title: Association of social support and socio-demographic characteristics with poor self-rated health and depressive symptomatology among single mothers in Cyprus: a descriptive cross-sectional study.
abstract: BACKGROUND
  The number of single-parent families headed by mothers is rapidly growing worldwide. A large part of the international literature reveals that single motherhood is associated with increased levels of chronic stress, mainly due to economic distress and reduced levels of social support, which may eventually lead to physical and psychological illness. Most published research comes from Northern Europe and the US, while it is accepted that both social welfare systems and societal factors vary substantially across countries. These issues haven't been explored in Southern Europe and this study aims to fill this gap by a) assessing the health of single mothers in Cyprus in terms of self-assessed general health and the prevalence of clinical depressive symptoms and b) investigating the effect of perceived social support relation to their health status.
  
  
  METHODS
  General health was assessed in terms of Self-Rated Health (SRH), while the prevalence of clinical depressive symptoms was assessed with the Center of Epidemiological Studies-Depression Scale (CES-D). Perceived social Support was assessed with the Social Provision Scale. All scales were completed anonymously and voluntary by 316 single mothers. Univariable and multivariable associations between SRH and depressive symptoms with socio-demographic characteristics were investigated using chi-square tests and in multivariable backward stepwise logistic regression models respectively. Odd ratio of clinically significant depressive symptoms and SRH across decreasing levels of social support were estimated in logistic regression models.
  
  
  RESULTS
  The prevalence of depressive symptoms (CES-D score ≥ 22) was 38.9 %, which is almost three times greater than the general population. Strong associations with all health assessment tools were observed with variables relating to the lowest monthly family income and the presence of economic difficulties, unemployment, the single motherhood status and pre-existing illness. Social support as perceived by the mothers displayed a strong negative independent association with all tools, even after adjusting confounders.
  
  
  CONCLUSIONS
  These findings can be a challenge for health care professionals, especially those working in the field of community-family nursing and highlight the necessity of interventions and strategies at community level in order to support this vulnerable population group.
authors.affiliation: Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus.
authors.forename: Elena
authors.identifier: 0000-0001-6952-0483
authors.initials: E
authors.lastname: Rousou
authors.affiliation: Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus.
authors.forename: Christiana
authors.initials: C
authors.lastname: Kouta
authors.affiliation: Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, 15, Vragadinou str, 3041 Limassol, Cyprus.
authors.forename: Nicos
authors.initials: N
authors.lastname: Middleton
keywords: Community nursing; Depressive symptoms; Health; Single mothers; Single parent family; Social support