Social support and mental health: the mediating role of perceived stress

Social support encompasses feeling loved, valued, and part of a network that offers mutual assistance. Many studies highlight its protective role in mental health, yet the precise mechanisms by which it affects mental well-being remain unclear. The COVID-19 pandemic heightened stress, loneliness, depression, and anxiety worldwide, including in the Philippines, where strict quarantines were associated with widespread mental health concerns. This context renews interest in how social support benefits mental health and the mechanisms involved. Anchored in Lazarus and Folkman's stress and coping theory, this study emphasizes how social support shapes stress appraisal and influences mental health. Understanding these mechanisms is crucial given the prevalence of mental health issues and can guide development of interventions leveraging social support to improve well-being.

Social support is multidimensional and can be assessed by network structure or by functional aspects such as informational, instrumental, and emotional support. Perceived support (belief that help is available) has stronger links to mental health than received support. Sources include family, friends, and significant others (and even pets), and support benefits health in both stressful and non-stressful times. Empirical literature consistently documents social support’s protective role across the lifespan and populations: parental support reduces depression risk in children; adults benefit from support from spouses, family, and friends; low support is linked to higher depression, anxiety, self-harm during pregnancy; and weaker support hinders depression recovery and social functioning. Among international students, children, university students, and LGB youth, perceived support is tied to better well-being and adjustment. During COVID-19, higher social support has been associated with lower depression, anxiety, and stress. Lazarus and Folkman’s theory posits that social support is a key resource influencing primary and secondary appraisal of stressors, thereby reducing perceived stress. Perceived stress is strongly associated with mental health outcomes: higher stress relates to increased anxiety, depression, and harmful behaviors; epidemiological work links chronic perceived stress to poor mental health and mortality. During COVID-19, perceived stress rose and correlated with anxiety and depression; positive affect is typically negatively correlated with perceived stress. Evidence also links social support to lower perceived stress across samples (e.g., family and significant other support reduce stress, with stress partially mediating links to life satisfaction). Collectively, literature suggests that social support may enhance mental health indirectly by diminishing perceived stress, motivating the current mediation investigation.

Design: Correlational, cross-sectional mediation study testing whether perceived stress mediates the relationship between social support and mental health outcomes (positive affect, anxiety, depression), grounded in Lazarus and Folkman’s stress and coping theory. Participants: N=426 Filipino adults residing in the Philippines (mean age=28.40 years, SD=10.19; range 18–64). Majority female (74.2%), single (80.3%), living with family (88.5%). Education: 48.4% college graduates, 26.3% high school graduates, 11.7% college students. Recruited online via acquaintances and referrals; informed consent obtained. Measures: - Multidimensional Scale of Perceived Social Support (MSPSS; 12 items; subscales: family, friends, significant other; 1–7 Likert). Reported psychometrics: overall alpha=0.88; subscales: significant other 0.91, family 0.87, friends 0.85 in this study. - Perceived Stress Scale-10 (PSS-10; 0–4 Likert; total 0–40). Modified to COVID-19 context by prefacing items with “Since the COVID-19 has occurred…”. Established reliability alphas 0.78–0.91; test-retest 0.55–0.85. - Positive and Negative Affect Schedule (PANAS): Positive Affect subscale only (10 items; 1–5 Likert). Alpha=0.89 in this study. - Depression, Anxiety, and Stress Scales (DASS-21): Anxiety and Depression subscales used (0–3 Likert). Stress subscale not included since perceived stress was measured via PSS-10. Alpha=0.96 in this study. Procedure: Online survey administered via Google Forms between July 21, 2021 and August 5, 2021. Anonymity and confidentiality ensured. Ethics approval obtained; informed consent provided before participation. Ethical considerations: Procedures followed institutional standards; data accessible only to the researcher, stored securely, retained after publication for inquiries, and slated for deletion years later. Data analysis: Assessed normality, linearity, and homoscedasticity. Computed descriptive statistics and Pearson correlations. Used bootstrapping to estimate distributions and address multiple correlation testing. Mediation analyses conducted in IBM SPSS 25 with PROCESS v4.0 (Model 4), 5,000 bootstrap samples; indirect effects considered significant if 95% CI excluded zero; alpha set at p≤0.05. Potential confounders were included as covariates to isolate direct and indirect effects.

Descriptive: 61.3% reported high social support. Perceived stress: 78.2% moderate, 20.0% high, 1.9% low. Mean Positive Affect=36.45 (SD=7.94). Clinically, 65% reported moderate to severe anxiety symptoms and 49.7% reported moderate to severe depression symptoms. Correlations: - Family support correlated with Positive Affect (r=0.25, p≤0.01), Anxiety (r=-0.22, p≤0.01), Depression (r=-0.30, p≤0.01), and Perceived Stress (r=-0.18, p<0.01). - Significant other support correlated with Positive Affect (r=0.27, p≤0.01), Anxiety (r=-0.14, p<0.01), Depression (r=-0.25, p≤0.01), and Perceived Stress (r=-0.12, p<0.01). - Friend support correlated with Positive Affect (r=0.20, p≤0.01), Anxiety (r=-0.12, p≤0.05), Depression (r=-0.18, p≤0.05); relation to Perceived Stress was not significant. Mediation (PROCESS Model 4, 5,000 bootstraps): Family support: - Indirect effect on Positive Affect via Perceived Stress: β=0.02 (SE=0.011), 95% CI [0.00, 0.05]; a path to Perceived Stress a=-0.18 (p=0.000); mediator to Positive Affect b=-0.13 (p=0.004). - Indirect effect on Anxiety: β=-0.07 (SE=0.022), 95% CI [-0.12, -0.03]; mediator to Anxiety b=0.43 (p=0.000). - Indirect effect on Depression: β=-0.08 (SE=0.023), 95% CI [-0.13, -0.03]; mediator to Depression b=0.47 (p=0.000). Significant other support: - Indirect effect on Positive Affect: β=0.01 (SE=0.009), 95% CI [0.00, 0.04]; a≈-0.11 to -0.12 (p=0.01); mediator to Positive Affect b=-0.14 (p=0.001). - Indirect effect on Anxiety: β=-0.05 (SE=0.022), 95% CI [-0.09, -0.01]; mediator to Anxiety b=0.44 (p=0.000). - Indirect effect on Depression: β=-0.06 (SE=0.023), 95% CI [-0.19, -0.01]; mediator to Depression b=0.48 (p=0.000). Friend support: - No significant indirect effects via Perceived Stress on Positive Affect (β=0.01, 95% CI [-0.00, 0.03]), Anxiety (β=-0.03, 95% CI [-0.07, 0.00]), or Depression (β=-0.04, 95% CI [-0.08, 0.01]). Across models, direct effects of support (family, significant other, friend) on outcomes remained significant after accounting for Perceived Stress.

Findings support all primary hypotheses except the mediation of friend support through perceived stress. Social support from family and significant others was associated with higher positive affect and lower anxiety and depression, both directly and indirectly through reduced perceived stress, aligning with stress and coping theory that social support shapes appraisal and lowers stress. The lack of mediation for friend support may reflect pandemic-related restrictions that limited in-person friend interactions, suggesting different mechanisms for friend support effects under constrained social conditions. Clinically, integrating social support assessment and enhancement—especially from family and significant others—into interventions may bolster positive affect and reduce anxiety and depression by targeting perceived stress. The results underscore the relevance of considering social context in mental health care and tailoring strategies to the type and availability of support. The study adds nuanced evidence of the pathway linking social support to mental health via perceived stress, reinforcing theoretical models and informing intervention design.

This study demonstrates that perceived stress mediates the relationship between social support (from family and significant others) and key mental health outcomes (positive affect, anxiety, depression) among Filipino adults during the COVID-19 pandemic. Family and significant other support reduced perceived stress, which in turn increased positive affect and decreased anxiety and depression; friend support did not show a significant indirect effect via perceived stress. These findings clarify mechanisms underlying the social support–mental health link and suggest interventions that reduce perceived stress and strengthen family and significant other support networks. Future research should use longitudinal designs, examine different types and sources of support, explore moderators (e.g., cultural context, individual differences), and identify alternative pathways through which friend support affects mental health, especially under conditions limiting social contact.

• Cross-sectional design limits causal inference; longitudinal research is needed to establish temporal and causal relationships. - Reliance on self-reported measures raises risk of common-method bias; future work could add behavioral or multi-informant measures. - Online recruitment may bias the sample and limit generalizability (e.g., excluding those without internet access); alternative data collection methods are recommended.