Peggy A. Thoits

Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress.

The buffering hypothesis suggests that social support can moderate the impacts of life events upon mental health. However, several problems have yet to be resolved in this literature. Social support has been inadequately conceptualized and operationalized; therefore, the specific dimensions of support that reduce event impacts cannot be identified. The direct effect of events upon support and the interactive (buffering) effect of events with support have been confounded in many studies, such that results may have been biased in favor of the hypothesis. The relationships between events, support, and psychological disturbance have not been clarified theoretically; thus, the possibility that support itself is an etiologicalfactor has been overlooked. This article reviews empirical work on the buffering hypothesis, outlines alternate conceptualizations and operationalizations of support, presents a refined hypothesis and model for analysis, and suggests three theoretical approaches that may be used to explain the interrelationships between support, events, and disturbance.

Mechanisms Linking Social Ties and Support to Physical and Mental Health

Over the past 30 years investigators have called repeatedly for research on the mechanisms through which social relationships and social support improve physical and psychological well-being, both directly and as stress buffers. I describe seven possible mechanisms: social influence/social comparison, social control, role-based purpose and meaning (mattering), self-esteem, sense of control, belonging and companionship, and perceived support availability. Stress-buffering processes also involve these mechanisms. I argue that there are two broad types of support, emotional sustenance and active coping assistance, and two broad categories of supporters, significant others and experientially similar others, who specialize in supplying different types of support to distressed individuals. Emotionally sustaining behaviors and instrumental aid from significant others and empathy, active coping assistance, and role modeling from similar others should be most efficacious in alleviating the physical and emotional impacts of stressors.

Stress and Health Major Findings and Policy Implications

Forty decades of sociological stress research offer five major findings. First, when stressors (negative events, chronic strains, and traumas) are measured comprehensively, their damaging impacts on physical and mental health are substantial. Second, differential exposure to stressful experiences is a primary way that gender, racial-ethnic, marital status, and social class inequalities in physical and mental health are produced. Third, minority group members are additionally harmed by discrimination stress. Fourth, stressors proliferate over the life course and across generations, widening health gaps between advantaged and disadvantaged group members. Fifth, the impacts of stressors on health and well-being are reduced when persons have high levels of mastery, self-esteem, and/or social support. With respect to policy, to help individuals cope with adversity, tried and true coping and support interventions should be more widely disseminated and employed. To address health inequalities, the structural conditions that put people at risk of stressors should be a focus of programs and policies at macro and meso levels of intervention. Programs and policies also should target children who are at lifetime risk of ill health and distress due to exposure to poverty and stressful family circumstances.

Multiple Identities: Examining Gender and Marital Status Differences in Distress

Based upon assumptions that the social self is comprised of major role-identities and that role-identities reduce psychological distress, this paper examines the mental health advantage of married and unmarried men relative to comparable women as a function of multiple-role occupancy. Panel data from surveys of!, 106 adult heads of household in Chicago and 720 adults in New Haven are utilized. Possession of multiple role-identities (up to 6 in Chicago, 8 in New Haven) does significantly reduce distress in both samples. But identity summation does not consistently reduce gender or gender by marital status differences in distress. Further exploration revealed that men and women appear to experience equivalent levels of distress when they hold the same numbers and types of roles. When sex differences do occur, they appear to be a function of employment rather than of marriage, contrary to popular belief. Although structural inequalities in role occupancy appear to produce status differences in distress, future research will require deliberately stratified samples to adequately test this hypothesis.

Social Support and Psychological Well-Being: Theoretical Possibilities

Considerable controversy has centered on the role of social support in the stress process. Some theorists (Cassel, 1976; Cobb, 1976; Kaplan, Cassel, & Gore, 1977) have argued that support acts only as a resistance factor; that is, support reduces, or buffers, the adverse psychological impacts of exposure to negative life events and/or chronic difficulties, but support has no direct effects upon psychological symptoms when stressful circumstances are absent. Several studies confirm this buffering-only view of social support influences (sec Turner, 1983, for a review). Others (Thoits, 1982a, 1983c) have argued that lack of social support and changes in support over time are stressors in themselves, and as such ought to have direct influences upon psychological symptomatology, whether or not other stressful circumstances occur. A number of studies now confirm this main-effect view of social support influences (e.g., Andrews, Tennant, Hewson, & Vaillant, 1978; Aneshensel & Frerichs, 1982; Lin, Ensel, Simeone, & Kuo, 1979; Thoits, 1983b; Turner, 1981; Williams, Ware, & Donald, 1981). These studies report an inverse association between measures of support and indicators of psychological disturbance, and no stress-buffering effects at all.

The impact of culture on the cognitive structure of illness

This paper presents a theoretical framework for understanding the impact of culture on the processes of symptom recognition, labeling, and help-seeking and consequently on large-scale epidemiological studies involving different ethnic groups. We begin with the assumption that the subjective experience of illness is culture- bound and that the cognitive and linguistic categories of illness characteristic of any culture constrain the interpretative and behavioral options available to individuals in response to symptoms. We hypothesize the existence of learned cognitive structures, through which bodily experiences are filtered, that influence the interpretation of deviations from culturally-defined physical and mental health norms. Certain contradictory findings concerning the self-reported health of Mexican Americans are discussed in order to illustrate the impact of culture on perceived health status.

Life stress, social support, and psychological vulnerability: epidemiological considerations.

Previous research indicates that relatively disadvantaged sociodemographic groups (women, the poor, the unmarried) are more vulnerable to the impacts of life events. More recently, researchers have hypothesized that the psychological vulnerability of these groups may be due to the joint occurrence of many stress events and few psychological resources with which to cope with such events. This latter hypothesis is called here the applied buffering hypothesis. Using data from the New Haven Community Survey, the existence of differential psychological vulnerability is first reconfirmed. Women; older adults; unmarried persons; those with less education, income, and occupational prestige; married women; and unmarried women are found significantly more distressed by the experience of life events than their sociodemographic counterparts. The applied buffering hypothesis is then tested with several measures of social support. Little support for the hypothesis is found. That is, the psychological vulnerability of low status groups cannot be explained by the interaction of many events and few available sources of social support. Limitations of the data and alternative explanations of these findings are discussed. The confirmation of psychological vulnerability in disadvantaged groups suggests new directions for future epidemiological research.

Stressors and problem-solving: the individual as psychological activist

Sociological researchers have tended to deemphasize the degree to which people are conscious, active agents in their own lives, focusing instead on factors which promote vulnerability to stress. But people are often motivated to act deliberately to resolve both acute and chronic role-related stressors. Thus, the relationship between stress experiences and negative psychological outcomes may be attributable primarily to stressors which individuals are unable to resolve. Using panel data on 532 married and divorced respondents in Indianapolis, I illustrate the effects of solved and unsolved problems (in the domains of work and love/marriage) on changes in psychological distress and substance use. People who failed to solve their job or love problems had more psychological symptoms, while the symptoms of successful problem-solvers did not differ from those of individuals whose situations were nonproblematic. Further exploratory analyses showed that the personality characteristics of mastery and self-esteem served to select individuals into--and out of--stressful circumstances, and that individuals were affected by the outcomes of problem-solving efforts in the work domain, or by attempts to solve problems in the love/marriage domain. These illustrative findings suggest that it can be theoretically and empirically fruitful to view individuals as agents making and shaping their lives, rather than primarily as passive subjects overwhelmed by situational stress.

Self, Identity, Stress, and Mental Health

It is virtually impossible to develop a theory of the etiology of mental illness without thinking about self and identity issues. Almost all approaches in psychiatry and clinical psychology (with the exception of behaviorism) view individuals’ mental health as at least partly influenced by positive self-conceptions, high self-esteem, and/or the possession of valued social identities. Conversely, psychological disorder has been attributed to unconscious conflicts within the ego (Freud, 1933), arrested or inadequate identity development (e.g., Erikson, 1963; Freud, 1933), threats to self-conception or self-esteem (e.g., Abramson, Metalsky, & Alloy, 1989), and identity loss (Breakwell, 1986; Brown & Harris, 1978; Thoits, 1986), among many related processes. Indeed, some theorists and researchers see injuries to identity or self-worth not only as precursors but as keymarkers of mental disorder (e.g., Beck, 1967; Abramson et al., 1989).1 This can be seen in the criteria for various mental disorders in the fourth edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). For example, “low self-esteem,” “feelings of worthlessness,” and/or “unstable self-image” are key criteria in the identification of major depression, bipolar disorder, dysthymia (chronic depressed mood), and borderline and avoidant personality disorders.2

Advances in identity theory and research

Introduction The Editors. Part I: Sources of Identity. 1: The Me and the Not-Me: Positive and Negative Poles of Identity G.J. McCall. 2: Roots of Identity: Family Resemblances and Ascribed Traits K.J. Kiecolt, A. LoMascolo. 3: Identities and Behavior A.D. Cast. Part II: Identities and Social Structure. 4: The Political Self: Identity Resources for Radical Democracy P. Callero. 5: Identity and Inequality: Exploring Links between Self and Stratification Processes M.O. Hunt. 6: The Role of Self-Evaluation in Identity Salience and Commitment T.J. Owens, R. Serpe. Part III: Identities, Emotion, and Health. 7: Justice, Emotion, and Identity Theory J.E. Stets. 8: Feeling Good, Feeling Well: Identity, Emotion, and Health L.E. Francis. 9: Interaction, Emotion, and Collective Identities E.J. Lawler. 10: Using Identity Discrepancy Theory to Predict Psychological Distress K. Marcussen, M.D. Large. Part IV: Multiple Identities. 11: The Self, Multiple Identities and the Production of Mixed Emotions L. Smith-Lovin. 12: Personal Agency in the Accumulation of Multiple Role-Identities P.A. Thoits. 13: Relationships among Multiple Identities P.J. Burke. Final Commentary: A Peek Ahead S. Stryker.