THE ASSOCIATIONs AMONG SOCIAL SUPPORT, STRESS, AND LIFE SATISFACTION AS PERCEIVED BY INJURED COLLEGE ATHLETES

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1 SOCIAL BEHAVIOR AND PERSONALITY, 2010, 38(6), Society for Personality Research (Inc.) DOI /sbp THE ASSOCIATIONs AMONG SOCIAL SUPPORT, STRESS, AND LIFE SATISFACTION AS PERCEIVED BY INJURED COLLEGE ATHLETES Romualdas Malinauskas Lithuanian Academy of Physical Education, Kaunas, Lithuania The relationships were examined among severity of injury, and participants perceptions of stress, social support, and life satisfaction. Participants were 123 college athletes (male, n = 69, female n = 54) with minor (69) or severe (54) injuries, who ranged in age from 18 to 25 years. Participants completed measures of perceived social support, stress, and satisfaction with life. Greater perceived stress was associated with diminished life satisfaction for athletes with a major injury more than for those with a minor injury. The interaction between perceived stress and perceived social support was associated most with diminished life satisfaction for participants with a major injury. Keywords: perceived stress, perceived social support, life satisfaction, sports injury, college athletes. In recent years there have been many studies of the relationship among stress, social support, and psychological well-being or life satisfaction (Hardy, Richman, & Rosenfeld, 1991; Malinauskas, 2008; Petrie, 1992, 1993; Ryska & Yin, 1999; Smith, Smoll, & Ptacek, 1990). Stress can be defined as an experience when people perceive situational demands to exceed their coping resources (Ryska & Yin, 1999; Udry, Gould, Bridges, & Tuffey, 1997). In their sport, athletes often have to deal with acute Romualdas Malinauskas, Professor, Department of Psychology, Lithuanian Academy of Physical Education, Kaunas, Lithuania. Appreciation is due to reviewers including: Ramazan Ari, Faculty of Occupational Education, Selcuk University, Alaaddin Keykubat Kampusü, Konya, Turkey, ramazanari2@yahoo.com Please address correspondence and reprint requests to: Romualdas Malinauskas, Department of Psychology, Lithuanian Academy of Physical Education, Sporto 6, Kaunas, Lithuania. Phone: ; Fax ; r.malinauskas@lkka.lt 741

2 742 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY stress, which is a persistent feature of time-limited and short-term events (Wasley & Lox, 1998). It is also important not to overlook long-term stressors that athletes may encounter, such as dealing with an injury. An injury can be stressful and this stress can impede the rehabilitation process (Washington-Lofgren, Westerman, Sullivan, & Nashman, 2004). From the behavioral perspective, perceived stress may influence health practices, social coping, and well-being (Cohen & Williamson, 1988). Researchers (Warren, Wrigley, Yoels, & Fine, 1996) have recognized the importance of injury severity and the mechanism of injury in emotional response and in life satisfaction. In several studies it has been demonstrated that severe injuries have a greater effect on mood states than do minor injuries. For example, Smith et al. (1990) noted that when injured athletes were categorized according to the severity of injury, the least seriously injured athletes said they experienced less tension, fatigue, and confusion than did the athletes who had more serious injuries. The most seriously injured athletes experienced significantly more tension, anger, and decreased vigor compared to the other groups (Smith et al.). The severity of the injury and the athlete s perception of recovery appeared to influence the mood state. A second factor likely to impact upon athletes life satisfaction is life event stress. In a study with collegiate football players by Albinson and Petrie (2003) a significant relationship was found between life event stress and mood disturbance after an injury. These authors reported that greater perception of a negative life event stress predicted greater postinjury mood disturbance immediately after the injury occurred. Athletes with a greater perception of stress at day four after an injury reported greater difficulty in coping with the injury at day seven (Albinson & Petrie). Brewer, Linder, and Phelps (1995) explored the relationships between a variety of situational factors and emotional adjustment to athletic injury. They found that postinjury depression was significantly correlated with physician-rated current injury status, perceived impairment of sport performance, and perceived social support for rehabilitation. A number of researchers (Ahern & Lohr, 1997; Brewer et al., 1995; Reed & Giacobbi, 2004) have found that stress has a direct (main) negative effect and that social support has a direct (main) positive effect on psychological adjustment of injured athletes. However, in some studies there has also been evidence of the stress-buffering effect of social support, that is, an interaction between social support and stress such that social support has more impact on psychological adjustment under conditions of high stress (Cohen & Wills, 1985; Hamarat & Steele, 2002; Rees & Freeman, 2007). According to Cohen and Wills, stressbuffering mechanisms of social support could intervene between the stressful event and a stress reaction by attenuating or preventing a stress response. Alternatively, adequate support may intervene between the experience of stress

3 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY 743 and the onset of a pathological outcome by reducing or eliminating the stress reaction or by directly influencing physiological processes. There are studies in which the relationship between stress and social support in the injured athletes has been specifically examined (Bone & Fry, 2006; Quackenbush & Crossman, 1994; Ryska & Yin, 1999) but the present study differs from these investigations in that the studies already mentioned were not focused on the associations among social support, stress, and life satisfaction as perceived by the injured athletes. For a variety of reasons, it is important to know the factors influencing the perception of life satisfaction of injured athletes as life satisfaction is viewed as a major adaptive outcome of coping and an important indicator of quality of life. As the findings of previous researchers suggest (Brewer, 2007) examining injured athletes life satisfaction is important because prolonged negative cognition can lead to negative affect which may affect subsequent rehabilitation behaviors (e.g., rehabilitation adherence), functional rehabilitation outcomes (e.g., proprioception, muscular endurance, agility), and postinjury performance. Social support is an integral aspect of the social environment and a wellknown and widely recognized concept associated with positive health practices that influence an athlete s life satisfaction. Social support is defined by Cohen, Underwood, and Gottlieb (2000) as the social resources that persons perceive to be available or that are actually provided to them by non-professionals in the context of both formal support groups and informal helping relationships (p. 4). Cohen and Wills (1985) found perceived social support to be more significant in relation to health behaviors than was actual social support. Their rationale for this finding is that if the resources of support are not perceived as being present by an individual, they cannot be utilized. This theory is supported in a number of studies which it has been found that perceived social support was more influential than actual social support for establishing a level of well-being and life satisfaction (Cohen & Wills; Feldman, Dunkel-Schetter, Sandman, & Wadhwa, 2000). Social support preserves health by protecting or buffering a person from ill effects of stress (Hamarat & Steele, 2002). Theoretically, social support is an important factor in trauma recovery (Robins & Rosenfeld, 2001). It has been proposed in relevant literature (Hamarat & Steele; Robins & Rosenfeld; Smith et al., 1993) that social support influences life satisfaction. Life satisfaction is described as a psychological state that may be broadly associated with psychological well-being (Neugarten, Havighurst, & Tobin, 1961) rather than some objective assessment of the person s quality of life. Life satisfaction is defined as a global feeling of contentment, fulfillment, or happiness with life in general (Diener, Emmons, Larsen, & Griffin, 1985; Hamarat & Steele, 2002). Decreased life satisfaction following injury has been associated with a number of factors including separation, anxiety, decreased

4 744 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY productivity, poor general health, and a reduction in sport activities (Corrigan, Bogner, Mysiw, Clinchot, & Fugate, 2001; Steadman-Pare, Colantonio, Ratcliff, Chase, & Vernich, 2001). Research findings regarding the impact of severity of injury on diminished life satisfaction have been mixed. Some researchers have found that greater life satisfaction follows mild injury (Engberg & Teasdale, 2004), and in some studies it was reported that greater life satisfaction follows severe injury (Steadman-Pare et al., 2001). The purpose in this study was to investigate the associations among social support, stress, and life satisfaction as perceived by college athletes with a minor or major injury. The following hypotheses were tested: (1) greater perceived stress will be associated with diminished life satisfaction for athletes with a major injury more than for those with a minor injury; (2) interaction between perception of stress and social support will influence life satisfaction of injured athletes (i.e., the buffering role of perceived social support will be stronger for the athletes with a major injury than for the athletes with a minor injury). METHOD Participants Participants were 123 university athletes with either minor or severe injuries who were forced to sit out of practice or competition for at least three days because of their injury. The classification of an injury as minor or severe was based on the number of days lost to participation in the athlete s sport. An injury forcing a loss of participation for less than one week is considered minor, and anything forcing loss of participation beyond 21 days is major (Powell, 1991; Quackenbush & Crossman, 1994; Robins & Rosenfeld, 2001). The athletes (male, n = 69; female, n = 54) who took part in our study were participants in a variety of sports, including basketball, football, track and field, Eastern martial arts, volleyball, and gymnastics, and they ranged in age from 18 to 25 years (M = 21.22, SD = 1.28). Of the group there were 54 who had a major injury, and 69 who had a minor injury. Procedure We contacted the coach of each of the sporting codes involved in the study and obtained permission to survey athletes in their teams at university who were currently injured. The testing occurred during the time that these athletes were unable to participate in their sport because of their injury. Participants were recruited to fill out the research surveys by the coaches of the university teams. Athletes were asked to complete measures of their perception of social support, stress, and satisfaction with life. The demographic information included

5 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY 745 items identifying sport, age, gender, and year at university. Indications of injury severity were also recorded. The demographic questionnaire provided additional information about the athlete and their injury. The questions were designed to identify how long the athlete expected to be unable to participate in their sport because of the injury, the type of injury that they had sustained, and when the injury occurred. To ensure confidentiality, coaches of teams handed out the questionnaires to the injured athletes and then left the area, to allow the athletes to answer questions measuring their perception of social support, stress, and satisfaction with life in privacy. In addition, the athletes placed the completed forms in a sealed envelope opened only by the investigator. The completed forms in envelopes were submitted to the researchers by the coaches. The data were collected over a period of two years. Measures Multidimensional Scale of Perceived Social Support (MSPSS) Individual perceptions of social support were assessed using the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet, Dahlem, Zimet, & Farley, 1988; Zimet, Powell, Farley, Werkman, & Berkoff, 1990). The MSPSS has been shown to be psychometrically sound, with good reliability, factor validity, and adequate construct validity (Zimet et al., 1988). The authors specifically constructed the scale to be economical, thus providing for the use of the instrument in conjunction with other measures. The MSPSS consists of 12 items describing 3 different subscales: Family Support (4 items), Friend Support (4), and Significant Other Support (4). Respondents use a 7-point Likert-type scale (very strongly disagree to very strongly agree) with each item. The validity and reliability of the scale has been reported to be satisfactory (Kazarian & McCabe, 1991; Zimet et al., 1988). Cronbach s alpha was.71 for the whole scale, and ranked from.69,.74, and.76 for the subscales of perceived support from family, friends, and significant other respectively (Kazarian & McCabe; Zimet et al.). The coefficient alpha for whole scale was.61 for the present sample. Perceived Stress Scale 10 (PSS-10) The Perceived Stress Scale-10 is a 10- item, self-report inventory aimed at assessing the degree to which situations in an individual s life are appraised as stressful (Cohen, Kamarck, & Mermelstein, 1983). PSS-10 items are designed to tap the degree to which respondents find their lives unpredictable, uncontrollable, and overloading. These three issues have repeatedly been found to be central components of the experience of stress. Respondents indicate how often they have felt or thought a certain way on a 5- point Likert scale (0 = never, 1 = almost never, 2 = sometimes, 3 = fairly often, 4 = very often). The standard response time frame used in the current study was During the time of injury.... For example,... how often have you felt that you were unable to control the important things in your life? Internal reliability

6 746 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY of the PSS-10 was measured using Cronbach s coefficient alpha. The coefficient alpha for the total scale was.90 for the present sample. Satisfaction with Life Scale (SWLS) The Satisfaction with Life Scale (SWLS) developed by Diener et al. (1985) was used. The SWLS measures global life satisfaction and consists of 5 items of which the values are evaluated according to 7 scores (1 = strongly disagree, 7 = strongly agree). Scores ranging between 9 and 14 correspond to extreme dissatisfaction and scores falling between 15 and 19 indicate slight dissatisfaction with life (Pavot & Diener, 1993). A score of 20 represents neutral satisfaction with life, which indicates equal satisfaction and dissatisfaction. Scores ranging between 21 and 25 indicate being slightly satisfied and scores between 26 and 30 represent being extremely satisfied with life. Adequate psychometric properties have been demonstrated for this measure. Diener et al. reported an internal consistency value of.87 and a 2-week test-retest correlation of.82. Results of studies have also established convergent validity of the SWLS with moderately strong correlations with other measures of subjective well-being and life satisfaction (e.g., Diener et al., 1985; Pavot, Diener, Colvin, & Sandvik, 1991). These correlations include.58 with the Fordyce s Global Scale (1977) and.68 with the Andrew and Withey s (1976) D-T Scale (Diener et al., 1985). The coefficient alpha for the total scale was.79 for the present sample. Data Analysis The data were analyzed using SPSS for Windows version Analysis included Cronbach s alpha coefficients, descriptive statistics, independentsamples t test, and hierarchical multiple regression calculations. The predictor variables (main effects) were entered in the regression equation in step 1, followed by the 2-way interactions in step 2. The independent variables were centered by standardizing them before the product term was created (Jaccard, Turrisi, & Wan, 1990). The standardized solution was then examined. Statistical significance was set at p < 0.05 for all tests. RESULTS Table 1 displays the standardized means and standard deviations for the two groups (athletes with major versus minor injuries). There were significant differences at the.05 level or greater between the two groups for perceived stress (t(121) = -4.70, p <.001), with the major injuries group having the greater perceived stress, and for life satisfaction (t(121) = 5.11, p <.001), with the major injuries group having less life satisfaction. There were no significant differences between the athletes scores for perceived social support in the groups with major versus minor injuries. The t test for the MSPSS revealed no overall significant effect.

7 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY 747 Table 1 Results from the MSPSS, PSS 10, and SWLS * Major injuries Minor injuries n = 54 n = 69 M SD M SD t p MSPSS-total Family Friends Significant other PSS SWLS Notes: * MSPSS indicates Multidimensional Scale of Perceived Social Support; PSS 10, Perceived Stress Scale 10 Item; SWLS Satisfaction with Life Scale Table 2 presents the results of the hierarchical regression analyses relevant to testing the hypotheses of the study. The first hypothesis referred to the negative role of perceived stress in life satisfaction of the athletes with injury (greater perceived stress was associated with diminished life satisfaction for athletes with a major injury more than for those with a minor injury). Results pertaining to this hypothesis are located in the first step rows of Table 2 with life satisfaction for a dependent variable. As predicted, the perceived stress measure to the regression equation did add significantly to the prediction of diminished life satisfaction for the athletes with a minor injury ( R 2 =.08, F = 5.80, p =.02), and stress did add significantly to the prediction of diminished life satisfaction for athletes with a major injury ( R 2 =.34, F = 26.99, p =.001). The second hypothesis was that interaction between perceived stress and social support was expected to influence life satisfaction of injured athletes. As predicted, perceived stress and perceived total social support interaction did not significantly add to the prediction of diminished life satisfaction for the group of athletes with a minor injury group ( R 2 =.01, F =.66, p =.42), but perceived stress and perceived total social support interaction did add significantly to the prediction of life satisfaction for the group of athletes with a major injury ( R 2 =.09, F = 8.06, p =.01). As can be seen in Table 2, for athletes in the major injury group perceived stress and perceived family support were found to be significant predictors of diminished life satisfaction (p =.03). These two variables can explain 40% of the total variance. For athletes with a major injury perceived stress and perceived friends support were also found to be significant predictors of diminished life satisfaction (p =.01). These two variables can explain 43% of the total variance. In Table 2, for athletes with a major injury perceived stress and perceived significant other s social support were likewise found to be significant predictors

8 748 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY of diminished life satisfaction (p =.01). These two variables can explain 44% of the total variance. Table 2 Results of Hierarchical Multiple Regression Analysis: Main Effects of Perception of Stress and Social Support on Life Satisfaction by Severity of Injury Groups Major injury Minor injury Model R R 2 R 2 F p R R 2 R 2 F p 1. Perceived stress (A) A Family social support Perceived stress (A) A Friends social support Perceived stress (A) A Significant other s social support 1. Perceived stress (A) A Total social support DISCUSSION The focus of this study was the associations among perceptions of social support, stress, and life satisfaction by injured university athletes. Significant associations were found between perceived stress and diminished life satisfaction and among perceived stress and perceived social support interaction and diminished life satisfaction in the athletes with a major injury. Results of our study revealed that greater perceived stress was associated with diminished life satisfaction for athletes with a major injury more than for those with a minor injury, thus contradicting the findings of Hardy et al. (1991) who reported that results for injury severity of athletes were not significant. Thus, our findings are consistent with those of Ahern and Lohr (1997) and Reed and Giacobbi (2004) suggesting that stress has a direct (main) negative effect on psychological adjustment (but not on life satisfaction) of injured athletes. The unique contribution of the present study was the categorization of injured athletes according to the severity of injury. In the present study it was found that higher perceived stress was associated with diminished life satisfaction for athletes with a major injury, from an aspect of the research subject that was not explored in previous investigations. In addition, the level of injury of the participants in this study was found to be related to life satisfaction: participants with a major injury had the least life

9 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY 749 satisfaction. This is inconsistent with previous studies, in which it was found that injury level was not correlated with life satisfaction (Hampton, 2004; Krause, 1998; Trieschmann, 1988). Those studies were performed with people who had spinal cord injuries; college athletes are a population that has been relatively unstudied. There are multiple factors that can differentiate a sample of college athletes from a sample of people with spinal cord injuries. Inclusion of a variable for the interaction between perceived stress and perceived social support (the buffering effect) did add significantly to the prediction of diminished life satisfaction for the college athletes with a major injury: the interaction between perceived stress and perceived social support was associated most with diminished life satisfaction for the athletes with a major injury. A multidimensional measure of social support was used. Cohen and Wills (1985) point out that perceived multidimensional measures of social support such as the one used in the present study usually have a greater correlation with psychological adjustment (or life satisfaction) than do measures that are not multidimensional. As anticipated, our findings with the sample of college athletes were consistent with the results of previous studies of stress/social and stress-buffering mechanisms of social support, that is, the addition of stress and social support interaction to the regression equation increased the likelihood of diminished life satisfaction in the sample only among athletes with a major injury (Warren et al., 1996). The present findings support the buffering model. Findings in other studies have been similar (Affleck, Pfeiffer, Tennen, & Fifield, 1988; Warren et al., 1996; Wasley & Lox, 1998). These findings draw attention to the importance of the type of injury in mood state and in life satisfaction. For example, Affleck et al. (1988) found evidence for the potential stress-buffering effect of social support: a significant interaction effect was found between social support and functional disability, indicating that the association between social support and life satisfaction was stronger among patients with poorer functional status. Conclusions drawn from the results of this investigation are limited by the collection of data in only one student division, albeit in a variety of sports. Future research in this area should look at a variety of divisions, high schools, and middle schools. Comparisons among different divisions and athletes of different ages may provide insight into how the various levels of competition affect the perception of stress, social support, and life satisfaction. The present study was a cross-sectional and correlational, not an experimental, investigation. The study design allows for examination of associations among variables, but because of the correlational nature of the study, it is difficult to prove causal conclusions about the effects of perception of stress and social support on life satisfaction.

10 750 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY Although the findings of this study provide confirmatory support for the role that perceived stress and perceived social support play in the life satisfaction of injured college athletes, we did not include other psychosocial factors, such as mood states (Adam, Brassington, Steiner, & Matheson, 2004), selfconfidence (Rees & Freeman, 2007), and coping strategies (Park, 2000). In future studies the joint contributions of diverse predictors of life satisfaction may be considered, such as mood states, self-esteem, self-confidence, and types of coping strategies. References Adam, M. U., Brassington, G. S., Steiner, H., & Matheson, G. O. (2004). Psychological factors associated with performance-limiting injuries in professional ballet dancers. Journal of Dance Medicine and Science, 8, Affleck, G., Pfeiffer, C., Tennen, H., & Fifield, J. (1988). Social support and psychological adjustment in rheumatoid arthritis. Arthritis Care and Research, 1(2), Ahern, D. K., & Lohr, B. A. (1997). Psychosocial factors in sports injury rehabilitation. Clinics in Sports Medicine, 16(4), Albinson, C. B., & Petrie, T. A. (2003). Cognitive appraisals, stress, and coping: Preinjury and postinjury factors influencing psychological adjustment to sport injury. Journal of Sport Rehabilitation, 12(4), Andrews, F. M., & Withey, S. B. (1976). Social indicators of well-being: America s perception of life quality. New York: Plenum. Bone, J. B., & Fry, M. D. (2006). The influence of injured athletes perceptions of social support from ATCs on their beliefs about rehabilitation. Journal of Sport Rehabilitation, 15, Brewer, B. W. (2007). Psychology of sport injury rehabilitation. In G. S. Tennenbaum & R. C. Eklund (Eds.), Handbook of sport psychology (3rd ed., pp ). Hoboken, NJ: John Wiley & Sons. Brewer, B. W., Linder, D. E., & Phelps, C. M. (1995). Situational correlates of emotional adjustment to athletic injury. Clinical Journal of Sport Medicine, 5(4), Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, Cohen, S., Underwood, L. G., & Gottlieb, B. H. (2000). Social support measurement and intervention: A guide for health and social scientists. New York: Oxford University Press. Cohen, S., & Williamson, G. M. (1988). Perceived stress in a probability sample of the United States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health: Claremont symposium on applied social psychology, pp Newbury Park, CA: Sage. Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), Corrigan, J. D., Bogner, J. A., Mysiw, W. J., Clinchot, D., & Fugate, L. (2001). Life satisfaction after traumatic brain injury. The Journal of Head Trauma Rehabilitation, 16(6), Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49(1), Engberg, A. W., & Teasdale, T. W. (2004). Psychosocial outcome following traumatic brain injury in adults: A long-term population-based follow-up. Brain Injury, 18(6), Feldman, P. J., Dunkel-Schetter, C., Sandman, C. A., & Wadhwa, P. D. (2000). Maternal social support predicts birth weight and fetal growth in pregnancy. Psychosomatic Medicine, 62,

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12 752 STRESS, SOCIAL SUPPORT, AND LIFE SATISFACTION AFTER INJURY Smith, A. M, Stuart, M. J., Wiese-Bjornstal, D. M., Milliner, E. K., O Fallon, W. M., & Crowson, C. S. (1993). Competitive athletes: Preinjury and postinjury mood states and self-esteem. Mayo Clinic Proceedings, 68(10), Steadman-Pare, D., Colantonio, A., Ratcliff, G., Chase, S., & Vernich, L. (2001). Factors associated with perceived quality of life many years after traumatic brain injury. Journal of Head Trauma Rehabilitation, 16(4), Trieschmann, R. B. (1988). Spinal cord injuries: Psychological, social, and vocational rehabilitation (2nd ed.). New York: Demos. Udry, E., Gould, D., Bridges, D., & Tuffey, S. (1997). People helping people? Examining the social ties of athletes coping with burnout and injury stress. Journal of Sport and Exercise Psychology, 19(4), Warren, L., Wrigley, J. M., Yoels, W. C., & Fine, P. R. (1996). Factors associated with life satisfaction among a sample of persons with neurotrauma. Journal of Rehabilitation Research and Development, 33(4), Washington-Lofgren, L., Westerman, B. J., Sullivan, P. A., & Nashman, H. W. (2004). The role of the athletic trainer in the post-injury psychological recovery of collegiate athletes. International Sports Journal, 8, Wasley, D., & Lox, C. L. (1998). Self-esteem and coping responses of athletes with acute versus chronic injuries. Perceptual and Motor Skills, 86(3), Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 55(3 & 4),

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