Social Support and Mental Health in Middle-Aged ... - SAGE Journals

425087 iori and DencklaJournal of Aging and Health © The Author(s) 2012

JAH24310.1177/0898264311425087F

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Journal of Aging and Health 24(3) 407–438 © The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0898264311425087 http://jah.sagepub.com

Social Support and Mental Health in MiddleAged Men and Women: A Multidimensional Approach

Katherine L. Fiori, PhD1 and Christy A. Denckla, MA1

Abstract Objective: The purpose of this study is to examine the association between various aspects of social support and depressive symptoms separately among men and women. Method: Using a sample of 6,767 middle-aged adults from one wave of the Wisconsin Longitudinal Study (1992-1993), the authors performed a series of ANCOVAs predicting depressive symptoms and controlling for background variables. Results: The authors found that the receipt of emotional support was associated with mental health in women only, whereas the provision of emotional and instrumental support was associated with mental health among men and women, but with varying patterns. For example, men who provided instrumental support to nonkin only had the highest levels of depressive symptoms, whereas women who provided instrumental support to kin only had the highest levels of symptoms. Discussion: This study helps to clarify if and what types of social support are related to mental health in men and women. Keywords gender, depression, social support, middle-aged adults

1

Adelphi University, Garden City, NY, USA

Corresponding Author: Katherine L. Fiori, Gordon F. Derner Institute of Advanced Psychological Studies, Hy Weinberg Center, Adelphi University, Garden City, NY 11530, USA Email: [email protected]

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Social support can ease life’s transitions and is often linked with beneficial health outcomes (e.g., Antonucci & Jackson, 1987; Cohen & Willis, 1985; House, Landis, & Umberson, 1988; Orth-Gomér, 2009); however, there is substantial complexity underlying this association (Schwarzer & Leppin, 1991). Specifically, theory and research suggest the existence of gender differences in the association between social support and physical and mental health (e.g., Antonucci & Akiyama, 1987; Taylor et al., 2000). The purpose of the present study is to clarify the nature of gender differences in the association between social support and depressive symptoms in late middle-aged adults. To aid in this clarification, the present study uses a large, homogeneous sample as well as multidimensional assessments of support exchanges, including the provision and receipt of emotional and instrumental support to and from kin and nonkin.

The Problem in Context Gender and depressive symptoms. Depression is a substantial public health problem (Cassano & Fava, 2002). Growing consensus suggests that adults in midlife experience distinct vulnerabilities with respect to depression in terms of genetic factors, cognitive diathesis, neurobiological factors, and types of stressful events (Brockmann, 2010; Fiske, Loeback Wetherell, & Gatz, 2009; Newmann, 1989). In addition, depressive symptoms tend to covary with gender such that depression is more prevalent among women compared with men, and among midlife women compared with younger or older women (Burt & Stein, 2002; Tomey et al., 2010). A recent study of a large national data sample (Shim, Baltrus, Ye, & Rust, 2011) showed that more than 15% of men and nearly 23% of women aged 55 years and older experience mild to severe depressive symptoms. Gender and social support. Research also shows that, in general, women have larger, denser, more supportive, and more diverse social networks than do men (Acitelli & Antonucci, 1994; Antonucci, 1994; Antonucci & Jackson, 1987; Pugliesi & Shook, 1998; H. A. Turner, 1994; Umberson, Chen, House, Hopkins, & Slaten, 1996); that density impacts perceived adequacy of support for women but not men (Haines, Beggs, & Hurlbert, 2008); and that women are more likely to give and receive emotional support than men (Liebler & Sandefur, 2002). Women’s relationships are more likely to depend on emotional closeness, whereas men’s relationships tend to focus more on shared activities (see Leavy, 1983, for a review; Swain, 1992). Furthermore, studies suggest that women are more likely than men to mobilize social support

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in times of stress (Belle, 1983; Krause & Keith, 1989; Walen & Lachman, 2000). Research also shows that marriage bonds tend to be more central to the well-being of men than women (Dykstra & de Jong Gierveld, 2004), implying that social support outside of the spousal relationship may be more important for women than men. Transitioning to late life. Late midlife is an important transitional period in which adults begin to prepare for the many challenges associated with late life. During this time of transition, adults negotiate complex and changing social roles with important implications for healthy aging (Lachman, 2004; Nolen-Hoeksema & Ahrens, 2002). For example, the midlife adult is both a major source of social support and a major beneficiary of support from others (Antonucci, Akiyama, & Merline, 2001). Successful negotiation of the changing roles associated with becoming the recipient of support in old age will promote health and well-being in late life (Lachman, 2001). One study showed that the positive association between age and depressive symptoms for adults aged 65 years and older is diminished by controlling for factors like social support (Blazer, Burchett, Service, & George, 1991), providing further evidence of the potentially adaptive nature of social support for individuals preparing to enter late life. In sum, given evidence of gender differences in depression and social support, it is important to examine the differential nature of the association between social support and depressive symptoms in men and women in midlife as a first step toward promoting the health of individuals across the transition into late life. Although some researchers have already examined this differential association, they have tended to use nonrepresentative samples or contexts (e.g., Flaherty & Richman, 1989; Hann et al., 2002; Rueda & Pérez-García, 2006; van Daalen, Sanders, & Willemsen, 2005), and/or used measures of social support that tended to be very broad (e.g., Cheng & Chan, 2006; Rueda & Pérez-García, 2006), and/or confounded support from kin and nonkin (e.g., Seeman, Singer, Ryff, Dienberg Love, & Levy-Storms, 2002). Perhaps not surprisingly, the resulting findings are inconsistent. For example, although some studies show that social support benefits women and not men (e.g., Matud, Carballeira, López, Marrero, & Ibáñez, 2002), others show that social support benefits men but not women (e.g., van Well, Kolk, & Klugkist, 2008), and still others find that social support operates similarly for women and men (e.g., Cheng & Chan, 2006; Flaherty & Richman, 1989; van Daalen et al., 2005). In the present study, we attempt to move this literature forward by using a large, homogeneous sample and a multidimensional assessment of support.

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Conceptual Framework Although definitions of social support vary, there is general consensus in the literature that social support entails the provision or receipt of a supportive social behavior (see House et al., 1988). The distinction between provision and receipt is an important one; providing support has been found to be more beneficial than receiving support in terms of both morbidity and mortality (S. L. Brown, Nesse, Vinokur, & Smith, 2003). However, the provision and receipt of support can be confounded with need; that is, individuals may not report receiving support because they do not actually need the support, and likewise, individuals may not report providing support because no one in their network needs that support. This phenomenon can help explain why support received is often negatively associated with mental health (i.e., individuals who receive support may be more distressed and have greater need for the support; Helgeson, 1993; 2003). Some research has circumvented this problem by assessing the availability of support (or “perceived support”) rather than the actual exchange of support (e.g., Takizawa et al., 2006), but this approach makes the questionable assumption that perceived availability would necessarily lead to actual support in the presence of need. In the present study, we were able to assess support in a hierarchical manner, with questions about need followed by questions about actual exchange. In the present study, we also distinguish between emotional and instrumental support; unlike emotional support, the receipt of instrumental support may predict depression in specific cases (Nagurney, Reich, & Newsom, 2004; Penninx et al., 1998; Pretorius, 1996). In addition, we distinguish between support exchanged with kin versus nonkin. Research has shown that friendships may be more important for well-being than family relationships (Adams & Blieszner, 1995; Cavanaugh, 1998; Johnson & Troll, 1994; Larson, Mannell, & Zuzanek, 1986), given that family relationships are generally obligatory, whereas friend relationships are optional (Antonucci & Akiyama, 1995). In reality, of course, many individuals receive support from and give support to both friends and family; research shows that having neither family nor friends to rely on is clearly the most damaging for mental health (e.g., Takahashi, Tamura, & Tokoro, 1997), whereas having contact with both friends and family appears to be the most beneficial (DuPertuis, Aldwin, & Bosse, 2001; Litwin, 2001; Wenger, 1997). In the present study, we are able to distinguish among individuals who receive support from and provide support to only kin, only nonkin, and both kin and nonkin. As we

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explain later in the article, all of the distinctions made in the present study are important not only from an empirical perspective but also from a theoretical one.

Theoretical Framework Existing theories provide explanations for gender differences in social relationships and also suggest that certain aspects of social exchange may be more beneficial for women than men. From a “nurture” perspective, socialization theories imply that even at very young ages, boys are encouraged (by parents, teachers, the media, etc.) to express traditionally male behaviors, like aggression, whereas girls are encouraged to exhibit nurturance (Marini, 1988; Umberson et al., 1996). These early socialization experiences, then, shape women into the more nurturant, supportive, and affectively connected sex (Flaherty & Richman, 1989). Presumably, experiences throughout the life span continue to reinforce these traits, such that being nurturing may have a more beneficial effect on adult women’s mental health compared with men’s. From a “nature” perspective, Taylor et al. (2000) suggest that the biobehavioral responses to stress differ for men and women. The traditional “fight-or-flight” response may characterize the stress responses of men, whereas female responses may be better described by a pattern known as “tend-and-befriend.” There is both evolutionary (attachment–caregiving system) and neuroendocrine (oxytocin) evidence to suggest that females are better served protecting their offspring and creating and maintaining social networks than they are fighting or fleeing in times of stress. Again, this theory implies that nurturing behaviors may be more beneficial for women than men.

Current Study and Hypotheses This study takes a sex-stratified approach to examining gender differences in the association between social support and depressive symptoms among a White, non-Hispanic American sample of men and women aged 52 to 57 years. Using a large homogeneous sample (N = 6,767), although it may limit our external validity, maximizes the power of our analyses. This demographic is also fairly stable in terms of social networks (Lachman, 2004). For example, they are likely to be married or have children and therefore demonstrate stable patterns of social support that are relatively

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fixed (Neugarten, 1968). Unlike a younger group, they have addressed developmental tasks related to identity formation (Singer, 2004). Moreover, unlike the elderly, they are not yet likely to require extensive instrumental support owing to declining health (Carstensen, 1998). Given our innovative assessment of social support (e.g., need vs. actual exchange, kin vs. nonkin vs. both kin and nonkin, etc.), our study is primarily exploratory. However, based on empirical research on gender differences and Taylor et al.’s (2000) “tend-and-befriend” theory, we made some predictions about gender differences in the association between social support and depressive symptoms. We first address the four “receipt” variables: emotional and instrumental support needed (no; yes, but no one available; yes, and someone available) and emotional and instrumental support received (none, kin only, nonkin only, both kin and nonkin). In terms of the need questions, we had no theoretical reason to expect gender differences, but we did hypothesize that Hypothesis 1: Those who did not need support would have the lowest levels of depressive symptoms because the most distressed individuals will likely have the greatest need (Helgeson, 2003) and that those who needed support but had no one available to provide it would have the highest levels of depressive symptoms. In terms of emotional support received, given that women are more likely than men to seek out social support as a coping mechanism (e.g., Krause & Keith, 1989) and that women’s relationships are more likely to depend on emotional closeness (Leavy, 1983), we hypothesized that Hypothesis 2: Emotional support received would have a greater association with depressive symptoms for women compared with men. Furthermore, although research has shown that friendships may be more important for well-being than family relationships (Adams & Blieszner, 1995; Cavanaugh, 1998; Johnson & Troll, 1994; Larson et al., 1986), research has also shown that kin ties tend to be more effective conduits of emotional support than nonkin ties (Antonucci & Akiyama, 1987; Wellman & Wortley, 1990). In addition, Taylor et al.’s (2000) “tend-and-befriend” theory suggests that the receipt of emotional support (from both kin and nonkin) is particularly important for women as a means of protecting themselves and their offspring and reducing distress. As such, we hypothesized that

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Hypothesis 3: Women would benefit most from emotional support received from both kin and nonkin. As socialization theories and Taylor et al.’s (2000) “tend-and-befriend” theory emphasize the social, evolutionary, and biobehavioral importance of emotional support exchange for women (in other words, the emphasis is more on intimacy and nurturance than on instrumental support behaviors), we did not expect to find gender differences in the association of instrumental support receipt with depressive symptoms.1 Next, we address the four “provision” variables: need in the network for emotional and instrumental support (no, yes) and emotional and instrumental support provided (none, kin only, nonkin only, both kin and nonkin). As above, we had no theoretical reason to expect gender differences in the association of the need variables with depressive symptoms; we also did not expect to find differences in depressive symptoms more generally between individuals who had people in their network who needed help versus those who did not. In terms of emotional support provision, as mentioned earlier, giving support has been found to be more health protective than receiving support in general (W. M. Brown, Consedine, & Magai, 2005; S. L. Brown et al., 2003). However, empirical evidence for gender differences is mixed. Although women may benefit more than men from any type of emotional support exchange (giving or receiving), many close relationships can be particularly burdensome to women because they are so committed to emotional exchanges (Belle, 1983; Shumaker & Hill, 1991; Troll, 1988; B. Turner, 1982). That said, from a theoretical and evolutionary perspective (Taylor et al., 2000), we hypothesized the following: Hypothesis 4: Emotional support provision would have a greater association with depressive symptoms for women compared with men. Hypothesis 5: Women would benefit most from emotional support provided to both kin and nonkin (i.e., tend-and-befriend). Finally, as above, because both socialization theories and Taylor et al.’s (2000) “tend-and-befriend” theory emphasize the social, evolutionary, and biobehavioral importance of emotional support exchange for women, we did not expect to find gender differences in the association of instrumental support provision with depressive symptoms.

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Method Data and Participants The data for the present study come from a recent wave of the Wisconsin Longitudinal Study (WLS), a long-term study of a one-third simple random sample of the roughly 30,000 men and women who graduated from Wisconsin high schools in 1957 (N = 10,317). The participants were first interviewed during their senior year in high school (1957), then again in 1975, 1992-1993, and 2003-2005. The present study uses the 1992-1993 wave, when participants were about 54 years old. At that time, WLS interviewed 8,493 of the 9,741 surviving members of the original sample. Of these 8,493 people, 6,875 answered the additional mail questionnaire, which includes the questions on social support used in the present study. The total N for the present study is 6,767, which includes all individuals for whom there is valid depressive symptomatology data. The WLS sample is roughly representative of White, non-Hispanic American men and women with at least a high school education. Among Americans aged 50 to 54 years in 1990 and 1991, around 66% were non-Hispanic Whites who completed at least 12 years of schooling.

Measures Social support. In the 1992-1993 mail survey, WLS respondents were asked to complete grids of questions about receiving help (see Figure 1 for details). First, they were asked, “During the past month have you GIVEN the following types of help?” and they were instructed to “Check the box for everyone that you GAVE each kind of help TO (other than spouse or young child).” Categories of help were (a) transportation, errands, or shopping; (b) housework, yard work, repairs, or other work around the house; (c) advice, encouragement, or moral or emotional support; and (d) babysitting or child care. The categories of people to whom help could be given were as follows: (a) no one needed help; (b) friends, neighbors, or coworkers; (c) sons or daughters (19 and older); (d) parents; (e) brothers or sisters; and (f) other relatives. Then, they were asked to complete a parallel set of questions about the kinds of help they RECEIVE from the above types of people. However, instead of the “no one needed help” option, respondents could answer “help not needed” or “no one available to help.” For the purposes of the present study, “friends, neighbors, or coworkers” were categorized as “nonkin,” and the other four categories of relationships (“sons or daughters [19 and older],” “parents,” “brothers or sisters,” and “other relatives”) were collapsed to encompass “kin.”

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Figure 1. Social support questions from mail questionnaire of the Wisconsin Longitudinal Study

For the present study, we created eight variables from this grid of questions: 1. Emotional support needed: 1 (no; respondents checked that they did not need encouragement, moral, or emotional support over the past month, n = 2,363), 2 (yes, but no one was available; respondents

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indicated that no one was available to provide emotional support, n = 95), or 3 (yes, and someone available; respondents did not check either of these boxes, n = 3,641). 2. Emotional support received (only relevant for the 3,641 “yes, and someone available” respondents): 0 (none; respondents did not check a box to indicate having received emotional support from either nonkin or kin, n = 14), 1 (kin only; respondents indicated that they had received emotional support from at least one type of kin relationship but did not receive this type of support from nonkin, n = 962), 2 (nonkin only; respondents indicated that they received emotional support from nonkin but not from kin, n = 1,271), or 3 (both kin and nonkin; respondents indicated receiving emotional support from both kin and nonkin, n = 1,394). 3. Instrumental support needed2: 1 (no; respondents checked that they did not need help with either of the two types of instrumental support [transportation/errands or housework/yard work], n = 3,224), 2 (yes, but no one available; respondents checked “no one available for help” for both types of instrumental support, n = 137), or 3 (yes, and someone available; respondents did not check either of these boxes, n = 2,535). 4. Instrumental support received (only relevant for the 2,535 “yes, and someone available” respondents): 0 (none; respondents did not check a box to indicate having received either type of instrumental support from either nonkin or any type of kin, n = 4), 1 (kin only; respondents indicated that they received at least one of the two types of instrumental support from at least one kin relationship but did not indicate receiving either type of instrumental support from nonkin, n = 517), 2 (nonkin only; respondents indicated that they received at least one type of instrumental support from nonkin but did not receive either type of instrumental support from kin, n = 126), or 3 (both kin and nonkin; respondents reported receiving at least one type of instrumental support from both nonkin and kin, n = 501).3 5. Anyone needed emotional support: 1 (no; respondents checked that “no one needed” advice, encouragement, moral, or emotional support, n = 607) or 2 (yes; respondents did not check this box, n = 5,603). 6. Emotional support provided (only relevant for the 5,603 “yes” respondents): 0 (none; respondents did not check a box to indicate having provided help to nonkin or kin, n = 16), 1 (kin only; respondents indicated that they provided emotional support to at

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least one type of kin relationship exclusively, n = 1,922), 2 (nonkin only; respondents indicated that they provided emotional support to nonkin exclusively, n = 1,101), or 3 (both kin and nonkin; respondents indicated providing emotional support to both kin and nonkin, n = 2,564). 7. Anyone needed instrumental support: 1 (no; respondents checked that no one needed help for all three types of instrumental support [transportation, errands, or shopping; housework, yard work, repairs, or other work around the house; and babysitting or child care], n = 940) or 2 (yes; respondents did not check “no one needed help” for at least one of these three types of instrumental support, n = 5,228). 8. Instrumental support provided (only relevant for the 5,228 “yes” respondents): 0 (none; respondents did not check any of the “no one needed help” boxes and yet also did not check any boxes to indicate having provided any of the three types of instrumental support to nonkin or kin, n = 0), 1 (kin only; respondents indicated that they provided at least one of the three types of instrumental support to at least one kin relationship but did not indicate providing any type of instrumental support to nonkin, n = 889), 2 (nonkin only; respondents indicated that they provided at least one type of instrumental support to nonkin exclusively, n = 116), or 3 (both kin and nonkin; respondents reported providing at least one type of instrumental support to both nonkin and any of the kin relations, n = 1,810).4 Depressive symptomatology. Depressive symptomatology was measured using a modified version of the Center for Epidemiologic Studies–Depression Scale (CES-D; Radloff, 1977). The questions are the same as used for the standard CES-D, but the scoring method differs. In the WLS, respondents indicate (for each of the 20 CES-D items) the actual number of days they experienced the particular event in the past week (0-7 days; e.g., “On how many days during the past week did you feel bothered by things that usually don’t bother you?”). The standard method collapses days into 1,3; 3 > 1 Emotional support received None 8 0.3 4.06 (.66) (1) Kin only 625 27.3 3.93 (.07) (2) Nonkin only 662 28.9 4.11 (.07) (3) Both kin and 997 43.5 3.71 (.06) nonkin F test F(2, 2276) = 10.49*** Pairwise comparisons 1,2 > 3; 2 > 1 (trend) Instrumental support needed (1) No 1,633 52.6 3.60 (.05) (2) Yes, but no one 81 2.6 5.12 (.20) available (3) Yes, and someone 1,390 44.8 3.86 (.05) available F test F(2, 3096) = 31.78*** Pairwise comparisons 2 > 1,3; 3 > 1 Instrumental support received None 3 0.4 3.45 (1.09) (1) Kin only (2) Nonkin only (3) Both kin and nonkin

328 58 280

49.0 8.7 41.9

4.13 (.10) 4.05 (.25) 3.97 (.11)

F test

F(2, 658) = .56, p = .57

Males (n = 3,143) n

%

M (SE)

1,444 51

50.8 1.8

3.26 (.05) 5.21 (.24)

1,349

47.4

3.68 (.05)

F(2, 2836) = 46.29*** 2 > 1,3; 3 > 1 6 337 609 397

0.4 25.1 45.1 29.4

5.57 (.73) 3.84 (.10) 3.67 (.07) 3.59 (.09)

F(2, 1335) = 1.93, p = .15 NA 1,591 56

57.0 2.0

3.40 (.04) 4.70 (.23)

1,145

41.0

3.54 (.05)

F(2, 2784) = 16.10*** 2 > 1,3; 3 > 1 1

0.2

189 68 221

39.5 14.2 46.1

1.80 (1.83) 3.56 (.13) 3.76 (.22) 3.45 (.12)

F(2, 470) = .77, p = .47

Note. Only significant pairwise comparisons (p < .05) are provided (with trends, p < .10, indicated where relevant); “Emotional support received” and “Instrumental support received” analyses were only conducted for individuals who indicated that support was needed and someone was available (“3” on support needed variables); ns may not add up to totals due to missing data. *p < .05. **p < .01. ***p < .001.

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Estimated Marginal Means Depressive Symptomatology

Journal of Aging and Health 24(3) 4.2 4.1 4 3.9 3.8 3.7 3.6 3.5 3.4 3.3 3.2 3.1 3

Females Males

Nonkin only Both kin and nonkin Emotional Support Received

Kin only

Figure 2. Estimated marginal mean levels of depressive symptomatology as a function of emotional support received (from kin only, nonkin only, or both kin and nonkin) and gender, controlling for background variables

symptomatology (M = 3.90, SE = .09) than females who reported having someone in their network in need (M = 3.72, SE = .03). More females (51.2%) than males (38.6%) reported providing emotional support to both kin and nonkin, whereas fewer females (16.4% and 31.2%) than males (23.7% and 37.4%) reported providing emotional support to nonkin only or kin only, respectively. Contrary to Hypothesis 4, females and males in the various categories of emotional support provision differed significantly on depressive symptomatology. However, the strength of effects differed. Specifically, females who provided support to both kin and nonkin (M = 3.59, SE = .05) had significantly lower levels of depressive symptomatology than those who provided emotional support to kin only (M = 3.88, SE =.06) or to nonkin only (M = 3.90, SE =.08; p < .001), consistent with Hypothesis 5. Men who provided support to both kin and nonkin (M = 3.38, SE = .06) had significantly lower levels of depressive symptomatology than those who provided emotional support to kin only (M = 3.58, SE = .06; p < .05; see Figure 3). Very few males (4.1%) or females (4.1%) provided instrumental support to nonkin only, but a greater percentage of males (70.1%) than females (59.7%) provided instrumental support to both kin and nonkin. Although not hypothesized, the effect of providing instrumental support on depressive symptomology differed significantly for females, such that the females who

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Table 3. Estimated Marginal Means in Depressive Symptomatology for Provided Support, Stratified by Gender Females (n = 3,624) Variables

n

%

M (SE)

Anyone need emotional support (1) No 195 5.9 4.01 (.13) (2) Yes 3,104 94.1 3.74 (.03) F test F(1, 3292) = 4.11* Emotional support provided None 8 0.3 3.86 (.64) (1) Kin only 987 31.2 3.88 (.06) (2) N onkin 509 16.4 3.90 (.08) only (3) B oth kin 1,600 51.2 3.59 (.05) and nonkin F test F(2, 3088) = 10.26*** Pairwise 1,2 > 3 comparisons Anyone need instrumental support (1) No 436 13.3 3.90 (.09) (2) Yes 2,830 86.7 3.72 (.03) F test F(1, 3259) = 3.54†, p = .06 Instrumental support provided None 0 566 36.2 3.90 (.08) (1) Kin only 64 4.1 3.30 (.23) (2) N onkin only (3) Both kin 932 59.7 3.62 (.06) and nonkin F test F(2, 1554) = 5.76** Pairwise 1 > 2,3 comparisons

Males (n = 3,143) n

%

M (SE)

412 14.2 3.49 (.09) 2,499 85.8 3.48 (.04) F(1, 2904) = .00, p = .97 8 935 592

0.3 37.4 23.7

3.69 (.63) 3.58 (.06) 3.49 (.07)

964

38.6

3.38 (.06)

F(2, 2483) = 3.13* 1>3

504 17.4 3.60 (.08) 2,398 82.6 3.46 (.04) F(1, 2895) = 2.75, p = .10 0 323 52

25.8 4.1

3.40 (.10) 3.94 (.24)

878

70.1

3.38 (.06)

F(2, 1245) = 2.60†, p = .08 2 > 1,3

Note. Only significant pairwise comparisons (p < .05) are provided; “Emotional support provided” and “Instrumental support provided” analyses were only conducted for individuals who indicated that someone in their network needed that type of support (“2” anyone need support variables); ns may not add up to totals due to missing data. † p < .10. *p < .05. **p < .01. ***p < .001.

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Journal of Aging and Health 24(3) 4.2 4.1 4 3.9 3.8 3.7 3.6 3.5 3.4 3.3 3.2 3.1 3

Females Males

Nonkin only Both kin and nonkin Emotional Support Provided

Kin only

Figure 3. Estimated marginal mean levels of depressive symptomatology as a function of emotional support provided (to kin only, nonkin only, or both kin and nonkin) and gender, controlling for background variables

provided instrumental support only to kin (M = 3.90, SE = .08) had significantly higher levels of depressive symptoms than those who provided such support only to nonkin (M = 3.30, SE = .23) or to both kin and nonkin (M = 3.62, SE = .06). For males, the differences were significant at the level of a trend (p = .075), but in the opposite direction; specifically, males who reported providing instrumental support to nonkin only had the highest levels of depressive symptoms (M = 3.94, SE = .24; see Figure 4).

Discussion The present study offers insight into the rather complex literature on gender differences in the link between social relationships and mental health. By examining multiple aspects of social relationships in a single study, including questions of need and availability, and by focusing on a very large sample in a narrow age range, we more clearly outlined those situations in which social support may operate differently for middle-aged men and women than has past research on this topic. Specifically, because of the extensive nature of data collection on social support in the WLS, we examined eight different aspects of support: instrumental and emotional support needed by both the respondents and members of the respondents’ networks,

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Fiori and Denckla 4.2 4.1 4 3.9 3.8 3.7 3.6 3.5 3.4 3.3 3.2 3.1 3

Females Males

Kin only

Nonkin only Both kin and nonkin Instrumental Support Provided

Figure 4. Estimated marginal mean levels of depressive symptomatology as a function of instrumental support provided (to kin only, nonkin only, or both kin and nonkin) and gender, controlling for background variables

in addition to instrumental and emotional support provided to and received from kin only, nonkin only, or both kin and nonkin.

Summary of Findings The majority of our hypotheses (and less formal expectations) were supported. We turn first to support receipt. As predicted (Hypothesis 1), for both men and women and for both instrumental and emotional support, those who reported not needing help had the lowest levels of depressive symptoms, whereas individuals who reported needing emotional or instrumental support but not having anyone available to provide it had the highest levels of depressive symptoms. In line with Hypothesis 2, emotional support receipt was significantly associated with depressive symptoms for women but not for men, and consistent with Hypothesis 3, women seemed to benefit the most from emotional support received from both kin and nonkin. Finally, as expected, for men and women the receipt of instrumental support was not predictive of depressive symptoms. We turn next to our findings concerning support provision. Although we had no theoretical reason to expect differences in depressive symptoms between individuals who had people in their network who needed help versus

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those who did not (and therefore no reason to expect gender differences), we found that women who reported having need in their network (emotional or instrumental) had lower levels of depressive symptomatology than those who reported no need, but there were no differences among men. Contrary to Hypothesis 4, the association of emotional support provision with depressive symptoms was significant for women and men, but consistent with Hypothesis 5, women who reported providing emotional support to both kin and nonkin had the lowest levels of depressive symptoms. Unexpectedly, however, a similar (though weaker) pattern emerged for men. Finally, contrary to our expectations, the association of instrumental support provision with depressive symptoms was significant for women and men but in opposite directions; women who provided instrumental support to kin only had the highest levels of depressive symptoms, whereas men who provided instrumental support to nonkin only had the highest levels. In the following section, we attempt to make sense of these findings in light of existing empirical research and our theoretical framework.

Understanding the Findings Support receipt. Among men and women, those individuals who reported not needing support had the lowest levels of depressive symptoms. These findings are consistent with the idea that the least distressed individuals have the least need for support (Helgeson, 2003). However, those few individuals who reported needing support but not having anyone available had the highest levels of depressive symptoms. These individuals could be considered “at risk” for more serious mental health problems because not only are they likely experiencing stress and/or health problems to require emotional and/or instrumental support, but they are also suffering the added burden of not having anyone to provide it. Future research should try to determine what distinguishes these individuals from others as a means to better detect and assist this at-risk group. Emotional support receipt was significantly associated with depressive symptoms for women but not for men, and women seemed to benefit the most from emotional support received from both kin and nonkin. Furthermore, women who received emotional support from kin only had lower levels of depressive symptoms compared with those who received such support from nonkin only. Together, these findings emphasize the importance of kinprovided emotional support for women, which is consistent with the idea that women’s relationships are more likely to depend on emotional closeness (Leavy, 1983) and that kin ties tend to be more effective conduits of

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emotional support than nonkin ties (Antonucci & Akiyama, 1987; Wellman & Wortley, 1990). Although Taylor et al.’s (2000) “tend-and-befriend” theory highlights the motivation of women to “provide” support (i.e., protect their offspring and create and maintain social networks), it may be this very protection, creation, and maintenance that later allows women (particularly middle-aged women) to benefit from emotional support received from kin (e.g., adult children) and nonkin. Reciprocity is, after all, considered key to the creation and maintenance of social networks (Jung, 1990; Rook, 1987). Unfortunately, for reasons of parsimony, we were not able to examine such reciprocity in the present study; future research should examine whether those women who receive emotional support and benefit from such receipt also provide emotional support to those in their network. There were no significant differences in levels of depressive symptoms for type of instrumental support received for men or women. This is not surprising, given that the receipt of instrumental support has actually been found to predict depression (Nagurney et al., 2004; Penninx et al., 1998; Pretorius, 1996) and because both socialization theories and Taylor et al.’s (2000) “tend-and-befriend” theory emphasize the social, evolutionary, and biobehavioral importance of emotional support exchange for women (rather than of instrumental support behaviors). Because very few respondents reported needing support and having someone available, yet not receiving any support (n = 14 for emotional support, n = 4 for instrumental support), they were not included in our analyses of support receipt. However, it is interesting to note that those 14 individuals who did not receive emotional support had higher levels of depressive symptoms than those who received emotional support (from kin, nonkin, or both) but had slightly lower levels of depressive symptoms than those who had no one available to provide such support (see Table 2). In contrast, the four individuals who did not receive instrumental support had the lowest levels of depressive symptoms; perhaps completing instrumental tasks on their own while knowing that they had support if needed actually increased their feelings of selfefficacy. This reasoning is entirely speculative, however, and again because of small cell sizes, these individuals were not included in our final analyses. Support provision. Although unexpected, it is interesting to note that women who reported need in their network (either instrumental or emotional) reported fewer depressive symptoms than those who did not. This implies that simply knowing she is needed may be beneficial for a woman’s mental health. Feeling needed may complement women’s desires to be nurturant and thereby increase feelings of well-being. Future research should explore possible mechanisms; for example, perhaps feeling needed is enough to increase

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levels of oxytocin in women. Alternatively or additionally, it could be that depressed women are simply reporting less need in their network because friends and family recognize their emotional distress and do not want to place additional demands on the individual. As predicted, women who reported providing support to both kin and nonkin had the lowest levels of depressive symptoms. According to Taylor and colleagues (2000), oxytocin, the production of which is disproportionately triggered in women compared with men when “tending,” or caring for offspring, may serve both to calm the female in times of stress and promote further affiliative behaviors. It is conceivable that over time, the association between tending to kin and the calming effects of oxytocin are manifested in an association between emotional support provided to kin and reduced depressive symptomatology. Relatedly, research shows that women tend to be the “kin-keepers” in their families (see, for example, Lye, 1996); Taylor and colleagues’ “tend-and-befriend” theory would predict that this role of kin-keeper is one that is valued by women. As such, being able to provide emotional support to their kin should have a particularly beneficial effect on their mental health. However, in order for women to “tend-and-befriend,” they need to not only “tend” to kin (e.g., by providing emotional support to their adult children and their grandchildren) but also to “befriend” nonkin (e.g., by providing emotional support to friends). According to Taylor et al.’s theory, it is essential to create and maintain networks beyond the family unit to garner support when needed (i.e., in times of stress). However, contrary to our predictions, this association was also significant for men; specifically, men who provided emotional support to both kin and nonkin had lower levels of depressive symptoms than men who provided such support only to kin. Unlike for women, however, providing emotional support to nonkin only was no different than providing to both kin and nonkin. Together, these findings imply that providing emotional support to nonkin may be particularly important for men’s mental health. One potential explanation could be that the kin of these men may already be sufficiently emotionally supported by women in the network (e.g., their wives). Finally, contrary to our expectations, we found that women who provided instrumental support to kin only had higher levels of depressive symptoms than those who provided such support to nonkin only or to both kin and nonkin. This finding may relate to the fact that family relationships are generally considered obligatory, whereas friend relationships are optional (Antonucci & Akiyama, 1995); as such, although individuals may expect to receive emotional support from both kin and nonkin, they may be less likely to expect instrumental support from nonkin compared with kin

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(Felton & Berry, 1992). Thus, unlike kin, the friends to whom these women are providing instrumental support may be particularly expressive of their appreciation, thereby boosting feelings of self-worth and efficacy in the female respondents. Furthermore, women who provide instrumental support to kin only could be the primary caregivers to a family member (or multiple family members), and the link between family caregiving and depression among women in particular has been established in the research (e.g., Cannuscio et al., 2002; Yee & Schulz, 2000). In contrast, although the findings were only statistically significant at the level of a trend, the men who provided instrumental support to “kin only” had the lowest levels of depressive symptoms. This may relate to the theory that men are socialized to express traditionally male behaviors, like providing for their families (Marini, 1988; Umberson et al., 1996). Thus, men, particularly middle-aged men who may be expected to provide for a spouse, adult children, grandchildren, and aging parents, may feel that their masculinity is threatened if they are only able to provide instrumental support to nonkin (Thomson & Whearty, 2004).

Strengths, Limitations, and Future Research The present study has several strengths. The sample was very large and relatively homogeneous (in terms of age, education, and ethnicity), increasing the power of our analyses and allowing us to address a complex question. Furthermore, we examined gender differences in the associations between depressive symptoms and multidimensional aspects of social support (provided and received, emotional and instrumental, etc.). In fact, the sheer number of participants allowed us to conduct analyses “hierarchically”; that is, we first examined differences in need and then looked at support receipt and provision for only those individuals in need or with network members in need, respectively. Importantly, our findings concerning need demonstrate an important potential explanation for conflicting findings in the literature; that is, research confounding “need” with “receipt” may indeed show a negative association between support receipt and mental health. As such, future research should continue to assess the “perceived availability” of support rather than actual support exchange, or for more detailed assessments of support, distinguish between “need” and “receipt” as in the present study. In spite of these strengths, some limitations of the present study should be noted. Although the current sample is very large, and the power of our analyses benefited from its homogeneity, future research should examine more

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diverse populations. For instance, it is unclear from this study how gender might interact with other important individual difference variables, like ethnicity and age. Perhaps the most significant limitation lies in the creation of the instrumental support provided and instrumental support received variables. Due to the fact that there were three different types of instrumental support provided and two different types of instrumental support received (recall that child care was not included in the formulation of instrumental support received), the creation of the variables was unavoidably complicated and resulted in a large number of “missings” (see the notes section). Although we could have examined all of the different types of instrumental support separately to avoid this problem, this would have resulted in a far less parsimonious model consisting of many additional analyses; furthermore, there is no theoretical reason to expect gender differences across the different types of instrumental support received/provided. Relatedly, because there were so few individuals who reported needing support and having someone available but not actually receiving any support, we were not able to directly compare these individuals with individuals who received some type of support. We also did not directly compare individuals who needed support but for whom no one was available to provide it with individuals who received support (because only those individuals who had someone available to provide support answered questions about received support). However, although a very small group, it is clear that those individuals who needed support but could not get it were the most at risk (i.e., highest levels of depressive symptoms) and that this difference did not seem to vary by gender. In addition, as mentioned earlier, we did not examine reciprocity (i.e., whether those individuals who received support were also providing support and vice versa). We opted instead to create “layers” based on to whom or from whom the support was being provided or received, respectively (i.e., kin only, nonkin only, or both kin and nonkin). Examining both layers simultaneously (i.e., provision vs. receipt, and kin vs. nonkin) would have reduced our cell sizes dramatically and would have raised more questions about the necessity of the reciprocal support being of the same type (i.e., instrumental or emotional). In future research, we could instead collapse across kin/nonkin exchange and look more closely at issues of reciprocity (e.g., by examining emotional support received only, provided only, or received and provided [i.e., reciprocal exchange]). Issues of reciprocity may be particularly relevant to gender differences in social support (Rook, 1987).

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In addition, the present study is correlational and cross-sectional in nature, and as such we cannot infer causality. For example, the high levels of depressive symptoms among women who provide emotional support only to kin or to nonkin, and not to both, could be related to an impaired ability to provide such support when suffering from depression (e.g., Stice, Ragan, & Randall, 2004). Furthermore, it could be that women (and men) who feel depressed are more likely to seek out social support. However, this latter possibility seems unable to explain some of our findings; for example, if more depressed women are more likely to seek out emotional support, then those women who are receiving support from both kin and nonkin should be the most depressed. However, we found that these women had the lowest levels of depressive symptoms. That said, it is important to recall that the measures of support provision and receipt were designed to encompass the previous month and were self-reported by the participants. Thus, it could be that mentally healthier individuals are more likely to recall providing/receiving support over the past month. It is also important to keep in mind that social support in the present study was assessed by asking about relationships other than the spousal relationship. As marriage bonds tend to be more central to the well-being of men than women (Dykstra & de Jong Gierveld, 2004; Stroebe, Stroebe, & Schut, 2001), it may be that married men are not as influenced as women by exchanges outside of the marital relationship. More than 86% of the men in the present study were married, and our results may have differed if participants had been asked specifically about support exchanged with the spouse (e.g., perhaps spousal support is more closely linked with men’s mental health than with women’s). For example, research shows that men suffer more in bereavement than women (Stroebe, Hansson, Stroebe, & Schut, 2001; Stroebe & Stroebe, 1983), which might be related to their reduced capacity to obtain social support after the death of their spouse. Finally, given that our arguments for gender differences were based partially on Taylor et al.’s (2000) “tend-and-befriend” theory, which focuses on responses to stress, it should be acknowledged that we did not assess levels of stress in the present study. However, because those individuals who needed support had significantly higher levels of depressive symptoms than those who did not, it is arguable that the individuals for whom we assessed support receipt and provision were under greater levels of stress. In any case, given that women are more likely than men to mobilize social support in times of stress (Belle, 1983; Krause & Keith, 1989; Walen & Lachman, 2000), future research should examine styles of coping to test whether gender differences are mediated by coping styles (Muller, Judd, & Yzerbyt, 2005).

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Conclusions Our study offers insight into the complex issue of gender differences in the link between social support and mental health. As the only study (of which we are presently aware) that uses a single homogeneous (and very large) sample and examines need separately from support receipt and provision, as well as instrumental support separately from emotional support and kin support separately from nonkin support, this study was able to clarify the ways in which social support may impact mental health differently for middleaged men and women. Our findings are consistent with Taylor et al.’s (2000) “tend-and-befriend” theory, which highlights the potential health benefits for women in particular of nurturing relationships with both kin and nonkin. Successful negotiation of the changing roles associated with becoming the recipient of support in old age is a critical task during this transitional stage of midlife (Lachman, 2001). As such, understanding gender differences in support and their implications for health as individuals prepare to enter late life is a crucial first step toward intervention. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding This research was supported in part by the 2008 Wisconsin Longitudinal Study Pilot Grant Program from the Center for Demography of Health and Aging (CDHA) at the University of Wisconsin at Madison.

Notes 1. We did not create formal hypotheses for the expectations of “null” results, and therefore refer to these as “expectations.” 2. When creating the variable “instrumental support needed” (and “instrumental support received”), help with babysitting or child care was excluded because it is extremely rare among Wisconsin Longitudinal Study respondents from the 1992-1993 wave (who are all in their mid-50s) to need such help and would only lead to additional missings in the “instrumental support received” variable (as outlined below for the “instrumental support provided” variable). 3. Due to the nature of the variable creation (as explained below for the “instrumental support provided” variable), 1,387 participants were considered “missing” on this variable.

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4. Due to the nature of the variable creation, 2,413 of the 5,228 participants who indicated that someone in their network needed instrumental support were considered “missing” on this variable. For example, if an individual indicated with check marks that “no one needed help” with transportation/errands/shopping and “no one needed help” with babysitting/child care but did not indicate this for housework/yard work, they received a “2” (yes) on “anyone need instrumental support.” If they then did not indicate providing help to anyone, they were considered “missing” (recall that participants were only categorized as providing no instrumental support if they did not check any of the “no one needed help” boxes and yet also did not check any boxes to indicate having provided any of the three types of instrumental support to nonkin or kin).

References Acitelli, L. K., & Antonucci, T. C. (1994). Gender differences in the link between marital support and satisfaction in older couples. Journal of Personality and Social Psychology, 67, 688-698. Adams, R. G., & Blieszner, R. (1995). Aging well with friends and family. American Behavioral Scientist, 39, 209-224. Ajrouch, K. J., Blandon, A., & Antonucci, T. C. (2005). Social networks among men and women: The effects of age and socioeconomic status. Journal of Gerontology: Social Sciences, 60B, 311-317. Antonucci, T. C. (1985). Personal characteristics, social support and social behavior. In R. H. Binstock & E. Shanas (Eds.), Handbook of aging and the social sciences (2nd ed., pp. 94-128). New York, NY: Van Nostrand Reinhold. Antonucci, T. C. (1994). A life-span view of women’s social relations. In B. F. Turner & L. E. Troll (Eds.), Women growing older (pp. 239-269). Thousand Oaks, CA: SAGE. Antonucci, T. C., & Akiyama, H. (1987). An examination of sex differences in social support in mid and late life. Sex Roles, 17, 737-749. Antonucci, T. C., & Akiyama, H. (1995). Convoys of social relations: Family and friendships within a life span context. In R. Blieszner, V. H. Bedford (Eds.), Handbook of aging and the family (pp. 355-371). Westport, CT: Greenwood. Antonucci, T. C., Akiyama, H., & Merline, A. (2001). Dynamics of social relationships in midlife. In M. E. Lachman (Ed.), Handbook of midlife development (pp. 571-598). New York, NY: Wiley. Antonucci, T. C., & Jackson, J. S. (1987). Social support, interpersonal efficacy, and health: A life course perspective. In L. L. Carstensen & B. A. Edelstein (Eds.), Handbook of clinical gerontology (pp. 291-311). Elmsford, NY: Pergamon. Belle, D. (1983). The impact of poverty on social networks and support. Women & Health, 9, 89-103.

434


Blazer, D. G., Burchett, B. M., Service, C., & George, L. K. (1991). The association of age and depression among the elderly: An epidemiologic exploration. Journal of Gerontology: Medical Sciences, 46, M210-M215. Brockmann, H. (2010). Why are middle-aged people so depressed? Evidence from West Germany. Social Indicators Research, 97, 23-42. Broese van Groenou, M. I., & van Tilburg, T. (2003). Network size and support in old age: Differentials by socio-economic status in childhood and adulthood. Ageing & Society, 23, 625-645. Brown, S. L., Nesse, R. M., Vinokur, A. D., & Smith, D. M. (2003). Providing social support may be more beneficial than receiving it: Results from a prospective study of mortality. Psychological Science, 14, 320-327. Brown, W. M., Consedine, N. S., & Magai, C. (2005). Altruism relates to health in an ethnically diverse sample of older adults. Journals of Gerontology: Psychological Sciences, 60B, P143-P152. Burt, V. K., & Stein, K. (2002). Epidemiology of depression throughout the female life cycle. Journal of Clinical Psychiatry, 63, 9-15. Cannuscio, C. C., Jones, C., Kawachi, I., Colditz, G. A., Berkman, L., & Rimm, E. (2002). Reverberations of family illness: A longitudinal assessment of informal caregiving and mental health status in the Nurses’ Health Study. American Journal of Public Health, 92, 1305-1311. Carr, D. (1997). The fulfillment of career dreams at midlife: Does it matter for women’s mental health? Journal of Health and Social Behavior, 38, 331-344. Carstensen, L. L. (1998). A life-span approach to social motivation. In J. Heckhausen (Ed.), Motivation and self-regulation across the life span (pp. 341-364). New York, NY: Cambridge University Press. Cassano, P., & Fava, M. (2002). Depression and public health: An overview. Journal of Psychosomatic Research, 53, 849-857. Cavanaugh, J. C. (1998). Friendships and social networks among older people. In I. H. Nordhus & G. R. VandenBos (Eds.), Clinical geropsychology (pp. 137-140). Washington, DC: American Psychological Association. Cheng, S. & Chan, A. (2006). Social support and self-related health revisited: Is there a gender difference in later life? Social Science & Medicine, 63, 118-122. Cohen, S., & Willis, T. A. (1985). Stress, social support and the buffering hypothesis. Psychological Bulletin, 98, 310-357. DuPertuis, L. L., Aldwin, C. M., & Bosse, R. (2001). Does the source of support matter for different health outcomes? Findings from the Normative Aging Study. Journal of Aging and Health, 13, 494-510. Dykstra, P. A., & de Jong Gierveld, J. (2004). Gender and marital-history differences in emotional and social loneliness among Dutch older adults. Canadian Journal on Aging, 23, 141-155.

Fiori and Denckla

435

Felton, B. J., & Berry, C. A. (1992). Do the sources of the urban elderly’s social support determine its psychological consequences? Psychology and Aging, 7, 89-97. Fiske, A., Loeback Wetherell, J., & Gatz, M. (2009). Depression in older adults. Annual Review of Clinical Psychology, 5, 363-389. Flaherty, J., & Richman, J. (1989). Gender differences in the perception and utilization of social support: Theoretical perspectives and an empirical test. Social Science Medicine, 28, 1221-1228. Fox, J. (2008). Applied regression analysis and generalized linear models (2nd ed.). Los Angeles, CA: SAGE. Haines, V., Beggs, J., & Hurlbert, J. (2008). Contextualizing health outcomes: Do effects of network structure differ for women and men? Sex Roles, 59, 164-175. Hann, D., Baker, F., Denniston, M., Gesme, D., Reding, D., Flynn, T., . . . Kieltya, R. (2002). The influence of social support on depressive symptoms in cancer patients age and gender differences. Journal of Psychosomatic Research, 52, 279-283. Helgeson, V. S. (1993). Implications of agency and communion for patient and spouse adjustment to a first coronary event. Journal of Personality and Social Psychology, 64, 807-816. Helgeson, V. S. (2003). Social support and quality of life. Quality of Life Research, 12, 25-31. House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241, 540-545. Johnson, C. L., & Troll, L. E. (1994). Constraints and facilitators to friendships in late late life. The Gerontologist, 34, 79-87. Jung, J. (1990). The role of reciprocity in social support. Basic and Applied Social Psychology, 11, 243-253. Krause, N. (2001). Social support. In R. H. Binstock (Ed.), Handbook of aging and the social sciences (5th ed., pp. 272-294). San Diego, CA: Academic Press. Krause, N., & Keith, V. (1989). Gender differences in social support among older adults. Sex Roles, 21, 609-629. Lachman, M. E. (Ed.). (2001). Handbook of midlife development. New York, NY: Wiley. Lachman, M. E. (2004). Development in midlife. Annual Review of Psychology, 55, 305-331. Lang, F. R. (2001). Regulation of social relationships in later adulthood. Journals of Gerontology: Psychological Sciences, 56B, P321-P326. Larson, R., Mannell, R., & Zuzanek, J. (1986). Daily well-being of older adults with friends and family. Psychology and Aging, 1, 117-126. Leavy, R. L. (1983). Social support and psychological disorder: A review. Journal of Community Psychology, 11, 3-21.

436


Liebler, C. A., & Sandefur, G. D. (2002). Gender differences in the exchange of social support with friends, neighbors, and co-workers at midlife. Social Science Research, 31, 364-391. Litwin, H. (2001). Social network type and morale in old age. The Gerontologist, 41, 516-524. Lye, D. N. (1996). Adult child–parent relationships. Annual Review of Sociology, 22, 79-102. Marini, M. M. (1988). Sociology of gender. In E. F. Borgatta & K. S. Cook (Eds.), The future of sociology (pp. 374-393). Beverly Hills, CA: SAGE. Matud, P., Carballeira, M., López, M., Marrero, R., & Ibáñez, I. (2002). Apoyo social y salud: Un analisis de genero [Social support and health: A gender analysis]. Salud Mental, 25, 32-37. Muller, D., Judd, C. M., & Yzerbyt, V. Y. (2005). When moderation is mediated and mediation is moderated. Journal of Personality and Social Psychology, 89, 852863. Nagurney, A. J., Reich, J. W., & Newsom, J. (2004). Gender moderates the effects of independence and dependence desires during the social support process. Psychology and Aging, 19, 215-218. Neugarten, B. L. (Ed.). (1968). Middle age and aging. Chicago, IL: University of Chicago Press. Newmann, J. P. (1989). Aging and depression. Psychology and Aging, 4, 150-165. Nolen-Hoeksema, S., & Ahrens, C. (2002). Age differences and similarities in the correlates of depressive symptoms. Psychology and Aging, 17, 116-124. Orth-Gomér, K. (2009). Are social relations less health protective in women than in men? Social relations, gender, and cardiovascular health. Journal of Social and Personal Relationships, 26, 63-71. Penninx, B. W. J. H., Guralnik, J. M., Ferrucci, L., Simonsick, E. M., Deeg, D., & Wallace, R. B. (1998). Depressive symptoms and physical decline in communitydwelling older persons. Journal of the American Medical Association, 279, 17201726. Pretorius, T. B. (1996). Gender and the health-sustaining and stress-reducing functions of social support: A South African study. Journal of Social Behavior and Personality, 11, 193-208. Pugliesi, K., & Shook, S. L. (1998). Gender, ethnicity, and network characteristics: Variation in social support resources. Sex Roles, 38, 251-238. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. Rook, K. S. (1987). Social support versus companionship: Effects on life stress, loneliness, and evaluations by others. Journal of Personality and Social Psychology, 52, 1132-1147.

Fiori and Denckla

437

Rueda, B., & Pérez-García, A. M. (2006). Gender and social support in the context of cardiovascular disease. Women & Health, 43, 59-73. Schwarzer, R., & Leppin, A. (1991). Social support and health: A theoretical and empirical overview. Journal of Social and Personal Relationships, 8, 99-127. Seeman, T. E., Singer, B. H., Ryff, C. D., Dienberg Love, G., & Levy-Storms, L. (2002). Social relationships, gender, and allostatic load across two age cohorts. Psychosomatic Medicine, 64, 395-406. Shim, R. S., Baltrus, P., Ye, J., & Rust, G. (2011). Prevalence, treatment, and control of depressive symptoms in the United States: Results from the National Health and Nutrition Examination Survey (NHANES), 2005–2008. Journal of the American Board of Family Medicine, 24, 33-38. Shumaker, S., & Hill, D. (1991). Gender differences in social support and physical health. Health Psychology, 10, 102-111. Singer, J. A. (2004). Narrative identity and meaning making across the adult lifespan: An introduction. Journal of Personality, 72, 437-460. Stice, E., Ragan, J., & Randall, P. (2004). Prospective relations between social support and depression: Differential direction of effects for parent and peer support? Journal of Abnormal Psychology, 113, 155-159. Stroebe, M. S., Hansson, R. O., Stroebe, W., & Schut, H. (Eds.). (2001). Handbook of bereavement research: Consequences, coping, and care. Washington, DC: American Psychological Association Press. Stroebe, M. S., & Stroebe, W. (1983). Who suffers more? Sex differences in health risks of the widowed. Psychological Bulletin, 93, 279-301. Stroebe, M. S., Stroebe, W., & Schut, H. (2001). Gender differences in adjustment to bereavement: An empirical and theoretical review. Review of General Psychology, 5, 62-83. Swain, S. O. (1992). Men’s friendships with women: Intimacy, sexual boundaries, and the informant role. In P. Nardi (Ed.), Men’s friendships (pp. 153-171). Newbury Park, CA: SAGE. Takahashi, K., Tamura, J., & Tokoro, M. (1997). Patterns of social relationships and psychological well-being among the elderly. International Journal of Behavioral Development, 21, 417-430. Takizawa, T., Kondo, T., Sakihara, S., Arizumi, M., Watanabe, N., & Oyama, H. (2006). Stress buffering effects of social support on depressive symptoms in middle age: Reciprocity and community mental health. Psychiatry and Clinical Neurosciences, 60, 652-661. Taylor, S. E., Klein, L. C., Lewis, B. P., Gruenewald, T. L., Gurung, R. A. R., & Updegraff., J. A. (2000). Biobehavioral responses to stress in females: Tend-and-befriend, not fight-or-flight. Psychological Review, 107, 411-429.

438


Thomson, E. H., & Whearty, P. M. (2004). Older men’s social participation: The importance of masculinity ideology. Journal of Men’s Studies, 13, 5-24. Tomey, K., Sowers, M. R., Harlow, S., Jannausch, M., Zheng, H., & Bromberger, J. (2010). Physical functioning among mid-life women: Associations with trajectory of depressive symptoms. Social Science & Medicine, 71, 1259-1267. Troll, L. (1988). New thoughts on old families. The Gerontologist, 28, 586-591. Turner, B. (1982). Sex-related differences in aging. In J. Wolman (Ed.), Handbook of developmental psychology (pp. 911-936). Englewood Cliffs, NJ: Prentice Hall. Turner, H. A. (1994). Gender and social support: Taking the bad with the good? Sex Roles, 30, 521-541. Umberson, D., Chen, M. D., House, J. S., Hopkins, K., & Slaten, E. (1996). The effect of social relationships on psychological well-being: Are men and women really so different? American Sociological Review, 61, 837-857. van Daalen, G., Sanders, K., & Willemsen, T. M. (2005). Sources of social support as predictors of health, psychological well-being and life satisfaction among Dutch male and female dual-earners. Women and Health, 41, 43-62. van Well, S., Kolk, A. M., & Klugkist, I. G. (2008). Effects of sex, gender role identification, and gender relevance of two types of stressors on cardiovascular and subjective responses: Sex and gender match and mismatch effects. Behavior Modification, 32, 427-449. Walen, H. R., & Lachman, M. E. (2000). Social support and strain from partner, family, and friends: Costs and benefits for men and women in adulthood. Journal of Social and Personal Relationships, 17, 5-30. Weinfurt, K. P. (2004). Multivariate analysis of variance. In L. G. Grimm & P. R. Yarnold (Eds.), Reading and understanding multivariate statistics (pp. 245-276). Washington, DC: American Psychological Association. Wellman, B., & Wortley, W. (1990). Different strokes from different folks: Community ties and social support. American Journal of Sociology, 96, 558-588. Wenger, G. C. (1996). Social networks and gerontology. Reviews in Clinical Gerontology, 6, 285-293. Wenger, G. C. (1997). Social networks and the prediction of elderly people at risk. Aging & Mental Health, 1, 311-320. Yee, J. L., & Schulz, R. (2000). Gender differences in psychiatric morbidity among family caregivers: A review and analysis. The Gerontologist, 40, 147-164.