Sot. Sci. Med. Vol. 28, No. 12, pp. 1221-1228, 1989 Printed in Great Britain. All rights reserved

02779536189 53.00 + 0.00 Copyright c 1989 Pcrgamon Press plc

GENDER DIFFERENCES IN THE PERCEPTION AND UTILIZATION OF SOCIAL SUPPORT: THEORETICAL

PERSPECTIVES AND AN EMPIRICAL TEST

JOSEPH FLAHERTY and JUDITH RICHMAN

Department of Psychiatry, University of Illinois at Chicago. 912 S. Wood St, Chicago, IL 60612, U.S.A.

Abstract-The authors contend that women are the more supportive, nurturing and affectively-connected sex. They argue that these gender differences result from socialization experiences which may be modified by social and occupational roles. Theoretical perspectives and research addressing this proposition arc reviewed. Empirical data on support-eliciting and support-providing behaviors in a cohort of medical students are then provided to test their thesis. The data suggest that women have developed a greater sensitivity to the needs of themselves and others. leading to a greater capacity to provide support and a greater dependence upon social support for psychological well-being. Personality and developmental factors that may account for these differences are examined. The implications of these findings for gender differences in mental health are discussed.

INTRODUCTION

The role and significance of kinship bonds, other primary group attachments and the overall level of social integration in the larger society have been central areas of concern in the development of socio- logical theory. In the 1940s and 50s social scientists developed models and measuring schemes addressing various network characteristics such as density, diversity and reciprocity to depict the relationship of individuals to close and distinct members of their network and the interrelatedness of network mem- bers to each other. Over the last decade, psychiatric epidemiologists have borrowed these concepts in attempting to predict vulnerability to mental illness, or, alternatively, psychological well-being. In ap- plying the social bonding concept to mental health, there has been a refocusing of interest from variables such as density and homogeneity associated with social networks to a consideration of both instru- mental (e.g. practical, financial help) and emotional assistance (e.g. empathy, validation of self worth) associated with the concept of social support. In essence, social support has become one type of social exchange between network members. This concept of social support was originally proposed to buffer the effects of stressors and thus reduce the stress-distress linkage [ 11. While support for this thesis has emerged, evidence also suggests that social support has a direct and positive effect on psychological well-being inde- pendent of its stress-buffering capacity [2, 31. These findings have been at the forefront of the literature attempting to explain the relationship between psychosocial factors and psychiatric disorders [4].

Social support research has developed in parallel although slightly behind stressful life events research. Life events research has progressed beyond global assessments of events purported to affect many out- comes [5] to a smaller collection of events affecting specific outcomes such as schizophrenia [6] and de-

pression [7,8] and finally to specific types of life events affecting specific outcomes. For example, Finlay-Jones and Brown [9] have shown a relation- ship between loss events (e.g. death of a spouse) and depression while events which threaten loss are asso- ciated with anxiety. Similarly, social support in- vestigators are beginning to disaggregate the overall social support construct into components capable of differentially affecting a particular outcome or each affecting separate outcomes. Thoits [IO] has empha- sized the greater predictive power of affective over instrumental support in relation to psychological outcomes, while Brown and colleagues [l 1, 121 have consistently highlighted one source of affective support, that provided by an intimate confident, in preventing depression. Despite these efforts, Berkman [13] concludes: “we have not yet done an adequate job of capturing the critical dimensions of social networks and support for those groups of people for whom social support is apparently very important” (p. 560).

One potential group that Berkman alludes to is women. Her own work suggests that social isolation is associated with an increased mortality risk for women [ 141. Given the reported gender differences in psychiatric disorders [ 151 investigators are now begin- ning to consider the gender differences in the elici- tation and provision of social support [ 161. We believe that there is considerable evidence from the child development and parenting literature to suggest that there are strong gender differences in both the elicitation and provision of social support. We believe that these gender differences are based on gender specific socialization experiences which are also per- petuated within adult social roles. Our empirical focus is on a population of males and females in similar social roles: the preparation for careers in medicine. If gender differences are shown to persist in the context of traditionally male social roles, such as those connected with the institution of medicine,

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1222 JOSEPH FLAHERTT and JUDITH RICHMAN

these findings would provide evidence that support differences are due more to earlier socialization experiences than to differential adult social role incumbency.

THEORETICAL PERSPECTIVES

Primate studies and human evolution

Natural observations of chimpanzees [17, 181 and baboons [19] clearly show the primacy of the mother-infant bond and the socialization experiences of pre-pubertal primates that render females more capable as the natural suppliers of nutritional needs (e.g. food gathering and feeding) and physical com- forting (e.g. petting and grooming) to both infants and adult males. Redican [20] provides evidence that male primates show this nurturing capacity as well, but that gender-based socialization experiences em- phasize and reward this role for females. Tanner and Zihlman [21] mount considerable evidence to support their contention that in early man hominid devel- opment, women emerged as the nurturing sex by providing food through hunting and gathering and by encouraging the development of extended kinship bonding. Considerable evidence suggests that early clans developed from matrilineal groups that were brought together by the need for females to share in child care and food gathering [22]. These data have replaced Washburn’s early theory of social evolution based on the male’s need for hunting partners with a female-driven theory of social evolution [23].

Developmental studies

While a body of literature exists on gender differences in the developmental origins of social support, the implications of these differences are less clear. Not only is it difficult to parcel out biological from psychosocial contributions, but the complex and subtle interrelationships between parent and child stimulus-response patterns further complicate our complete understanding. An example of this difficulty can be seen in the research on infant social behavior in response to mothers. Early work on child social behavior focused on the mother’s ‘shaping’ of her child’s behavior [24]. Recent work has focused on the baby’s behavior as stimuli-eliciting and termin- ating of the mother’s care [25]. For example, Beckwith [26] has demonstrated that females (7-l I months) displayed greater closeness to the mother in response to strangers than did their male age-mates. Similarly, girls have more ‘maternal-searching’ be- havior in response to separations from their mother. What is not clear in research of this type is the extent to which mothers are ‘shaping’ this gender response or are responding to temperamental/constitutional differences between the two sexes.

One particularly salient source of data regarding gender differences is that of infant smiling behavior. While a true ‘social smile’ does not begin until about 6 weeks of age, reflex smiles are evidenced after birth. Korner’s [27] observations of 2- or 3-day-old neo- nates showed that boys have more startle responses while girls have more reflex smiling. She suggests such ‘constitutional’ differences may result in subsequent differences in social interaction. Sroufe [28] depicted the manner in which female infant’s smiling and

vocalizations are coupled with gender-specific ex- pectations and readiness (particularly an increased parental responsivenes to female crying) leading to an ‘affiliative’ child who likes people and expects them to satisfy their needs. Alternatively, the male child’s basic temperament is characterized by increased cry- ing and motor activity and the maternal response is more irritable and less responsive. These authors’ suggest that this (male) parentalxhild interaction leads to increased aggressiveness and a child who expects to get his needs satisfied through his own efforts.

Maccoby and Jacklin’s [29] broad review of re- search on gender differences in development con- cluded that girls excel1 in vergal abilities by the age of 11, while boys (10-13) excel in visual-spatial and mathematical ability. The verbal superiority of girls went beyond spelling and talking and included more complex assessments of comprehension and creativity. As these verbal talents encompass both receiving and sending of verbal messages, it seems logical that girls/women would have an earlier capac- ity to perceive needs and provide social support by verbal means. One area closely related to social support is empathic perception and communication, entailing both verbal and nonverbal responses. Although Maccoby and Jacklin’s review did not find evidence for gender differences, more recent data and reviews have. Hoffman [30] differentiated empathy (defined as emotional responsiveness to another’s affective state) from role-taking and social sensitivity and concluded that female children are more empathic than males. Eisenberg and Lennon [31] have shown that this gender difference in empathy is most prominent in adults in situations where gender role expectations encourage women to display appropriate social concern.

Another focus in empathy research is on the accu- racy of the child’s emotional response to the pro- tagonist in a picture or story; the data shows that female children are more accurate [32,33]. In addi- tion to this verbal assessment, female children also evidence more nonverbal indices of empathy (partic- ularly vocal) while reporting their affective state. Only in physiologic responses to infant cries (i.e. galvanic skin response, heart rate) did men show greater or equal empathy [34]. This supports Buck’s [35] contention that women are externalizers and men are internalizers, if verbalization of affect is considered an externalizing trait. Frodi et al. [36] have argued that this near or equal male physiologic response to children is evidence for biological simi- larity and equal capacity for parenting. It suggests, moreover, that sex differences in the expression of empathy are psychosocial in origin.

In summary, these data support the view that female socialization experiences. beginning at in- fancy, render them more affectively-connected and perceptive in the interpersonal sphere.

Parenthood

Parenting behaviors are an obvious area for exploring social support because the parent-child relationship is both a vivid illustration of support- providing capacity, and a likely source for the devel- opment of support needs and eliciting capacities. For

Gender differences in social support 1223

example. Flaherty and Richman [37] have shown that social support networks of young adults bear a significant relationship to their perceived earlier levels of maternal and paternal affectivity in childhood, although a stronger relationship to maternal affectivity. There is also considerable observational evidence to support the greater affective capacity of women in child-rearing activities. The LaRossas’ [38] suggest that men display role-distancing in early infant care: they react to the baby as ‘things’ and act clumsier and less skillful than they actually are. Women, on the other hand. illustrate role- embracement: they immerse themselves in their inter- personal relationship with the child and try to act more skillful than they feel. Lamb and Goldberg [39] have also shown that fathers tend to engage in physical play with babies under 12 months while mothers soothe them and provide basic care. Data by Feldman and Ingham 1401 support the view that both men and women are responding to social pressures to maintain gender role differences in parenting.

A great deal of attention has recently been ac- corded to the early attachment or bonding of the child to its mother. Klaus and Kennel [46] argue that mothers are in a sensitive period after delivery which serves to solidify the mother-infant bonding. More recent studies suggest that this attachment is not necessarily due to the critical period to the general excitement of the birthing process and the positive social-emotional climate created by interested mothers in their early days of parenting [47]. Early contact between fathers and infants also results in stronger subsequent attachment, suggesting that the social-cultural milieu that has traditionally kept fathers out of the birth process has also affected their involvement in parenting.

Adult social support and mental health

Three basic questions exist regarding gender differences in the genesis and consequences of social support: (1) Do women provide more social support in their interpersonal relationships with significant others? (2) Do women receive more social support? and (3) Are there gender differences in the effects of social support on mental health and well-being.

There are only a few studies specifically examining gender differences in support provision. Leventhal and Haven [43] report that wives are most often mentioned by husbands as a confidant whereas husbands are not the primary source of support for their wives. Kessler [44] reports that women are between 30 and 50% more likely to be mentioned as ‘helper’ in surveys of help-seeking behavior. Vernoff et al. [45] found that while men know more people, women are more aware of and responsive to the crises that occur in the people around them. Women, to a greater extent than men, report providing their friends with personal favors, emotional support and informal counselling about personal problems.

The literature on gender differences on support reception is more equivocal [46]. Many studies have produced conflicting or nonsignificant results. How- ever, all but two of the significant results [47,48] indicate that women either receive or utilize more emotional social supports than men [49-521. A recur-

ring finding is that women are more likely than men to have a close confidant, while not necessarily a larger total network size (53, 541. Vaux and colleagues [55] have suggested that these reported gender differences are a function of sex roles rather than gender per se. Feminine and androgynous individuals (both high on feminine characteristics) reported more global support, as well as individual and family support, than did masculine individuals, regardless of gender.

There are even fewer studies examining gender differences in the effects of social support. Henderson [56] reports that the social support distress re- lationship is stronger for women for both somatic complaints and depressive symptoms. Similarly, Sarason [57] found that for female college students there was a stronger correlation between social sup- port and well-being than in males.

Mortality and morbidity data on the effects of social support are derived primarily from studies on conjugal bereavement. Although the data is equiv- ocal, Stroebe and Stroebe [58] conclude from their comprehensive review of the literature that men have higher mortality rates following the death of a spouse than either widows or nonbereaved controls of both sexes. Men are particularly at higher risk for suicide, accidents, heart disease and cirrhosis of the liver in the first 6 months of bereavement [59,60]. A consis- tent finding in the literature is that social support buffer the morbidity and mortality effects of bereave- ment [61,62]. The evidence, therefore suggests that men suffer more in bereavement because of their reduced capacity to obtain social support. Expla- nations for this gender difference are than men find it more difficult to admit to feelings of loneliness and the need for companionship [63], and that married men have relied exclusively on their wives as confidants and have typically depended on their wives to maintain contacts with friends, relatives and the larger community [64].

We believe that the preceding literature supports the perspective that women are the more nurturent, supportive and affectively-connected sex based on gender differences in earlier socialization experiences. An alternative perspective would argue that the nature of adult roles constitutes the major deter- minant of the acquisition and utilization of social support. Following a social role argument, one would expect gender differences in social support to diminish in the context of a traditionally male- dominated occupation such as medicine, in which women have recently entered on a relatively equal basis to that of men. Current female medical students, therefore, represent a group likely to evidence less traditionally feminine interpersonal styles than their age-mates who have selected tradi- tional or gender-neutral occupations. Evidence for the persistence of gender differences in social support in the medical school context would suggest powerful socialization factors responsible for perpetuating traditional female styles. The current study was designed to explore gender differences in the percep- tion of social support, its differential effect on psychopathology, and to examine personality and developmental factors that could account for these differences.

1224 JOSEPH FLAHERTY and JUDITH RICHMAN

RESEARCH DESIGN

Sample

The sample derives from the first year cohort of medical students (N = 210) entering a state College of Medicine in the fall of 1985. During the initial registration period, the entire class was administered a self-report questionnaire. Participation was defined as confidential and voluntary. The final response rate (following a second request for participation 2 weeks later) was 93% of the cohort (N = 195). The sample was 66.5% male and 33.4% female, similar to the sex distribution of the total population.

Table 1 shows the sociodemographic character- istics of the male and female respondents. The mean age of the males was 23.1 and the mean age of the females was 24.4, with most of the respondents in their twenties. Both the males and females are pre- dominantly single (83%) and from socioeconomic backgrounds characterized by parents with at least high school educations, and in many cases, college and post-graduate training.

Hypotheses

The following hypotheses were generated prior to data collection: (1) Women medical students will manifest stronger social supports in the areas of reciprocity and intimacy, but equal scores in relation to the perceived availability of social supports. (2) A higher percentage of females than males will be listed as the principal support provider in the social net- work of both men and women students. (3) The correlation between social support and psychological distress (depression and anxiety) will be stronger for women than for men. (4) High interpersonal dependency will be associated with higher social support for women. (5) There will be a stronger relationship between perceived early maternal affectivity and social support than between paternal affectivity and social support for both sexes. Finally, we were interested in examining (but did not formu- late specific hypotheses regarding) gender differences in the influence of personality (self-esteem and locus of control) factors on the development of support networks.

Measures

1. Social support was measured by a modification of the Social Support Network Inventory (SSNI) [65]. It consists of questions concerning the most im- portant members (up to 5) in one’s social support network. The questions tap three dimensions of social support: availability, intimacy and reciprocity. The scale has demonstrated high reliability and convergent and concurrent validity [65, 661.

2. Depressive symptomatology was measured by the Center for Epidemiologic Studies Depression (CES-D) scale. The CES-D is a 20-item self report symptom rating scale designed to measure depressive mood in community populations [67]. The CES-D has been considered reliable and valid as an indicator of depressive symptomatology, although it does not necessarily correspond to a clinical diagnosis of depression.

3. The qualitative assessment of earlier parentchild relations was made utilizing the ‘Parent

Table I. So&demographic characteristics of medical student respondents

Males Females (.V = 121) (.Y =61)

Mean age Marital status:

Single Married Separated’divorced

Mother’s education: <High school High School graduate College graduate Post-graduate

Father’s education: <High school High School Graduate College graduate Post-graduate

23.1 24.4

90.9 80.3 8.3 14.8 0.8 4.9

9. I Il.5 48.8 47.5 20.7 16.4 21.4 24.6

10.7 19.7 28.9 23.0 19.8 13.1 40.6 44.2

Bonding Instrument’ [68]. The PBI is a relatively brief (25 item) self report instrument designed to character- ize relations with each parent during the first 16 years of life in terms of two dimensions (derived from factor analysis): levels of affection and control. It taps the two dimensions of early family relations (lack of parental affection and parental over control) high- lighted in the general clinical literature on depression [69,70]. Second, given the methodologic difficulties involved in retrospective data gathering, the PBI has been shown by Parker and colleagues to manifest evidence of both reliability and concurrent and pre- dictive validity. For example, Parker and colleagues have found significant correlations between re- spondents’ ratings of their mothers’ earlier behaviors and those ratings made by the mothers themselves regarding their own earlier behaviors. In addition, both the respondents’ ratings and those made by the mothers were predictive of depression in the re- spondents. Thus, these and other validation studies to date of retrospective accounts of childhood experi- ences as measured by the PBI, have provided some support for the accuracy of adult recall and the ability of the PBI to predict psychopathology [70, 711.

4. Anxiety was measured by a nine-item (tension-anxiety) factor of the Profile of Mood State [72]. This factor has manifested a high correlation with other anxiety measures, high internal consis- tency (Alpha = 90) test-retest reliability. and has been validated in community and patient samples and has been used extensively in college populations.

5. Interpersonal dependency was measured by the Emotional Reliance on another person factor of the Hirshfield [73], Interpersonal Dependency Scale. This is an 18-item scale reflecting degrees of attach- ment and depending, with an adequate level of split-half reliability and demonstrations of validity by discriminating between patients and normal subjects.

6. Locus of control was measured by the Rotter 23-item (plus six filler items) internalexternal scale. This is the most widely used scale assessing the belief as to whether one is controlled by external forces, with considerable research available on reliability and validity [74].

7. Self-esteem was assessed by five of the widely used Rosenberg items shown to relate inversely to psychological distress in epidemiologic research [75].

Gender differences in social support 1225

Table 2. Male and female scores on social support, depression and anxiety

Male (N = 121) Female (N =61)

f SD .f SD

Social support (overall) 4.8 I k 0.722 4.94 r 0.652 Availability 4.71 f 0.92 4.76 t I .04 Intimacy 5.25 f 0.95 5.33 + 0.89 Reciprocity 3.87 * I.2 4.18 * 1.3

Depression 10.72 I 7.6 9.98 + 7.6 Anxiety I .20 i 0.64 1.08 f 0.58

RESULTS

Table 2 shows the mean scores and standard deviations by gender on each variable: social support, dependency, self-esteem, locus of control, depression, anxiety and maternal and paternal affectivity. There are no significant gender differences in any of these variables. Of particular note is the lack of a significant social support difference as hypothesized. While a gender difference exists in reciprocity (female students provide more support to other people); this difference was not significant.

Table 3 shows the gender differences in the provid- ers of social support to male and female students. The providers of social support are the people listed on the SSNI as the most important people in their support network; the gender and the relationship to the respondent is also assessed in the SSNI. Both sexes rely more strongly on female supporters as predicted. The most common relationship of support providers to respondent were (in descending order): parent, friend, spouse/lover.

Table 4 shows the Pearson correlations between social support composite and subscores with the two outcome measures, depression and anxiety, computed separately for each sex. As can be seen,

Table 3. Percentage of gender of support providers to male and female students

Male students (N = 122) Female students (N = 50)

% Sex % Sex

45 55

39 61

34 66

For three supparr persons Male 45 Female 55

For IWO .wppm persons Male 45 Female 55

For one .supporr person Male 47 Female 53

Male Female

Male Female

Male Female

Table 4. Correlations between social support psychological distress

Depression Anxietv

Males (N = 118) Total SSNI

Availability Intimacy Reciprocity

Females (N = 65) Total SSNI

Availability Intimacy

-0.04 -0.14

0.09 -0.03

-0.20’ -0.05 -0.52”

-0.04 -0.08 -0.01 -0.02

-0.30** -0.07 -0.46”’

Reciprocity -0.04 -0.10

l FJ < 0.05: l *P < 0.01: l **p < 0.001

Table 5. Pearson correlations of social support with predtctor varubles

Males Females (N = 118) (N =6l)

Self-esteem -0.27’. -0.28 Interpersonal dependency 0.07 0.21. Locus of control 0.04 -0.23** Maternal affectivity 0.37*** 0.38”. Paternal affectivity 0.19* 0.24.

l FJ co.05: l *P < 0.01; ***p < 0.001.

hypothesis three was confirmed: correlations between composite scores of social support with depression and anxiety were both significant for women (P < 0.05 for depression and P < 0.001 for anxiety), but not for men. It is clear also that the strength of this correlation is due to the relatively strong correlations between the intimacy component of social support and psychopathology. Interestingly, although not significant, males have a negative cor- relation between support availability and depression but a positive correlation between support intimacy and depression, i.e. more intimate support is associ- ated with more depressive symptoms in men. Z-tests were calculated to examine the significance of the gender differences in these correlation coefficients. The gender difference between the intimacy- depression correlation and the intimacy-anxiety correlation were both significant (P < 0.01, Z = 3.02 and 3.03 respectively), while the overall social support-anxiety correlations were nearly significant (Z = 1.67). No other gender differences in correlation coefficients reached significance.

Table 5 shows the Pearson correlations between support and parental affectivity, interpersonal de- pendency, locus of control and self-esteem. All five personality-development variables are significantly correlated with social support in women, while three of the five are significant for men. Z-test analyses showed that none of the gender differences in cor- relation coefficients were significant. As predicted, maternal affectivity is more strongly associated with social support for both sexes, although paternal affectivity also manifests a significant positive correlation with social support. In women, social support was significantly correlated with (high) self- esteem, (high) interpersonal dependency and an external locus of control. The only significant person- ality variable associated with social support in men was (high) self-esteem.

DISCUSSION

Relative to our initial set of hypotheses, the data demonstrate mixed findings regarding gender differences in social supports. On the one hand, males and females perceive equivalent levels of social sup- ports. On the other hand, the perception of social supports has very different consequences for the psychological well-being of men and women. The first set of findings may reflect the powerful influence of adult social role incumbency. In particular, both males and females preparing for and embarking on a demanding career in medicine may experience at the same time limitations regarding recreational activ- ities, including those involving interpersonal re-

s s Y., ?X 12-B

1226 JOSEPH FLAHERTY and JUDITH RICHMAN

lationships. At the same time, however, the data provide indirect evidence that women provide more support than men in so far as both male and female students emphasized women as support providers. As many of these providers were mothers and older female siblings, this finding does not directly support our contention that these women students provide more support than their male counterparts. Female medical students were, however, slightly more likely to be listed as support providers than male students, despite the fact that they represent only 32% of the student body.

The clearest gender differences in this study in- volved the higher correlations between social support and symptoms for female students. Of particular note is that the close relationship between intimate support and reduced symptoms for women largely accounts for the modest overall support-psycho- pathology correlations in the whole sample. Not only does intimacy fail to reduce depression in male students, but the relationship (not significant) is positive, i.e. males with more intimate support have more depressive symptoms. This strong protective effective of intimacy for women provides meaning to previous reports showing greater intimacy behavior in women. Women have been reported to engage in more intimate, emotional and self-disclosing relation- ships while men engage in task or activity-oriented behavior [53,76,77]. Rubin [76] has characterized these male relationships as ‘bonding’ in the contrast to the ‘intimacy’ mode seen in women. She also provides data showing that two-thirds of women sampled reported a ‘best friend’ while only one- quarter of males could do so. For both sexes the best friend was most likely to be a woman. Psychoanalytic authors and critics have varied in their description of female intimacy as either a ‘developmental deficit’ based on womens’ vulnerability to loss and dis- ruption or as a striking capacity which should be a model for human interactions [78]. Most analytic writers relate this capacity/need to girls’ unique development through nurturance and care from a same-sexed object, their mother. This is perceived to create a stronger bond, making complete autonomy and independence less likely for women.

As predicted, high interpersonal dependency scores did correlate with greater social supports for women, but not for men. This finding suggests dependency needs serve as a driving force in the solicitation of supporting relationships for women. Likewise, an external locus of control also was associated with high social support for women. Interestingly, how- ever, both males and females manifested stronger support in the presence of high self-esteem and a background of high parental affectivity, suggesting common positive factors in support acquisition. It would appear that a prerequisite to positive social supports for both sexes is the experience of affectively-positive parental relationships in child- hood and positive self-regard. Given these factors, women with higher dependency and an external locus are more likely to seek out supportive relationships.

While it appears that women benefit from intimate support, does it pose any risks? Unfortunately, many of these women may lose close sources of support, particularly from their mothers, as professional role

demands (and often personal role expectations as mothers and wives) demand more time. In time- consuming and stressful professions such as medi- cine, other coping styles may be more practical as a buffer to depression. Instrumental coping traits (e.g. active problem solving) may be more beneficial than affective traits (e.g. seeking reassurance) in reducing depression. The question raised here involves the extent to which women’s need for and reliance on intimate support will change from a benefit to a detriment under conditions of stress? Will women physicians who occupy demanding professional (and perhaps familial) roles assimilate the modeling of their male counterparts and respond by affective-distancing, active coping, and emphasis on their instrumental roles? We hope to provide answers to these questions as we continue to follow this cohort of medical students through medical school and into post-graduate training.

Acknowledgemenls-This work was supported, in part, by a grant from the John D. and Catherine T. MacArthur Foundation. Our thanks to Mary Pittman for her valuable computer analyses.

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