| Literature DB >> 35682189 |
Mas Ayu Said1,2, Govindamal Thangiah1,3, Hazreen Abdul Majid1,4,5, Rozmi Ismail6, Tan Maw Pin7, Hussein Rizal1,5, Mohd Azlan Shah Zaidi8, Daniel Reidpath3,9, Tin Tin Su3,5.
Abstract
Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.Entities:
Keywords: income; mediation; mental health; older adults; social capital
Mesh:
Year: 2022 PMID: 35682189 PMCID: PMC9180219 DOI: 10.3390/ijerph19116604
Source DB: PubMed Journal: Int J Environ Res Public Health ISSN: 1660-4601 Impact factor: 4.614
Figure 1Framework of the mediation analysis.
Sample characteristics of the semi-urban and rural community (n = 6651).
| Characteristics | Prevalence, | Mean ± SD |
|---|---|---|
| Age ( | 6651 (100.0) | 65.5 ± 7.7 |
| Gender ( | ||
| Female | 3556 (53.5) | |
| Male | 3095 (46.5) | |
| Ethnicity ( | ||
| Malays | 4111 (61.9) | |
| Indians | 522 (7.9) | |
| Chinese | 1957 (29.4) | |
| Others | 56 (0.8) | |
| Marital Status ( | ||
| Single | 167 (2.5) | |
| Married | 5000 (75.2) | |
| Separated/divorced/other | 105 (1.6) | |
| Widow | 1377 (20.7) | |
| Education Level ( | ||
| None | 381 (5.9) | |
| Primary | 3822 (58.9) | |
| Secondary | 1804 (27.8) | |
| Tertiary | 150 (2.3) | |
| Others | 330 (5.1) | |
| Employment Status ( | ||
| Housewife | 2163 (32.7) | |
| Unemployed | 1420 (21.5) | |
| Paid employment | 901 (13.6) | |
| Pensioners | 907 (13.7) | |
| Self employed | 1226 (18.5) | |
| Income groups ( | ||
| B40 (Less than RM3860) | 6061 (99.7) | |
| M40 (RM3860 to RM8319) | 84 (0.3) | |
| Individual social capital variables | ||
| Reciprocity ( | ||
| Agree | 4439 (67.9) | |
| Disagree or “neutral” | 2103 (32.1) | |
| Cooperation ( | ||
| Agree | 4780 (73.0) | |
| Disagree or “neutral” | 1769 (27.0) | |
| Trust in community ( | ||
| Disagree or “neutral” | 4290 (65.7) | |
| Agree | 2237 (34.3) | |
| Attached to community ( | ||
| Disagree or “neutral” | 4176 (63.9) | |
| Agree | 2358 (36.1) | |
| Mental health (DASS-21) | 12.39 (17.80) | |
| Depression ( | ||
| Normal | 5511 (83.5) | |
| Mild and above | 1090 (16.5) | |
| Anxiety ( | ||
| Normal | 5128 (77.6) | |
| Mild and above | 1478 (22.4) | |
| Stress ( | ||
| Normal | 6135 (93.1) | |
| Mild and above | 456 (6.9) |
Note: SD—standard deviation.
Mediating effects of social capital on the association between income groups and anxiety, depression, and stress.
| Outcome | Mediator | |||
|---|---|---|---|---|
| Reciprocity | Cooperation among | Trust in | Attached to Local | |
| Anxiety | ||||
| Total effect M40 | 0.74 *** (0.25) | 0.79 *** (0.27) | 0.78 *** (0.27) | 0.78 *** (0.27) |
| Direct effect M40 | 0.57 ** (0.25) | 0.63 ** (0.27) | 0.54 * (0.27) | 0.57 ** (0.27) |
| Indirect effect | 0.17 ** (0.08) | 0.15 (0.10) | 0.24 ** (0.10) | 0.21 ** (0.10) |
| Mediation (%) | 22.8 | 19.5 | 30.8 | 26.5 |
| Partial mediation | yes | no | yes | yes |
| Full mediation | no | no | no | no |
| Depression | ||||
| Total effect M40 | 1.01 *** (0.26) | 1.09 *** (0.28) | 1.07 *** (0.28) | 1.08 *** (0.29) |
| Direct effect M40 | 0.82 *** (0.26) | 0.92 *** (0.28) | 0.80 *** (0.28) | 0.82 *** (0.29) |
| Indirect effect | 0.19 ** (0.08) | 0.17 (0.11) | 0.26 ** (0.11) | 0.24 ** (0.11) |
| Mediation (%) | 18.5 | 15.3 | 24.8 | 22.6 |
| Partial mediation | yes | no | yes | yes |
| Full mediation | no | no | no | no |
| Stress | ||||
| Total effect M40 | 1.28 *** (0.28) | 1.34 *** (0.29) | 1.34 *** (0.31) | 1.31 *** (0.30) |
| Direct effect M40 | 1.12 *** (0.28) | 1.17 *** (0.29) | 1.08 *** (0.31) | 1.05 *** (0.30) |
| Indirect effect | 0.15 ** (0.07) | 0.17 ** (0.10) | 0.26 ** (0.12) | 0.26 ** (0.11) |
| Mediation (%) | 12.0 | 12.9 | 19.5 | 19.7 |
| Partial mediation | yes | yes | yes | yes |
| Full mediation | no | no | no | no |
Note: ***, **, * Significant at 1%, 5% and 10% significance level; B- coefficient, SE- standard error; Model is adjusted for ethnicity, marital status, age, gender, education and employment status.
Bivariate association between stress, depression, anxiety, and other predictor variables.
| Characteristics | Stress | Chi-Square | Anxiety | Chi-Square | Depression | Chi-Square | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| Normal | Mild, Moderate, Severe, and Extremely Severe | Normal | Mild, Moderate, Severe, and Extremely Severe | Normal | Mild, Moderate, Severe, and Extremely Severe | |||||
| Ethnicity | Malay | 3849 | 230 | 32.6 *** | 3103 | 987 | 22.3 *** | 3441 | 649 | 8.36 ** |
| Indian | 461 | 58 | 404 | 116 | 415 | 106 | ||||
| Chinese | 1768 | 164 | 1570 | 365 | 1602 | 328 | ||||
| Others | 53 | 3 | 47 | 9 | 49 | 6 | ||||
| Gender | Female | 3292 | 235 | 0.77 | 2737 | 794 | 0.06 | 2941 | 590 | 0.21 |
| Male | 2843 | 221 | 2391 | 684 | 2570 | 500 | ||||
| Marital status | Single | 146 | 19 | 24.3 *** | 126 | 39 | 10.1 ** | 130 | 34 | 9.53 ** |
| Married | 4585 | 371 | 3816 | 1154 | 4118 | 849 | ||||
| Separated/ | 95 | 9 | 81 | 23 | 90 | 15 | ||||
| Widow | 1307 | 57 | 1103 | 262 | 1171 | 192 | ||||
| Education Status | None | 351 | 22 | 164.2 *** | 314 | 61 | 34.5 *** | 322 | 49 | 48.9 *** |
| Primary | 3624 | 171 | 2949 | 857 | 3207 | 601 | ||||
| Secondary | 1548 | 236 | 1344 | 444 | 1430 | 356 | ||||
| Tertiary | 139 | 11 | 123 | 27 | 125 | 23 | ||||
| Other | 325 | 3 | 287 | 41 | 310 | 18 | ||||
| Employment Status | Housewife | 2052 | 95 | 327.0 *** | 1734 | 411 | 211.0 *** | 1860 | 293 | 273.7 *** |
| Unemployed | 1286 | 114 | 995 | 404 | 1102 | 298 | ||||
| Paid employment | 719 | 177 | 573 | 325 | 610 | 287 | ||||
| Pensioners | 841 | 52 | 752 | 148 | 803 | 95 | ||||
| Self employed | 1213 | 11 | 1048 | 175 | 1119 | 104 | ||||
| Income | B40 | 5590 | 412 | 94.3 *** | 4617 | 1400 | 19.9 *** | 5001 | 1011 | 39.5 *** |
| M40 | 55 | 29 | 47 | 37 | 48 | 36 | ||||
| Reciprocity | Agree | 4245 | 179 | 182.9 *** | 3788 | 647 | 493.4 *** | 4011 | 421 | 494.9 *** |
| Disagree or “neutral” | 1808 | 275 | 1269 | 818 | 1431 | 656 | ||||
| Cooperation among community members | Agree | 4616 | 147 | 408.3 *** | 4138 | 634 | 855.3*** | 4383 | 388 | 903.8 *** |
| Disagree or “neutral” | 1443 | 305 | 924 | 831 | 1064 | 689 | ||||
| Trust in community | Disagree or “neutral” | 4182 | 94 | 435.0 *** | 3792 | 491 | 867.8 *** | 3999 | 285 | 883.0 *** |
| Agree | 1860 | 356 | 1254 | 969 | 1432 | 788 | ||||
| Attached to local community | Disagree or “neutral” | 4095 | 70 | 466.3 *** | 3709 | 461 | 835.7 *** | 3925 | 247 | 914.5 *** |
| Agree | 1970 | 365 | 1357 | 986 | 1526 | 813 | ||||
Note: ***, ** Significant at 1% and 5% significance level.