Culture Moderates The Relation Between Perceived Stress, Social Support, and Mental and Physical Health

656132
research-article2016
JCCXXX10.1177/0022022116656132Journal of Cross-Cultural PsychologyShavitt et al.
Article
Journal of Cross-Cultural Psychology
2016, Vol. 47(7) 956–980
Culture Moderates the Relation © The Author(s) 2016
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DOI: 10.1177/0022022116656132
Support, and Mental and Physical jccp.sagepub.com
Health
Sharon Shavitt1, Young Ik Cho2, Timothy P. Johnson3,

Duo Jiang1, Allyson Holbrook3, and Marina Stavrakantonaki3
Abstract
Cultural differences in the relations between perceived stress and mental and physical health,
and the role of social support in buffering these relations, are examined in a survey of multiple
U.S. cultural/ethnic groups. Findings from a health survey of N = 603 adults comprising
approximately equal numbers of non-Hispanic Whites, Mexican Americans, Korean Americans,
and African Americans show that perceived stress is negatively correlated with one’s perceived
mental and physical health, in line with previous research. However, the role of social support
in mitigating this relationship is culturally contingent. A buffering effect of social support on the
relation between perceived stress and both mental and physical health was only observed for
Mexican Americans, not for the other cultural/ethnic groups. These patterns are discussed in
the context of research on differences in social help seeking among distinct types of collectivistic
cultural groups. The findings are consistent with recent research on horizontal versus vertical
collectivism that highlights the importance of sociability and benevolence in Latin American
cultural contexts. The results affirm the importance of distinguishing between collectivistic
cultures in understanding how social support may impact mental and physical health.
Keywords
horizontal and vertical collectivism and individualism, perceived stress, stress buffering, social
support, health
Experiencing stress that is intense and chronic increases the likelihood of serious mental and
physical health problems (Avey, Matheny, Robbins, & Jacobson, 2003; Cohen, Janicki-Deverts,
& Miller, 2007; M.-F. Marin et al., 2011; Sapolsky, 2004; S. E. Taylor, 2011; Uchino, 2006).
Evidence links long-term experience of stress to the development of all leading causes of death
such as heart disease, cancer, and stroke (Cohen et al., 2007) and most major mental health prob-
lems such as depression, posttraumatic stress disorder, and pathologic aging (M.-F. Marin et al.,
1University of Illinois at Urbana–Champaign, IL, USA

2University of Wisconsin–Milwaukee, WI, USA
3University of Illinois at Chicago, IL, USA
Corresponding Author:
Sharon Shavitt, Department of Business Administration, University of Illinois at Urbana–Champaign, 350 Wohlers
Hall, 1206 South Sixth Street, Champaign, IL 61820, USA.
Email: shavitt@illinois.edu
Shavitt et al. 957
2011). As damaging as stress may be to one’s mental and physical health, however, the impact of
perceived stress on health appears to be contingent on cultural/ethnic origins (Aldwin &
Greenberger, 1987; Anderson, 1989; Farley, Galves, Dickinson, & Perez, 2005; Oyserman, Coon,
& Kemmelmeier, 2002; Triandis, Bontempo, Villareal, Asai, & Lucca, 1988). For example,
although they perceive being under similar amounts of stress, non-Hispanic Whites report sig-
nificantly worse mental health functioning than do Mexican Americans (Farley et al., 2005), but
feel less depressed than do Korean Americans (Aldwin & Greenberger, 1987; H. S. Kim,
Sherman, & Taylor, 2008). In addition, African Americans are more susceptible to stress-induced
hypertension than non-Hispanic Whites are (Anderson, 1989; Hicken, Lee, Morenoff, House, &
Williams, 2014). One reason that stress has different implications for mental and physical health
across cultural groups may lie in cultural differences in the ways that social support is construed,
sought, and used to buffer the damaging long-term effects of stress (e.g., H. S. Kim et al., 2008;
Wang & Lau, 2015).
In this study, we investigate the relations between perceived stress, health, and social support
via a health survey of participants across a broad range of cultural/ethnic groups. By interviewing
and surveying non-Hispanic Whites, Mexican Americans, Korean Americans, and African
Americans, we build upon previous research addressing the role of culture in the relationships
between perceived stress and health perceptions (both mental and physical), and the role of struc-
tural social support in buffering these relationships. In particular, we base our research questions
on established differences in vertical/horizontal cultural orientations (Triandis, 1995; Triandis &
Gelfand, 1998). Our analysis highlights implications of the strong and distinct emphasis in hori-
zontal collectivistic cultural groups, particularly among Latin Americans and Hispanics, on
benevolence and sociability (Holloway, Waldrip, & Ickes, 2009; Torelli, Leslie, Stoner, & Puente,
2014; Torelli & Shavitt, 2010; Torelli et al., 2015) and on attachment to family (Campos et al.,
2008; G. Marin & Marin, 1991; Triandis, Marin, Betancourt, Lisansky, & Chang, 1982). This
emphasis, we suggest, has implications for the way in which social support is perceived and its
potential role in buffering the damaging effects of chronic stress on perceived health.
Previous research in this area has highlighted comparisons between collectivistic and indi-
vidualistic cultural groups (e.g., Mojaverian & Kim, 2013; Wang & Lau, 2015). However, we
propose that the role of social support in coping with stress will differ within collectivistic cul-
tural groups. In addition, we situate this prediction within the broader literatures on the role of
social support and stress in mental and physical health. Our findings suggest that, although there
are robust relations between stress and health, as well as between social support and health, social
support is more likely to buffer the relation between stress and perceived health for those with a
cultural background that particularly emphasizes benevolence and sociability.
Stress, Social Support, and Cultural Background

Social support is a fundamental psychosocial coping resource (Thoits, 1995). Defined as “a social
network’s provision of psychological and material resources intended to benefit an individual’s
ability to cope with stress” (Cohen, 2004, p. 676), the provision of social support from significant
others (family, friends, and coworkers) can be very helpful in coping with stressors by providing
both emotional and instrumental support (Cohen, 2004; Cohen & McKay, 1984; Cohen & Wills,
1985; Reblin & Uchino, 2008; S. E. Taylor, 2011; Thoits, 1995; Uchino, 2004; Uchino, Cacioppo,
& Kiecolt-Glaser, 1996). Emotional social support refers to things that others do that make us feel
loved and cared for (e.g., talking over a problem, providing encouragement/positive feedback),
whereas instrumental social support refers to various types of tangible help that others may provide
(e.g., help with childcare, provision of transportation or money; S. E. Taylor, 2011; Thoits, 1982).
It should be noted that there is no single agreed-upon definition of social support (Uchino,
2006). Social support has been measured in a number of distinct ways (Cohen & Wills, 1985;
958 Journal of Cross-Cultural Psychology 47(7)
Gottlieb & Bergen, 2010; S. E. Taylor, 2011). It may be indexed either by the structural properties
of one’s socially supportive networks such as the number of relationships one has, the size, den-
sity, interconnectedness, kinship-reliance, and stability of one’s social networks, and the fre-
quency of contact with its members (Brissette, Cohen, & Seeman, 2000; House, Landis, &
Umberson, 1988; S. E. Taylor, 2011; Thoits, 1982) or by the functions that network members
may provide such as the perceived instrumental aid received from various support system mem-
bers (Baum, Revenson, & Singer, 2012; Cohen & Wills, 1985; S. E. Taylor, 2011). Structural
social support and functional social support may have distinct associations with health outcomes
(e.g., Fortmann et al., 2015). According to Cohen and Wills’s (1985) model, structural types of
social support (also called social integration) usually are associated with a broad effect on general
health status. This may happen through multiple processes (S. E. Taylor, 2011). For example,
structural social support may provide individuals with regular positive experiences and help peo-
ple to avoid negative experiences (Cohen & Wills, 1985). Indeed, the more friends one has, the
healthier and happier one is (e.g., J. Kim & Lee, 2011; Umberson & Montez, 2010). In contrast,
functional types of social support are often expected to buffer the effects of a major stressful
event (S. E. Taylor, 2011; Thoits, 1982). For example, perceived functional social support from
family may help one to recover from a natural disaster (Uchino et al., 1996).
Because our focus is on whether and when social support buffers the impact of everyday stress
on one’s perceived health, both mental and physical, we index perceived social support by assess-
ing one’s socially supportive networks, using a measure that assesses the number of close or
confiding relationships one has as well as the frequency of interpersonal contacts with them.
Whether a person has one or more confiding relationships is one of the simplest and most useful
social support measures (Thoits, 1995), and having a confidant buffers the effects of stressors on
mental and physical health (Cohen & Wills, 1985). Although it should be noted that our study
does not assess all structural aspects of one’s support network, such as size, density, and intercon-
nectedness, it indexes some key social integration and social network elements that reflect struc-
tural social support (Gottlieb & Bergen, 2010; S. E. Taylor, 2011).
A significant body of research suggests a positive effect of social support on health across
cardiovascular, neuroendocrine, and immune systems (Barth, Schneider, & von Känel, 2010;
Berkman, Glass, Brissette, & Seeman, 2000; Cohen, 1988; House et al., 1988; Seeman, 1996; S.
E. Taylor, 2011; Thoits, 2011; Uchino, 2004, 2006; Uchino et al., 1996; Vinokur & van Ryn,
1993). For example, evidence links high social support to a reduced likelihood of developing
coronary heart disease and to better prognosis of the disease (Barth et al., 2010; Uchino, 2004,
2006; Uchino et al., 1996) as well as to better immune system functioning (Esterling, Kiecolt-
Glaser, & Glaser, 1996; Lutgendorf et al., 2005; Uchino, 2006).
However, as we will review presently, research suggests that the effectiveness of social sup-
port in buffering the impact of stress experiences varies across cultural and ethnic groups (e.g.,
Jasinskaja-Lahti, Liebkind, Jaakkola, & Reuter, 2006; Triandis et al., 1985; Uchino, 2004). In
this article, we examine differences between a broad set of cultural or ethnic groups in the degree
to which people use social support to cope with stressors, and the implications for both their
perceived mental and physical health. As established by previous research (Markus & Kitayama,
1991; Triandis, 1995), people from collectivistic cultures are more likely to emphasize attending
to others, fitting in, and having harmonious interdependence with others, whereas people from
individualistic cultures are less likely to do so, and these emphases are associated with a broad
range of differences (e.g., Lalwani & Shavitt, 2013; Riemer, Shavitt, Koo, & Markus, 2014).
Indeed, research suggests that basic cultural distinctions such as individualism-collectivism may
predict perception of and intention to use social support (S. E. Taylor, 2011; Triandis, Leung,
Villareal, & Clack, 1985; Wang & Lau, 2015) as suggested in Figure 1. Individuals who are more
collectivistic report perceiving more social support and feeling less lonely than those who are
more individualistic (Triandis et al., 1988; Triandis et al., 1985). As such, one might predict that
Shavitt et al. 959
Figure 1. Culture/ethnicity moderates the impact of social support in buffering the relation between
stress and health.
people from collectivistic cultures, such as those in East Asia or Latin America, will be more
likely to experience health benefits from social support than will people from individualistic
cultures, such as North Americans.
Yet, based on recent research (Ruby, Falk, Heine, Villa, & Silberstein, 2012; Shavitt, Torelli,
& Wong, 2009; Torelli & Shavitt, 2010, 2011; Triandis & Gelfand, 1998), we propose that there
will be important differences between collectivistic ethnic groups, particularly Latin American
and East Asian groups, in the degree to which social support buffers the relation between stress
experiences and health. Collectivistic cultures differ in their emphasis on horizontal versus verti-
cal relationships, as do individualistic ones (Triandis & Gelfand, 1998). Horizontal collectivism,
characteristic in Latin American cultures such as Mexico, is associated with a tendency to value
ingroups and familial relationships, but to perceive those relationships in a relatively equal,
mutually beneficial way. The tendency toward a more horizontal collectivistic cultural orienta-
tion in Latin American cultures relative to Anglo-Americans and other cultural groups has been
shown using cultural orientation measures of horizontal and vertical collectivism and individual-
ism (Torelli & Shavitt, 2010; Triandis & Gelfand, 1998), as well as using measures of goals,
scripts, and self-schemata (Holloway et al., 2009; Triandis, Marin, Lisansky, & Betancourt,
1984): Latin American and Hispanic cultural groups tend to emphasize benevolence, warmth,
and sociability in their relationships (Holloway et al., 2009; G. Marin & Marin, 1991; Torelli
et al., 2014; Torelli & Shavitt, 2010; Triandis, 1995; Triandis & Gelfand, 1998; Triandis et al.,
1984), and to underscore individuals’ strong identification with and attachment to their nuclear
and extended families (Campos et al., 2008; G. Marin & Marin, 1991; Triandis et al., 1982). This
cultural orientation may enhance the value of social support in buffering the effects of stress
experiences. For instance, higher social support (in particular, warm and positive social interac-
tion support) has been associated with higher infant birth weight among foreign-born Latinas, but
not among European Americans (Campos et al., 2008), and higher social support was correlated
with lower diabetes prevalence among U.S. Hispanics/Latinos (Gallo et al., 2015). Social support
is by and large negatively correlated with depression symptoms in various populations (S. E.
Taylor, 2007; Thoits, 1995; Uchino et al., 1996), a relation that is often observed among Hispanic-
American women (e.g., Leadbeater & Linares, 1992; Salgado de Snyder, 1987).
Furthermore, in Hispanic or Latin American cultural contexts, injunctive norms emphasize
that those in a position to help others should do so (Torelli et al., 2014; Torelli & Shavitt, 2010;
Triandis et al., 1984) and this norm influences judgments of power holders. For instance, political
leaders in Latin America are frequently idealized as patrons or benefactors who can protect help-
less individuals (L. Taylor, 2004). Indeed, this expectation of compassion from those in a position
to help can also impact how satisfaction with medical care is judged. Hispanics appear predis-
posed to judge physicians and others in powerful positions in terms of injunctive norms of com-
passion and warmth (Torelli et al., 2015).
Because of such normative expectations of compassionate social support, one might expect
people from Hispanic or Latin American cultural contexts to be more likely than others to receive
social support. In line with this, Almeida, Molnar, Kawachi, and Subramanian (2009) found that
foreign-born Mexicans have stronger familial social support than other racial/ethnic groups.
Sarkisian, Gerena, and Gerstel (2007) found that Mexican American women are more likely than
European American women to give household or childcare help. Therefore, because the giving
and receiving of compassionate social support is expected and consistent with prevailing cultural
norms, we predict that for people from Hispanic or Latin American cultural contexts, perceived
social support is likely to mitigate the negative relation between exposure to stress and perceived
mental and physical health.
In contrast, vertical societies are more likely than horizontal societies to emphasize hierarchy
and to be motivated by status (e.g., Shavitt, Johnson, & Zhang, 2011). Vertical collectivism,
observed and measured in East Asian cultures such as Korea, is associated with a tendency to
value ingroups and social relationships, but to perceive those social relationships in a relatively
hierarchical way (Kurman & Sriram, 2002; Triandis & Gelfand, 1998). Social relationships
depend on people behaving in ways appropriate to their relative social positions, foregoing
autonomy, and fulfilling their obligations accordingly (Chirkov, Ryan, Kim, & Kaplan, 2003). In
such cultural contexts, helping or receiving help involves plenty of responsibility and liability.
People with vertical collectivistic backgrounds may be reluctant to seek frequent social support
because they may feel obliged to reciprocate with even more help in the future (Mojaverian &
Kim, 2013). In line with this reasoning, a significant body of work indicates that, compared with
European Americans, Asians and Asian Americans report lower use of social support to cope
with stress (Aldwin & Greenberger, 1987; H. S. Kim, Sherman, Ko, & Taylor, 2006; H. S. Kim
et al., 2008; Sasaki & Kim, 2011; S. E. Taylor et al., 2004).
Asian cultures also cultivate norms that emphasize controlling or suppressing one’s emotional
expressions (Ruby et al., 2012) so as to maintain harmony within one’s relationships (S. E. Taylor
et al., 2004). In this context, confiding with close others about stress and stressors may be regarded
as a norm violation that could disrupt harmonious relations. Indeed, such emotional suppression
among Asian Americans can be directly associated with emotional distress (Saw & Okazaki,
2010). As a result, social support can sometimes even create psychological stress for Asian
Americans (Mojaverian & Kim, 2013; S. E. Taylor et al., 2004; Wang & Lau, 2015). When asked
to recall a situation in which they sought non-mutual help from a close other, Asian Americans
experienced more psychological stress than did European Americans (Wang & Lau, 2015).
Based on these findings, we predict that people with a horizontal collectivistic cultural back-
ground (Mexican Americans) compared with other groups, including those with a vertical collec-
tivistic cultural background (Korean Americans) or individualistic cultural backgrounds (European
Americans, African Americans), may be more likely to show evidence that structural social sup-
port buffers or mitigates the relation between their stress experiences and their mental and physical
health. We also explore whether Mexican Americans may be more likely to turn to their social
support network for advice on health-related issues than those with other cultural backgrounds.
Overview of the Present Study

In a survey of multiple ethnic groups, we interviewed non-Hispanic Whites, Mexican Americans,
African Americans, and Korean Americans, and measured their perceived stress, mental and
Shavitt et al. 961
physical health, and structural social support, as well as tapping health-related self-reports,
sources of health advice, and demographic factors. We then investigated cultural differences in
mean self-ratings and in relations among these variables. We explored whether the relation
between perceived stress and health self-perceptions varies by one’s cultural background/ethnic-
ity. In particular, because past research suggests that the ways in which people experience and use
social support varies across cultures, we examined whether the role of social support in buffering
the relation between stress experiences and health is also predicted by cultural background. We
also explored whether cultural factors moderate the degree to which social support is sought in
maintaining one’s health by comparing the sources of health advice most likely to be used by
members of each cultural group. Finally, we discuss our findings in the context of recent cross-
cultural research highlighting distinctions between the values and relationship norms of Hispanic
and Latin American cultural contexts (Holloway, et al., 2009; Torelli & Shavitt, 2010; Torelli
et al., 2014; Torelli et al., 2015) compared with Asian and Asian American cultural contexts
(Mojaverian & Kim, 2013; S. E. Taylor et al., 2004).
Although some of the variables we examine have been investigated in the context of specific
cultural subgroups and their mental health (e.g., African American and Puerto Rican adolescent
mothers; Leadbeater & Linares, 1992, or middle-class African American women; Warren, 1997),
we examine the patterns for a broader range of cultural/ethnic groups, focusing on the symptoms
of depression. We also examine predictors of physical health self-ratings, allowing a comparison
between the variables that drive self-ratings of depression and those that predict a number of
physical health self-reports. The findings affirm the importance of social factors in coping with
stressors that impact on mental and physical health, previously observed in the literature, while
underscoring the culturally bounded nature of this relationship.
Methods
We conducted a large-scale health survey to address a broad range of cross-cultural issues in
health self-reports, and the data reported in this research emerge from the broader survey. We
recruited adults between the ages of 18 and 70 from multiple ethnic groups in the Chicago area,
with equal numbers of non-Hispanic Whites, Mexican Americans, African Americans, and
Korean Americans to participate. Half of Mexican Americans (Korean Americans) were inter-
viewed in Spanish (Korean) and the rest in English based on respondent preference. Trained
bilingual interviewers who were native Spanish or Korean speakers conducted the non-English
interviews. Respondents completed a detailed face-to-face computer-assisted personal interview
as well as paper-and-pencil questionnaires that asked a broad set of questions, including a variety
of mental and physical health self-reports, measures of health knowledge and perceptions, demo-
graphics, and individual difference scales.
Sampling and Recruitment

Sampling and recruitment began with list-assisted sampling from Chicago-area census tracts
with high concentrations of the racial/ethnic groups being targeted. Phone calls were made to
households on the list and respondents within household were selected using a predetermined
decision rule to achieve a random selection of oldest/youngest male/female. We supplemented
these recruiting efforts with online ads and postings, in particular for Korean respondents,
because the size of this sample was limited. We also sent advance letters in English and Korean
to this sample.
We paid respondents $40 to come to the Survey Research Laboratory offices in Chicago to
complete a data collection session lasting approximately 90 min, conducted by trained interview-
ers. These interviews were recorded with participant consent.
The 603 respondents were adults living in the Chicago area. They were an average age of 44.2
years, 44% of them were female, and 54% had not graduated college (33% had a high school
education or less). Respondents completed the survey instruments and interview in their pre-
ferred language: in English or in either Spanish or Korean if they were of Mexican or Korean
descent, respectively.
Measures
We produced translations for both the Spanish and the Korean instruments using a team transla-
tion approach. In this approach, one person translated all or part of the instrument. Then, a team
of bilinguals reviewed the translation to identify problematic words or phrases and come to a
resolution on the final translation. The team included a number of native Korean or Spanish
speakers with survey measurement expertise, including one of the authors, who participated in
the translation of the Korean instrument.
Several of our survey measures were borrowed from questionnaire modules employed as part
of the 2006 Behavioral Risk Factor Surveillance System Program at the Centers for Disease
Control (Pierannunzi, Hu, & Balluz, 2013). Items were also borrowed from the 2002 National
Latino and Asian American Study (Alegría et al., 2004), the Short Form–12 instrument (Ware,
Kosinski, & Keller, 1996), and the Berkman-Syme Social Network Index (Berkman & Syme,
1979). All other items were developed specifically for use in this study. See Table 1 for the
sources of each of the focal questionnaire items.
Culture. Race/ethnicity was employed as a proxy for culture in these analyses, in line with previ-
ous research on culture and social support (e.g., H. S. Kim et al., 2006; Mojaverian & Kim, 2013;
S. E. Taylor et al., 2004; Wang & Lau, 2015).
Stress. Perceived stress was measured with the item, “Thinking about the past year, how would
you rate the total amount of stress you have experienced?” (1 = no stress at all, 5 = a great deal
of stress). This item was developed and pretested specifically for use in this study. It is similar in
format to established measures such as the 14-item Perceived Stress Scale (Cohen, Kamarck, &
Mermelstein, 1983) in which respondents rate on a 5-point scale the frequency of stressed feel-
ings in the previous month. Although use of a multi-item measure of perceived stress would have
been desirable, space limitations in our questionnaire, which contained more than 300 items and
required 1.5 hr to administer, necessitated reliance on this single item. We note that other research-
ers have successfully employed single-item stress measures (American Psychological Associa-
tion, 2012; Elo, Leppänen, & Jahkola, 2003).
Structural social support. Structural social support was assessed with an ad hoc four-item mea-
sure (α = .70; see Table 1 for exact wording of all items). One item was adapted from the
Berkman-Syme Social Network Index, which is a widely used measure reflecting structural
social support (Berkman & Syme, 1979; see also Lubben et al., 2006): “In general, how many
close friends do you have? By ‘close friends’ I mean relatives or non-relatives that you feel at
ease with, can talk to about private matters, and can call on for help.” The definition of close
friends was broad to include any social relations people could turn to as confidants. As noted
earlier, the presence of confiding relationships is one of the simplest and most useful social sup-
port measures (Thoits, 1995), and having a confidant buffers the effects of stressors on mental
and physical health (Cohen & Wills, 1985). Other items were developed specifically for this
study, including two items that assessed frequency of contact via electronic and face-to-face
means, which also address structural support and social integration (Gottlieb & Bergen, 2010;
S. E. Taylor, 2011).
Shavitt et al. 963
Table 1. Items Comprising the Physical Health Index, Social Support Index, and Depression/Mental
Health Index.
Item Scale
Physical health index
In general, would you say your health is excellent, 1. Excellent
very good, good, fair, or poor?a 2. Very good
3. Good
4. Fair
5. Poor
Using the scale on card A1, which face comes
closest to expressing how you feel your health
is today?b
A B C D E F G
How satisfied are you with your present health in 1. Pretty well satisfied
general? Would you say that you are pretty well 2. More or less satisfied
satisfied, more or less satisfied, or not satisfied at 3. Not satisfied at all
all with your present health?b
Now thinking about your physical health, which <0-30> Days
includes physical illness and injury, for how many
days during the past 30 days was your physical
health not good?a
Structural social support index
In general, how many close friends do you have? <0> None
By “close friends” I mean relatives or non- <1-20> Close friends
relatives that you feel at ease with, can talk to <21> 21 or more close friends
about private matters, and can call on for help.c
How many of these close friends did you do <0-20> Close friends networked with
social networking with through things like e-mail <21> 21 or more close friends networked with
and Facebook during the past 7 days?b
Excluding electronic social networking like e-mail <0-20> Close friends talked to
and Facebook, how many of these close friends <21> 21 or more close friends talked to
did you spend time with or talk to during the
past 7 days?b
Would you say you have more friends, fewer 1. More friends than most
friends, or about the same number of friends as 2. Fewer friends than most
most people you know?b 3. About the same number of friends as most
other people you know
Depression/mental health index
How would you rate your overall mental health? 1. Excellent
Would you say excellent, very good, good, fair, 2. Very good
or poor?d 3. Good
4. Fair
5. Poor
Thinking again about your mental health, which <0-30> Days
includes stress, depression, and problems with
emotions, for how many days during the past 30
days was your mental health not good?c
Has a doctor or other health care provider ever Yes
told you that you have a depressive disorder, No
including depression, major depression,
dysthymia, or minor depression?c
(continued)
Table 1. (continued)
Item Scale
How many times in the past 7 days have you felt <0-95> Times
down or depressed in general?b <96> 96 or more times
How many times in the past 7 days have you felt <0-95> Times
down or depressed about the way you look?b <96> 96 or more times
And how often have you felt downhearted and 1. All of the time
depressed during the past 4 weeks? Would you 2. Most of the time
say all of the time, most of the time, some of the 3. Some of the time
time, a little of the time, or none of the time?b 4. A little of the time
5. None of the time
During the past 4 weeks, how much of the time 1. All of the time
have you had any of the following problems with 2. Most of the time
your work or other regular daily activities as a 3. Some of the time
result of any emotional problems such as feeling 4. A little of the time
depressed or anxious?b 5. None of the time
First, would you say you have accomplished less
than you would like all of the time, most of the
time, some of the time, a little of the time, or
none of the time?b
Note. The measure was coded for analysis such that higher scores represented greater levels of depression/poorer
perceived mental health. Question sources see below.
aShort-Form 12 questionnaire.
bOriginal item modified from other sources.
c2006 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire; 1979 Berkman-Syme Social Network Index
(for Structural Social Support).

d2002 National Latino and Asian American Study.
Similar measurements of social support have been employed in previous research (e.g.,
Berkman & Syme, 1979; Gottlieb & Bergen, 2010; J. Kim & Lee, 2011; Lubben et al., 2006). For
example, number of Facebook friends has been used to index perceived social support (J. Kim &
Lee, 2011). Although our measure was not designed to assess all structural elements of one’s sup-
port network, such as size, density, and interconnectedness of one’s social networks, it indexes
some important aspects of structural support and integration that are consistent with prior research.
Response options for each individual item were standardized to range from 0 to 1 and then
summed to construct an index that ranged from 0 to 4. The measure was coded such that higher
scores reflected greater amounts of social support.
Perceived mental health. Perceived mental health was assessed by measuring recently experienced
depression symptoms. Depression is known to place individuals at increased risk for other mental
disorders (Fergusson, Horwood, Ridder, & Beautrais, 2005) and is thus employed as a proxy indi-
cator for mental health in this research. We assessed depression using a 7-item scale (α = .72). An
example item included “How often have you felt downhearted and depressed during the past 4
weeks?” (“all of the time,” “most of the time,” “some of the time,” “a little of the time,” or “none
of the time”?) The wording and sources for all scale items are presented in Table 1. As with the
social support measure, the response options for each individual item were standardized to range
from 0 to 1 and then summed to construct an index that ranged from 0 to 7. The measure was coded
such that higher scores represented greater levels of depression/poorer perceived mental health.
Perceived physical health. Perceived physical health was assessed with a four-item measure includ-
ing items such as self-rated health, “In general, would you say your health is excellent, very
Shavitt et al. 965
Table 2. Reliability Coefficients of All Three Main Variables by Cultural/Ethnic Groups.
Social support Depression/mental health Physical health

White .713 .725 .799
Mexican American .642 .762 .730
African American .562 .750 .822
Korean American .789 .668 .768
All .696 .724 .791
good, fair, or poor?”, which research has been found to be strongly and consistently associated
with objective physical health measures (Lee, 2015). The specific wording of all items can be
found in Table 1. Our four-item index had good reliability (α = .79; for reliability coefficients of
all three main variables by ethnic groups, see Table 2). Consistent with the other indices described
above, the response options for each individual item were standardized to range from 0 to 1 and
then summed to construct an index that ranged from 0 to 4. Higher values were coded to repre-
sent better perceived physical health.
Sources of health advice. To address where respondents primarily turned for advice on their health,
they were asked, “During the past year, where have you gotten most of your health advice from?
Would you say a health professional, friends and family, television, newspapers, magazines, the
internet, or someplace else?”
In addition to these measures, all of which were part of an extended personal interview, a
paper-and-pencil questionnaire at the conclusion of the session obtained basic demographic
information and other ratings.
Results
Before investigating the hypothesized cultural differences in the relations between perceived
stress and mental or physical health, as well as the role of structural social support in moderating
these relations, we explored potential cultural differences in mean self-ratings on these variables.
We ran a series of regression models to compare self-reports of health, stress, and social support
as a function of ethnic group, while controlling for age, education level, gender, income, and,
where appropriate, language of interview. Because of the large number of comparisons between
pairs of ethnic groups, we tested the significance of these mean comparisons using a Bonferroni-
adjusted p value of p = .002.
Cultural/Ethnic Group Differences in Mental Health Ratings

Mexican Americans rated themselves somewhat more favorably than others did on mental health,
consistent with past research (Farley et al., 2005). Their mean depression ratings (M = 1.443),
controlling for background variables, appeared lower than each of the other three groups (vs.
Whites, M = 1.864, t = 2.117, p = .035; vs. African Americans, M = 1.814, t = 1.971, p = .049; vs.
Korean Americans, M = 1.903, t = 2.119, p = .035). However, none of these differences were
significant at p < .002.
Cultural/Ethnic Group Differences in Physical Health Ratings

There were also no significant group differences in physical health self-ratings. Whites rated
themselves somewhat more favorably with respect to their physical health (M = 2.871) relative
to African Americans (M = 2.498; t = −2.949, p = .003), yet similar to Korean Americans (M =

2.597, t = −1.782, p = .075) and Mexican Americans (M = 2.650, t = −1.515, p = .13).
Cultural/Ethnic Group Differences in Stress Ratings

Self-reported stress levels did not differ significantly by group, either, although Whites and
Mexican Americans reported directionally less stress compared to African Americans (MAfr-Ams =
0.611 compared with MWhites = 0.531, t = −2.006, p = .045; compared with MMex-Ams = 0.517, t =
−2.183, p = .029). There were no other between-group differences (ps >.07).
Cultural/Ethnic Group Differences in Social Support Ratings

Finally, with respect to social support, Whites reported significantly more social support (MWhites =
2.063) than did African Americans (MAfr-Ams = 1.463, t = −4.846, p < .001) and marginally more
social support than did Mexican Americans (MMex-Ams = 1.647, t = −2.904, p = .004). Korean
Americans rated themselves somewhat but not significantly higher in social support than did
African Americans (t = 2.227, p = .026). No other group differences were significant (ps > .07).
In short, a conservative analysis suggested that these four ethnic groups were statistically similar
in their mean self-rated mental and physical health, stress, and social support.
In subsequent analyses, given that ethnic groups reported similar levels of perceived stress
and perceived mental and physical health, we examined cultural differences in the relations
between stress and perceived mental or physical health as well as between social support and
perceived health, focusing on the role of social support in buffering the relation between stress
and health. We also examined cultural differences in self-reported sources of health advice.
Relations Between Stress and Health Self-Reports Across Cultural/Ethnic Groups

A consistent relationship was observed between perceived stress and self-rated depression/men-
tal health as well as between perceived stress and physical health across groups. The more stress
one reported experiencing in the previous year, the worse one’s rated mental health (more depres-
sion) and the worse one’s rated physical health. These robust findings are in line with a broader
literature on the damaging effects of chronic stress experiences on health (Avey et al., 2003;
Cohen et al., 2007; M.-F. Marin et al., 2011).
Main effect regression models controlling for demographic variables, language of interview,
and score on the social support scale confirmed positive and significant relations between stress
and depression for each ethnic group surveyed (all ps < .001; see Table 3). Similar analyses
showed an inverse relationship between stress and physical health for Mexican Americans (p =
.004), African Americans (p = .017), and Korean Americans (p < .001), with the relation for
Whites being non-significant (p = .071; see Table 4).
Relations Between Social Support and Health Self-Reports Across Cultural/Ethnic

Groups
Whereas stress broadly predicted depression across groups, the observed relation between social
support and depression/mental health was culturally contingent. Our findings suggested that
social support was more important to the mental health of Mexican Americans than others.
Regression models controlling for demographic variables, language of interview, and perceived
stress showed that greater social support predicted significantly less depression for Mexican
Americans (p = .026), but not for African Americans (p = .075), Korean Americans (p = .450), or
Whites (p = .803; see Table 3). Although previous research has suggested that social support can
Table 3. Main Effect Model for Prediction of Depression/Mental Health for Each Cultural/Ethnic Group.
All White Mexican American African American Korean American
b SE p b SE p b SE p b SE p b SE p
Constant 1.753 .372 .000 0.558 .918 .544 1.685 .552 .003 1.217 .634 .057 1.100 .575 .058
Past year stress level 1.730 .172 .000 1.969 .358 .000 1.572 .346 .000 1.559 .359 .000 1.899 .314 .000
Social support −0.108 .055 .052 0.029 .116 .803 −0.262 .116 .026 −0.224 .125 .075 −0.069 .091 .450
Age 0.001 .004 .886 −0.008 .007 .219 −0.001 .008 .926 0.012 .008 .127 −0.007 .008 .363
Education −0.625 .274 .023 0.110 .760 .886 −0.673 .468 .153 −0.327 .622 .600 −0.453 .454 .321
Male −0.169 .100 .092 −0.250 .214 .245 −0.188 .210 .374 0.120 .220 .585 −0.315 .168 .064
Income −0.052 .036 .147 0.078 .100 .437 −0.023 .079 .774 −0.202 .072 .006 0.100 .053 .063
Mexican American −0.429 .183 .019
African American −0.274 .162 .091
Korean American −0.121 .190 .526
Spanish speaking 0.352 .207 .090 0.335 .239 .163
Korean speaking 0.345 .214 .108 0.555 .242 .023
Adjusted R2 .203 .201 .245 .200 .277
967
968
Table 4. Main Effect Model for Prediction of Physical Health for Each Cultural/Ethnic Group.
All White Mexican American African American Korean American
b SE p b SE p b SE p b SE p b SE p
Constant 2.814 .288 .000 2.811 .690 .000 2.895 .399 .000 2.765 .532 .000 3.491 .443 .000
Past year stress level −0.679 .134 .000 −0.484 .265 .071 −0.729 .249 .004 −0.733 .304 .017 −1.036 .242 .000
Social support 0.186 .043 .000 0.236 .087 .007 0.219 .084 .010 0.194 .104 .064 0.145 .070 .040
Age −0.004 .003 .219 0.008 .005 .109 −0.002 .006 .681 −0.012 .007 .064 −0.007 .006 .238
Education 0.073 .213 .732 −0.195 .569 .733 0.283 .337 .404 0.107 .523 .838 −0.368 .351 .296
Male 0.042 .078 .587 0.301 .160 .062 −0.111 .151 .463 0.017 .185 .928 0.049 .130 .705
Income 0.057 .028 .040 −0.093 .075 .215 −0.082 .057 .151 0.182 .060 .003 0.030 .041 .462
Spanish speaking −0.134 .161 .407 −0.251 .171 .144
Korean speaking −0.207 .167 .217 −0.231 .186 .218
Adjusted R2 .144 .064 .120 .155 .176
Shavitt et al. 969
have ameliorative effects on depression among African American and some Hispanic popula-
tions (Gant et al., 1993; Leadbeater & Linares, 1992; Salgado de Snyder, 1987; Warren, 1997),
in our results the observed relation is limited to Mexican Americans.
Social support had a more robust relation with physical health across cultures. Regression
models controlling for demographic variables, language of interview, and perceived stress
showed that greater social support predicted better physical health self-reports for most cultural
groups: Whites (p = .007), Mexican Americans (p = .010), Korean Americans (p = .040), and
non-significantly for African Americans (p = .064; see Table 4).
Social Support as a Buffer of the Relation Between Stress and Health Across
Cultural/Ethnic Groups
Next, we conducted analyses to determine the degree to which social support buffers or moderates
the relation between stress and mental and physical health, and in particular whether this buffering
effect is culturally contingent. To address this, we examined whether there was an interaction of
Stress × Social Support × Ethnic Group. The stress-buffering hypothesis has been evaluated using
interaction terms in regression models in numerous studies (e.g., Burton, Stice, & Seeley, 2004;
Cohen & Wills, 1985; Katz & Campbell, 1994; Takizawa et al., 2006; Wheaton, 1985; Zimmerman,
Ramirez-Valles, Zapert, & Maton, 2000). Consistent with this analytical approach, we did multi-
ple-regression modeling of mental health and of physical health self-ratings to examine the influ-
ence of stress level, social support, and their interaction, as well as the focal Stress × Social
Support × Ethnic Group interaction. Given that the ethnic group variable has four categories, but
is not a continuous variable, we used dummy variables to compare each ethnic group (Mexican
Americans, African Americans, and Asian Americans) with Anglo Whites. For depression/mental
health, the three-way interaction was significant only for the Mexican American dummy variable
(b = −1.100, p < .04), not for the other ethnic group comparisons (ps ≥ .57), as shown in Table 5
and depicted graphically in Figure 2. This indicates that the buffering effect of social support in the
relation between stress and mental health depended on cultural group.
We ran the same regression models for physical health and observed the same pattern of
results. The three-way interaction was only significant for the Mexican American dummy vari-
able (b = 1.164, p < .005), as shown in Table 6 and depicted graphically in Figure 2. The other
ethnic group comparisons showed no three-way interaction (ps > .58), suggesting again that the
buffering effect of social support in the relation between stress and physical health was culturally
contingent, emerging only for Mexican Americans.
For ease of interpretation, we next ran a two-way interaction model within each of the four
ethnic groups, in which the directional effects of stress and social support, the Stress × Social
Support interaction, as well as all of the background variables previously noted were entered. For
depression ratings, among Mexican Americans, there was a significant negative coefficient for
Stress × Social Support (b = −1.163, p = .001) meaning that as social support increased, the effect
of stress on depression was reduced. There was no interaction for any other ethnic group (all ps
> .49). The same pattern was observed for physical health. For Mexican Americans, there was a
significant positive coefficient for Stress × Social Support (b = .999, p < .001), indicating that as
social support increased, the negative relation between stress and physical health was reduced.
There was no interaction between stress and social support for any other group (all ps > .40).
Self-Reported Sources of Health Advice Across Cultural/Ethnic Groups

Finally, we explored ethnic group differences in self-reported sources of health advice because
such differences may reveal the extent to which social support is sought in maintaining one’s
health. Analyses indicated differences across groups in the primary sources of health advice that
Table 5. Three-Way Interaction Model for Prediction of Depression/Mental Health.
Three-way interaction model
b SE p
Constant 1.015 .633 .109
Age 0.001 .004 .794
Education −0.591 .272 .030
Male −0.131 .102 .197
Income −0.050 .036 .162
African American 0.796 .685 .246
Spanish speaking 0.249 .208 .232
Korean speaking 0.440 .232 .058
Past year stress level 2.200 .899 .015
Social support 0.105 .231 .651
Stress × Social Support −0.044 .374 .907
Mexican American × Stress 1.204 1.113 .280
African American × Stress −0.705 1.078 .513
Korean American × Stress 0.346 1.144 .762
Mexican American × Social Support 0.266 .322 .409
African American × Social Support −0.299 .325 .358
Korean American × Social Support 0.064 .333 .847
Mexican American × Social Support × Stress −1.100 .512 .032
African American × Social Support × Stress −0.096 .506 .849
Korean American × Social Support × Stress −0.288 .518 .579
Adjusted R2 .223
people reported. Not surprisingly, health professionals were the most frequently identified source
of health advice by most groups—Whites (35.8%), Mexican Americans (35.1%), African
Americans (44.4%)—although this was less so for Korean Americans (12.7%), χ2 = 38.0, p <
.001. Importantly, however, how much people turned to their social support network as a source
of health advice varied by culture. “Friends and family” were identified by 19.2% of Mexican
Americans as their primary source of health advice, more frequently than by Korean Americans
(11.3%), Whites (9.9%), or African Americans (7.3%), χ2 = 11.32, p = .01.1 This result is consis-
tent with the finding that only for Mexican Americans did social support buffer the effect of stress
on health, and suggests a possible corollary: Mexican Americans may be more likely to turn to
their social support network, and/or feel more supported by their friends and family, in the effort
to maintain their health.
Discussion and Conclusions

A consistent relationship between stress and both mental and physical health has been observed
reliably in previous research (Avey et al., 2003; Cohen et al., 2007; M.-F. Marin et al., 2011).
However, stress can affect people of different cultural/ethnic backgrounds to different degrees
and in distinct ways (Aldwin & Greenberger, 1987; Farley et al., 2005; Greenberger & Chen,
1996), and the impact of stress on mental and physical health may be culturally contingent
(Anderson, 1989; Triandis et al., 1988). This may in part be due to cultural differences in the
perception and use of social support to buffer the damaging effects of stress. For instance, they
Shavitt et al. 971
Stress and Mental Health/Depression by Social Support

3
2 Non-Hispanic White Mexican-American
Mental Health Status
1
0
African-American Korean-American
3
2
1
0
0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1 0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1
Stress Level
Social Support=0 Social Support=1 Social Support=2
Social Support=3 Social Support=4
Stress and Physical Health by Social Support

Non-Hispanic White Mexican-American
4
3
Physical Health Status
2
1
African-American Korean-American
4
3
2
1
0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1 0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1
Stress Level
Social Support=0 Social Support=1 Social Support=2
Social Support=3 Social Support=4
Figure 2. Interaction of culture/ethnicity, stress, and social support in predicting mental health/
depression and physical health.
Note. For social support, response options for each individual item were rescaled based on the frequency distribution
and standardized to range from 0-1, and then summed to construct an index that ranged from 0-4 to facilitate
graphical illustration.
Table 6. Three-Way Interaction Model for Prediction of Physical Health.
Three-way interaction model
b SE p
Constant 2.695 .493 .000
Age −0.003 .003 .238
Education 0.058 .212 .785
Male 0.043 .079 .586
Income 0.055 .028 .050
Mexican American 0.860 .556 .123
Korean American 0.234 .583 .688
Spanish speaking −0.077 .162 .638
Korean speaking −0.300 .182 .099
Past year stress level −0.353 .695 .612
Social support 0.239 .181 .187
Stress × Social Support −0.132 .291 .651
Mexican American × Stress −1.936 .865 .026
African American × Stress 0.337 .835 .687
Korean American × Stress −0.658 .889 .460
Mexican American × Social Support −0.615 .251 .015
African American × Social Support 0.208 .253 .412
Korean American × Social Support −0.091 .261 .728
Mexican American × Social Support × Stress 1.164 .400 .004
African American × Social Support × Stress −0.217 .393 .580
Korean American × Social Support × Stress 0.143 .405 .724
Adjusted R2 .158
may reflect differences between cultural groups in the emphasis on benevolence and sociability
(Holloway et al., 2009), values that are characteristic of a horizontal collectivistic cultural con-
text (Torelli & Shavitt, 2010; Torelli et al., 2014; Triandis & Gelfand, 1998).
Our results based on survey interviews conducted among multiple cultural/ethnic groups—
Mexican Americans, Korean Americans, African Americans, and Whites—examined the posi-
tive and significant relationship between stress and depression, as well as the negative relationship
between stress and physical health self-ratings, for each ethnic group surveyed. We found that
stress was negatively correlated with mental and physical health to a similar extent across cul-
tural groups. This result suggests that efforts to enhance health by communicating about the
benefits of stress reduction techniques would be of potential value across ethnic and cultural
boundaries.
However, the role of social support in mental and physical health varied by cultural groups.
Only for Mexican Americans was social support associated with less depression. And only in this
group did social support appear to buffer the relationship between stress and mental health as
well as physical health. In other words, the results suggest that the positive role of social support,
including its role in coping with the damaging effects of stress on health, is culturally contingent,
being observed only for one of the four cultural groups examined.
These findings are consistent with recent cross-cultural research highlighting the impor-
tance of sociability and benevolence in Mexican American and South American cultural con-
texts (Torelli et al., 2014; Torelli & Shavitt, 2010) that are characterized by a horizontal form
of collectivism (Triandis & Gelfand, 1998). They suggest that in such cultural contexts, social
resources are especially important to bolstering mental and physical health. Indeed, differences
Shavitt et al. 973
between Mexican Americans and other groups in their self-reported primary sources of health
advice are also consistent with this pattern. Friends and family were significantly more likely
to be identified as a primary source of health advice by Mexican Americans than by all others.
Although these findings are exploratory, they suggest that, for Mexican Americans, support
from social networks is more instrumental in buffering stress perhaps because Mexican
Americans are using this support differently—to seek advice from their social networks on
maintaining their health.
As predicted, social support did not buffer the relationship between stress and mental and
physical health in another collectivistic cultural group, Korean Americans. This is consistent with
research suggesting that members of Asian American cultural groups, who tend to be character-
ized by a vertical form of collectivism (Triandis & Gelfand, 1998), have greater concerns about
obligation and indebtedness if they turn to their social contacts for help (H. S. Kim et al., 2006;
H. S. Kim et al., 2008; Mojaverian & Kim, 2013; Wang & Lau, 2015). The finding that Korean
Americans (and Whites) were more likely than other groups to say that they use the Internet as
their primary source of health advice is also consistent with this finding, giving priority to a mass
medium as opposed to direct communication with important others. On the whole, these findings
underscore the importance of distinguishing among horizontal and vertical collectivistic cultural
groups in understanding social behaviors and normative expectations (Lalwani, Shavitt, &
Johnson, 2006; Torelli & Shavitt, 2010), particularly as they pertain to maintaining one’s health.
Our findings are consistent with other research suggesting that the drivers of mental health
and depression are distinct for Hispanic and Asian American populations (Gupta, Rogers-Sirin,
Okazaki, Ryce, & Sirin, 2014), although we note that comparisons of these two collectivistic
populations are relatively uncommon in the literature. The strong evidence for the positive role
of social support for Mexican Americans is also consistent with some previous research high-
lighting the ways in which Latin American immigrants use social support and social networks to
address stressors (Padilla, Cervantes, Maldonado, & Garcia, 1988). As an example, mortality
rates of Mexican American neighborhoods have been found to be lower in high-density commu-
nities than in low density ones (Eschbach, Ostir, Patel, Markides, & Goodwin, 2004). This is
consistent with the notion that having access to more sources of social support, stemming from
high-density neighborhoods, benefits the health of Mexican Americans.
Limitations and Strengths

We also note some limitations of this research, including use of a single item to measure per-
ceived stress, the use of race/ethnicity as a proxy for culture, and the reliance on cross-sectional
data to model dynamic social processes. Although use of a multi-item measure of perceived
stress would have been desirable, space limitations in our questionnaire, which contained more
than 300 items and required 1.5 hr to administer, necessitated reliance on this single item. We
note that other researchers have successfully employed single-item stress measures (American
Psychological Association, 2012; Elo et al., 2003). Future research could address whether multi-
item measures of global perceived stress yield similar relationships as those observed in the pres-
ent research. Previous research has emphasized the degree to which the experience of stress is
characterized by feelings of unpredictability, uncontrollability, and overload in one’s everyday
life (see Cohen et al., 1983). Measures that tap these feelings in greater depth could shed more
light on how cultural factors moderate the relations between felt stress, structural social support,
and health. It would also be worthwhile investigating whether global versus event-specific expe-
riences of stress show distinct relationships with the variables we investigated.
Another limitation of our study is the use of race/ethnicity as a proxy for culture, rather than
direct measures of cultural orientation. Our study had included two well-established measures of
cultural orientation and values, the 16-item measure of horizontal and vertical individualism and
collectivism (Triandis & Gelfand, 1998) and the 21-item version of the Schwartz Values Survey
(Davidov, Schmidt, & Schwartz, 2008). Both scales were completed in paper-and-pencil form
after the lengthy and detailed personal interview. Confirmatory factor analyses did not confirm
the equivalence of these measures across racial/ethnic groups. Significant variability across
racial and ethnic groups in response effects (e.g., acquiescence, extreme response style) was
observed, which may have affected scale comparability across groups. As a result of these fac-
tors, we decided to use race/ethnicity as a proxy for culture.
Although the observed patterns across ethnic groups are consistent with known differences
between these groups in horizontal and vertical collectivism and individualism, it is important to
note that we have no direct evidence to establish the role of these cultural distinctions. Because
various theoretical distinctions can sometimes serve as explanatory variables for cross-cultural
differences (e.g., Kurman, Liem, Ivancovsky, Morio, & Lee, 2015), direct assessment of cultural
orientations or self-construals would be important in future research to examine the role of hori-
zontal/vertical collectivism and individualism as well as other distinctions. For instance, differ-
ences in relatedness are likely to be relevant to the patterns we reported as a function of ethnic
group. Relatedness is distinct from collectivism (Oyserman et al., 2002). People who have a
strong relational-interdependent self-construal (Cross, Bacon, & Morris, 2000) report having a
greater number of relationships that are very important to them and higher levels of social sup-
port than others do. Moreover, these relationships are characterized by greater levels of self-dis-
closure, perceived closeness, and commitment. Such relational characteristics are in line with the
focal variables in our research. It is possible that differences in relational-interdependent self-
construal underlie the observed differences between Mexican Americans and Korean Americans
in the role of social support in coping with stressors that affect health. Future research could
examine the role of this theoretical distinction, as well as distinctions between face and honor
cultures (Leung & Cohen, 2011) and between tight and loose cultures (Harrington & Gelfand,
2014), all of which are relevant to the ethnic groups we studied.
Finally, regarding the reliance on cross-sectional data, although our models assume that
social ties influence mental health outcomes, past longitudinal research has demonstrated that
mental health has a bi-directional association with social networks such that mental distress may
also contribute to reductions in the size of social networks (Johnson, 1991). This possible bi-
directional association deserves more attention across cultures.
Several strengths should also be acknowledged, including the use of sizable samples of adults
representing several diverse cultures, which enabled us to identify important group differences in
the processes being examined. In addition, the use of measures of stress and social support that
are not operationally confounded with one another is another strength of this study. In other stud-
ies, there is often a concern when life events indices are employed to measure stress, as some of
the events measured are associated with the formation and dissolution of social ties (i.e., divorce,
death of a loved one, marriage, birth of a child, etc.). Our use of a self-report measure of per-
ceived stress, even though it is based on a single item, enables us to avoid this confounding.
Future Directions
In summary, these findings affirm the important role that social factors can sometimes play in
coping with stressors that affect health, while underscoring the culturally bounded nature of this
relationship. Future research could investigate the implications for other collectivistic and indi-
vidualistic cultural groups. Studies could also examine which types of social support are most
effective in buffering stress in distinct ethnic groups. For instance, our research focused on
aspects relevant to structural social support, but it is possible that other patterns would be
observed for functional types of support (Baum et al., 2012; Cohen & Wills, 1985; S. E. Taylor,
2011).
Shavitt et al. 975
The health advice-seeking patterns we observed also deserve further attention. For instance,
they have implications for the effective delivery of health communications to ethnic cultural
groups. Word of mouth communication may be more important in Mexican American or Hispanic
contexts, whereas mass mediated messaging may be more effective in delivering health informa-
tion to those in Asian cultural contexts. This possibility awaits further research.
Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publi-
cation of this article: Preparation of this paper was supported by Grant No. 1R01HD053636-01A1 from the
National Institutes of Health, Grant No. 0648539 from the National Science Foundation, and Grant No.
63842 from the Robert Wood Johnson Foundation.
Note
1. Uses of specific media types also varied by group, with the Internet more likely to be the primary source
of health advice for Korean Americans (48.0%) and Whites (33.1%) than for Mexican Americans
(16.6%) and African Americans (9.9%), χ2 = 67.3, p < .001. TV was a greater source of health advice
for African Americans (21.2%) than for other groups—Whites (3.3%), Mexican Americans (10.8%),
and Korean Americans (10.7%), χ2 = 24.2, p < .001. Of course, socioeconomic differences may play
a role in these patterns, especially with respect to Internet access. It should be noted that regression
analyses showed that one’s primary source of health advice did not predict self-reports of either mental
or physical health in any ethnic group.
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Culture Moderates The Relation Between Perceived Stress, Social Support, and Mental and Physical Health

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Sharon Shavitt1, Young Ik Cho2, Timothy P. Johnson3,

1University of Illinois at Urbana–Champaign, IL, USA

Stress, Social Support, and Cultural Background

Overview of the Present Study

Sampling and Recruitment

(for Structural Social Support).

Social support Depression/mental health Physical health

Cultural/Ethnic Group Differences in Mental Health Ratings

Cultural/Ethnic Group Differences in Physical Health Ratings

to African Americans (M = 2.498; t = −2.949, p = .003), yet similar to Korean Americans (M =

Cultural/Ethnic Group Differences in Stress Ratings

Cultural/Ethnic Group Differences in Social Support Ratings

Relations Between Stress and Health Self-Reports Across Cultural/Ethnic Groups

Relations Between Social Support and Health Self-Reports Across Cultural/Ethnic

All White Mexican American African American Korean American

All White Mexican American African American Korean American

Self-Reported Sources of Health Advice Across Cultural/Ethnic Groups

Table 5. Three-Way Interaction Model for Prediction of Depression/Mental Health.

Three-way interaction model

Discussion and Conclusions

Stress and Mental Health/Depression by Social Support

Stress and Physical Health by Social Support

Table 6. Three-Way Interaction Model for Prediction of Physical Health.

Three-way interaction model

Limitations and Strengths

Declaration of Conflicting Interests

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