Original Article
A brief form of the Perceived Social Support Questionnaire (F-SozU) was developed, validated, and standardized

https://doi.org/10.1016/j.jclinepi.2014.11.003Get rights and content

Abstract

Objectives

Development of a brief instrument (F-SozU K-6) for the measurement of perceived social support in epidemiologic contexts by shortening a well-established German questionnaire (F-SozU K-14).

Study Design and Setting

The development of the F-SozU K-6 consisted of two phases; phase 1: the F-SozU K-14 was presented to a general population sample representative for the Federal Republic of Germany (N = 2,007; age: 14–92 years). Six items for the short form were selected based on the maximization of coefficient alpha. Phase 2: the new short form (F-SozU K-6) was evaluated and standardized in an independent second population survey (N = 2,508, age: 14–92 years).

Results

The F-SozU K-6 showed very good reliability and excellent model fit indices for the one-dimensional factorial structure of the scale. Furthermore, strict measurement invariance was detected allowing unbiased comparison of means and correlation coefficients and path coefficients between both sexes across the full lifespan from adolescence (14–92 years). Well-established associations of perceived social support with depression and somatic symptoms could be replicated using the short form.

Conclusion

The F-SozU K-6 presents a reliable, valid, and economical instrument to assess perceived social support and can thus be effectively applied within the frameworks of clinical epidemiologic studies or related areas.

Introduction

What is new?

Key findings

  1. Decades of research have shown that perceived social support plays an essential role in preventing mental and physical illness. In this study, the six-item brief social support questionnaire, F-SozU K-6, was developed and evaluated based on two independent surveys, representative of the general population of Germany.

  2. The F-SozU K-6 showed very good reliability, and excellent model fit indices were detected for the one-dimensional factorial structure of the scale.

What this adds to what was known?
  1. The F-SozU K-6 provides an economical and reliable instrument for evaluating the degree of perceived social support.

  2. Based on measurement invariance analyses, the F-SozU K-6 allows comparison of means and correlation coefficients, as well as path coefficients within structural equation models between both sexes across the full lifespan (14–92 years).

What is the implication and what should change now?
  1. The application of the F-SozU K-6 within the frameworks of clinical epidemiologic studies or related areas is supported.

In the field of clinical epidemiology, economizing self-assessment instruments seems of particular relevance. This is especially true for large population samples, with the necessity to assess a variety of relevant constructs and given space constraints due to reasons of costs and acceptance. One solution to this problem could be to include short forms of well-established instruments, which are highly correlated with their long versions. In the past, numerous short forms assessing physical health or physical constraints [1], [2], [3], [4] and psychopathology (eg, depression [5], [6], [7], anxiety [6], [8], somatoform disorder [3], [9], or posttraumatic stress symptoms [10], [11]) have been either well established or recently developed. In addition to these clinically relevant measures, short forms of more general constructs are needed that possibly (1) maintain or induce pathology, (2) moderate or mediate the outcome of medical or psychotherapeutic interventions, or (3) could be seen as secondary outcome measures (eg, quality of life or global functioning).

Decades of research have shown that perceived social support plays an essential role in preventing mental and physical illness [12], [13], [14], [15], [16], [17]. Correspondingly, a current meta-analysis [12], which evaluated three major components of social relationships, shows that regarding mortality, the importance of the functional aspects of social relationship (ie, received and perceived social support) may be rated as comparable to other well-researched risk factors, such as smoking or regular alcohol consumption, and even surpasses the importance of other risk factors, such as obesity or physical inactivity.

Furthermore, social support can be awarded to have relevance in medical settings, for example, the development and progression of cardiovascular disease [18], compliance with medical regimens [19], and a decreased length of hospitalization [20].

The importance of the concept of social support is also reflected in the number of measures developed for its assessment. However, available instruments for assessing perceived social support seem to be unsuited in the framework of clinical–epidemiologic studies due to the number of items [eg, MSPSS (Multidimensional Scale of Perceived Social Support) [21], SPS (Social Provisions Scale) [22], DUFSS (Duke-UNC Functional Social Support Questionnaire) [23], ASSIS (Arizona Social Support Interview Schedule) [24], PSSS (Perceived Social Support Scale) [25], SSQ (Social Support Questionnaire) [26]]; low validity or reliability [eg, short forms of the OSSS (Oslo Social Support Scale) [27], [28], short form of the SPS [29]]; or elaborated scoring [NSSQ (Norbeck Social Support Questionnaire) [30], SSQ-6 [31]] or they have not been conceived [eg, mMOS-SS (modified Medical Outcomes Study Social Support Survey) [32], DUFSS-10 [33]] or even evaluated (DUFSS-8 [34], DUFSS-6 [35], NSSQ [30], SSQ-6 [31]) in the general population.

In German-speaking countries, the Social Support Questionnaire (F-SozU) by Fydrich et al. [36] is well accepted to assess general social support in the general population and in clinical trials. Since the 1980s, it is primarily used in research contexts in clinical psychology, psychotherapy, medical sociology, health psychology, and behavioral medicine [37]. Following Barrera [38], Heller and Swindle [39], and House [40], the authors conceptualize social support as perceived or anticipated support from the social network. This cognitive approach goes back to Cobb [41] and focuses on the assessment by the recipient of social support. Several studies have shown that in clinical and epidemiologic contexts, this perspective attains higher significance than formal or structural network characteristics. The F-SozU assesses social support in the natural environment (general social support) that excludes help from health care professionals [37].

From an individual perspective, statements regarding perceived or anticipated social support are rated on a five-point Likert scale, ranging from 1 (does not apply) to 5 (exactly applicable). These statements cover generalized experiences rather that concrete situations. A long version with 54 items (S-54) [36], [37] and a short version with 22 items (K-22) [37] cover three central characteristics of social support: practical and material (instrumental) support (being able to receive practical help with daily problems, for example, borrowing something, receiving practical advice, being relieved of tasks), emotional support (being liked and accepted by others, being able to show feelings, experiencing sympathy), and social integration (belonging to a circle of friends, undertaking ventures together, knowing people with similar interests). These dimensions can be interpreted as subscales and combined to a total score of general perceived social support. Although also containing items from all the three dimensions, another short version comprising 14 items (K-14) [37], [42] focuses exclusively on general perceived social support, which in this instrument is not further differentiated. Hence, the authors suggest an unidimensional interpretation of a total score. Quality criteria of the F-SozU K-14 are overall convincing, showing high consistency of the instrument (α = 0.94) and satisfactory selectivity between 0.55 and 0.76 [42]; a 1-week retest reliability of 0.96 is specified. All short forms were generated by selecting items based on psychometric properties [37].

Perceived social support as measured by the F-SozU has been shown to be associated with social competence, social insecurity, psychopathological symptoms as well as several social, and sociodemographic variables [eg, gender (higher values for woman), relationship status (higher values for being in a relationship), educational status (higher values for individuals with university degree)] in accordance with its theoretical framework and hence provides support for construct validity [37]. These relations could be replicated using the short forms [37].

For use within the context of clinical epidemiology, it would be desirable to have an economical (ie, low completion and scoring time) instrument convincingly covering various areas of perceived social support that is still characterized by high reliability and validity. The goals of this study were hence to (1) develop a brief form for assessing social support (F-SozU K-6) based on the F-SozU K-14, using a representative community sample, and (2) subsequently examine its psychometric properties and standardize this brief form in a second representative population sample. To the best of our knowledge, to date, no shorter versions of the F-SozU than the F-SozU K-14 have been developed and validated.

Section snippets

Overview

The development of the brief form was carried out in two phases.

Phase 1: In the first phase, the F-SozU K-14 was administered to a community sample. Based on the data collected in phase 1, the items were evaluated and the short form F-SozU K-6 was compiled.

Phase 2: In a second general population survey, the newly developed brief form (F-SozU K-6) was administered and evaluated. Norms regarding age and gender were compiled.

Procedure

The overall design of the two surveys was highly similar. Both surveys

Study design and participants

The development of the brief form was carried out based on data from a representative sample of the Federal Republic of Germany from a 2003 survey by the University of Leipzig [N = 2,007 aged between 14 and 92 years; for a more detailed description, see 42] and authorized by the Ethics Committee of the Medical Faculty of the University of Leipzig.

Statistical analyses

Criteria for the shortened scale were a very good coefficient alpha value, unidimensionality of the instrument (necessary to calculate a total score),

Phase 2: psychometric evaluation of short form F-SozU K-6

The newly created brief questionnaire (F-SozU K-6) was subsequently analyzed based on an independent survey that was again representative of the Federal Republic of Germany with regard to its psychometric parameters. The representative sample of this survey furthermore served as a norming group.

Discussion

In the present study, the six-item short form of the German Social Support Questionnaire (F-SozU) was developed based on a representative German population sample. The newly developed questionnaire (F-SozU K-6) was subsequently evaluated and standardized in another independent population sample that was also representative of the general German population. The reliability of the short form was found to be comparable to the longer versions of the German Social Support Questionnaire (F-SozU K-14,

Acknowledgments

Authors' contributions: S.K., M.Z., and E.B. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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    Conflict of interest: None.

    Funding: The study was authorized by the Ethics Committee of the Medical Faculty of the University of Leipzig (Az.: 050/13-03.05.2013). The study was financed by internal funds of the Department for Medical Psychology and Medical Sociology of the University Clinic of Leipzig.

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