JOURNAL OF AGING AND HEALTH / August 2000

Allen et al. / LIFE COURSE AND SOCIAL SUPPORT

Stage of Life Course and Social Support

as a Mediator of Mood State
Among Persons With Disability

SUSAN M. ALLEN, PhD

DESIRÉE CIAMBRONE, PhD
Center for Gerontology and Health Care Research, Brown University
LISA C. WELCH, MA
Department of Sociology, Brown University

Objective: This research seeks to determine which aspects of social support are most
effective in mediating mood state among working-age and elderly adults with disabil-
ity (N = 442). Methods: Participants were identified through random-digit dialing of
telephone exchanges and administration of a disability screen. Multiple regression
was used to model multiple aspects of social support while holding sociodemographic
and disability indicators constant. Results: Analyses revealed that network size and
confidence in the reliability of helping networks are significantly and negatively
related to depressed mood. Confidant support was related to lower levels of depressed
mood for younger respondents only. Neither marital status, advisor support, nor social
integration were related to mood. Discussion: Both instrumental and emotional sup-
port are key in mediating depressed mood among this population. We conclude that all
types of social support are not equally effective in mediating mood among people with
disability.

Depression is a common sequela of chronic, debilitating physical con-

ditions (Elliott & Shewchuk, 1995). The symptoms, especially pain,
that may accompany a physically disabling illness are strong and sig-
nificant predictors of negative mood and psychological distress

AUTHORS’ NOTE: Address correspondence and reprint requests to Susan M. Allen, Center
for Gerontology and Health Care Research, Brown University, Box G-B214, Providence, RI
02912. This work was supported by grants from the Robert Wood Johnson Foundation (028141)
and the National Institute on Aging (AG12449).
JOURNAL OF AGING AND HEALTH, Vol. 12 No. 3, August 2000 318-341
© 2000 Sage Publications, Inc.

318
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 319

(Bruce, Seeman, Merrill, & Blazer, 1994; Faucett, 1994; Fifield,

Reisine, Sheehan, & McQuillan, 1996; Williamson & Schulz, 1995;
Wolfe & Hawley, 1993; Wright et al., 1996). Depressed mood, in turn,
may pose additional obstacles to a person’s ability to function effec-
tively in daily life.
Research shows that social support acts as a buffer against stressful
life events, including depressed moods associated with poor physical
health. Social support networks, particularly familial networks, often
ease adjustment to chronic illnesses (Bloom, 1982; Bloom & Spiegel,
1984; Friedman et al., 1988; Northouse, 1981; Vachon, 1986) and
encourage health-promoting activities and lifestyles (Levy, 1983;
Spiegel, Bloom, & Yalom, 1981). The positive effects of social sup-
port on morale, coping, and even mortality are well established in
large-scale studies of the general population (Berkman & Syme,
1979; Ell, Nishimoto, Mediansky, Mantell, & Hamovitch, 1992;
House, Landis, & Umberson, 1988a; Waxler- Morrison, Hislop,
Mears, & Kan, 1991). However, despite the extensive research vali-
dating the benefits of social support for a variety of health outcomes,
the mechanisms by which social support operate remain open to
debate and study (Broadhead & Kaplan, 1991; House et al., 1988b).
This research aims to advance our understanding of the relationship
between social support and mood among adults with chronic dis-
abling illnesses and conditions. Specifically, we seek to differentiate
those aspects of social support that are particularly effective as media-
tors of depressed mood from those that are less effective. Furthermore,
we examine whether the particular types or aspects of social support
that matter most differ according to stage of adult life course, namely,
preretirement versus postretirement age.

Social Support and Depression

Typically, researchers conceptualize social support in terms of two

general categories—emotional and instrumental assistance (Bailey,
Wolfe, & Wolfe, 1996; Morgan, 1989). It is not uncommon for
researchers to use indices of social support that combine instrumental
and emotional aspects, making it difficult to determine which has the
greatest impact on mood (e.g., Gilchrist & Creed, 1994; Revenson,
320 JOURNAL OF AGING AND HEALTH / August 2000

Schiaffino, Majerovitz, & Gibofsky, 1991). Furthermore, there are

multiple dimensions within these general categories, making it hard to
identify which aspects of social support are most effective in specific
situations. Below we review the theoretical and empirical work on
social support and mental health and discuss how this literature relates
to our study of support and mood among people with disability.

INSTRUMENTAL SUPPORT

Instrumental, or tangible, assistance typically refers to actual trans-

actions that occur between the care provider and care recipient (i.e.,
received support) (Thoits, 1991). However, instrumental support may
also be measured in terms of support availability, including investiga-
tion of the structure of support networks (e.g., network size and living
arrangement).
Due to the problems accompanying physical conditions (e.g., pain,
progressive impaired mobility, and fatigue), persons with disability
may require assistance with a range of daily activities. A shortage of
adequate instrumental assistance may lead to unmet daily living needs
that can interfere with condition management and ultimately compro-
mise health status. Theoretically, the larger one’s social network, the
more instrumental support available, as helpers can share support
tasks and reduce burden (Berg & Piner, 1990). Whereas one helper
may suffice through phases of temporary disability (e.g., recovery
from surgery), a large network may be crucial to individuals for whom
disability is ongoing. For example, among adults with disability living
in the community, the availability of three or more helpers decreased
the likelihood of unmet need for help with daily living tasks (Allen &
Mor, 1997).
Cognitive guidance, or having someone to offer advice and infor-
mation, is often classified as an aspect of instrumental support (Fiore,
Becker, & Coppel, 1983). Given the concomitant uncertainties of ill-
ness and increased need for greater information about one’s condition,
an advisor may provide information about medical care, treatment
options, and links to other necessary resources (Antonucci & Depner,
1982; Berkman, 1983) as well as feedback on how one is coping with
his or her disability (Schaefer, Coyne, & Lazarus, 1981; Wortman &
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 321

Conway, 1985). The positive effects of advisor support on depressed

mood have been demonstrated in studies of older adults (Newsom &
Schulz, 1996) and spousal caregivers to people with Alzheimer’s dis-
ease (Fiore et al., 1983).
Although objective measures of support availability such as net-
work size are important, qualitative measures of social support may be
more important than quantitative indicators (Kutner, 1987; Smith,
Redman, Burns, & Sagert, 1986). In fact, in several studies, perceived
adequacy of support was more strongly associated with lower depres-
sion scores than were objective support network indicators (Godding,
McAnulty, Wittrock, Britt, & Khansur, 1995; Newsom & Schulz,
1996; Oxman, Berkman, Kasl, Freeman, & Barrett, 1992). Similarly,
perceived confidence in the reliability of support networks to help
when needed has a protective function against psychological distress
associated with stressful life events (Cohen, 1988) and has also been
shown to have greater power in predicting unmet need than network
size (Mor, Allen, Siegel, & Houts, 1992). The perceived reliability of
one’s social support network may be critical for people with long-term
disabilities with little or no chance of improvement. Subjective indica-
tors of support may be more realistic measures, as they more accu-
rately reflect people’s past experiences with their support systems.

EMOTIONAL SUPPORT

Emotional support helps to ease the distress associated with alter-

ations in lifestyle and self-image that accompany disability by offer-
ing self-validation and reassurance (Morgan, 1989). Having someone
to confide in about personal issues appears to be the “simplest and
most powerful measure of social support” and is the most common
operationalization of the concept (Thoits, 1995, p. 64). Confiding
relationships allow individuals an opportunity to discuss their prob-
lems and concerns with significant others (Cohen, 1988). Research
shows that the presence of a confidant contributes to well-being for
older adults (Gupta & Korte, 1994), and women with cancer identify
having a confidant as the most advantageous type of social support
(Smith et al., 1986).
322 JOURNAL OF AGING AND HEALTH / August 2000

The need for various types of support may vary according to one’s
illness trajectory; thus, there may be times when emotional support
may be equally important or more important than instrumental help.
Satisfying emotional support, for example, makes a more marked
impact than instrumental support among scleroderma outpatients
(Roca, Wigley, & White, 1996) and long-term cancer survivors
(Bloom et al., 1991), the majority of whom do not have ongoing diffi-
culties with physical functioning. However, people with chronic dis-
abilities are likely to need both emotional and instrumental support,
given the concomitant ongoing need for practical assistance and the
increased risk of social isolation that prevents the formation of social
ties.

MARITAL STATUS

Marital status is an indicator of social support that involves compo-

nents of both instrumental and emotional support. The protective psy-
chological and physical health benefits of being married are well
established, particularly for men (Argyle, 1992; Berkman, 1983;
House & Kahn, 1985; Schone & Weinick, 1998). When faced with
external stressors such as illness and disability, married individuals
appear to fare better than their unmarried counterparts (Thompson &
Pitts, 1992). Not surprisingly, when married individuals become
impaired, they typically turn to their spouse for assistance (Thompson &
Pitts, 1992).
Theoretically, married individuals are in an ideal position to pro-
vide emotional and instrumental support due to their long-term, inter-
nalized commitment and close proximity to their spouses (Messeri,
Silverstein, & Litwak, 1993). However, as recent research suggests,
being married does not guarantee positive spousal support (Allen,
Goldscheider, & Ciambrone, 1999). The assumption that spouses are
able and willing to meet a variety of support needs is problematic,
especially in regard to middle-aged adults with disability, due to the
premature need for spousal care. Furthermore, given gender differ-
ences in caregiving, the effect of marital status on depressed mood
may well differ for husbands and wives (Allen, 1994).
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 323

SOCIAL INTEGRATION

Although social integration has been conceptualized in various

ways (Fiore et al., 1983), the term generally refers to the extent to
which individuals socially engage with others, typically outside of
their familial networks. The antithesis of social integration is social
isolation, a ubiquitous problem among people with disability. Dis-
abling conditions may lead to a reduction in recreational activity, sev-
erance of community ties, and reduction in opportunities for socializ-
ing with friends and relatives.
Research has found community attachment and higher levels of
socialization to be inversely associated with negative mood states,
including lower levels of depression, among residents of rural com-
munities (O’Brien, Hassinger, & Dershem, 1994) and lower anxiety
scores among spouses of terminally ill individuals (Willert, Beckwith,
Holm, & Beckwith, 1995). Similarly, feelings of belonging and social
activity mediated depression among people with a variety of chronic
illnesses including Hodgkin’s disease (Bloom et al., 1991) and spinal-
cord injuries (Elliott et al., 1991; Fuhrer, Rintala, Har, Clearman, &
Young, 1993).

Social Support, Depression, and Disability

in Younger Versus Older Adulthood

In addition to describing the experiences of living with disabilities

in old age, research is beginning to identify the unique difficulties of
disability in middle life. This literature notes that issues that are less
relevant to older adults are pertinent to adults who become disabled in
midlife, including reevaluating one’s goals, dealing with discrimina-
tion in the workforce, establishing intimate relationships, and ensur-
ing the future welfare of one’s children (Bryan, 1996; Lyons, Sullivan, &
Ritvo, 1995; Quinn, 1998).
Adults who are born with, or who have developed disabling condi-
tions as children and adolescents, face obstacles to full participation in
social life that are similar to those who become disabled in midlife.
Although they have had more experience managing and coping with
illness, they are often blocked from realizing socially valued goals
324 JOURNAL OF AGING AND HEALTH / August 2000

from early on such as gainful employment, home ownership, educa-

tional pursuits, and marriage.
Middle-aged adulthood is typically characterized by participation
in multiple roles including familial obligations and gainful employ-
ment. In fact, individuals are considered well-adjusted adults, in large
part, by successfully meeting social and occupational responsibilities
(Bryan, 1996, p. 143). The stigma and social isolation accompanying
many types of disability, however, make achieving social goals much
more difficult and at times impossible.
In contrast, older adults have already transitioned out of many roles
and have had to deal with substantial loss. Furthermore, due to the
increasing prevalence of chronic conditions with age, older adults
have generally had more experience with chronic pain and activity
restrictions and hence tend to tolerate them better than their younger
counterparts (Williamson & Schulz, 1995). Not surprisingly, studies
of various illness populations have revealed that younger respondents
demonstrated higher levels of depression than their older counterparts
(Laatsch & Shahani, 1996; Roca et al., 1996; Turner & Wood, 1985;
Wright et al., 1996).
Research conducted on women with breast cancer at the time of
diagnosis or while undergoing treatment illustrates these points. This
work suggests that women’s experiences with and reactions to breast
cancer vary substantially according to stage of the life course. In par-
ticular, research has shown that women in midlife fare poorly on a
broad range of quality-of-life measures in comparison to women who
are elderly at the time of diagnosis (Mor, Allen, & Malin, 1994; Mor,
Malin, & Allen, 1994). In short, although the need for instrumental
assistance may be the same, the untimeliness of illness and disability
in young and middle-aged adults may result in a greater need for emo-
tional support than exists among their elderly counterparts.
In summary, research has identified a number of aspects of social
support to be helpful in mitigating depression among people with dis-
ability, and this research seeks to determine which of several indica-
tors of social support are more effective than others. Because disabil-
ity in this sample is ongoing, we hypothesize that both instrumental
and emotional support will be protective of negative mood, and based
on past results, we expect that subjective perceptions will be more
effective in mediating depression than objective measures. In
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 325

addition, we hypothesize that emotional support and opportunities for

social engagement will be more important for younger than for elderly
respondents, given the barriers and problems to fulfilling social roles
and establishing social relationships presented by disability when it
occurs in midlife as opposed to the retirement years.

Data and Methods

The data for this study were collected as part of a community study
of people with disability residing in a medium-size city in western
Massachusetts. Participants (N = 632) were recruited through random-
digit dialing, with eligible respondents identified by a disability
screen. Study eligibility criteria specified a health problem lasting 3 or
more months and need for assistance in at least one activity of daily
living (ADL), or use of mobility equipment or inability to walk one
quarter mile. Nonelderly adults who received Supplementary Security
Income or Social Security Disability Income were also eligible. We
strove for equal numbers of adults older and younger than 65, target-
ing 300 participants in each strata, or a total of 600 individuals. Sev-
enty eight percent of identified eligible people agreed to participate,
yielding a final sample of 632 participants (311 aged 18 to 64, 321
aged 65 and older). All interviews were conducted by telephone.
This data set provides two significant advantages. The inclusion of
nonelderly adults with disabilities provides a unique opportunity to
evaluate social support and mood among a younger population rela-
tive to an elderly population. Second, because a main focus of the
interview was concerned with management of disability in everyday
life, indicators of various aspects of social support are available in a
single data set.

Analytic Sample

Of the 632 participants in this study, 95 had proxies respond to the

interview for them. Highly subjective questions such as those with
regard to mood state were not asked of proxy respondents. Therefore,
these 95 cases are not included in this study. An additional 95 cases are
excluded due to one or more missing values on the independent
326 JOURNAL OF AGING AND HEALTH / August 2000

variables selected for multivariate modeling. Thus, our analytic sam-

ple comprises 442 cases.

Dependent Variable

The dependent variable for multivariate analysis is mood state,

measured by the widely used five-item Mental Health Index (MHI-5)
(Ware & Sherbourne, 1992). Respondents were asked, “How much of
the time during the past month have you

been a very nervous person?”

felt so down in the dumps that nothing could cheer you up?”
felt calm and peaceful?”
felt downhearted and blue?”
been a happy person?”

Response categories include all of the time, most of the time, a good
bit of the time, a little bit of the time, or none of the time. Scores for in-
dividual items range from 0 (none of the time) to 4 (all of the time).
Thus, scores for the full scale range from 0 to 20 (with 20 indicating
the most depressed mood state).

Independent Variables

Social support indicators. We tested a variety of indicators of net-

work support. Our measures of instrumental support include network
size, advisor support, and perceived confidence in the reliability of
support systems. Network size was established by the question, “How
many relatives and friends do you feel you can turn to for help or can
rely on when you need help?” Because the distribution of responses to
this question was highly skewed, we collapsed the variables into two
categories (0 = none to two helpers, 1 = three or more helpers). To
ascertain the presence or absence of an advisor, respondents were
asked, “Do you have someone to turn to for advice when you need to
make a decision or solve a problem?” (yes = 1, no = 0). Confidence in
the reliability of support systems was ascertained by asking respon-
dents, “How confident are you that your family and/or friends would
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 327

provide help when you need it?” Responses were coded as 0 = not or
somewhat confident, 1 = very or extremely confident.
Our measure of emotional support, the presence of a confidant, was
ascertained by the following question: “People sometimes look to oth-
ers for companionship, assistance, or other types of support. Do you
have someone you can talk to about your personal feelings, worries or
hopes?” (yes = 1, no = 0). Marital status is often used as a proxy for the
presence of social support, with the assumption that married people
have adequate instrumental and emotional help. To test for the impor-
tance of spousal support in mediating depression, we included a
dichotomous variable, married (1) versus unmarried (0, including
never married, divorced or separated, and widowed).
Finally, as an indicator of integration into the community, we
include the number of times per week respondents reported leaving
their homes. Response categories range from never (0) to every day
(4). This variable is included in our multivariate model as a continuous
variable.

Age. Age was operationalized as a dichotomous variable with 1 =

age 65 and older and 0 = younger than 65 and older than 21. This form
of the variable was used to capture the effect of stage of life course,
namely, working-age versus retirement-age adulthood.

Disability and morbidity. To control for the severity of illness and

disability on mood state we included several morbidity indicators,
including number of ADL impairments (range 0-6) and instrumental
activities of daily living (IADL) impairments (range 0-4). Two dichot-
omous (1, 0) variables were created for bivariate analyses to reflect
high levels of ADL and IADL impairment (3+ vs. 0-2); continuous
forms of the variables were used for multivariate modeling. (I)ADL
impairment was assessed by asking respondents if they have difficulty
or need assistance with a number of ADL tasks (showering and bath-
ing, dressing, eating, transferring, toileting, and moving around
indoors) and IADL tasks (grocery shopping, meal preparation, and
light and heavy housekeeping).
As noted above, pain is a strong and consistent predictor of depres-
sion. The extent of pain caused by participants’ disabilities was elic-
ited by the question, “How much bodily pain have you had during the
328 JOURNAL OF AGING AND HEALTH / August 2000

past month? Would you say none, very mild, mild, moderate, severe or
very severe?” Responses were categorized as none (0), mild-moderate
(1), severe-very severe (2), and this was entered as a continuous vari-
able into our model.

Other control variables. Literature points to the importance of gen-

der, race, education, and poverty status on social support and mood;
thus, these variables are included to control for confounding influ-
ences. Gender is dummy-coded with female as the reference group.
Race was self-reported (via the question, “What race do you consider
yourself to be? Are you White, Black, Asian or Pacific Islander, or
something else?”). Race was coded into three categories: non-His-
panic White, non-Hispanic Black, and Hispanic, with White as the
reference group. Given the small number of cases (n = 9) coded as
another race, these cases were not included in the analyses. Two vari-
ables are used to measure socioeconomic status—educational level
and ability to meet daily expenses. Education was dummy-coded into
college graduate (1) versus lower levels of education (0), as mood
scores were fairly consistent across groups with the exception of those
with a college or postgraduate education, who displayed more positive
mood scores. To assess respondents’ financial situations, we inquired
about routine expenses and their ability to meet these expenses. Spe-
cifically, we asked if there were “times in the past 12 months when you
did not have enough money to buy or pay for” the following items:
clothing, food, rent or mortgage, medical bills, prescription drugs, and
utility bills. Based on the distribution of responses, this variable was
coded as none, 1-2, and 3 or more.

Analytic Approach

Chi-square analyses were used to detect differences in the distribu-

tion of independent variables by age groups (ages 65 and older vs.
younger than 65). Spearman correlation coefficients were calculated
to determine the extent to which our six indicators of social support
were related to each other. A high correlation (i.e., above .7) would
indicate that we were measuring very similar aspects of social support
rather than distinct aspects. Analysis of variance was used to determine
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 329

the bivariate relationship between our independent variables and the

dependent variable, mood state.
Finally, multiple regression was used to control for independent
variables simultaneously. Variables were entered into the model in
separate blocks in order to assess the additive explanatory power of
each set of variables. We first entered all sociodemographic character-
istics simultaneously. We added measures of disability next. Our third
block of variables included all six indicators of social support. As a
final block for entry into the model we interacted age with the social
support indicators that we hypothesized would ameliorate negative
mood (i.e., presence of a confidant and social integration). Nonsignifi-
cant interaction terms were not included in the final model.

Results

Descriptive information with regard to our independent variables

by age groups is presented in Table 1. Not surprisingly, due to gender
differences in life expectancy our sample contains a higher proportion
of females than males. There are also a greater proportion of White
respondents compared to Blacks and Latinos. In terms of our socio-
economic status (SES) measures, the vast majority of respondents
have less than a college education, and approximately half can afford
all basic living expenses. Our disability variables show that respon-
dents tend to have more IADL impairments than ADL impairments
and mild to moderate levels of pain. They also tend to have fairly high
levels of social support; that is, most reported having three or more
helpers, a confidant, and an advisor. In addition, over half of the sam-
ple are very or extremely confident of the reliability of their support
network. Our sample appears to have moderate chances for social
engagement; that is, respondents typically leave their homes about
one to three times per week. Not surprisingly among this population,
most are not married.
There are a number of statistically significant differences between
age cohorts in the sample. Specifically, younger respondents are more
likely to be male and are also more likely to be members of a minority
group than are older (age 65+) respondents. Younger respondents are
also poorer than older respondents, indicated here by reporting
330 JOURNAL OF AGING AND HEALTH / August 2000

Table 1
Independent Variables by Age Groups (N = 442)

Ages 18-64 Ages 65+

Variable (n = 232) % (n = 210) % Total

Demographics
Gender**
Female 56.0 74.8 64.9
Male 44.0 25.2 35.1
Race**
White 57.3 77.1 66.7
Black 25.9 18.6 22.4
Hispanic 16.8 4.3 10.8
Education
College graduate 9.5 7.6 8.6
Noncollege graduate 90.5 92.4 91.4
Number of basic expenses cannot afford**
None 36.2 67.1 50.9
1-2 28.4 21.0 24.9
3+ 35.3 11.9 24.2
Disability
ADL impairment
0-2 64.7 65.7 65.2
3+ 35.3 34.3 34.8
IADL impairment*
0-2 42.7 37.6 40.3
3+ 57.3 62.4 59.7
Pain
None 11.2 12.4 11.8
Mild to moderate 50.9 57.6 54.1
Severe 37.9 30.0 34.2
Social support
Number of helpers
0-2 32.8 29.0 31.0
3+ 67.2 71.0 69.0
Times leaving home**
Never 1.7 7.1 4.3
Less than once/week 4.7 12.4 8.4
1-3 times/week 33.2 40.0 36.4
4-6 times/week 25.0 18.6 21.9
Every day 35.3 21.9 29.0
Marital status
Married 38.8 34.8 36.9
Unmarried 61.2 65.2 63.1
Advisor
Yes 78.0 79.0 78.5
No 22.0 21.0 21.5
Confidant
Yes 84.9 82.9 83.9
No 15.1 17.1 16.1
Confident of support system**
Not or somewhat 39.2 27.6 33.7
Very or extremely 60.8 72.4 66.3

Note. ADL = activities of daily living; IADL = instrumental activities of daily living.
*p < .05. **p < .001.
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 331

Table 2
Intercorrelations of Social Support Variables

Number of Times Marital Confident of

Helpers Leaving Home Status Advisor Confidant Support System

Number of helpers 1.00

Times leaving home .14** 1.00
Marital status .10* .06 1.00
Advisor .23*** .05 .06 1.00
Confidant .24*** .04 –.05 .37*** 1.00
Confident of support
system .37*** .07 .09 .25*** .16*** 1.00

*p < .05. **p < .01. ***p < .001.

inability to afford basic living expenses. However, level of disability

and pain are comparable between the two age groups.
Although network size, marital status, and the proportion of
respondents having an advisor and confidant are similar between
older and younger groups, younger people report leaving their home
more often than older respondents. In addition, younger respondents
report less confidence in the ability of their support systems to provide
care.
As seen in Table 2, many of our social support variables are signifi-
cantly related to one another. Significant intercorrelations, however,
are of relatively low magnitude (< .4), indicating that multicollinearity
is not a problem, and that each variable measures a unique aspect of
social support.
Bivariate analyses reveal numerous associations between inde-
pendent variables and mood state (see Table 3). In fact, the only
nonsignificant difference in mood scores is between sample men and
women. Observed differences are in the expected direction at the
bivariate level, with younger respondents reporting greater negative
affect than older respondents, noncollege graduates reporting more
negative mood than college graduates, and poorer respondents faring
worse than those who can afford basic living expenses. Whereas
Whites and Blacks report comparable levels of depressed mood, His-
panics show a more negative mood state than both groups.
As expected, respondents with more ADL and IADL impairments
are scored higher on the MHI-5 than those with fewer impairments,
and people with more severe pain fared worse than those with less
332 JOURNAL OF AGING AND HEALTH / August 2000

Table 3
ANOVA for Mood Scores Independent Variables

Variable Average Mood Score SD

Demographics
Age***
18-64 7.30 4.48
65+ 5.80 3.73
Gender
Female 6.82 4.07
Male 6.16 4.43
Race**
White 6.36 4.14
Black 6.31 3.98
Hispanic 8.54 4.62
Education*
College graduate 5.24 4.15
Noncollege graduate 6.72 4.15
Number of basic expenses cannot afford***
None 5.22 3.46
1-2 6.93 4.20
3+ 9.11 4.43
Disability
ADL impairment***
0-2 5.95 3.84
3+ 7.79 4.59
IADL impairment***
0-2 5.61 3.81
3+ 7.25 4.34
Pain***
None 4.79 3.94
Mild to moderate 5.90 3.72
Severe 8.29 4.46
Social support
Number of helpers***
0-2 8.53 4.57
3+ 5.71 3.72
Times leaving home**
Never 5.37 3.74
Less than once/week 8.30 5.17
1-3 times/week 7.29 4.40
4-6 times/week 6.11 3.63
Every day 5.76 3.87
Marital status*
Married 6.01 3.97
Unmarried 6.92 4.31
Advisor*
Yes 6.34 4.12
No 7.48 4.40
Confidant**
Yes 6.34 4.03
No 7.90 4.87
Confident of support system***
Very or extremely 5.64 4.17
Not or somewhat 8.45 4.17

Note. ADL = activities of daily living; IADL = instrumental activities of daily living.
*p < .05. **p < .01. ***p < .001.
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 333

severe pain. Finally, nearly all indicators of social support suggest that
the presence of support, or of higher levels of support, are associated
with lower levels of depressed mood. A puzzling exception is the
small minority of people (4.3%) who report never leaving home but
have low levels of depressed mood comparable to people who leave
home every day.
Regression coefficients and 95% confidence intervals are pre-
sented in Table 4. Demographic variables were entered simulta-
neously in the first block. These variables explained 16% of the vari-
ance in levels of mood state, indicating that women and people who
cannot afford some of their basic expenses have more negative mood
states than their counterparts, i.e., men and people who can afford all
basic expenses. Blacks are less likely to have high levels of depressed
mood, as are college graduates.
In the next block, disability variables are added to Block 1, increas-
ing the predictive power of the model by 6%, to 22%. Pain is strongly
and significantly predictive of higher mood scores although ADL and
IADL impairment levels are not. When disability variables are added,
gender, education, and Black race no longer significantly predict neg-
ative mood state.
Our social support variables were entered in the third block,
2
increasing the adjusted R to 29%. Of these indicators, only the num-
ber of available helpers and confidence in family and friends were sig-
nificantly related to mood. The negative coefficient for number of
helpers reveals that having more people to whom one can turn for
assistance is significantly and negatively related to negative mood
state. Similarly, the highly significant coefficient for confidence in
support system suggests that those who are very or extremely confi-
dent that their family and/or friends will be there in times of need
experience less depressed mood. The presence of an advisor and
spouse, as well as the times per week one leaves his or her home, do
not appear very important in mediating negative affect among persons
with disability. With the addition of the social support variables, youn-
ger age is associated with higher depressed mood, whereas Black race
is associated with lower depressed mood. Other effects remain the
same.
Of the two interactions with age, only confidant status and age are
statistically significantly related to negative mood. Separate
334 JOURNAL OF AGING AND HEALTH / August 2000

Table 4
Multiple Regression Coefficients Predicting Mood (N = 441)

Block 1 Block 2 Block 3 Block 4

(CI) (CI) (CI) (CI)

Demographics
Aged 65+ (vs. 18-64) –.71 –.70 –.82* –2.70
(–1.502, .088) (–1.473, .065) (–1.573, –.068) (–4.471, –.934)
Female (vs. male) .79* .33 .19 .20
(.010, 1.562) (–.439, 1.098) (–.578, .963) (–.571, .962)
Black –.94* –.78 –.95* –.97*
(–1.845, –.026) (–1.665, .095) (–.1.798, –.092)(–1.814, –.116)
Hispanic .64 .51 .01 .00
(–.610, 1.887) (–.693, 1.720) (–1.160, 1.174) (–1.160, 1.163)
Education –1.32* –1.21 –.89 –.90
(–2.622, –.025) (–2.462, .039) (–2.092, .307) (–2.096, .291)
Number of basic
expenses cannot 3.57*** 2.92*** 2.18*** 2.07***
afford (2.597, 4.538) (1.962, 3.876) (1.230, 3.123) (1.129, 3.020)
Disability
3+ ADL impairment
(vs. 0-2 needs) .21 .19 .20
(–.031, .452) (–.045, .422) (–.030, .436)
3+ IADL impairment
(vs. 0-2 needs) .21 .10 .08
(–.099, .513) (–.193, .401) (–.219, .373)
Pain .51*** .54*** .52***
(.248, .768) (.290, .791) (.271, .771)
Social support
3+ helpers (vs. 0-2
helpers) –1.60*** –1.48**
(–2.409, –.785) (–2.291, –.663)
Leaving home –.19 –.21
(–.525, .137) (–.536, .123)
Married (vs. unmarried) –.58 –.58
(–1.311, .152) (–1.307, .148)
Has an advisor .31 .41
(–.591, 1.218) (–.494, 1.313)
Has a confidant –.44 –1.63*
(–1.451, .570) (–3.054, –.202)
Very or extremely
confident (vs. not or
somewhat confident) –1.32*** –1.30***
(–2.109, –.527) (–2.09, –.518 )
Interaction
Age × Confidant 2.19*
(.324, 4.049)
2
Adjusted R .16 .22 .29 .30

Note. CI = confidence interval; ADL = activities of daily living; IADL = instrumental activities
of daily living.
*p < .05. **p < .01. ***p < .001.
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 335

regression analyses were conducted for age groups 18 to 64 and 65

and older to facilitate interpretation of the interaction (data not
shown). These analyses revealed that having a confidant is effective in
mediating depressed mood for respondents in young or middle adult-
hood (age 18-64), but not for elderly respondents. This interaction is
entered in the final block, increasing our predictive power by an addi-
tional percentage point (to 30%), indicating a fairly high percentage of
explained variance.

Discussion

The mechanisms by which social support ameliorates depressed

mood are of theoretical and practical interest. To further the under-
standing of effects of support on psychological well-being, we investi-
gated the influence of life course stage and six indicators of various
aspects of social support on mood state in a randomly selected sample
of older and younger adults with chronic illness and disability. Results
from this analysis suggest that of all aspects of social support tested,
size of helping network and confidence in the ability of the network to
provide needed help are the strongest mediators of negative mood
state in this population. Furthermore, it appears that having a confi-
dant is more important for younger people with disability than for the
elderly.
Consistent with our prediction, our results suggest that aspects of
both instrumental and emotional support are key in mediating
depressed mood among people in this sample. Instrumental support is
crucial among the disabled population, perhaps making the difference
between remaining in the community and having to relocate to a more
restricted setting such as a nursing home. It is likely that the influence
of network size may also be related to dependability; that is, there is
more opportunity for substitution if one helper cannot come through.
Division of labor may also be more efficient among large helping net-
works, with the burden of helping distributed among a number of
helpers rather than one or two. Our study confirms previous findings
and suggests that a large network is a good indicator of adequate
instrumental support, thus mediating negative mood among adults
336 JOURNAL OF AGING AND HEALTH / August 2000

with chronic disabling conditions (e.g., Bazargan & Hamm-Baugh,

1995; Biegel, Magaziner, & Baum, 1991).
In addition to this objective measure, our analysis shows that our
subjective measure of instrumental support mediates negative mood
state. It is therefore not surprising that it is not only the existence of a
network that is important to maintaining positive mood but also confi-
dence in the ability of that network to provide care. Congruent with
other studies, these results reiterate the beneficial influence of percep-
tions of social support on mental health (Newsom & Schulz, 1996;
Oxman et al., 1992). This effect is independent of size, suggesting that
even a small network may be enough to offset depressed mood if one’s
helper or helpers are reliably there when needed. Given the proportion
of women who are employed in paid labor today, it is not surprising
that their disabled friends and family worry about their reliability as
care providers.
Contrary to other research (Schaefer, Coyne, & Lazarus, 1981;
Wortman & Conway, 1985), we found that having an advisor has little
effect on mood. Informational support appears to be significantly less
important than other aspects of instrumental assistance. Given the
losses accompanying disabling conditions, such as the decrease in
function (Friedland & McColl, 1992), the need for tangible help may
be more urgent than for cognitive guidance. Furthermore, the impact
of advisor support may vary depending on other factors, including
personality characteristics. For example, in their investigation of psy-
chological adjustment among persons with spinal cord injuries, Elliot
et al. (1991) found that higher levels of guidance support mediated
depression among unassertive respondents but not among assertive
respondents. These authors found that advisor support may heighten
levels of distress among individuals who feel that others are in greater
control of information and hence, their behavior. Thus, advisor sup-
port may be advantageous for certain types of individuals (e.g., less
assertive), but not equally beneficial for the population as a whole.
With other indicators of social support held constant, marital status
does not appear to be an important mediator of depressed mood in this
population. This finding suggests a cautionary attitude toward con-
ventional wisdom that married people have adequate social support in
times of need. Although a spouse is a potentially ideal source of sup-
port, not all partners are equipped to cater to the needs of their
 Allen et al. / LIFE COURSE AND SOCIAL SUPPORT 337

impaired spouses. Spousal support may be particularly problematic in

middle age, a period when adults generally do not expect to assume
spousal caregiving roles. Furthermore, an unhappy or emotionally
distant marriage may well be more of a detriment to one’s health than
the lack of such a relationship (Allen et al., 1999).
Results from this analysis also emphasize the importance of emo-
tional support to people who become ill or disabled “before their
time,” when age peers are active in multiple roles. Contrary to other
studies showing the positive effects of a confiding relationship on
health (e.g., Gupta & Korte, 1994; Smith et al., 1986), our analysis
suggests that the importance of a confidant may vary by age. This type
of emotional support may not be as important to the mood state of the
elderly, whose expectations may allow for better acceptance of the ill-
ness experience. Furthermore, it is much more difficult for younger
adults with disability to establish and maintain close social ties than it
is for older adults with disability. Although ill health may make it diffi-
cult for elderly persons to maintain relationships, they are more likely
to be in contact with family members and/or long-time friends. Youn-
ger persons, on the other hand, are often prematurely excluded from
social roles that facilitate such relationships.
Given the frequently reported benefits of social integration (e.g.,
Bloom et al., 1991; Elliot et al., 1991; Willert et al., 1995), it was sur-
prising that opportunity to socialize was not a statistically significant
predictor of mood among this population. This may be in part because
our indicator of social integration (i.e., the number of times per week
that respondents left their homes) did not capture the essence of this
multidimensional concept. Perhaps employing a more specific vari-
able or variables that measured respondents’ actual social engagement
in lieu of socialization potential would yield significant results. For
example, the extent to which respondents get together with friends
and/or a measure of the specific activities in which respondents partic-
ipate may more aptly capture their degree of social involvement. In
addition, our findings may reflect a scenario wherein individuals are
engaging in social activities to varying degrees without leaving their
homes (e.g., entertaining friends and family in their houses). Thus,
respondents may be getting their socialization needs met even though
they appear to be somewhat detached from the larger community.
338 JOURNAL OF AGING AND HEALTH / August 2000

It is clear from these results that social support is a catchall phrase,

and that all types of social support are not equally effective in mediat-
ing mood state for this vulnerable population. This study included a
theoretically important set of social support indicators; however, the
aspects of social support investigated here are not exhaustive. Future
research should continue to explore the multidimensionality of this
important construct. Studies that aim at further specifying the concept
of social support across life course stages will identify those aspects of
support that are most important to the well-being of people with dis-
ability at various ages. Theoretically, such research may lead to finer
conceptualizations of social support, allowing researchers to replicate
findings from other studies. These studies would also assist health
care professionals in detecting specific types of unmet support needs
experienced by disabled populations who live in the community and
who rely on informal care.

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