Norbeck Social Support Questionnaire (NSSQ)

Abstract

The Norbeck Social Support Questionnaire (NSSQ) is a seminal psychometric instrument designed to provide a comprehensive, multidimensional assessment of perceived social support. Developed in the early 1980s by nurse researchers Jane S. Norbeck, Ada M. Lindsey, and Virginia L. Carrieri, the NSSQ operationalizes social support by integrating both functional dimensions (the qualitative aspects of interpersonal assistance) and structural or network properties (the quantitative configuration of an individual’s relational sphere). Grounded primarily in Robert L. Kahn’s conceptualization of social support, the instrument systematically evaluates three primary functional subscales: Affect (expressions of love, liking, and respect), Affirmation (endorsement of behaviors, perceptions, and confiding), and Aid (tangible assistance, instrumental aid, and caretaking during illness). In addition to functional support, the NSSQ measures key network properties, including Network Size (number of supportive ties listed, up to 24), Duration of Relationships, Frequency of Contact, and Recent Network Loss.

The NSSQ utilizes a distinct matrix administration format wherein respondents generate a personal roster of network members and evaluate each member across items using a 5-point Likert-type scale ranging from 0 (“not at all”) to 4 (“a great deal”), alongside specific categorical and interval-level metrics for relational duration, contact frequency, and network loss. Extensive psychometric evaluations demonstrate exceptional internal consistency reliability, with Cronbach’s alpha coefficients typically ranging from .88 to .98 for functional subscales and exceeding .97 for total functional support. Test-retest reliability across a one-week interval ranges from .86 to .92, with moderate-to-high stability observed over seven-month intervals (.58 to .78). Construct, convergent, and discriminant validity have been rigorously corroborated across diverse clinical, perinatal, psychiatric, and multicultural populations. The instrument remains an international benchmark in health psychology, nursing science, and clinical epidemiology for elucidating the buffering and direct mechanisms through which interpersonal relations safeguard psychological well-being and physical health.

Keywords

Norbeck Social Support Questionnaire, NSSQ, social support measurement, functional social support, structural network, affect, affirmation, instrumental aid, Kahn convoy model, psychometrics

Authors

The Norbeck Social Support Questionnaire was created through the collaborative research of faculty members at the University of California, San Francisco (UCSF) School of Nursing:

• Jane S. Norbeck, DNSc, RN, FAAN: Professor Emerita and former Dean of the School of Nursing at the University of California, San Francisco (UCSF). Dr. Norbeck is an internationally recognized leader in psychiatric and mental health nursing, stress and coping paradigms, and the health effects of social networks in vulnerable and minority populations.
• Ada M. Lindsey, PhD, RN, FAAN: Professor Emerita and former Dean of the College of Nursing at the University of Nebraska Medical Center, and former Professor and Chair of the Department of Physiological Nursing at UCSF. Her research focused on oncology nursing, physiological stress, and the biological mediation of supportive care.
• Virginia L. Carrieri-Kohlman, DNSc, RN, FAAN: Professor Emerita of Physiological Nursing at the University of California, San Francisco. Dr. Carrieri-Kohlman is widely noted for her research on dyspnea management, cardiopulmonary rehabilitation, and biobehavioral interventions in chronic illness.

Purpose

The primary purpose of the Norbeck Social Support Questionnaire (NSSQ) is to provide clinicians, behavioral scientists, and healthcare researchers with a clinically sensitive, theoretically sound, and psychometrically robust measurement tool capable of evaluating the intricate topography of human social relationships. Prior to the development of the NSSQ in 1981, the empirical literature on social support was impeded by fragmented, idiosyncratic, and unidimensional measurement strategies. Many existing instruments treated social support either as a monolithic global perception or solely as a count of social interactions, routinely failing to capture the qualitative essence of interpersonal resources or confounding social support with underlying psychopathology and personality traits.

Norbeck, Lindsey, and Carrieri recognized that to understand the mechanisms connecting interpersonal relations to health outcomes, an instrument must fulfill multiple theoretical and methodological criteria simultaneously:

1. It must measure distinct functional components of support (emotional, cognitive-evaluative, and tangible-instrumental).
2. It must assess critical structural network characteristics (network size, stability over time, intensity/frequency of contact, and relational attrition).
3. It must minimize response burden while retaining the capacity to pinpoint specific relational configurations within an individual’s personal network.
4. It must demonstrate clear discriminant validity from constructs such as social desirability, neurosis, and negative affectivity.

In research domains, the NSSQ was engineered to test the competing paradigms of the buffering hypothesis (which posits that social support primarily acts as an immunizing buffer against the deleterious physiological and psychological consequences of life stress) and the direct-effect hypothesis (which asserts that social integration is intrinsically beneficial regardless of ambient environmental stressors). Clinically, the NSSQ serves as a systematic diagnostic framework for healthcare practitioners, including advanced practice registered nurses, clinical psychologists, medical social workers, and primary care physicians. By administering the NSSQ, practitioners can rapidly identify socially isolated individuals, map deficits in specific support domains (e.g., adequate emotional intimacy but an absence of emergency tangible aid), and guide community-based or therapeutic interventions tailored to fortify specific deficits within the patient’s interpersonal network.

The NSSQ has found extensive application across specialized healthcare populations. It is widely employed in perinatal medicine to examine maternal-fetal outcomes, postpartum depression, and low-income maternal stress; in oncology and chronic illness to track caregiver burden and patient adaptation to debilitating diagnoses; and in community psychiatric populations to evaluate the stabilizing effect of social convoys against institutional recidivism. Its design uniquely permits respondents to self-define who constitutes their network, avoiding prescriptive institutional assumptions about family structures, marital ties, or formal caregiving systems.

Psychological Construct

The psychological construct of social support as operationalized within the NSSQ is a multifaceted biobehavioral and psychosocial entity comprising two foundational domains: Functional Support and Structural/Network Properties. These dimensions reflect both what social relationships provide to the focal individual and how the relational network is configured in time and space.

1. Functional Social Support

Functional support refers to the specific interpersonal resources exchanged between members of a social dyad. The NSSQ conceptualizes functional support across three interrelated yet theoretically distinct subdimensions:

• Affect: This dimension captures emotional support and the subjective experience of interpersonal warmth. Affective support involves actions and communications that communicate to the individual that they are fundamentally loved, valued, cared for, respected, and esteemed. Item 1 (“How much does this person make you feel loved?”) measures unconditional emotional validation, intimacy, and affection. Item 2 (“How much does this person make you feel respected or admired?”) assesses social esteem, interpersonal recognition, and the affirmation of one’s moral or personal worth. Affective support provides the emotional baseline required to foster psychological safety and resilience against depressive cognitions.
• Affirmation: Grounded in cognitive validation and social comparison processes, affirmation refers to the communication of information that validates the appropriateness of an individual’s behavior, perceptions, values, and emotions. Item 3 (“How much can you confide in this person?”) reflects relational trust, safety in self-disclosure, and the presence of a psychological confidant. Item 4 (“How much does this person agree with or support your actions or thoughts?”) measures cognitive consensus, ideological alignment, and the provision of constructive feedback that reinforces the individual’s self-concept and reality-testing capabilities under ambiguous or stressful circumstances.
• Aid: In contrast to emotional and cognitive support, aid represents tangible, practical, or instrumental resources delivered to solve concrete problems or alleviate direct physical burdens. The NSSQ divides aid into acute/short-term assistance and sustained/long-term instrumental care. Item 5 (“If you needed to borrow $10, a ride to the doctor, or some other immediate help, how much could this person usually help?”) measures acute instrumental assistance requiring modest investment of time or capital. Item 6 (“If you were confined to bed for several weeks, how much could this person help you?”) assesses high-investment, sustained instrumental caretaking, which requires considerable personal commitment, logistical sacrifice, and physical presence.

2. Structural and Network Properties

A social network is not merely an abstract supplier of functional resources; its capacity to deliver sustained support is fundamentally constrained and shaped by its structural properties. The NSSQ captures these structural properties systematically:

• Network Size: Determined by the total number of individuals listed by the respondent on the network roster (up to a ceiling of 24 individuals). Network size provides a basic metric of social density and integration, serving as the denominator that determines an individual’s relational bandwidth and vulnerability to isolation.
• Duration of Relationships: Assessed via Item 7 (“How long have you known this person?”), this dimension measures relational stability, historical continuity, and shared biographical background. Long-standing relationships often carry deeply entrenched reciprocal obligations and profound affective depth, whereas newer relationships may reflect contemporary context-specific integration.
• Frequency of Contact: Assessed via Item 8 (“How frequently do you usually have contact with this person?”), this structural variable measures the operational density and transactional intensity of the relationship across various communication modalities (face-to-face visits, telephone calls, letters, and modern digital modalities such as email and electronic messaging).
• Recent Network Loss: Captured through Item 9 and its sub-components (Items 9, 9a, and 9b), this dimension evaluates structural disruption, relational bereavement, and network instability occurring within the preceding 12 months due to geographic relocation, occupational change, marital dissolution, estrangement, or mortality. It measures both the objective quantity of lost ties and the subjective magnitude of support that departed with those ties.
• Geographical Distance: In extended versions and specialized implementations of the NSSQ (Item 10), geographic proximity is explicitly documented to evaluate the immediate ecological availability of physical assistance versus geographically dispersed, telemediated affective networks.

Theoretical Framework

The Norbeck Social Support Questionnaire is deeply embedded within classical sociological, psychological, and epidemiological theories of human relations and health. The primary conceptual foundation for the NSSQ is Robert L. Kahn’s (1979) Convoy Model of Social Support, further articulated by Toni Antonucci and colleagues. Kahn defined social support as interpersonal transactions that include one or more of three key elements: affect (expressions of positive affect, love, and respect), affirmation (expressions of agreement or acknowledgment of the appropriateness of beliefs or behaviors), and aid (the direct giving of symbolic or material assistance). Norbeck and her co-authors deliberately mapped the functional subscales of the NSSQ directly onto Kahn’s tripartite taxonomy, creating an operational translation of this theoretical framework.

The Convoy Model conceptualizes the individual as traveling through the life course surrounded by a dynamic, protective “convoy” of social relationships. These relational ties vary across concentric circles of intimacy, permanence, role demands, and functional capacity. Inner-circle relationships (typically spouses, immediate family, or lifelong confidants) are characterized by profound affect, high durability, and non-contingent instrumental aid; middle- and outer-circle ties (extended family, colleagues, neighbors, institutional acquaintances) are frequently more task-specific, geographically contingent, and vulnerable to environmental disruptions. The NSSQ operationalizes this convoy by prompting respondents to generate a sequential roster of members who comprise their current interpersonal world, thereby delineating the specific members forming the client’s social convoy.

Additionally, the NSSQ incorporates insights from Sidney Cobb’s (1976) Information Theory of Social Support. Cobb defined social support as information leading the subject to believe that he or she is cared for and loved, esteemed and valued, and belongs to a network of communication and mutual obligation. This conceptualization emphasizes that social support is fundamentally an internal cognitive appraisal rather than an objective environmental census of interactions. By using subjective Likert ratings across listed members, the NSSQ bridges Cobb’s focus on cognitive appraisal with Kahn’s structural network taxonomy.

The theoretical necessity of measuring social support stems directly from the epidemiological work of John Cassel (1976) and subsequent stress-coping theorists, such as Richard Lazarus and Susan Folkman (1984). Cassel posited that social environments characterized by high stress and low social support stimulate chronic neuroendocrine activation, compromising host resistance and elevating generalized susceptibility to organic and psychiatric disease. Under Lazarus and Folkman’s cognitive appraisal theory of coping, social resources operate during secondary appraisal: when confronting a stressor, individuals assess the resources available to manage environmental demands. If an individual recognizes a dense, high-functioning network of affect, affirmation, and aid, the stressor is appraised as a manageable challenge rather than an overwhelming threat, blunting autonomic arousal and harmful biobehavioral responses.

Validity

The validity of the Norbeck Social Support Questionnaire has been verified through an extensive corpus of construct, convergent, discriminant, and predictive validity studies across four decades of empirical investigation.

Construct and Convergent Validity

During the initial psychometric validation of the NSSQ, Norbeck, Lindsey, and Carrieri (1981, 1983) established construct and convergent validity by correlating NSSQ subscales with established measures of interpersonal functioning and psychological distress. In their normative cohort of 136 employed adults and subsequent university and clinical cohorts, functional support scores (Affect, Affirmation, and Aid) correlated significantly with comparable subscales of the Social Support Questionnaire developed by Sarason et al. and the Personal Resource Questionnaire (PRQ) developed by Brandt and Weinert (correlations typically ranging from .44 to .71, p < .001).

Convergent validity was further corroborated in clinical and high-stress cohorts. Studies examining expectant mothers (Norbeck & Anderson, 1989; Zachariah, 1996, 2009) demonstrated that high scores on NSSQ Affect and Affirmation subscales correlated negatively with symptoms of maternal anxiety measured via the State-Trait Anxiety Inventory (STAI) and general distress on the Profile of Mood States (POMS). Furthermore, Patricia H. Byers and Marcia R. Mullis (1987) examined the psychometric behavior of the NSSQ within psychiatric inpatient populations, demonstrating that functional support scores differentiated between hospitalized psychiatric patients and matched community controls, with inpatients reporting significantly smaller network sizes, lower perceived aid, and higher rates of recent network disruption.

Discriminant Validity

A central challenge in the measurement of perceived social support is isolating the construct from concurrent social desirability bias and general personality dispositions such as extraversion and neuroticism. To evaluate discriminant validity, Norbeck et al. (1981, 1983) administered the NSSQ alongside the Marlowe-Crowne Social Desirability Scale. Correlational analyses revealed non-significant correlations between the NSSQ functional subscales (Affect, Affirmation, Aid) and Marlowe-Crowne scores (correlations ranging from .01 to .14, p > .05), confirming that responses on the NSSQ are not artifacts of a defensive need for social approval or virtuous self-presentation.

Predictive and Criterion Validity

The NSSQ has exhibited substantial predictive utility in longitudinal and prospective epidemiological investigations. In a series of classical investigations on stress-buffering mechanisms, Norbeck and Tilden (1983) and Norbeck and Anderson (1989) demonstrated that low functional support (particularly low emotional support, combining Affect and Affirmation) prospectively predicted higher rates of medical complications during labor and delivery among economically disadvantaged women facing high life stress. Similarly, Monica Leah Stevens (2008) examined the NSSQ in relation to chronic illness adaptation, demonstrating that network density and functional aid prospectively predicted adherence to complex medical regimens and lower rates of re-hospitalization.

Reliability

The reliability of the Norbeck Social Support Questionnaire has been verified across multiple testing modalities, including internal consistency, test-retest temporal stability, and inter-item correlational structures.

Internal Consistency

Internal consistency estimates for the NSSQ are exceptionally high across varied clinical and non-clinical samples. In the foundational validation studies by Norbeck et al. (1981, 1983), the internal consistency coefficients (Cronbach’s alpha) for the individual functional subscales were:

• Affect Subscale: α = .95 to .98
• Affirmation Subscale: α = .92 to .97
• Aid Subscale: α = .89 to .91
• Total Functional Support (Affect + Affirmation + Aid combined): α = .97 to .98
• Network Properties (Duration and Frequency of Contact across network members): α = .88 to .96

Subsequent independent validation studies have consistently replicated these findings. For instance, in a rigorous structural equation modeling study conducted by Eileen Gigliotti (2002), the 6-item functional NSSQ demonstrated a total Cronbach’s alpha of .97, with individual subscales yielding .98 for Affect, .97 for Affirmation, and .91 for Aid. Similarly, Rachel Zachariah (1996) calculated the internal consistency of an Emotional Support composite score (combining the Affect and Affirmation subscales) in pregnant cohorts, yielding an alpha coefficient of .97. In psychiatric settings, Byers and Mullis (1987) confirmed alpha coefficients exceeding .90 for functional support scales, demonstrating that the questionnaire retains its psychometric reliability even in samples experiencing acute psychological distress.

Test-Retest Temporal Stability

The temporal stability of the NSSQ has been confirmed across short-term and extended longitudinal re-test intervals:

• Short-Term Stability (One-Week Interval): Norbeck et al. (1981) administered the NSSQ to a cohort of 67 respondents across a 7-day interval. Pearson correlation coefficients demonstrated high stability across all dimensions: Affect (r = .89), Affirmation (r = .88), Aid (r = .86), Total Functional Support (r = .89), Network Size (r = .92), Duration of Relationships (r = .92), and Frequency of Contact (r = .88).
• Long-Term Stability (Seven-Month Interval): In a subsequent follow-up investigation with 44 subjects (Norbeck et al., 1983), stability coefficients across a seven-month interval ranged from r = .58 to .78 (p < .001). These coefficients reflect substantial underlying trait stability while allowing sufficient sensitivity to register genuine life-course shifts in interpersonal networks.

Factor Analysis

The underlying latent architecture of the NSSQ has been investigated via exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). In the initial exploratory analyses conducted by Norbeck, Lindsey, and Carrieri (1981, 1983), principal components analyses with varimax and oblique rotations revealed that the items comprising Affect, Affirmation, and Aid loaded strongly onto a dominant primary factor, frequently termed Total Functional Support, which accounted for more than 70% to 80% of the explained common variance. Inter-correlations among the functional subscales were high (typically r > .80 between Affect and Affirmation, and r > .70 between Emotional Support and Aid), suggesting that respondents perceive supportive social behaviors as a cohesive, interrelated construct.

To address whether the three theoretical functional dimensions could be empirically separated, Eileen Gigliotti (2002) conducted a confirmatory factor analysis using structural equation modeling across a sample of 258 adult women. Gigliotti tested competing structural configurations:

1. A One-Factor Model positing that all six functional items load onto a single undifferentiated social support factor.
2. A Two-Factor Model distinguishing between Emotional Support (Affect and Affirmation items combined) and Instrumental/Tangible Support (Aid items).
3. A Three-Factor Model reflecting Kahn’s theoretical separation of Affect, Affirmation, and Aid.

Gigliotti’s CFA results confirmed that while the 1-factor model demonstrated acceptable baseline fit indices due to high inter-item correlations, the two-factor model (separating Emotional Support from Aid) and a hierarchical second-order factor model exhibited superior fit to the data (χ²/df ratio < 2.5, Comparative Fit Index [CFI] > .97, Root Mean Square Error of Approximation [RMSEA] < .06). Standardized factor loadings across all functional items were uniformly high, consistently exceeding .85 on their designated latent factors. These findings empirically justify the common practice in research of analyzing both a global functional support score and distinct subscale scores for Affect, Affirmation, and Aid.

Instrument / Measurement Tool

The Norbeck Social Support Questionnaire is a structured, respondent-completed matrix assessment. The following parameters define its administration, structural format, and scoring algorithms:

• Instrument Designation: Norbeck Social Support Questionnaire (NSSQ).
• Format / Administration: Paper-and-pencil or secure computerized matrix grid. Respondents generate a personal network list containing up to 24 individuals (using initials or first names) and then evaluate each listed individual across the functional and structural questions.
• Item Inventory:
  • Items 1 & 2: Measure Affect (emotional closeness, feeling loved, respected, or admired).
  • Items 3 & 4: Measure Affirmation (confiding, cognitive and behavioral validation).
  • Items 5 & 6: Measure Aid (acute short-term assistance and sustained caregiving aid).
  • Item 7: Measures Duration of Relationship.
  • Item 8: Measures Frequency of Contact.
  • Item 9 (with 9a & 9b): Measures Recent Network Loss (relational bereavement or loss within the preceding year, number of persons lost, and amount of support lost).
  • Item 10: Measures Geographical Distance (proximity of network members).
• Response Scales:
  • Functional Items (1 to 6): Rated on a 5-point Likert scale: 0 = not at all, 1 = a little, 2 = a moderate amount (or moderately), 3 = quite a bit, 4 = a great deal.
  • Duration of Relationship (Item 7): Rated on a 5-point categorical/interval scale: 1 = less than 6 months, 2 = 6 to 12 months, 3 = 1 to 2 years, 4 = 2 to 5 years, 5 = more than 5 years.
  • Frequency of Contact (Item 8): Rated on a 5-point scale: 1 = once a year or less, 2 = a few times a year, 3 = monthly, 4 = weekly, 5 = daily.
  • Network Loss (Item 9): Binary screening response (Yes / No); Item 9a records count of lost ties; Item 9b rates support lost using the 5-point scale: 0 = none at all to 4 = a great deal.
  • Geographical Distance (Item 10): Rated on a 7-point scale ranging from same household/immediate neighborhood to distant/international residence.
• Scoring and Computational Rules:
  • Subscale Functional Scores: Calculated by summing the ratings for the specific items across all network members listed on the roster. For example, the Affect Subscale Score is the sum of ratings for Item 1 and Item 2 across all nominated members.
  • Total Functional Support: The grand sum of all ratings for Items 1 through 6 across all listed network members.
  • Average Functional Scores: Alternatively computed by dividing the subscale total by the Network Size, yielding a metric of support quality independent of network volume.
  • Total Network Properties: Network Size is the raw count of listed individuals (0 to 24); Total Duration and Total Contact are the sums of scores for Items 7 and 8, respectively.
  • Loss Score: Represents the subjective rating of lost support from Item 9b.
• Completion Time: Approximately 10 to 15 minutes depending on the size of the respondent’s network.

Permissions & Fee and Test Year

The Norbeck Social Support Questionnaire was initially published in 1981 by Dr. Jane S. Norbeck, Dr. Ada M. Lindsey, and Dr. Virginia L. Carrieri, with expanded normative data and scoring guidelines published in 1983. The original instrument and its scoring manual were placed into the public scientific domain to facilitate non-commercial clinical, academic, and nursing research. Researchers and clinicians may administer the NSSQ for non-commercial educational, scholarly, and healthcare purposes without royalty fees, provided appropriate scholarly attribution is accorded to the original authors and the Nursing Research publications. Commercial applications, commercial software integration, or proprietary redistributions require explicit formal licensing and permission from the copyright holders and the respective journal publishers (Lippincott Williams & Wilkins / Wolters Kluwer Health). Detailed administrative scoring sheets and user manuals are archived across academic institutional repositories (such as the OhioLINK Electronic Theses and Dissertations Center and University of Florida digital collections).

References

• Byers, P. H., & Mullis, M. R. (1987). Reliability and validity of the Norbeck Social Support Questionnaire in psychiatric inpatients. Educational and Psychological Measurement, 47(2), 445–448. https://doi.org/10.1177/0013164487472017
• Cassel, J. (1976). The contribution of the social environment to host resistance: The Fourth Wade Hampton Frost Lecture. American Journal of Epidemiology, 104(2), 107–123. https://doi.org/10.1093/oxfordjournals.aje.a112281
• Cobb, S. (1976). Social support as a moderator of life stress. Psychosomatic Medicine, 38(5), 300–314. https://doi.org/10.1097/00006842-197609000-00003
• Gigliotti, E. (2002). A confirmation of the factor structure of the Norbeck Social Support Questionnaire. Nursing Research, 51(5), 276–284. https://doi.org/10.1097/00006199-200209000-00002
• Kahn, R. L. (1979). Aging and social support. In M. W. Riley (Ed.), Aging from Birth to Death: Interdisciplinary Perspectives (pp. 77–91). Westview Press.
• La Roche, M. (1999). The association of social relations and depression levels among Dominicans in the United States. Hispanic Journal of Behavioral Sciences, 21(4), 420–430. https://doi.org/10.1177/0739986399214003
• La Roche, M., & Turner, C. (1997). Self-orientation and depression level among Dominicans in the United States. Hispanic Journal of Behavioral Sciences, 19(4), 479–488. https://doi.org/10.1177/07399863970194006
• Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. Springer Publishing Company.
• Norbeck, J. S. (1984). Modification of a recent life event questionnaire for use with female respondents. Research in Nursing & Health, 7(1), 61–71. https://doi.org/10.1002/nur.4770070110
• Norbeck, J. S. (1984). The Norbeck Social Support Questionnaire. Birth Defects Original Article Series, 20(5), 45–57.
• Norbeck, J. S., & Anderson, N. J. (1989). Life stress, social support, and anxiety in mid- and late-pregnancy among low income women. Research in Nursing & Health, 12(5), 281–287. https://doi.org/10.1002/nur.4770120503
• Norbeck, J. S., Lindsey, A. M., & Carrieri, V. L. (1981). The development of an instrument to measure social support. Nursing Research, 30(5), 264–269. https://doi.org/10.1097/00006199-198109000-00003
• Norbeck, J. S., Lindsey, A. M., & Carrieri, V. L. (1983). Further development of the Norbeck Social Support Questionnaire: Normative data and validity testing. Nursing Research, 32(1), 4–9. https://doi.org/10.1097/00006199-198301000-00002
• Norbeck, J. S., & Tilden, V. P. (1983). Life stress, social support, and emotional disequilibrium in complications of pregnancy: A prospective, multivariate study. Journal of Health and Social Behavior, 24(1), 30–46. https://doi.org/10.2307/2136385
• Stevens, M. L. (2008). Psychometric properties of the Norbeck Social Support Questionnaire (Master’s thesis). University of Florida. http://ufdcimages.uflib.ufl.edu/UF/E0/02/20/29/00001/stevens_m.pdf
• Zachariah, R. (1996). Predictors of psychological well-being of women during pregnancy: Replication and extension. Journal of Social Behavior and Personality, 11(1), 127–140.
• Zachariah, R. (2009). Social support, life stress, and anxiety as predictors of pregnancy complications in low-income women. Research in Nursing & Health, 32(4), 391–404. https://doi.org/10.1002/nur.20334

13. Items of the Scale (Questionnaire)