Following a quantitative review examining the relative influence of positive and negative social exchanges on emotional health, a second-order factor model of negative social exchange was tested and supported in a sample of 906 college students. Structural equation analysis exploring the unique effects of negative social exchange and perceived support satisfaction on depression revealed both variables to predict this outcome, over and above the contribution of personality and coping variables. In addition to the direct effects of the Big Five personality dimensions on depression, indirect effects of the Big Five via negative social exchange, support satisfaction, and avoidant coping also were observed. Although the prevailing belief among support researchers is that the negative effects of conflictual social interactions outweigh the positive effects of social support, the results of the quantitative review suggest boundary conditions that qualify this conclusion. In addition to corroborating a hierarchical measurement model of negative social exchange, the results of the present investigation suggest that how social support and social negativity are measured substantially influences conclusions concerning their relative impact on psychological distress.