low social threat
(i.e., punitive consequences). Kamarck, Annunziato, and
Amaateau (1995) found that, under conditions of low stress,
the availability of social support made no difference in heart
rate or blood pressure. Under conditions of high stress, the
same social support reduced cardiovascular response. Similar