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Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth
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Comprehensive Psychiatry 49 (2008) 195 – 201 www.elsevier.com/locate/comppsych
Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth Belinda Bruwer a,⁎, Robin Emsley a , Martin Kidd b , Christine Lochner c , Soraya Seedat c a Department of Psychiatry, University of Stellenbosch, Cape Town 7505, South Africa Department of Statistics and Actuarial Sciences, Centre for Statistical Consultation, University of Stellenbosch, Cape Town 7602, South Africa c Department of Psychiatry, MRC Unit on Anxiety Disorders, University of Stellenbosch, Cape Town 7505, South Africa
b
Abstract Introduction: There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, although its reproducibility in the South African youth has not yet been investigated. Methods: This study aimed to investigate the psychometric properties of the MSPSS in the South African youth using confirmatory factor analysis. The relationship of PSS to depressive and anxiety symptoms, as well as the effects of sex and ethnicity, was investigated. Participants completed a battery of self-report measures, including the MSPSS, Beck Depression Inventory, and the Child Posttraumatic Stress Disorder Checklist on a single occasion. Confirmatory factor analysis was performed to validate the a priori factor structure of the MSPSS. In addition, Cronbach α coefficients and intercorrelations (for clinical variables) were calculated. A missing value analysis was performed to assess the influence of missing data on our findings. Results: Data are reported for 502 youth (11.3-23.5 years). The 3-factor structure of the MSPSS (significant other, family, and friends) fitted the data well. The MSPSS showed good internal consistency. Perceived social support was also positively correlated with resilience and negatively correlated with depression, exposure to community violence, and other potentially life-threatening traumas. Females and youth of white or mixed race reported significantly higher levels of PSS than males and black youth, respectively. Conclusions: The MSPSS is a psychometrically sound instrument that can be applied to South African youth. © 2008 Elsevier Inc. All rights reserved.
1. Introduction The role of social support as a coping resource, as well as its relationship to stressors and mental and physical wellbeing, has spurred much interest in recent years. In this regard, the question of how social support works and how it can be measured with a brief, effective, and well-validated instrument has been examined [1,2]. Social support is a complex multidimensional construct, and conceptual definitions and the type of social support vary widely [1,3-6]. Many different theories and hypotheses have been put forward, for example, the main effect hypothesis proposes that social support has direct effects on health that are independent of the presence of stressors, whereas the buffer
⁎ Corresponding author. PO Box 19063, Tygerberg 7505, Cape Town, South Africa. E-mail address: [email protected] (B. Bruwer). 0010-440X/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2007.09.002
(or indirect) hypothesis proposes that the impact of social support on health increases during stressful circumstances [5,7,8]. Several studies in diverse adolescent populations found that social support from parents and peers lessened the impact of adverse life events and were associated with improved health status [5,8-10]. Arguably, social support plays a role in health maintenance and in recovery from disease, as well as in creating a positive emotional experience, a sense of control, and self-esteem that decreases the deleterious impact of stressful situations. Two different aspects of social support, that is, the size of the support system and satisfaction with the perceived support system, may each be independently vital in terms of coping with stressful situations. Notably, qualitative measures or subjective perceptions of social support adequacy have been shown to be more accurate predictors of psychologic health than more quantitative or objective measures of social support [1].
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Differences in perceived social support (PSS) between different racial groups is an area that warrants further research, including multicultural settings such as South Africa. For example, Klineberg et al [9], found in a diverse East London (England) adolescent sample that ethnic differences in psychologic distress were not explained by differences in social support. South Africa is a country with diverse cultures. The midyear population estimates for 2007 estimated a total South African population of 47.9 million of which 24.3 million (51%) are female. Of the total population, 79.6% are African/black, 8.9% colored/mixed race (a heterogeneous racial group of mixed ancestry), 2.5% Indian/Asian, and 9.1% white (European origin). Of the total population in the country, 10.1% resides in the Western Cape. In the Western Cape, 432 500 females are between 15 and 24 years old, and 465 200 males are between 15 and 24 years old [11]. There are several qualities that make the Multidimensional Scale of Perceived Social Support (MSPSS) an ideal assessment tool. First, the MSPSS was specifically designed to focus on perceived or subjective evaluation of social support adequacy from 3 particular sources: family, friends, and significant others. Most other scales do not evaluate these 3 sources of support as distinct subscales. Second, the MSPSS has been shown in several studies, using diverse populations, to be psychometrically sound [1-4,6,12-15]. Third, although some other scales are lengthy and difficult to administer, the MSPSS is a brief and easy-to-follow selfreport measure of PSS [1,4]. The original MSPSS contained 24 items rated on a 5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5). Factors that addressed popularity and respect were excluded after repeated factor analyses found that these items did not specifically address PSS. The modified version has 12 items, 4 items per subscale (family, friends, or significant other), and was originally tested by Zimet et al [1] on a rather narrowly defined group of male and female undergraduate students. The MSPSS uses positive and negative phrasing to limit response set bias of agreement. Items are added and divided by 12 for the total score. The 4 items for each subscale are added and divided by 4. Total and subscale scores range from 1 to 7. A higher score reflects greater PSS (Appendix A) [12]. Initially, exploratory factor analyses demonstrated a 3factor structure in ethnically and socioeconomic diverse Western youth and adult populations [1-3,6,13,14]. Factorial validity was subsequently confirmed in clinical and nonclinical samples [12,15]. However, other studies have found alternative factor structures. A 2-factor structure emerged in a Chinese adolescent sample where the friend and significant other subscales merged into one (friend) subscale [4]. A confirmatory factor analytic study in a sample of high school students in Hong Kong demonstrated that the significant other subscale measured both friend and family support simultaneously and thus posed significant measurement and theoretical problems to the construct of the MSPSS [16].
In view of the lack of consistency in factorial structure documented in previous studies, as well as relatively few factor analytic replications in cross-cultural adolescent samples, this study sought, for the first time, to investigate the psychometric properties of the MSPSS in a multicultural South African adolescent population.
2. Methods 2.1. Design This study formed part of a cross-sectional survey conducted between August and October 2006 examining the relationship between posttraumatic stress disorder (PTSD) symptoms, trauma exposure, resilience, perceived stress, depression, and social support among youth living in the Western Cape in South Africa [17]. 2.2. Participants A convenience sample of 787 young people from 5 different high schools in Cape Town, South Africa, was recruited [17]. All participants who were approached agreed to participate in the survey. The survey was administered in English. English is a compulsory subject in South African schools, and all participants spoke English as their first or second language. The age of participants ranged from 11.25 to 23.50 years (mean, 16.22 years; SD, 1.84 years), and 41.4% of participants were male, 58.6% female, 30.7% white, 23.8% mixed race, and 44.0% black (0.2% Asian and 1.2% other). 2.3. Procedure A battery of self-report scales was administered by research assistants at the 5 schools, after standardized detailed instructions had been provided [17]. Participants completed all measures within 30 to 35 minutes, including the MSPSS, which took 5 to 10 minutes to complete, at a time that was convenient to the schools. 2.4. Ethical approval and informed consent Ethical approval to conduct the study was provided by the University of Stellenbosch Committee for Human Research. In addition, permission was provided by the Western Cape Department of Health and the school principals. Participants assented to participate in the study, and their parents provided written informed consent [17]. Participants were ensured that participation was entirely voluntary, and confidentiality was ensured through the anonymity of questionnaires. 2.5. Measures Various measures of trauma and violence exposure, childhood abuse and neglect, stressful life events, and resilience were administered. All of these measures were originally developed for use in Western samples.
B. Bruwer et al. / Comprehensive Psychiatry 49 (2008) 195–201
For the purpose of these analyses, the following are discussed: 1. Multidimensional Scale of Perceived Social Support [1]. The MSPSS measures perceived adequacy of social support from 3 sources: family (items 3, 4, 8, and 11), friends (items 6, 7, 9, and 12), and significant other (items 1, 2, 5, and 10). Twelve-item ratings are made on a 7-point Likert-type scale ranging from very strongly disagree (1) to very strongly agree (7). Although the initial 12-item MSPSS was examined using a narrowly defined undergraduate student population, several further studies suggested that the MSPSS is psychometrically sound in diverse subject samples with good internal reliability, test-retest reliability, and strong factorial validity [1-4,6,12-15]. The construct validity of the significant other, family, and friend subscales was also demonstrated [1,2,13,18,19]. Therefore, we did not use a culturally adopted version of the MSPSS in this study and postulated that the factor structure of the MSPSS would be similar in South African youth. 2. Child PTSD Checklist [20]. This is a checklist containing 28 items, which rates Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision–characterized PTSD symptoms during the past month on a 4-point Likert-type scale. The child PTSD Checklist has excellent internal consistency, good test-retest reliability, as well as good convergent validity [21]. 3. Beck Depression Inventory (BDI) [22]. The BDI is a 21-item self-report 4-point Likert-type inventory composed of items designed to evaluate severity of depression and that reflect attitudes and symptoms associated with depression. It demonstrates excellent internal consistency for psychiatric and nonpsychiatric populations [23]. The BDI has been shown to be a valid screening measure for depression in adolescent samples [24,25]. 4. Children’s Exposure to Community Violence (CECV) [26]. The CECV is a self-report measure that evaluates youth exposure (experienced, witnessed, heard about) to different forms of community violence on a 5-point Likert scale (never to more than 10 times). Good internal consistency and test-retest reliability have been demonstrated [27]. 5. Childhood Trauma Questionnaire (CTQ) [28]. This is a self-report instrument containing 28 items and 5 subscales that reliably screens for a history of emotional abuse/neglect, physical abuse/neglect, and sexual abuse using a 5-point Likert scale (never true to very often true). Good sensitivity and specificity have been found in psychiatric adolescent samples [29]. 6. Connor-Davidson Resilience Scale (CD-RISC) [30]. The CD-RISC is a 25-item self-rated instrument, with each item assessed on a 5-point Likert scale, designed
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to quantify resilience in the context of trauma exposure and has shown good reliability and validity in previous studies [30]. 7. Perceived stress scale [31]. This is an inventory of life circumstances that were perceived as being stressful within the past month. Good internal reliability and validity have been reported in adolescent populations [32]. 2.6. Data analysis Cases with missing data on the MSPSS were deleted listwise, resulting in a sample size of 502. All statistical procedures were performed using SPSS 14.0 (SPSS, Chicago, Ill) and Statistica 7.0 (Statistica, Tulsa, OK) software packages. Confirmatory factor analysis (CFA) using Lisrel 8.8 (Lisrel, Chicago, IL) was performed to validate the a priori factor structure of the MSPSS. The CFA model was fitted using robust diagonally weighted least squares, which is an appropriate technique applied to Likerttype data. The fit indices reported were root mean square error of approximation (RMSEA) (b0.05 acceptable), adjusted goodness of fit index (AGFI) (N0.95 acceptable), variance extracted (N0.5 acceptable), and construct reliability (N0.7 acceptable). The CFA model is shown in Fig. 1. Descriptive statistics were calculated for demographic variables. Intercorrelations were calculated to determine the nature and strength of the relationships between clinical (dependent) variables. Cronbach α coefficients were computed for internal validity purposes. Missing value analysis
Fig. 1. Confirmatory factor analysis model for all data with missing value cases removed. fam indicates family; fri, friends; so, significant other.
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Table 1 Total scores (means and SDs) for various measures (N = 502)
PTSD CD-RISC PSS BDI CECV CTQ MSPSS MSPSS_SO MSPSS_FAM MSPSS_FRI
Minimum
Maximum
Mean
SD
0 0 2 0 0 25 12 4.00 4.00 4.00
68 100 36 60 143 92 84 28.00 28.00 28.00
20.17 65.98 19.05 11.70 30.73 41.05 62.94 21.49 21.08 20.37
14.76 18.59 6.66 10.87 24.80 13.61 18.04 6.99 6.59 6.75
Table 3 Cronbach α values for the various subsets of the data as well as all the data excluding all cases with missing values Replacement of missing values Data set
Construct
n
Cronbach α
n
Cronbach α
Black/African
FAM FRI SO FAM FRI SO FAM FRI SO FAM FRI SO
287
0.82 0.79 0.85 0.89 0.88 0.86 0.91 0.95 0.95 0.86 0.86 0.88
218
0.86 0.81 0.87 0.90 0.89 0.88 0.92 0.96 0.95 0.89 0.88 0.90
Colored/mixed race
Whites
MSPSS_SO indicates significant other subscale of MSPSS; MSPSS_FAM, family subscale of MSPSS; MSPSS_FRI, friend subscale of MSPSS. All races combined
compared missing and nonmissing data for age, sex, and race. The analysis was repeated by replacing missing data where there were 2 or less missing values. Reliability and CFA analyses were conducted first with all missing value cases excluded and second with replacement of missing data for all cases with 2 or fewer missing values. These analyses were also conducted per race group. 3. Results 3.1. Demographics A convenience sample of 787 young people from 5 different high schools in Cape Town, South Africa, was recruited. The response rate was 100%; however, because all cases with any missing data on the MSPSS were deleted listwise, the final sample was 502. Most of the participants were female and black. 3.2. Clinical data Table 1 shows the scores (means and SD) for the various measures, and Table 2 reports on the intercorrelations among the various measures. Perceptions of social support (MSPSS
No replacement of missing values
127
163
592
118
152
502
FAM indicates family; FRI, friends; SO, significant other.
scores) among youth were positively correlated with resilience scores (CD-RISC total) and negatively correlated with depression scores (BDI total), levels of exposure to violence (CECV total), and levels of childhood trauma (total CTQ scores). Thus, greater PSS was associated with more resilience, less depression, and less exposure to trauma. Females, compared with males, reported higher levels of PSS from a significant other, family, and friends, as well as significantly higher overall PSS. Participants who were either white or of mixed race reported significantly higher levels of PSS from friends compared with participants from other race groups and significantly higher overall PSS compared with black participants. 3.3. Psychometric qualities of the MSPSS 3.3.1. Internal reliability In the total sample, Cronbach α coefficients ranged from 0.86 to 0.90 for the subscales and 0.86 for the entire scale (Table 3).
Table 2 Intercorrelations among clinical variables (N = 502)
PTSD CD-RISC PSS BDI CECV CTQ MSPSS MSPSS (SO) MSPSS (FAM) MSPSS (FRI)
PTSD
CD-RISC
PSS
BDI
CECV
CTQ
MSPSS
MSPSS (SO)
MSPSS (FAM)
MSPSS (FRI)
1 −0.148 ⁎⁎ 0.549 ⁎⁎ 0.458 ⁎⁎ 0.352 ⁎⁎ 0.251 ⁎⁎ −0.044 −0.032 −0.104 ⁎ 0.019
1 −0.289 ⁎⁎ −0.438 ⁎⁎ −0.128 ⁎ −0.326 ⁎⁎ 0.426 ⁎⁎ 0.381 ⁎⁎ 0.369 ⁎⁎ 0.387 ⁎⁎
1 0.478 ⁎⁎ 0.171 ⁎⁎ 0.200 ⁎⁎ −0.086 −0.031 −0.162 ⁎⁎ −0.040
1 0.405 ⁎⁎ 0.380 ⁎⁎ −0.271 ⁎⁎ −0.219 ⁎⁎ −0.279 ⁎⁎ −0.223 ⁎⁎
1 0.448 ⁎⁎ −0.126 ⁎ −0.093 −0.131 ⁎ −0.115 ⁎
1 −0.428 ⁎⁎ −0.362 ⁎⁎ −0.474 ⁎⁎ −0.304 ⁎⁎
1 0.914 ⁎⁎ 0.886 ⁎⁎ 0.861 ⁎⁎
1 0.747 ⁎⁎ 0.676 ⁎⁎
1 0.616 ⁎⁎
1
SO indicates significant other; FAM, family; FRI, friend. ⁎ P b .05. ⁎⁎ P b .01.
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but there was a sex effect. That said, the percentage difference in missing values between boys (28%) and . girls (21%) was not dramatic. Again, the significant P value (P = .02) was probably attributable to large sample size. Third, reliability and CFA analyses with all missing value cases excluded and with 2 or less missing values were conducted. Further analyses were done per race group. In general, Cronbach α's and all CFA fit indices were good (Tables 3 and 4).
3.3.2. Confirmatory factor analysis Results from the CFA analysis on the data with missing value cases removed are shown in Fig. 1 and Table 4. The fit was reasonable with respect to RMSEA (0.051, P = .44), and the AGFI indicated a good fit (1.00). The variance extracted and construct reliability values were all within acceptable range for the 3 constructs (variance extracted N0.5; construct reliability N0.7). 3.3.3. Missing value analysis First, there were significant age differences (P b .01), but no sex differences, when comparing missing and nonmissing values for age, sex, and race. The significant P value for age could arguably be attributed to the large sample size. There were race differences with blacks seemingly having more missing data (43% blacks, 32% whites, and 25% colored participants had missing data, P b .000 17). Second, when missing data were replaced for all cases where there were 2 or less missing values, the age and race effects disappeared,
4. Discussion We found a positive correlation between PSS and resilience, and a negative correlation between PSS and depression, exposure to community violence, and other potentially life-threatening trauma. In terms of the psychometric qualities and applicability of the MSPSS within the South African context, our findings suggest that the MSPSS
Table 4 Fit indices for CFA models fitted on various subsets of the data as well as all the data where cases with missing data were removed Data set
Construct
Replacement of missing values Black/African FAM FRI SO Colored/mixed race FAM FRI SO Whites FAM FRI SO All races FAM FRI SO No replacement of missing values Black/African FAM FRI SO Colored/mixed race FAM FRI SO Whites FAM FRI SO All races FAM FRI SO
RMSEA (95% CI)
P value for test of close fit (RMSEA b0.05)
AGFI
0.045 (0.026-0.063)
.64
1.00
0.0 (0.0-0.055)
0.024 (0.0-0.057)
0.042 (0.030-0.053)
0.061 (0.041-0.081)
0.050 (0.0-0.082)
0.023 (0.0-0.058)
0.051 (0.039-0.063)
.92
.88
.88
.17
.48
.88
.44
CI indicates confidence interval; FAM, family; FRI, friends; SO, significant other.
Variance extracted
Construct reliability
0.62 0.54 0.67
0.86 0.82 0.89
0.72 0.74 0.74
0.91 0.92 0.92
0.82 0.87 0.87
0.95 0.97 0.96
0.69 0.69 0.74
0.90 0.90 0.92
0.68 0.58 0.73
0.89 0.84 0.92
0.74 0.77 0.76
0.92 0.93 0.93
0.83 0.89 0.88
0.95 0.97 0.97
0.74 0.72 0.78
0.92 0.92 0.92
0.99
1.00
1.00
0.99
0.99
1.00
1.00
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has divergent/discriminant validity (as supported by a negative correlation between MSPSS and BDI scores). Our findings are in keeping with the literature that PSS correlates negatively with depression and anxiety symptoms [1,3,4, 9,33,34], although the strength of correlations between the MSPSS subscales and other symptom measures were in the small to moderate range and could have been influenced by factors that affected the constitution of the final sample. Our findings are consistent with the findings of sex and ethnic effects on levels of PSS. In this study, as well as in previous studies, females and whites reported greater PSS than males and blacks, respectively [1,9,10,14]. We also found that youth of mixed race experienced more PSS than blacks. There are a few limitations to this study, mainly stemming from the cultural diversity of this population. Owing to the cross-sectional nature of this study, we are unable to comment on the relationship between social support and depression in respect of cause and effect. Further limitations to this study include missing data in a relatively large number of participants. The use of a convenience sample of high school students in Cape Town, which may not necessarily be representative of the entire South African youth population, is a further limitation of this article. South Africa is known for its cultural diversity, and a large number of South Africans do not speak English as their first language. These cultural and language differences may have had an influence on the interpretation of questionnaires and consequently the number of missing data in the sample. Previous studies have found that the MSPSS had good internal validity when applied to diverse populations, including adolescents [1-4,6,12-15]. The findings in this study confirm that the MSPSS is psychometrically sound and has excellent internal validity (coefficient α, 0.88-0.90 for the subscales and 0.86 for the entire scale) in South African youth. There are discrepancies regarding the factor structure of the MSPSS, with some studies finding a 3factor structure [1-3,6,12-15] and others a 2-factor structure [4,16]. Consistent with most other studies, we found that a 3-factor model fits the data best [6,34]. As such, the a priori factor structure of the MSPSS established in Western adolescents extends to South African youth in the Western Cape and provides support for its crosscultural utility. 4.1. Conclusion In conclusion, our findings indicate that the MSPSS is a psychometrically sound instrument with good internal consistency and factorial validity that can be applied to South African youth to measure the adequacy of PSS. Acknowledgment The authors thank (1) Mr Dylan Fincham for assistance with data analysis; (2) Professor Dana Niehaus for assistance with the tables; (3) Aliza le Roux for assistance with
proofreading; and (4) the Department of Education of South Africa, the school principals, and the students who participated in the survey. Appendix A. Addendum A: Multidimensional Scale of Perceived Social Support Instructions: We are interested in how you feel about the following statements. Read each statement carefully. Indicate how you feel about each statement. Circle Circle Circle Circle Circle Circle Circle
the the the the the the the
“1” “2” “3” “4” “5” “6” “7”
if if if if if if if
you you you you you you you
Very Strongly Disagree Strongly Disagree Mildly Disagree are Neutral Mildly Agree Strongly Agree Very Strongly Agree
1. There is a special person who is around when I am in need. 2. There is a special person with whom I can share my joys and sorrows. 3. My family really tries to help me. 4. I get the emotional help and support I need from my family. 5. I have a special person who is a real source of comfort to me. 6. My friends really try to help me. 7. I can count on my friends when things go wrong. 8. I can talk about my problems with my family. 9. I have friends with whom I can share my joys and sorrows. 10. There is a special person in my life who cares about my feelings. 11. My family is willing to help me make decisions. 12. I can talk about my problems with my friends.
1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 Fri 1 2 3 4 5 6 7 Fri 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 Fri 1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 Fri
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Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth Belinda Bruwer a,⁎, Robin Emsley a , Martin Kidd b , Christine Lochner c , Soraya Seedat c a Department of Psychiatry, University of Stellenbosch, Cape Town 7505, South Africa Department of Statistics and Actuarial Sciences, Centre for Statistical Consultation, University of Stellenbosch, Cape Town 7602, South Africa c Department of Psychiatry, MRC Unit on Anxiety Disorders, University of Stellenbosch, Cape Town 7505, South Africa
b
Abstract Introduction: There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, although its reproducibility in the South African youth has not yet been investigated. Methods: This study aimed to investigate the psychometric properties of the MSPSS in the South African youth using confirmatory factor analysis. The relationship of PSS to depressive and anxiety symptoms, as well as the effects of sex and ethnicity, was investigated. Participants completed a battery of self-report measures, including the MSPSS, Beck Depression Inventory, and the Child Posttraumatic Stress Disorder Checklist on a single occasion. Confirmatory factor analysis was performed to validate the a priori factor structure of the MSPSS. In addition, Cronbach α coefficients and intercorrelations (for clinical variables) were calculated. A missing value analysis was performed to assess the influence of missing data on our findings. Results: Data are reported for 502 youth (11.3-23.5 years). The 3-factor structure of the MSPSS (significant other, family, and friends) fitted the data well. The MSPSS showed good internal consistency. Perceived social support was also positively correlated with resilience and negatively correlated with depression, exposure to community violence, and other potentially life-threatening traumas. Females and youth of white or mixed race reported significantly higher levels of PSS than males and black youth, respectively. Conclusions: The MSPSS is a psychometrically sound instrument that can be applied to South African youth. © 2008 Elsevier Inc. All rights reserved.
1. Introduction The role of social support as a coping resource, as well as its relationship to stressors and mental and physical wellbeing, has spurred much interest in recent years. In this regard, the question of how social support works and how it can be measured with a brief, effective, and well-validated instrument has been examined [1,2]. Social support is a complex multidimensional construct, and conceptual definitions and the type of social support vary widely [1,3-6]. Many different theories and hypotheses have been put forward, for example, the main effect hypothesis proposes that social support has direct effects on health that are independent of the presence of stressors, whereas the buffer
⁎ Corresponding author. PO Box 19063, Tygerberg 7505, Cape Town, South Africa. E-mail address: [email protected] (B. Bruwer). 0010-440X/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2007.09.002
(or indirect) hypothesis proposes that the impact of social support on health increases during stressful circumstances [5,7,8]. Several studies in diverse adolescent populations found that social support from parents and peers lessened the impact of adverse life events and were associated with improved health status [5,8-10]. Arguably, social support plays a role in health maintenance and in recovery from disease, as well as in creating a positive emotional experience, a sense of control, and self-esteem that decreases the deleterious impact of stressful situations. Two different aspects of social support, that is, the size of the support system and satisfaction with the perceived support system, may each be independently vital in terms of coping with stressful situations. Notably, qualitative measures or subjective perceptions of social support adequacy have been shown to be more accurate predictors of psychologic health than more quantitative or objective measures of social support [1].
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Differences in perceived social support (PSS) between different racial groups is an area that warrants further research, including multicultural settings such as South Africa. For example, Klineberg et al [9], found in a diverse East London (England) adolescent sample that ethnic differences in psychologic distress were not explained by differences in social support. South Africa is a country with diverse cultures. The midyear population estimates for 2007 estimated a total South African population of 47.9 million of which 24.3 million (51%) are female. Of the total population, 79.6% are African/black, 8.9% colored/mixed race (a heterogeneous racial group of mixed ancestry), 2.5% Indian/Asian, and 9.1% white (European origin). Of the total population in the country, 10.1% resides in the Western Cape. In the Western Cape, 432 500 females are between 15 and 24 years old, and 465 200 males are between 15 and 24 years old [11]. There are several qualities that make the Multidimensional Scale of Perceived Social Support (MSPSS) an ideal assessment tool. First, the MSPSS was specifically designed to focus on perceived or subjective evaluation of social support adequacy from 3 particular sources: family, friends, and significant others. Most other scales do not evaluate these 3 sources of support as distinct subscales. Second, the MSPSS has been shown in several studies, using diverse populations, to be psychometrically sound [1-4,6,12-15]. Third, although some other scales are lengthy and difficult to administer, the MSPSS is a brief and easy-to-follow selfreport measure of PSS [1,4]. The original MSPSS contained 24 items rated on a 5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5). Factors that addressed popularity and respect were excluded after repeated factor analyses found that these items did not specifically address PSS. The modified version has 12 items, 4 items per subscale (family, friends, or significant other), and was originally tested by Zimet et al [1] on a rather narrowly defined group of male and female undergraduate students. The MSPSS uses positive and negative phrasing to limit response set bias of agreement. Items are added and divided by 12 for the total score. The 4 items for each subscale are added and divided by 4. Total and subscale scores range from 1 to 7. A higher score reflects greater PSS (Appendix A) [12]. Initially, exploratory factor analyses demonstrated a 3factor structure in ethnically and socioeconomic diverse Western youth and adult populations [1-3,6,13,14]. Factorial validity was subsequently confirmed in clinical and nonclinical samples [12,15]. However, other studies have found alternative factor structures. A 2-factor structure emerged in a Chinese adolescent sample where the friend and significant other subscales merged into one (friend) subscale [4]. A confirmatory factor analytic study in a sample of high school students in Hong Kong demonstrated that the significant other subscale measured both friend and family support simultaneously and thus posed significant measurement and theoretical problems to the construct of the MSPSS [16].
In view of the lack of consistency in factorial structure documented in previous studies, as well as relatively few factor analytic replications in cross-cultural adolescent samples, this study sought, for the first time, to investigate the psychometric properties of the MSPSS in a multicultural South African adolescent population.
2. Methods 2.1. Design This study formed part of a cross-sectional survey conducted between August and October 2006 examining the relationship between posttraumatic stress disorder (PTSD) symptoms, trauma exposure, resilience, perceived stress, depression, and social support among youth living in the Western Cape in South Africa [17]. 2.2. Participants A convenience sample of 787 young people from 5 different high schools in Cape Town, South Africa, was recruited [17]. All participants who were approached agreed to participate in the survey. The survey was administered in English. English is a compulsory subject in South African schools, and all participants spoke English as their first or second language. The age of participants ranged from 11.25 to 23.50 years (mean, 16.22 years; SD, 1.84 years), and 41.4% of participants were male, 58.6% female, 30.7% white, 23.8% mixed race, and 44.0% black (0.2% Asian and 1.2% other). 2.3. Procedure A battery of self-report scales was administered by research assistants at the 5 schools, after standardized detailed instructions had been provided [17]. Participants completed all measures within 30 to 35 minutes, including the MSPSS, which took 5 to 10 minutes to complete, at a time that was convenient to the schools. 2.4. Ethical approval and informed consent Ethical approval to conduct the study was provided by the University of Stellenbosch Committee for Human Research. In addition, permission was provided by the Western Cape Department of Health and the school principals. Participants assented to participate in the study, and their parents provided written informed consent [17]. Participants were ensured that participation was entirely voluntary, and confidentiality was ensured through the anonymity of questionnaires. 2.5. Measures Various measures of trauma and violence exposure, childhood abuse and neglect, stressful life events, and resilience were administered. All of these measures were originally developed for use in Western samples.
B. Bruwer et al. / Comprehensive Psychiatry 49 (2008) 195–201
For the purpose of these analyses, the following are discussed: 1. Multidimensional Scale of Perceived Social Support [1]. The MSPSS measures perceived adequacy of social support from 3 sources: family (items 3, 4, 8, and 11), friends (items 6, 7, 9, and 12), and significant other (items 1, 2, 5, and 10). Twelve-item ratings are made on a 7-point Likert-type scale ranging from very strongly disagree (1) to very strongly agree (7). Although the initial 12-item MSPSS was examined using a narrowly defined undergraduate student population, several further studies suggested that the MSPSS is psychometrically sound in diverse subject samples with good internal reliability, test-retest reliability, and strong factorial validity [1-4,6,12-15]. The construct validity of the significant other, family, and friend subscales was also demonstrated [1,2,13,18,19]. Therefore, we did not use a culturally adopted version of the MSPSS in this study and postulated that the factor structure of the MSPSS would be similar in South African youth. 2. Child PTSD Checklist [20]. This is a checklist containing 28 items, which rates Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision–characterized PTSD symptoms during the past month on a 4-point Likert-type scale. The child PTSD Checklist has excellent internal consistency, good test-retest reliability, as well as good convergent validity [21]. 3. Beck Depression Inventory (BDI) [22]. The BDI is a 21-item self-report 4-point Likert-type inventory composed of items designed to evaluate severity of depression and that reflect attitudes and symptoms associated with depression. It demonstrates excellent internal consistency for psychiatric and nonpsychiatric populations [23]. The BDI has been shown to be a valid screening measure for depression in adolescent samples [24,25]. 4. Children’s Exposure to Community Violence (CECV) [26]. The CECV is a self-report measure that evaluates youth exposure (experienced, witnessed, heard about) to different forms of community violence on a 5-point Likert scale (never to more than 10 times). Good internal consistency and test-retest reliability have been demonstrated [27]. 5. Childhood Trauma Questionnaire (CTQ) [28]. This is a self-report instrument containing 28 items and 5 subscales that reliably screens for a history of emotional abuse/neglect, physical abuse/neglect, and sexual abuse using a 5-point Likert scale (never true to very often true). Good sensitivity and specificity have been found in psychiatric adolescent samples [29]. 6. Connor-Davidson Resilience Scale (CD-RISC) [30]. The CD-RISC is a 25-item self-rated instrument, with each item assessed on a 5-point Likert scale, designed
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to quantify resilience in the context of trauma exposure and has shown good reliability and validity in previous studies [30]. 7. Perceived stress scale [31]. This is an inventory of life circumstances that were perceived as being stressful within the past month. Good internal reliability and validity have been reported in adolescent populations [32]. 2.6. Data analysis Cases with missing data on the MSPSS were deleted listwise, resulting in a sample size of 502. All statistical procedures were performed using SPSS 14.0 (SPSS, Chicago, Ill) and Statistica 7.0 (Statistica, Tulsa, OK) software packages. Confirmatory factor analysis (CFA) using Lisrel 8.8 (Lisrel, Chicago, IL) was performed to validate the a priori factor structure of the MSPSS. The CFA model was fitted using robust diagonally weighted least squares, which is an appropriate technique applied to Likerttype data. The fit indices reported were root mean square error of approximation (RMSEA) (b0.05 acceptable), adjusted goodness of fit index (AGFI) (N0.95 acceptable), variance extracted (N0.5 acceptable), and construct reliability (N0.7 acceptable). The CFA model is shown in Fig. 1. Descriptive statistics were calculated for demographic variables. Intercorrelations were calculated to determine the nature and strength of the relationships between clinical (dependent) variables. Cronbach α coefficients were computed for internal validity purposes. Missing value analysis
Fig. 1. Confirmatory factor analysis model for all data with missing value cases removed. fam indicates family; fri, friends; so, significant other.
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Table 1 Total scores (means and SDs) for various measures (N = 502)
PTSD CD-RISC PSS BDI CECV CTQ MSPSS MSPSS_SO MSPSS_FAM MSPSS_FRI
Minimum
Maximum
Mean
SD
0 0 2 0 0 25 12 4.00 4.00 4.00
68 100 36 60 143 92 84 28.00 28.00 28.00
20.17 65.98 19.05 11.70 30.73 41.05 62.94 21.49 21.08 20.37
14.76 18.59 6.66 10.87 24.80 13.61 18.04 6.99 6.59 6.75
Table 3 Cronbach α values for the various subsets of the data as well as all the data excluding all cases with missing values Replacement of missing values Data set
Construct
n
Cronbach α
n
Cronbach α
Black/African
FAM FRI SO FAM FRI SO FAM FRI SO FAM FRI SO
287
0.82 0.79 0.85 0.89 0.88 0.86 0.91 0.95 0.95 0.86 0.86 0.88
218
0.86 0.81 0.87 0.90 0.89 0.88 0.92 0.96 0.95 0.89 0.88 0.90
Colored/mixed race
Whites
MSPSS_SO indicates significant other subscale of MSPSS; MSPSS_FAM, family subscale of MSPSS; MSPSS_FRI, friend subscale of MSPSS. All races combined
compared missing and nonmissing data for age, sex, and race. The analysis was repeated by replacing missing data where there were 2 or less missing values. Reliability and CFA analyses were conducted first with all missing value cases excluded and second with replacement of missing data for all cases with 2 or fewer missing values. These analyses were also conducted per race group. 3. Results 3.1. Demographics A convenience sample of 787 young people from 5 different high schools in Cape Town, South Africa, was recruited. The response rate was 100%; however, because all cases with any missing data on the MSPSS were deleted listwise, the final sample was 502. Most of the participants were female and black. 3.2. Clinical data Table 1 shows the scores (means and SD) for the various measures, and Table 2 reports on the intercorrelations among the various measures. Perceptions of social support (MSPSS
No replacement of missing values
127
163
592
118
152
502
FAM indicates family; FRI, friends; SO, significant other.
scores) among youth were positively correlated with resilience scores (CD-RISC total) and negatively correlated with depression scores (BDI total), levels of exposure to violence (CECV total), and levels of childhood trauma (total CTQ scores). Thus, greater PSS was associated with more resilience, less depression, and less exposure to trauma. Females, compared with males, reported higher levels of PSS from a significant other, family, and friends, as well as significantly higher overall PSS. Participants who were either white or of mixed race reported significantly higher levels of PSS from friends compared with participants from other race groups and significantly higher overall PSS compared with black participants. 3.3. Psychometric qualities of the MSPSS 3.3.1. Internal reliability In the total sample, Cronbach α coefficients ranged from 0.86 to 0.90 for the subscales and 0.86 for the entire scale (Table 3).
Table 2 Intercorrelations among clinical variables (N = 502)
PTSD CD-RISC PSS BDI CECV CTQ MSPSS MSPSS (SO) MSPSS (FAM) MSPSS (FRI)
PTSD
CD-RISC
PSS
BDI
CECV
CTQ
MSPSS
MSPSS (SO)
MSPSS (FAM)
MSPSS (FRI)
1 −0.148 ⁎⁎ 0.549 ⁎⁎ 0.458 ⁎⁎ 0.352 ⁎⁎ 0.251 ⁎⁎ −0.044 −0.032 −0.104 ⁎ 0.019
1 −0.289 ⁎⁎ −0.438 ⁎⁎ −0.128 ⁎ −0.326 ⁎⁎ 0.426 ⁎⁎ 0.381 ⁎⁎ 0.369 ⁎⁎ 0.387 ⁎⁎
1 0.478 ⁎⁎ 0.171 ⁎⁎ 0.200 ⁎⁎ −0.086 −0.031 −0.162 ⁎⁎ −0.040
1 0.405 ⁎⁎ 0.380 ⁎⁎ −0.271 ⁎⁎ −0.219 ⁎⁎ −0.279 ⁎⁎ −0.223 ⁎⁎
1 0.448 ⁎⁎ −0.126 ⁎ −0.093 −0.131 ⁎ −0.115 ⁎
1 −0.428 ⁎⁎ −0.362 ⁎⁎ −0.474 ⁎⁎ −0.304 ⁎⁎
1 0.914 ⁎⁎ 0.886 ⁎⁎ 0.861 ⁎⁎
1 0.747 ⁎⁎ 0.676 ⁎⁎
1 0.616 ⁎⁎
1
SO indicates significant other; FAM, family; FRI, friend. ⁎ P b .05. ⁎⁎ P b .01.
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but there was a sex effect. That said, the percentage difference in missing values between boys (28%) and . girls (21%) was not dramatic. Again, the significant P value (P = .02) was probably attributable to large sample size. Third, reliability and CFA analyses with all missing value cases excluded and with 2 or less missing values were conducted. Further analyses were done per race group. In general, Cronbach α's and all CFA fit indices were good (Tables 3 and 4).
3.3.2. Confirmatory factor analysis Results from the CFA analysis on the data with missing value cases removed are shown in Fig. 1 and Table 4. The fit was reasonable with respect to RMSEA (0.051, P = .44), and the AGFI indicated a good fit (1.00). The variance extracted and construct reliability values were all within acceptable range for the 3 constructs (variance extracted N0.5; construct reliability N0.7). 3.3.3. Missing value analysis First, there were significant age differences (P b .01), but no sex differences, when comparing missing and nonmissing values for age, sex, and race. The significant P value for age could arguably be attributed to the large sample size. There were race differences with blacks seemingly having more missing data (43% blacks, 32% whites, and 25% colored participants had missing data, P b .000 17). Second, when missing data were replaced for all cases where there were 2 or less missing values, the age and race effects disappeared,
4. Discussion We found a positive correlation between PSS and resilience, and a negative correlation between PSS and depression, exposure to community violence, and other potentially life-threatening trauma. In terms of the psychometric qualities and applicability of the MSPSS within the South African context, our findings suggest that the MSPSS
Table 4 Fit indices for CFA models fitted on various subsets of the data as well as all the data where cases with missing data were removed Data set
Construct
Replacement of missing values Black/African FAM FRI SO Colored/mixed race FAM FRI SO Whites FAM FRI SO All races FAM FRI SO No replacement of missing values Black/African FAM FRI SO Colored/mixed race FAM FRI SO Whites FAM FRI SO All races FAM FRI SO
RMSEA (95% CI)
P value for test of close fit (RMSEA b0.05)
AGFI
0.045 (0.026-0.063)
.64
1.00
0.0 (0.0-0.055)
0.024 (0.0-0.057)
0.042 (0.030-0.053)
0.061 (0.041-0.081)
0.050 (0.0-0.082)
0.023 (0.0-0.058)
0.051 (0.039-0.063)
.92
.88
.88
.17
.48
.88
.44
CI indicates confidence interval; FAM, family; FRI, friends; SO, significant other.
Variance extracted
Construct reliability
0.62 0.54 0.67
0.86 0.82 0.89
0.72 0.74 0.74
0.91 0.92 0.92
0.82 0.87 0.87
0.95 0.97 0.96
0.69 0.69 0.74
0.90 0.90 0.92
0.68 0.58 0.73
0.89 0.84 0.92
0.74 0.77 0.76
0.92 0.93 0.93
0.83 0.89 0.88
0.95 0.97 0.97
0.74 0.72 0.78
0.92 0.92 0.92
0.99
1.00
1.00
0.99
0.99
1.00
1.00
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has divergent/discriminant validity (as supported by a negative correlation between MSPSS and BDI scores). Our findings are in keeping with the literature that PSS correlates negatively with depression and anxiety symptoms [1,3,4, 9,33,34], although the strength of correlations between the MSPSS subscales and other symptom measures were in the small to moderate range and could have been influenced by factors that affected the constitution of the final sample. Our findings are consistent with the findings of sex and ethnic effects on levels of PSS. In this study, as well as in previous studies, females and whites reported greater PSS than males and blacks, respectively [1,9,10,14]. We also found that youth of mixed race experienced more PSS than blacks. There are a few limitations to this study, mainly stemming from the cultural diversity of this population. Owing to the cross-sectional nature of this study, we are unable to comment on the relationship between social support and depression in respect of cause and effect. Further limitations to this study include missing data in a relatively large number of participants. The use of a convenience sample of high school students in Cape Town, which may not necessarily be representative of the entire South African youth population, is a further limitation of this article. South Africa is known for its cultural diversity, and a large number of South Africans do not speak English as their first language. These cultural and language differences may have had an influence on the interpretation of questionnaires and consequently the number of missing data in the sample. Previous studies have found that the MSPSS had good internal validity when applied to diverse populations, including adolescents [1-4,6,12-15]. The findings in this study confirm that the MSPSS is psychometrically sound and has excellent internal validity (coefficient α, 0.88-0.90 for the subscales and 0.86 for the entire scale) in South African youth. There are discrepancies regarding the factor structure of the MSPSS, with some studies finding a 3factor structure [1-3,6,12-15] and others a 2-factor structure [4,16]. Consistent with most other studies, we found that a 3-factor model fits the data best [6,34]. As such, the a priori factor structure of the MSPSS established in Western adolescents extends to South African youth in the Western Cape and provides support for its crosscultural utility. 4.1. Conclusion In conclusion, our findings indicate that the MSPSS is a psychometrically sound instrument with good internal consistency and factorial validity that can be applied to South African youth to measure the adequacy of PSS. Acknowledgment The authors thank (1) Mr Dylan Fincham for assistance with data analysis; (2) Professor Dana Niehaus for assistance with the tables; (3) Aliza le Roux for assistance with
proofreading; and (4) the Department of Education of South Africa, the school principals, and the students who participated in the survey. Appendix A. Addendum A: Multidimensional Scale of Perceived Social Support Instructions: We are interested in how you feel about the following statements. Read each statement carefully. Indicate how you feel about each statement. Circle Circle Circle Circle Circle Circle Circle
the the the the the the the
“1” “2” “3” “4” “5” “6” “7”
if if if if if if if
you you you you you you you
Very Strongly Disagree Strongly Disagree Mildly Disagree are Neutral Mildly Agree Strongly Agree Very Strongly Agree
1. There is a special person who is around when I am in need. 2. There is a special person with whom I can share my joys and sorrows. 3. My family really tries to help me. 4. I get the emotional help and support I need from my family. 5. I have a special person who is a real source of comfort to me. 6. My friends really try to help me. 7. I can count on my friends when things go wrong. 8. I can talk about my problems with my family. 9. I have friends with whom I can share my joys and sorrows. 10. There is a special person in my life who cares about my feelings. 11. My family is willing to help me make decisions. 12. I can talk about my problems with my friends.
1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 Fri 1 2 3 4 5 6 7 Fri 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 Fri 1 2 3 4 5 6 7 SO 1 2 3 4 5 6 7 Fam 1 2 3 4 5 6 7 Fri
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