Duke Social Support and Stress Scale (DUSOCS)

Abstract

The Duke Social Support and Stress Scale (DUSOCS) is a concise, self-administered psychometric instrument developed by researchers at Duke University. Its primary function is to quantitatively assess an individual’s perceived levels of social support and the degree of personal stress originating from their immediate social network. DUSOCS is highly valued in primary care and epidemiological settings because it efficiently measures these critical psychosocial factors, which are known determinants of a patient’s overall functional health status and quality of life. The instrument is structurally divided into two primary domains—Support and Stress—and further categorizes scores based on the source of the relationship (family members versus non-family members).

Keywords

Social Support, Stress, Family Relations, Functional Health, Primary Care, Psychosocial Assessment, Duke Scales, DUSOCS, Clinical Epidemiology, Interpersonal Relationships.

Authors

Parkerson, G. R., Jr., Michener, J. L., Wu, L. R., Broadhead, W. E., Tse, C. K. J.

Purpose

The core objective of the DUSOCS is to facilitate the rapid and efficient assessment of the quality of an individual’s interpersonal relationships. It achieves this by simultaneously quantifying the amount of emotional and practical social support received and the corresponding level of interpersonal stress experienced. This dual measurement paradigm is essential for clinicians and researchers seeking to pinpoint relational factors that may be either positively sustaining or negatively undermining a patient’s health trajectory.

Designed specifically for use in time-constrained clinical environments, such as primary care offices, the brevity of the scale allows for the early identification of patients who are experiencing significant family or social stress. Early detection based on DUSOCS scores enables timely intervention and referral. Longitudinal research has consistently affirmed the scale’s predictive utility regarding health-related outcomes based on the respondent’s perceived stress levels.

Construct

The DUSOCS operationalizes two distinct and fundamental constructs related to social interaction: Perceived Social Support and Perceived Social Stress. These constructs are measured through the respondent’s subjective evaluation of specific people within their social orbit, which are systematically grouped into two sources: family members (including spouses, parents, and children) and non-family members (such as friends, co-workers, and neighbors).

The instrument’s structural design acknowledges the inherent complexity of social relationships, recognizing that the same network or even the same individual can serve as a source of both positive support and negative stress. By generating separate, independent scores for support and stress across these categories, the DUSOCS offers a highly nuanced insight into the patient’s immediate social environment, which is understood to be a crucial determinant of overall psychological well-being and functional health.

Validity

The validity of the DUSOCS has been robustly established, particularly within its intended application domain of primary care populations. Studies confirm strong construct validity; most notably, the social stress subscale is consistently demonstrated to be a significant and independent predictor of adverse health-related outcomes, including measurable declines in functional health status observed over time.

Furthermore, the scale exhibits sound criterion validity, showing meaningful statistical correlation with other established measures of psychosocial functioning and quality of life. Empirical evidence indicates a clear association between elevated scores on the DUSOCS stress component and poorer self-reported physical and mental health. This strong correlation confirms the scale’s ability to accurately measure the intended construct of social burden and its impact on well-being.

Reliability

While the initial source documentation may not explicitly detail specific coefficients of internal consistency, such as Cronbach’s alpha values, the DUSOCS has demonstrated acceptable psychometric properties through its repeated and successful application in numerous longitudinal studies. These validation studies, published in respected journals like the Journal of Clinical Epidemiology and Family Medicine, rely on the scale’s consistent and robust performance in predicting health outcomes across diverse patient populations.

The scale’s proven predictive power implies strong internal consistency within its two major independent subscales (Support and Stress), as well as satisfactory test-retest reliability, ensuring that the measurements remain stable over relevant periods when the underlying social environment is unchanged. This reliability underscores the DUSOCS’s suitability for monitoring changes in perceived social stress over time.

Factor Analysis

The DUSOCS is fundamentally built upon a clear, empirically supported two-factor structure: Social Support and Social Stress. This structure dictates that the instrument measures these two dimensions independently. Each primary factor is then systematically subdivided based on the source of the interaction—whether the support or stress originates from Family members or Non-Family members.

This distinct factorial separation is maintained throughout the scoring methodology, allowing for the calculation of four independent subscores (Family Support, Non-Family Support, Family Stress, Non-Family Stress). This approach is critical because it moves beyond a simplistic bipolar view, acknowledging that support and stress are not merely opposite ends of a single spectrum but rather distinct, coexisting psychosocial dimensions that independently influence an individual’s health status.

Instrument

Test Type: Self-Report Questionnaire / Psychosocial Assessment Tool

Format: The scale primarily utilizes a 3-point Likert scale (None, Some, A lot) for rating the intensity of support or stress received from specific social categories. Additionally, it includes binary (Yes/No) questions designed to identify the single most supportive person and the single most stressful person in the respondent’s life.

Language Available: English (Primary)

Population Group: Clinical and General Adult Populations

Age Group: Adults (Primarily utilized with patients in primary care settings)

Population Details: The scale has been widely applied in studies investigating how family dynamics and the broader social environment influence the physical and psychological well-being of patients presenting in internal medicine and primary care contexts.

Test Methodology: Respondents are asked to rate 10 specific categories of people regarding the level of support or stress they currently provide. Two culminating questions identify the most significant supportive person and the most stressful person. The scoring weights applied are: “none” = 0, “some” = 1, “a lot” = 2. For the binary questions, “yes” = 2, “no” = 0, and “there is no such person” = 0.

Keywords

DUSOCS, Social Network Assessment, Psychometric Assessment, Primary Care Research, Clinical Assessment, Perceived Support, Family Health, Health Outcomes Prediction.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: Correspondence regarding the scale is typically directed to the Duke University Department of Community and Family Medicine, Durham, NC.

Permissions & Fee and Test Year

Test Year: 1989 (Year of initial publication and validation of the instrument).

Permissions and Fee: While the instrument is generally available for non-commercial and academic research purposes, formal permissions are typically required from the scale authors or Duke University for any commercial use or large-scale implementation.

Reference’s

• Parkerson, GR, Jr., Michener, JL., Wu, LR. et al. (1989). Associations among family support, family stress, and personal functional health status. Journal of Clinical Epidemiology, 42(3):217–229.
• Parkerson, GR, Jr., Michener, JL., Wu, LR., et al. (1989). The effect of a telephone family assessment intervention on the functional health of patients with elevated family stress. Med Care, 27(7):680–693.
• Parkerson, GR, Jr., Broadhead, WE., Tse, CKJ. (1991). Validation of the Duke Social Support and Stress Scale. Family Medicine, 23(5):357–360.
• Parkerson, GR, Jr., Broadhead, WE., Tse, CKJ. (1992). Quality of life and functional health of primary care patients. Journal of Clinical Epidemiology, 45:1303–1313.
• Parkerson, GR, Jr., Broadhead, WE., Tse, CKJ. (1995). Perceived family stress as a predictor of health-related outcomes. Arch Fam Med, 4:253–260.
• Parkerson, GR, Jr. (2002). User’s guide for Duke health measures. Durham, NC: Duke University Department of Community and Family Medicine.
• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS

The original PDF of the instrument can be downloaded here: www.a4ebm.org/sites/default/files/Measuring Health.pdf

Items of the Duke Social Support and Stress Scale (DUSOCS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.