Relevance for public health

It is important for public health policy to collect information on social support in the population, to enable risk assessment and the planning of preventive interventions at different levels. Reliable and valid instruments exist for monitoring social support.

Instruments for measuring social support

There is a great number of instruments measuring social support, but many of them have low or unknown validity and reliability (O'Reilly, 1988). Many of the instruments are quite extensive, and not feasible for population surveys. For a selection of instruments

assessing social networks and social support see Berkman & Glass, 2000.

The Oslo-3 Social Support Scale (OSS-3), is a short instrument, feasible for population surveys, which is included in the ECHI shortlist of health indicators after recommendation by the MINDFUL project. For this reason the instrument is of particular interest for international comparative studies. OSS-3 has high predictive validity with respect to anxiety and depression, as well as to positive mental health and quality of life, and has been used as a survey instrument in a number of countries (Melzer, 2003, Malkowska et al., 2004; Lehtinen et al., 2005; Korkeila et al., 2007)

OSS-3 is a three-item scored rating scale that has been developed on the basis of a number of community surveys in Norway. These surveys investigated the association between social support and psychological distress. Out of 12 questions on support from family, friends and neighbours, three questions were selected because of high correlations with psychological distress: (Dalgard et al., 2006a):

• Number of persons to count on if in serious trouble;
• Perceived positive interest and concern from other people;
• Available help from neighbours if necessary.

Whereas the first item overlaps with the quality of social network, the two other items give information on different aspects of perceived social support. Because of the multidimensionality of the scale, the Cronbach’s alpha is rather low (0.60), and it is recommended to use the score for each item as well as the combined score (MINDFUL).

The level of social support differs between European countries

The level of social support differs between European countries as shown in Percentage of people with poor social support in the EU, as measured by the OSS-3. The highest percentages of poor support are reported in Italy, France, Belgium, Greece and Finland, whereas the lowest percentages are found in Sweden, Ireland, Northern Ireland, Spain the Netherlands and Denmark

Another survey, EUROHIS (Meltzer, 2003) showed only slight variations between countries. Possible explanations of this discrepancy are:

- EUROHIS reported mean scores, whereas the Eurobarometer reported percentages A country with the highest percentage of poor social support does not necessarily have the lowest mean score on social support.

- EUROHIS is mainly limited to Eastern European countries, whereas the Eurobarometer covers a wider geographical range.

Anyhow, from a health point of view the percentage receiving poor support is of the greatest interest.

Women experience more social support than men

In a survey of five European countries using the Oslo-3 Social Support Scale, women reported more social support than men (Dalgard et al., 2006a), see Social support (OSS-3) by country and gender. A possible explanation of this is that women have a more socially oriented lifestyle than men: they are more focused on establishing social contacts and get more emotionally involved in other people. Their emotional involvement also seems to have negative consequences: women also reported more social network problems than men. In all countries except Spain, the women reported more support in terms of ‘people to count on’ (‘confidents’) and ‘peoples’ interests’ (‘concern’). The OSS-3 item ‘help from neighbors’ showed less stable gender relations. For both genders, Spain was among the highest scorers for all items, whereas the lowest scores were recorded in Finland.