Stress, social support and fear of disclosure

Angela Forbes and Derek Roger*

Department of Psychology, University of York, UK
Purpose. This study was aimed at developing a measure of the capacity to use social
support effectively.
Methods. The responses of 329 participants to a preliminary 130-item scale derived
from a scenario study were subjected to principal axis factoring. This resulted in a 48-
item Interpersonal Trust Questionnaire (ITQ) comprising three factors labelled fear of
disclosure (FOD), social coping (SC) and social intimacy (SI). A second sample of 380
participants then completed the nal form of the ITQ together with the rehearsal
(rumination) and emotional inhibition scales from the Emotion Control Questionnaire
(ECQ; Roger & Najarian, 1989), the Social Support Questionnaire (SSQ; Sarason,
Levine, Basham & Sarason, 1983) and the Inventory of Socially Supportive Behaviours
(ISSB: Barrera, 1981). Data on deteriorationin health status over a period of adaptation
were also available for a subsample of these participants. An additional sample provided
scores on the ITQ and the Network Orientation Scale (NOS; Vaux, Burda & Stewart,
1986).
Results. The scales were found to correlate in predictable ways with measures of both
social support and emotion control. However, there were gender differences conrming
the preference amongst women for emotional rather than informational support.
Regression analyses using deterioration in health status as the dependent variable
showed an effect for FOD, but this was signicant only amongst women.
Conclusions. The ndings indicate the importance of taking both individual
differences and availability of support into account, and it is hoped that the new ITQ
scale will offer the means for including relevant individual differences in future studies
of the role of social support in moderating stress responses.
The deleterious effects of stress on health and well-being have been widely reported in the
literature, but assuming that stress causes illness raises questions about the mechanisms
which might be involved in linking cognitive processes such as perceived threat with
physical symptomatology. Psychoimmunological research has suggested that the most
plausible candidate mechanism involves the sustained activation of the hypothalamic-
pituitary-adrenal axis (Jemmott & Locke, 1984), and there is certainly evidence for the
role of corticosteroids in compromising immune function (Asterita, 1985). However, in
view of the wide individual differences in cognitive and physiological responses to stress,
physiological mechanisms alone provide only a partial answer.
One explanation is that moderator variables such as personality may be involved. For
165 British Journal of Health Psychology (1999), 4, 165179 Printed in Great Britain
1999 The British Psychological Society
*Requests for reprints should be addressed to Derek Roger, Department of Psychology, University of York, Heslington,
York YO1 5DD, UK.
example, Kobasas (1979) research on hardiness had suggested that having an internal
locus of control may buffer individuals against the impact of stressful life events.
Unfortunately, Denney & Frisch (1981) failed to support the hypothesized moderating
effect of locus of control on stress, and when situational control is taken into account,
having an internal locus of control has been shown to be associated with a greater
susceptibility to stress amongst individuals who experienced high levels of uncon-
trollable life events (Meadows, 1989). Extraversion and neuroticism have also been
investigated in the context of stress, but the ndings have similarly been equivocal: while
Totman, Kiff, Reed & Craig (1980) and Broadbent, Broadbent, Phillpotts & Wallace
(1984) reported higher levels of susceptibility to experimentally induced colds amongst
introverts as compared to extraverts, the effect was not replicated in a more carefully
controlled study by Cohen, Tyrrell & Smith (1993). The latter authors also included a
measure of locus of control in their study, and again they found no moderating effects for
perceived control on outcomes.
Reviewing these inconclusive ndings, Roger (1995) has argued that the personality
constructs used in earlier studies were inappropriate because they had not been developed
specically in the context of stress research. Roger and his colleagues suggested that
inhibiting emotion or ruminating over emotional distress might contribute to delayed
recovery, and the Emotion Control Questionnaire (ECQ; Roger & Najarian, 1989; Roger
& Nesshoever, 1987) was developed to assess these tendencies. The ECQ comprises
subscales for rehearsal (or emotional rumination) as well as emotional inhibition, and
validation studies of the ECQ have shown that rumination is particularly strongly related
to impaired physiological and psychological adaptation following stress (Nieland &
Roger, 1993; Roger &Jamieson, 1988; Roger &Najarian, 1998). Scores on the emotional
inhibition subscale were also implicated in these studies, and Kaiser, Hinton, Krohne,
Stewart & Burton (1995) have shown independently that emotional inhibition is
signicantly related to delayed muscle tension recovery following stress.
In addition to personality, social support has frequently been investigated as a
potential moderator of the impact of stress, and the benecial effects of social support
have been reported for general health and well-being (Cobb, 1976; Cohen & Wills, 1985;
Thoits, 1985) and for facilitating adaptation and adjustment to change (Cobb, 1976;
Sarason, 1981). However, it has also been suggested that high levels of social support may
have negative consequences in mental health settings (Sandler & Barrera, 1984), and in a
comparison of the effects of positive and negative interactions on health, negative
interactions were found to outweigh the benecial effects of social support (Fiore, Becker
& Coppel, 1983). These conicting ndings stem in part from a lack of consensus over the
denition of social support, which is often referred to as a unitary construct when in fact
it appears to be multidimensional, broad in scope and highly heterogeneous. More precise
denitions of social support based on functional categories such as emotional
support, information support and instrumental support have been proposed (House &
Kahn, 1985; Turner, 1981), but the different functions have been found to be highly
correlated.
In an attempt to resolve some of these issues, Barrera (1981; 1986) and others (for
example, Gottlieb, 1985; Sarason, Sarason & Pierce, 1990) have proposed placing
research on social support into three categories labelled social integration, enacted or
received support, and perceived support. Social integration refers to the objective
Angela Forbes and Derek Roger 166
assessment of the number or density of people in an individuals social network
(Berkman, 1985), while enacted support assesses the amount of supportive behaviour
received over a specied period of time (Tardy, 1985). However, neither of these measures
provides an assessment of the quality of the support received, and it has frequently been
argued that satisfaction with supports is far more important than the number available
(Barrera, 1981). Measures of perceived support provide a subjective assessment of
satisfaction as well as availability (Cohen & Hoberman, 1983; Procidano & Heller,
1983; Sarason, Levine, Basham & Sarason, 1983), and have been found to exhibit a far
stronger relationship with health than either of the other two measures (Cohen &
Hoberman, 1983).
Gottlieb (1985) has concluded that individuals who have a strong sense of perceived
support are likely to make less threat-focused appraisals of potentially stressful situations,
which results in their ability to cope more independently. The emphasis on cognitive
evaluation ts well with the current literature on the relationship between stress and
illness, in that the appraisal of a potential stressor and of the coping resources available
will inuence whether or not the situation is dened as stressful (Folkman, Schaefer &
Lazarus, 1979). However, the appraisal process is strongly inuenced by individual
differences which may act as moderator variables, and one question which arises is
whether perceived support is a function of objective evaluations of the quality of
supports, or whether it has more to do with personality. As early as 1984, Lefcourt,
Martin & Saleh (1984) had shown that people with an internal locus of control derived
greater benets from social support than externals, and Sarason, Sarason & Shearin (1986)
have taken the further step of suggesting that support might be regarded as a personality
variable in its own right.
A number of studies have suggested that the expression of emotion serves to reduce or
attenuate physiological arousal associated with stress (Mendolia & Kleck, 1993), and that
it represents a stable individual difference (Kring, Smith & Neale, 1994). These ndings
have direct implications for social support, since it is in the context of support that
emotion is expressedindeed, one might argue that the function of social supports is
to provide the opportunity for the expression of emotion. As early as 1976, Tolsdorf
dened what he called network orientation as an individuals attitudes about the
usefulness of others in helping to cope with problems, and Vaux, Burda & Stewart (1986)
used Tolsdorfs ideas to develop the Network Orientation Scale (NOS), which was
designed specically to assess individual differences in the propensity to draw upon social
supports.
Unfortunately, item selection for the NOS was based on item total correlations rather
than factor analysis, and the selection criteria were not consistent across the samples
which were used. Internal consistency for the scale was also modest, and retest reliability
was low (.18 over a 3-week inter-test interval). The network orientation model has
recently been adapted by Gruen, Schuldberg, Nelson, Epstein, Weiss & Quinlan (1994)
to form the Network Utilization Scale (NUS). These authors reported a signicant
relationship between scores on the new scale and depressive symptomatology, but they
acknowledge that further work is needed on the scale, particularly with respect to retest
reliability and validation against observational data and other forms of psychopathology.
The reduction in stress-related physiological arousal through the expression of
emotion implies that social support is used as a coping strategy. Coping processes are
167 Stress, social support and fear of disclosure
typically classied as either rational or emotional, but within this broad classication a
variety of different strategies have been identied. Folkman & Lazarus (1985), for
example, describe eight factors in their Ways of Coping Questionnaire (WCQ), but half
of them comprised fewer than ve items each. In response to these and other psycho-
metric shortcomings in the WCQ, Endler & Parker (1990) devised the Multidimensional
Coping Inventory (MCI), which comprises three factors: task (or rational), emotional and
avoidance. Roger, Jarvis & Najarian (1993) expanded this model with the inclusion of an
additional detachment factor, and subsequent research by Roger, Najarian & Nash
(1996) demonstrated that the detached and emotional factors combine into a single
bipolar factor which signicantly predicts worsening health status during stress.
The aim of the present study was to shed further light on individual differences in the
capacity to self-disclose and express emotion in an adaptive manner in the context of
social support. The study reports on the development of a new instrument, the
Interpersonal Trust Questionnaire (ITQ). The relationship of the ITQ to existing indices
of social support, coping and other relevant measures of individual differences is
examined, including the NOS, as well as the extent to which inhibiting emotional
expression inuences health during periods of adaptation.
Method
Participants
Two samples of participants were included in the study. The rst sample was used for the construction and
factorial validation of the new scale, and comprised 329 participants of which 242 were females (mean age
20.52 years; SD 4.01) and 75 were males (mean age 22.19 years; SD 6.78). They were all undergraduate
students, drawn from a wide range of academic disciplines, excluding psychology, at the University of York,
the University of Ripon and York St. John in York, and the University of Humberside in Hull.
The second sample of 380 was used for the validation studies, and comprised 149 males (mean age 20.38
years; SD 5.78) and 231 females (mean age 19.65 years; SD 4.22). All were undergraduatesat the University
of York.
Test construction
In order to generate items for the preliminary item pool, a scenario-basedquestionnairewas completed by an
independent sample of 43 undergraduates from the University of York, 19 males and 24 females (mean age
18.98 years; SD 1.60). The questionnaireconsisted of 10 scenarios describing potentially stressful situations
that were intendedto be of relevance to the populationin question, based on a methodology developedby the
second author (Roger, Jarvis & Najarian, 1993; Roger & Nesshoever, 1987). The participants were asked to
give as much informationas possible about the way in which they would respond to the situations described.
Their responses were used to generate the items for the initial pool, and the scenario technique has the
advantage of providing questionnaire items which are more contemporaneous and less biased than
conventional trawls through literature and existing scales.
The responses generated by the scenarios were combined with those from a review of the literature to
generate a 130-item pilot questionnaire. The response format was a 4-point Likert scale ranging from
strongly agree to strongly disagree. The questionnairewas sent out to the 329 students comprisingthe rst
sample, and their returns were subjectedto principal axis factor analysis. Ascree test (Cattell, 1966) indicated
a three-factor terminal solution, which was produced by Varimax orthogonal rotation. Only three items
which loaded on more than one factor were omitted, and using a criterion of 0.4, the three-factor solution
included 48 items, 27 on the rst factor, 12 on the second factor and 9 on the third factor. The loadings are
shown in Table 1 (the items in the scale appear in the Appendix).
Angela Forbes and Derek Roger 168
169 Stress, social support and fear of disclosure
Table 1. Factor loadings for the three-factor solution
Loading
Item Factor 1 (FOD) Factor 2 (SC) Factor 3 (SI)
16 + .692
10 + .685
23 + .683
9 + .623
40 + .620
29 + .598
12 + .583
36 + .579
27 + .564
25 + .555
19 + .550
47 + .543
2 + .540
43 + .539
7 + .506
45 + .477
34 + .471
14 + .456
38 + .452
6 + .440
17 + .445
41
2
.439
4
2
.434
32 + .424
31 + .413
21 + .406
28 + .404
26 + .674
22 + .652
37 + .622
11
2
.595
18 + .571
1 + .556
15 + .549
39 + .548
3 + .522
46 + .461
8 + .411
48 + .407
33 + .626
13 + .600
5 + .557
42 + .545
24 + .460
30 + .448
20 + .439
35 + .424
44 + .419
Note. FOD = fear of disclosure; SC = social coping; SI = social intimacy.
The two highest loadingitems on the rst factor were 16 (I worry too much about what others think of me
to conde in them) and 10 (To discuss my problems with somebody feels good at the time but afterwards I
worry about what I have said), and this factor was labelled fear of disclosure (FOD). The two highest loading
items on the second factor were 26 (I like to talk problems over to get them off my chest) and 22 (When I
feel upset about something I feel the need to talk to somebody about it), and this factor was labelled social
coping (SC). Items 33 (A good friend is somebody you can be honest with) and 13 (To be able to give and
take in a friendship is important) loaded highest on the third factor, which was labelled social intimacy (SI).
Four-factor and two-factor solutions were also examined. The items on the rst three factors of the four-
factor solution were virtually identical to those for the three-factor solution. Only six items loaded on the
fourth factor, all of which referredexplicitly to the familyfor example, the highest loading was for item55
in the initial pool, I feel that I can turn to my family for help whenever I need to. In fact, this item and the
item, I can conde in at least one family member of my family, both loaded below criterion on the third
factor of the three-factor solution (.380 and .372, respectively). These items may well be salient to the
student population used, but in view of a low coefcient alpha for the fourth factor and the small number of
items, the four-factor solution was rejected in favour of three factors. The second factor on the two-factor
solution was very similar to FOD, while the rst factor appeared to combine some elements of the second and
third factors from the three-factor solution. In fact, rotating only the items on the rst factor solution to a
two-factor solution yielded factors very similar to SC and SI, but with fewer items that either factor from the
three-factor solution.
Separate factor analyses for the male and female samples producedalmost identical three-factor structures.
The analysis was also repeated using an oblique rotation, but this did not signicantly alter the orthogonal
structure. There was no increase in double loads over the three which occurred in the orthogonal rotation,
thus conrming that the three factors were indeed independent. Responses to the full item pool were
subsequently collected from an additional sample of undergraduatestudents, and these were used to increase
the original sample to a total of 543 participants, 176 males (mean age 20.96 years; SD6.33) and 367 females
(mean age 20.19 years; SD 4.47). A scree test again indicated a three-factor structure, and a maximum
likelihood conrmatory factor analysis of these data yielded a structure indistinguishable from the earlier
solution. Testing the t of the three-factor model yielded a chi-square value of 2299.15 (p < .0001).
One of the shortcomings of the initial factor analysis was the low participant:variable ratio, but the
robustness of the factor structure is conrmed by the replication of the ndings with the substantially larger
sample. The fact that the analyses extracted only approximately one third of items from the initial pool was
not surprising in view of the scenario technique used to generate items, which tends to be exhaustive and
uncontaminated by experimenter bias in item selection.
All three of the factors had good face validity and were internally consistent, and in viewof the convergent
structure across analyses and samples, a three-factor solution was accepted as representing the best t.
Correlations were computed between the factors for the original sample, and SC was found to correlate
signicantly inversely with FOD (r(327) =
2
.338; p < .001) and signicantly positively with SI
(r(327) = .416; p < .001). The FOD and SI factors did not correlate signicantly (r(327) =
2
.104).
Separate correlation matrices for equal samples of 75 males and females yielded broadly similar results.
The FOD and SI factors did correlate signicantly for males (r(73) =
2
.297; p < .01) but not for females
(r(74) =
2
.111), but the correlation was modest, accounting for less than 10% of the common variance.
The mean scores for the male and female samples were compared using independent t tests (in all cases,
d.f. = N1 + N2
2
2). There was no signicant difference in the means for males and females for FOD
(t(315) = .52; n.s.), but the means for both SC and SI did differ signicantly between groups, with females
scoring higher than males on SC (t(315) = 3.06; p < .05) and on SI (t(315) = 3.54; p < .001). The mean
scores for the samples and the relevant t ratios are displayed in Table 2.
Results
Reliability
Internal consistency. The internal consistency for all of the factors was highly satisfactory,
with alpha coefcients of .879 for FOD, .771 for SC and .778 for SI.
Angela Forbes and Derek Roger 170
Test retest reliability. Following an inter-test interval of 10 weeks, the questionnaire was
sent out to 156 of the students from the University of York who could be contacted,
45 males and 111 females. Returns were received from 134 subjects (40 males and
94 females), representing 86% of the total. The retest coefcients for FOD (.846) and SC
(.732) were highly satisfactory, although the coefcient for SI was somewhat more modest
(.609). Separate sets of retest coefcients for males and females were comparable to those
obtained for the overall sample.
Interpersonal trust, emotion control, coping and social support
To investigate the relationship of the ITQ to relevant measures of personality, coping and
social support, the participants scores were correlated with the following indices:
(a) The rehearsal (rumination) and emotional inhibition scales from the Emotion Control
Questionnaire (ECQ; Roger & Najarian, 1989), each of which comprises 14 items. ECQ
rehearsal measures the tendency to ruminate about emotional upset, and as the name
implies, ECQ emotional inhibition assesses the tendency to inhibit the expression of
emotion.
(b) The detachment scale derived from the Coping Styles Questionnaire (CSQ; Roger,
Jarvis & Najarian, 1993). The 22-item scale is bipolar, comprising detached and
emotional coping, and is keyed for higher scores to reect a more detached coping style.
(c) The Social Support Questionnaire (SSQ; Sarason et al., 1983), which is primarily a
measure of perceived emotional support comprising 27 items. For each item, the
participant is asked to state the number of people (up to a maximum of nine) who
provide them with the type of support specied, and to give a summary rating of overall
satisfaction with the support perceived to be available. There are thus two scores for each
subject: SSQN (the sum of the number of people listed divided by the number of items),
and SSQS (the mean satisfaction score).
(d) The Inventory of Socially Supportive Behaviours (ISSB; Barrera, 1981). The ISSB
consists of 40 items. It provides a measure of enacted or received support and assesses the
amount of support received over the past month.
The overall sample of 380 included in the validation studies were divided into two
groups. The rst group of 150, comprising 42 males (mean age 20.69 years; SD 5.88) and
171 Stress, social support and fear of disclosure
Table 2. Comparison of mean scores for males (N = 75) and females (N = 242) on the three-
factor solution
Gender Means SD d.f. t ratio
Factor
Fear of disclosure Male 33.88 8.39 315 .52 n.s.
Female 34.68 11.70
Social coping Male 23.68 4.76 315 3.06**
Female 25.61 4.75
Social intimacy Male 21.08 3.02 315 3.54***
Female 22.48 2.87
**p < .05; ***p < .001.
108 females (mean age 19.74 years; SD 3.02), completed the ITQ, the ECQ and the CSQ
detachment scale. The second group of 230 participants included 107 males (mean age
20.06 years; SD 5.71) and 123 females (mean age 19.56 years; SD 5.42), and these
participants all completed the ITQ and the ISSB. A subsample of this group, comprising
126 participants, 55 males (mean age 19.87 years; SD 4.20) and 71 females (mean age
19.83 years; SD 6.26), also completed the SSQ in addition to the ITQ and ISSB.
The mean scores for the ITQ scales were almost identical to those obtained for the
questionnaire construction sample reported in Table 2, with females again scoring higher
on SC and SI than males. The means for the remaining scales were consistent with
previously reported data, and as expected there was a trend for females to obtain lower
scores on emotional inhibition and lower scores on detached coping. The correlations
between the three ITQ scales and the ECQ, CSQ, SSQ and ISSB scales are shown in
Table 3 below, for the total samples and for males and females separately.
As had been anticipated, the correlations between the ITQ factors and the emotional
inhibition scale from the ECQ were all signicant and consistent, with FOD correlating
positively and both SC and SI correlating negatively. The pattern of correlations for the
Angela Forbes and Derek Roger 172
Table 3. Correlations between the three ITQ factors and the ECQ, CSQ, detachment, SSQ and
ISSB scales
ITQ factors
FOD SC SI
ECQ and CSQ
ECQ E-I Males (N = 42) .277
2
.434**
2
.190
Females (N = 108) .375***
2
.421***
2
.188
Total (N = 150) .345***
2
.441***
2
.222**
ECQ R Males (N = 42) .351*
2
.081
2
.091
Females (N = 108) .161 .068 .029
Total (N = 150) .206* .046 .029
CSQ Det. Males (N = 42)
2
.557*** .054
2
.113
Females (N = 108)
2
.459*** .068 .029
Total (N = 150)
2
.436*** .048
2
.124
SSQ and ISSB
SSQ N Males (N = 55)
2
.483*** .462*** .314*
Females (N = 71)
2
.200 .074 .095
Total (N = 126)
2
.345*** .345*** .255**
SSQ S Males (N = 55)
2
.527*** .326* .280*
Females (N = 71)
2
.332* .014 .054
Total (N = 126)
2
.468*** .328*** .262**
ISSB Males (N = 107)
2
.222* .342*** .225*
Females (N = 123)
2
.268** .317*** .189*
Total (N = 230) .253*** .369*** .231**
Note. ITQ: FOD = fear of disclosure; SC = social coping; SI = social intimacy.
ECQ/CSQ: E-I = emotional inhibition; R = rehearsal; Det. = detachment.
overall sample was broadly similar for males and females separately, although the
correlation between FOD and ECQ rehearsal (r(148) = .206; p < .05) for the total
sample was clearly carried by the correlation for males. ECQ emotional inhibition
correlated higher with FOD for females (r(106) = .375; p < .01) than for males
(r(40) = .277; p < .05), although the difference between the coefcients was not
signicant (z = 0.59; n.s.). The correlations between the ITQ and ISSB showed similar
consistencies, but the correlations between the ITQ factors and the SSQ were stronger for
males than for females. Indeed, only SSQS and FOD correlated signicantly for females
(r(69) =
2
.332; p < .05), whereas all of the ITQ factors correlated signicantly with
SSQN and SSQS for males.
Interpersonal trust and network orientation
In addition to the emotion control and social support scales, data were obtained from an
independent sample of undergraduate students who completed only the ITQ and Vaux,
Burda & Stewarts (1986) Network Orientation Scale (NOS), a 20-item questionnaire
based on a 4-point Likert scale. As has been noted, the network orientation construct has
been used to devise the more recent Network Utilization Scale (NUS; Gruen et al., 1994),
but in view of the preliminary nature of the scale the NOS was chosen in preference for
the present study.
The sample compromised 178 participants, 102 females (mean age 19.36 years;
SD 4.4) and 76 males (mean age 2.78 years; SD 6.7). The NOS and ITQ were included
with a package of unrelated scales which were sent out by mail to members of a volunteer
undergraduate participant panel at the University of York. Vaux (1985a) reported a
three-factor structure for the NOS, but the analysis was based on a small sample of 80.
The responses to the NOS in the present study were therefore initially subjected to factor
analysis, and the scree plot suggested a unifactor or perhaps a two-factor solution rather
than the three factors extracted by Vaux. A one-factor extraction included 18 of the 20
items, with only items 16 and 17 failing to load above the .30 criterion, and the factor
accounted for 27.7% of the variance. However, the internal consistency was extremely
low (coefcient alpha = .10), and the items were therefore rotated to a two-factor
Varimax orthogonal terminal solution. This yielded factors with 10 and 9 items,
respectively, with the previously omitted item 17 entering the second factor.
The highest-loading items on the rst factor were 2 (Friends often have good advice to
give) and 14 (It really helps when you are angry to tell a friend what has happened), and
the two highest loadings on the second factor were 15 (Some things are too personal to
talk to anyone about) and 18 (If you conde in other people, they take advantage of
you). The two factors clearly reect a distinction between positive (factor 1) and negative
or defensive attitudes (factor 2) about disclosure and conding, but there were four
double-loading items of factor 1 and ve on factor 2. The number of double loads
increased with an oblique rotation, and the internal consistency remained very modest for
both factor 1 (coefcient alpha =.468) and factor 2 (coefcient alpha =.360).
Despite these unsatisfactory ndings, the scores from the 18-item unifactor solution
were correlated with scores from the three ITQ factors. The NOS correlated signicantly
with FOD (r(176) = .398; p < .01) and with SC (r(176) =
2
.180; p < .05) but not
with SI. Slightly higher correlations between the rst factor from the NOS and FOD and
173 Stress, social support and fear of disclosure
between the second factor and SC conrmed the apparent correspondence between them,
but in view of the psychometric inadequacies of the NOS, this was not explored further.
Interpersonal trust and health status during adaptation
As part of the larger programme of research to which this study is related, additional data
were available for the sample of 126 participants who completed the ITQ, the SSQ and
the ISSB. The additional data for this sample included measures of health status, and
returns from repeated administrations were obtained from a subsample of 102, compris-
ing 44 males (mean age 19.95 years; SD 4.38) and 52 females (mean age 19.19; SD 4.98).
Health status was assessed over a period of adaptation, which was dened as the 4 months
between entering university as rst-year undergraduates and the middle of the second
term of their rst academic year. Previous studies have shown that this is a period of
signicant demand for adaptation to a new social environment, and that deterioration in
health status during this time is inuenced by a variety of individual difference variables
(Roger, 1996). The students were contacted for the rst time immediately after entry to
the University of York, and were asked to complete a health inventory entitled the Health
Status Checklist (HSC; Meadows, 1989). The HSC is based on an extensive GP survey
covering 30 common illnesses, and yields overall scores based on stability, deterioration
or improvement across repeated administrations, thus allowing for the partialling out of
initial health status.
The HSC was rst administered at the start of the study to provide a baseline, and
administered again after an interval of ve months. A difference score reecting relative
deterioration in health status was calculated, using the initial administration as a baseline
to take account of initial values. The participants scores on the ITQ, the ISSB and both
subscales of the SSQ (SSQN and SSQS) were then entered into stepwise multiple
regression analyses as independent variables, with deterioration in health status as the
dependent variable.
In view of the differential effects for gender in the correlations between the ITQ factors
and the independent variables used in the concurrent validation exercise, the data for
males and females were analysed separately. Results for females showed that scores on
FOD contributed signicantly, with an adjusted R
2
of .106 and a standardized beta of
.358 (t(1, 41) = 2.426; p < .02). The remaining independent variables were excluded in
the analysis, and none were included in the stepwise regression for males. Combining the
data for males and females in the present study yielded similar effects to those obtained
for females.
Discussion and conclusions
The factor analysis of a preliminary item pool based on participants perceptions of social
support produced a stable three-factor structure which included 48 items. The factors
were labelled fear of disclosure (FOD), social coping (SC) and social intimacy (SI). All
three were internally consistent and apart from SI were also stable over time. The retest
reliability coefcient for SI fell below .70, but this factor may well be tapping attitudes
towards social support or friendship rather than a stable predisposition to use support in a
particular way, and may thus reect changes in friendship patterns over the inter-test
Angela Forbes and Derek Roger 174
interval. The factors were moderately correlated, but were found to be empirically
discriminable when compared with other personality scales.
Comparisons between the mean scores for the male and female samples included in the
study indicated signicant gender differences for the SC and SI scales, with females
scoring signicantly higher than males. These factors primarily assess emotional support,
and research has found that while females are more likely to use emotional support, males
are more likely to use informational or tangible support (Ashton & Fuehrer, 1993).
However, it has been suggested (Sarason, Shearin, Pierce & Sarason, 1987) that the
difference in results for males and females is an artifact of the questionnaire items being
biased towards a feminine stereotype.
Previous studies have found that women are more likely to emphasize self-disclosure
within a relationship, whereas within male relationships there is a tendency to inhibit
self-disclosure (Lowenthal & Haven, 1968). The absence of signicant gender differences
in the mean scores for the FOD factor in the present study was therefore surprising, but
the results may have been affected by the student population which was used. Work
currently in progress is attempting to discover whether there are systematic gender
differences in the ITQ factors, using sex-role inventories across gender rather than relying
on simple gender classication.
The investigation of the questionnaires concurrent validity showed that FOD
correlated signicantly positively with emotional inhibition and rehearsal from the
ECQ. Fear of disclosure is associated with an inability or difculty in conding in others,
particularly concerning matters of an emotional nature, and it is not surprising that there
was a positive correlation with emotional inhibition, but in fact the coefcient accounts
for little more than 12% of the common variance, indicating that the scales are not
assessing identical constructs. Emotional inhibition also correlated inversely with SI and
especially SC, which may be explained in part by a degree of item overlap between the
emotional inhibition and SC scales. Neither SI nor SC correlated with ECQ rehearsal.
All three factors correlated signicantly with SSQN, SSQS and ISSB for the overall
sample. For the components of the SSQ, the highest correlation was between FOD and
SSQS, which suggests that participants with a greater fear of disclosing emotionally
upsetting information may be less satised with the amount of support they perceive to
be available. This could be because they have fewer supportive others to draw upon, or
there may be a third variable such as neuroticism which is affecting their responses.
Interestingly, there were substantial gender differences in the separate correlation
matrices computed for the SSQ, with only one signicant coefcient remaining for
females (an inverse correlation between FOD and SSQS). The SSQN score is a simple
measure of the frequency or number of supports available, and frequency measures have
been shown to be less satisfactory indices of social support than the satisfaction with
supports assessed by SSQS (Barrera, 1981). What the results suggest is that the quality of
the support is more important for females than it is for males.
These gender differences appear consistent with those reported by Ashton & Fuerher
(1993), discussed earlier. They are also conrmed to some extent by the multiple
regression analyses carried out as part of the present study, where deterioration in health
status was signicantly associated with scores on the FOD component of the ITQ for
females but not for males. The ability to make effective use of social support has been
found to predict mental health outcomes (for example, Tolsdorf, 1976; Vaux, 1985b), and
175 Stress, social support and fear of disclosure
the present ndings indicate that this may also be true for physical well-being, at least as
far as females are concerned. There has been little agreement over the individual
differences which might be involved in these effects, and these present study clearly
implicates fear of disclosure as an important variable. Again, gender differences are highly
signicant, and form the focus of current research at the University of York.
The present study also offered the opportunity to explore further the Network
Orientation Scale (NOS; Vaux, Burda & Stewart, 1986), which was developed as an
index of individuals propensity to call upon social support. The ndings suggested a
unifactor structure, but the internal consistency was very low. Extending the terminal
solution to two factors yielded a structure which corresponded broadly to the FOD and
SC factors from the ITQ, but the factors were psychometrically weak and the solution
included a large number of double loadings. The single factor correlated signicantly
positively with FOD and negatively with SC, but the correlations were modest,
accounting for less than 16% of the common variance in the rst case and less than
4% in the second. In view of the psychometric inadequacies of the NOS and the
conrmatory data from the validation of the ITQ, the latter scale represents a
substantially better instrument for assessing the capacity to use social support.
Research on social support has tended to focus on attitudes towards support rather than
on individual differences which might moderate its effectiveness. Fear of intimacy had
been mooted as a factor which might affect the ability to use social support (see Emmons
& Colby, 1995), and the denition of support used for generating the item pool for the
ITQ was based on the ability to conde in others. The results indicate that fear of
disclosure is a key individual difference which needs to be taken into account, and the
new scale offers the opportunity for developing more focused, interactive models for
explaining the role of social support in moderating stress responses.
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Received 4 November 1997; revised version received 9 September 1998
Appendix
Items comprising the Interpersonal Trust Questionnaire
1. It is important to have somebody who I can talk things over with.
2. Sometimes I am unable to conde even in someone who is close to me.
3. I like to discuss even trivial problems to reassure myself that I am making sensible decisions.
4. I am not afraid to ask somebody for help.
5. A good friend is somebody that is understanding.
6. I am unable to trust anybody with my problems.
7. Nobody can understand what I am going through so why should I try and explain.
8. Talking things over helps to focus on the positive aspects of a situation.
9. Sometimes I want to talk things over with a friend but I just cannot.
10. To discuss my problems with somebody feels good at the time but afterwards I worry about what I have said.
11. Some people need somebody to conde in but I prefer to solve my own problems.
12. I regret having told somebody something that is personal.
13. To be able to give and take in a friendship is important.
14. As I get older I nd it continuously more difcult to conde in people.
15. It is important to me to have somebody that will listen to my problems.
16. I worry too much about what others think of me to conde in them.
17. It is easy to be friendly but difcult to make friends.
18. I feel better when I have talked to my friends about my problems.
19. There are some situations which I am unable to conde in anybody.
20. I like to feel that people can conde in me.
Angela Forbes and Derek Roger 178
21. In the past I have been hurt by people breaking a condence.
22. When I feel upset about something I feel the need to talk to somebody about it.
23. I worry about what I have told people.
24. I am selective in who I conde in.
25. People will not be interested in my problems.
26. I like to talk problems over to get them off my chest.
27. People will not want to know me if they know what I am really like.
28. I am often given advice that I do not want.
29. I am afraid that if I conde in someone they will tell my problems to others.
30. I have somebody that I can turn to when I am in need of help.
31. People who I have thought were my friends have let me down in the past.
32. I have nobody that I feel that I can conde in.
33. A good friend is somebody that you can be honest with.
34. I do not want everybody to know what I am really like.
35. I prefer to conde in somebody who I feel knows me well.
36. I am afraid that people will laugh at me if I tell them my problems.
37. In the past I have found a problem easier to solve if I have talked it over with somebody.
38. If I trust someone it will only result in upset.
39. It is good to hear problems out loud.
40. Everybody seems so sure of themselves they will think that I am being foolish.
41. I nd it easy to trust people.
42. It is important to be there for someone if they need you.
43. I do not want to alienate people by showing them when I am upset.
44. It is good to have people who can give you encouragement.
45. I have friends who I know would help me but I nd it difcult to ask.
46. There are some things that I would be unable to cope with on my own.
47. I feel vulnerable if I have to ask other people for help.
48. It helps to discuss a problem even if it is impossible to reach a solution.
179 Stress, social support and fear of disclosure