Depression, Loneliness and Cognitive Distortion among Young Unwed Pregnant Women in Malaysia: Counseling Implications

Inability to meet the demands and challenges resulting from the rapid social and economic growth bring about social and psychological problems among youths and their families. One of the problems that young women are facing now is unwed pregnancies. Unwed pregnancies bring about negative social and psychological effects. The objective of this quantitative study is to ascertain the relationships among depression, loneliness and cognitive distortion. Respondents for this study were 150 young unwed pregnant women whose age ranged between 14 and 29 years old who were placed in shelters for unwed pregnant women run by the Social Welfare Department and various non governmental agencies throughout Malaysia. Four research instruments were used namely: Information on the respondents’ background, UCLA Loneliness Scale, Reynolds Adolescents Depression Scale (RADS) and Cognitive Distortion Scale (CDS). Results of the study showed that there were positive significant correlations between depression and loneliness, depression and cognitive distortion and loneliness and cognitive distortion. This paper also discussed the implications of the research findings on counselling and psychotherapy for the unwed pregnant women. Counselling and psychotherapy should focus on giving strength and hope for the young women to rebuild their life.


Introduction
The rapid social, physical and economic changers can be very demanding and challenging on young people and their families. Failure to meet the demands and challenges may result in all kinds of social and psychological problems. In the United States of America unwed pregnancies was identified as one of the most serious and complex social problems (Coles, 2006). Unwed pregnancies bring about negative psychological effects on both mothers and their babies (Baber, 1994).
Pregnancies interfere with the adolescents' education (de Anda & Becerra, 1984;Hoffman et al., 1993) and affect them financially. They become economically dependent on their parents and the public (Medora & von der Hellen, 1997). Pregnancies caused them to abandon their dreams, vision and inspiration (Ugoji, 2013).
control on the thoughts.
A large number of researches have proven that individuals who suffer from depression reported poor self-efficacy, low self-esteem, feelings of worthlessness, an external locus of control, and experience of guilt or shame over their limitations (Wardle et al., 2004;Beck, 2003). Elek and Grossman (2000) on the other hand pointed out that loneliness is related to depression. Heinrich and Gullone (2006) indicated that loneliness is associated with symptoms of poor mental health such as depression. Loneliness has been shown to be strongly associated with depression, anxiety and interpersonal hostility (Hansson et al., 1986).
Depression, low self esteem, loneliness and need for social support are quite common among unwed pregnant women (Barnet et al., 1996;Hudson et al., 2000). Both loneliness (Beck, 1963) and depression result in negative consequences including suicide. Prolonged loneliness sets off depression (Huseyin, 2009) and depression and loneliness can become a vicious circle (Huseyin, 2009). Loneliness had long been recognized as a strong correlate of depressive symptoms (Kawi, 2011;Siti Nor Yaakob et al., 2009) and loneliness is a risk factor for depression (Nolen-Hoeksema, & Ahrens, 2002). The relationship between loneliness and depression appears to be stable (Nolen-Hoeksema, & Ahrens, 2002).
Depression and cognitive distortion was found to be related in juvenile delinquents  and cognitive distortion predicts depression (Nasir et al., 2011) among adolescents. Depression is a widespread disorder specifically among adolescents and this is alarming for mental health professionals (American Psychiatric Association, 2000). Depressed adolescents tend to have negative thinking (Beck, 1963;Beck, 1964) and may be created by cognitive distortions, stressful life events, and physiological states and significantly greater cognitive distortion than non-depressed adolescents (Marton, 1993).
Studies had also found relationship between loneliness and cognitive distortion. The studies had focused on cognitive aspects to explain loneliness. Positive relationship between irrational believes which reflects cognitive distortion was found with loneliness (Karameh & Al-Ammar, 2013). Research conducted by Hamamci & Duy (2007) found that cognitive distortions especially regarding interpersonal rejection have negative effects on the experience of loneliness. What it means is that the perception that one is being rejected will make one feel more isolated and hence results in feeling lonelier. Further, unrealistic beliefs which can be categorised as a form of cognitive distortion were also found to be a strong predictor of loneliness (Halamandaris & Power, 1997).
Generally, studies outside Malaysia and on other populations had shown relationships between depression and loneliness and cognitive distortion and depression. Therefore, it is the aim of this study to ascertain whether relationships exist between depression, loneliness and cognitive distortion among unwed pregnant young women in Malaysia. The hypotheses are: a) there is a relationship between depression and loneliness, b) there is a relationship between depression and cognitive distortions and c) there is a relationship between loneliness and cognitive distortions.

Background of the Respondents
Respondents for this study were 150 young unwed pregnant women whose age ranged between 14 and 29 years old. Most of the respondents or 138 were from the Malay ethnic background and the rest were Chinese and Indians. In terms of their place of origins, 98 of them were from the urban areas while the rest were from the rural areas. They were placed in shelters for unwed pregnant women run by the Social Welfare Department and various non governmental agencies throughout Malaysia. The respondents or their guardians had to sign a consent form before they could participate in the study.

Research Procedure
Written permissions from the Social Welfare Department and various non governmental agencies had to be obtained before embarking on this research. Once the permissions were obtained, the respondents who were going to participate in the study were identified. Questionnaires were distributed to the respondents once they or their guardians signed the written consents forms. The whole process of collecting the research data took six www.ccsenet.org/ass Asian Social Science Vol. 12, No. 8; months to complete. Once collected the data was processed using SPSS Version 22.0. The results of the study as reflected in Table 1, shows significant positive correlations between depression and loneliness (r = .367, p<.05), loneliness and cognitive distortion (r = .404, p<.05) and depression and cognitive distortion (r = .516, p < .05). The results therefore indicate that the more depressed the unwed women are the more lonely they get and the higher their cognitive distortion. The three variables are all related. This finding is consistent with other studies which found that cognitive distortion was associated with depression such as (Marton, & Kuthcher, 1993) on the prevalence of cognitive distortion in depressed adolescent; Nasir et al.'s (2011) study on juvenile delinquents and other studies by Maxwell, Gatchel, and Mayer (1997). Nasir et al.'s (2010) & Wong (Wong, 2008) showed relationship between depression and cognitive distortion. Relationship between loneliness and depression was seen in the findings of studies by Cacioppo et al.'s (2006); Siti Nor Yaakob et al.'s (2009).

Results
Results of this study is supported by studies in the past on unwed pregnant women Barnet et al.,(1996); Nasir et al.'s (2011), which showed that unwed pregnant women have a tendency to experience symptoms of depression. Their findings support that of Hudson et al. (2000).

Discussion
Results from this study found that the unwed pregnant women tend to experience loneliness during their stay in the shelters. Their feeling of loneliness led to depression. It is also expected that the unwed pregnant adolescents experienced loneliness because they were being placed in the shelter home away from their homes and families. It is quite expected for them to feel alienated from the rest of the world as the purpose of placing them in the shelter in the first place was to get them away from the public. This was done so that nobody would find out about their condition. Families find that it is necessary to protect the unwed pregnant women and their families from being humiliated and despised by friends, neighbours and the community at large. For victims of incest and rapes it was mandatory for them to be at the shelter until they have given birth and ready to be sent home. One of the reasons being is to protect them from the perpetrators.
It is not unusual for the unwed pregnant young women to perceive that there is no future and hopes for them, which is a reflection of distorted thinking. It is also somewhat expected for them to feel depressed and lonely since they were isolated from families and friends. As such, it is crucial to assist the young women on what options are available to them and how to disclose their condition to family members (Hayward, 2011;Treffers et al., 2001). A lot of encouragement and motivation are also needed to give them hope for the future.
Results also show significant relation between depression and cognitive distortion. This suggests that cognitive distortion in depression is associated with greater social phobia and more negative expectations of social interactions. Depression may cause low self-efficacy, low self-esteem, feelings of worthlessness, an external locus of control, and experience guilt or shame over their limitations (Wardle et al., 2004;Beck, 2003). Hence, counselling should also focus on dealing with problems and issues related to distorted, negative and irrational thoughts. The premise of cognitive therapy is that psychological problems are caused by dysfunctional cognitions such as irrational beliefs (Beck et al., 1979;Ellis, 1977). Cognitive behaviour therapy would seem to be most appropriate in changing cognitions from negative, distorted or unrealistic to normal thinking patterns. The restructuring and modifying of these thoughts can help to minimize the expected negative effects being experienced .

Counselling Implications
Researchers have linked loneliness to depression, anxiety, interpersonal hostility, not feeling healthy, suicide, alcoholism, poor self-concept, and psychosomatic illness (Archana & Nishi Misra, 2012;Lasgaard et al., 2011). As such, counselling with the unwed women should address the feelings of loneliness and depression while at the same time corrects their distorted thinking. Harington et al.'s (Harington et al., 1980) suggested that depressed adolescents are at greater risk of developing into depressed adults.
Group counselling would help to encourage sharing among the young women. Empathy and understanding from the counsellors as well as the group members would enable the women to feel that they were connected and being understood. This will help overcome the feeling of loneliness and alienation. Furthermore, Pettigrew and Roberts (2008) suggest that loneliness can be reduced by getting emotional support from friends and family members.
Person-centred therapy by a non-judgemental counsellor will give ample opportunities for the young women to share their feelings and thoughts about their experiences of depression and loneliness. Non-judgmental counselling would be helpful in order to make them feel unconditionally accepted and empathised despite being judged and rejected by the society. They should also be guided as to how to cope with unexpected pregnancy by helping them to manage their anxieties and pressures that they encountered (Hayward, 2011).

Conclusion
Very often we find that unwed pregnant women experienced feelings of loneliness and alienation, depression and cognitive distortion. Findings from this study had shown support for the previous studies whereby the three variables are related. Group counselling should focus on the three issues and giving strengths and motivation to the young mothers to help them build back their lives.