Social Psychiatrya0
Soc Psychiatry Psychiatr Epidemiol (1_990)25:250-259 9
Psychiatric Epidemiology
Springer-Verlag1990
The Mannheim Interview on Social Support Reliability and validity data from three samples* H. O. E Veiel Central Institute of Mental Health, Mannheim, Federal Republic of Germany Accepted: April 26, 1990
Summary. Social support questionnaires usually provide scant information about the members of supporting networks, while network-analytical approaches often fail to sufficiently detail the functional aspects of social support available to an individual. A structured interview, the "Mannheim Interview on Social Support" (MISS) is presented which combines the advantages of both approaches by mapping an individual's social resources in a "support matrix" of [network members[ * [relationship characteristics + support functions]. Stability and validity data collected in three different samples (discharged depressed in-patients, university students, and parents of children afflicted with cancer) are reported. Test-retest correlations are compared with alternative measures of stability, and the relationship of various MISS scores to scores based on conceptually related instruments is explored. The results indicate good test-retest stability of the main functional and structural MISS scores r t t = 0.66 to 0.88 for a four-week interval, and rt~ = 0.42 to 0.79 for a sixmonth-interval). It is shown that the MISS captures several dimensions of a person's social support environment not covered by questionnaires targeting subjective perceptions of support. It is now commonplace to assert that "social support" has a beneficial effect on mental health, but no consensus has evolved about what social support is and how it is to be assessed. While, in the seventies, it was typically regarded as a unitary phenomenon, it is now rather considered a "meta-construct" (Vaux et al. 1986) and "insufficiently specific to be useful as a research concept" (Barrera 1986; cf. Baumann 1987; House and Kahn 1985). As a consequence, current research on social support increasingly tends to focus on specific supportive aspects of the social environment.
* The research on which this paper is based was made possible, in part, by Grant No. Ve 97/2 from the German Research Association (DFG).
In the last few years, several assessment instruments have been presented that purport to measure circumscribed support categories in a systematic and reliable way (e.g. Barrera et al. 1981; Baumann et al. 1987; Vaux et al. 1986; Cohen et al. 1985; I. G. Sarason et al. 1983; Procidano and Heller 1983; Turner et al. 1983). These instruments assess perceptions and evaluations of actual or potential social support by the focal individual, and some of them yield several scores referring to different kinds (e. g. I.G. Sarason et al. 1983; Cohen et al. 1985) or different "sources" of support (e.g. Procidano and Heller 1983; Turner et al. 1983;Vaux et aI. t 986). Most of these instruments, and practically all the American ones, have been fashioned after psychological questionnaires designed for the assessment of personality traits or states such as anxiety, extraversion, or aggressiveness. Thus, they do not systematically record an individual's support environment but attempt to operationalize pre-defined concepts such as, for example, "friend-based support", or "emotional support". Categories are typically derived from, or validated with, factor-analytical or related methods based on the analysis of item covariations. Factor analysis, however, while useful for discovering or defining personality traits, is not appropriate for evaluating measures referring to characteristics of the social environment and their effects on a person: covariations of support behaviours reflect patterns of occurrence of supportive acts that cannot be relied upon to parallel functional patterns; they show which behaviours are emitted or received together, but not necessarily which behaviours or relationships have equivalent supportive functions. This is probably the reason for the frequent failures to replicate theoretical distinctions between different types of support in factor-analytical empirical studies (e. g. Antonucci and Israel 1986; Turner et al. 1983). It follows that factor-analytically derived or validated scales are not particularly suited for the exploration of the social support complex itself, i.e., for determining what the relevant dimensions, "modes", or functional units of support are, and how these depend on particular network structures. This, however, is crucial for aetiological and epidemiological research. Equally important, assessing
251 social support functions without being able to relate these functions to specific network members makes it difficult to formulate intervention strategies: the fact that an individual lacks, say, adequate emotional support does not indicate whom he or she should or could get it from. Most network-analytical approaches, on the other hand, are too general and insufficiently specific regarding the supportive aspects of social networks. As Cohen and Syme (1985) have noted, "there is little systematic work characterizing network structures in terms of the functions that they normally provide" (p 13), although the studies reported by Wellman (1981) and by Phillips (1981) represent notable exceptions. In the following, an assessment instrument, the "Mannheim Interview on Social Support" (MISS), is described. It maps the supportive environment of an individual simultaneously in terms of prototypical social support functions and in terms of person and relationship characteristics. It was conceived for meeting the needs of researchers in social and community psychiatry and psychology to collect concurrent information about a person's subjective evaluation of available support resources, about their actual distribution among the members of his or her social network, and about the structure of the support network as a whole. The MISS is currently being applied in a number of major epidemiological and community studies in Germany, Switzerland, Austria, Spain, Portugal, and Argentina with a variety of clinical and nonclinical populations. (MISS versions in the respective languages are available from the author.) A brief description has appeared in German (Veiel 1987). This paper is intended as a more in-depth presentation to the Englishspeaking research community. Stability and validity data from three different samples are reported, and areas of applicability are sketched. The "Mannheim Interview on Social Support" (MISS)
The "Mannheim Interview on Social Support" (MISS; see Appendix) is a structured interview designed to elicit comprehensive and fine-grained information about the availability and distribution of various specific support resources in an individual's social network, about the latter's size and composition, and about the individual's satisfaction with the available support resources. The complete interview takes between 30 and 40 minutes to administer and is usually well accepted by the interviewees. It is based on, and represents an extension of, the approach described by McCallister and Fischer (1978) and Phillips and Fischer (1981). Similar methods were used by Vaux and Harrison (1985) and by Wellman (1981). The MISS differs from these approaches insofar as its structure is explicitly based on a multidimensional conceptual framework of support, which systematically distinguishes between everyday and crisis support, between psychological-emotional and instrumental-material support, between different support providers, and between different assessment loci (Veie11985). The interview consists of two parts. In the first, twelve main questions (A1, A 2 , . . . , D3; see Appendix) elicit the
persons actually or potentially providing support in prototypical everyday and crisis situations. Care was taken to make the eliciting items as precise and specific as possible while maintaining their prototypical quality. A typical question is, for example: "Suppose you fell gravely ill and were unable to leave your bed for about a week. Who would be prepared to care for you? Who else?" (Item C2). After each main question, the subject's satisfaction with the support available in the particular situation (questions Alb, A2b etc.) is recorded. In the second phase, the interviewee evaluates/describes each person mentioned regarding gender, age, role relationship, frequency of contact, distance between homes, importance of and satisfaction with the relationship. (Other dimensions are conceivable and can easily be integrated.) Finally, the items G1 and H1 attempt to assess the interviewee's attitudes towards seeking and receiving support that may moderate the availability and utilization of support resources. Regarding support functions or ty~es, two basic distinctions are made which, in one form or another, are usually considered relevant theoretically (cf. House 1981; Turner 1983; Veie11985) or empirically (Brown et al. 1986; Veiel et al. 1988): between support in crises and support in everyday situations, and between psychological support (aimed at restoring or maintaining the subject's psychological equilibrium) and instrumental support (aimed at improving task performance or changing the environment directly). Everyday support is elicited with items targeting daily situations when it would be good to have someone's assistance, but where going without would present no major problems. Crisis support is defined as support in situations that are grave, not part of everyday life, and where another persons's assistance is essential. Because crisis situations are infrequent and not within everybody's immediate experience, the corresponding questions refer to hypothetical situations. The two basic distinctions result in the following four general categories of support (the corresponding MISS items are indicated in brackets): (a) Psychological Everyday Support (social integration), comprising social participation (A1, A2) and esteem (A3, a4); (b) Instrumental Everyday Support (B1); (c) Instrumental Crisis Support, comprising materialpractical support (C1, C2) and instrumental information (C3, C4); and (d) Psychological Crisis Support, comprising confiding (D1, D2) and encouragement (D3). The members of the support network, i.e. the persons named in response to the main questions (A1, A2 . . . . , D3), are coded as to their sex and role-relationship with the subject and are given a running number within the respective categories. It is therefore possible to relate each specific support function to the network members that provide it and, vice versa, to list for each network member his or her support functions. Individual network members can be differentiated and classified according to the characteristics listed above. The MISS data are arranged in a "support matrix" of [network members] * [support functions + person characteristics] (Fig. 1; cf. House and Kahn 1985).
252 [--
Person characteristics
][
Addifionat functions/
Support functions
characteristics
Mentioned in response to item No.:
Person E0de
j IEB/I I E2 I E3 IE4 IFI I E6 r A1 A2 A3 A4 BI [I
E2 C3 [4
DI 02 D3
o 3= Z
Fig.1. The MISS data structure
This data format allows analyses of rows (network members), of columns (support functions), or of partial matrices (network categories by support categories) of any desired degree of specificity, and corresponding scores can be computed. The support matrix allows further the calculation of multiplexity indices (again, if desired, restricted to particular functions and/or network members). The individual tagging of support providers makes it possible to examine directly the stability and composition of the support system over time (cf. Cohen and Syme 1985) and indices can be based on the part of a person's support environment that remains stable between two assessment points. Such a score may more faithfully reflect the support available for coping with stressful life events in the interval (Thoits 1982). With a suitable research design it is also possible to investigate which members of the social network actually do provide support in subsequent crises. For specific research problems, the support matrix can be extended in both dimensions: additional network members (not belonging to the support network) can be evaluated, additional person characteristics and support functions can be added (and/or others deleted). As long as the main questions are unchanged, the core matrix of [persons[ by [functions], i. e the definition of the support network, remains comparable across different studies and assessment points. The MISS in its standard form obtains all its information about an individual's support environment from the individual him- or herself. While, in this manner, it measures perceptions of social support resources by the subject, it attempts to minimize the influence of the subject's evaluations, i.e., the bias produced by his or her mental state, mood, attitudes, personality, and response styles, by concentrating on specific situations and persons. Such biasing factors can be expected to play
a considerably greater role in unspecific items such as, for example, "My family gives me the moral support I need" (Procidano and Heller 1983), and generally in approaches where an individual's evaluations enter into the selection of relevant network members (e. g. by asking for the "most important" network members - cf. Mitchell 1982). To assess a person's support environment makes sense only if it remains reasonably stable over time, and if the assessment procedure meets some minimal standards of reliability and validity. Because of its structural heterogeneity, the appropriate reliability index for the MISS is its test-retest stability which, however, confounds measurement error with fluctuations in the support network itself. While, over periods of days or weeks, network fluctuations can perhaps be neglected, over longer intervals (months and years) the test-retest correlation represents but a lower bound for both instrument reliability and network stability. Since the MISS assesses social resources which cannot reasonably be considered as reflecting latent traits, empirical evaluation of construct validity (Cronbach and Meehl 1955) by factor analysis or related methods is inappropriate. At the same time, the predictive validity of a heterogeneous and complex construct with ramifications in most areas of an individual's life is a matter of cumulative evidence which is difficult to collect in a single empirical study, however extensive. (Some relevant data, though, will be reported below.) The aspect of the MISS's validity that is both important and most feasible to determine is the relationship of the MISS scores to support indices obtained with other instruments, i.e. its concurrent validity. In the remainder of this paper the test-retest stability of the major MISS scores and their relationship with other measures of social support will be evaluated.
253 Method
Samples and data collection Sample 1: University students. This sample consisted of 100 undergraduate students from three institutions of higher learning in the Heidelberg-Mannheim area of southwestern Germany. One hundred (75 %) out of a total of 133 students who were asked in class agreed to participate in this study. Immediately after obtaining their agreement to participate, about half were given several questionnaires to complete (see below). The other half were administered the same questionnaires individually as the first part of the main interview. Within a week after the first contact, all participants were interviewed with the MISS (T1). Four weeks after T1, seventy-one (71%) were re-interviewed (T2). The mean age of the T1 sample (n = 100) was 24 years, 54% were female, and 65% had a stable intimate partner or were married. These percentages were only minimally different in the subsample of n = 71 who completed T2. Analyses of the test-retest stability are based on the T2 subsample (n -- 71), the others on the whole T1 sample (n = 100).
Sample2: Discharged depressed patients. The patient sample was part of a large longitudinal study on the course of depressive disorders, consisting of consecutive admissions to a psychiatric university hospital with a diagnosis of Major Depressive Disorder. The mean length of hospitalization was 8 weeks. They were interviewed four weeks after discharge (T1) and again six months thereafter (T2). Complete T1 interviews were obtained from 117 patients, representing 86% of those contacted during their hospital stay. Ninety-three patients could be approached for the T2 interview of which 88 (94%) agreed to participate. At T1, thirty-one patients (26.7%) still met the criteria for a Major Depressive Episode, and this percentage remained constant at T2 (23/88). The mean age of the sample (T1) was 40.8 years, 62% were women, 63% were married, 18% never married, 16% separated, and 4% widowed. These percentages, again, were only very marginally different for the T2 subsample.
Sample 3: Parents of children afflicted with cance~ The population from which this sample was drawn consisted of the parents of all patients of the Children's Hospital of Heidelberg University who were treated for intracranial tumours between 1978 and 1988. From this pool were excluded: patients with tumours of unknown aetiology, deceased patients, patients younger than four years of age at diagnosis or older than 19 years in 1988, and patients whose addresses were not known or who could not be reached by telephone (twelve cases). The families of the remaining 38 children were contacted by mail. In two cases, the parents refused to participate. After excluding two single mothers, a final n of 68 (2 • 34) was arrived at. The interviews were conducted separately at home where the questionnaires were administered as well. The mean age of this sample was 40.7 years, all were married and, of course, the sex ratio was exactly even. This sample represents a normal, middle-aged population under chronic and severe emotional stress: a child's critical illness. Since
the support network of husbands and wives are not independent of each other, the actual degrees of freedom for this sample must be assumed to be lower than suggested by the total n = 68. Statistical tests based on n = 68 will therefore overestimate the significance levels. This is noted in the tables.
~s~umen~ Apart from collecting reliability and validity data on the MISS, the reasons for investigating the various samples differed. Particularly in the patient sample, which formed part of an ongoing longitudinal, multi-stage research project, many data were collected which are not comparable with the data of the other two samples and which are of marginal relevance here. They will not be reported on. In the student and parent samples, identical additional instruments were used, with the explicit purpose of assessing the concurrent validity of the MISS. These were the revised UCLA-Loneliness Scale (ULS; Russell et al. 1980), the Perceived Social Support scale (PSS) by Procidano and Heller (1983) and the Beck Depression Inventory (BDI; Beck et al. 1961). Stability data for the MISS were available only for the patient sample (test-retest interval 6 months) and the student sample (test-retest interval 4 weeks).
Variables The MISS data structure (the support matrix) allows the calculation of a large number of different network parameters and of functional support scores. For this study, three sets of variables were selected: 1. a rather subjective evaluation of available support, the average Satisfaction with available support resources (averaged over all items Alb, A2b, ..., D3b; cf. appendix). 2. Parameters of the total support network, which was defined as all persons 15 years old or older who were either mentioned as a resource for crisis support (i. e. in response to a C or D question), or who were mentioned as an everyday support resource (A and B questions) and who had contact with the focal individual at least once every two weeks on average: over-all Support Network Size, over-all Frequency of Contact (per week) with the members of the support network, and over-all Multiplexity of support Amctions (i.e. the average number of support functions for which a network member was mentioned). Contact frequency was computed by counting and adding up the number of days per week on which each support network member was seen or spoken to. Fractional values were used for network members seen less frequently than once per week. 3. Four scores for the functional support categories Psy-
chological Everyday Support, Instrumental Everyday Support, Psychological Crisis Support, Instrumental Crisis Support, which were computed as the number of network
254
Table 1. Means and standard deviations for the three samples
MISS kin scores Psychological Everyday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support Support Network Size Contact Frequency per week Multiplexity MISS nonkin scores Psychological Everyday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support Support Network Size Contact Frequency per week Multiplexity
Students (n : 100) Mean SD
Parents (n = 68) Mean SD
Patients (n = 117) Mean SD
2.6 2.3 2.5 3.7 4.1 11.0 5.5
(1.7) (1.5) (1.7) (1.7) (2.0) (8.0) (2.1)
4.2 2.5 1.8 3.7 5.3 16.7 3.4
(2.3) (1.9) (1.2)" (1.5) (2.2) (7.8) (1.4) b
3.3 2.7 3.0 3.4 4.7 13.4 4.1
(2.l) (2.0) (2.3) (2.0) (2.6) (8.2) (1.7)
8.5 5.4 4.7 5.0 10.6 21.4 3.8
(3.9) (3.2) (3.0) (3.0) (3.9) (11.8) (1.1)
4.3 2.1 1.0 1.6 4.6 9.6 2.9
(2.6) (1.9) (1.9) ~ (1.4) (2.6) (9.7) (1.2) b
4.2 2.8 2.8 2.7 6.0 13.1 2.8
(3.4) (2.7) (3.2) (2.8) (4.5) (13,1) (1.2)
Other scores Satisfaction with Support (MISS) 0,71 (0.20) 0.63 (0.21) 0.62 (0.27) PSS-Fr 15.3 (3.7) 12.5 (5.4) PSS-Fa 10.8 (5.6) 14.3 (3.9) ULS 0.92 (0.45) 0.98 (0.44) BDI 5.9 (4.6) 7.6 (6.3) For the student and the patient samples, T1 scores are shown. Kin scores include spouses and partners, except Multiplexity (kin), which is based on family members excluding spouses and partners.(PSS-FR Perceived Social Support scale, Friends stun score; PSS-Fa Perceived Social Support scale, Family sum score; ULS UCLA Loneliness Scale mean score; BDI Beck Depression Inventory sum score). " Item D1 (death of a close person) was not administered in the parent sample - scores are based on Items D2 and D3 only. b Scores are based on 11 Items (excluding D1). m e m b e r s m e n t i o n e d in r e s p o n s e to at least one item of the respective category. E a c h score (except Satisfaction) was c o m p u t e d separately for kin and for nonkin. Kin scores also include in-laws, spouses and steady intimate partners, with one exception: Multiplexity of kin was calculated excluding partners. T h e data collected with the other instruments in the student and p a r e n t samples were scored according to the instructions of their respective authors, yielding a depression sum score ( B D I ) , a m e a n loneliness score (ULS), a perceived family s u p p o r t s u m score (PSS-Fa), and a perceived friend support sum score (PSS-Fr).
Analyses and results As a base-line for the analyses r e p o r t e d below, the m e a n s and standard deviations for the three samples are shown in Table 1. A m o n g the students, the a v e r a g e size of the kin support n e t w o r k was 4.1, and of the nonkin n e t w o r k 10.6. T h e corresponding figures for the patient sample were 4.7 and 6.0, and for the p a r e n t sample 5.3 and 4.6. T h e PSS-Fa and PSS-Fr scores of the students were similar to the figures r e p o r t e d by Procidano and H e l l e r (1983) for a comp a r a b l e sample, but significantly different f r o m the corresponding scores of the p a r e n t sample. T h e m e a n U L S score for b o t h samples was very similar to the one rep o r t e d by Stokes (1985) for students. T h e distributions of most MISS variables were left-skewed. In order to check
w h e t h e r this had influenced the p a t t e r n of association, all of the following analyses were r e p e a t e d with log-transf o r m e d variables, with only m i n o r differences in the results. Table 2 shows the m e a n intercorrelations of the (functionally specific) kin and n o n k i n scores in the three samples. T h e y are m o d e r a t e , varying f r o m a r o u n d 0.40-0.45 in the p a r e n t sample to 0.55-0.65 in the other two samples. T h e s e correlations are c o m p a r a b l e to those r e p o r t e d by B. R. Sarason et al. (1987) b e t w e e n different social support instruments. A t the s a m e time, the correlations of corresponding kin and nonkin scores were practically zero, with the exception of Psychological E v e r y d a y Support in the student sample (r = - 0.25) and Psychological Crisis S u p p o r t in the parent sample (r = 0.37). T h e unrelatedness of the kin and n o n k i n scores fits with the variously r e p o r t e d s e p a r a t i o n of kin and nonkin support functions (Turner et al. 1983; Veiel et al. 1988; Vaux 1987).
Table 2. Mean intercorrelations of functional MISS scores Students (n = 100)
Parents (n = 68)
Patients (n = 117)
Kin scores 0.62 0.44 0.65 Nonkin scores 0.51 0.42 0.59 In each category, the correlations corresponding to the 6 possible combinations of the four variables Psychological Everyday Support, Instrumental Everyday Support, Psychological Crisis Support, Instrumental Crisis Support were averaged (via Fisher's Z-transformations).
255 Table 3. Test-retest stability of MISS scores Students a (n = 71)
Patients b (n = 88)
rtt
OVLP ~ rtt
OVLP ~
Kin scores PsychologicalEveryday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support
0.81 0.74 0.73 0.85
0.99 0.97 0.96 0.98
0.69 0.65 0.54 0.75
0.97 0.95 0.96 0.95
Support Network Size Contact Frequency per week Multiplexity d
0.88 0.85 0.70
0.98 -
0.79 0.66 0.46
0.93 -
0.83 O.71 0.68 0.66
1.00 0.91 0.86 0.89
0.52 0.48 0.73 0.66
0.99 0.96 0.85 0.81
0.78 0.84 0.73
0.83 --
0.62 0.42 0.60
0.70 -
0.69
-
0.66
-
Nonkin scores Psychological Everyday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support Support Network Size Contact Frequency per week Multiplexity d Satisfaction with Support
a T h e test-retest i n t e r v a l w a s 4 weeks. b T h e test-retest interval was 6 m o n t h s . O v e r l a p was c o m p u t e d as: n ( p e r s o n s m e n t i o n e d at T 1 and T2) Minimum (n(T1), n (T2)) Only participants with b o t h T1 and T2 scores greater than zero w e r e included in the computations. Especially in the patient sample, the Ns on which the overlap scores w e r e based were often considerably
smaller than the actual samplesize. d Ns vary because Multiplexitycould only be computedif at least one person was mentionedin the respectivecategory. Test-retest stability For the following analyses, data from the student and the patient subsamples with two completed assessments (n -- 71 and n = 88, respectively) were used. The test-retest interval of the students was four weeks, of the patient sample six months. In both samples, the mean TI-T1 differences were practically zero for all MISS variables. The test-retest correlations in the two samples are shown in columns one and three of Table 3. (Corresponding indices for single items are available from the author.) In the student sample, we find acceptable stability coefficients around or above 0.80 for kin and non-kin scores of Support Network Size, Contact Frequency, and Psychological Everyday Support, but also for kin-based scores referring to Instrumental Crisis Support. In contrast, the coefficients for nonkin crisis support are in a lower 0.65-0.70 range. In the patient sample, the correlations were generally about 20 points lower, with the exception of nonkin Crisis Support and kin Network Size. The lower stability figures must be expected considering the far longer test-retest interval, but they may also reflect the changes in network structure and social interaction patterns occurring in the process of re-adapting to a normal life outside the hospital. The student figures, therefore, probably come closer to representing the reliability of the instrument itself. Test-retest correlations indicate the extent to which the same number of persons are mentioned at T1 and T2 in the different support categories. They do not indicate
whether the same individuals are mentioned at T1 and T2. Identical scores could be based on two totally disjunctive sets of support providers, and very different scores could result either from disjunctive sets or from sets that completely include each other. In order to determine the extent to which corresponding sets ofT1 and T2 support providers were included in each other, the number of persons named (and forming part of the support network as defined above) both at T1 and at T2 was divided by either the number named at T1 or the number named at T2, whichever was smaller. The resulting figure represents the proportion of the smaller set of persons which is included in the larger one. Their arithmetic means are shown in columns two and four of Table 3. In general, the indices in the student samples are rather high. (Most medians equalled 1.00, and the 5% confidence intervals of the kin scores was consistently above 0.90.) To interpret them properly it should be kept in mind that an overlap of zero would indicate mutually exclusive sets of persons, and that the range of the overlap index (0.00-1.00) is half the range of correlation coefficients. Despite the rather lower test-retest correlations of the patients, the overlap figures were not much lower here than in the student sample. Again, the kin figures tended to be higher than the nonkin figures. The generally rather higher overlap in both samples indicates that the subjects had a relatively stable "core" of network members for each support category, which changed only marginally over the time periods considered. With the possible exception of the nonkin scores Network Size and Psychological and Instrumental Crisis Support, the instabilities indicated by the correlation coefficient were due mainly to expansions or contractions in the pool of support providers, rather than to replacement of one set of providers by another. This is strikingly illustrated by the figures for Psychological Everyday Support (nonkin) for the patient sample: despite the quite low testretest correlation of r = 0.53, which indicates a considerable fluctuation in the number of friends in agreeable everyday contact, the smaller of the two provider sets is practically always included in the larger one, as demonstrated by a mean overlap of 0.99. The high overlap figures also indicate that the meaning of the prototypical situations described by the MISS items had remained fairly constant for the participants; the inconsistencies were mainly restricted to the more marginal providers and can be ascribed to fluctuations in the actual or perceived magnitude of a network member's support potential, rather than of its quality
Concurrent validity To assess the concurrent validity of the MISS, the UCLALoneliness Scale (ULS), the Perceived Social Support scale (PSS), and the Beck Depression Inventory (BDI) were administered in the student and parent samples. Table 4 shows their correlations with the MISS scores. Regarding the two PSS scores, a clear and surprising pattern emerged: in the student sample, perceived family support (PSS-Fa) was substantially correlated with all MISS kin scores, while perceived friend support (PSS-Fr)
256
Table 4. Correlations of MISS scores with o t h e r s u p p o r t scores Students (n = 98) PS-Fa MISS kin scores Psychological E v e r y d a y S u p p o r t Instrumental Everyday Support Psychological Crisis S u p p o r t I n s t r u m e n t a l Crisis S u p p o r t S u p p o r t N e t w o r k Size Contact F r e q u e n c y p e r w e e k Multiplexity
0.47** 0.45** 0.48** 0.42** 0.35** 0.39"* 0.52"*
Parents (n = 68)
PS-Fr
ULS
BDI
PS-Fa
0.03 0.03 - 0.01 - 0.04 - 0.02 0.01 0.14
-
-
0.15 0.13 0.16 0.18 0.12 0.13 0.25*
0.22 0.11 0.11 0.20 0.32* - 0.04 - 0.11 0.25* 0.19 0.31' 0.16 0.24 0.21 0.08
0.23* 0.20 0.06 0.11 0.07 0.13 0.24*
MISS nonkin scores Psychological E v e r y d a y S u p p o r t Instrumental Everyday Support Psychological Crisis S u p p o r t I n s t r u m e n t a l Crisis S u p p o r t S u p p o r t N e t w o r k Size Contact F r e q u e n c y per w e e k Multiplexity
0.12 0.09 0.11 - 0.02 0.09 0.11 0.00
0.02 - 0.03 0.19 - 0.09 - 0.02 - 0.19 0.17
- 0.21 - 0.21 0.18 0.13 - 0.20 - 0.12 - 0.11
- 0.24* - 0.24* 0.11 - 0.11 - 0.24* - 0.20 - 0.03
O t h e r scores Satisfaction with S u p p o r t (MISS) PSS-Fa PSS-Fr ULS
0.26* 0.16 - 0.35**
0.28* 0.16 - 0.57**
- 0.42** - 0.35** - 0.57** -
-
0.26* 0.36** 0.29** 0.54**
PS-Fr
- 0.52** 0.68** - 0.72**
ULS
BDI
0.13 0.10 0.16 0.22 0.10 0.00 0.03
-
0.20 0.05 0.10 0.15 0.22 0.00 0.02
-
0.05 0.07 0.09 0.18 0.13 0.08 0.03
0.52** 0.33* 0.37** 0.34* 0.50** 0.39** 0.18
-
0.25* 0.20 0.27* 0.08 0.27* 0.17 0.00
-
0.26* 0.26* 0.31" 0.I6 0.30* 0.24 0.13
- 0.51"* 0.68**
- 0.50** - 0.72** - 0.68** -
- 0.68**
- 0.41"* - 0.57** - 0.55** 0.62**
* P _
Soc Psychiatry Psychiatr Epidemiol (1_990)25:250-259 9
Psychiatric Epidemiology
Springer-Verlag1990
The Mannheim Interview on Social Support Reliability and validity data from three samples* H. O. E Veiel Central Institute of Mental Health, Mannheim, Federal Republic of Germany Accepted: April 26, 1990
Summary. Social support questionnaires usually provide scant information about the members of supporting networks, while network-analytical approaches often fail to sufficiently detail the functional aspects of social support available to an individual. A structured interview, the "Mannheim Interview on Social Support" (MISS) is presented which combines the advantages of both approaches by mapping an individual's social resources in a "support matrix" of [network members[ * [relationship characteristics + support functions]. Stability and validity data collected in three different samples (discharged depressed in-patients, university students, and parents of children afflicted with cancer) are reported. Test-retest correlations are compared with alternative measures of stability, and the relationship of various MISS scores to scores based on conceptually related instruments is explored. The results indicate good test-retest stability of the main functional and structural MISS scores r t t = 0.66 to 0.88 for a four-week interval, and rt~ = 0.42 to 0.79 for a sixmonth-interval). It is shown that the MISS captures several dimensions of a person's social support environment not covered by questionnaires targeting subjective perceptions of support. It is now commonplace to assert that "social support" has a beneficial effect on mental health, but no consensus has evolved about what social support is and how it is to be assessed. While, in the seventies, it was typically regarded as a unitary phenomenon, it is now rather considered a "meta-construct" (Vaux et al. 1986) and "insufficiently specific to be useful as a research concept" (Barrera 1986; cf. Baumann 1987; House and Kahn 1985). As a consequence, current research on social support increasingly tends to focus on specific supportive aspects of the social environment.
* The research on which this paper is based was made possible, in part, by Grant No. Ve 97/2 from the German Research Association (DFG).
In the last few years, several assessment instruments have been presented that purport to measure circumscribed support categories in a systematic and reliable way (e.g. Barrera et al. 1981; Baumann et al. 1987; Vaux et al. 1986; Cohen et al. 1985; I. G. Sarason et al. 1983; Procidano and Heller 1983; Turner et al. 1983). These instruments assess perceptions and evaluations of actual or potential social support by the focal individual, and some of them yield several scores referring to different kinds (e. g. I.G. Sarason et al. 1983; Cohen et al. 1985) or different "sources" of support (e.g. Procidano and Heller 1983; Turner et al. 1983;Vaux et aI. t 986). Most of these instruments, and practically all the American ones, have been fashioned after psychological questionnaires designed for the assessment of personality traits or states such as anxiety, extraversion, or aggressiveness. Thus, they do not systematically record an individual's support environment but attempt to operationalize pre-defined concepts such as, for example, "friend-based support", or "emotional support". Categories are typically derived from, or validated with, factor-analytical or related methods based on the analysis of item covariations. Factor analysis, however, while useful for discovering or defining personality traits, is not appropriate for evaluating measures referring to characteristics of the social environment and their effects on a person: covariations of support behaviours reflect patterns of occurrence of supportive acts that cannot be relied upon to parallel functional patterns; they show which behaviours are emitted or received together, but not necessarily which behaviours or relationships have equivalent supportive functions. This is probably the reason for the frequent failures to replicate theoretical distinctions between different types of support in factor-analytical empirical studies (e. g. Antonucci and Israel 1986; Turner et al. 1983). It follows that factor-analytically derived or validated scales are not particularly suited for the exploration of the social support complex itself, i.e., for determining what the relevant dimensions, "modes", or functional units of support are, and how these depend on particular network structures. This, however, is crucial for aetiological and epidemiological research. Equally important, assessing
251 social support functions without being able to relate these functions to specific network members makes it difficult to formulate intervention strategies: the fact that an individual lacks, say, adequate emotional support does not indicate whom he or she should or could get it from. Most network-analytical approaches, on the other hand, are too general and insufficiently specific regarding the supportive aspects of social networks. As Cohen and Syme (1985) have noted, "there is little systematic work characterizing network structures in terms of the functions that they normally provide" (p 13), although the studies reported by Wellman (1981) and by Phillips (1981) represent notable exceptions. In the following, an assessment instrument, the "Mannheim Interview on Social Support" (MISS), is described. It maps the supportive environment of an individual simultaneously in terms of prototypical social support functions and in terms of person and relationship characteristics. It was conceived for meeting the needs of researchers in social and community psychiatry and psychology to collect concurrent information about a person's subjective evaluation of available support resources, about their actual distribution among the members of his or her social network, and about the structure of the support network as a whole. The MISS is currently being applied in a number of major epidemiological and community studies in Germany, Switzerland, Austria, Spain, Portugal, and Argentina with a variety of clinical and nonclinical populations. (MISS versions in the respective languages are available from the author.) A brief description has appeared in German (Veiel 1987). This paper is intended as a more in-depth presentation to the Englishspeaking research community. Stability and validity data from three different samples are reported, and areas of applicability are sketched. The "Mannheim Interview on Social Support" (MISS)
The "Mannheim Interview on Social Support" (MISS; see Appendix) is a structured interview designed to elicit comprehensive and fine-grained information about the availability and distribution of various specific support resources in an individual's social network, about the latter's size and composition, and about the individual's satisfaction with the available support resources. The complete interview takes between 30 and 40 minutes to administer and is usually well accepted by the interviewees. It is based on, and represents an extension of, the approach described by McCallister and Fischer (1978) and Phillips and Fischer (1981). Similar methods were used by Vaux and Harrison (1985) and by Wellman (1981). The MISS differs from these approaches insofar as its structure is explicitly based on a multidimensional conceptual framework of support, which systematically distinguishes between everyday and crisis support, between psychological-emotional and instrumental-material support, between different support providers, and between different assessment loci (Veie11985). The interview consists of two parts. In the first, twelve main questions (A1, A 2 , . . . , D3; see Appendix) elicit the
persons actually or potentially providing support in prototypical everyday and crisis situations. Care was taken to make the eliciting items as precise and specific as possible while maintaining their prototypical quality. A typical question is, for example: "Suppose you fell gravely ill and were unable to leave your bed for about a week. Who would be prepared to care for you? Who else?" (Item C2). After each main question, the subject's satisfaction with the support available in the particular situation (questions Alb, A2b etc.) is recorded. In the second phase, the interviewee evaluates/describes each person mentioned regarding gender, age, role relationship, frequency of contact, distance between homes, importance of and satisfaction with the relationship. (Other dimensions are conceivable and can easily be integrated.) Finally, the items G1 and H1 attempt to assess the interviewee's attitudes towards seeking and receiving support that may moderate the availability and utilization of support resources. Regarding support functions or ty~es, two basic distinctions are made which, in one form or another, are usually considered relevant theoretically (cf. House 1981; Turner 1983; Veie11985) or empirically (Brown et al. 1986; Veiel et al. 1988): between support in crises and support in everyday situations, and between psychological support (aimed at restoring or maintaining the subject's psychological equilibrium) and instrumental support (aimed at improving task performance or changing the environment directly). Everyday support is elicited with items targeting daily situations when it would be good to have someone's assistance, but where going without would present no major problems. Crisis support is defined as support in situations that are grave, not part of everyday life, and where another persons's assistance is essential. Because crisis situations are infrequent and not within everybody's immediate experience, the corresponding questions refer to hypothetical situations. The two basic distinctions result in the following four general categories of support (the corresponding MISS items are indicated in brackets): (a) Psychological Everyday Support (social integration), comprising social participation (A1, A2) and esteem (A3, a4); (b) Instrumental Everyday Support (B1); (c) Instrumental Crisis Support, comprising materialpractical support (C1, C2) and instrumental information (C3, C4); and (d) Psychological Crisis Support, comprising confiding (D1, D2) and encouragement (D3). The members of the support network, i.e. the persons named in response to the main questions (A1, A2 . . . . , D3), are coded as to their sex and role-relationship with the subject and are given a running number within the respective categories. It is therefore possible to relate each specific support function to the network members that provide it and, vice versa, to list for each network member his or her support functions. Individual network members can be differentiated and classified according to the characteristics listed above. The MISS data are arranged in a "support matrix" of [network members] * [support functions + person characteristics] (Fig. 1; cf. House and Kahn 1985).
252 [--
Person characteristics
][
Addifionat functions/
Support functions
characteristics
Mentioned in response to item No.:
Person E0de
j IEB/I I E2 I E3 IE4 IFI I E6 r A1 A2 A3 A4 BI [I
E2 C3 [4
DI 02 D3
o 3= Z
Fig.1. The MISS data structure
This data format allows analyses of rows (network members), of columns (support functions), or of partial matrices (network categories by support categories) of any desired degree of specificity, and corresponding scores can be computed. The support matrix allows further the calculation of multiplexity indices (again, if desired, restricted to particular functions and/or network members). The individual tagging of support providers makes it possible to examine directly the stability and composition of the support system over time (cf. Cohen and Syme 1985) and indices can be based on the part of a person's support environment that remains stable between two assessment points. Such a score may more faithfully reflect the support available for coping with stressful life events in the interval (Thoits 1982). With a suitable research design it is also possible to investigate which members of the social network actually do provide support in subsequent crises. For specific research problems, the support matrix can be extended in both dimensions: additional network members (not belonging to the support network) can be evaluated, additional person characteristics and support functions can be added (and/or others deleted). As long as the main questions are unchanged, the core matrix of [persons[ by [functions], i. e the definition of the support network, remains comparable across different studies and assessment points. The MISS in its standard form obtains all its information about an individual's support environment from the individual him- or herself. While, in this manner, it measures perceptions of social support resources by the subject, it attempts to minimize the influence of the subject's evaluations, i.e., the bias produced by his or her mental state, mood, attitudes, personality, and response styles, by concentrating on specific situations and persons. Such biasing factors can be expected to play
a considerably greater role in unspecific items such as, for example, "My family gives me the moral support I need" (Procidano and Heller 1983), and generally in approaches where an individual's evaluations enter into the selection of relevant network members (e. g. by asking for the "most important" network members - cf. Mitchell 1982). To assess a person's support environment makes sense only if it remains reasonably stable over time, and if the assessment procedure meets some minimal standards of reliability and validity. Because of its structural heterogeneity, the appropriate reliability index for the MISS is its test-retest stability which, however, confounds measurement error with fluctuations in the support network itself. While, over periods of days or weeks, network fluctuations can perhaps be neglected, over longer intervals (months and years) the test-retest correlation represents but a lower bound for both instrument reliability and network stability. Since the MISS assesses social resources which cannot reasonably be considered as reflecting latent traits, empirical evaluation of construct validity (Cronbach and Meehl 1955) by factor analysis or related methods is inappropriate. At the same time, the predictive validity of a heterogeneous and complex construct with ramifications in most areas of an individual's life is a matter of cumulative evidence which is difficult to collect in a single empirical study, however extensive. (Some relevant data, though, will be reported below.) The aspect of the MISS's validity that is both important and most feasible to determine is the relationship of the MISS scores to support indices obtained with other instruments, i.e. its concurrent validity. In the remainder of this paper the test-retest stability of the major MISS scores and their relationship with other measures of social support will be evaluated.
253 Method
Samples and data collection Sample 1: University students. This sample consisted of 100 undergraduate students from three institutions of higher learning in the Heidelberg-Mannheim area of southwestern Germany. One hundred (75 %) out of a total of 133 students who were asked in class agreed to participate in this study. Immediately after obtaining their agreement to participate, about half were given several questionnaires to complete (see below). The other half were administered the same questionnaires individually as the first part of the main interview. Within a week after the first contact, all participants were interviewed with the MISS (T1). Four weeks after T1, seventy-one (71%) were re-interviewed (T2). The mean age of the T1 sample (n = 100) was 24 years, 54% were female, and 65% had a stable intimate partner or were married. These percentages were only minimally different in the subsample of n = 71 who completed T2. Analyses of the test-retest stability are based on the T2 subsample (n -- 71), the others on the whole T1 sample (n = 100).
Sample2: Discharged depressed patients. The patient sample was part of a large longitudinal study on the course of depressive disorders, consisting of consecutive admissions to a psychiatric university hospital with a diagnosis of Major Depressive Disorder. The mean length of hospitalization was 8 weeks. They were interviewed four weeks after discharge (T1) and again six months thereafter (T2). Complete T1 interviews were obtained from 117 patients, representing 86% of those contacted during their hospital stay. Ninety-three patients could be approached for the T2 interview of which 88 (94%) agreed to participate. At T1, thirty-one patients (26.7%) still met the criteria for a Major Depressive Episode, and this percentage remained constant at T2 (23/88). The mean age of the sample (T1) was 40.8 years, 62% were women, 63% were married, 18% never married, 16% separated, and 4% widowed. These percentages, again, were only very marginally different for the T2 subsample.
Sample 3: Parents of children afflicted with cance~ The population from which this sample was drawn consisted of the parents of all patients of the Children's Hospital of Heidelberg University who were treated for intracranial tumours between 1978 and 1988. From this pool were excluded: patients with tumours of unknown aetiology, deceased patients, patients younger than four years of age at diagnosis or older than 19 years in 1988, and patients whose addresses were not known or who could not be reached by telephone (twelve cases). The families of the remaining 38 children were contacted by mail. In two cases, the parents refused to participate. After excluding two single mothers, a final n of 68 (2 • 34) was arrived at. The interviews were conducted separately at home where the questionnaires were administered as well. The mean age of this sample was 40.7 years, all were married and, of course, the sex ratio was exactly even. This sample represents a normal, middle-aged population under chronic and severe emotional stress: a child's critical illness. Since
the support network of husbands and wives are not independent of each other, the actual degrees of freedom for this sample must be assumed to be lower than suggested by the total n = 68. Statistical tests based on n = 68 will therefore overestimate the significance levels. This is noted in the tables.
~s~umen~ Apart from collecting reliability and validity data on the MISS, the reasons for investigating the various samples differed. Particularly in the patient sample, which formed part of an ongoing longitudinal, multi-stage research project, many data were collected which are not comparable with the data of the other two samples and which are of marginal relevance here. They will not be reported on. In the student and parent samples, identical additional instruments were used, with the explicit purpose of assessing the concurrent validity of the MISS. These were the revised UCLA-Loneliness Scale (ULS; Russell et al. 1980), the Perceived Social Support scale (PSS) by Procidano and Heller (1983) and the Beck Depression Inventory (BDI; Beck et al. 1961). Stability data for the MISS were available only for the patient sample (test-retest interval 6 months) and the student sample (test-retest interval 4 weeks).
Variables The MISS data structure (the support matrix) allows the calculation of a large number of different network parameters and of functional support scores. For this study, three sets of variables were selected: 1. a rather subjective evaluation of available support, the average Satisfaction with available support resources (averaged over all items Alb, A2b, ..., D3b; cf. appendix). 2. Parameters of the total support network, which was defined as all persons 15 years old or older who were either mentioned as a resource for crisis support (i. e. in response to a C or D question), or who were mentioned as an everyday support resource (A and B questions) and who had contact with the focal individual at least once every two weeks on average: over-all Support Network Size, over-all Frequency of Contact (per week) with the members of the support network, and over-all Multiplexity of support Amctions (i.e. the average number of support functions for which a network member was mentioned). Contact frequency was computed by counting and adding up the number of days per week on which each support network member was seen or spoken to. Fractional values were used for network members seen less frequently than once per week. 3. Four scores for the functional support categories Psy-
chological Everyday Support, Instrumental Everyday Support, Psychological Crisis Support, Instrumental Crisis Support, which were computed as the number of network
254
Table 1. Means and standard deviations for the three samples
MISS kin scores Psychological Everyday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support Support Network Size Contact Frequency per week Multiplexity MISS nonkin scores Psychological Everyday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support Support Network Size Contact Frequency per week Multiplexity
Students (n : 100) Mean SD
Parents (n = 68) Mean SD
Patients (n = 117) Mean SD
2.6 2.3 2.5 3.7 4.1 11.0 5.5
(1.7) (1.5) (1.7) (1.7) (2.0) (8.0) (2.1)
4.2 2.5 1.8 3.7 5.3 16.7 3.4
(2.3) (1.9) (1.2)" (1.5) (2.2) (7.8) (1.4) b
3.3 2.7 3.0 3.4 4.7 13.4 4.1
(2.l) (2.0) (2.3) (2.0) (2.6) (8.2) (1.7)
8.5 5.4 4.7 5.0 10.6 21.4 3.8
(3.9) (3.2) (3.0) (3.0) (3.9) (11.8) (1.1)
4.3 2.1 1.0 1.6 4.6 9.6 2.9
(2.6) (1.9) (1.9) ~ (1.4) (2.6) (9.7) (1.2) b
4.2 2.8 2.8 2.7 6.0 13.1 2.8
(3.4) (2.7) (3.2) (2.8) (4.5) (13,1) (1.2)
Other scores Satisfaction with Support (MISS) 0,71 (0.20) 0.63 (0.21) 0.62 (0.27) PSS-Fr 15.3 (3.7) 12.5 (5.4) PSS-Fa 10.8 (5.6) 14.3 (3.9) ULS 0.92 (0.45) 0.98 (0.44) BDI 5.9 (4.6) 7.6 (6.3) For the student and the patient samples, T1 scores are shown. Kin scores include spouses and partners, except Multiplexity (kin), which is based on family members excluding spouses and partners.(PSS-FR Perceived Social Support scale, Friends stun score; PSS-Fa Perceived Social Support scale, Family sum score; ULS UCLA Loneliness Scale mean score; BDI Beck Depression Inventory sum score). " Item D1 (death of a close person) was not administered in the parent sample - scores are based on Items D2 and D3 only. b Scores are based on 11 Items (excluding D1). m e m b e r s m e n t i o n e d in r e s p o n s e to at least one item of the respective category. E a c h score (except Satisfaction) was c o m p u t e d separately for kin and for nonkin. Kin scores also include in-laws, spouses and steady intimate partners, with one exception: Multiplexity of kin was calculated excluding partners. T h e data collected with the other instruments in the student and p a r e n t samples were scored according to the instructions of their respective authors, yielding a depression sum score ( B D I ) , a m e a n loneliness score (ULS), a perceived family s u p p o r t s u m score (PSS-Fa), and a perceived friend support sum score (PSS-Fr).
Analyses and results As a base-line for the analyses r e p o r t e d below, the m e a n s and standard deviations for the three samples are shown in Table 1. A m o n g the students, the a v e r a g e size of the kin support n e t w o r k was 4.1, and of the nonkin n e t w o r k 10.6. T h e corresponding figures for the patient sample were 4.7 and 6.0, and for the p a r e n t sample 5.3 and 4.6. T h e PSS-Fa and PSS-Fr scores of the students were similar to the figures r e p o r t e d by Procidano and H e l l e r (1983) for a comp a r a b l e sample, but significantly different f r o m the corresponding scores of the p a r e n t sample. T h e m e a n U L S score for b o t h samples was very similar to the one rep o r t e d by Stokes (1985) for students. T h e distributions of most MISS variables were left-skewed. In order to check
w h e t h e r this had influenced the p a t t e r n of association, all of the following analyses were r e p e a t e d with log-transf o r m e d variables, with only m i n o r differences in the results. Table 2 shows the m e a n intercorrelations of the (functionally specific) kin and n o n k i n scores in the three samples. T h e y are m o d e r a t e , varying f r o m a r o u n d 0.40-0.45 in the p a r e n t sample to 0.55-0.65 in the other two samples. T h e s e correlations are c o m p a r a b l e to those r e p o r t e d by B. R. Sarason et al. (1987) b e t w e e n different social support instruments. A t the s a m e time, the correlations of corresponding kin and nonkin scores were practically zero, with the exception of Psychological E v e r y d a y Support in the student sample (r = - 0.25) and Psychological Crisis S u p p o r t in the parent sample (r = 0.37). T h e unrelatedness of the kin and n o n k i n scores fits with the variously r e p o r t e d s e p a r a t i o n of kin and nonkin support functions (Turner et al. 1983; Veiel et al. 1988; Vaux 1987).
Table 2. Mean intercorrelations of functional MISS scores Students (n = 100)
Parents (n = 68)
Patients (n = 117)
Kin scores 0.62 0.44 0.65 Nonkin scores 0.51 0.42 0.59 In each category, the correlations corresponding to the 6 possible combinations of the four variables Psychological Everyday Support, Instrumental Everyday Support, Psychological Crisis Support, Instrumental Crisis Support were averaged (via Fisher's Z-transformations).
255 Table 3. Test-retest stability of MISS scores Students a (n = 71)
Patients b (n = 88)
rtt
OVLP ~ rtt
OVLP ~
Kin scores PsychologicalEveryday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support
0.81 0.74 0.73 0.85
0.99 0.97 0.96 0.98
0.69 0.65 0.54 0.75
0.97 0.95 0.96 0.95
Support Network Size Contact Frequency per week Multiplexity d
0.88 0.85 0.70
0.98 -
0.79 0.66 0.46
0.93 -
0.83 O.71 0.68 0.66
1.00 0.91 0.86 0.89
0.52 0.48 0.73 0.66
0.99 0.96 0.85 0.81
0.78 0.84 0.73
0.83 --
0.62 0.42 0.60
0.70 -
0.69
-
0.66
-
Nonkin scores Psychological Everyday Support Instrumental Everyday Support Psychological Crisis Support Instrumental Crisis Support Support Network Size Contact Frequency per week Multiplexity d Satisfaction with Support
a T h e test-retest i n t e r v a l w a s 4 weeks. b T h e test-retest interval was 6 m o n t h s . O v e r l a p was c o m p u t e d as: n ( p e r s o n s m e n t i o n e d at T 1 and T2) Minimum (n(T1), n (T2)) Only participants with b o t h T1 and T2 scores greater than zero w e r e included in the computations. Especially in the patient sample, the Ns on which the overlap scores w e r e based were often considerably
smaller than the actual samplesize. d Ns vary because Multiplexitycould only be computedif at least one person was mentionedin the respectivecategory. Test-retest stability For the following analyses, data from the student and the patient subsamples with two completed assessments (n -- 71 and n = 88, respectively) were used. The test-retest interval of the students was four weeks, of the patient sample six months. In both samples, the mean TI-T1 differences were practically zero for all MISS variables. The test-retest correlations in the two samples are shown in columns one and three of Table 3. (Corresponding indices for single items are available from the author.) In the student sample, we find acceptable stability coefficients around or above 0.80 for kin and non-kin scores of Support Network Size, Contact Frequency, and Psychological Everyday Support, but also for kin-based scores referring to Instrumental Crisis Support. In contrast, the coefficients for nonkin crisis support are in a lower 0.65-0.70 range. In the patient sample, the correlations were generally about 20 points lower, with the exception of nonkin Crisis Support and kin Network Size. The lower stability figures must be expected considering the far longer test-retest interval, but they may also reflect the changes in network structure and social interaction patterns occurring in the process of re-adapting to a normal life outside the hospital. The student figures, therefore, probably come closer to representing the reliability of the instrument itself. Test-retest correlations indicate the extent to which the same number of persons are mentioned at T1 and T2 in the different support categories. They do not indicate
whether the same individuals are mentioned at T1 and T2. Identical scores could be based on two totally disjunctive sets of support providers, and very different scores could result either from disjunctive sets or from sets that completely include each other. In order to determine the extent to which corresponding sets ofT1 and T2 support providers were included in each other, the number of persons named (and forming part of the support network as defined above) both at T1 and at T2 was divided by either the number named at T1 or the number named at T2, whichever was smaller. The resulting figure represents the proportion of the smaller set of persons which is included in the larger one. Their arithmetic means are shown in columns two and four of Table 3. In general, the indices in the student samples are rather high. (Most medians equalled 1.00, and the 5% confidence intervals of the kin scores was consistently above 0.90.) To interpret them properly it should be kept in mind that an overlap of zero would indicate mutually exclusive sets of persons, and that the range of the overlap index (0.00-1.00) is half the range of correlation coefficients. Despite the rather lower test-retest correlations of the patients, the overlap figures were not much lower here than in the student sample. Again, the kin figures tended to be higher than the nonkin figures. The generally rather higher overlap in both samples indicates that the subjects had a relatively stable "core" of network members for each support category, which changed only marginally over the time periods considered. With the possible exception of the nonkin scores Network Size and Psychological and Instrumental Crisis Support, the instabilities indicated by the correlation coefficient were due mainly to expansions or contractions in the pool of support providers, rather than to replacement of one set of providers by another. This is strikingly illustrated by the figures for Psychological Everyday Support (nonkin) for the patient sample: despite the quite low testretest correlation of r = 0.53, which indicates a considerable fluctuation in the number of friends in agreeable everyday contact, the smaller of the two provider sets is practically always included in the larger one, as demonstrated by a mean overlap of 0.99. The high overlap figures also indicate that the meaning of the prototypical situations described by the MISS items had remained fairly constant for the participants; the inconsistencies were mainly restricted to the more marginal providers and can be ascribed to fluctuations in the actual or perceived magnitude of a network member's support potential, rather than of its quality
Concurrent validity To assess the concurrent validity of the MISS, the UCLALoneliness Scale (ULS), the Perceived Social Support scale (PSS), and the Beck Depression Inventory (BDI) were administered in the student and parent samples. Table 4 shows their correlations with the MISS scores. Regarding the two PSS scores, a clear and surprising pattern emerged: in the student sample, perceived family support (PSS-Fa) was substantially correlated with all MISS kin scores, while perceived friend support (PSS-Fr)
256
Table 4. Correlations of MISS scores with o t h e r s u p p o r t scores Students (n = 98) PS-Fa MISS kin scores Psychological E v e r y d a y S u p p o r t Instrumental Everyday Support Psychological Crisis S u p p o r t I n s t r u m e n t a l Crisis S u p p o r t S u p p o r t N e t w o r k Size Contact F r e q u e n c y p e r w e e k Multiplexity
0.47** 0.45** 0.48** 0.42** 0.35** 0.39"* 0.52"*
Parents (n = 68)
PS-Fr
ULS
BDI
PS-Fa
0.03 0.03 - 0.01 - 0.04 - 0.02 0.01 0.14
-
-
0.15 0.13 0.16 0.18 0.12 0.13 0.25*
0.22 0.11 0.11 0.20 0.32* - 0.04 - 0.11 0.25* 0.19 0.31' 0.16 0.24 0.21 0.08
0.23* 0.20 0.06 0.11 0.07 0.13 0.24*
MISS nonkin scores Psychological E v e r y d a y S u p p o r t Instrumental Everyday Support Psychological Crisis S u p p o r t I n s t r u m e n t a l Crisis S u p p o r t S u p p o r t N e t w o r k Size Contact F r e q u e n c y per w e e k Multiplexity
0.12 0.09 0.11 - 0.02 0.09 0.11 0.00
0.02 - 0.03 0.19 - 0.09 - 0.02 - 0.19 0.17
- 0.21 - 0.21 0.18 0.13 - 0.20 - 0.12 - 0.11
- 0.24* - 0.24* 0.11 - 0.11 - 0.24* - 0.20 - 0.03
O t h e r scores Satisfaction with S u p p o r t (MISS) PSS-Fa PSS-Fr ULS
0.26* 0.16 - 0.35**
0.28* 0.16 - 0.57**
- 0.42** - 0.35** - 0.57** -
-
0.26* 0.36** 0.29** 0.54**
PS-Fr
- 0.52** 0.68** - 0.72**
ULS
BDI
0.13 0.10 0.16 0.22 0.10 0.00 0.03
-
0.20 0.05 0.10 0.15 0.22 0.00 0.02
-
0.05 0.07 0.09 0.18 0.13 0.08 0.03
0.52** 0.33* 0.37** 0.34* 0.50** 0.39** 0.18
-
0.25* 0.20 0.27* 0.08 0.27* 0.17 0.00
-
0.26* 0.26* 0.31" 0.I6 0.30* 0.24 0.13
- 0.51"* 0.68**
- 0.50** - 0.72** - 0.68** -
- 0.68**
- 0.41"* - 0.57** - 0.55** 0.62**
* P _
