Coping with uncertainty in mental illness: Associations among desired support,support seeking strategies,and received support from family members

Abstract

Individuals with mental illness commonly experience uncertainty related to not only the condition itself but also personal and social implications surrounding mental illness. Support from family has the potential to alleviate uncertain feelings and reduce perceived stress. Drawing on the sensitive interaction systems theory, this longitudinal study investigated the support seeking processes and outcomes in mental illness. Results suggested that perceived uncertainty about mental illness was negatively associated with desired emotional and informational support from close family. Desired support predicted received support and reduced perceived stress 2 weeks later. The effect of desired support on received support was mediated by direct support seeking behaviors. Communication efficacy, relational trust, and motivation to seek support moderated the associations between desired support and support seeking behaviors. Findings offer theoretical and practical implications for support seeking from family members in mental illness.

Keywords

Uncertainty social support support seeking perceived stress mental illness

For people who experience uncertainty in illness, supportive communication from close relationships can facilitate effective management of uncertainty (e.g., Bowen et al., 2020; Brashers et al., 2004; Choi et al., 2012). Supportive communication refers to “verbal and nonverbal behavior produced with the intention of providing assistance to others perceived as needing that aid” (MacGeorge et al., 2011, p. 317). When individuals with mental illness directly state their problem and explicitly seek desired support from close others, they may receive quality support that expresses love, concern, and empathy, communicates validation and acceptance, offers useful information and advice, and subsequently reduce stress associated with uncertainty (e.g., Brashers et al., 2004; Gariepy et al., 2016). However, when people desire support but do not seek it, or when they seek support indirectly and ambiguously, supportive interactions may interfere with uncertainty management, exacerbate stress, and result in maladaptive variants of support seeking such as rumination and excessive reassurance seeking (e.g., Brashers et al., 2004; Starr, 2015; Williams & Mickelson, 2008). Understanding the mechanism through which illness uncertainty influences support seeking behaviors and outcomes is essential to theorizing supportive communication processes and offers important practical implications for how individuals can effectively solicit desired support to better manage illness-related uncertainty.

Overall, the objectives of this project are threefold: (a) to test the effect of illness uncertainty on desired support, (b) to examine the time-lagged effects of desired support on direct and indirect support seeking behaviors, received support, and perceived stress, and (c) to investigate the roles of three potential moderators that may influence the extent to which desired support leads to direct or indirect support seeking, including communication efficacy, relational trust, and motivation to seek support. Drawing on the sensitive interaction systems theory (SIST; Barbee & Cunningham, 1995), we situate this longitudinal study within the health context of mental illness and the relational context of close family. On the one hand, as a highly prevalent chronic condition, mental illness is frequently associated with uncertainty experiences and is a context in which supportive communication is particularly challenging (e.g., Hippman et al., 2013; Thompson et al., 2022). On the other hand, although not all family relationships are positive or supportive, family is a critical source of social support for most people (e.g., Pierce et al., 1996). Therefore, in this study, we focus on how individuals with mental illness seek support from close family members – those who share strong bonds, high levels of care, concern, and love for each other, and see the familial relationship as important (e.g., Waters & Cummings, 2000).

Uncertainty in mental illness and supportive communication

In the United States, an estimated 50% of Americans are diagnosed with a mental illness at some point in their lifetime (Centers for Disease Control and Prevention, 2021). According to the National Alliance on Mental Illness (NAMI, 2021), mental illness, also referred to as mental health disorders, is “a condition that affects a person’s thinking, feeling, behavior or mood.” These conditions can be unpredictable and have a profound impact on people’s day-to-day living. For example, individuals living with mental illness may experience uncertainty related to their medical condition (e.g., diagnosis, prognosis, treatment). Additionally, their mental illness conditions oftentimes are associated with uncertainty about the self (e.g., identity) and relationships (e.g., social implications; Brashers et al., 2000; Hippman et al., 2013). Uncertainty, in general, refers to the inability to determine the probability and outcome of an event due to insufficient, inconsistent, and/or complex information (e.g., Brashers, 2001). Depending on how uncertainty is appraised (e.g., as a threat or opportunity; Mishel, 1988), it may activate negative (e.g., anxiety) or positive emotional responses (e.g., hope). In illness contexts, uncertainty and associated emotions tend to function as a stressor (Lazarus & Folkman, 1984). Even when uncertainty is appraised as positive or neutral, people may desire a different level of uncertainty than what is experienced and need to cope with such discrepancies (e.g., Afifi & Weiner, 2004).

Supportive interactions in close relationships can facilitate coping with uncertainty in illness and buffer the impact of uncertainty-related stress. In mental illness, emotional support may involve supportive actions that convey empathy, love, and concern to individuals living with mental illness. Informational support refers to sharing knowledge, advice, and facts about different aspects of mental illness (e.g., diagnosis, prognosis, treatment, recovery) and involves “messages that make recommendations about what to do, think, or feel in response to a problematic situation” (MacGeorge et al., 2011, p. 335). Other types of support (e.g., Holmstrom & Burleson, 2011; Xu & Burleson, 2001) may help validate and bolster the self-concept (esteem support), create a sense of belonging through connecting with people who have similar mental illness experiences (network support), or help provide material assistance such as transportation and food (tangible support). Although individuals with mental illness may need various types of support under different circumstances, emotional and informational support tend to be most crucial when coping with illness-related uncertainties. Therefore, we focus on these two support types in this study.

Previous empirical evidence suggests that uncertainty in illness, as a stressor, may lead to desired support from close others. Desired support refers to what people hope to receive in ideal scenarios to help them better cope with stressors (Xu & Burleson, 2001). In the context of young adults’ illicit stimulant use, for example, Morse and colleagues (2013) found that when individuals experienced higher-than-desired levels of uncertainty, they also perceived higher desire for informational support. Additionally, people may desire emotional support to help them manage uncertainty-related (negative) emotions. Brashers and colleagues (2004) examined uncertainty management and social support among individuals living with HIV/AIDS and found that different types of support, especially emotional support such as giving acceptance or validation, allowing ventilation, and encouraging alternative perspectives, can facilitate uncertainty management. Choi et al. (2012) found that emotional and informational support was negatively associated with pregnancy-related uncertainty and promoted prenatal psychosocial adaptation. These findings point to the possible associations between uncertainty in mental illness and desired emotional and informational support from close family members. Hence, we propose that (see Figure 1):

H1: Perceived levels of uncertainty related to individuals’ mental illness will be positively associated with levels of desired support from close family members.

Desired support, direct/indirect support seeking, and outcomes

Desired Support and support seeking behaviors

In most situations, one’s desire for support needs to be met through support seeking behaviors, as individuals often act as “activists on behalf of their own well-being” (Thoits, 1995, p. 58), rather than passive recipients of support from others. Support seeking is defined as a person’s “intentional communicative activity with the aim of eliciting supportive actions from others” (MacGeorge et al., 2011, p. 330). Support seeking is often driven by a desire for support and can influence the amount of support received. For instance, High and Crowley (2018) found that for people coping with taboo stressors, their desires for support were indirectly related to the support they received through how much support they actually sought. Seeking to replicate and extend these findings in mental illness, we examine the indirect associations between desired support and received support through two types of support seeking behaviors: direct versus indirect support seeking.

Support seeking is essentially a communicative activity (MacGeorge et al., 2011), and therefore, strategies for support seeking may differ on various dimensions. The sensitive interaction systems theory (SIST; Barbee & Cunningham, 1995) offers a theoretical perspective for understanding support seeking processes. In particular, one major dimension on which support seeking behaviors can be differentiated is the directness of support seeking communication. According to the SIST, direct support seeking refers to behavior that explicitly communicates a desire for help with a problem, such as verbally asking for support or by showing obvious emotional distress (e.g., crying). Indirect support seeking behaviors, in contrast, are more subtle and less explicit – instead of stating the nature of the problem and expressing feelings in a straightforward way, people may indirectly hint or complain about their problem and ambiguously communicate their desire for support. Such indirect support seeking behaviors can serve to protect the support seekers’ face and self-esteem or to test the interest of the helper and likelihood of receiving support, without making the potential helper feel the pressure to provide support. The SIST proposes whether and how individuals engage in direct support seeking behaviors depend on a range of individual and relational factors (discussed in more detail below). In general, desired support is an antecedent to support seeking, either directly or indirectly. Therefore, we propose:

H2: Participants’ levels of desired support will predict their levels of a) direct support seeking and b) indirect support seeking behaviors from family members.

Outcomes of direct vs. indirect support seeking strategies

Direct versus indirect support seeking strategies may lead to different responses from the potential support provider. Support seekers who adopt direct forms of support seeking are more likely to receive the desired support. Derlega and colleagues (2003) found that individuals living with HIV who directly asked for help from friends and intimate partners reported receiving more help for problem solution and responses that expressed emotional closeness than avoidance. Compared to direct support seeking, indirect support seeking tends to lead to unsupportive responses such as rejection. For example, Williams and Mickelson (2008) showed that stigma perceptions in contexts such as poverty and abuse were linked to increased indirect support seeking, which, in turn, was related to higher levels of unsupportive network responses (e.g., criticizing, blaming, disapproval). Don and colleagues (2019) also found that indirect support seeking behaviors led to negative support from partners in intimate relationships. In contrast, direct support seeking was related to increased supportive responses (e.g., understanding, valuing, and caring) and decreased unsupportive responses from personal relationships and networks. Therefore, we expect to replicate these findings in mental illness, such that direct support seeking strategies will be more effective in solicitating emotional and informational support from close family compared to indirect support seeking strategies.

H3: Participants’ (a) reported levels of direct support seeking behaviors will be positively associated with the levels of received support from family members, whereas (b) reported levels of indirect support seeking behaviors will be negatively associated with levels of received support from family members.

Based on H2 and H3, desired support will drive individuals’ direct and indirect support seeking behaviors, which, in turn, will influence the amount of support received. In other words, support seeking behaviors will mediate the association between desired support and received support reported at a later time point.

H4: The effect of desired support on received support will be mediated by direct and indirect support seeking behaviors.

In addition, the amount of support that a person desires may also directly influence the amount of support they will receive. For example, Smith et al. (2019) found that parole/probation agents offered informational support (in the form of advice and suggestion) to women offenders who showed antisocial attitude. In addition, agents’ own and women’s reports of their communication pattern predicted the agents’ intent to provide emotional support messages (in the form of encouragement). In this case, the exhibition of antisocial attitude and different communication patterns between the agents and women offenders may be interpreted (by the supervising agents) as indicators of the women offenders’ desire for support, which then led the agents to offer support in the form that they thought would benefit the women. However, no existing study has tested the association between desired support and received support after accounting for individuals’ direct and indirect support seeking behaviors. Therefore, we ask the following research question:

RQ: Is there an association between desired support and received support after the mediation effects of direct and indirect support seeking behaviors are accounted for? If so, in what direction?

Although the effects of support seeking on health outcomes can be either helpful or harmful depending on factors such as the quantity and quality of the support desired, sought, and received (e.g., support surplus vs. deficit; e.g., Brock & Lawrence, 2009; High & Crowley, 2018) and whether the support recipient is able and motivated to process the support message (e.g., Bodie, 2011; Burleson et al., 2011), overall, support received from close others has been found to facilitate coping with illness and buffer the negative impact of illness-related stress (the buffering hypothesis; Cohen & Wills, 1985). For example, Wang et al.’s (2018) systematic review suggested that within mental illness, individuals who perceived their social support as poorer at baseline had worse outcomes including greater symptom severity, poorer recovery and remission, and worse social functioning. Segrin and colleagues’ (2016) longitudinal study showed that emerging adults’ social skills were positively associated with received social support, which in turn, reduced levels of distress. Therefore, we propose that:

H5: The levels of support that participants receive from close family members will be negatively associated with perceived stress.

Potential moderating effects of communication efficacy, trust, and motivation

The SIST (Barbee & Cunningham, 1995) suggests that individuals who desire support do not necessarily engage in universal support seeking behaviors. Instead, people evaluate the nature of their problem, the relationship with the support provider, the availability of support and the likelihood of receiving support, and the cost of seeking and obtaining support before they decide whether to seek support and, if yes, how to seek. Another goal of this project is to examine factors that may moderate the associations between desired support and different support seeking strategies.

Previous work shows that support seekers’ characteristics and expectations can influence their support seeking behaviors and outcomes (e.g., Mortenson, 2009; Rains et al., 2020). For example, Rains et al. (2020) examined support seekers’ expectations about the (un)helpfulness of support providers and found that their expectations affected the evaluations of the quality of providers’ feedback and the extent to which the support provided was able to reduce their emotional stress. Redmond and colleagues (2002) focused on parent support seeking and found that both family- (e.g., household income, number of children) and community-level (e.g., community population size) socio-demographic predictors influenced whether and how parents of six-graders sought support from others. These findings suggest that people who desire support from close others may engage in different levels and types of support seeking behaviors depending on individual and relational factors. In this study, we focus on three potential moderators related to supportive interaction and the relational context under examination (i.e., close family): communication efficacy, trust toward family members, and motivation to seek support.

Communication efficacy

First, individuals’ perceived ability to talk about issues related to their uncertainty, desired support, and need surrounding their mental illness conditions may play a crucial role in determining individuals’ communicative behaviors. For example, High and Scharp (2015) examined undergraduate students’ support seeking behaviors when faced with personal problems and found that communicative ability was positively associated with direct support seeking and negatively associated with indirect support seeking. In this case, communication efficacy may serve as a moderator for the effect of desired support on support seeking behaviors, which subsequently influence the actual support received by the support seekers. In other words, those who desire support from family members but do not see themselves as efficacious in communicating such desire may choose to seek support indirectly and thus are less likely to receive quality support. In contrast, people who desire support from close others and are confident in their ability to talk about related issues are more likely to engage in direct support seeking behaviors and receive the support needed, as a result of explicitly seeking and competently communicating their desire. Therefore, it is proposed that:

H6a: Participants’ levels of communication efficacy will moderate the association between desired support and direct support seeking behaviors, such that the association will be stronger for those who report higher levels of communication efficacy and weaker for those who have lower levels of communication efficacy.

H6b: Participants’ levels of communication efficacy will moderate the association between desired support and indirect support seeking behaviors, such that the association will be stronger for those who report lower levels of communication efficacy and weaker for those who have higher levels of communication efficacy.

Relational trust

Second, relational factors such as trust may also moderate the effects of desired support on support seeking behaviors. Mortenson (2009) examined how interpersonal trust may facilitate the support-seeking process in China and the United States and found that trust was significantly associated with perceived appropriateness of seeking support, which predicted participants’ likelihood of showing emotional distress to friends. This shows that when trust level is high, individuals who desire support likely will view support seeking as appropriate and, as a result, directly seek support. For those who have low relational trust, despite their desire for support, individuals may choose to not seek support or do so in an implicit way, resulting in lower levels of received support. Therefore, we propose that:

H7a: Participants’ levels of trust with family will moderate the association between desired support and direct support seeking, such that the association will be stronger for those who report higher levels of trust and weaker for those who have lower levels of trust.

H7b: Participants’ levels of trust with family will moderate the association between desired support and indirect support seeking, such that the association will be stronger for those who report lower levels of trust and weaker for those who have higher levels of trust.

Motivation to seek support

Last, individuals’ motivation to seek support may moderate the associations between desired support and support seeking behaviors. Previous research shows that motivation increases the likelihood that effective supportive messages are produced and processed (e.g., Bodie, 2011; Burleson et al., 2011) and directly influences support seeking behaviors (High & Scharp, 2015). From a dual perspective model perspective (e.g., Bodie, 2011), motivation may function as a moderator in supportive communication – individuals who desire support and are motivated to seek support may engage in direct (and possibly effective) support communication, whereas people who desire support but are not motivated to seek support may not engage in supportive communication directly, which in turn reduces the levels of support one can receive:

H8a: Motivation to seek support will moderate the association between desired support and direct support seeking, such that the association will be stronger for those who report higher levels of motivation and weaker for those who have lower levels of motivation.

H8b: Motivation to seek support will moderate the association between desired support and indirect support seeking, such that the association will be stronger for those who report lower levels of motivation and weaker for those who have higher levels of motivation.

Method

Participants and procedure

Participants were recruited via Cloud Research’s Prime Panels, an online crowdsourcing platform. Specifically, individuals on Prime Panels were qualified for participating in the survey if they (a) were at least 18 years old, (b) were living in the United States, (c) had an approval rate of over 75%, and (d) had one or more mental health conditions. During Wave 1 survey, participants were first asked to respond to an open-ended question that asked when and about what they felt most uncertain in their mental illness experience.¹ They then answered questions about the level of uncertainty related to their mental health conditions, the amount of desired support from family, trust with family, motivation to seek support from family, communication efficacy, and demographics. Upon completion of the Wave 1 survey, participants were asked to provide their Cloud Research worker IDs if they would like to be contacted for a follow-up survey 2 weeks later.

Five hundred and 39 participants (N = 539) left their worker IDs at the end of Wave 1 survey and were invited to participate in Wave 2 survey 2 weeks later. To ensure data quality, participants who submitted the Time 1 survey in less than 240 seconds were excluded and were not invited to participate in the Time 2 survey. Three hundred and ninety-nine (N = 399; 74%) participants completed Wave 2 survey, in which they answered questions about the amount of support received from close family and their support seeking from close family in the past 2 weeks. They also reported on perceived stress level in the past 2 weeks. Participants received $3 for completion of the Wave 1 survey and an additional $1 for completing the Wave 2 survey. Further, we checked straightlining responses using a measure of nondifferentiation of scores (i.e., mean root of pairs; Kim et al., 2019). Of the 399 participants who completed both the initial and follow-up surveys, 344 passed data quality check and thus were retained in the final sample.

Of the participants in the final sample (n = 344), 67.73% were female (n = 233), 30.81% were male (n = 106), and five participants reported as “other” (e.g., non-binary). The mean age was 36.7 (SD = 10.45, range = 19–70). More than 80% of the participants self-identified as White/Caucasian (81.10%, n = 279), followed by African American/Black (5.81%, n = 20), Hispanic/Latino (5.23%, n = 18), Multiracial (4.36%, n = 15), Asian (2.9%, n = 10), and Native American/Alaskan Native (.58%, n = 2). Many reported having mental health conditions including anxiety (n = 283) and/or depression (n = 263). Some reported one or more of the following conditions: posttraumatic stress disorder (PTSD; n = 83), obsessive-compulsive disorder (n = 63), attention deficit hyperactivity disorder (n = 51), bipolar disorder (n = 48), eating disorder (n = 31), autism (n = 7), and schizophrenia (n = 5).

Measures

For all measures, higher scores indicate higher values for the variable. Table 1 presents descriptive statistics for study variables.

Table 1.

Descriptive statistics and correlations.

	M	SD	Range	1	2	3	4	5	6	7	8	9	10	11
1. Uncertainty (W1)	2.82	1.57	1–7
2. Desired EMO support (W1)	3.79	1.10	1–5	−.15^*	.87
3. Desired INFO support (W1)	3.18	1.19	1–5	−.20^**	.68^***	.90
4. Direct support seeking (W2)	2.14	1.10	1–5	−.13^*	.27^***	.30^***	.93
5. Indirect support seeking (W2)	2.26	1.12	1–5	.10	−.01	−.08	−.13^*	.80
6. Received EMO support (W2)	2.91	1.14	1–5	−.22^***	.32^***	.31^***	.64^***	−.18^**	.88
7. Received INFO support (W2)	2.48	1.16	1–5	−.19^***	.23^***	.37^***	.67^***	−.12^*	.78^***	.90
8. Perceived stress (W2)	3.24	.84	1–5	.20^***	.10	.01	−.03	.26^***	−.22^***	−.14^**	.87
9. Com efficacy (W1)	4.39	2.04	1–7	−.29^***	.41^***	.43^***	.44^***	−.24^***	.59^***	.43^***	−.23^**	.98
10. Motivation to seek (W1)	3.81	2.01	1–7	−.25^***	.44^***	.51^***	.49^***	−.23^***	.57^***	.51^***	−.19^**	.85^**	.98
11. Trust with family (W1)	4.49	1.35	1–7	−.23^***	.37^***	.31^***	.30^***	−.21^***	.48^***	.38^***	−.23^**	.71^**	.67^**	.96

Note. N = 344. Cronbach’s alphas are displayed at the diagonal of the table.

EMO = emotional. INFO = informational. Com efficacy = communication efficacy. *p < .05; **p < .01; ***p < .001.

Uncertainty related to mental health conditions (wave 1)

Perceived uncertainty related to one’s mental health conditions was measured using the item “How certain are you about your mental health?” Participants responded to the item on a 7-point scale (1 = completely uncertain, 7 = completely certain). Scores were reverse coded so that higher scores indicated higher levels of uncertainty.

Desired support from close family (wave 1)

Six items from Xu and Burleson (2001) were used to assess participants’ desire for support from close family members with the following instruction: “How much of each behavior do you DESIRE from your close family to help you better manage your mental health condition?”. Specifically, three items tapped desired emotional support (e.g., “Telling you that they love you and feel close to you”) and three assessed desired informational support (e.g., “Giving you advice about what to do”). Participants responded using a 5-point scale (1 = not at all, 5 = a great deal).

Communication efficacy (wave 1)

Four items from Afifi and Afifi (2009) measured communication efficacy (e.g., “I am able to approach my close family members to ask for help with my mental health condition”). Participants responded to the items on 7-point Likert scales (1 = strongly disagree, 7 = strongly agree).

Trust with close family (wave 1)

An 8-item relational trust scale (Larzelere & Huston, 1980) was adapted to assess participants’ trust with their close family (e.g., “My close family members are perfectly honest and truthful with me”; “I feel that I can trust my close family completely”). Participants rated their responses using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree).

Motivation to seek support from close family (wave 1)

Five items were adapted from High and Scharp (2015) to measure participants’ motivation to seek support from close family members. Using a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree), participants responded to items such as “I’m highly motivated to seek support from my close family when I have issues regarding my mental health condition.”

Support seeking from close family (wave 2)

In the second wave of survey, participants reported on how they approached their close family members about their mental health situation. Items were adapted from Derlega et al. (2003) and responses were rated on a 5-point scale (1 = never, 5 = always). Four items measured direct support seeking behaviors from close family in the past 2 weeks (e.g., “In the past 2 weeks, I told my close family members the exact emotions I am experiencing related to my mental health”). Another three items measured indirect support seeking from close family in the past 2 weeks (e.g., “In the past 2 weeks, I had a difficult time expressing to my close family members the emotions I was feeling as a result of my mental health issues”).²

Received support from close family (wave 2)

The same six items used to measure desired support from close family in the previous wave were used to measure received support from close family (Xu & Burleson, 2001). On a 5-point scale (1 = not at all, 5 = a great deal), participants responded to three items about how much emotional support (e.g., “Telling you that they love you and feel close to you”) and informational support (e.g., “Giving you advice about what to do”) they received from close family in the past 2 weeks to help them better manage their mental health condition.

Perceived stress (wave 2)

Participants responded to six items adapted from Cohen et al. (1983) that tap into perceived stress. On a 5-point scale (1 = never, 5 = very often), participants indicated how often they felt or thought a certain way during the past 2 weeks (e.g., “In the past 2 weeks, how often have you felt that you were unable to control the important things in your life?”).

Results

Structural equation modeling (H1 to H5 and RQ)

H1-H5 were tested using structural equation models (SEMs) in lavaan using R. First, for both support types, a measurement model with all latent factors (i.e., desired and received support from family, direct and indirect support seeking from family, and perceived stress) was tested for fit.³ Specifically, Confirmatory Factor Analyses (CFAs) were conducted with the observed indicators loading onto the corresponding latent factors. All latent factors were free to covary in the measurement model. The full information maximum likelihood estimator was used to handle missing data (Graham, 2009). Model fit was considered good if root mean squared error of approximation (RMSEA) was below .06 and Comparative Fit Index (CFI) was above .95. Fit was considered acceptable if RMSEA was between .06 and .08 and CFI was between .90 and .95 (Hu & Bentler, 1999; Kline, 2011).

The measurement models fit the data well for emotional support: χ²(142) = 293.62, p < .001, χ²/df = 2.07, RMSEA = .06 [90% CI = .051, .069], SRMR = .05, CFI = .95, and informational support: χ²(142) = 288.73, p < .001, χ²/df = 2.03, RMSEA = .06 [90% CI = .046, .064], SRMR = .05, CFI = .96. Next, goodness-of-fit for the full structural models were examined (see Figure 2). The proposed structural model yielded acceptable fit for emotional support: χ²(163) = 382.69, p < .001, χ²/df = 2.35, RMSEA = .06 [90% CI = .054, .071], SRMR = .079, CFI = .94, and good fit for informational support: χ²(163) = 341.41, p < .001, χ²/df = 2.09, RMSEA = .06 [90% CI = .048, .065], SRMR = .07, CFI = .96.

Figure 1.

Summary of hypotheses and proposed model.

H1 predicted that perceived levels of uncertainty would be positively associated with the amount of desired support from close family. In contrast to this prediction, results showed negative associations between participants’ self-reported levels of uncertainty regarding their mental health condition and the amount of emotional support (b = −.12, SE = .04, p = .008) and informational support (b = −.16, SE = .05, p = .001) that they desired from close family members. H1 was not supported.

H2 hypothesized that desired support from close family would predict (a) direct and (b) indirect support seeking behaviors. Results showed that desired emotional support (b = .33, SE = .07, p < .001) and informational support (b = .32, SE = .06, p < .001) at Wave 1 were positively associated with direct support seeking behaviors from close family at Wave 2. H2a was supported. However, neither desired emotional support (b = −.01, SE = .08, p = .90) nor informational support (b = −.08, SE = .06, p = .19) was associated with indirect support seeking behaviors. H2b was not supported.

H3 proposed that participants’ reported (a) levels of direct support seeking would be positively associated with levels of received support from close family members, whereas (b) levels of indirect support seeking would be negatively associated with received support from family. Results suggested that direct support seeking from close family led to more received emotional support (b = .63, SE = .06, p < .001) as well as informational support (b = .64, SE = .06, p < .001). H3a was supported. Indirect support seeking predicted less emotional support received from close family (b = −.13, SE = .05, p = .02), but was not significantly associated with the amount of received informational support (b = −.06, SE = .05, p = .22). H3b was partially supported.

H4 predicted that the associations between desired support and received support would be mediated by direct and indirect support seeking behaviors from close family. Mediation analyses were conducted in R by computing bias-corrected confidence intervals with 5000 random samples. Direct support seeking behaviors mediated the association between desired emotional support and received emotional support from family (b = .21, 95% CI = [.13, .29]), but indirect support seeking did not mediate this association (b = .001, 95% CI = [−.02, .03]). Similarly, direct support seeking behaviors mediated the association between desired informational support and received informational support from family (b = .20, 95% CI = [.13, .28]), but indirect support seeking was not a significant mediator (b = .01, 95% CI = [−.01, .02]). Thus, H4 was partially supported.

RQ asked whether desired support would be directly associated with received support after accounting for the mediation effects through support seeking behaviors. Results showed positive associations between desired support from close family at Wave 1 and received support from close family 2 weeks later for both emotional support (b = .15, SE = .06, p = .02) and informational support (b = .16, SE = .05, p = .03) after mediation effects were accounted for.

Figure 2.

Structural equation model results. Note. Displayed are standardized path coefficients. Coefficients for the emotional support model were presented before the slash, and coefficients for the informational support model were presented after the slash. *p < .05; **p < .01; ***p < .001.

H5 predicted that the amount of support participants received from close family would be negatively associated with their perceived stress. Results indicated a negative relationship between received emotional support from close family and perceived stress reported during the second wave of survey (b = −.15, SE = .04, p < .001). Received informational support from close family also was negatively associated with perceived stress (b = −.10, SE = .04, p = .01). Therefore, H5 was supported.

Moderation analyses

H6-H8 proposed that the effects of desired support on direct and indirect support seeking from close family would be moderated by communication efficacy, trust with family, and motivation to seek support from close family members. H6-H8 were tested using PROCESS (version 3.5.3) in R (Hayes, 2022). Emotional support and informational support were examined in separate models. For each type of support, three models were specified in PROCESS: desired support from family reported at Wave 1 was entered as the independent variable and received support reported at Wave 2 as the dependent variable. Direct and indirect support seeking behaviors reported at Wave 2 were two parallel mediators between desired and received support. Because the association between desired support and received support was significant after accounting for support seeking behaviors (per RQ), the models also included a direct path between desired and received support. Each of the three potential moderators was tested for the paths from desired support to direct and indirect support seeking. Statistically significant interactions were probed with simple slopes analyses at the mean and one SD above and below the moderator mean (see Figures 3, 4 and 5 for plots of significant interactions). The Johnson-Neyman technique was used to determine the values of a moderator at which the association between the independent and dependent variables is statistically significant (Hayes, 2022).

Figure 3.

Communication efficacy as moderator for desired Support’s effect on direct/indirect support seeking.

Figure 4.

Trust with family as moderator for desired Support’s effect on direct support seeking.

Figure 5.

Motivation as moderator for desired Support’s effect on indirect support seeking.

Communication efficacy as a moderator

Regarding H6, participants’ levels of communication efficacy significantly moderated the effects of desired emotional support (b = .07, SE = .03, p = .01) and desired informational support on direct support seeking (b = .06, SE = .02, p = .01; see Figure 3). Specifically, the positive association between desired emotional support and direct support seeking was stronger for those who reported higher levels of communication efficacy compared to those who reported lower communication efficacy; the association became nonsignificant when communication efficacy was below 2.99 (on a 7-point scale). Likewise, desired informational support was more strongly associated with increased direct support seeking for participants reporting higher levels of communication efficacy than those reporting lower communication efficacy. When communication efficacy was lower than 3.45 (on the 7-point scale), the association became non-significant. H6a was supported.

Communication efficacy also moderated the association between desired emotional support and indirect support seeking (b = −.08, SE = .03, p = .01), such that desired support led to more indirect support seeking when communication efficacy was low (the positive association was only significant when communication efficacy was below 2.93 on the 7-point scale). Communication efficacy did not significantly moderate the association between desired informational support and indirect support seeking (b = −.04, SE = .03, p = .08). Thus, H6b was partially supported.

Trust with family as a moderator

Regarding H7, participants’ trust with their close family members moderated the association between desired emotional support and direct support seeking from family (b = .10, SE = .04, p = .008; see Figure 4), such that the association was stronger when levels of trust were higher compared to when trust levels were lower. The positive association became non-significant when trust with family was below 3.13 on the 7-point scale. Trust also moderated the relationship between desired informational support and direct support seeking from close family (b = .08, SE = .04, p = .03). Desired informational support had a stronger positive relationship with direct support seeking when participants reported high levels of trust with their close family members. The desired informational support to direct support seeking path became non-significant when trust was lower than 3.06 (on the 7-point scale). In other words, desired support led to more direct support seeking when individuals had higher levels of trust. Therefore, H7a was supported. However, trust did not significantly moderate the effects of desired emotional support (b = −.08, SE = .04, p = .07) or desired informational support (b = −.03, SE = .03, p = .31) on indirect support seeking. H7b was not supported.

Motivation to seek support as a moderator

Last, regarding the moderating role of motivation, results indicated that participants’ levels of motivation to seek support did not moderate the associations between desired support and direct support seeking (emotional support: b = .02, SE = .03, p = .43; informational support: b = .03, SE = .03, p = .18). H8a was not supported. However, motivation to seek support from close family did significantly moderate the association between desired emotional support and indirect support seeking from family (b = −.07, SE = .03, p = .03). As shown in Figure 5, desired emotional support led to more indirect support seeking when motivation to seek support was low (i.e., the positive association was significant when motivation to seek support was below 2.54 on the 7-point scale). Motivation to seek support did not moderate the association between desired informational support and indirect support seeking (b = −.05, SE = .03, p = .09). Therefore, H8b was partially supported.

Discussion

Using a two-wave longitudinal design, this study examined the associations among perceived uncertainty in mental illness and social support seeking within family relationships. Results suggest that perceived uncertainty was negatively associated with desired support. Desired support measured at Wave 1 was positively associated with received support at Wave 2, and the association was partially mediated by direct support seeking behaviors. Communication efficacy, trust with family, and motivation to seek support influenced whether individuals sought desired support directly (or indirectly). In general, direct support seeking behaviors predicted received support and reduced perceived stress. Findings offer theoretical and practical implications.

Theoretical contributions

First, contrary to our prediction, higher levels of perceived uncertainty related to one’s mental illness condition were associated with lower levels of desired emotional and informational support. It may be the case that people who experience uncertainty related to mental health are ambiguous or ambivalent about the exact kinds of support they desire and need, resulting in lower levels of reported desired support. Uncertainty may take on different forms and meanings (Babrow, 1992, 2007). For example, uncertainties related to one’s treatment options and side effects of specific drugs (medical uncertainty) can be addressed through informational support (i.e., epistemological uncertainty related to the nature of knowledge). Uncertainties associated with mental illness stigmas and how the condition may influence one’s identities and relationships (personal and social forms of uncertainties) may be addressed through emotional support. Different sources of uncertainty may result in desires of distinct types of support. In some cases, individuals may experience high levels of uncertainty but cannot articulate the desired support that can help address the uncertainty (e.g., ontological uncertainty related to the nature of the world and inherently unknowable). Without a clear idea about what they need (source of uncertainty), individuals’ previous support seeking behaviors likely have resulted in unsatisfied outcomes (e.g., the support received does not help manage appraised uncertainty), which may inhibit a desire for future support when experiencing uncertainty.

Alternatively, it is possible that some mental illness conditions (e.g., depression) might make it less likely that people can act as “activists” for their own well-being. In those cases, individuals with mental illness may experience high uncertainty but lack the ability or motivation to seek support, resulting in lower levels of desired support. In addition, it could be that people with mental illness desire specific types of support that were not captured in this study, such as esteem support and network support, or they may desire support from sources other than close family (e.g., friends, online networks) to cope with the uncertainty. For example, perceptions of limited availability of support from family might have contributed to heightened uncertainty about mental illness and lower desired support from family (e.g., Giurgescu et al., 2006). Future research should continue to examine the complicated associations among different sources of uncertainty, types of desired support, as well as availability and sources of support to systematically account for and theorize patterns of these associations.

Second, both desired emotional support and desired informational support motivated direct support seeking behaviors but not indirect support seeking behaviors. The SIST proposes that support seeker characteristics (e.g., demographic differences, social skills, stigma), their appraisal of the current problem (e.g., importance and cause of the problem, relevance to one’s ego), as well as helper characteristics (e.g., closeness, power dynamics) can influence whether individuals decide to seek support and if so, how. Findings suggest that direct forms of support seeking are driven by one’s desired support, whereas indirect support seeking is likely caused by other factors not examined in this study. For example, perceived stigma surrounding the problem that individuals need support for may be a key factor in determining indirect forms of support seeking behaviors (e.g., Read et al., 2015; Wagner et al., 2016; Williams et al., 2016). As another example, the cultural context within which supportive communication takes place can influence perceptions regarding the appropriateness of specific direct or indirect support seeking strategies (e.g., Kim et al., 2006; Zhou et al., 2017). Future research should explore additional individual, relational, and cultural factors that predict indirect support seeking behaviors.

Importantly, communication efficacy, trust with family members, and motivation to seek support moderated the associations between desired support and support seeking behaviors. Past research has established that desired support motivates support seeking (e.g., High & Crowley, 2018). Findings of the moderation effects provide a more nuanced understanding of the association between desired support and support seeking behavior. Specifically, our findings suggest that high levels of communication efficacy and trust with family make it more conducive for individuals to seek support from close family directly, whereas a low motivation to seek support tends to accentuate the positive association between desired emotional support and indirect support seeking. Overall, consistent with the SIST, the moderation effects demonstrate how individual and relational factors interact with people’s desire for support to determine whether and how to seek support (e.g., directly or indirectly). Future research should continue to situate support seeking processes within specific relational context and examine factors that may influence support seeking decisions.

Third, consistent with previous research (e.g., High & Crowley, 2018), desired emotional and informational support at Wave 1 led to higher levels of received support at Wave 2 and these associations were mediated by direct support seeking behaviors. In other words, individuals who need support and choose to solicit it directly oftentimes obtain supportive responses and quality support (Steuber & High, 2015). It is worth noting that the emotional and informational support received may not match the support desired (i.e., support gaps; High & Steuber, 2014; Wang, 2019). For example, people with mental illness may receive unsolicited advice (a surplus of informational support) and thus experience increased stress. Future research can consider adopting longitudinal designs to investigate how desired-received support (in)congruence may correspond with well-being outcomes (e.g., stress) and relational outcomes (e.g., relational satisfaction) and the roles of support seeking behaviors in impacting support gaps over time.

Importantly, indirect support seeking from family was negatively associated with received emotional support but not related to received informational support. This finding suggests that the “paradox of support seeking and rejection” (e.g., Williams & Mickelson, 2008; Williams et al., 2016) may be more salient for emotional support than for informational support. Individuals who solicit support through indirect means due to the fear of rejection may receive unsupportive or neglectful responses, leading to (perceptions of) less received emotional support. In comparison, indirect support seeking did not influence received informational support, possibly because individuals rarely resort to indirect means of seeking when it comes to informational support. Indeed, our findings revealed a lack of main effect or moderated effect from desired informational support to indirect support seeking. In mental illness, individuals may feel more comfortable asking for informational support from close family than requesting emotional support. Future research can examine whether individuals engage in direct support seeking depending on the types of support desired and sought.

Last, in this study, the emotional support and informational support that participants received from close family members were negatively associated with their perceived stress levels. This finding is consistent with previous research that showed how social support can buffer stress associated with different health conditions and enhance quality of life for individuals living with illness (e.g., Steuber & High, 2015). However, it is important to note that direct support seeking does not necessarily lead to quality support, and the effects of support seeking on well-being outcomes can be either helpful or harmful (Caughlin et al., 2008; Scott et al., 2013). The associations between support seeking and outcomes can depend on factors such as the quantity and quality of the support desired, sought, and received (e.g., support surplus vs. deficit; e.g., Brock & Lawrence, 2009), the ability and motivation of the support seeker to process the support message (e.g., Bodie, 2011), cultural backgrounds (e.g., Kim et al., 2006), family communication patterns (e.g., High & Scharp, 2015), and other individual differences (e.g., Don et al., 2019). Additionally, support seeking that takes place online may involve communicative behaviors unique to the mediated platform (e.g., post a status about one’s problem, share a selfie showing one’s negative emotions; Rife et al., 2016). Future research should identify conditional factors for the associations among support seeking behavior, received support (that matches desired support), and coping outcomes.

Practical implications and limitations

Findings offer practical implications for supportive communication in facilitating management of mental illness-related uncertainties within family contexts. For example, communication efficacy serves as a key factor that can influence whether individuals who desire support will engage in direct versus indirect support seeking behaviors from family. Therefore, communicative efforts that enhance perceptions about individuals’ ability to talk about their need for help are especially helpful to encourage direct support seeking behaviors. For those who perceive low levels of communication efficacy, skill building sessions on how to approach family members and ask for help using different verbal and nonverbal communication strategies may be beneficial. In addition, family members can focus on building relational trust with individuals who experience uncertainty about their mental illness and motivate them to seek support from close others (e.g., family and friends). In so doing, individual may be more likely to engage in direct forms (as opposed to indirect forms) of support seeking strategies and receive the support they desire.

The study has several limitations. First, we focused on two specific support types (emotional and informational support) and did not assess other types of support (e.g., esteem support). Second, we adopted a one-item measure to assess participants’ general uncertainty perceptions and did not distinguish between different sources of uncertainty in mental illness (e.g., medical, personal, social uncertainty), which limited our ability to unpack the negative association between uncertainty and desired support. Third, we did not ask our participants of certain demographic questions (e.g., gender identity, sexual orientation, disability), which may influence their support seeking behaviors. In addition, the sample used in this study was based in the U.S., limiting its generalizability to other cultural contexts. As discussed earlier, support seeking processes and outcomes may differ depending on the cultural contexts within which supportive communication takes place. Future research should examine associations tested in this study using more diverse samples. Despite these limitations, this study offers theoretical insights regarding the support seeking processes and outcomes and practical implications for communicative strategies that can motivate individuals experiencing illness uncertainty to seek support effectively.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author’s Note

An earlier version of the manuscript was presented at the 2021 National Communication Association Annual Conference in Seattle, WA.

Open research statement

As part of IARR’s encouragement of open research practices, the author(s) have provided the following information: This research was not pre-registered.

The data used in the research are publicly posted. The data can be obtained at: . The materials used in the research can be publicly posted. The materials can be obtained at: https://osf.io/nv8ar/?view_only=e7a16be8c3384d859d0284dae5ce2b76.

ORCID iD

Kai Kuang

Notes

References

Afifi

W. A.

Afifi

T. D.

(2009). Avoidance among adolescents in conversations about their parents’ relationship: Applying the theory of motivated information management. Journal of Social and Personal Relationships, 26(4), 488–511. https://doi.org/10.1177/0265407509350869

Afifi

W. A.

Weiner

J. L.

(2004). Toward a theory of motivated information management. Communication Theory, 14(2), 167–190. https://doi.org/10.1111/j.1468-2885.2004.tb00310.x

Babrow

A. S.

(1992). Communication and problematic integration: Understanding diverging probability and value, ambiguity, ambivalence, and impossibility. Communication Theory, 2(2), 95-130. https://doi.org/10.1111/j.1468-2885.1992.tb00031.x.

Babrow

A. S.

(2007). Problematic integration theory. In Explaining communication: Contemporary theories and exemplars (pp. 181-200). Lawrence Erlbaum.

Barbee

A. P.

Cunningham

M. R.

(1995). An experimental approach to social support communications: Interactive coping in close relationships. Annals of the International Communication Association, 18(1), 381–413. https://doi.org/10.1080/23808985.1995.11678921

Bodie

G. D.

(2011). The role of thinking in the comforting process: An empirical test of a dual-process framework. Communication Research, 40(4), 533–558. https://doi.org/10.1177/0093650211427030

Bowen

D. J.

Hyams

Laurino

Woolley

Cohen

Leppig

K. A.

Jarvik

(2020). Development of familytalk: An intervention to support communication and educate families about colorectal cancer risk. Journal of Cancer Education, 35(3), 470–478. https://doi.org/10.1007/s13187-019-1484-3

Brashers

D. E.

(2001). Communication and uncertainty management. Journal of Communication, 51(3), 477–497. https://doi.org/10.1111/j.1460-2466.2001.tb02892.x

Brashers

D. E.

Neidig

J. L.

Goldsmith

D. J.

(2004). Social support and the management of uncertainty for people living with HIV or AIDS. Health Communication, 16(3), 305–331. https://doi.org/10.1207/S15327027HC1603_3

10.

Brashers

D. E.

Neidig

J. L.

Haas

S. M.

Dobbs

L. K.

Cardillo

L. W.

Russell

J. A.

(2000). Communication in the management of uncertainty: The case of persons living with HIV or AIDS. Communications Monographs, 67(1), 63–84. https://doi.org/10.1080/03637750009376495

11.

Brock

R. L.

Lawrence

(2009). Too much of a good thing: Underprovision versus overprovision of partner support. Journal of Family Psychology, 23(2), 181–192. https://doi.org/10.1037/a0015402

12.

Burleson

B. R.

Hanasono

L. K.

Bodie

G. D.

Holmstrom

A. J.

McCullough

J. D.

Rack

J. J.

Gill Rosier

(2011). Are gender differences in responses to supportive communication a matter of ability, motivation, or both? Communication Quarterly, 59(1), 37–60. https://doi.org/10.1080/01463373.2011.541324

13.

Caughlin

J. P.

Brashers

D. E.

Ramey

M. E.

Kosenko

K. A.

Donovan-Kicken

Bute

J. J.

(2008). The message design logics of responses to HIV disclosures. Human Communication Research, 34(4), 655–684. https://doi.org/10.1111/j.1468-2958.2008.00336.x

14.

Centers for Disease Control and Prevention (2021). Learn about mental health. https://www.cdc.gov/nchs/fastats/mental-health.htm

15.

Choi

W. H.

Lee

G. L.

Chan

C. H.

Cheung

R. Y.

Lee

I. L.

Chan

C. L.

(2012). The relationships of social support, uncertainty, self-efficacy, and commitment to prenatal psychosocial adaptation. Journal of Advanced Nursing, 68(12), 2633–2645. https://doi.org/10.1111/j.1365-2648.2012.05962.x

16.

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404

17.

Cohen

Wills

T. A.

(1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357. https://doi.org/10.1037/0033-2909.98.2.310

18.

Derlega

V. J.

Winstead

B. A.

Oldfield

E. C.

Barbee

A. P.

(2003). Close relationships and social support in coping with HIV: A test of sensitive interaction systems theory. AIDS and Behavior, 7(2), 119–129. https://doi.org/10.1023/A:1023990107075

19.

Don

B. P.

Girme

Y. U.

Hammond

M. D.

(2019). Low self-esteem predicts indirect support seeking and its relationship consequences in intimate relationships. Personality and Social Psychology Bulletin, 45(7), 1028–1041. https://doi.org/10.1177/0146167218802837

20.

Gariepy

Honkaniemi

Quesnel-Vallee

(2016). Social support and protection from depression: Systematic review of current findings in Western countries. The British Journal of Psychiatry, 209(4), 284–293. https://doi.org/10.1192/bjp.bp.115.169094

21.

Giurgescu

Penckofer

Maurer

M. C.

Bryant

F. B.

(2006). Impact of uncertainty, social support, and prenatal coping on the psychological well-being of high-risk pregnant women. Nursing Research, 55(5), 356–365. https://doi.org/10.1097/00006199-200609000-00008

22.

Graham

J. W.

(2009). Missing data analysis: Making it work in the real world. Annual Review of Psychology, 60(1), 549–576. https://doi.org/10.1146/annurev.psych.58.110405.085530

23.

Hayes

A. F.

(2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford.

24.

High

A. C.

Crowley

J. L.

(2018). Gaps among desired, sought, and received support: Deficits and surpluses in support when coping with taboo marital stressors. Communication Research, 45(3), 319–338. https://doi.org/10.1177/0093650215626975

25.

High

A. C.

Scharp

K. M.

(2015). Examining family communication patterns and seeking social support direct and indirect effects through ability and motivation. Human Communication Research, 41(4), 459–479. https://doi.org/10.1111/hcre.12061

26.

High

A. C.

Steuber

K. R.

(2014). An examination of support (in) adequacy: Types, sources, and consequences of social support among infertile women. Communication Monographs, 81(2), 157–178. https://doi.org/10.1080/03637751.2013.878868

27.

Hippman

Lohn

Ringrose

Inglis

Cheek

Austin

J. C.

(2013). Nothing is absolute in life”: Understanding uncertainty in the context of psychiatric genetic counseling from the perspective of those with serious mental illness. Journal of Genetic Counseling, 22(5), 625–632. https://doi.org/10.1007/s10897-013-9594-2

28.

Holmstrom

A. J.

Burleson

B. R.

(2011). An initial test of a cognitive-emotional theory of esteem support messages. Communication Research, 38(3), 326–355. https://doi.org/10.1177/0093650210376191

29.

L. T.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

30.

Kim

H. S.

Sherman

D. K.

Taylor

S. E.

(2006). Pursuit of comfort and pursuit of harmony: Culture, relationships, and social support seeking. Personality and Social Psychology Bulletin, 32(12), 1595–1607. https://doi.org/10.1177/0146167206291991

31.

Kim

Dykema

Stevenson

Black

Moberg

D.P.

(2019). Straightlining: Overview of measurement, comparison of indicators, and effects in mail-web mixed-mode surveys. Social Science Computer Review, 37(2), 214–233. https://doi.org/10.1177/0894439317752406

32.

Kline

R. B.

(2011). Principles and practice of structural equation modeling (3rd ed.). Guilford Press.

33.

Larzelere

R. E.

Huston

T. L.

(1980). The dyadic trust scale: Toward understanding interpersonal trust in close relationships. Journal of Marriage and the Family, 42(3), 595–604. https://doi.org/10.2307/351903

34.

Lazarus

R. S.

Folkman

(1984). Stress, appraisal, and coping. Springer.

35.

MacGeorge

E. L.

Feng

Burlseson

B. R.

(2011). Supportive communication. In Knapp

M. L.

Daly

J. A.

(Eds.), The Sage handbook of interpersonal communication (4th ed., pp. 317–354). Sage.

36.

Mishel

M. H.

(1988). Uncertainty in illness. Image: The Journal of Nursing Scholarship, 20(4), 225–232. https://doi.org/10.1111/j.1547-5069.1988.tb00082.x

37.

Morse

C. R.

Volkman

J. E.

Samter

Trunzo

McClure

Kohn

Logue

J. C.

(2013). The influence of uncertainty and social support on information seeking concerning illicit stimulant use among young adults. Health Communication, 28(4), 366–377. https://doi.org/10.1080/10410236.2012.689095

38.

Mortenson

S. T.

(2009). Interpersonal trust and social skill in seeking social support among Chinese and Americans. Communication Research, 36(1), 32–53. https://doi.org/10.1177/0093650208326460

39.

National Alliance on Mental Illness (2021). Mental health conditions. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions

40.

Pierce

G. R.

Sarason

B. R.

Sarason

I. G.

Joseph

H, J.

Henderson

C. A.

(1996). Conceptualizing and assessing social support in the context of the family. In Pierce

G. R.

Sarason

B. R.

Sarason

I. G.

(Eds.), Handbook of social support and the family (pp. 3–24). Plenum.

41.

Rains

S. A.

Akers

Pavlich

C. A.

Tsetsi

Ashtaputre

Lutovsky

B. R.

(2020). The role of support seeker expectations in supportive communication. Communication Monographs, 87(4), 445–463. https://doi.org/10.1080/03637751.2020.1737326

42.

Read

S. A.

Morton

T. A.

Ryan

M. K.

(2015). Negotiating identity: A qualitative analysis of stigma and support seeking for individuals with cerebral palsy. Disability and Rehabilitation, 37(13), 1162–1169. https://doi.org/10.3109/09638288.2014.956814

43.

Redmond

Spoth

Trudeau

(2002). Family-and community-level predictors of parent support seeking. Journal of Community Psychology, 30(2), 153–171. https://doi.org/10.1002/jcop.10002

44.

Rife

S. C.

Kerns

K. A.

Updegraff

J. A.

(2016). Seeking support in response to social and achievement stressors: A multivenue analysis. Personal Relationships, 23(2), 364-379. https://doi.org/10.1111/pere.12130.

45.

Scott

A. M.

Caughlin

J. P.

Donovan-Kicken

&Mikucki-Enyart

S. L.

(2013). Do message features influence responses to depression disclosure? A message design logics perspective. Western Journal of Communication, 77(2), 139–163. https://doi.org/10.1080/10570314.2012.694007

46.

Segrin

McNelis

Swiatkowski

(2016). Social skills, social support, and psychological distress: A test of the social skills deficit vulnerability model. Human Communication Research, 42(1), 122–137. https://doi.org/10.1111/hcre.12070

47.

Smith

S. W.

Morash

Walling

Adams

E. A.

Holmstrom

A. J.

(2019). Precursors to probation and parole agent intent to send informational, emotional, and esteem social support messages to female clients. Journal of Applied Communication Research, 47(3), 344–363. https://doi.org/10.1080/00909882.2019.1615632

48.

Starr

L. R.

(2015). When support seeking backfires: Co-Rumination, excessive reassurance seeking, and depressed mood in the daily lives of young adults. Journal of Social and Clinical Psychology, 34(5), 436–457. https://doi.org/10.1521/jscp.2015.34.5.436

49.

Steuber

K. R.

High

(2015). Disclosure strategies, social support, and quality of life in infertile women. Human Reproduction, 30(7), 1635–1642. https://doi.org/10.1093/humrep/dev093

50.

Thoits

P. A.

(1995). Stress, coping, and social support processes: Where are we? What next? Journal of Health and Social Behavior, Extra Issue, 35, 53–79. https://doi.org/10.2307/2626957

51.

Thompson

C. M.

Pulido

M. D.

Caban

(2022). Why is it difficult for social network members to support people living with mental illnesses?: Linking mental illness uncertainty to support provision. Health Communication, 37(2), 202–213. https://doi.org/10.1080/10410236.2020.1831166

52.

Wagner

P. E.

Kunkel

Asbury

M. B.

Soto

(2016). Health (trans) gressions: Identity and stigma management in trans* healthcare support seeking. Women & Language, 39(1), 49–74.

53.

Wang

Mann

Lloyd-Evans

Johnson

(2018). Associations between loneliness and perceived social support and outcomes of mental health problems: A systematic review. BMC Psychiatry, 18(1), 156. https://doi.org/10.1186/s12888-018-1736-5

54.

Wang

(2019). Emerging adults’ received and desired support from parents: Evidence for optimal received–desired support matching and optimal support surpluses. Journal of Social and Personal Relationships, 36(11–12), 3448–3470. https://doi.org/10.1177/0265407518822784

55.

Waters

Cummings

E. M.

(2000). A secure base from which to explore close relationships. Child Development, 71(1), 164–172. https://doi.org/10.1111/1467-8624.00130

56.

Williams

S. L.

Laduke

S. L.

Klik

K. A.

Hutsell

D. W.

(2016). A paradox of support seeking and support response among gays and lesbians. Personal Relationships, 23(2), 296–310. https://doi.org/10.1111/pere.12127

57.

Williams

S. L.

Mickelson

K. D.

(2008). A paradox of support seeking and rejection among the stigmatized. Personal Relationships, 15(4), 493–509. https://doi.org/10.1111/j.1475-6811.2008.00212.x

58.

Burleson

B. R.

(2001). Effects of sex, culture, and support type on perceptions of spousal social support: An assessment of the “support gap” hypothesis in early marriage. Human Communication Research, 27(4), 535–566. https://doi.org/10.1111/j.1468-2958.2001.tb00792.x

59.

Zhou

Heather

Cesare

A. D.

Ryder

A. G.

(2017). Ask and you might receive: The actor–partner interdependence model approach to estimating cultural and gender variations in social support. European Journal of Social Psychology, 47(4), 412–428. https://doi.org/10.1002/ejsp.2251