East Asian Arch Psychiatry 2011;21:73-8


The Association between Perceived Social Support, Socio-economic Status and Mental Health in Young Malaysian Adults
CL Tam, YC Foo, TH Lee

Dr Cai-Lian Tam, PhD, MA, BSc, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Jalan Lagoon Selatan, 46150 Bandar Sunway, Selangor Darul Ehsan, Malaysia.
Ms Yie-Chu Foo, BSc, School of Health and Natural Sciences, Sunway University College, No. 5 Jalan Universiti, Bandar Sunway, 46150 Petaling Jaya, Selangor Darul Ehsan, Malaysia.
Dr Teck-Heang Lee, DBA, MCom, BA, School of Business, Monash University Sunway Campus, Jalan Lagoon Selatan, 46150 Bandar Sunway, Selangor Darul Ehsan, Malaysia.

Address for correspondence: Dr Cai-Lian Tam, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Jalan Lagoon Selatan, 46150 Bandar Sunway, Selangor Darul Ehsan, Malaysia.
Tel: (60-3) 5514 6300 (ext. 44974); Fax: (60-3) 5514 6307; Email: tam.cai.lian@med.monash.edu.my

Submitted: 4 November 2010; Accepted: 24 January 2011

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Objectives: To examine gender differences in mental health and perceived social support, relationship between parents’ income and mental health, and differences in mental health across education levels.

Methods: A total of 303 students aged 16 to 26 years were recruited from Selangor, Malaysia. The Multidimensional Scale of Perceived Social Support and General Health Questionnaire were used to measure the level of perceived social support and the mental health status. Demographic data, including education level and parents’ income, were also obtained.

Results: Females perceived significantly higher levels of overall social support than males (t = –2.7; p < 0.05). However, there were no significant differences in mental health status between males and females (t = –1.8; p > 0.05), as well as mental health status among different parental income groups (χ2 = 5.0; p > 0.05) and the education levels of the subjects (χ2 = 0.7; p > 0.05). A more favourable mental health status of the subjects was associated with higher parental incomes (r = –0.1; p < 0.05).

Conclusions: There were gender differences for perceived social support, but not for mental health status in older adolescents and young adults. There was also a relationship between parental income and an individual’s mental health status, but mental health was not related to their education level.

Key words: Mental health; Social class; Social support




结果:相比男性,女性的总体认知社会支持水平较高(t = -2.7,p < 0.05)。然而在精神健康方面,不论在两性之间(t = -1.8; p > 0.05)、不同家庭收入组别(χ2 = 5.0;p > 0.05)和教育程度(χ2 = 0.7;p > 0.05)下均无显著分别。精神健康较佳的学生也与父母收入较高呈相关(r = -0.1; p < 0.05)。




Due to the increasing awareness of psychological health on functioning, possible factors that may affect mental health have been extensively studied.1,2 According to the World Health Organization (WHO) as cited in the Malaysian National Mental Health Registry,3 mental health is the key to mental disability worldwide, and includes conditions such as depression, schizophrenia, and dementia. The WHO predicted that by 2020, such disorders would increase to 15%.3 Thus, it is crucial to emphasise mental health issues as a means of achieving better lives.

Chen and Paterson4 conducted research on 300 adolescents to investigate the relationship of socio- economic status (SES), physical health, and psychological health. Their results suggested that lower incomes may create negative consequences, which lead to poorer mental health states.

Howell and Howell5 also conducted a meta-analysis on the relationship between SES and the subjective well- being of individuals from 54 developing countries, and found that economic status alone may not affect a person’s psychological well-being, and that it was essential to consider other factors such as education level (a proxy for wealth or income). The results of this study may serve as a reference for the mental health professionals to plan strategies to improve societal mental health. This is crucial as researchers found that individuals from the low-income homes had a higher tendency to suffer from psychological problems and mental illness due to insecurity related to SES and emotional instability.6 Providing insight into such matters can prepare society to respond to its own psychological and emotional needs.

Zimet et al7 defined an individual as having mental illnesses if he or she had somatic symptoms, anxiety, insomnia, social dysfunction, or depression, in the absence of an organic cause. In addition, Dalgard et al8 explained that mental health can be measured using the 25-item Hopkins Symptom Checklist, which included: anxiety, depression, and common psychosomatic symptoms. Hence, mental health could be understood in terms of how a person was affected by mental health concerns.

Perceived social support is a multidimensional construct that includes the size of the social network, frequency of contact with people within one’s own network, and quality of social support.9 Kim et al10 further explained that social support can be determined by how an individual is loved and cared for, well-regarded, and valued. Comprehending the abovementioned definitions, perceived social support could be understood in terms of quantity, quality, or both.

Socio-economic status is defined differently by different scholars, but always includes a broad spectrum of variables.11 For instance, Thomas et al12 defined SES as a complex domain which included: income, wealth, education, employment, occupations, and types of housing occupied. It has also been proposed that social prestige and material circumstances are inherent for socio-economic classification.12 In the current study, 2 elements of SES were to be studied: parents’ income and the individual’s level of education.

Stock et al13 studied first-year female university students, including 662 from Spain, 650 from Germany, and 1,031 from Lithuania. The students were asked to rate their frequency of psychosomatic complaints over the past 12 months. It transpired that females had more such complaints than males, which showed that males had better mental health than females. A study on secondary school students in Slovakia indicated that males reported better mental health than females.14 Another study involving 3,131 adults subjected to a highly structured interview showed no association between gender and mental health.15

An investigation by Matthews et al16 in 11,405 respondents showed that males and females differed significantly in their perceived social support. Specifically, 19.4% of males as opposed to 7.9% of females complained of low levels of emotional support, while 16.1% of males compared with 9.6% of females complained of low levels of instrumental support.16

A study was conducted by Cheng and Chan17 among 2,105 adolescents in Hong Kong using the Multidimensional Scale of Perceived Social Support (MSPSS). This showed that females perceived lower family support but higher support from friends than males.17 This result could be due to the generally high level of self-disclosure among females. In addition, a study by Prezza and Pacilli18 found that there was a significant gender difference in family support; males reported having higher levels of social support from the family than their female counterparts. Antonucci and Akiyama19 reported that females received more support from networks than males. Previous studies17,19 have found that females generally tend to have higher overall social support, lower family support, and more support from friends than their male counterparts.

Research entailing SES, elements such as parents’ income, and their own educational attainment have been carried out. An investigation was carried out on 939 respondents to measure the relationship between SES as a composite and mental disorders using the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders.20 The study revealed a significant negative correlation between mental disorder and the parents’ composite SES.20 That is, the better the parental SES, the better the individuals’ mental health. In addition, Sundquist and Ahlen21 conducted a multi-level study with a sample of 4.5 million Swedish males and females to investigate the relationship of neighbourhood income and mental health. They also found an inverse relationship between the 2 variables. Another national survey in the United States revealed that increases in income tended to improve mental health.22 Thus, generally, there is an inverse relationship between SES and mental health.

When educational attainment was studied as an element of SES, a positive impact was also evident. A study was conducted in a sample of 4,446 individuals aged 25 to 67 years in Norway,8 and found that individuals with low education levels had the most mental health problems. Andrews et al23 probed into the same matter using the Composite International Diagnostic Interview as a measure of mental health among 10,642 Australians aged above 17 years. As compared with those with a bachelor’s degree or higher, individuals with only a high school education were more prone to mood and anxiety disorders.23

Although most studies found significant associations between an individual’s education level and mental health, a study on 7,171 females and 1,799 males by Lahelma et al24 found no such relationship. Most previous studies also found relationships between SES and mental health. However, this does not prove that SES had a definite bearing on mental health, as others reported contradictory findings. The current research set out to investigate the possible influence of gender, SES, and educational background on the mental health of young adults in Malaysia. The relationship between mental health and other factors has been frequently studied by the scholars in western countries. A few such studies have also been conducted in Asian countries, but were still lacking in the Malaysian context. Social support from others has an important bearing on maintaining mental health and in its improvement if impaired. Therefore, differences in perceived social support between genders merited investigation.

The hypotheses being studied were that: (1) females reported higher level of psychiatric disorder symptoms than males; (2) females perceived higher levels of overall social support than males; (3) females perceived lower levels of family social support than males; (4) females perceived higher levels of social support from friends than males; (5) the higher the parental income, the better the quality of mental health; and (6) there were significant differences in mental health status depending on education levels.



The current research involved 303 respondents (151 females, 152 males) aged 16 to 26 years. There were 99 Malays, 100 Chinese, 102 Indians, and 2 from other races. In all, 76 respondents attained the highest education level, which was the Malaysian Certificate of Education (Sijil Pelajaran Malaysia) or equivalent; 44 had the Malaysian Higher School Certificate (Sijil Tinggi Persekolahan Malaysia), A-Level qualifications, or equivalent; 48 had diplomas; 129 had attended an undergraduate programme; and 6 had a postgraduate education.


Ethics approval was granted by the university prior to recruitment of subjects. Between September and November 2008, potential respondents were randomly approached in different universities in Selangor state, Malaysia. After they were informed about the purpose of the survey, the response rate was 100%.

Respondents were required to fill out a detailed questionnaire, regarding gender, education, and parental income. Choices for monthly parental income were: ≤ RM 2,000, RM 2,001-4,000, RM 4,001-6,000, RM 6,001- 8,000, and ≥ RM 8,001.


The General Health Questionnaire

The 12-item General Health Questionnaire (GHQ-12) was used in the study. It is a measure of current mental health and addresses somatic symptoms, anxiety and insomnia, social dysfunction, and depression. The respondents rated these with regard to their own health on a 4-point Likert scale (1 = ‘better than usual / not at all’; 2 = ‘same as / no more than usual’; 3 = ‘worse / rather more than usual’; 4 = ‘much worse / much more than usual’). The scores of all 12 items were added to obtain the overall score; higher scores reflected more symptomatology or lower health status. The GHQ had high internal consistency with Cronbach’s alpha values of 0.37 to 0.79, and the test-retest coefficients of the instrument were highly significant.25

Multidimensional Scale of Perceived Social Support

This scale consisted of 12 items in which respondents were required to rate each on a 7-point Likert scale from 1 (never) to 7 (always). It contained 3 subscales, namely the family subscale, the friends subscale, and the significant other subscale. The family subscale score was obtained by summing the scores of items 3, 4, 8, and 11, dividing by four. Similar scoring was applied for the friends subscale (including items 1, 2, 5, 6, 7, 9, and 12) and the significant other subscale (including items 1, 2, 5, and 10). For the overall perceived social support score, all item scores were summed and divided by 12. Higher scores meant higher perceived support. The MSPSS has strong reliability that ranged from 0.77 to 0.92, good internal consistency,24 and construct validity.26

Statistical Analyses

In order to analyse gender differences in mental health and social support, independent sample t tests were used. Crosstab analyses were used for gender differences in each subject’s own education level and the range of respective parental incomes, while the Kruskal-Wallis test was used for gender difference in parents’ exact amount of income. The latter test was also used to analyse parents’ range of income and the subjects’ own education levels, while correlation tests were applied for parents’ exact amount of income.


Gender Difference in Mental Health

There was no significant difference between males (mean [standard deviation] GHQ score, 23.3 [5.8]) and females (24.5 [5.6]) in terms of their mental health (t = –1.8; p > 0.05). Summing the two, 29.7 was yielded as the clinical cut-off score. Scores of 29.7 or above were coded as clinically relevant, while lower scores were regarded as normal.

Gender Difference in Perceived Social Support

Overall perceived social support, and perceived family support, support from friends, and significant other support were assessed using independent sample t test, and that the significant and non-significant gender differences are shown in Table 1. Females perceived significantly higher levels of overall social support than males (t = –2.7; p < 0.05).

Gender Difference in Socio-economic Status

Crosstab analyses were for gender and level of parental education, and different parental income ranges yielded no significant differences (Table 2). The same was true after applying the Kruskal-Wallis test to the exact amounts of parental income, with no significant difference being found (χ2 = 1.98; p > 0.05). Hence, there appeared to be no difference between males and females in terms of their parental incomes.

Parents’ Income and Mental Health

The Kruskal-Wallis test was conducted to examine the association between parental income and mental health. In addition, bivariate correlation was conducted between parental income and mental health. Results indicated that there was no significant difference in mental health across parental incomes (χ2 = 5.0; p > 0.05), but a significant relationship with the individual’s mental health (r = –0.1; p < 0.05) was found. The negative correlation indicated that the higher parental income, the fewer the number of identified symptoms.

Differences between Education Levels and Mental Health

Applying the Kruskal-Wallis test to examine differences between education level of individuals and their mental health, the differences were insignificant (χ2 = 0.7; p > 0.05).


The current study aimed to examine gender differences in mental health and perceived social support, relationships between parental income and mental health, and differences in mental health across education levels. Females perceived significantly higher social support, social support from friends, and social support from persons other than males. There were no significant differences between genders in terms of mental health and perceived social support from family, and between individual education levels and mental health.

The analysis of mental health between genders revealed no significance. The original hypothesis proposing higher levels of psychiatric symptoms in females was rejected. This was contrary to some previous research indicating that women had higher prevalence of psychosomatic complaints13 and distress14 than males, but the findings were consistent with that of Aneshensel et al.15 The common factor in the current study and that by Aneshensel et al15 was that their samples included working adults, which differed from the other investigations13,14 that only included students. Conceivably, being a student or working individual could affect gender differences in mental health.

One possible explanation for the insignificant findings in the present study could be related to cultural differences. Asians are generally regarded as gaining more benefits from social support without requiring explicit expression of relevant problems, which is in contrast to individualistic societies such as Europe and North America.10 The sample in the current study represented Malaysian inhabitants, who adopted the collectivistic culture. Thus, the lack of sufficient differences between genders with respect to mental health could have been moderated by their collectivistic nature on perceived social support.

The current study found that females perceived higher levels of overall social support and social support from friends than males, which was in accordance with Cheng and Chan’s study.17 One possible reason was due to gender differences in self-disclosure. Studies by Davidson and Duberman27 and Reisman28 revealed that females across all ages had a higher tendency to disclose matters to friends. Females become involved in more in-depth communication through willingness to express their problems and stress. Another study18 revealed that compared with males, females had larger social networks, more sources to draw support from, and were more satisfied with friends.

In this study, no significant difference for perceived family social support between gender was found, which was contrary to our third hypothesis and prior findings17 that females perceived less social support than males. Cheng and Chan17 explained that the lower perception of family support by females as stemming from the possibility that adolescent females are taught to value closeness with parents. This makes them more frustrated than their counterpart males, at a time that they need / want to express their independence. However, further research is still required to clarify independence issues in perceived support from family.

Our study revealed no significant difference between mental health and different categories of parental income. However, when the parent’s exact income was used instead of ranges, a positive relationship existed and seemed to support the fifth hypothesis. This finding was supported by Lahelma et al24 who found that individuals who experienced economic difficulties consistently had higher rates of common mental disorders compared with those who had less economic difficulties.

The association between parental income and mental health can be further understood using the social causation model that was supported by a study examining the association between SES and depression or distress.29 The social causation model proposed that mental illnesses are an effect of poor socio-economic circumstances. It therefore seems reasonable to view better mental health as an effect of higher parental income, which is a component of SES. Thus, those capable of attaining resources could maintain good mental health. In short, there was a relationship between parental income and mental health.

When considering the mental health of individuals in terms of education status, the current research showed no significant difference across education levels of the participants. Thus, the last hypothesis was not supported, which was comparable to the findings of Lahelma et al.24 At this stage of life, parental education may be more influential than an individual’s own education, as the educational achievements of parents affect their occupation, and consequentially contribute to income.24

As compared with females, males perceived lower levels of social support from people generally and from friends in particular. This may indicate that males really receive less social support or alternatively they crave for more social support. Sufficient social support could be included as precautions and interventions for males affected by mental illness.

The parental income but not the participant’s own education level, which was correlated with mental health, shows that parents have a role in the mental health of late adolescents and young adults. One possible explanation is that this group of individuals is still at the initial stage of gaining their own SES that could provide them with different kinds of living conditions. Therefore, they are still considerably dependent on their parents or relevant adults, and their own educational background has little influence on their mental health. Hence, while their own SES should be the target of interventions for western young adults, parental SES should be a better target for young individuals in Malaysia.

The strengths of this study were its focus on the equality of female and male respondents as well as their ethnicity. The instruments used to measure the variables were established in terms of reliability and validity. The sample size was also sufficient to yield significant results. However, the participants were mostly from the Selangor state of Malaysia, and hence not representative of the whole nation.

Future research should also explore other socio- economic components, including parental education status, parental occupation, and physical living conditions so as to arrive at a more holistic perspective of what might affect mental health. Cultural influences in perceived social support, mental health and SES all have important implications and warrant studies to analyse perceived social support and SES functioning, and how they might be manipulated to improve and / or maintain good mental health.

Our study in young adults showed that generally there were gender differences for perceived social support, but not for mental health status. There was also a relationship between parental income and mental health. Conversely, there was no significant difference in mental health across subjects with differing education levels. These results reflect the importance of social support, especially in females. The latter appear to benefit more due to their associated larger social networks and correspondingly more sources for support. Besides, the various components of SES affect mental health differently and thus could be viewed individually, though they are not mutually exclusive. It should also be appreciated that the present study was exploratory, and that more research is necessary before its findings are taken as conclusive.


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