Full text of DOI:10.1093/geronb/56.6.P374

Journal of Gerontology: PSYCHOLOGICAL SCIENCES
Copyright 2001 by The Gerontological Society of America
2001, Vol. 56B, No. 6, P374–P382
Interactive Effect of Support From Family and Friends
in Visually Impaired Elders
Jessica M. McIlvane1 and Joann P. Reinhardt2
1Department of Psychology, Fordham University, New York.
2Lighthouse International, New York.
The interactive relationship of high and low friend and family support for adaptation to chronic vision impair-
ment was examined in 241 men and women. Two 2 (High/Low Family Support) ꢀ 2 (High/Low Friend Sup-
port) ꢀ 2 (Gender) multivariate analyses of covariance tested for psychological well-being, one with qualitative
support measures, the other with quantitative support measures. Two analyses of covariance models tested for
adaptation to vision loss. A significant multivariate 3-way interaction effect for qualitative support was found.
Women with high support from both friends and family had better psychological well-being, whereas men with
high support from both friends and family or just from family had better psychological well-being. Two univari-
ate main effects showed that participants with high qualitative friend support and high quantitative family sup-
port had better adaptation to vision loss. Findings demonstrate the complexity of measuring and understanding
relationships among social support, well-being, and domain-specific adaptation to chronic impairment.
GE-RELATED vision loss is a common physical dis-
ability that adults aged 65 and older face (Ford et al.,
being (Adams & Blieszner, 1993; Blieszner, 1995; Rook,
1984). However, it is unclear which variables are most im-
portant in terms of designing interventions focused on so-
cial relationships (Heller, Thompson, Trueba, Hogg, & Vla-
chos-Weber, 1991). The conceptualization of social support
can be very complex, and interventions may focus on a vari-
ety of strategies such as attempting to increase the quality
of support, frequency of contact, or network size. An
additional consideration involves the support provider and
whether the intervention will target family, friends, neigh-
bors or other important relationships. Knowledge of the
complex associations among social support variables and
well-being can be useful to service providers in terms of
identifying older adults at risk for loneliness and poor well-
being (Rook, 1984).
In the present study, we assessed three commonly used
conceptualizations of support in terms of their effect on
multiple outcomes including psychological well-being (i.e.,
depressive symptomatology and life satisfaction) and adap-
tation to vision loss in a sample of older men and women.
We examined the structural aspect of social support in terms
of the relationship type of the support provider, family, or
friend. We used perceived support quality as a measure of
the qualitative aspect of social support, hereafter termed
qualitative support. Finally, we used network size as a mea-
sure of quantitative support, hereafter termed quantitative
support. On the basis of prior research showing gender dif-
ferences in support use (e.g., Antonucci, 1990; Wright,
1989), we also examined the impact of gender on adapta-
tion. We assessed both positive and negative aspects of life
quality, as earlier work has stressed the importance of in-
cluding both of these aspects in studies of well-being (e.g.,
Diener & Emmons, 1984; Zautra & Reich, 1983). Further,
we examined the impact of these support variables on both
the general outcome of well-being and the domain-specific
A
1988). A recent national survey on age-related vision loss in
middle-aged and older Americans found that self-reported
vision impairment affects 15% of adults between 45 and 64
years of age, 17% of adults between 65 and 75 years of age,
and 26% of adults older than the age of 75 (The Lighthouse
Research Institute, 1995). Research has demonstrated that
age-related vision loss is associated with increased func-
tional disability (Horowitz, 1994; LaForge, Spector, & Stern-
berg, 1992) and poorer psychological well-being (Branch,
Horowitz, & Carr, 1989; Horowitz, Reinhardt, McInerney,
& Balistreri, 1994; Reinhardt, 1996). Research has shown
that one important factor for more positive adaptation to
age-related vision loss is higher levels of social support
(e.g., Horowitz et al., 1994; Reinhardt, 1996).
Relationships with family and friends influence well-
being across the life span and low levels of support have
been consistently linked with lower levels of well-being
(Antonucci & Akiyama, 1995). Older adults may be espe-
cially vulnerable to the detrimental effects of stress on their
well-being when they do not have adequate levels of social
support (Sauer & Coward, 1985). Supportive relationships
are especially important when a person experiences signifi-
cant chronic impairment and may even serve as a buffer be-
tween this chronic stressor and the individual’s psychologi-
cal and physical well-being (Cohen & Wills, 1985). Low
levels of social support from family and friends may de-
crease an individual’s ability to adapt to vision loss and may
be associated with poorer psychological well-being.
Understanding the relationship between social support,
well-being, and adaptation to chronic impairment can be
useful in designing interventions for older people with vi-
sion impairment. In theory, interventions focused on main-
taining or improving existing relationships may affect well-
P374

SOCIAL SUPPORT IN VISUALLY IMPAIRED ELDERS
P375
outcome of adaptation to vision loss for comparison. Thus,
Effects of Qualitative Support Versus Quantitative
Support on Well-Being
in this study, overall well-being is not considered a proxy
for adjustment to vision loss. The latter is specifically de-
fined as including realistic acceptance of the impairment,
having a positive attitude regarding continuing one’s social
relationships, and using rehabilitative interventions.
Social support has often been defined in either qualitative
terms (e.g., perception of support) or quantitative terms
(e.g., size of network). Generally, the literature shows more
consistent evidence for the impact of qualitative social sup-
port on well-being, whereas the impact of quantitative so-
cial support on well-being has mixed results.
Source of Support: Family and Friends
An important aspect of social support involves the struc-
ture of the social network in terms of the relationship type
of the support provider. Past research has revealed mixed
findings in terms of the importance of family support and
friend support for older individuals. Mancini and Simon
(1984) studied older adults’ expectations of support from
family, close friends, and casual friends. Older adults’ ex-
pectations for assistance were greater for family compared
with close friends and casual friends. However, social inte-
gration and intimacy were expected from both family mem-
bers and close friends.
Research has also demonstrated that support from family
versus friends can have a differential effect on well-being.
Felton and Berry (1992) investigated the effects of a vari-
ety of social provisions made either by family or friends on
the psychological well-being of users of a geriatric clinic.
Provision of reassurance of worth by friends (i.e., recogni-
tion of older persons’ unique abilities), but not by family,
was related to well-being. On the other hand, provision of
instrumental support by family, but not by friends, was re-
lated to better well-being. Larson, Mannell, and Zuzanek
(1986) examined the relationship between social support
from family and friends and well-being in older adults by
assessing self-reported activities and subjective state at ran-
dom points in daily life. The enjoyment of companionship
from friends was found to be related to the immediate well-
being of the older individuals (i.e., their current level of af-
fect and enjoyment), however, the long-term provision of
support by friends was not as important. On the other hand,
the long-term provision of emotional and instrumental sup-
port from family was related to the global well-being of
these older adults, whereas the immediate enjoyment from
family members was not as important for their current af-
fect.
Reinhardt (1996) investigated the importance of support
from both family and friends for psychological well-being
and adaptation to vision loss in older adults. Findings
demonstrated that friendship support predicted unique
variability in well-being after accounting for family sup-
port. Yet, only friendship support was a significant predic-
tor of adaptation to vision loss when both family and
friendship support were added in the model. Thus, overall,
support from both family and friends is important for well-
being, but friendship support may be particularly impor-
tant in the domain-specific area of adaptation to vision
loss. The studies cited above demonstrate that, taken sepa-
rately, support from family and friends is important for
older persons; however, these studies do not address how
the interaction of family and friend support may affect
well-being. That is, it is unclear whether having high sup-
port from just one of these supportive relationships is suf-
ficient for well-being.
Some studies that compared the effect of qualitative and
quantitative support on well-being found significant effects
only for the former. For example, Chappell and Badger
(1989) found that elders who lacked a confidant reported
less happiness with life and lower life satisfaction, yet quan-
titative measures that assessed contact frequency in elders
were not related to subjective well-being. Newsom and
Schulz (1996) investigated the relationships between quali-
tative and quantitative aspects of support, functional status,
depression, and life satisfaction in a sample of older adults.
Quantitative support (i.e., frequency of contact with family
and friends) was associated with lower depressive symp-
toms and higher life satisfaction. However, these effects
disappeared when qualitative support (i.e., perceived sup-
port quality) was added to the regression analysis.
Other studies that compared the effects of qualitative and
quantitative support have found significant effects for both,
but the effects for qualitative support are stronger. Anto-
nucci, Fuhrer, and Dartigues (1997) found that although
quantitative support measures influenced depressive symp-
toms, qualitative measures were most strongly related to de-
pressive symptoms; that is, they provided a better fitting
model. In another study, Hays and colleagues (1998) dem-
onstrated that qualitative support was associated with all
four dimensions of depression as assessed by the Center for
Epidemiologic Studies–Depression scale (CES-D), whereas
quantitative support was associated with only two of these
dimensions (depressed affect, interpersonal problems).
Finally, the importance of both qualitative and quantita-
tive friend and family support has been demonstrated by
Thompson and Heller (1990), who studied community-
dwelling older women who were targeted for a peer-support
intervention. This study demonstrated effects for both quan-
titative (network embeddedness as assessed by number of
network ties and contact frequency) and qualitative (per-
ceived support) support. Results showed that older women
who had low network embeddedness with both family and
friends revealed low levels of psychological well-being, re-
gardless of their level of qualitative support. Also, elders
with low perceived family support did show lower levels of
psychological well-being compared with those with high
perceived support from family regardless of perceived sup-
port from friends or network embeddedness.
Although the majority of studies cited above showed that
quantitative support was not related—or not as strongly re-
lated—to well-being, Thompson and Heller (1990) demon-
strated that quantitative support was relevant to their sample
of older women. Thus, overall, there are conflicting findings
concerning the relative effects of qualitative and quantita-
tive support. Therefore, it is necessary to examine both as-
pects of social support to gain a clear picture of the effects
of support on well-being.

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MCILVANE AND REINHARDT
Gender Differences in the Use of Social Networks
Gender differences involved with the use of supportive
relationships and subsequent effects on well-being have
been established in past research. According to Antonucci
(1990), women are more inclined than men to have multiple
sources of support. Older men, on the other hand, rely
heavily on their spouses. Further, men seem to perceive
spousal support as the most positive, compared with women,
who perceive support from adult children to be the most sig-
nificant (Lynch, 1998).
adaptation to vision loss compared with individuals who
are high in social support from both of these providers.
2. The second goal was to determine whether having high
support from at least one provider (high-family–low-
friend support or low-family–high-friend support) in vi-
sually impaired women or men results in more positive
psychological well-being and better adaptation to vision
loss compared with those with both low family and low
friend support.
Antonucci (1990) has suggested that older men are more
likely than older women to be vulnerable to stressful events
because broader social networks have been linked to better
adaptation to stressors in late life. These findings indicate
that women use a larger and more extensive social network,
which may be essential to their well-being. Thus, for older
women, not having multiple sources of support may lead to
poor well-being.
According to Belle (1991), a review of the literature con-
cerning the effects of gender differences on stress revealed
that men and women composed and used their social net-
works in different ways, which has implications for well-
being. Women tend to be more likely to use their social net-
works in terms of seeking and receiving support during
stressful times compared with men. Consequently, it is nec-
essary to examine gender differences when exploring the ef-
fects of supportive relationships on well-being for men and
women.
METHODS
Participants
Study participants were 130 women and 111 men (n ꢁ
241) whom we approached when their cases had closed at a
vision rehabilitation service agency. These respondents rep-
resented a subset of the total sample (Reinhardt, 1994; N ꢁ
343) of visually impaired elders who were chosen because
they had both a close family member and a close friend for
comparison. Comparisons between this subset and the re-
mainder of the larger sample showed that participants in the
subset were significantly younger, reported better health
status, and reported less functional disability. There were no
significant differences between the two groups on the basis
of gender, marital status, education, vision loss severity, life
satisfaction, depressive symptoms, or adaptation to vision
loss.
For the subset who had both a close friend and a close
family member, on which this article is based, the relation-
ship type of the closest family member was almost equally
divided among spouses (33%), adult children (38%), and
other relatives (29%). Age ranged from 65 to 99 years with
an average age of 78.60 years (SD ꢁ 7.14). Just over half
(53%) of the sample were female and 85% were Caucasian.
Fifty-eight percent reported that they were without a spouse
and 40% lived alone. Thirty-four percent reported that they
had less than a high school education, 23% had a high
school diploma, 16% had 1 to 3 years of college, 13% were
college graduates, and 13% had a professional degree (MA
or PhD). Scores on the four-factor Hollingshead Index of
socioeconomic status were normally distributed across the
five categories. Seventy-six percent reported having a grad-
ual loss of vision compared with the sudden loss of vision
and 49% of respondents reported having more than one vi-
sion problem. Vision problems reported by participants in-
cluded macular degeneration (48%), cataracts (38%), and
glaucoma (26%).
Purpose and Hypotheses
This research represents additional analyses of prior work
that demonstrated the unique contribution of friendship sup-
port after accounting for family support in adaptation to vi-
sion impairment in elders (Reinhardt, 1996). The purpose of
the present study is to extend this earlier finding by examin-
ing the interactive effects of the support variables (i.e., fam-
ily and friend support) and gender on psychological well-
being (i.e., depressive symptoms and life satisfaction) and
adaptation to vision loss in a sample of elders dealing with
chronic vision impairment. Because of their association
with these outcome variables, we used vision loss severity
and education (Horowitz et al., 1994; Reinhardt, 1996) as
control variables in this study. This research also builds on
and expands the prior work of Thompson and Heller (1990).
These researchers examined the impact of both qualitative
and quantitative support on well-being but studied only
women and chose participants who were low in qualitative
friendship support and income by definition. The present
study also compared the impact of support variables on both
psychological well-being and a domain-specific indicator of
adaptation to age-related vision loss.
Procedures
Face-to-face structured interviews were conducted in
participants’ homes by trained interviewers (average length
of interview was 93.12 min, SD ꢁ 25.21). The study was
initially described to potential participants by letter, and
follow-up phone calls were used to set up appointments
with those who were eligible (were English-speaking,
held community residence, and were age 65 or older) and
interested. We obtained a 60% response rate (Reinhardt,
1996). Respondents were given $10 in appreciation for
their time.
There are two main goals in this study, which we exam-
ined separately for both qualitative and quantitative support
variables. Study hypotheses focus specifically on the inter-
active effects of friendship and family support.
1. The first goal was to test the hypothesis that visually im-
paired men and women with low social support from
both their closest family member and their closest friend
experience poorer psychological well-being and poorer

SOCIAL SUPPORT IN VISUALLY IMPAIRED ELDERS
P377
Qualitative support.—The 24-item Social Provisions
Scale (SPS; Cutrona & Russell, 1987) was used to measure
perceived support quality. The SPS was asked in relation to
both the respondent’s closest friend and closest family
member. The order of questions relating to the closest fam-
ily member and closest friend was counterbalanced. The
SPS, which is based on Weiss’s (1974) theory of social pro-
visions, contains six components including reliable alliance
(e.g., “I can count on this person to help me if I really need
it”), guidance (e.g., “I can talk to this person about impor-
tant decisions in my life”), attachment (e.g., “I feel a strong
emotional bond with this person”), reassurance of worth
(e.g., “This person admires my talents and abilities”), social
integration (e.g., “This person enjoys the same social activi-
ties I do”) and nurturance (e.g., “I feel that this person relies
on me for his/her well-being”). Items are rated on a 4-point
Likert scale ranging from 4 (strongly agree) to 1 (strongly
disagree). Total scores range from 24 to 96. The compo-
nents are added together for a measure of total perceived
support quality with a high score indicating high total per-
ceived support. The SPS has been demonstrated to be a reli-
able and valid instrument in previous research dealing with
samples of older individuals (Cutrona & Russell, 1987;
Mancini & Blieszner, 1992). For this particular study, reli-
ability for the total friend support scale was ꢂ ꢁ .88 and for
the total family support scale was ꢂ ꢁ .89. Scores on the
SPS for both the closest family member and the closest
friend were divided at the median to indicate low versus
high levels of perceived support.
Scores on the CES-D range from 0 to 60 with high scores
indicating high depressive symptoms. For this sample, the
reliability for the CES-D was ꢂ ꢁ .90.
Adaptation to vision loss.—The Adaptation to Age-
Related Vision Loss Scale (AVL; Horowitz & Reinhardt,
1998) is a 24-item scale that measures the extent to which
an individual has adapted to vision loss. It includes items
that assess realistic acceptance of vision impairment, atti-
tudes toward rehabilitation including having a positive atti-
tude toward the importance of learning new skills, and
attitudes towards relationships with family and friends in-
cluding having a positive view of relationships with family
and friends. The respondent is asked to agree or disagree
with a series of statements related to vision loss (e.g., “Vi-
sual impairment is the cause of all my problems,” “It is de-
grading for visually impaired persons to depend so much on
family and friends,” and “I can still do many of the things I
love, it just takes me longer because of my vision impair-
ment”). Scores on the AVL range from 0 to 24 with higher
scores indicating greater adaptation to vision loss. The reli-
ability for the AVL in this sample was ꢂ ꢁ .87.
Vision-loss severity and education level were used as
control variables because of their association with the out-
come variables. The 15-item Functional Vision Index (Horow-
itz, Teresi, & Cassels, 1991) was used to measure vision
loss severity. Sample items include “Does trouble with your
vision make it difficult for you to read medicine bottle la-
bels?” and “When you are walking in the street, can you
read the street name signs?” Scores range from 0 to 15 with
a high score demonstrating high vision loss severity. Educa-
tion was assessed with a single-item measure (“How many
years of schooling did you complete?”). Education was bro-
ken down into seven categories ranging from 1 (less than
seven years of school) to 7 (professional degree).
Quantitative support.—Quantitative social support was
defined in terms of network size for both friends and family.
Respondents were asked to indicate the number of close
friends and the number of close family members (i.e., chil-
dren, siblings, and close relatives) in their social network.
Once again, a median split was used to define high versus
low levels of quantitative support for family and friends.
RESULTS
As in prior research (Thompson & Heller, 1990), the me-
dian-split technique was used to define high and low quali-
tative support and quantitative social support for family and
friends. Scores for low qualitative family support ranged
from 53 to 77 with a mean score of 70.07 (SD ꢁ 5.45) and
scores for high qualitative family support ranged from 78 to
96 with a mean score of 84.00 (SD ꢁ 4.83). Scores for low
qualitative friend support ranged from 51 to 70 with a mean
of 64.62 (SD ꢁ 4.62), and scores for high qualitative friend
support scores ranged from 71 to 93 with a mean of 78.35
(SD ꢁ 5.33). We used cross-tabulation to create four cate-
gories of individuals that included (a) individuals who had
low qualitative social support from both family and friends
(31%), (b) individuals who had low qualitative social sup-
port from family but not from friends (19%), (c) individuals
who had low qualitative social support from friends but not
from family (19%), and (d) individuals who had high quali-
tative social support from both friends and family (31%).
Scores for low quantitative family support ranged from 1
to 5 family members reported in the individual’s network
(M ꢁ 3.37; SD ꢁ 1.28), and scores for high quantitative
family support ranged from 6 to 30 family members re-
ported (M ꢁ 9.28; SD ꢁ 4.52). Scores for low quantitative
Psychological well-being.—Psychological well-being was
measured with both a positive and a negative indicator. The
Life Satisfaction Index–A (LSI; Neugarten, Havighurst, &
Tobin, 1961) was used as a positive indicator of well-being.
The 18-item version (Adams, 1969) of the LSI was used,
with scores that range from 0 to 18, with high scores dem-
onstrating more positive well-being. Respondents are asked
whether they agree or disagree with a series of statements.
Example items from the LSI include “My life could be hap-
pier than it is now” and “As I look back on my life, I am
fairly well satisfied.” The reliability for the LSI was ꢂ ꢁ .82
for this sample.
The CES-D (Radloff, 1977) is a measure of depressive
symptomatology that was used as a negative measure of
well-being. The CES-D is a 20-item self-report scale that is
used to examine the frequency of mood and behavioral
symptoms that occurred during the previous week. Fre-
quency of behavior is rated on a 4-point scale ranging from
0 (rarely/none of the time), to 3 (most of the time). Positive
items are reverse coded. Examples of items include “I felt
that I could not shake off the blues even with the help of my
family and friends,” “I felt depressed,” and “I enjoyed life.”

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MCILVANE AND REINHARDT
Table 2. Descriptive Statistics for Psychological Well-Being by
Qualitative Support and Gender
friend support ranged from 1 to 3 friends reported in the in-
dividual’s network (M ꢁ 1.85; SD ꢁ 0.79), and scores for
high quantitative friend support ranged from 4 to 22 friends
reported (M ꢁ 6.20; SD ꢁ 3.35). We used cross-tabulation
to create four categories of individuals that included (a) in-
dividuals who had low quantitative social support from both
family and friends (42%), (b) individuals who had low
quantitative social support from family but not from friends
(22%), (c) individuals who had low quantitative social sup-
port from friends but not from family (20%), and (d) indi-
viduals who had high quantitative social support from both
friends and family (16%).
CES-D
LSI
AVL
Type of Qualitative Support
M
SD
M
SD
M
SD
Low family support
High family support
Low friend support
High friend support
Gender
14.99
10.60
14.67
10.98
11.29
10.41
11.50
10.34
8.77 4.09 17.18 5.48
10.86 3.78 19.06 4.25
9.01 4.15 16.85 5.29
10.60 3.84 19.35 4.33
Women
Men
14.53
10.80
11.24
10.55
9.23 4.09 17.86 5.07
10.50 3.94 18.42 4.87
Note: CES-D ꢁ Center for Epidemiologic Study–Depression scale; LSI ꢁ
Life Satisfication Index; AVL ꢁ Age-Related Vision Loss Scale.
Data Analysis Strategy
Descriptive statistics for the support variables, the three
outcome variables and the control variables are presented in
Table 1. We conducted two 2 ꢀ 2 ꢀ 2 multivariate analyses
of covariance (MANCOVA) to examine the effects of fam-
ily support (high and low), friendship support (high and
low), and gender on psychological well-being. One of these
analyses focused on qualitative support, and the other fo-
cused on quantitative support. We tested depressive symp-
toms and life satisfaction as a system as these two variables
are highly correlated (r ꢁ ꢃ.72, p ꢄ .001) and conceptually
similar (i.e., negative and positive global measures of well-
being; Huberty & Morris, 1989). Similarly, we tested two
2 ꢀ 2 ꢀ 2 analysis of covariance (ANCOVA) models using
adaptation to age-related vision loss as the outcome vari-
able. Although AVL scores were highly correlated with the
CES-D and the LSI (r ꢁ .55 and .49, respectively), we
tested ANCOVA models for adaptation to vision loss be-
cause this variable is domain specific and conceptually dif-
ferent from the global measures (Horowitz & Reinhardt,
1998; Reinhardt, 1996).
qualitative family support had higher levels of psychologi-
cal well-being than did individuals with low qualitative sup-
port from family. There were no significant main effects for
friendship support or gender, and there were no significant
two-way interactions. However, a significant, multivariate
three-way interaction was demonstrated, F(2,220) ꢁ 3.07,
p ꢄ .05. Adjusted means for women and men are presented
in Table 3. Examination of univariate effects showed that
the three-way interaction was significant for depressive
symptoms, but not significant for life satisfaction. There-
fore, the significant multivariate interaction was due largely
to depressive symptoms, so we conducted planned compari-
sons for depressive symptoms only.
To aid in interpretation, we plotted the interaction for de-
pressive symptoms separately for women and men (See Fig-
ures 1 and 2). Using Scheffe’s post hoc tests, we examined
three pairwise comparisons for men and women separately
(Maxwell & Delaney, 1990). Because Scheffe’s tests are
conservative, the alpha level was maintained at the .05
level. Additionally, the harmonic mean was used to control
for unequal sample sizes between the cells. To test Hypoth-
esis 1, we compared participants with low family support
and low friend support with those with high family and high
friend support in terms of depressive symptoms. Results
showed that women with high support from both family and
friends had significantly lower depressive symptoms com-
Results for Qualitative Social Support and
Psychological Well-Being
The MANCOVA that examined the effect of qualitative
friend and family support and gender on psychological
well-being (listwise n ꢁ 231) demonstrated two significant
multivariate effects: one main effect and a three-way inter-
action. Table 2 shows mean scores and standard deviations
for high and low support and gender. There was a signifi-
cant main effect of qualitative family support on psycholog-
ical well-being, F(2,220) ꢁ 5.26, p ꢄ .01. Elders with high
Table 3. Adjusted Means for Psychological Well-Being for
Qualitative Support by Quantitative Support by Gender
Qualitative Social Support
Women’s M
Men’s M
Table 1. Descriptive Statistics for Study Variables for
Entire Sample
CES-D
Low Family/Low Friend Support
High Friend/Low Family Support
High Family/Low Friend Support
High Family/High Friend Support
LSI
14.93
15.76
15.96
9.63
15.91
10.40
9.20
Variable
Range
M
SD
Qualitative family support
Qualitative friend support
Quantitative family support
Quantitative friend support
Depressive symptoms
Adaptation to vision loss
Life satisfaction
53–96
51–93
1–30
1–22
0–48
3–24
0–18
1–15
1–7
77.05
71.56
5.52
8.72
8.56
4.07
3.06
11.05
4.97
4.07
2.77
1.81
10.36
Low Family/Low Friend Support
High Friend/Low Family Support
High Family/Low Friend Support
High Family/High Friend Support
8.69
8.56
8.76
8.60
9.93
11.08
11.35
3.46
12.74
18.10
9.81
11.25
4.16
11.23
Vision loss severity
Education
Note: CES-D ꢁ Center for Epidemiologic Study–Depression scale; LSI ꢁ
Life Satisfaction Index.

SOCIAL SUPPORT IN VISUALLY IMPAIRED ELDERS
P379
low family support. Similarly, there was no significant dif-
ference between women with low support from both provid-
ers compared with those with high family support, but low
friend support.
In contrast, for men, those with high family support but
low friend support had significantly lower depressive symp-
toms than did those with low support from both providers,
F(1,27) ꢁ 5.81, p ꢄ .05. Men with low support from both
providers also had higher depressive symptoms than did
men with high friend support and low family support, yet
this effect was only marginally significant, F(1,23) ꢁ 3.46,
p ꢄ .10.
Results for Qualitative Social Support and Adaptation to
Vision Loss
There was one significant main effect for the ANCOVA
examining the effect of qualitative friendship support on ad-
aptation to vision loss, F(1,232) ꢁ 9.39, p ꢄ .01 (listwise
n ꢁ 232). Individuals with high friendship support demon-
strated better adaptation to vision loss than did individuals
with low friendship support, (see Table 4 for descriptive sta-
tistics for women and men). There was no significant main
effect for family support or gender, and there were no sig-
nificant two-way or three-way interactions for adaptation to
vision loss.
Figure 1. Depressive symptoms for women by friend and fam-
ily support. --ꢀ-- Low friend support; —ꢀ— high friend support.
CES-D ꢁ Center for Epidemiologic Studies–Depression scale.
pared with women with low support from both family and
friends, F(1,33) ꢁ 4.85, p ꢄ .05. Likewise, men with high
support from both family and friends had significantly
lower depressive symptoms than did men with low support
from both providers, F(1,33) ꢁ 4.85, p ꢄ .05.
To test Hypothesis 2, we compared individuals with low
support from both family and friends with those with high
support from family, but low support from friends. Then,
we compared individuals with low support from both pro-
viders with those with high support from friends, but low
support from family. For women, there was no significant
difference between those with low support from both pro-
viders compared with those with high friend support but
Results for Quantitative Social Support and
Psychological Well-Being
There were no significant main effects or interactions
demonstrated in the MANCOVA that examined the effect
of quantitative friend and family support and gender on psy-
chological well-being (listwise n ꢁ 238).
Results for Quantitative Social Support and Adaptation
to Vision Loss
There was one significant main effect for the ANCOVA
that examined quantitative social support and adaptation to
vision loss (listwise n ꢁ 239). The result, F(1,239) ꢁ 5.60,
p ꢄ .05, for family support indicated that individuals with a
larger family-network size had significantly better adapta-
tion to vision loss than did individuals with a smaller family
network. There were no significant main effects for quanti-
tative friendship support or gender for adaptation to vision
loss, and there were no significant two-way or three-way in-
teractions.
Table 4. Descriptive Statistics for Adaptation to Vision Loss by
Qualitative Support and Gender
AVL
Type of Qualitative Support
M
SD
Low Family Support
High Family Support
Low Friend Support
High Friend Support
Gender
17.18
19.06
16.85
19.35
5.48
4.25
5.29
4.33
Women
Men
17.86
18.42
5.07
4.87
Figure 2. Depressive symptoms for men by friend and family sup-
port. --ꢀ-- Low friend support; —ꢀ— high friend support. CES-D ꢁ
Center for Epidemiologic Studies–Depression scale.
Note: AVL ꢁ Age-Related Vision Loss Scale.

P380
MCILVANE AND REINHARDT
DISCUSSION
show the interactive effects of family support, friendship
support, and gender.
Social support is very important to the psychological
functioning of older adults. Supportive relationships may be
especially meaningful to older individuals who are adjusting
to late-life chronic impairment such as vision loss. Impor-
tant distinctions need to be made regarding the operational-
ization of social support. First, the significant three-way
multivariate interaction effect highlights the importance of
looking at gender in addition to support from both family
and friends. Different patterns emerged for women com-
pared with men in terms of the effects of family and friend
support on depressive symptoms. Specifically, for men,
having high support from just family, or from both family
and friends, was associated with lower depressive symp-
toms, whereas, for women, having lower depressive symp-
toms was associated only with having high support from
both family and friends. Thus, having qualitative support
from both family and friends is important for men; however,
having support from at least one is also beneficial, espe-
cially when it’s family. As in prior research (e.g., Anto-
nucci, 1990), women tended to rely on multiple sources of
support, and this use of multiple network members was ben-
eficial to their well-being.
Note that we examined both positive and negative aspects
of psychological status. That is, we assessed depressive
symptoms and life satisfaction together as psychological
well-being. The multivariate interaction effect was signifi-
cant for psychological well-being, however, this effect was
really driven by depressive symptoms, or—more appropri-
ately—psychological status, rather than life satisfaction.
However, life satisfaction did contribute something to this
effect, although its contribution was not significant.
Second, the present study confirms prior findings in the
literature that it is the quality of social relationships, not the
quantity of network members, that is important to the psy-
chological functioning of older individuals (e.g., Chappell
& Badger, 1989; Newsom & Schulz, 1996; Thompson &
Heller, 1990). In addition to the interaction effect for quali-
tative support on psychological status, there was a main ef-
fect for qualitative support on adaptation to vision loss.
Thus, having high qualitative friendship support was espe-
cially important for domain-specific adaptation to vision
loss. There was, however, one main effect for quantitative
support as it related to adaptation to vision loss. Simply hav-
ing a larger family network was also associated with better
adaptation to vision loss in elders.
With the exception of the effect just mentioned, quantita-
tive support does not appear to be a significant influence on
the psychological functioning of older persons with chronic
vision impairment. Although this does not support Thomp-
son and Heller’s (1990) findings on the effect of quantita-
tive isolation on the well-being of older women, the two
samples did differ. Thompson and Heller (1990) initially
chose study participants on the basis of low levels of friend-
ship support and low income. These two variables were
more evenly distributed in the current study, which also in-
cluded both women and men. The present study does, how-
ever, confirm Thompson and Heller’s finding that lower
qualitative support from family has a negative impact on the
well-being of older individuals and extends this finding to
Study results also showed the importance of using multi-
ple outcome variables including those that are both global
and domain specific. More important, having high family
support was associated with better psychological status, yet
having high friendship support was associated with better
adaptation to vision loss for elders. Thus, whereas having
higher family support is an important part of one’s general
well-being, having supportive relationships and interacting
with peers may be what encourages older adults to continue
their daily functioning when faced with chronic impairment.
We expected in this study that individuals with low social
support from both family and friends would be especially
vulnerable to poor psychological functioning and poor ad-
aptation to vision loss. This hypothesis was confirmed in
that individuals with low qualitative support from both fam-
ily and friends had poorer psychological status compared
with those with high qualitative support from both family
and friends. Interactive effects were also explored because
the importance of having support from both the closest fam-
ily member and the closest friend was unclear. Is it neces-
sary for older individuals to receive support from both fam-
ily and friends, or is one supportive relationship sufficient in
terms of their psychological functioning? It seems that this
question may need to be answered differently for men com-
pared with women. For men, having high support from both
family and friends, or just from family, was better for their
psychological status than having low support from both
friends and family. This supports prior research showing the
importance of family relationships for men, particularly
those with spouses (Antonucci, 1990). However, a different
pattern was revealed for women such that only having high
support from both family and friends was associated with
better psychological status.
These findings also elaborate on Reinhardt’s (1996) find-
ing that friendship support contributed unique variance to
adaptation above and beyond the effects of family support.
The current study shows that interesting patterns emerge
when the interactive effects of family and friend support are
examined rather than their individual contributions. The
complexity of the relationships that emerged between the
various aspects of social support and the three measures of
adaptation point to the importance of using multiple con-
ceptualization of both social support and well-being and to
the consideration of interaction effects. Interesting patterns
regarding the effects of social support on psychological
functioning may have been missed if a single conceptualiza-
tion of support or a single outcome measure had been used.
Family and friend support influenced the global measures of
psychological functioning differently than did the domain-
specific measure of adaptation to vision loss. Both higher
qualitative friend support and a larger family network were
related to better adaptation to vision loss. These findings,
including the only significant finding for quantitative sup-
port, may have been missed had the focus been on only the
global measures of psychological status.
This study suggests potentially important implications in
terms of interventions for older persons adapting to vision
loss. It may be important for interventions to focus prima-

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These findings are also relevant for service providers
working with visually impaired older women. Older women
with low qualitative support from both their family and
friends might be targeted as being at risk for poor psycho-
logical status (i.e., depression). It may not always be possi-
ble to strengthen supportive ties because they may not exist.
However, these women may benefit from counseling on
how to deal with their situation (Rook, 1984).
Two possible limitations to this study need to be ad-
dressed. First, qualitative support from only the closest fam-
ily member and the closest friend was examined. This ap-
proach allowed us to look at the supportive relationship
between these older persons and their self-appointed closest
relationships. Although these relationships are important in
one’s social network, it may also be useful to study qualita-
tive support from the larger network of family and friends
that may be available to visually impaired elders. Second,
the quality and quantity of supportive relationships were ex-
amined at one point in time, therefore we cannot speculate
about the effects of support across time. The hypotheses
tested in this study need to be confirmed longitudinally. As
Rook and Schuster (1996) have stressed, longitudinal data is
essential to truly examine the issue of substitution in social
relationships. However, the findings of this cross-sectional
study support the importance of looking at these issues.
The major strength of the current study is the focus on
multiple indicators of support and psychological function-
ing, as well as the effects of gender. The importance of
qualitative support from friends versus family in terms of
both psychological status and domain-specific adaptation to
vision loss should not be overlooked when dealing with
older individuals who have chronic stressors, such as vision
loss. The relationship between gender and perception of
support from family versus friends needs further explora-
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Acknowledgments
This research was supported by National Institute of Mental Health
Grant R03MH46596 to the second author.
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Address correspondence to Jessica M. McIlvane, Institute for Social
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Received January 14, 1999
Accepted September 7, 2000
Decision Editor: Toni C. Antonucci, PhD