Relationship: Social Support, Depression, Maldivian Mothers, Study

This report presents a comprehensive investigation into the relationship between perceived social support and depression among Maldivian mothers, comparing the experiences of single and married women. The study aims to determine the prevalence of depression and assess the impact of s...Read More

Running head: PERCEIVED SOCIAL SUPPORT 1
THE RELATIONSHIP BETWEEN PERCEIVED SOCIAL SUPPORT AND
DEPRESSION AMONG MALDIVIAN SINGLE AND MARRIED MOTHERS
Student’s Name:
Instructor’s Name:
Name of University:
Course Number:
Date of Submission:
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CONTENTS
ABSTRACT................................................................................................................................. 3
INTRODUCTION......................................................................................................................... 4
Research Question.................................................................................................................... 6
Hypothesis................................................................................................................................ 6
OBJECTIVES AND AIMS............................................................................................................6
Specific Aims............................................................................................................................ 6
Overall Objective...................................................................................................................... 7
BACKGROUND AND SIGNIFICANCE........................................................................................8
LITERATURE REVIEW............................................................................................................. 11
RESEARCH DESIGN AND METHODS.....................................................................................13
Design..................................................................................................................................... 13
Participants............................................................................................................................ 13
Measures................................................................................................................................ 13
Procedure............................................................................................................................... 15
Data Analysis.......................................................................................................................... 15
Ethics and Human Subjects Issues...........................................................................................15
RESULTS.................................................................................................................................. 17
Descriptive Statistics............................................................................................................... 17
Prevalence of Depression among Single and Married Mothers.................................................18
Inferential Statistics................................................................................................................ 19
DISCUSSION............................................................................................................................ 21
FURTHER RECOMMENDATION..............................................................................................24
CONCLUSION........................................................................................................................... 25
STRENGTHS AND WEAKNESSES OF THE STUDY...............................................................25
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SIGNIFICANCE......................................................................................................................... 27
REFERENCE............................................................................................................................ 28
APPENDIX................................................................................................................................ 33
Appendix 1: Participants Information Sheet............................................................................33
Appendix 2: Consent Form........................................................................................................33
Appendix 3: Demographic Questionnaire................................................................................33
Appendix 4: Perceived Social Support Scale – MSPSS.............................................................33
Appendix 5: Depression Scale – PHQ-9....................................................................................33
Appendix 6: Debreifing Information sheet...............................................................................33
Appendix 7: Authors Permission to use Scale MSPSS..............................................................33
Appendix 8: Authors Permission to use Scale PHQ-9...............................................................33
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ABSTRACT
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INTRODUCTION
Single mother headed families is one of the structural changes in modern society, which
is growing rapidly. The country of Maldives has the highest divorce rate in worldwide, which is
per year 10.97 divorces for every 1,000 inhabitants (Guinness World Records 2002). According
to the Department of Judicial Administration, 6509 couples got married in 2019, and 5117
couples were divorced in the same year (Department of Judicial Administration 2020). After the
divorce, normally women take custody of their children or take the responsibilities to raise their
children. In the Maldives, the latest census statistics revealed that over 20 per cent of the children
lives with their mother only (National Bureau of Statistics 2014). This could be due to divorce,
separation, having children without marriage, and fathers living or working in different Islands.
According to Crosier, Butterworth, and Rodgers (2007) suggested that parental well-being was
negatively influenced by a transition to single parenthood, dissolution, and family instability.
Likewise, international literature reveals that single motherhood is linked with a greater level of
chronic stress, because of the economic hardship and decreased the level of social support from
families, friends and others (Targosz et al. 2003; Tobias et al. 2009; Rousou, Kouta and
Middleton 2016). Thus, this eventually causes psychological and physical illness amongst single
mothers (Targosz et al. 2003; Tobias et al. 2009; Rousou, Kouta, and Middleton 2016).
Depression is defined as a common mental disorder, presented by losing interest about
events that you once enjoyed, reduced energy, failure to carry out daily tasks, and having
persistent sadness for at least two weeks (WHO 2012). A survey done in the Maldives found that
five per cent of the population is suffering from depression and anxiety (Niyaz and Naz 2003).
Also, the results found women experience depression, anxiety, and somatic symptoms twice
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higher than men (Niyaz and Naz 2003). Similarly, prevalence study conducted by Maldivian
National University students found that female students have a higher prevalence of depression,
anxiety, and stress (Shanoora and Nawaza 2018).
Social support is known as the process of taking care of social relationships. According to
Tardy (1985) suggested that social support is a broad, multidimensional concept which includes
emotion support and instrumental support. Emotional support consists of the support received
from intimate, confiding relationships which include love, and empathy (Tardy 1985).
Instrumental support was more pragmatic and practical or helping behavior: which includes
providing financial support and giving once a time (Tardy 1985). However, Zimet et al. (1988)
defined social support as emotional support from family, friend, and significant others. A recent
meta-analysis done by Gariépy, Honkaniemi, and Quesnel-Vallée (2016) claimed that emotional,
social support was more closely related to depression compared to instrumental social support.
However, Werner-Seidler et al. (2017) stated that some studies merge these social support
aspects, and the ability to differentiate between social support roles in depression were
precluded. This paper will focus on how emotional, social support from families, friends, and
significant others affect depression among Maldivian mothers and identify whether there is any
difference in perceived social support and depression between Maldivian single and married
mothers.
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PROBLEM STATEMENT
Research Question
i. Is there a relationship between perceived social support and depression among Maldivian
mothers?
ii. Does the difference exist in perceived social support and depression between Maldivian
single married mothers?
Hypothesis
H :₀ There is no statistically significant relationship between perceived social support and
depression among Maldivian mothers
H :₁ There is a statistically significant relationship between perceived social support and
depression among Maldivian mothers
H :₀ There is no statistically significant difference in perceived social support between
Maldivian single and married mothers
H :₂ There is a statistically significant difference in perceived social support between
Maldivian single and married mothers
H :₀ There is no statistically significant difference in the level of depression between
Maldivian single and married mothers
H :₃ There is a statistically significant difference in the level of depression between Maldivian
single and married mothers
OBJECTIVES AND AIMS
Specific Aims
i. To investigate the relationship between perceived social support and depression among
Maldivian Mothers
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ii. Identify the difference in perceived social support and depression between Maldivian
single and married mothers
iii. Identify the difference in the level of depression between Maldivian single and married
mothers
Overall Objective
i. Identify the prevalence rate of depression among Maldivian single and married mothers
ii. Identifying the difference in perceived social support based on three dimensions: Friends,
Family and significant others
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BACKGROUND AND SIGNIFICANCE
The theorists have proposed two theoretical frameworks to explain the relationship
between social support and depression, which includes the main effect model and the stress-
buffering model (Cohen and Wills 1985). The direct or main effect of social support model states
that by promoting healthy psychological states can be beneficial regardless of whether an
individual was under stress (Cohen and Wills 1985). Whereas stress-buffering hypothesis
suggests that social support was beneficial after an event has been considered as stressful (Cohen
and Wills 1985). Nevertheless, Stroebe and Stroebe (1997) stated according to that modified
Stress Buffering model, Social support offers benefits to individuals who were suffering from
high stressful as well as low-stress situations. Moreover, Werner-Seidler et al. (2017) mentioned
that social support deals with stress to stop depression by facilitating adaptive coping strategies
or eliminating or reducing the stressful reaction. The evaluation of these models, studies found
mixed results. Some studies support the stress-buffering model, whereas other studies favour the
primary effect model (Cohen 2014; Rueger et al. 2016). These models do not appear to be
mutually exclusive, since both the model given support in the empirical literature (Cohen and
Wills 1985). Thus, evidence revealed that surrounded in a strong social support network acts as a
protective factor during the stressful or hardship time in life.
Studies found that statistically significant negative relationship between social support
and depression (Santini et al. 2015; Bell, Leroy and Stephenson 1982). Nevertheless, social
support may cause psychological illness, also believable that individuals who suffer from
psychological distress or illness might avoid social interaction (Johnson 1991). Similarly,
Almquist, Landstedt, and Hammarström (2017) longitudinally investigated the structural and
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functional characteristics of social support concerning depressive symptoms and found social
support and depressive symptoms have bi-directional effects over time among women. Changes
in social support levels affect changes in depressive symptoms and vice versa. Moreover, a study
done in Cyprus revealed that single mothers perceived social support have a strong negative
independent relationship with depression (Rousou, Kouta and Middleton 2016).
Studies revealed that compared to married mothers’, single mothers experience a
disproportionately greater level of physical and psychiatric illness (Berkman 1996; Lipman
2001). Cairney et al. (1999) did a study using a large Canadian sample and investigated the
episode of major depression in the previous year among mothers. Further, authors did find single
mothers were likely to experience depression twice higher than married mothers. Similar results
were found in the study done in Germany. The results revealed that depressive symptom among
single mothers were twice higher than that of married mothers (Liang, Berger and Brand, 2019).
There are many mediate and moderate factors that influence single parent to cause psychological
distress. The factors that identified in the past literature includes, negative life event and single
parenting responsibilities (Avison 1995), child abuse and other adversities experience in early
childhood (Lipman, MacMillan, Boyle 2001; Davies, Avison, McAlpine DD 1997), financial
hardship (Hope, Power and Rodgers 1999) and reduced the level of social support (Cairney et al.
2003). Also, Cairney et al. (2003) claimed that together, stress and social support were the reason
for depression, for nearly 40 per cent of single mothers. Furthermore, inadequate social support
and history of partner were a risk factor of depression among mothers with young children
(Liang, Berger and Brand, 2019).
One of the main assumptions about single parenthood was that family members and
friends were more likely to offer help because of the absence of the partner. Also, believe that a
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single mother’s family’s member will provide instrumental and emotional social support during
her difficult times. However, a study found that compared to married mothers, single mother’s
contact with families and friends were limited; and social involvement was low (Cairney et al.
2003). Additionally, they reported a lower level of perceived social support than married
mothers. Furthermore, the result also found that married mothers were more likely to be
depressed due to a life event than single mothers (Cairney et al. 2003).
Generally, existing research mainly focus on how economic hardship or how high stress
influence mental health of single motherhood, and very few studies focus on the role of social
support (Liang, Berger and Brand, 2019; Rousou, Kouta and Middleton 2016; Kim, Jeon and
Jang 2010; Cairney et al. 2003), which plays an important role in psychological well-being of
single mothers, because stress was relatively high on this group. In addition, most of the past
literature comes from Western countries (Liang, Berger and Brand, 2019; Rousou, Kouta and
Middleton 2016; Cairney et al. 2003). Therefore, it is questionable that these findings would be
generalized to Maldivian population; meanwhile, it is accepted that both social welfare systems
and societal factors vary substantially across multiple countries. International literature revealed
that social support varies cultural and socio-political context (Burstrom et al. 2010; Fritzell et al.
2007; Rousou, Kouta and Middleton 2016). Studies found that financial hardship plays a role in
depression among single mothers (Hope, Power and Rodgers 1999), while in the Maldives,
National Social Protection Agency assists single parents who are struggling financially (NSPA
2019). Therefore, this might impact on the results as well. The relationship between social
support and depression among single and married mothers were not studied in the Maldives, and
this study aims to fill this gap. Also due to the high percentage of divorce rate and an increasing
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number of single mothers headed families, its vital to investigate the mental health status of
mothers because it will negatively impact on the child’s wellbeing.
LITERATURE REVIEW
Existing literature shows that the status of single motherhood exposes them to
disadvantaged social position and are predisposed to poor mental health due to factors such as
stress when in comparison to their married counteparts (Rousou, Kouta Middleton, &
Karanikola, 2013). Multiple factors have been associated with increased depression among
mothers. The association between income status and health differences between married and
single mothers was carried out in South Korea (Kim, Jeon, & Jang, 2010). Kim and friends
carried out a longitudinal survey of Korean Women and found out that single mothers were
highly exposed to poor health than married mothers. This was attributable to several factors with
the most common being subjective economic status (28%) with all the factors contributing to
41.4% risk of developing depression among single mothers. Although the results showed clearly
that single mothers suffer more depression symptoms, socioeconomic status alone is not
sufficient to explain the causal association.
A comparison of the health differences between single and married women was carried
out in three states: Britain, Sweden, Italy (Burstrom et al., 2010). The researchers used data from
national household surveys and the outcomes reported both the similarities and differences. The
health of single mothers was more deteriorated than their counterparts in all the three nations,
had greater chances of being disadvantaged economically and venturing into drug abuse. The
health inequalities were prevalent in all the countries despite the existing counter policies.
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Besides singlehood, other factors such as unemployment, poverty, and composition also
contributed to the health inequalities.
Loneliness has also been reported as one among other factors that contribute to negative
emotional state among single mothers. A multidimensional concept of loneliness was suggested
by Adamczyk and DiTommaso (2014). as one consisting of social and emotional and caused by
an absence of social association and emotional attachment respectively. Gierveld and Van
Tilburg (2010) also pointed out that Depression results from an absence of intimate relationships.
In a study of senior adults experiencing different levels of depression, 83% of them were lonely
and most of them suffered depression compared to 32% who had reported minimal incidences of
loneliness (Holvast et al., 2015).
A cross-sectional correlational study on cognitive health among lone mothers was carried
out. The study used GHQ-28 to measure the extent of mental distress among lone mothers and
how its affected by financial status and supposed social support. The researchers reported 44.6%
of cases that were distressed with significant relations with family income, aged, previous health,
and economical challenges. Moreover, there was a significant negative independent association
of perceived social support with depression among single mothers. The study also attributes the
increase in single parenthood as a prevalent cause of emotional suffering among women because
they are the most affected when there is a breakup (Rousou, Kouta, Middleton, & Karanikola,
2019).
To date, there are limited studies that examine the association between perceived social
support and depression among lone and partnered mothers. Most of the studies have either
examined socioeconomic status and lone mothers but based on the knowledge of the researcher
no other study has examined both lone and partnered mothers.
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RESEARCH DESIGN AND METHODS
Design
A quantitative cross-sectional design was carried out with perceived social support as
predictor variable and the level of depression as the outcome variables. The traditional paper
pencil method was used to collect data and sample was selected using the convenient sample
method. The snowball sampling method was used to reached single mothers.
Participants
Total number of 370 questionnaires were distributed among Maldivian mothers but only
320 questionnaires were returned. The sample included Maldivian mothers competent in English
within the age range of 18 to 54years and who have a child under the age of 18. Married mothers
who have history of divorce, and mothers who have children above 18 and Mothers outside the
age criteria were excluded from the study. After considering the inclusion and exclusion criteria
43 questionnaires had to be discarded as they did not meet the criteria. The final sample size was
277.
Measures
The study data was collected with a Demographics Questionnaire, Multidimensional
Scale of Perceived Social Support (MSPSS) and Patient Health Questionnaire -9 (PHQ-9).
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Demographics Questionnaire: A demographics questionnaire was used to ensure the
inclusion and exclusion criteria was maintained, as well as to collect data related to the
classification of major of the participant.
Multidimensional Scale of Perceived Social Support (MSPSS): Participant’s social
support was assessed by using the Multidimensional Scale of Perceived Social Support (MSPSS)
(Zimet et al. 1988). It is a 12-item self-report assessment instrument designed to assess perceived
social support from three sources. The scale includes 4 items to each subscale, namely, family,
friends and significant others. For example, ‘My family really tries to help me’, this item used to
measure social support from family. Participants have to answer the questions using 7-point
Likert scale (1 = Very Strongly Disagree, 2 = Strongly Disagree, 3 = Mildly Disagree, 4 =
Neutral, 5 = Mildly Agree, 6 = Strongly Agree, and 7 = Very Strongly Agree) (Zimet et al.
1988). The overall total social support score will be obtained by adding all the items and dividing
it by 12. The subscale total will be obtained by addition subscale items and divided it by 4
(Zimet et al. 1988). The overall score ranges from 5.1 to 7, with higher scores indicating a higher
level of perceived social support and lower scores indicating a lower level of social support
(Zimet et al. 1988). Internal consistency reported for the scale is between .80 and .95. (Zimet et
al 1990).
Patient Health Questionnaire -9 (PHQ-9): Participants depression was assessed by
using the Patient Health Questionnaire -9 (PHQ-9). The PHQ-9 is a multipurpose instrument
developed by Kroenke, Spitzer and Williams (2001) and it includes DSM-IV Diagnostic
Criterion A symptoms for major depressive disorder. The scale is used for screening, diagnosing
depression or monitoring and measuring severity of depression (see Appendix D). The
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participants were asked how often, prior to two weeks, they have been bothered by each of the
depressive symptoms. There are four answer options: not at all (0), several days (1), more than
half of the days (2), and nearly every day (3) (Kroenke et al. 2001). The scale includes items
such as ‘Feeling tired or having little energy’ and “Trouble falling asleep, staying asleep or
sleeping too much’. The overall score was obtained by the sum of all item scores. The score
(range 0 to 27) indicates the degree of depression, with scores of ≥5, ≥10, and ≥15 represent
mild, moderate, and severe levels of depression. The PHQ 9 has been proved excellent internal
reliability with a Cronbach's α of 0.86 to 0.89 (Kroenke, Spitzer and Williams 2001) and and test
re-test reliability (interclass correlation coefficient=0.92) (Gelaye et al. 2013).
Procedure
Traditional (paper-pencil) method was used to collect data. First, to start with data
collection, participants were approached and given a verbal description of the purpose of
the study. Then the participant's information sheet was provided. After reading the
participant's information sheet, mothers who wish to participate in the study were asked to
fill in the consent form. After obtaining the consent, demographic sheet, perceived social
support questionnaire, and depression questionnaire was given to the participants. After
they have completed the questionnaire, the debriefing sheet was provided.
Data Analysis
The data collected was statistically analysed via SPSS (version 20). The H1 met the assumptions
of normality for parametric testing, then Pearson correlation was used. For the H2
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To test hypothesis 2 normality is violated, the non-parametric method would be used, which is
the Mann-Whitney U-test and H3 met the assumptions of normality for parametric testing,
independent t-test.
Ethics and Human Subjects Issues
Firstly, to maintain the ethical guidelines of research, the essential actions were taken into
account. Data collection was commenced after getting an ethics clearance letter from the
Psychology Ethics Committee of Colombo Institute of Research and Psychology. Before
collecting data, the participants were informed that their participation in the study is voluntary.
After that, the participants were informed about the study by providing information sheet. If a
respondent was willing to participate in the study, written consent was obtained before collection
data from the participants. Participants were debriefed on the nature and purpose of the study, at
the end of data collection. Further, the participants were informed on the methods to withdraw
from the study, and they could contact the researcher within two weeks of data collection and
request to have their data removed. Also, in the information sheet, researcher and supervisor
email address was provided, so any concerns or complaints regarding the study could be made.
Participant’s privacy were protected by guaranteed anonymity because participant name was not
be collected during the study, and data will be collected through questioner. Informed participant
to create their own personal reference code (example: first two letters of the name and birth year
-FS1991), which they can write on the consent form and the questionnaire. In addition to this, the
consent forms and data obtained through the study were stored separately in locked cabinets.
Access was only with the researcher and supervisor, who could access, and once the project over
the data will be destroyed.
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RESULTS
Descriptive Statistics
Table 1: Distribution of Married and Unmarried Mothers’ Demographic Characteristics
Characteristics (n=277) Frequency Percentage
Age
18-28 114 41.2
29-39 145 52.3
40-50 18 6.5
Marital Status
Single 126 45.5
Married 151 54.5
Number of Children
1 153 55.2
2 91 32.9
3 27 9.7
4 6 2.2
Children below 18 yrs
1 153 55.2
2 91 32.9
3 27 9.7
4 6 2.2
Employment status
Unemployed 150 54.2
Employed 127 45.8
Monthly Family
Income
Less than MVR 5,000 97 35
MVR 5,001 – MVR
10,000 81 29.2
More than MVR 10,001 99 35.7
Single Parent Status
Divorced 118 42.6
Separated 3 1.1
Unmarried 2 0.7
Widow 3 1.1
Single Mother
Allowance
No 91 32.9
Yes 35 12.6
Father's Financial
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Support
Yes 50 18.1
Missing 227 81.9
Table 1 shows that most of the participants (52.3%) were married and unmarried women aged
29-39 years, whereas the least (6.5%) of them were aged 40-50 years. Over half of the
participants were married (54.5%), divorced (42.6%), separated (1.1%), unmarried (0.7%), and
widow (1.1%). The majority of the women (55.2%) had one child and aged below 18 years with
only 2.2% having 4 children aged 18 years and below.
Prevalence of Depression among Single and Married Mothers
Table 1 above shows the scores for the risk factors for depression among single and married
mothers. Those with high frequencies implies that they experience more depression than their
counterparts.
Employment Status
The unemployment rate was highest among single mothers (54.2%) compared to married
mothers (45.8%). Unemployment is a factor that contributes to the increase in depression, hence
the reason why depression is much higher among single mothers than married mothers.
Monthly income
35% of the single mothers had a monthly income of less than MVR 5,000 with 35.7% having an
in come of more than MVR 10,001. A low monthly income is an indication of poverty and the
inability to meet daily needs. As a result, single mothers experience depression due to the
pressures of life and lack of adequate social support.
Single mother allowance
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32.9% single mothers indicated that they never received single mother allowance thus
contributing to their inability to cater for their daily needs. Only 12.6% of the single mothers
were receiving single mother allowance. Low financial support is an indication of depression due
to the inability to afford financial support to the family of the single mother.
Fathers financial support
81.9% of the single mothers indicated that they did not receive any financial support from the
fathers. This further adds to the burden of financial needs since the single mothers have double
financial burden upon themselves and thus increasing depression levels.
Inferential Statistics
Table 2: Pearson Correlation Between Perceived Social Support and Depression
Depression Total
Score
TOTAL Average
Social Support
Depression Total
Score
Pearson
Correlation
1 -.353**
Sig. (2-
tailed)
0.000
N 277 277
TOTAL Average
Social Support
Pearson
Correlation
-.353** 1
Sig. (2-
tailed)
0.000
N 277 277
Any p value less than 0.01 implies the relationship is statistically significant. From table 2 above,
the p value is 0.000 which is less than 0.01. Therefore, there was a strong association between
perceived social support and depression among Maldivian Mothers at the level of p<0.01 (Table
2).
Table 3: Difference in Perceived Social Support Between Maldivian Single and Married
Mothers
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Mann-Whitney test
Ranks
2. Marital status: N
Mean
Rank
Sum of
Ranks
TOTALAverageSocialSupport Single 126 157.29 19818.50
Married 151 123.74 18684.50
Total 277
Test Statisticsa
TOTALAverageSocialSupport
Mann-Whitney U 7208.500
Wilcoxon W 18684.500
Z -3.474
Asymp. Sig. (2-tailed) 0.001
a. Grouping Variable: 2. Marital status:
If the p value is less than 0.5 then the null hypothesis is rejected. The p-value from table 3
above is 0.001, which is less than 0.5. This implies that there exists a significant difference in
perceived social support between the married and single mothers in Maldives. Additionally, there
is a wide variation between the mean ranks to warrant its significant difference.
Table 4: Difference in The Level of Depression Between Maldivian Single and Married
Mothers
Independent Samples Test
Levene's
Test for
Equality of
Variances t-test for Equality of Means
F Sig. t df
Sig.
(2-
tailed
)
Mean
Differenc
e
Std.
Error
Differenc
e
95%
Confidence
Interval of
the
Difference
Lowe
r
Uppe
r
Depression_Severi Equal 2.82 0.09 3.09 275 0.002 0.376 0.121 0.137 0.61
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ty variance
s
assume
d
4 4 5 4
Equal
variance
s not
assume
d
3.14
7
274.99
3
0.002 0.376 0.119 0.141 0.61
0
The p-value is 0.094 and is less than 0.5, implying that the variation between the two means is
statistically significant at zero at a 5% significance level. As a result, we reject the null
hypothesis.
DISCUSSION
There was a strong association between perceived social support and depression among
Maldivian Mothers at the level of p<0.01 (Table 2). After evaluating the relationship the study
variables using the Pearson Correlation coefficient as shown in table 2, a strong negative
association was found between the study variables. This, therefore, implies that any increase in
the perceived social support among the lone mothers and their counterparts results in a
corresponding decrease in depression. In other words, social support is a predictive factor for
depression (Erdem, & Apay, 2014). Similar studies carried out among mothers also found out
that the absence of social support resulted in heightened cases of depression among women
(Omoaregba et al., 2011). Additionally, research has shown that the absence of the fathers’
support leads to a decline in mental health and increased depression (Martins et al., 2014).
The Mann-Whitney test was used to test for any significant difference in perceived social
support between Maldivian single and married mothers. The difference between the mean ranks
is sufficient to be significant, and thus leading to the rejection of the null hypothesis. Since
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p<0.5, the null hypothesis is rejected and thus there is a variance in perceived social support
between the study participants.
Lone and coupled mothers have different perceived social support due to the varying
circumstances that they undergo. For instance, married mothers may have low perceived social
support due to the assumption that they obtain it from the husbands or higher social support
because of their irresponsible husbands who are likely to be more burdensome instead of being
helpful.
The study by Rousou, Kouta, Middleton, and Karanikola (2019) found out that lower
degrees of perceived social support were significantly related to lower financial income,
economic challenges and thus receiving single parent allowance. There was also reported a
perceived higher social support levels for single registered mothers with single mothers’
association.
Single mothers are likely to experience increased levels of perceived social support
depending on their situation. For instance, it has been reported that perceived social support is
affected by age. Vaughn-Coaxum, Smith, Iverson, and Vogt (2015) found out that women who
had been single mothers for five years had minimal cases of perceived support and hence lower
cases of mental stress compared to the single mothers who had been in such status for two years.
An independent t-test was used to examine the variation in the level of depression
between Maldivian single and married mothers. The p-value is 0.094 and is less than 0.5, and
thus, the variation between the two means is statistically insignificant difference from zero at a
5% significance level. However, since this was a 2 tailed test, and the sig(2-tailed) value is less
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than 0.5, there is a statistically significant difference in the level of depression between
Maldivian single and married mothers, hence the null hypothesis is rejected.
The level of depression in lone and coupled women has been studied and relatively
similar findings obtained. Previous studies have found out that single mothers have relatively
higher levels of depression as compared to their married counterparts. Psychiatric disorders were
on the increase among single mothers than married mothers. Marital history had a significant
role in psychiatric disorders and marital status as well (Wade, Veldhuizen, & Cairney, 2011).
Previous studies have also found out that single mothers are at a higher risk of developing
both mental and physical health complications (Broussard, Joseph, & Thompson, 2012).
Similarly, anxiety and mood disorders have been found to be prevalent among single mothers
(Subramaniam et al., 2014). Studies have associated this condition to the risk factors that
predispose them to depression such as low economic status, gender among others, which are
linked to single mothers.
Limitations
There are multiple limitations to the study. The research used a cross-sectional design
that prevents the generation of ultimate conclusions about the associations between the variables
under study. Besides, there is the possibility of a change in social support over time (Eisman et
al., 2015). Hence the need for a longitudinal study design to ascertain the underlying association
between the study variables.
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Furthermore, a convenience sample was used in the analysis and thus limiting the
generalization of the outcomes to the population of Maldives or elsewhere. All the questionnaires
used relied on self-reports thus exposing them to the impacts of social desirability. Lastly, even
though the current study explored the association between perceived social support and
depression among Maldivian single and married mothers, it did not examine other significant
factors attributable to depression such as domestic violence, loneliness, etc.
Implication
Theory Development
The outcomes of the current study are important in advancing theoretical comprehension
of the intricate relationship between the different factors of social support and depression in
addition to the consideration in which perceived social support can improve existing models of
depression. Several studies have increasingly focused on exploring different models of
depression (Schmidt, & Vermetten, 2017).
Multiple new models that examine other affective factors of depression have been
examined and proofed (Beck, & Bredemeier, 2016), however, fewer studies have explored the
social aspect. As a result, the current study forms a basis for theoretical development.
Clinical Implications
The findings of the current research have significant implications for families and trainers
on enhancing social support with an emphasis on controlling depression among single and
married mothers. Parental relationship is critical in family set-ups and the development of
depression among the family members. It is significant for parents to understand the value of
their influence in promoting a safe relational environment in the family.
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FURTHER RECOMMENDATION
Based on the outcomes of this study and in the reflection of its weaknesses, further
recommendations are hereby given:
1. Future studies should explore specific sources of depression to provide additional
opportunities for further studies into relationships with depression. More specifically,
future studies should explore the sources of social support.
2. There is also the need for a longitudinal study design to ascertain the underlying
association between the study variables.
3. It is high time that researchers focused more on the details of social support such as
appraisal support instead of generally exploring emotional support.
CONCLUSION
The major aim of the present study was to explore the relationship between perceived
social support and depression among single and married mothers. The study found out significant
relationship and difference in perceived social support between Maldivian single and married
mothers. Furthermore, there was a statistically significant difference in the level of depression
between Maldivian single and married mothers. However, there is a need for more research in
the specific sources of social support and longitudinal studies to examine the causal association.
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STRENGTHS AND WEAKNESSES OF THE STUDY
There are several strengths to the study. Firstly, in the Maldives, depression and mental
health problems are taboo topics until very recently. Now people are starting to be aware of this
area, and through this study have contributed to the mental health fields, and have people to be
more aware of women’s mental health. Also, the study results have helped to identify the
prevalence rate of depression among Maldivian single and married mothers. No such study has
been done in the Maldives before, and this study will be the first study that investigates the
depression level of Maldivian Mothers and the role of perceived social support on depression. In
addition, it also helps relevant authorities to establish an early intervention and ongoing
psychological support for mothers who are going through depression. Moreover, mothers and the
general public could be made aware of the common mental health issues and treatment through
awareness programs. This is done with a particular focus on prevention and control of stress,
depression and the role of social support. Besides, the study results also provide valuable
information to relevant government authorities on developing new policies for single mothers.
Furthermore, based on the study results, it is recommended to create awareness in the general
public regarding the importance of social-emotional support and depression. Finally, the research
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opens the door to conduct further research on this area does identify various causes for the
prevalence of depression among Maldivian mothers.
There are several limitations or weakness in this study. Firstly, a mother living in Male’
might face many social problems compared to a mother living in an “Atoll”, which might affect
the results. Besides, the transition period (in and out of single parenthood) will affect the results.
Thirdly, data will be collected using self-report questionnaires which can result in response bias.
Fourthly, the scale used to measure depression (PHQ9) and perceived social support (MSPSS)
was not standardized to Maldivian population. Finally, the questionnaires were presented in
English, and the language of the questionnaires could have also affected the responses as many
mothers might have difficulties in understanding the English language.
SIGNIFICANCE
The study results have helped to identify the prevalence rate of depression among
Maldivian single and married mothers. No such study has been done in the Maldives before, and
this study will be the first study that investigates the depression level of Maldivian Mothers and
the role of perceived social support on depression. In addition, it also helps relevant authorities to
establish an early intervention and ongoing psychological support for mothers who are going
through depression. Moreover, mothers and the general public could be made aware of the
common mental health issues and treatment through awareness programs. This is done with a
particular focus on prevention and control of stress, depression and the role of social support.
Besides, the study results also provide valuable information to relevant government authorities
on developing new policies for single mothers. Furthermore, based on the study results, it is
recommended to create awareness in the general public regarding the importance of social-
28

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29
emotional support and depression. Finally, the research opens the door to conduct further
research on this area does identify various causes for the prevalence of depression among
Maldivian mothers.
29

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30
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APPENDIX
Appendix 1: Participants Information Sheet
Appendix 2: Consent Form
Appendix 3: Demographic Questionnaire
Appendix 4: Perceived Social Support Scale – MSPSS
Appendix 5: Depression Scale – PHQ-9
Appendix 6: Debreifing Information sheet
Appendix 7: Authors Permission to use Scale MSPSS
Appendix 8: Authors Permission to use Scale PHQ-9
36