Social Support Measure

Abstract

The Social Support Measure, developed by Lisa F. Berkman and Lester Breslow in 1983, is a concise and highly influential psychometrics instrument designed to quantify an individual’s level of social integration and the availability of Social Support. It assesses both the structural components of an individual’s social environment, such as the quantity of close relationships and participation in groups, and the functional components, which relate to the perceived availability of emotional and instrumental support.

This measure is fundamentally rooted in the field of Epidemiology, serving as a critical predictor variable in numerous large-scale cohort studies, including the seminal Alameda County Study and the Framingham Heart Study. Its primary utility lies in identifying individuals at high risk due to social isolation or lack of perceived support, linking social connectedness to health outcomes such as mortality and cardiovascular disease.

Keywords

Social Support, Social Networks, Social Connectedness, Berkman-Breslow, Epidemiology, Health Outcomes, Structural Support, Functional Support, Social Isolation, Cardiovascular Health.

Authors

Lisa F. Berkman, Lester Breslow

Purpose

The primary purpose of the Social Support Measure is to provide a standardized, brief assessment of an individual’s social integration status for use in large-scale population health research. It was conceptualized to operationalize the findings that social ties act as a protective factor against morbidity and mortality, a concept widely established by Berkman and Syme (1979).

The scale systematically captures different facets of an individual’s engagement with their community and personal relationships, allowing researchers to categorize subjects based on their level of social connectedness versus isolation. This categorization is then utilized to study the independent effects of social environment on various physical and psychological health outcomes, such as recovery following Myocardial Infarction.

Construct

The scale measures the overarching construct of Social Support by dividing it into two recognized sub-constructs: Structural Support and Functional Support. Structural support focuses on the existence, size, and frequency of contact within an individual’s Social Networks. This includes quantifiable measures like the number of close friends and relatives, marital status (often included in scoring adaptations), and participation in community or religious groups.

Functional support assesses the perceived quality and availability of resources from these social ties. Items addressing functional support inquire about the presence of individuals who can provide emotional comfort, affection, advice, or assistance during difficult decision-making processes. The strength of this instrument lies in its ability to quickly gauge both the presence of social ties and the perceived utility of those ties.

Validity

The validity of the Berkman and Breslow measure is predominantly supported by its extensive use and demonstrated predictive validity in epidemiological research. The scale, or composite indices derived from its items, consistently predicts significant long-term health outcomes. For instance, low social support scores were identified as a major risk factor in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) trial, linking perceived social isolation to adverse clinical events after Myocardial Infarction (Berkman et al., 2003).

Additionally, the measure exhibits high face validity, as the items directly correspond to commonly understood indicators of social integration and support availability. Its utility has been further corroborated by studies that successfully link social support scores to biological measures, such as inflammatory markers observed in the Framingham Heart Study (Loucks et al., 2006), lending support to its construct validity within the biopsychosocial model of health.

Reliability

Given the diverse nature of the questions (ranging from counts of people to frequency of behavior and binary availability), standard internal consistency measures (like Cronbach’s alpha) are often not the primary indicator of reliability for this index. Instead, researchers typically focus on the stability of the structural components over time.

The test-retest reliability for structural items—such as the number of close friends or participation in groups—is generally considered acceptable, reflecting the relative stability of an individual’s core social structure across short measurement periods. Furthermore, the robust predictive power observed across multiple large, independent cohort studies serves as a strong indicator of the measure’s reliability in public health and Epidemiology contexts.

Factor Analysis

Although the Social Support Measure is often utilized as a single, summed index, conceptual and empirical analyses generally support a two-factor structure. These factors correspond directly to the theoretical dimensions of Social Support: Structural Integration and Functional Support.

The items related to counts of friends, relatives, and group membership typically load onto the Structural Factor, reflecting the size and density of the social network. Conversely, items concerning the availability of emotional listening, advice, and affection load onto the Functional Factor. This inherent factor structure supports the measure’s broad applicability in research that seeks to differentiate the effects of simply having social ties versus the quality of support those ties provide.

Instrument

Test Type: Brief Self-Report Inventory / Epidemiological Index

Format: 11 items utilizing count data, frequency scales, and dichotomous (Yes/No) responses.

Language Available: English (original); widely adapted and translated for use in international public health and epidemiological studies.

Population Group: General adult population; frequently applied in clinical and high-risk cohorts (e.g., patients with cardiovascular disease).

Age Group: Adult (typically middle-aged and older adults in health outcome studies).

Population Details: Used extensively in major longitudinal cohort studies, including the Framingham Heart Study and the ENRICHD randomized controlled trial.

Test Methodology: Can be administered via self-report questionnaire or structured interview. Scoring adaptations, such as the one described by Loucks et al. (2006), often convert ordinal data into categorical scores (0 or 1) before summing them to create a final index of social connectedness (ranging from 0 to 4).

Keywords

Social isolation, Berkman and Breslow, ENRICHD trial, Framingham Study, Public health, Emotional support, Structural support, Social Networks, Psychometrics, Social Integration.

Authors

Author ORCID Identifier: Not specified in source materials.

Affiliation Email addresses: Not specified in source materials.

Correspondence Address: Not specified in source materials.

Permissions & Fee and Test Year

The Social Support Measure was first published in 1983 as part of the work by Berkman and Breslow. Due to its status as a core measure in public health research, it is generally available for non-commercial research use, provided the original authors and foundational works are appropriately cited. The instrument is listed in public domain resources for health measures, such as the PhenX Toolkit, which indicates its widespread accessibility. The instrument can be reviewed through the PhenX resource here: https://phenx.org/Default.aspx?tabid=695

Reference’s

• Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up of Alameda county residents. American Journal of Epidemiology, 109, 186–204.
• Berkman, L., F., & Breslow, L. (1983). Health and ways of living. New York: Oxford University Press.
• Berkman, L. F., Blumenthal, J., Burg, M., Carney, R. M., Catellier, D., Cowan, M. J., Czajkowski, S. M., DeBusk, R., Hosking, J., Jaffe, A., Kaufmann, P. G., Mitchell, P., Norman, J., Powell, L. H., Raczynski, J. M., & Schneiderman, N.; (2003). Enhancing Recovery in Coronary Heart Disease Patients Investigators (ENRICHD). Effects of treating depression and low-perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial. Journal of the American Medical Association, 289(23), 2106–3116.
• Loucks, E., Sullivan, L., D’Agostino, R., Larson, M., Berkman, L., & Benjamin, E. (2006). Social networks and inflammatory markers in the Framingham Heart Study. Journal of Biosocial Science, 38(6), 835–842.

Items of the Social Support Measure

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

Berkman and Breslow‚1983

1. How many close friends do you have‚ people that you feel at ease with‚ can talk to about private matters?
2. How many of these close friends do you see at least once a month?
3. How many relatives do you have‚ people that you feel at ease with‚ can talk to about private matters?
4. How many of these relatives do you see at least once a month?
5. Do you participate in any groups‚ such as a senior center‚ social or work group‚ religious-connected group‚ self-help group‚ or ch‎arity‚ public service‚ or community group? 0 = No‚ 1 = Yes‚ 9 = Unknown
6. About how often do you go to religious meetings or services? 0 = Never or almost never‚ 1 = Once or twice a year‚ 2 = Every few months‚ 3 = Once or twice a month‚ 4 = Once a week‚ 5 = More than once a week‚ 9 = Unknown
7. Is there someone available to you whom you can count on to listen to you when you need to talk?
8. Is there someone available to give you good advice about a problem?
9. Is there someone available to you who shows you love and affection?
10. Can you count on anyone to provide you with emotional support (talking over problems or helping you make a difficult decision)?
11. Do you have as much contact as you would like with someone you feel close to‚ someone in

Scoring Instructions (Loucks et al. 2006 Adaptation):

Loucks et al. (2006) scored as follows: Married (no = 0; yes = 1); close friends and relatives (0–2 friends and 0–2 relatives = 0; all other scores = 1); group participation (no = 0; yes = 1); participation in religious meetings or services (less than or equal to every few months = 0; greater than or equal to once or twice a month = 1). The latter two categories were mutually exclusive from each other. Scores were summed: 0 or 1 being the most isolated category; and 2‚ 3‚ or 4 formed the other three categories of increasing social connectedness.

Response categories for count items (1 and 3): 0 = None‚ 1 = 1 or 2‚ 2 = 3 to 5‚ 3 = 6 to 9‚ 4 = 10 or more‚ 9 = Unknown