Journal of Psychology and Aging Copyright 1986 by the American Psychological Association, Inc.

1986, Vol, I. No. 1,47-54 OB82-7974/86/S00.75

Social Support and Adaptation to Stress by the Elderly

Carolyn Cutrona and Dan Russell Jayne Rose

University of Iowa Concordia College, Moorehead, Minnesota

The fiist of a two-phase project is reported that examined the prospective effects of stress and social
support on the physical and mental health of the elderly. A sample of 50 elderly subjects was assessed
at two points in time over a 6-month period. Results indicated that social support was a significant
predictor of physical health status, whereas mental health was related to the Stress X Social Support
interaction term. These latter results were consistent with the buffering hypothesis, in that high levels
of social support served to reduce the negative impact of stress on mental health. Individuals who
were in better mental health at the initial assessment experienced fewer stressful events and higher
levels of social support over the subsequent 6-month period. The implications of these findings for
research and theory regarding the relation between stress and social support are discussed.

A consistent association has been found between negative life
events and the onset of physical and mental health problems
(e.g., Thoits, 1983). Recently, interest has focused on how positive
resources, such as social support, may have beneficial effects on
health in the context of stressful life experiences. Two different
models of the relation between negative life events and social
support have been proposed. The first, the buffering hypothesis,
states that social support serves a protective role primarily during
times of stress, through an enhancement of adaptive coping be-
havior (Cassel, 1976; Cobb, 1976, 1979). Thus, an interaction
between stress and social support in predicting physical and
mental health is hypothesized, with the role of social support
differing depending on the level of stress. The second model views
social support as having positive effects on health and well-being
both in the presence and absence of stress. This latter model
predicts that there will be a direct relation between social support
and physical and mental health, independent of the effects of
stress.
Empirical research on the relation between stress, social sup-
port, and physical and mental health has provided only mixed
support for the buffering hypothesis (for recent reviews, see
Broadhead et al., 1983; Cohen & McKay, 1984; Thoits, 1982;
Wallston, Alagna, DeVellis, & DeVellis, 1983; Wortman, 1984).
Although some studies have found that high levels of social sup-
port protect the person from the negative effects of stress, other
studies have found that supportive relationships with others are
associated with good physical and mental health regardless of
the presence or absence of stress.
Few studies of the elderly have examined whether social sup-
port aids this age group in adapting to stressful experiences. In-
stead, researchers have tended to investigate the independent ef-
This research was supported by a Biomedical Seed Grant to Carolyn
Cutrona and by Grant AG03846 from the National Institute on Aging
to Dan Russell and Carolyn Cutrona. An earlier version of this article
was presented at the American Psychological Association convention in
Toronto, Ontario, Canada, in August,1984.
Correspondence concerning this article should be addressed to Carolyn
Cutrona, Department of Psychology, University of Iowa, Iowa City, Iowa
52242.
fects of stress and social support on the physical and mental
health of the elderly, without considering their joint influence.
The experience of major life events, such as widowhood or change
in residence, has been associated with increased morbidity and
mortality among the aged (see review by Kasl & Berkman, 1981).
Research has also indicated that the number of recent stressful
life events reported by elderly persons is predictive of deterioration
in mental functioning (Amster & Krauss, 1974; Sands, 1981-
1982) and depression (Ayuso-Gutierrez, de Diego, & Martin,
1982; Linn, Hunter, & Harris, 1980). Finally, a recent study
found that the experience of more minor "daily hassles" by the
elderly was negatively related to measures of physical health and
morale (Holahan, Holahan, & Belk, 1984).
A long tradition of research has indicated that social relation-
ships are an important determinant of life satisfaction among
the elderly (see Larson, 1978; Liang, Dvorkin, Kahana, & Mazian,
1980). More recent research has found correlations between the
adequacy of the elderly individual's social relationships and
measures of health status (Gallo, 1982; Snow & Crapo, 1982).
Finally, two prospective studies have found that measures of social
contact and social support are significant negative predictors of
mortality for elderly samples (Blazer, 1982; Kasl & Berkman,
1981).
Only a few studies have examined whether supportive social
relationships assist the elderly in adapting to stressful experiences.
A classic study by Lowenthal and Haven (1968) found that the
presence of a confidant was associated with better adjustment
to widowhood and retirement. Results of a cross-sectional study
of 50 elderly individuals showed that health status was related
to stressful life events, whereas morale was predicted by social
support (Fuller & Larson, 1980). This study reported no evidence
for interactions between social support and stress in predicting
either physical health or morale. Finally, a study that compared
a sample of depressed elderly patients to matched control sub-
jects, with respect to stressful life events and intimate relationships
found that the experience of negative life events in the absence
of an intimate relationship was associated with depression (Mur-
phy, 1982).
The present study represents the first of a two-phase project
to investigate stress, social support, and health among the elderly.

47
48 C. CUTRONA, D. RUSSELL, AND J. ROSE
Phase 1, reported here, was a pilot study designed to determine
the feasibility of a more extensive investigation and to provide
preliminary tests of hypotheses. Phase 2, currently underway, is
a longitudinal study of a large representative sample of urban
and rural elderly. Although the results of the pilot investigation
must be considered tentative, this two-phase strategy permits the
opportunity to test the replicability of the findings reported here.
In the pilot study, a sample of 50 elderly men and women
were interviewed twice over a 6-month period. At each time
point, social support, negative life events, and physical and mental
health were assessed. This longitudinal design allowed prospective
analyses to be performed on psychosocial determinants of mental
and physical health. Measures of stress and social support from
the first assessment were tested as predictors of physical and
mental health 6 months later, while statistically controlling for
initial levels of pathology.
In addition, the design allowed us to examine factors that
predict the occurrence of negative life events and level of social
support over time. Most of the research on predictors of stress
and social support has been unsystematic. A particular strength
of the current study is that the design permits analyses in which
initial values of stress and social support are statistically con-
trolled in predictions of future values. It has been proposed that
social support may affect the occurrence of negative life events.
People with high levels of support may be able to avoid some of
the difficulties experienced by those with less support (Thoits,
1982). Previous research on nonelderly populations has shown
that individuals with poor mental health subsequently experience
higher rates of negative life events than those with good mental
health (Aneshensel & Frerichs, 1982; Billings & Moos, 1982a,
1982b; Lin & Dean, 1984; Turner & Noh, 1982). The effect of
physical health on subsequent life events is not known, although
it seems likely that a range of related problems (e.g., financial
strain) would follow illness. A limited body of research has ad-
dressed predictors of social support. Both poor mental health
and negative life events have been implicated as determinants of
low levels of social support (Thoits, 1982). In the current study,
mental and physical health were examined as predictors of future
life events and social support. In addition, possible reciprocal
relations between stress and social support were tested.
Most prior studies of psychosocial factors and health have
included exclusively physical or psychological symptoms as out-
come variables. Because few studies have included both, little is
known about the differential contribution of specific stress and
social support variables to each. Furthermore, most physical
symptom checklists are contaminated with mental health symp-
toms (e.g., depression), and most mental health measures contain
symptoms that could reflect physical disease or the aging process
rather than mental illness (e.g., fatigue). In the current research,
an effort was made to distinguish between physical and psycho-
logical symptoms as much as possible and to assess the psycho-
social predictors of each symptom category separately.
A multidimensional view of social support was taken in both
phases of this research project, reflecting the view that relation-
ships with others can serve multiple functions (Cobb, 1979;
House, 1981; Kahn & Antonucci, 1980; Weiss, 1974). Cohen
and McKay (1984) have argued that different kinds of stressful
life events may require different components of social support
to promote coping. Thus, it is important to examine which spe-
cific aspects of support are of assistance in coping with the kinds
of events that most often befall an elderly population. Based on
Robert Weiss's (1974) theory of relational provisions, the current
research examined the relative importance of each of six specific
components of social support as predictors of physical and mental
health. This finer-grained approach to the study of social support
promises to have theoretical implications in elucidating the spe-
cific mechanisms through which social support operates to pro-
tect against stress, and to have clinical implications in the design
of treatment programs for the elderly.
Weiss's theoretical framework was chosen because it incor-
porates the major elements of most current conceptualizations
of social support (e.g., Caplan, 1974; Cobb, 1976; Cohen &
McKay, 1984; Hirsch, 1980; House, 1981; Schaefer, Coyne, &
Lazarus, 1981). Weiss has described six different social functions
or "provisions" that may be obtained from relationships with
others. He contends that all six provisions are needed for indi-
viduals to feel adequately supported and to avoid loneliness, al-
though different provisions may be most crucial at different stages
of the life cycle. Each of the provisions is most often obtained
from a particular kind of relationship, but multiple provisions
may be obtained from the same person. The six relational pro-
visions described by Weiss are
1. Attachment, a sense of emotional closeness and security,
usually provided by a spouse or lover;
2. Social integration, a sense of belonging to a group of people
who share common interests and recreational activities, usually
obtained from friends;
3. Reassurance of worth, acknowledgment of one's compe-
tence and skill, usually obtained from co-workers;
4. Reliable alliance, the assurance that one can count on others
for assistance under any circumstances, usually obtained from
family members;
5. Guidance, advice and information, usually obtained from
teachers, mentors, or parent figures;
6. Opportunity for nurturance, a sense of responsibility for
the well-being of another, usually obtained from one's children.
To summarize, the research to be reported addressed the in-
terplay of negative life events, social support, and physical and
mental health in an elderly population. Over a 6-month period,
life events and social support were tested as predictors of sub-
sequent mental and physical health. In addition, predictors of
life events and social support were examined over the same 6-
month period. A multidimensional view of social support was
adopted, and an effort was made to identify specific components
of support that were most predictive of outcomes in all analyses.
Method
Subjects
Participants in the study were recruited from a local Senior Citizens
Center. All of the measures were administered verbally by trained inter-
viewers to ensure that respondents understood the questions. Subjects
received $10 for each interview they completed.
Sixty-one individuals completed the first interview. The average age of
the sample was 70.0 years (range = 60-88 years), and 62% of the partic-
ipants were women. Twenty-six of the participants were married. As might
be expected in a university community, the sample was generally well
educated. Eighty-nine percent of the participants had graduated from
 SOCIAL SUPPORT AND STRESS
high school, and 33% had graduated from college. Consistent with the
data on education, 48% of the sample indicated that they had been em-
ployed in a white-collar occupation before retirement
Approximately 6 months following completion of the first interviews,
a second wave of interviews was conducted. We were successful in com-
pleting interviews with 50 (82%) of the original participants. Reasons for
participants dropping out of the study ranged from moving out of state
to serious illness. Two of the subjects had died in the subsequent 6-month
period. Analyses were conducted that compared dropouts to individuals
who were reinterviewed, using data that were gathered in the initial in-
terviews. Age was the only variable that differentiated between these two
groups of subjects. Participants who remained in the study were younger
(M = 69.4 years) than those who dropped out (M = 74.5 years), 1(59) =
2.22, p < .05. It therefore appears that subject attrition did not seriously
bias the sample that was employed in this study, beyond lowering the
average age of the sample slightly.
Measures
As part of a more extensive interview protocol, measures of stressful
life events, social support, and physical and mental health were included.
These measures were administered at the initial interview and at the
6-month follow-up interview.
Stressful life events. To measure the occurrence of various life events
during the period of time involved in the study, the Geriatric Social
Readjustment Rating Scale (GSRRS; Amster & Krauss, 1974) was ad-
ministered. This scale is a modification of the measure developed by
Holmes and Rahe (1967). It includes events that were judged by a group
of gerontologists to be relevant to the life experiences of the elderly. Sup-
porting the validity of this measure, scores on the GSRRS have been
found to be related to the physical and mental health of the elderly (Amster
& Krauss, 1974; Fuller & Larson, 1980).
In the present study, respondents were asked to indicate which of the
stressful life events on the GSRRS they had experienced. In the first
interview, subjects indicated which events they had experienced in the
previous 6 months; in the second interview, they indicated which events
they had experienced since the first interview. Subjects also indicated for
each event whether they had experienced the event as positive, negative,
or neutral. A total negative life events score was computed for each subject
at each time point, consisting of the number of events experienced that
were viewed by the subject as negative.
Social support. Perceived social support was assessed using the Social
Provisions Scale (Cutrona, 1984; Russell & Cutrona, 1984). This scale
was developed by our research group to assess the six relational provisions
identified by Weiss (1974). The measure asks respondents to rate the
degree to which their social relationships are currently supplying each
of the provisions. Each provision is assessed by four items, two that de-
scribe the presence and two that describe the absence of the provision.
For example, two of the statements used to assess attachment are "I have
close relationships that provide me with a sense of emotional security
and well-being" and "I lack a feeling of intimacy with another person."
Respondents indicate on 4-point scales (ranging from completely true to
not at all true) the extent to which each statement describes their current
social relationships. For scoring purposes, the negative items are reversed
and summed together with the positive items to form a score for each
social provision. A total social support score is also formed by summing
the six individual provision scores.
Internal consistency for the total scale score is relatively high, ranging
from .85 to .92 across a variety of populations. Alpha coefficients for the
individual subscales range from .64 to .76. Factor analysis has confirmed
a six-factor structure that corresponds to the six social provisions (Russell
& Cutrona, 1984). Several studies support the validity of the Social Pro-
visions Scale. Among first-year college students, the six social provisions
in combination accounted for 66% of the variance in scores on the UCLA
Loneliness Scale (Cutrona, 1982). At the first assessment of the elderly
49
sample who participated in the current study, the Social Provisions Scale
showed significant concurrent negative correlations with depression and
positive correlations with life satisfaction. Similar results were found
among samples of nurses and public school teachers (Russell & Cutrona,
1984). Finally, analyses of data from a college student sample have sup-
ported the discriminant validity of the Social Provisions Scale against
relevant measures of mood (e.g., depression), personality (i.e., neuroticism,
introversion-extraversion), and social desirability.
Physical and mental health. To assess physical health, four measures
were administered. Two of these measures, a symptom checklist and a
functional abilities measure, were subscales from the Duke-UNC Health
Profile (Parkerson et al., 1981). The symptom checklist is designed to
assess the presence and severity of 24 physical symptoms that are con-
sidered medically important, such as fainting, headaches, or indigestion.
The measure of functional abilities is designed to assess the person's
ability to perform seven activities required in daily living, such as walking
up a flight of stairs or peeling an apple. Reliability for these measures
has been indicated by test-retest correlations of .68 and .82, respectively,
over a 1- to 8-week interval for individuals who did not experience any
intervening medical problems. Validity for both measures has been in-
dicated by significant correlations with scores from the Sickness Impact
Profile (Bergner, Bobbin, Carter, & Gilson, 1981), another general measure
of health status.
A third measure of physical health status involved subjective ratings
by the subject of his or her health. Research with elderly respondents has
indicated that self-ratings of health are significantly correlated with phy-
sician ratings of health status (Maddox & Douglass, 1973). In the present
study, participants were asked to indicate (a) how they would rate their
health in general, on a 5-point scale ranging from very poor to very good;
(b) how their health compared to that of other people their age, on a
5-point scale ranging from much worse to much better; and (c) how their
health had changed over the previous 6 months, on a 5-point scale rang-
ing from much worse to much better. In the current study, responses to
these three scales were standardized and summed together (coefficient
a = .67).
The final measure of physical health involved the number of illnesses
the subject had experienced. In the first interview, subjects were asked
to list any significant illnesses they had experienced in the previous 6
months. In the second interview, subjects indicated the number of illnesses
they had experienced since the first interview.
Three measures of the psychological well-being of subjects were in-
cluded. First, to assess life satisfaction, a set of items were selected based
on the factor analysis results reported by Lohmann (1980) of 10 different
measures of life satisfaction. We selected 10 items for inclusion that loaded
above .40 on the first two factors found by Lohmann, with the constraint
that an equal number of positive and negative items be included to lessen
the effects of response sets on life satisfaction scores. Based on analyses
of the data from our first interview, this measure appears to be quite
reliable (coefficient a = .79).
A second mental health measure that we administered was the UCLA
Loneliness Scale (Russell, 1982; Russell, Peplau, & Cutrona, 1980; Russell,
Peplau, & Ferguson, 1978). This scale consists of 20 statements that are
descriptive of feelings of loneliness and nonloneliness. Studies have con-
sistently indicated that this scale is very reliable, with alpha coefficients
above .90 reported for a variety of different populations. Correlations
with number of relationships, satisfaction with relationships, and related
affective states (e.g., anxiety and depression) support its concurrent and
predictive validity. The UCLA Loneliness Scale has also been shown to
have discriminant validity against a variety of mood and personality
measures (Russell et al., 1980). In the present study, we administered a
simplified version of the scale, in which the wording of the items was
slightly altered to make them more understandable to an elderly popu-
lation.
The final psychological measure we administered was the Zung Self-
Rating Depression Scale (Zung, 1965). This scale was designed as a brief,
50 C. CUTRONA, D. RUSSELL, AND J. ROSE
self-administered measure of the affective, psychological, and physiological
symptoms of depression. Studies have indicated that the Zung is a reliable
measure of depression among older adults. McGarvey, Gallagher,
Thompson, and Zelinski (1982) reported an alpha coefficient of .76 for
individuals aged 65 to 74, and .59 for individuals aged 75 years and over.
Steuer, Bank, Olson, and Jarvik (1980) reported high interitem corre-
lations for the Zung scale (ranging from .16 to .64), indicating adequate
levels of internal consistency for the measure.
Computation of Physical and Mental
Health Factor Scores
Because we expected that the measures of physical and mental health
would be highly intercorrelated, we performed a factor analysis to test
whether these measures could be reduced to a smaller set of factor scores.
A maximum likelihood factor-extraction procedure was used. Two factors
were extracted that had eigenvalues above 1.0. The maximum likelihood
goodness-of-fit test was nonsignificant, X2(7, N =
61) = 4.54, p = .80.
Thus, these two factors appeared to adequately account for the relations
among the variables. An oblique rotation was performed on these extracted
factors, which resulted in the factor pattern matrix shown in Table 1. As
expected, the two factors appear to reflect physical and mental health,
respectively. The two factors were also found to be highly correlated,
r(59) = .449.
Based on the above results, scores were computed to reflect these two
factors. In calculating factor scores, each of the mental and physical health
measures was first standardized. Several of the measures were then reversed
in sign (i.e., loneliness, depression, symptom status, and number of ill-
nesses), so that high scores represented better mental and physical health.
Measures that loaded above .50 in magnitude were then selected and
averaged together to form a score reflecting each factor. These factor
scores were employed in the subsequent analyses.
Results
Descriptive Analyses
Means and standard deviations for all of the measures ad-
ministered at each time point are shown in Table 2. Only those
individuals who completed both assessments were included in
the analyses. Over the 6-month time span of the study, partici-
pants remained stable or showed a more positive adjustment at
the second assessment. Participants showed significantly lower
depression, fewer and less severe physical symptoms, and a higher
level of physical functioning at the second assessment than at
the first. Social support was generally stable, with reliable alliance
showing the only significant change. It may be that those indi-
viduals whose health and well-being declined over the study pe-
riod were overrepresented among those who could not be rein-
terviewed at the time of follow-up, due to hospitalization or in-
stitutionalization. This hypothesis is consistent with the more
advanced mean age of the dropouts. Or it may be that the rela-
tively privileged social status of the sample enabled them to re-
main healthy. Although the improved functioning observed in
the sample over time could be attributable to seasonal factors,
results are counterintuitive inasmuch as the first assessment was
in summer and the second in winter.
Effects of Stress and Social Support
To examine the effects of stress and social support on physical
and mental health, regression analyses were conducted to predict
Table I
Factor Analysis Results for the Measures of
Physical and Mental Health
Variable Factor 1 Factor 2
Life satisfaction .700 .169
Loneliness -.901 .156
Depression -.698 -.327
Symptom status -.263 -.630
Functional abilities -.030 .528
Global health rating .199 .668
No. of illnesses .094 -.667
Note. These are the factor loadings from the factor pattern matrix fol-
lowing an oblique rotation of the factors.
Time 2 physical and mental health. In these regression analyses,
initial levels of the criterion variable were statistically held con-
stant by entering Time 1 physical or mental health first into the
regression equation. After the initial value of the dependent vari-
able had been entered, stress, social support, and the Stress X
Social Support interaction terms (based on the first interviews)
were entered into the regression equation.
The results of these analyses for the physical health measure
are shown in Table 3. Time 1 levels of physical health were
strongly related to physical health as assessed at the second in-
terview. The number of negative life events reported in the first
interview did add significantly to the variance explained by initial
health status, as evidenced by a significant increment in R2.
However, life events did not make a unique contribution beyond
the variance explained by initial physical health and social sup-
port jointly, as evidenced by the nonsignificant beta weight, p =
.07. Total scores from the Social Provisions Scale were signifi-
cantly related to Time 2 physical health status. Individuals who
reported higher levels of social support at Time 1 reported better
physical health at the second interview. Finally, as indicated in
Table 3, the Stress X Social Support interaction was nonsignif-
icant. Further regression analyses were conducted to examine
which of the individual social provisions were predictive of phys-
ical health. The provisions of reassurance of worth, 0 = .178,
F(l, 44) = 5.11, p < .05, R2 change = .031, p < .05, and op-
portunity for nurturance, 0 = .184, F(l, 44) = 5.59,p < .05, .R2
change = .034, p < .05, were found to be significant predictors.
In both cases, the direction of these relations indicated that in-
dividuals who were receiving that provision from their social
relationships at the first interview showed better physical health
over the next 6 months. Neither analysis yielded a significant
Social Provision X Stress interaction.
The results for the mental health measure are presented in
Table 4. Initial scores on the mental health measure were also
strongly related to subsequent mental health status. Neither the
Time 1 stress nor social support variables were found to be pre-
dictive of Time 2 mental health. However, a statistically significant
interaction was found between stress and total social provision
scores in predicting Time 2 mental health. Analyses that ex-
amined the impact of the individual social provisions indicated
that the provisions of reliable alliance, R2 change = .046, F[l,
43) = 11.81, p < .01 and guidance, R2 change = .055, F(\,
43) = 15.20, p < .001, also interacted with stress in predicting
changes in mental health. Following the suggestion of Cohen and
 SOCIAL SUPPORT AND STRESS 51

Table 2 Table 4
Means and Standard Deviations of Health, Social Support, Hierarchical Multiple Regression Predicting
and Negative Life Event Variables Time 2 Mental Health

Time 1 Time 2 R2 Standardized

Predictor r* change beta
Variable M SD M SD
Time 1 mental health .881" .776" .878**"
Mental health No. of negative events -.501** .001 .040°
Loneliness 37.4 8.8 37.5 9.5 Total social support .320* .001 .033'
Life satisfaction 34.8 6.1 35.0 6.4 Stress X Social Support .434** .032* .188*"
Depression 36.8. 7.5 33.3 8.1
Overall R2 = .810
Physical health
Symptom ratings 41.0, 6.4 29.5 5.4 Note. Significance of betas tested with F statistic.
No. of illnesses 0.8 0.8 1.0 1.0 •d/=48. "<#s = 1,48. <<#s = 1,46. "<#s= 1,45.
Functional level 8.7, 2.3 12.5 2.1 *p<.01.**p<.001.
Health status 10.6 2.1 10.6 2.2

Social support
Total Social
depicted graphically in Figure 1. These results are consistent
Provisions Scale 76.9 9.2 74.7 10.3
Attachment 12.7 2.2 12.3 2.4 with the buffering hypothesis, in that social support was found
Social integration 13.0 1.7 12.6 1.6 to be positively related to subsequent mental health only at high
Reassurance of worth 12.4 2.0 12.2 1.6 levels of negative life events. Patterns of results for the interactions
Reliable alliance 13.7. 1.6 13.1 1.8
with reliable alliance and guidance were similar, but showed even
Guidance 13.0 1.9 12.6 2.3
Opportunity for greater divergence at high versus low levels of stress.2
nurturance 12.3 2.4 12.2 2.1
Negative life events Prediction of Stress and Social Support
Total no. 2.0 2.3 1.7 2.1
The final set of analvses examined predictors of Time 2 life
Note. N - 50. Subscript indicates a significant difference, p < .05, between events and social support. Reciprocal relations between stress
means at Time 1 and Time 2, based on a pairwise t test (df= 48). and social support were tested, as was the impact of initial levels
of physical and mental health.
To examine predictors of negative life events, a hierarchical
Cohen (1983), to further investigate the nature of the interactions, multiple regression analysis was performed. The Time 1 life event
the slopes of the regression lines relating social support to physical score was entered first into the regression equation predicting
health were computed for different values of the negative life Time 2 stress scores. Next, the Time 1 predictor variables (social
events variable (1 SD above the sample mean, at the sample support, physical health, and mental health) were entered as a
mean, and 1 SD below the sample mean). This is roughly equiv- block into the equation.
alent to plotting subgroup means following a significant analysis Table 5 presents the results of the regression analysis for
of variance, but variables are treated continuously. The relative stressful life events. As can be seen, the number of negative events
magnitude of the slopes represents the relative strength of the reported by the person at the initial interview was strongly related
association between social support and health at different levels to the experience of negative life events in the subsequent 6-
of stressful life events.' month period. This finding suggests that individuals tend to be
Results for the interaction between negative events and the
total Social Provisions Scale score predicting physical health are
1
With all of the predictor variables standardized, the regression equa-
tion predicting Time 2 mental health from Time 1 mental health, nega-
tive events, total social support, and the negative Events X Social Sup-
Table 3
port interaction is Y = .039 + .835 (mental health,) + .039 (negative
Hierarchical Multiple Regression Predicting
events,) + .032 (social support,) + .174 (Negative Events, X Social Sup-
Time 2 Physical Health port,). By assuming that Time I mental health was at the mean for the
sample (i.e., Time 1 mental health = 0) and setting negative life events
R2 Standardized
Predictor r* change beta at low (i.e., I SD below the sample mean, or a value of — 1), moderate
(i.e., at the sample mean, or a value of 0), and high (i.e., I SD above the
Time 1 physical health .812** .660** .594**" sample mean, or a value of +1) levels, the regression lines shown in
No. of negative events -.726** .031* -.219" Figure 1 result.
2
Total social support .310* .028* .162" The comparable regression equation substituting the reliable alliance
Stress X Social Support .319* .022 .152" subscale score for the total social support score is Y = .071 + .856 (mental
Overall R 2 = .741 health,) + .111 (negative events,) + .069 (reliable alliance,) + .319 (Neg-
ative Events, X Reliable Alliance,). Substituting the guidance subscale
Note. Significance of betas tested with F statistic. score, the regression equation is Y = .058 + .909 (mental health,) + .118
•<//=48. "<#s= l,48."<#s = l , 4 6 . a < # s = 1,45. (negative events,) + .071 (guidance,) + .252 (Negative Events, X Guid-
*p<.05. **p<.001. ance,).
52 C. CUTRONA, D. RUSSELL, AND J. ROSE

MENTAL Table 6
HEALTH)
Hierarchical Multiple Regression Predicting Time 2 Social
Support From Time I Variables

R2 Standardized
Predictor ri change beta

Time 1 social support ,560*** .313***

Physical health .274* .037 '.246'
Menial health .504*** .077* .442**°
Negative events -.180 .050* .365*

Overall /*' = .477

Note. Significance of betas tested with F statistic.

' <//= 48. b dfs = 1, 47. ' dfs = 1, 44.
* p < .05. ** p < .01. *'* p < .001.

•—High Slress
A—Moderate Stress
• —Low Stress
Figure I. Relation of Time 1 total social support scores to Time 2 mental
health for high (1 SI) above the sample mean), moderate {sample mean),
and low (1 SD below the sample mean) levels of Time 1 negative life
events. (Time 1 mental health was statistically controlled.)
support. The direction of this relation indicated that individuals
who were in better mental health at the first interview also re-
ported higher levels of social support at the second interview,
after controlling for the effects of initial levels of support. In
addition, number of negative life events significantly predicted
Time 2 social support, such that individuals who experienced
more negative events subsequently described lower levels of social
support.
Discussion

Negative life events and perceptions of social support were

consistent over time in their experience of stress. The only other examined as determinants of physical and mental health among
predictor variable that was significantly related to stress was elderly men and women. Despite the fact that the measures of
mental health. Individuals who were in better mental health at physical and mental health were significantly correlated, our re-
the initial interview reported experiencing fewer negative life sults clearly indicated different patterns of association with the
events in the subsequent 6-rnonth period. predictor variables for physical versus mental health. Such find-
To explore predictors of social support, a second hierarchical ings suggest that different causal processes are operative, de-
multiple regression analysis was performed. The Time 1 Social pending on the outcome under study.
Provisions Scale score was entered first into the regression equa- As expected, the number of negative life events reported was
tion predicting Time 2 Social Provisions Scale scores. Next, the predictive of Time 2 physical health when initial health was sta-
Time 1 predictor variables (stress, physical health, and mental
tistically held constant. However, due to shared variance between
health) were entered as a block into the equation. initial life events and social support, number of events did not
Table 6 presents results for total scores on the Social Provisions make a unique contribution to physical health beyond that of
Scale. The level of social support reported by subjects also ap-
Time 1 social support. Overall levels of social support and the
peared to be relatively consistent over time. Initial level of mental
provisions of reassurance of worth and nurturance were directly
health was found to be a significant predictor of Time 2 social related to changes in physical health. Reassurance of worth re-
flects a sense of respect from one's peers, whereas nurturance
represents the belief that others need or rely on one. Taken to-
Table 5 gether, these results suggest that elderly persons whose relation-
Hierarchical Multiple Regression Predicting Time 2 Negative ships enhance their self-esteem are less susceptible to declining
Events From Time 1 Variables health.
One possible explanation for these results is that individuals
R* Standardized
Predictor ra change beta who are appreciated and valued by others may be in better health
initially than individuals who do not report such elements in
Time 1 negative events .754*** .568"* .526**** their lives. Individuals who are healthier initially would be ex-
Physical health -.598*** .002 -.001C pected to show smaller declines in physical functioning over time.
Mental health -.694*** .089** -.377**g
Social support -.281* .000 However, initial health status did not correlate significantly with
-.003*
either of these two social provisions, all re < . 12. Thus, a con-
Overall R2 = .660 founding with initial physical condition does not appear to ex-
Note. Significance of betas tested with F statistic. plain these results. Perhaps individuals whose self-worth is bol-
V/=48. b (#s= [,47.'djs= 1,44. stered by others take better care of themselves, and therefore are
* p < .05. ** p < .01. *** p < .001. able to prevent certain illnesses. Alternatively, it may be that
 SOCIAL SUPPORT AND STRESS
maintaining a high level of self-esteem has beneficial effects on
the immune system (e.g., Kiecolt-Glaser, Speicher, Holliday, &
Glaser, 1984). Phase 2 of this research program tests the rep-
licability of these results, and addresses possible explanations for
how worth-affirming aspects of social relationships may influence
physical health.
Neither stressful life events nor initial social support were direct
predictors of Time 2 in mental health. However, several of the
Stress X Support interaction terms were significant predictors.
Under conditions of high stress, overall social support, reliable
alliance, and guidance were significantly related to Time 2 mental
health. Reliable alliance and guidance may be viewed as assis-
tance-related provisions, referring to the availability ofnoncon-
tingent help and advice. These findings suggest that elderly per-
sons whose social networks provided them with these forms of
social support were able to use these resources in the context of
stressful experiences. Future research needs to assess this coping
process directly. That is, researchers should examine how the
elderly employ their support networks during the ongoing process
of dealing with a stressful event, rather than assessing the person's
level of social support at a single point in time prior to the onset
of stress.
Consistent with previous studies, results indicated that initial
mental health was predictive of subsequent stress and social sup-
port reported by the elderly. Individuals who were in good mental
health at the initial assessment experienced fewer negative life
events and reported higher levels of social support at the 6-month
follow-up than did individuals who were in poor mental health.
Psychologically healthy individuals may have perceived their ex-
periences more positively, thereby failing to report negative
events, or they may actually have behaved in more adaptive ways
that prevented the occurrence of stress. Similarly, they may have
perceived their relationships with others in an unusually positive
way, or they may have engaged in socially skillful behaviors that
attracted others to them. Future studies need to examine in more
detail why individuals who are depressed or experiencing other
mental health problems are at risk for increased levels of stress
and decrements in social support.
The reciprocal effects of stressful life events and social support
upon each other were also explored. Previous studies have sug-
gested that these two variables may influence one another over
time. Our results did not reveal any tendency for individuals
with outstanding social support subsequently to encounter fewer
stressful life events. However, the experience of high levels of
stress did appear to result in decrements in social support. One
explanation for this finding is that many negative life events in-
volve the loss of a valued relationship (e.g., bereavement, divorce).
Thus, it is not surprising that those who experienced many neg-
ative events also reported lower levels of support. Due to the
small sample size in this study, replication of these findings is
necessary before we can draw firm conclusions about the effects
of social support and stress upon each other among the elderly.
To summarize, different components of social support were
associated with changes in psychological and physical health.
Physical health was directly influenced by social provisions that
are related to feeling valued by others, whereas psychological
health was related to the stress-buffering effects of social provi-
sions that involve assistance from others. Reciprocal relationships
were found most notably between mental health and the predictor
53
variables. Initial mental health was a relatively strong predictor
of both future stressful life events and social support.
A note of caution is in order concerning the interpretation of
these results. The sample that was studied was small and non-
representative of the general elderly population. We must await
the results of our second, much larger longitudinal study of elderly
persons to test the replicability of these findings. In particular,
it will be of interest to determine whether stronger effects of
negative life events upon subsequent health will be found. At a
minimum, however, the present results suggest that the relations
among stress, social support, and physical and mental health are
complex. In the future, researchers need to distinguish carefully
between physical and mental health when drawing conclusions
about the effects of psychosocial variables. Similarly, possible
reciprocal causal relations among these variables need to be ex-
amined further, using techniques such as structural equation
analysis with latent variables (LISREL; Joreskog & Sorbom, 1983)
to test such complex theoretical models. Finally, finer-grained
component analyses of social support are needed if we are to
advance our understanding of the actual mechanisms by which
social support influences physical and mental health among the
elderly.
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