Assessing social support, companionship, and distress: National Institute of Health (NIH) Toolbox Adult Social Relationship Scales.
Open accessAbstract
OBJECTIVE: The quality of our daily social interactions-including perceptions of support, feelings of loneliness, and distress stemming from negative social exchanges-influence physical health and well-being. Despite the importance of social relationships, brief yet precise unidimensional scales that assess key aspects of social relationship quality are lacking. As part of the National Institute of Health (NIH) Toolbox for the Assessment of Neurological and Behavioral Function, we developed brief self-report scales designed to assess aspects of social support, companionship, and social distress across age cohorts. This article details the development and psychometric testing of the adult NIH Toolbox Social Relationship scales. METHODS: Social relationship concepts were selected, and item sets were developed and revised based on expert feedback and literature review. Items were then tested across a community-dwelling U.S. Internet panel sample of adults aged 18 and above (N = 692) using traditional (classic) psychometric methods and item response theory approaches to identify items for inclusion in 5-8 item unidimensional scales. Finally, concurrent validity of the newly developed scales was evaluated with respect to their interrelationships with classic social relationship validation instruments. RESULTS: Results provide support for the internal reliability and concurrent validity of resulting self-report scales assessing Emotional Support, Instrumental Support, Friendship, Loneliness, Perceived Rejection, and Perceived Hostility. CONCLUSION: These brief social relationship scales provide the pragmatic utility and enhanced precision needed to promote future epidemiological and social neuroscience research on the impact of social relationships on physical and emotional health outcomes.
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The 5-item NIH Loneliness scale was used to assess loneliness.
“We used the 5-item National Institutes of Health Loneliness scale (Cyranowski et al., 2013) to assess loneliness.”
From Prevalence of meditation-related adverse effects in a population-based sample in the United States (2022) · cites this paper as Cyranowski et al., 2013
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BackgroundJelsma, E. B., Goosby, B. J., & Cheadle, J. E. (2021) · Psychophysiology · doi:10.1111/psyp.13763 · Cited by 25 · see citing works
Developing the perceived social support scale for older adults: A mixed-method study
Nazari, S., Afshar, P. F., Sadeghmoghadam, L., Shabestari, A. N., & Farhadi, A. (2020) · AIMS Public Health · doi:10.3934/publichealth.2020007 · Cited by 24 · see citing works
Kieckhäfer, C., Schilbach, L., & Bzdok, D. (2022) · Cerebral Cortex · doi:10.1093/cercor/bhac351 · Cited by 26 · see citing works
Mandelbaum, J., Moore, S., Silveira, P. P., Meaney, M. J., Levitan, R. D., & Dubé, L. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.12.023 · Cited by 23 · see citing works
“For example, measures of emotional support typically ask individuals whether they have people in their lives who care for or encourage them, whereas measures of instrumental support often capture whether tangible resources or functional aid, such as providing transportation, are available to individuals (Gottlieb and…”
BackgroundO’Riordan, A., Howard, S., & Gallagher, S. M. (2020) · Anxiety Stress & Coping · doi:10.1080/10615806.2020.1746284 · Cited by 21 · see citing works
“These scales have been found to display high internal consistency, with a Cronbach’s α of .97 and .95 for the emotional support and instrumental support scale respectively (Cyranowski et al., 2013).”
BackgroundMethodResultInfluentialGratitude, social support and cardiovascular reactivity to acute psychological stress
Gallagher, S. M., Creaven, A., Howard, S., Ginty, A. T., & Phillips, A. C. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108090 · Cited by 19 · see citing works
Reis, D., Krautter, K., Hart, A., & Friese, M. (2022) · Stress and Health · doi:10.1002/smi.3181 · Cited by 19 · see citing works
“2.3.1 | Predictor variables Loneliness, emotional support, instrumental support We used the NIH Toolbox Adult Social Relationship Scales (Cyranowski et al., 2013) to assess loneliness (2 items; e.g., ‘I feel alone and apart from others’), emotional support (four items; e.g., ‘I have someone who…”
MethodInfluentialHammond, T. C., Powell, E. S., Green, S. J., Chlipala, G. E., Frank, J. A., Yackzan, A. T., Yanckello, L. M., Chang, Y., Xing, X., Heil, S. D., et al. (2022) · Frontiers in Rehabilitation Sciences · doi:10.3389/fresc.2022.1017180 · Cited by 23 · see citing works
“The sadness (20), meaning and purpose (21), self-efficacy (22), and support (23) questionnaires were used to measure self-reported values of these emotional domains.”
MethodRöcke, C., Luo, M., Bereuter, P., Katana, M., Fillekes, M. P., Gehriger, V., Sofios, A., Martin, M., & Weibel, R. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1011177 · Cited by 20 · see citing works
“, perceived social support, support in autonomy, received support, provided support, companionship, social distress, and health related social control) were assessed using the Berlin Social Support Scales (BSSS; Schwarzer and Schulz, 2003), and adaptations from other measures (Kasser and Ryan, 1999; Williams et al., 1…”
MethodO’Riordan, A., Howard, S., Brown, E. G., & Gallagher, S. M. (2020) · Psychophysiology · doi:10.1111/psyp.13660 · Cited by 20 · see citing works
Blanchard, J. J., Savage, C. L. G., Orth, R. D., Ceron, A. J., & Bennett, M. E. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00486 · Cited by 19 · see citing works
“Assessment of Functioning The Adult Social Relationships Scales (ASRS) (56) consists of six self-report scales assessing for participant appraisals of social relationships over the past month across multiple domains.”
BackgroundMethodInfluentialProspective associations between alcohol consumption and psychological well-being in midlife
Grønkjær, M. S., Wimmelmann, C. L., Mortensen, E. L., & Flensborg‐Madsen, T. (2022) · BMC Public Health · doi:10.1186/s12889-021-12463-4 · Cited by 19 · see citing works
“social relations assessed with scales summarizing several questions [38] and reflecting both structural (quantitative) and functional (qualitative) aspects of social relations [39].”
BackgroundLoneliness is linked to specific subregional alterations in hippocampus-default network covariation
Zajner, C., Spreng, R. N., & Bzdok, D. (2021) · Journal of Neurophysiology · doi:10.1152/jn.00339.2021 · Cited by 18 · see citing works
Levenberg, K., George, D. R., & Lokon, E. (2021) · Dementia · doi:10.1177/1471301221997290 · Cited by 18 · see citing works
“…NIH questionnaire consisting of individual responses to statements such as “I have someone who understands my problems,” with responses ranging from numerical ratings of 1 to 5, representing frequency with 1 = never, 2 = rarely, 3 = sometimes, 4 = usually, and 5 = always (Cyranowski et al., 2013).”
BackgroundMethodThe Relationship Between Loneliness and Positive Affect in Older Adults
Davidson, E. J., Taylor, C. T., Ayers, C. R., Quach, N. E., Tu, X. M., & Lee, E. (2021) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2021.11.002 · Cited by 19 · see citing works
Januška, J., Straková, A., Dančík, D., Pečeňák, J., Heretik, A., & Hajdúk, M. (2021) · Journal of Experimental Psychopathology · doi:10.1177/20438087211067626 · Cited by 17 · see citing works
“NIH Toolbox Adult Social Relationship scales (Cyranowski et al., 2013) is a 45-item comprehensive measure of social relationships with six subscales focusing on areas of social support (emotional support – eight items, e.g. ‘I have someone to talk with when I have a bad day’; instrumental support –…”
Escaping Loneliness Through Tourist-Chatbot Interactions
Wang, P., & Shao, J. (2022) · Springer eBooks · doi:10.1007/978-3-030-94751-4_44 · Cited by 18 · see citing works
“By interacting with the chatbots, their loneliness will be alleviated [19].”
BackgroundYoung-Adult Social Outcomes of Attention-Deficit/Hyperactivity Disorder
Riglin, L., Todd, A., Blakey, R., Shakeshaft, A., Stergiakouli, E., Smith, G. D., Tilling, K. M., & Thapar, A. (2023) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.22m14379 · Cited by 17 · see citing works
Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV)—CTN 314
Zhabokritsky, A., Clarke, R., Rosenes, R., Smith, G. H. R., Loutfy, M. R., Andany, N., Falutz, J., Klein, M. B., Harris, M., Guillemi, S. A., et al. (2023) · Viruses · doi:10.3390/v15020517 · Cited by 17 · see citing works
Redlich-Amirav, D., Besor, O., & Amirav, I. (2021) · Cureus · doi:10.7759/cureus.15097 · Cited by 17 · see citing works
“The loneliness scale [16] used in this study is a 5-item self-report measure from the NIH Toolbox Adult Social Relationship Scales that has excellent internal reliability with a Cronbach’s α of 0.”
BackgroundMethodLau, N., Steineck, A., Walsh, C., Fladeboe, K., Yi‐Frazier, J. P., Rosenberg, A. R., & Barton, K. S. (2024) · BMC Palliative Care · doi:10.1186/s12904-024-01527-y · Cited by 16 · see citing works
An Exploration of Friendship and Well-Being in Established Adulthood and Midlife
Schmidt, M. E., Pellicciotti, H., & Long, R. M. (2022) · Journal of Adult Development · doi:10.1007/s10804-022-09421-8 · Cited by 16 · see citing works
Juarascio, A. S., Srivastava, P., Manasse, S. M., Wilkinson, M. L., Felonis, C. R., & Drexler, S. A. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.23905 · Cited by 16 · see citing works
Chen, J. I., Hooker, E. R., Niederhausen, M., Marsh, H. E., Saha, S., Dobscha, S. K., & Teo, A. R. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01785-9 · Cited by 16 · see citing works
A Pilot Study of Cognition Among Hypoparathyroid Adults
Rubin, M. R., Tabacco, G., Omeragic, B., Majeed, R., Hale, C., & Brickman, A. M. (2022) · Journal of the Endocrine Society · doi:10.1210/jendso/bvac002 · Cited by 16 · see citing works
“Duration of hypoparathyroidism, years 5 (2-10) [1-39]”
BackgroundSense of Community and Its Impact on the Life Satisfaction of Adults With Brain Injury
Ditchman, N., Keegan, J. P., Batchos, E., Haak, C., & Johnson, K. S. (2016) · Rehabilitation Counseling Bulletin · doi:10.1177/0034355216661850 · Cited by 15 · see citing works
“Factor analysis has supported the multidimensional nature of the scale and the two subscales (Cyranowski et al., 2013), and there is evidence for the internal consistency of the subscales (α = .97 and .95, respectively).”
MethodInfluentialPsenka, T. M., Freedy, J. R., Mims, L. D., DeCastro, A. O., Berini, C., Díaz, V. A., Jarrett, J. B., & Steyer, T. E. (2020) · Family Practice · doi:10.1093/fampra/cmaa075 · Cited by 15 · see citing works
Dziura, S. L., McNaughton, K. A., Giacobbe, E., Yarger, H. A., Hickey, A. C., Shariq, D. A., & Redcay, E. (2023) · Developmental Psychobiology · doi:10.1002/dev.22413 · Cited by 15 · see citing works
Marion, A., Bowman, K. L., Thomas, G., & Harrison, A. J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1243618 · Cited by 16 · see citing works
Jahnke, S. A., Watson, P., Leto, F., Jitnarin, N., Kaipust, C. M., Hollerbach, B. S., Haddock, C. K., Poston, W. S. C., & Gist, R. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20227067 · Cited by 14 · see citing works
McKenney, E. E., Richards, J. K., Day, T. C., Brunwasser, S. M., Cucchiara, C. L., Kofner, B., McDonald, R. G., Gillespie‐Lynch, K., Lamm, J., Kang, E., et al. (2024) · Autism · doi:10.1177/13623613231216879 · Cited by 17 · see citing works
“…2006); ACIPS = Anticipatory and Consummatory Interpersonal Pleasure Scale (Gooding & Pflum, 2014); NIH Friendship = NIH Toolbox Friendship Measure (Cyranowski et al., 2013). and collected initial data on key constructs related to emotional, social, behavioral, and physical health, as well as…”
InfluentialContextualization of Relational Connectedness Construct in Relationship Marketing
Obaze, Y., Xie, H., Prybutok, V. R., Randall, W. S., & Peak, D. A. (2021) · Journal of Nonprofit & Public Sector Marketing · doi:10.1080/10495142.2021.1902906 · Cited by 14 · see citing works
“Connection as a construct represents a necessary component for evaluating long-term emotional and relational bonds among consumers within service organizations (Cyranowski et al., 2013; Marin & Ruiz de Maya, 2013; Sashi, 2012).”
BackgroundYaden, D. B., & Haybron, D. M. (2022) · The Journal of Positive Psychology · doi:10.1080/17439760.2021.2016910 · Cited by 14 · see citing works
“’ NIH Toolbox Adult Social Relationship Scales – Loneliness Sub-Scale (Cyranowski et al., 2013).”
MethodInfluentialZajner, C., Spreng, R. N., & Bzdok, D. (2022) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsac006 · Cited by 13 · see citing works
“For examples, the Social Relationships scales are part of the NIH Toolbox (Cyranowski et al., 2013) feature dimensions of social networks, which closely resembles our measure of social support.”
MethodTeo, A. R., Benton, M., Hooker, E. R., Zaccari, B., Hidalgo, N. J., Newell, S., Tuepker, A., Greaves, D. W., & Nicosia, F. M. (2025) · Aging & Mental Health · doi:10.1080/13607863.2024.2449126 · Cited by 15 · see citing works
“…or highly rural based on the Rural-Urban Commuting Area (RUCA) system (US Department of Veteran Affairs, n.d.); (3) NIH Toolbox Loneliness Scale (Cyranowski et al., 2013), raw score greater than or equal to 13; (4) at least one pain diagnosis (e.g. musculoskeletal pain, neuropathy) in their…”
Pinkham, A. E., Hajdúk, M., Ziermans, T. B., Bang, M., Bertoux, M., Bodenhamer, B., Bonfils, K. A., Buunk, A. M., Chan, R. C. K., Davis, B. J., et al. (2025) · Schizophrenia · doi:10.1038/s41537-024-00540-7 · Cited by 14 · see citing works
Zarei, B., Kazemi, A., Bahrami, M., & Beigi-Harchegani, H. (2025) · BMC Psychology · doi:10.1186/s40359-025-03294-8 · Cited by 22 · see citing works
“Initially, relevant keywords aligned with the research objectives were identified and refined through pilot searches and consul-tation of a reference guide on social relationships from the NIH [37].”
Older Adults’ Opinion on Social Robot as Companion
FakhrHosseini, S., Lee, C., Miller, J. B., Patskanick, T. R., & Coughlin, J. F. (2020) · IEEE RO-MAN · doi:10.1109/ro-man47096.2020.9223578 · Cited by 13 · see citing works
Examining the Effectiveness of the Fathers and Babies Intervention: A Pilot Study
Tandon, S. D., Hamil, J. L., Gier, E. E., & Garfield, C. F. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.668284 · Cited by 15 · see citing works
Hajdúk, M., Straková, A., Januška, J., Ivančík, V., Dančík, D., Čavojská, N., Valkucakova, V., Heretik, A., Pečeňák, J., Abplanalp, S. J., et al. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.11.022 · Cited by 13 · see citing works
Riordan, K. M., Simonsson, O., Frye, C. J., Vack, N. J., Sachs, J., Fitch, D., Goldman, R. I., Chiang, E. S., Dahl, C. J., Davidson, R. J., et al. (2024) · Journal of Counseling Psychology · doi:10.1037/cou0000725 · Cited by 14 · see citing works
Social Robots for Socio-Physical Distancing
Joshi, S., Collins, S., Kamino, W., Gómez, R., & Šabanović, S. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-62056-1_37 · Cited by 13 · see citing works
The American Friendship Project: A report on the status and health of friendship in America
Pennington, N., Hall, J. A., & Holmstrom, A. J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305834 · Cited by 12 · see citing works
“The survey concluded with all participants answering a series of well-being measures, which included: life satisfaction [36]; loneliness [37]; state social connection and disconnection [38]; perceived stress [39]; companionship [40]; and perceived support from friends [41].”
BackgroundLapidos, A., Abraham, K. M., Jagusch, J., Garlick, J., Walters, H., Kim, H. M., Vega, E., Damschroder, L. J., Forman, J. H., Ahmedani, B. K., et al. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.105850 · Cited by 13 · see citing works
“Perceived friendship, as measured by the 8-item friendship scale of the NIH Toolbox Adult Social Relationship Scales (ASRS) [21].”
MethodInfluentialDietz, L. J., Cyranowski, J. M., Fladeboe, K., Kelly, M. A. R., Pilkonis, P. A., Butt, Z. A., Salsman, J. M., & Cella, D. F. (2022) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsac037 · Cited by 11 · see citing works
Self-citationHebert, L. E., Fruhbauerova, M., Evanson, A., Bogić, M., Petras, A., Shaw, J. L., Muller, C. J., Nelson, L. A., & Comtois, K. A. (2022) · Contemporary Clinical Trials · doi:10.1016/j.cct.2022.106966 · Cited by 10 · see citing works
Yoo-Jeong, M., Nguyen, A., & Waldrop, D. (2022) · AIDS Care · doi:10.1080/09540121.2022.2057907 · Cited by 13 · see citing works
“The PROMIS-SI measure uses a 5-point Likert scale (1 = “Never” to 5 = “Always”) on 8-items derived from social relationship scales and the UCLA-Loneliness Scale (Cyranowski et al., 2013).”
MethodRangachari, P., May, K. R., Stepleman, L. M., Tingen, M. S., Looney, S. W., Liang, Y., Rockich‐Winston, N., & Rethemeyer, R. K. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16173060 · Cited by 11 · see citing works
Son, E. H., Wallen, G. R., Flynn, S. L., Yang, L., & Lee, L. J. (2023) · Psycho-Oncology · doi:10.1002/pon.6145 · Cited by 10 · see citing works
Hirshberg, M. J., Dahl, C. J., Bolt, D. M., Davidson, R. J., & Goldberg, S. B. (2024) · Clinical Psychological Science · doi:10.1177/21677026241233262 · Cited by 10 · see citing works
Measures of social connectedness in adult populations: a systematic review
Plackett, R., Hulin, J., Mukuria, C., Clowes, M., Ramsay, S. E., Spencer, L. P., Adams, E. A., Dykxhoorn, J. L., Walters, K. R., Osborn, D., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-20779-0 · Cited by 13 · see citing works
“Three scales also showed evidence for construct validity through significant associations with measures of related constructs (R-UCLA, UCLA-3, Three-item loneliness scale) [29, 38, 39].”
Home alone: A population neuroscience investigation of brain morphology substrates
Noonan, M. P., Zajner, C., & Bzdok, D. (2023) · NeuroImage · doi:10.1016/j.neuroimage.2023.119936 · Cited by 11 · see citing works
Tassiopoulos, K., Huo, Y., Kacanek, D., Malee, K., Nichols, S., Mellins, C. A., Kohlhoff, S. A., & Dyke, R. B. V. (2023) · Clinical Epidemiology · doi:10.2147/clep.s403570 · Cited by 10 · see citing works
“The development and validation of the NIH Toolbox social support and friendship scales have been described in detail.(38,39) Raw scores were converted to T-scores (mean=50, standard deviation=10) using 2010 censusweighted demographic data,(40) and higher T-scores indicate greater perceived social support.”
Method
- Authors
- Cyranowski, J. M., Zill, N., Bode, R., Butt, Z., Kelly, M. A. R., Pilkonis, P. A., Salsman, J. M., & Cella, D.
- Affiliations
- University of Pittsburgh (US)
- Westat (United States) (US)
- Northwestern University (US)
- Venue
- Health Psychology
- Published
- 2013
- Volume
- 32
- Issue
- 3
- Pages
- 293-301
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- PMC
- PMC3759525
- OpenAlex
- W2040967213
- Cited by
- 276
- References
- 33
- Citations by year
- 2026: 44 · 2025: 44 · 2024: 25 · 2023: 39 · 2022: 32 · 2021: 30 · 2020: 14 · 2019: 15 · 2018: 12 · 2017: 6 · 2016: 7 · 2015: 5 · 2014: 2 · 2013: 1
- FWCI
- 6.84
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Blueprint for Neuroscience Research and the Basic Behavioral and Social Science Opportunity Network (OppNet)
- National Institutes of Health (HHS-N-260-2006-00007-C, MH085874, U01 AR052155, KL2RR0254740)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
- Keywords
- social support, interpersonal relationships, loneliness, social distress, NIH Toolbox, self-report scale, scale development, psychometric validation, item response theory, emotional support, instrumental support, friendship, perceived rejection, perceived hostility, brief measures, social neuroscience
- MeSH terms
- Adult, Female, Humans, Interpersonal Relations, Male, Middle Aged, National Institutes of Health (U.S.), Psychometrics, Social Support, Stress, Psychological, United States, Reproducibility of Results, Cohort Studies
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