Social Support 67that positive reappraisal coping mediates the relation between
spousal support and psychological well-being. Third, listen-
ing, caring, and reassuring a friend or loved one that he or she
is worthy and loved can directly bolster self-esteem. Druley
and Townsend (1998) found that self-esteem mediated the re-
lation between marital interactions and depressive symptoms
among individuals with lupus. Although some support for the
mechanisms of social support has accumulated, unfortunately
these studies have been cross-sectional. Longitudinal studies
may further elucidate support mechanisms.
Conclusions and Directions for Future Research
As the research reviewed indicates, social support is one of
the most widely researched constructs in health psychology.
The evidence linking social support to health outcomes de-
pends on the health problem investigated. Social support has
been consistently associated with cardiac outcomes: Social
integration and social isolation have been linked with recov-
ery post-MI, and the presence of a supportive other has been
associated with lower cardiovascular reactivity in laboratory
studies. Another widely researched area is social support and
birth outcomes. The data are more mixed with regard to ARC
to AIDS progression and with AIDS progression. Relatively
little attention has been given to the role of social support in
morbidity and mortality outcomes among individuals with
other health problems.
There are several important areas for future research. First,
future studies should examine the role of support in other dis-
ease outcomes. Second, it will be important for future studies
to identify why support has bene“cial health effects. For ex-
ample, instrumental support may be associated with better
birth outcomes because women receiving more assistance
with daily activities have less physical strain and fatigue, or
they are more compliant with prenatal care and have better
nutritional practices. Key mechanisms for support•s effects
on health outcomes may be medical adherence or health prac-
tices that prevent disease progression, or mechanisms may be
cardiovascular, endocrine, and immune changes. Few studies
have evaluated potential physiological mechanisms for sup-
port•s effects on health. The role of mood, particularly anxi-
ety and depression, on the relation between support and
health outcomes is also important to evaluate.
The bulk of the research on social support has evalu-
ated support•s effects on psychological outcomes among
individuals dealing with illness. The majority of this research
has assessed perceived support, with less research investigat-
ing support actually provided, or not provided, to the patient
during the illness experience. The link between perceived
available support (in particular, emotional support) and
psychological adaptation is stronger than the association be-
tween received support and adaptation. As pointed out in nu-
merous studies, one reason for the inconsistent “ndings about
received support is that distressed persons are more likely to
seek support from others. However, it is possible that re-
ceived support might result in lower distress at a later time. In
the case of a chronic health problem, it is also possible that
individuals who receive more support at one point may alien-
ate support providers in the long run, as providers tire of pro-
viding support. Longitudinal studies would be more likely to
unravel these complex associations.
Relatively few studies have identi“ed what characteristics
of patients may determine who bene“ts most from support,
and even less attention has been paid to potential mechanisms
for support. Does emotional support have its effect because it
bolsters the patients• self-esteem or reduces isolation, alters
perceptions of the illness to be less threatening, or because it
assists the patient in “nding bene“t and meaning in the illness
experience? What types of support are responsible for
changes in patients• cognitive appraisals? Another method-
ological issue that is particularly relevant to studies of adap-
tation to illness is the large number of instruments used to
assess illness-speci“c support. While measures of perceived
support selected have been relatively consistent across stud-
ies, many investigators have developed their own measures
speci“cally for their studies. This practice is problematic be-
cause it prevents comparisons across studies and because
many investigators do not provide adequate psychometric in-
formation on the measures.
One limitation of the majority of studies is that the re-
search is almost exclusively conducted on well-educated,
Caucasian individuals. Recent research on social support and
cancer screening is an exception. Differences in the types of
support that are perceived as helpful may differ across cul-
tures. For example, suggestions for cancer screening that are
made by an individual whom the person does not perceive as
credible are less likely to in”uence screening decisions. A
second limitation is the almost exclusive focus on the patient.
Since social support is obviously an exchange between recip-
ient and provider, evaluating providers• perceptions of sup-
port given and examining the dyadic exchange between
provider and recipients using observational methodologies
would be important.
The study of social support•s role in health outcomes has
yielded a rich set of “ndings that has illustrated the key role
that psychological factors may play in the prevention of
health problems, the progression of health problems once
they develop, as well as individuals• ultimate adaptation to
health problems. Despite the large number of studies, a large
number of unanswered questions remain.