Correlation between Social Support and Depression: A Study with

Adolescents in a Rural City in Indonesia

Luciana Kabang, Herni Susanti and Kurniawan

Mental Health Department, Faculty of Nursing, University of Indonesia,

Jalan Prof. Dr. Bahder Djohan UI Depok Campus, Depok, 16424, Indonesia

Keywords: Social Support, Depression, High School Adolescent.

Abstract: Depression that goes undetected for a long period of time may cause serious problems for adolescents, such

as suicide. Stress that leads to depression is commonly associated with interpersonal relation with their

closest people. Moreover, social support provided from their closest people is a protective factor which may

mitigate depression in adolescents. This study aimed to identify relationship between social support and

depression level among high school students in a rural area North Putussibau District, West Kalimantan,

Indonesia, 724 respondens were selected by total sampling method. CASSS and PHQ-9 were employed as

the instruments. Data were analyzed by Spearman Correlation. The findings suggest that there was a

significant correlation between social support and level of depression among adolescents with negative

direction of relationship. The higher social support which adolescents received, the lower their depression

level would be. Authors recommend to improve social support and conduct courses of stress management in

order to minimise stress in adolescence.

1 INTRODUCTION

Depression is a mood disorder characterized by

feeling sadness, loss of interest, guilty and feeling

worthless, sleeping problem, loss of appetite,

fatigue, and concentration problem (World Health

Organization, 2017). Depression may affect all

people of all ages, sexes, and social and economy

statuses, incuding adolescents.

In Indonesia, Basic Health Research/ Riskesdas

(2013) revealed that 6% of population of individuals

aged over than 15 years (approximately 14.000.000

people) in Indonesia were affected by mental health

problems, which are referred to alteration of

psychological condition including experiencing

depression symptoms. It affected around 5.6% of

adolescent population aged 15-24 years (Badan

Penelitian dan Pengembangan Kesehatan

Kementerian Kesehatan Republik Indonesia/ 2013).

Stress, as precipitating factor of depression

among adolescents, is associated with interpersonal

problems with people around them. Adolescents

perceived conflict with parents, peers, and fellows as

their common source of daily stressor (46-82%)

(Santrock, 2014). Another study discovered that

adolescents’ relationship with parent and school

fellows as the most common source of stressor

shared among them, rather than their relationship

with peer and fellow (Persike & Seiffge-Krenke,

2012). The studies implied that adolescents’ rapport

with social support may affect their stress level.

Furthermore, social support is also thought to be

the most important aspect in dealing with depression

among adolescents. Intimacy with family, colleague,

and teacher at school may mitigate stress in

adolescent. Adolescent who is able to recognize that

other people care for him would be able to manage

his stress (Santrock, 2014). Murberg & Bru (2009)

stated that teenager capable of employing social

support properly would be able to maintain

confidence and facilitate himself to use an adaptive

coping strategy. Support provided by the close ones

will help adolescent in dealing with stress. Review

of 51 studies on relationship between social support

and depression level revealed that there was a

significant correlation between the two variables in

both positive and negative direction. Positive

direction of relationship implied that higher social

support would result in higher depression level

(Santini, Koyanagi, Tyrovolas, Mason, & Haro,

2015). Contrarily, the negative direction implied that

lower social support received would result in higher

Kabang, L., Susanti, H. and Kurniawan, .

Correlation between Social Support and Depression: A Study with Adolescents in a Rural City in Indonesia.

DOI: 10.5220/0008206801630170

In Proceedings of the 1st International Conference of Indonesian National Nurses Association (ICINNA 2018), pages 163-170

ISBN: 978-989-758-406-0

163

depression level.

In Indonesia, a considerable number of studies

about the relationship between social support and

depression had been conducted although they

involved older adults as participants, including

studies conducted by Astuti (2013) that involved 72

older adults and by Saputri & Indrawati (2011) that

involved 36 older adults. Both studies confirmed

negative correlation between the two variables. On

the contrary, Parasari & Lestari's study (2015) on

233 elderly revealed a positive correlation between

them. Rahmawati, Arneliwati, & Elita (2015) on 26

adolescents in correctional facility also identified

correlation between them. Conversely, a study by

Ping (2016) which involved 60 women in

correctional facility revealed no significant

correlation between social support and depression.

North Putussibau is a district with the highest

population of high school adolescents in Kapuas

Hulu, West Kalimantan that mounted up 1.308

people (Statistics Kapuas Hulu, 2016; Education and

Culture Board of Kapuas Hulu District, 2017).

Evaluation of social support and depression level

among adolescents had never been conducted in this

district. A pilot study conducted by authors through

questionnaire revealed adolescents’ interpersonal

problem with their close person. There were records

of suicide attempt among them, such as ingesting

pesticide or other poisonous objects, self-harming,

or hanged; albeit it rarely happpened. The last

known case was 15-year old teenager hanged

himself (Uncak.com, 2017).

2 MATERIAL AND METHODS

The study design was cross-sectional. This study

aimed to identify relationship between social support

and depression level among high school students in

North Putussibau District.

Study sample was high school adolescents in

North Putussibau district. The inclusion criteria were

high school students of 2016/2017 academic year

who consented to be involved in this study. The

respondents were achieved through total sampling

method. There were 3 questionnaires employed in

this study, including questionnaire of participant

demography (age, class, sex, and number of

siblings), Children and Adolescent Social Support

Scale for measuring social support/ CASSS

(Malecki, Demaray & Elliot, 2000), and Patient

Health Questionnaire-9 for evaluating depression

level/ PHQ-9 (Kroenke, Spitzer & William, 2001).

Data were then undergone an editing process for

checking completeness of answers, coding for

keeping confidentiality purposes, processing for data

input into software, and cleaning for re-confirming.

The study involved univariate and bivariate

analyses. Univariate analysis was applied to identify

distribution of both dependent and independent

variables. Bivariate analysis of Spearman test was

performed to determine correlation between

dependent and independent variables. This study

was conducted by complying with principles of

research ethics, which include respect for human

dignity, respect for participant’s privacy and

confidentiality, justice, and assessing benefit and

harm of the study.

This study has been granted with ethical

clearance by ethical committee of Faculty of

Nursing Universitas Indonesia.

3 RESULT

The study was conducted from May to June 2017 in

North Putussibau by involving 724 participants.

Result of univariate analysis of participant

characteristics, social support, and depression level

is presented below. The average age of participants

was 16 years old, which was categorized as middle

adolescence. The range age of participants was

between 14 and 20 years old, indicated that

participants were in phase of early, middle, or late

adolescence.

Table 1: Description of Class, Sex, and Number of

Siblings of High School Teenagers in North Putussibau

(n=724).

Variable Frequency Percentage

Class

Sex

Number of

siblings

Male

Female

0-3

4-7

8-11

390

334

292

432

605

115

53.9

46.1

40.3

59.7

83.6

0.6

Table 1 revealed that majority of participants in

tenth grade (53.9%). Most of them were females and

the only child of family or having 1 to 3 siblings.

CASSS does not have specific category and its

measurement is based on total answers completed by

participants. If a participant mostly answered

“occasionally” or over, then his social support would

be classified as adequate. The table demonstrated

that social support received by high school

adolescents in total or per sub-variable was

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

164

adequate.

Table 2: Description of Social Support Received by High

School Teenagers in North Putussibau (n=724).

Variable Median

Standar

Deviation

Min-

Max

Total of Social Support

Parent’s Support

Teacher’s Support

Classmate’s Support

Close Friend’s Support

School Suppor

211.00

46.50

41.00

46.00

36.00

37.780

10.061

9.673

9.779

11.362

10.254

99-360

17-72

12-72

Median score of depression among adolescents

in North Putussibau was 8 that indicated mild level

of depression. Total score of PHQ-9 was categorized

into five levels as follows: normal/minimal (0-4),

mild (4-9), moderate (10-14), moderately severe

(15-19), and severe (20-27). The level of depression

is elaborated specifically in table 3.

Table 3: Description of Severity Level of Depression of

High School Adolescents in North Putussibau (n=724).

Level of depression Frequency Percentage (%)

Normal or Minimal

Mild

Moderate

Moderate Severe

Severe

161

280

177

22.2

38.7

24.4

11.2

3.5

Table 3 described that majority of adolescents in

North Putussibau were affected by mild level of

depression. About 11.2% of participants were

affected by moderately severe depression and 3.5%

of them were affected by severe depression, which

combined into 14.7% of total participants.

Following univariate analysis, bivariate analysis

was applied to investigate the relationship between

social support and level of depression by Spearman

test. Spearman test was used since the data of both

variables were not normally distributed

(Kolmogorov-Smirnov < 0,05).

Table 4: Normality Test of Dependent and Independent

Variables (n=724).

Variable Kolmogorov-Smirnov

Total of Social Support

Parent’s Support

Teacher’s Support

Classmate’s Support

Close Friend’s Support

School Support

Depression

0.000

Correlation significance was represented by p

value lower than 0.05. The table revealed that there

was significant correlation between overall social

support and depression level (p < 0.05). Specifically,

three sub-variables of social support were

significantly correlated with depression level; the

sub-variables included support provided by parent,

teacher, and classmate.

Table 5: Result of Bivariate Analysis of Social Support

and Depression Level in High School Adolescents in

North Putussibau (n=724).

Spearman Test p-value Strength Direction

Social Support-Depression

Level

Sub-variable support:

Parent’s Support-Depression

Level

Teacher’s Support-

Depression Level

Classmate’s Support-

Depression Level

Close Friend’s Support-

Depression Level

School Support-Depression

Level

0.021

0.000

0.002

0.050

0.225

0.122

0.085

0.138

0.114

0.073

0.045

0.058

Negative

Positive

Negative

The three sub-variables had negative direction of

correlation which implied that the higher support

provided by parent, teacher, and classmate, the

lower depression level in adolescents would be.

There was also a finding of positive correlation

between close friend’s support and depression level

in adolescents which implied that the higher support

provided by close friend, the higher their level of

depression would be, although it was not

significantly correlated (p > 0.05).

4 DISCUSSION

4.1 Participant Characteristics

The study result indicated that most of participants

were attending tenth grade (390 participants, 53.9

%). It implied that adolescents attending first year of

high school were at higher risk of depression.

Transition from Middle School and High School

is thought to be stressful experience due to changes

occurred in individual, family, and school. The

changes included changes in ideas, higher education

environment, new teachers, and peer. First year of

High School is a difficult situation for mostly

students. It might be resulted from student’s

dissatisfaction with school environment, lack of

commitment, and dislike of new teachers which

usually manifested as decline in academic

performance (Santrock, 2014).

Correlation between Social Support and Depression: A Study with Adolescents in a Rural City in Indonesia

165

The average of participants’ age was 16 years old

or middle adolescence. It demonstrated that younger

adolescent population was at higher risk of

depression. Stage transition from childhood to

adolescence affected adolescents’ ability to adapt or

unstable which rendered them vulnerable to

depression Tujuwale, Rottie, Wowling, & Kairupan

(2016).

Majority of participants were females (432

participants, 59.7%). Furthermore, this result

confirmed that female teenagers were at higher risk

of depression. Study review by Darmayanti (2008)

of 14 studies which involved 5206 participants also

confirmed this result. The study concluded that

female teenagers were more vulnerable to

depression. A study conducted by Ardiawan (2015)

on 25 male teenagers and 25 female teenagers

revealed that female adolescents had a higher level

of depression.

Depression was mostly affecting female due to

biological, environmental, hormonal, and psycho-

social factor which resulted in earlier onset of

depression in females than males. Hormon directly

influences chemical substance that regulates emotion

or mood. Onset of depression in females was

resulted from a higher sensitivity toward their own

feelings. Female was more likely to deal with

problem by using her feeling than logic (Utami &

Pratiwi, 2011).

4.2 Social Support

The study result revealed that 724 high school

adolescents in North Putussibau received adequate

support from closest people. This result coincided

with study by Camara, Bacigalupe, & Padilla (2017)

on 43 male teenagers and 37 female teenagers in

Spain which described that although the closest

people might become the stressor itself, adolescents

realized that social support provided by closest

people would improve their coping method in

dealing with said situation.

Stress in adolescents is generally caused by their

surrounding people, but at the same time they also

need their support to cope with the problem. When a

teenager does not receive the support he needs, he

tends to look for support from familiar people such

as parent and relative than health professionals such

as therapist. From perspective of adolescent, trust is

the most important factor in seeking for support in

solving problem and it could be acquired from

closest people than therapist. Adolescents perceived

that they did not need to tell their problems to

therapist (Camara et al., 2017).

In resolving problem, adolescents would

experience phase of support-seeking behavior and

acquiring help. There is a fundamental difference

between female and male teenagers in seeking for

support. Female teenager was more likely to try to

acquire emotional support, such as by venting

problem to her reliable friend, while male teenager

was more likely to divert his attention from problem

into activities and exercise (Camara et al., 2017).

Essentially, teenager requires social support from

his close ones. Social support received might come

as compassion, attention, appreciation, help, and

tenderness from closest people that made

adolescents feel loved, recognized, and respected

(Kumalasari & Ahyani, 2012). When adolescent is

accepted and respected positively, he inclines to

develop positive attitude and better coping in

solving a problem.

4.3 Depression

Adolescent’s depression should be treated properly

since the symptoms would likely to continue until

his adulthood. Depressive symptoms in adolescent is

usually manifested in many ways, including

tendency to wear dark-colored cloth, write poetries

and listen to depressive- themed song, sleep problem

such as unable to sleep at night or watch television

until late, difficult to rise or attend classes, and lack

of motivation which usually demonstrated as

absence in class. Depression in adolescent may also

emerge along with other problems, including

behavioral problems, substance abuse, or eating

disorder (Santrock, 2014). If the condition continues

to occur, their daily functions may be altered.

The analysis result indicated that most of

participants were affected by mild level of

depression (280 participants, 38.7 %). This result

was supported by Karnovinanda & Suciati (2014)

which involved 122 teenagers which revealed that

majority of participants were affected by depression

(75.4 %).

The analysis also showed that a number of

participants were suffering from moderately severe

level of depression (11.2 %) and severe depression

(3.5 %), or 14.7% in aggregate. This aggregate

required special consideration since these two

categories of depression necessitate medical

attention, such as antidepressant and psychothreapy.

Common cause of undetected and undiagnosed

depression in adolescents is the tendency of their

closest people, such as parent, teacher, or friend to

see their changing behavior as normal behavior.

They admitted that they occasionally feel difficult to

express their problems to the close ones for the

reactions that may surface. Parents usually reacted

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

166

exaggeratingly toward the problem that their

teenager should deal with, while friend tended to

underestimate their problem (Santrock, 2014;

Camara, Bacigalupe & Padila, 2017). This may

complicate their stress which eventually leads to

depression.

4.4 Relationship between Parent’s

Support and Depression Level

The study result implied a significant correlation

between parent’s support and depression level (p <

0.05). This result coincided with the study

conducted by Purnomo & Supratman (2011) which

identified that depression in adolescents was largely

affected by parent’s role. Parenting has an impact on

adolescent’s level of depression. Study by Sharma,

Sharma, & Yadava (2011) on 100 parents and 100

teenagers revealed that there was positive correlation

between authoritarian parenting and depression. It

illustrated that the more authoritarian parenting the

higher the risk of depression in adolescence would

be. Conversely, there was negative correlation

between permissive parenting and depression which

indicated that the more permissive parenting would

result in lower risk of depression. The study also

revealed that adolescents with history of

authoritarian and permissive parenting had a higher

risk of depression than authoritative parenting.

Hurlock (1991) in Purnomo & Supratman (2011)

stated that parenting incorporated various aspects

which should be enacted properly to avoid strain for

children or generate problem between child and

parent. Unmet desire and need, communication

trouble, and education pressure may lead to

depression among adolescents.

Based on statements above, authors concluded

that parenting had a pivotal role. Excessive restrain

or liberation that parents put on their children may

result in higher depression level. Applying

authoritative parenting or establishing definite rule

but still offering negotiation was proven to be

effective in reducing stress among adolescents.

Parent may serve as either protective factor of

depression or cause of the depression itself. Several

types of parents who may cause depression among

teenagers included depressive parent, emotionally

distant parent, and parent with marriage or financial

problem (Santrock, 2014).

4.5 Relationship between Teacher’s

Support and Depression Level

The statistical analysis demonstrated that there was

significant correlation between teacher’s support and

depression level. It suggested that support provided

by teacher may reduce depression level in

adolescent. In this matter, teacher’s support became

protective factor of depression. It was associated

with longer time of interaction with teachers at

school.

Santrock (2014) described that teacher’s

positive attitude might impact positively on

adolescents. Teacher’s positive attitude is reflected

by his enthusiasm, proper planning, providing

equality of care, adaptive, compassion, flexible, and

awareness of uniqueness in every teenager.

Teacher may help teenager in dealing with

depression at school through numerous methods,

including providing feedback for his academic

performances, social skill and behavior, as well

educating teenager in arranging plan and priority,

developing capability in responding with changes in

mood, ability to concentrate or on effect of

medication, providing chance for social interaction,

observing for suicidal ideas in adolescent, and

communicating with parents (Crundwell & Killu,

2010).

Furthermore, it was explained that adolescent

with depression was more likely to experience

difficulty in daily functions; hence, it was necessary

for teachers to use proactive strategies including

monitoring development and providing positive

feedback or positive reinforcement when a teenager

performed his task properly. In case of adolescent

who undergoes medication regimen, teacher is

expected to recognize the medication effect, such as

dry mouth, to allow the adolescent to drink as well

facilitates him to go out of the class and take rest

whenever he needs. Concentration deficit could be

improved by allowing adolescent to record the

learning process at class. Role of teacher does not

only involve teaching but also ensuring security and

safety of adolescent with depression at school

(Crundwell & Killu, 2010).

4.6 Relationship between Classmate’s

Support and Depression Level

The study results suggested that there was

significant correlation between classmate’s support

and depression level, while there was no significant

correlation between close friend’s support and

depression level in adolescents. Classmate and close

friend are adolescent’s peers. Santrock (2014)

described that peer had a huge influence for them.

Peer also served as both protective factor and cause

of depression.

Correlation between Social Support and Depression: A Study with Adolescents in a Rural City in Indonesia

167

The intriguing aspect of this study was positive

correlation between close friend’s support and

depression level which indicated the higher support

provided by close friend, the higher their depression

level would be. It might be resulted from times spent

together with peer that perceived as meaningful

experience for adolescents. Peer also play pivotal

role in developing social skill for adolescents, but on

the other hand, may became the source of stress,

such as in case of bullying.

Bullying is reported to be able to generate

anxiety and depression which increases the risk of

self injury or suicide. A study conducted by Bowes,

Joinson, Wolke, & Lewis (2015) which involved

6719 teenagers with history of bullying when they

were 13 years old revealed that 3898 of them

affected by depression five years later. Bullying is

aggressive behavior by individual or particular

group who possesses power greater than the victim.

Examples of bullying include calling someone with

improper name, spreading rumor, hitting, kicking,

and so on. It should not be left unresolved since it

may affect mental development and health in

adolescent.

Moreover, Klomek et al. (2013) identified that

bullying increased depression risk in male teenager

and depression was the risk factor of bullying in

female teenager. Bullying was reported to be able to

aggravate anxiety and depression that also increase

the risk of self injury and suicide. It also confirmed

that presence of peer is very crucial for adolescent.

Apart from bullying, there are several conditions

that may increase the risk of depression in

adolescent, such as poor relationship with peer,

having no close friend, lack of communication,

rejection from peer, and romantic relationship

problem. Contrarily, frequency of support provided

by close friends may help adolescents in dealing

with a problem. Expressing problem to close friend

may facilitate adolescents in resolving his problem

(Colderbank, 2009 & Santrock, 2011). Therefore, it

can be concluded that sympathy of peer, close

friend, or companion which is demonstrated by

openness and allocating time to listen to adolescent’s

problem may help in preventing depression among

adolescents.

4.7 Relationship between School’s

Support and Depression Level

The analysis result suggested that there was no

significant correlation between school support and

depression level. This result contradicted with

several studies which reported the impact of school

environment on depression among adolescents. A

study by Briere, Pascal, Dupere, & Janosz (2013) on

5262 teenagers revealed that school with proper

social environment might reduce the risk of

depression symptoms. Proper and poor school

environment may increase or decrease the risk of

depression in adolescent.

Study review by Kidger, Araya, Donovan, &

Gunnell (2012) which involved 23 studies on

correlation between school environment and

emotional health in adolescent reported that school

environment might have or have no impact on

adolescent’s mental health. Based on the study

review, it can be concluded that conditions affecting

adolescent’s mental health included width of school

building, ratio of student- teacher, quality of

interaction, and safe and fair school environment. A

number of studies suggested that there was

significant correlation between school environment

and adolescent’s mental health. It was possible since

depression affected their perspective of school

environment.

5 CONCLUSION

Authors concluded that there was a significant and

negative correlation between social support and

depression level among adolescents in North

Putussibau. The negative correlation implied that the

higher social support received by adolescent, the

lower his depression level would be.

Adolescent is expected to fully utilize health

services such as counseling provided by Public

Health Office through Centre of Adolescent Care

(Pelayanan Kesehatan Peduli Remaja/PKPR) in

Health Center or counseling teacher. Discussion

with parents about the importance of authoritative

parenting, providing courses of management of

adolescent with depression at school, and courses of

stress management in new academic year and prior

to National Examination are among the methods

recommended for treating depression by providing

support from closest people.

ACKNOWLEDGEMENTS

Authors would like to thank Board for Development

and Empowerment Human Resouces of Health

(BPPSDMK) of Ministry of Health of Indonesia as

benefactor of the study, and Education and Cultural

Office of Kapuas Hulu for their support throughout

ICINNA 2018 - The 1st International Conference of Indonesian National Nurses Association

168

data collection.

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