Social support is a multifaceted and complex concept that refers to the amount of assistance an individual can get through interpersonal interactions [1, 2], including family, friends, peers, and members of a community [3]. As opposed to received social support (i.e., the actual support that one receives), perceived social support infers the beliefs and/or perceptions of the already-present support provided by the social network when needed [4–7]. Social support has an important role in human health [8]. Its adequate availability seems essential to provide a buffer for stressful physical and psychosocial events through greater resilience [9, 10], promote self-esteem [11], and mitigate the effects of psychological distress [12]. In this regard, perceived social support has been argued to have a more significant impact on health determinants compared to actual received social support [13, 14]. However, the existing literature on the effect of social support on physical, mental health and quality of life has led to mixed findings; which is partly due to the use of different measurement instruments [15].
A number of social support measures have been developed and tested in various groups and populations [16].Out of these measures, the Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used worldwide [3, 6–8, 11, 12, 18]. The MSPSS is a 12-item brief, freely available, easy to administer, self-report scale designed by Zimet et al. to subjectively assess “the adequacy of received emotional social support” from three different sources (family, friends, and the significant other) ([17], p. 186). The original English version of the MSPSS consists of a three-factor construct which had high internal consistency and test-retest reliability, as well as moderate construct validity [17]. The scale has been translated in many languages (e.g., Italian [18], Swedish [19], Polish [20], Portuguese [21], Greek [22], South Korean [23], Turkish [24], Persian [25], Indian [26], Urdu [27], Thai [28], Hausa (Nigerian) [29], Ugandan [30], Malawi [31], Malay [32]) and countries (e.g., high- [19, 21–23], middle- [24, 25, 28, 32, 33], and low-income countries [29–31]) across the globe. The psychometric properties of the MSPSS have proven their appropriateness in individuals from a variety of cultural backgrounds, ages, and clinical profiles, i.e., Thai medical students and psychiatric patients [34], South Korean adolescent high school students [23], Korean breast cancer survivors [35], Indian [26], and Polish [20] university students Malay medical students [32] and psychiatric outpatients [36], Pakistani antenatal women [27], Italian patients with chronic diseases [37], Ghanaian [38] and Nigerian high-school adolescents [39], Greek oncology and mental health Nurses[40], UK family caregivers of people with dementia [41].
While there is evidence asserting the psychometric strength of the MSPSS across different contexts [42], literature has also documented a substantial impact of culture on social support access and sources [43–45]. For instance, collectivist cultures promote social cohesion and parenting/family relationships quality; therefore, individuals from such cultures expect extended family than other sources to supply them with any needed social support [46]. Despite these data, the largest amount of research on social support has emerged from the Western world. In addition, the original validation study and subsequent studies examining the MSPSS psychometric quality have been mostly performed in Western cultural backgrounds. This limits our knowledge about the pathways linking social support to mental health and prevents evidence-based policymaking in the under-researched contexts, including Arab countries and communities.
The Arab context
There are a total of 22 Arab countries geographically distributed over two continents (i.e., Africa and Asia), defined as lower-middle-income economies, traditional, religious and collectivist societies [47, 48], and having a current population estimated at greater than 450 million people [49]. Arabic is thus spoken by hundreds of millions of people in both Arab and non-Arab countries, and is ranked in the fourth position of most used languages of the Internet [50]. Over the last decades, Arab countries have faced a series of revolutions, armed conflicts, terrorist attacks, widespread violence, traumatic wars, and economic recessions, which have negatively affected their local communities’ mental health [51–53]. At the same time, Arab countries suffer a substantial lack of information, mental health legislation and policy [53]. One of the main factors that impede access to evidence-informed care and mental health research in Arab countries is the shortage of valid and reliable assessment tools [54]. As we specifically focus on perceived social support in the present study, we point to the little information available on this construct in Arab contexts. We could find only a few studies among Arab people using the MSPSS in specific populations (e.g., Arab American adolescents [55] and women [56], Arab immigrant women [57], refugees in Jordan [58], mothers of children with developmental disabilities [59]); which are far from being representative of the Arab general population. All these observations highlight the strong need for an Arabic valid tool to evaluate social support.
The present study
A systematic review published in 2018 by Dambi et al. [60] investigated the psychometric properties of the non-English translations of the MSPSS found only one Arabic version available (i.e., [33]). The authors described its methodology as “poor” on the basis of poor internal consistency and validity (no confirmatory factor analysis performed). Dambi et al. [60] also estimated that this version had “unknown evidence for construct validity” and provided “scanty details” for the adaptation process; which may in turn lead to the risk of misleading findings and negatively affect policy formulation. These potential methodological flaws encouraged our team to translate and validate the MSPSS to the Arabic language, in order to address the identified gaps of the previous Arabic version and provide a psychometrically sound social support scale for the Arabic-speaking researchers, clinicians, patients and the broad community. Our main objective was therefore to examine the psychometric properties of an Arabic translation of the MSPSS in a sample of Arabic-speaking Lebanese adults from the general population. We expect that the Arabic MSPSS will (1) replicate the original three-factor structure; and (2) yield good internal consistency, convergent validity (as evidenced by a positive correlation between MSPSS scores, resilience and posttraumatic growth), and measurement invariance across gender groups.