Deprivation is associated with worse physical and mental health beyond income poverty: a population-based household survey among Chinese adults

Association of Allostatic Load With Depression, Anxiety, and Suicide: A Prospective Cohort Study

BACKGROUND

Allostatic load (AL) is an objective measure of the biological components of chronic stress in clinical practice, which potentially influence depression, anxiety, and suicide. In this study, we investigated the association between AL and these mental disorders.

METHODS

In this cohort study of 333,017 adults, participants without previous diagnoses of depression, anxiety, or suicide were observed from March 13, 2006, to October 31, 2022. AL was estimated using 10 biomarkers that reflect metabolic, cardiovascular, and inflammatory dysregulation. Diagnoses were based on ICD-10. We performed Cox proportional hazard models to assess the relationship between AL and these mental disorders. We also conducted subgroup analyses for sex, age, and Townsend Deprivation Index, as well as sensitivity analyses.

RESULTS

The median follow-up period was 13 years. Over the follow-up period, 13,441 (4.04%) participants developed depression, 13,903 (4.17%) developed anxiety, and 796 (0.24%) committed suicide. In the fully adjusted model, individuals with high AL had an increased risk of depression (hazard ratio = 1.389, p = 8.38 × 10-27), anxiety (hazard ratio = 1.304, p = 5.82 ×10-19), and suicide (hazard ratio = 1.433, p = 4.46 ×10-3). Women and younger individuals with high AL were vulnerable to depression and anxiety, while moderate AL levels were significantly associated with suicide in men and younger participants. Moreover, individuals with middle and high AL had an elevated risk of comorbid depression and anxiety.

CONCLUSIONS

High AL is positively associated with increased risks of depression, anxiety, and suicide, highlighting its potential as a predictive tool in mental health.

Linking joint exposures to residential greenness and air pollution with adults' social health in dense Hong Kong

Despite the growing recognition of the impact of urban environments on social health, limited research explores the combined associations of multiple urban exposures, particularly in dense cities. This study examines the interplay between greenspace, air pollution, and social health as well as the underlying pathways and population heterogeneity in Hong Kong using cross-sectional survey data from 1977 adults and residential environmental data. Social health includes social contacts, relations, and support. Greenspace used street-view greenness (SVG), park density, and the normalized difference vegetation index (NDVI). 100-m daily ground NO2 and O3, indicative of air pollution, were derived using a spatiotemporal deep learning model. Mediators involved physical activity and negative emotions. Main analyses were performed in a 1000-m buffer with multivariate logistical regressions, stratification, interaction, and Partial Lease Square - Structural Equation Modelling (PLS-SEM). Multi-exposure models revealed positive associations between park density/SVG and social contacts, as well as between SVG and social relations, while O3 was negatively associated with social relations/support. Significant moderators included age, birthplace, employment, and education. PLS-SEM indicated direct positive associations between SVG and social contacts/relations and significant indirect negative associations between NO2/O3 and social health via negative emotions. This study adds to urban health research by exploring complex relationships between greenspace, air pollution, and social health, highlighting the role of the environment in fostering social restoration.

Investigating the impact of poverty on mental illness in the UK Biobank using Mendelian randomization

It is unclear whether poverty and mental illness are causally related. Using UK Biobank and Psychiatric Genomic Consortium data, we examined evidence of causal links between poverty and nine mental illnesses (attention deficit and hyperactivity disorder (ADHD), anorexia nervosa, anxiety disorder, autism spectrum disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, post-traumatic stress disorder and schizophrenia). We applied genomic structural equation modelling to derive a poverty common factor from household income, occupational income and social deprivation. Then, using Mendelian randomization, we found evidence that schizophrenia and ADHD causally contribute to poverty, while poverty contributes to major depressive disorder and schizophrenia but decreases the risk of anorexia nervosa. Poverty may also contribute to ADHD, albeit with uncertainty due to unbalanced pleiotropy. The effects of poverty were reduced by approximately 30% when we adjusted for cognitive ability. Further investigations of the bidirectional relationships between poverty and mental illness are warranted, as they may inform efforts to improve mental health for all.

Social relationship factors, depressive symptoms, and incident dementia: a prospective cohort study into their interrelatedness

BACKGROUND

Different aspects of social relationships (e.g., social network size or loneliness) have been associated with dementia risk, while their overlap and potentially underlying pathways remain largely unexplored. This study therefore aimed to (1) discriminate between different facets of social relationships by means of factor analysis, (2) examine their associations with dementia risk, and (3) assess mediation by depressive symptoms.

METHODS

Thirty-six items from questionnaires on social relationships administered in Wave 2 (2004/2005) of the English Longitudinal Study of Ageing (n = 7536) were used for exploratory and confirmatory factor analysis. Factors were then used as predictors in Cox proportional hazard models with dementia until Wave 9 as outcome, adjusted for demographics and cardiovascular risk factors. Structural equation modeling tested mediation by depressive symptoms through effect decomposition.

RESULTS

Factor analyses identified six social factors. Across a median follow-up time of 11.8 years (IQR = 5.9-13.9 years), 501 people developed dementia. Higher factor scores for frequency and quality of contact with children (HR = 0.88; p = 0.021) and more frequent social activity engagement (HR = 0.84; p < 0.001) were associated with lower dementia risk. Likewise, higher factor scores for loneliness (HR = 1.13; p = 0.011) and negative experiences of social support (HR = 1.10; p = 0.047) were associated with higher dementia risk. Mediation analyses showed a significant partial effect mediation by depressive symptoms for all four factors. Additional analyses provided little evidence for reverse causation.

CONCLUSIONS

Frequency and quality of social contacts, social activity engagement, and feelings of loneliness are associated with dementia risk and might be suitable targets for dementia prevention programs, partly by lowering depressive symptoms.

A cross-sectional survey of material deprivation and suicide-related ideation among Vietnamese technical interns in Japan

Background

The economic struggles faced by many technical intern trainees in Japan include the necessity to remit money to their home country, debts owed to intermediaries facilitating their arrival, and reduced working hours due to the COVID-19 pandemic. Furthermore, there is concern that the pandemic may contribute to mental instability resulting from the significant life changes experienced by the trainees. This study examined the experience of material deprivation among Vietnamese intern trainees in Japan and explored the correlation between material deprivation and suicidal ideation.

Methods

A cross-sectional study was conducted between September and October 2021, involving 310 Vietnamese technical intern trainees. Data from 200 participants were analyzed. The questionnaire included gender, age, duration of residence in Japan, proficiency in the Japanese language, income changes due to the COVID-19 pandemic, material deprivation status, and suicidal ideation. Suicidal ideation was assessed using the ninth item of the Patient Health Questionnaire-9. Logistic regression analysis was performed to investigate the relationship between material deprivation items and suicidal ideation.

Results

The mean age of the respondents was 26.0 ± 5.1 years, with 62.0% (n = 124) being male. Among the material deprivation items, 74.0% (n = 148) reported food deprivation, 59.0% (n = 118) reported cellphone bill deprivation, and 55.0% (n = 110) reported medical expense deprivation. Suicidal ideation was reported by 23.0% (n = 46) of the respondents. The prevalence of suicidal ideation was associated with age (p = 0.031, odds ratio [OR] = 0.889, 95% confidence interval [CI] = 0.799-0.990), deprivation of food expenses (p = 0.003, OR = 3.897, 95% CI = 1.597-9.511), and deprivation of cellphone usage (p = 0.021, OR = 3.671, 95% CI = 1.217-11.075).

Conclusion

Vietnamese technical intern trainees in Japan faced various forms of material deprivation, which correlated with a high prevalence of significant psychological issues. Suicidal ideation was influenced by factors such as age, deprivation of food expenses, and inability to pay cellphone bills. The experience of material deprivation could have intensified the mental health challenges faced by Vietnamese trainees, particularly in the demanding circumstances of the COVID-19 pandemic.

[Cross-cultural adaptation and evidence of psychometric validity of the Family Health Scale for Brazilian Portuguese]

This study aimed to translate and cross-culturally adapt the Family Health Scale into Brazilian Portuguese and analyze evidence of its psychometric validity. The 32 items on family health were cross-culturally adapted, using the content validity index to calculate semantic, idiomatic, cultural, and conceptual characteristics of the scale and its items. A pre-test to identify evidence of validity was applied to 40 families. At another time, the instrument was applied to 354 families in a Brazilian northeastern city. The index of agreement between the raters ranged from 0.84 for the scale items to 0.98 for the total scale, according to Kendall's coefficient. According to Cronbach's alpha, evidence of psychometric validity is adequate. Most families had a moderate degree of health, according to the scale. Therefore, the Brazilian version of the Family Health Scale showed conceptual, semantic, cultural, and operational equivalence with the original items, along with satisfactory psychometric properties for use among the Brazilian population with effectiveness and safety.

Influence of social deprivation on morbidity and all-cause mortality of cardiometabolic multi-morbidity: a cohort analysis of the UK Biobank cohort

BACKGROUND

The relation of social deprivation with single cardiometabolic disease (CMD) was widely investigated, whereas the association with cardiometabolic multi-morbidity (CMM), defined as experiencing more than two CMDs during the lifetime, is poorly understood.

METHODS

We analyzed 345,417 UK Biobank participants without any CMDs at recruitment to study the relation between social deprivation and four CMDs including type II diabetes (T2D), coronary artery disease (CAD), stroke and hypertension. Social deprivation was measured by Townsend deprivation index (TDI), and CMM was defined as occurrence of two or more of the above four diseases. Multivariable Cox models were performed to estimate hazard ratios (HRs) per one standard deviation (SD) change and in quartile (Q1-Q4, with Q1 as reference), as well as 95% confidence intervals (95% CIs).

RESULTS

During the follow up, 68,338 participants developed at least one CMD (median follow up of 13.2 years), 16,225 further developed CMM (median follow up of 13.4 years), and 18,876 ultimately died from all causes (median follow up of 13.4 years). Compared to Q1 of TDI (lowest deprivation), the multivariable adjusted HR (95%CIs) of Q4 (highest deprivation) among participants free of any CMDs was 1.23 (1.20 ~ 1.26) for developing one CMD, 1.42 (1.35 ~ 1.48) for developing CMM, and 1.34 (1.27 ~ 1.41) for all-cause mortality. Among participants with one CMD, the adjusted HR (95%CIs) of Q4 was 1.30 (1.27 ~ 1.33) for developing CMM and 1.34 (1.27 ~ 1.41) for all-cause mortality, with HR (95%CIs) = 1.11 (1.06 ~ 1.16) for T2D patients, 1.07 (1.03 ~ 1.11) for CAD patients, 1.07 (1.00 ~ 1.15) for stroke patients, and 1.24 (1.21 ~ 1.28) for hypertension patients. Among participants with CMM, TDI was also related to the risk of all-cause mortality (HR of Q4 = 1.35, 95%CIs 1.28 ~ 1.43).

CONCLUSIONS

We revealed that people living with high deprived conditions would suffer from higher hazard of CMD, CMM and all-cause mortality.

Period poverty and mental health in a representative sample of young women in Barcelona, Spain

BACKGROUND

The intersection between poverty and mental health is clear. Period poverty, understood as the lack of access to menstrual products, has been gaining attention especially among low and middle-income countries as an overlooked aspect of gendered poverty. Less is known about the incidence of period poverty in high-income countries and its association with mental health. The purpose of this study is to examine this association in a representative sample of young women living in an urban setting in southern Europe.

METHODS

This is a cross-sectional study. Data were obtained from a representative survey of individuals aged 15 to 34 in the city of Barcelona (Spain), with a sample group of 647 young women. Subjects were selected through a systematic stratified random sampling method. A proportional quota sampling was used. The information was registered using CAPI data collection method. Period poverty was measured by a combination of three questions about the lack of access or misuse of menstrual products for economic reasons. The GHQ-12 was used to measure the risk of poor mental health. The analysis was carried out using multivariable logistic regression.

RESULTS

From our sample, 15.3% of young women reported having experienced period poverty. Higher odds of poor mental health were estimated for women facing period poverty (AOR = 1.85 p < 0.05). This effect is statistically significant after controlling by their income status and level of deprivation. Young women living in poorer households have a higher probability of poor mental health than those living in high-income households (AOR = 0.47 p < 0.05). Finally, material deprivation was associated to an increased risk of poor mental health among young women reporting period poverty (AOR = 2.59 p < 0.01).

CONCLUSION

We found that a considerable number of young women living in an urban setting in a high-income country cannot afford menstrual products, and this may have an impact on their mental wellbeing. The relationship between period poverty and respondents' mental health is significant when controlling for factors known to confer an increased risk of poor mental health. If confirmed by further research, the public health burden of poor mental health in young women could be reduced by policy-level interventions to improve access to menstrual products.

Exploring the relationship between socioeconomic deprivation index and Alzheimer's disease using summary-level data: From genetic correlation to causality

Patients with Alzheimer's disease (AD) are markedly increasing as population aging and no disease-modifying therapies are currently available for AD. Previous studies suggested a broad link between socioeconomic status and a variety of disorders, including mental illness and cognitive abilities. However, the association between socioeconomic deprivation and AD has been unknown. We here employed Townsend deprivation index (TDI) to explore such relation and found a positive genetic correlation (r̂_g=0.211, P = 8.00 × 10^-4) between the two traits with summary statistics data (N = 455,258 for TDI and N = 455,815 for AD). Then, we performed pleiotropy analysis at both variant and gene levels using a powerful method called PLACO and detected 87 distinct pleiotropic genes. Functional analysis demonstrated these genes were significantly enriched in pancreas, liver, heart, blood, brain, and muscle tissues. Using Mendelian randomization methods, we further found that one genetically predicted standard deviation elevation in TDI could lead to approximately 18.5% (95% confidence intervals 1.6- 38.2%, P = 0.031) increase of AD risk, and that the identified causal association was robust against used MR approaches, horizontal pleiotropy, and instrumental selection. Overall, this study provides deep insight into common genetic components underlying TDI and AD, and further reveals causal connection between them. It is also helpful to develop a more suitable plan for ameliorating inequities, hardship, and disadvantage, with the hope of improving health outcomes among economically disadvantaged people.

Street-view and traditional greenness metrics with adults' sitting time in high-density living in Hong Kong: Comparing associations, air pollution and noise roles, and population heterogeneity

BACKGROUND

Emerging evidence suggests neighborhood greenness is associated with physical activity; however, the sitting-specific associations with multi-source greenness metrics remain unclear, especially in high-density cities.

OBJECTIVES

This cross-sectional study examined: 1) the associations of street-view greenness (SVG) and traditional greenness metrics (i.e., Normalized Difference Vegetable Index (NDVI) and park density) with sitting time; 2) the potential moderating/mediating roles of objective/perceived air pollution and perceived roadside noise; and 3) how the associations vary by demographics and socioeconomic status.

METHODS

Interview survey data of 1977 adults in Hong Kong from 2014 and 2015 was linked to environmental data. Using an object-based image classification algorithm, SVG was derived from Google Street View images, capturing human-viewed street-level greenery. NDVI was derived from Landsat 8 satellite images using the normalized difference between the near-infrared and red bands. Park density was calculated by point density. In the main analyses including regressions, parallel mediation, interaction, and stratified models, the environmental metrics were measured within a 1000-m Euclidean buffer of residence.

RESULTS

SVG and park density were negatively associated with sitting time after adjusting for covariates including physical activity while NDVI was not significantly associated with sitting time, and results were robust with 800-1800 m Euclidean and 1400-1800 m network distance. Greenness-sitting associations were not moderated/mediated by perceived air pollution/roadside noise while SVG-sitting associations were moderated by objective NO₂, O₃, and PM_2.5 and mediated by O₃. SVG-sitting associations differed by age, having under-school-aged children, birthplace, education, and occupation type while associations between traditional greenness metrics and prolonged sitting showed no significant population heterogeneity.

CONCLUSIONS

SVG appears to be more accurate in estimating exposure than traditional metrics to reflect greenness-sitting associations, objective air pollution moderating and mediating roles, and population heterogeneity, which emphasizes the importance of street-level greenness planning for health promotion in terms of reducing sitting time.

Association between birth by caesarian section and anxiety, self-harm: a gene-environment interaction study using UK Biobank data

BACKGROUND

Limited efforts have been paid to explore the underlying genetic mechanisms of birth by caesarian section (CS) affecting the risks of adult anxiety and self-harm.

METHODS

Using UK Biobank cohort, the logistic regression model was first applied to evaluate the associations of adult anxiety and self-harm with birth by CS. Using birth by CS as exposure variables, genome-wide by environment interaction study (GWEIS) was then applied by PLINK2.0 to identify associated genes interacting with birth by CS for anxiety and self-harm.

RESULTS

In the observational study, significant associations were observed between birth by CS and anxiety (odds ratio (OR) = 1.24; 95% confidence interval (CI), 1.12-1.38; P = 4.86 × 10- 5), and self-harm (OR = 1.12; 95% CI, 1.01-1.24; P = 2.90 × 10- 2). GWEIS revealed multiple suggestive genes interacted with birth by CS for anxiety, such as DKK2 (rs13137764, P = 1.24 × 10- 9, adjusted P = 2.68 × 10- 7) and ATXN1 (rs62389045, P = 4.38 × 10- 8, adjusted P = 3.55 × 10- 6). For self-harm, significant gene-environment interactions of birth by CS on self-harm were detected, such as ALDH1A2 (rs77828167, P = 1.62 × 10- 8; rs116899929, P = 1.92 × 10- 8) and DAB1 (rs116124269, P = 3.20 × 10- 8; rs191070006, P = 3.63 × 10- 8).

CONCLUSIONS

Our results suggested that birth by CS was associated with the risk of adult anxiety and self-harm. We also discovered some genes interacted with birth by CS might influence the risk of anxiety and self-harm, which may provide novel clues for the pathogenesis of those mental disorders.

Associations of residential greenness with unhealthy consumption behaviors: Evidence from high-density Hong Kong using street-view and conventional exposure metrics

AIM

Residential greenness was theoretically associated with health-related consumption behaviors concerning the socio-ecological model and restoration environment theory, but empirical studies were limited, especially in high-density cities. We examined the associations of residential greenness with unhealthy consumption behaviors (infrequent breakfast consumption, infrequent fruit consumption, infrequent vegetable consumption, alcohol drinking, binge drinking, cigarette smoking, moderate-to-heavy smoking, and heavy smoking) using street-view and conventional greenness metrics in high-density Hong Kong.

METHODS

This cross-sectional study employed survey data from 1,977 adults and residence-based objective environmental data in Hong Kong. Street-view greenness (SVG) was extracted from Google Street View images using an object-based image classification algorithm. Two conventional greenness metrics were used, including normalized difference vegetation index (NDVI) derived from Landsat 8 remote-sensing images and park density derived from a geographic information system database. In the main analyses, logistic regression analyses together with interaction and stratified models were performed with environmental metrics measured within a 1000-m buffer of residence.

RESULTS

A standard deviation higher SVG and NDVI were significantly associated with fewer odds of infrequent breakfast consumption (OR = 0.81, 95% CI 0.71-0.94 for SVG; OR = 0.83, 95% CI 0.73-0.95 for NDVI), infrequent fruit consumption (OR = 0.85, 95% CI 0.77-0.94 for SVG; OR = 0.85, 95% CI 0.77-0.94 for NDVI), and infrequent vegetable consumption (OR = 0.78, 95% CI 0.66-0.92 for SVG; OR = 0.81, 95% CI 0.69-0.94 for NDVI). The higher SVG was significantly associated with less binge drinking and the higher SVG at a 400-m buffer and a 600-m buffer were significantly associated with less heavy smoking. Park density was not significantly associated with any unhealthy consumption behaviors. Some of the above significant associations were moderated by moderate physical activity, mental and physical health, age, monthly income, and marital status.

CONCLUSIONS

This study highlights the potential beneficial impact of residential greenness, especially in terms of street greenery, on healthier eating habits, less binge drinking, and less heavy smoking.

The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe

AIMS

Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association.

METHODS

We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome.

RESULTS

High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results.

CONCLUSIONS

Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.

Alleviating mental health disorders through doses of green spaces: an updated review in times of the COVID-19 pandemic

The COVID-19 pandemic has highlighted issues due to mental health disorders, in particular the serious consequences derived from lockdown measures. This paper aims to analyse the literature on the potential direct impact of the natural environment on mental health disorders. We have systematically reviewed the studies analysing green spaces and mental health included in this review using PubMed, Web of Science, Scopus and Cochrane Library. A retrospective time-frame is considered, covering the COVID-19 pandemic. We have found that exposure to, use and proximity to green spaces have a beneficial impact on mental health among elderly, students and patients with underlying pathologies. However, it has negative effects on the mental health of women and young adults. Exposure to and interaction with the natural environment can improve certain mental health disorders and should be taken into account for strategies and policies related to future threats to public health.

The moderating role of trajectories of family hardiness in the relationship between trajectories of economic hardship and mental health of mothers and children

Trajectories of perceived economic hardship are related to clinical levels of mental health issues in mothers and children from low-income families. Cross-sectionally, family hardiness has been found to have a moderating effect on the relationship between stressors and mental health severity. Recent advances in family resilience theory highlight the importance of considering trajectories of family resilience. Trajectories of family hardiness and their moderating effect on the relationship between trajectories of perceived economic hardship and symptoms of depression and anxiety in low-income mothers and children were investigated in 511 mother-child dyads in Singapore. Three trajectories of family hardiness were delineated, namely the high stable, low rapidly increasing and moderate increasing group. The trajectories of family hardiness were found to moderate the relationship between trajectories of perceived economic hardship and symptoms of mental health in low-income mothers and children. The same moderation effect was not found when perceived economic hardship and family hardiness were investigated cross-sectionally. These findings highlight the importance of considering the family's trajectory of hardiness over time when working with low-income families. In addition, given that different trajectories of family hardiness were protective for different aspects of mental health, further studies to understand these relations are necessary.

Disrupted daily routines mediate the socioeconomic gradient of depression amid public health crises: A repeated cross-sectional study

OBJECTIVE

There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomic gradient in depression and the potential intermediary role of daily routine disruptions.

METHOD

We conducted repeated territory-wide telephone surveys in July 2019 and July 2020 with 1112 and 2034 population-representative Cantonese-speaking Hong Kong citizens above 15 years old, respectively. Stratified by year, we examined the association between socioeconomic indicators (education attainment, household income, employment status and marital status) and probable depression (nine-item Patient Health Questionnaire [PHQ-9] ⩾ 10) using logistic regression. Differences in the socioeconomic gradient between 2019 and 2020 were tested. Finally, we performed a path analysis to test for the mediating role of daily routine disruptions.

RESULTS

Logistic regression showed that higher education attainment in 2019 and being married in 2020 were protective against probable depression. Interaction analysis showed that the inverse association of higher education attainment with probable depression attenuated in 2020 but that of being married increased. Path analysis showed that the mediated effects through daily routine disruptions accounted for 95.9% of the socioeconomic gradient of probable depression in 2020, compared with 13.1% in 2019.

CONCLUSION

From July 2019 to July 2020, the mediating role of daily routine disruptions in the socioeconomic gradient of depression in Hong Kong increased. It is thus implied that infection control measures should consider the relevant potential mental health impacts accordingly.

Relative deprivation, depression and quality of life among adults in Shandong Province, China: A conditional process analysis based on social support

BACKGROUND

Relative deprivation has been confirmed as one of the pathways underlying the link between income inequality and health. However, the mechanism between relative deprivation and health was still unclear. This study aimed to test the mediating role of depression and the moderating role of social support in the association between relative deprivation and quality of life.

METHODS

Data were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. In total, 8496 adults were included to complete the measures of relative deprivation, depressive symptoms, perceived social support, and quality of life.

RESULTS

Relative deprivation was negatively associated with quality of life, and depressive symptoms could mediate this association. Furthermore, the direct effect of relative deprivation on quality of life and the indirect effect of depressive symptoms in this relationship were moderated by perceived social support. Both these two effects were stronger for individuals with a low level of perceived social support.

LIMITATIONS

Data are cross-sectional, and causal conclusions cannot be drawn. All measures were based on participant self-report.

CONCLUSIONS

Personal relative deprivation has negative effects on quality of life. Social support moderated the direct effect of relative deprivation and the mediating effect of depressive symptoms on quality of life. For individuals with a high level of relative deprivation, particularly those with a low level of social support, interventions tailoring psychological services and community-based activities could be designed to reduce relative deprivation and promote social support for disadvantaged individuals.

The effect of subjective social status on health-related quality of life decline in urban Chinese older adults: a four-year longitudinal study from Hong Kong

Background

Improving health-related quality of life (HRQOL) is becoming a major focus of old age care and social policy. Researchers have been increasingly examining subjective social status (SSS), one’s self-perceived social position, as a predictor of various health conditions. SSS encompasses not only concrete socio-economic (SES) factors but also intangible aspects of status. This study’s main objective was to examine the association between SSS and long-term change in HRQOL in older Chinese adults.

Methods

A longitudinal Hong Kong study recruited 2934 community-dwelling adults (age > 65 years). Participants completed SF-12 physical health (PCS) and mental health (MCS) HRQOL scales. This study analyzed baseline SSS-Society (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one’s own social network) as predictors of long-term HRQOL decline. After stratifying for sex, multiple-linear-regression was performed on 4-year follow-up SF-12 PCS and MCS scores after adjusting for baseline SF-12 scores, traditional SES indicators, demographic variables, clinical conditions, and lifestyle variables.

Results

In the multivariable analyses, lower SSS-Society was associated with declines in MCS in males (β_standardized = 0.08, p = 0.001) and declines in PCS (β_standardized = 0.07, p = 0.006) and MCS (β_standardized = 0.12, p < 0.001) in females.

SSS-Community was associated with declines in PCS in males (β_standardized = 0.07, p = 0.005) and MCS in females (β_standardized = 0.14, p < 0.001).

Conclusions

SSS may be a useful supplementary tool for predicting risk of long-term HRQOL decline in older Chinese adults. Strategies to reduce perceived social inequalities may improve HRQOL in older adults.

Inequalities in Psychiatric Morbidity in Hong Kong and Strategies for Mitigation

This study explores the social gradient of psychiatric morbidity. The Hong Kong Mental Morbidity Survey (HKMMS), consisting of 5719 Chinese adults aged 16 to 75 years, was used. The Chinese version of the Revised Clinical Interview Schedule (CIS-R) was employed for psychiatric assessment of common mental disorders (CMD). People with a less advantaged socioeconomic position (lower education, lower household income, unemployment, small living area and public rental housing) had a higher prevalence of depression and anxiety disorder. People with lower incomes had worse physical health (OR 2.01, 95% CI 1.05-3.82) and greater odds of having CMD in the presence of a family history of psychiatric illnesses (OR 1.67, 95% CI 1.18-2.36). Unemployment also had a greater impact for those in lower-income groups (OR 2.67; 95% CI 1.85-3.85), whereas no significant association was observed in high-income groups (OR 0.56; 95% CI 0.14-2.17). Mitigating strategies in terms of services and social support should target socially disadvantaged groups with a high risk of psychiatric morbidity. Such strategies include collaboration among government, civil society and business sectors in harnessing community resources.

Trajectories of perceived economic hardship: Relations with mother's and child's mental health and the role of self-esteem

Trajectories of poverty influence the mental health of mothers and children. Previous studies utilize objective measures despite the importance of subjective measures of poverty. Furthermore, chronic economic hardship may erode personal resources such as self-esteem which increases vulnerability to mental health issues. Trajectories of perceived family economic hardship and their relationship with common mental health disorders, as mediated by self-esteem, were investigated in 511 mother-child dyads from Singapore. Three distinct groups of economic hardship trajectories were delineated, namely the low stable, high stable and moderate decreasing group. The high stable group was found to be associated with a greater likelihood of mother's depression, mother's anxiety and child's anxiety when compared to the low stable group. The moderate decreasing group was found to be associated with a greater likelihood of mother's anxiety when compared to the low stable group. Mother's self-esteem was found to mediate all the significant relations found. These findings indicate the existence of distinct trajectories of perceived economic hardship within low-income families and their relation with mental health outcomes in mothers and children. The mediation of these relations by mother's self-esteem suggests the importance of enhancing self-esteem in mothers from low-income backgrounds.

Public Rental Housing and Obesogenic Behaviors among Adults in Hong Kong: Mediator Role of Food and Physical Activity Environment

Public rental housing (PRH) for low-income families has been shown in several studies to be associated with poor health status and obesity. However, the causes of this health disparity are controversial, and the associations and pathways between PRH and obesogenic behaviors remain unknown. Using cross-sectional survey data of 1977 adults living in Hong Kong (aged or over 18) together with multi-source GIS-based environmental data, we examined the associations between PRH and obesogenic behaviors and the extent to which those associations can be explained by neighborhood food and physical environment. The unhealthy food environment, which relates with infrequent fruit and vegetables consumption, was calculated based on the relative density of fast food restaurants and convenience stores to grocery stores. The physical activity environment, which relates to physical inactivity and prolonged sitting, was assessed in terms of density of sports facilities and street greenery, separately. Regressions and mediation analyses show that PRH was negatively associated with physical inactivity directly and also indirectly via higher sports facilities density; however, PRH was positively associated with unhealthy diet largely directly and positively associated with prolonged sitting indirectly via less street greenery. We advanced the international literature of PRH health impact assessment and its environmental health pathways by providing evidence from the least housing-affordable city in the world. The findings provide planning implications in formulating a healthier PRH community for these low-income PRH households and mitigating health disparities induced by housing type.

The role of neighborhood social capital on health and health inequality in rural and urban China

Given the "community lost" vs. "community saved" debate on how neighborhood solidarity changes with urbanization, we compared the rural-urban difference in the association of individuals' neighborhood social capital with health and the interaction effect between neighborhood social capital and income-poverty on health in China, where huge rural-urban disparities existed. Participants were 5014 Chinese adults (≥ 18 years) (rural: 2034; urban: 2980) from the 2012 cross-sectional Chinese General Social Survey. Health outcome was a factor score constructed by three items. Neighborhood social capital was divided into structural (neighborhood network size, frequency of socializing with neighbors, voting in neighborhood committee election, and participation in neighborhood voluntary activities) and cognitive (perceived neighborhood social cohesion) dimensions. Multivariable linear regression models showed positive associations between perceived neighborhood social cohesion and health in rural (β = 0.08, 95% CI: 0.03,0.14) and urban (β = 0.09, 95% CI: 0.05,0.12) areas. Only in rural but not urban areas was a neighborhood network of 10 or more persons (ref.: none) associated with better health (β = 0.25, 95% CI: 0.05,0.46). Interaction analysis showed that only in rural but not urban areas, with the increase of neighborhood network size, the health gap between the income-poor and the non-income-poor decreased generally. Our study suggested that cohesive neighborhoods benefit both rural and urban residents' health. Health interventions to improve neighborhood social cohesion should be designed to cope with the challenge of urbanization. Policymakers should avoid damaging neighborhood social capital when implementing other public policies, especially in rural areas where neighborhood network seems to matter more for health.

Perceived Poverty and Life Satisfaction in College Students with Impoverished Backgrounds: The Mediating Role of Self-Esteem

Background

Perceived poverty is a common psychological feeling among college students with impoverished backgrounds. Perceived poverty can harm impoverished college students’ interpersonal interactions, psychological health and life satisfaction. This study explored the effect of perceived poverty on the life satisfaction of impoverished college students and the mediating role of self-esteem.

Methods

In this cross-sectional study, 1044 impoverished college students from 22 universities completed an online questionnaire that included a measure of perceived poverty, self-esteem scale (SES) and satisfaction with life scale (SWLS). Mplus statistical software was used to test whether self-esteem mediates the relationship between perceived poverty and life satisfaction.

Results

Perceived poverty and life satisfaction were significantly negatively correlated, self-esteem was significantly positively correlated with life satisfaction, and perceived poverty was significantly negatively correlated with self-esteem. The structural equation model revealed that self-esteem partially mediated the relationship between perceived poverty and life satisfaction.

Conclusion

Financial aid programmes should safeguard and strengthen impoverished students’ self-esteem while also taking steps to lessen their perceived poverty.

Psychometrics of Persian Version of the Ageism Survey Among an Iranian Older Adult Population During COVID-19 Pandemic

Background: Studies have revealed an increase in discrimination, neglect, and abuse among the older adult population during this period. This study assessed the validity and reliability of the Persian version of the ageism survey instrument tested on a sample of the Iranian older adult population during coronavirus disease (COVID-19) pandemic. An important move in counteracting ageism is to classify the ageism scale comprehensively by employing adequate psychometrics.

Methods: The Persian version of the ageism scale was developed using a two-step procedure. The first step involved translating and revising the original scale to develop a Persian version of the ageism scale. The second step involved assessing the psychometric features of the newly adapted scale using construct validity through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and thereafter assessing the reliability through the average inter-item correlation (AIC), Cronbach's alpha. The sample consisted of 400 older adults (age 65 and older), who were recruited through online data collection, with samples for EFA and CFA randomly selected from the total samples.

Results: The Persian version of the ageism survey has three factors: age-related deprivation with five items, dignity with three items, and employment with three items; all of which explained 57.02% of the total variance. The outcome of the EFA was verified by the CFA, with internal consistency reliability being excellent (Cronbach's alpha was 0.725, 0.698, and 0.708 for the three factors).

Conclusion: This study specifically offers a restructured three factors Persian version of the ageism survey for Iranian older adults with acceptable construct validity and reliability.

Validation of a social deprivation index and association with cognitive function and decline in older adults

OBJECTIVES

Previous work using a US sample has shown that an index of social deprivation (SoDep Index) is associated with cognitive functioning and decline in older adults. This study aimed to replicate these findings using a European sample (Survey of Health, Ageing and Retirement in Europe, SHARE).

DESIGN

We analyzed data of 51,630 respondents aged 50 years and older (M: 63.5 years, standard deviation [SD]: 9.1) with at least two cognitive assessments (follow-up M: 6.06 years, SD: 3.86). Cognitive scores were transformed to Z-scores. Multiple growth curve modeling was used to model cognitive status and decline as predicted by the SoDep Index. In a sensitivity analysis, we constructed a new SoDep Index (SoDep Indexnew) including further social deprivation domains.

RESULTS

Adjusting for covariates, a unit increase in SoDep Index was associated with a cognitive score of 0.037 SDs smaller (p < .001) and a decline 0.003 SDs per year faster (p < .001). Of the covariates, depressive symptoms, chronic disease burden, male gender, and widowhood were also associated with poorer cognition. Being divorced was associated with better cognition. Sensitivity analysis confirmed findings. Compared to the SoDep Index, the SoDep Indexnew showed a more pronounced association with both cognition and cognitive decline.

CONCLUSIONS

We were able to replicate results showing an association between SoDep Index and cognitive function and decline. The sensitivity analysis further emphasizes the relevance of financial security. This strengthens the implication that preventing social deprivation can contribute to reducing the dementia burden by raising cognitive functioning in the older population. The findings are relevant to policy-makers and health care practitioners.

Socioeconomic inequality in mental well-being associated with COVID-19 containment measures in a low-incidence Asian globalized city

The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adults in Hong Kong were recruited via a cross-sectional population-wide telephone survey. The inter-relationship between deprivation, types of worry, mental health disorders, and subjective well-being was assessed using structural equation modelling. Results showed significant total effects of deprivation on worries about being infected (p = 0.002), economic activities and livelihood (p < 0.001), and personal savings (p < 0.001), as well as mental health disorders (p < 0.001) and subjective well-being (p < 0.001). Specifically, worry about economic activities and livelihood partly mediated the total effect of deprivation on mental health disorders (p = 0.004), whereas worry about personal savings and worry about economic activities and livelihood partially mediated the total effect of deprivation on subjective well-being (p = 0.007 and 0.002, respectively). Socioeconomic inequality, particularly in mental health and well-being, could be exacerbated via people's economic concerns during the pandemic, which was largely induced by the COVID-19 containment measures rather than the pandemic per se given the relatively low COVID-19 incidence in Hong Kong.

Gender-specific trends of educational inequality in diagnosed diabetes from 1999 to 2014 in Hong Kong: a serial cross-sectional study of 97,481 community-dwelling Chinese adults

Background

Gender differences in the trend of educational inequality in diabetes have been widely observed in the Western populations, indicating the increasing importance of educational attainment as a social determinant of diabetes among women. Nonetheless, relevant evidence is scarce in developed Asian settings for comparisons. This study examined the gender-specific trends of educational inequality in diagnosed diabetes in Hong Kong between 1999 and 2014.

Methods

A series of eight territory-wide population-representative samples of 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were surveyed between 1999 and 2014. Regression-based Relative Index of Inequality (RII) and age-standardized Slope Index of Inequality (SII) were adopted to examine the extent and trend of gender-specific educational inequality in self-reported physician-diagnosed diabetes.

Results

Age-standardized prevalence of diabetes increased in both genders over time, with a steeper surge among men. In addition, educational inequalities in diabetes, in both relative and absolute terms, significantly widened among women over the study period (annual RII change = 1.04; 95% CI = 1.02–1.07, annual SII change = 0.36%; 95% CI = 0.16–0.56%), with the peak in 2011 (RII = 2.44; 95% CI = 1.83–3.24, SII = 9.21%; 95% CI = 6.47–11.96%). However, no significant widening inequality was found among men. Further adjustment for household income level did not attenuate the observed educational inequality.

Conclusions

Despite a greater increase in diabetes prevalence among men, disparity in diabetes substantially widened across education levels among women in the past decade in Hong Kong. The gender perspective should be taken into considerations for policy making to alleviate the prevalence surge and rising educational inequality in diabetes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12963-021-00268-x.

Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature

BACKGROUND

It is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it.

PURPOSE OF STUDY

This study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients' economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation.

METHODS

Using a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes.

RESULTS

Two hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients' financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients' income needs.

CONCLUSION

Tools and processes to identify and address patients' economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.

Measuring health-related social deprivation in small areas: development of an index and examination of its association with cancer mortality

BACKGROUND

The small-area deprivation indices are varied across countries due to different social context and data availability. Due to lack of chronic disease-related social deprivation index (SDI) in Hong Kong, China, this study aimed to develop a new SDI and examine its association with cancer mortality.

METHODS

A total of 14 socio-economic variables of 154 large Tertiary Planning Unit groups (LTPUGs) in Hong Kong were obtained from 2016 population by-census. LTPUG-specific all-cause and chronic condition-related mortality and chronic condition inpatient episodes were calculated as health outcomes. Association of socio-economic variables with health outcomes was estimated for variable selection. Candidates for SDI were constructed with selected socio-economic variables and tested for criterion validity using health outcomes. Ecological association between the selected SDI and cancer mortality were examined using zero-inflated negative binomial regression.

RESULTS

A chronic disease-related SDI constructed by six area-level socio-economic variables was selected based on its criterion validity with health outcomes in Hong Kong. It was found that social deprivation was associated with higher cancer mortality during 2011-2016 (most deprived areas: incidence relative risk [IRR] = 1.40, 95% confidence interval [CI]: 1.27-1.55; second most deprived areas: IRR = 1.34, 95%CI: 1.21-1.48; least deprived areas as reference), and the cancer mortality gap became larger in more recent years. Excess cancer death related to social deprivation was found to have increased through 2011-2016.

CONCLUSIONS

Our newly developed SDI is a valid and routinely available measurement of social deprivation in small areas and is useful in resource allocation and policy-making for public health purpose in communities. There is a potential large improvement in cancer mortality by offering relevant policies and interventions to reduce health-related deprivation. Further studies can be done to design strategies to reduce the expanding health inequalities between more and less deprived areas.

Association of living density with anxiety and stress: A cross-sectional population study in Hong Kong

This study aims to enrich the comprehension of the effect of living density on anxiety and stress among adults in a global city. A random sample of 1,978 Hong Kong adults was interviewed in a cross-sectional population study in 2014-2015. Descriptive statistics and logistic regressions were used to investigate the association between housing variables and mental health indicators, namely, anxiety and stress. Logistic regression analysis results have shown that by controlling the confounding effect of demographic variables, income poverty, housing ownership and housing cost, the living density was significantly associated with anxiety and stress of residents. Compared with those living in high density of <7 m² , living in medium density of ≥7 and <13 m² was significantly associated with lower risk of anxiety (adjusted OR 0.52, 95% CI 0.30-0.88), and the risk was less for those living in low density of ≥13 m² (adjusted OR 0.41, 95% CI 0.23-0.72). Meanwhile, living in low density of ≥13 m² was significantly associated with a lower risk of stress (adjusted OR 0.44, 95% CI 0.20-0.97). These results highlighted the significant impact of living density on personal anxiety and stress. Moreover, female, younger adults or those living in income poverty were also at risk of anxiety and stress. In conclusion, our findings implied that improving housing policies, such as building public housing with adequate living areas and market regulation of living density of private housing, would help enhance the mental well-being of residents.

COVID-19 related health inequality exists even in a city where disease incidence is relatively low: a telephone survey in Hong Kong

BACKGROUND

We examined whether COVID-19 could exert inequalities in socioeconomic conditions and health in Hong Kong, where there has been a relatively low COVID-19 incidence.

METHODS

752 adult respondents from a previous random sample participated in a telephone survey from 20 April to 11 May 2020. We examined demographic and socioeconomic factors, worry of COVID-19, general health, economic activity, and personal protective equipment (PPE) and related hygiene practice by deprivation status. The associations between deprivation and negative COVID-19 related issues were analysed using binary logistic regressions, while the associations of these issues with health were analysed using linear regressions. Path analysis was conducted to determine the direct effect of deprivation, and the indirect effects via COVID-19 related issues, on health. Interactions between deprivation and the mediators were also tested.

RESULTS

Deprived individuals were more likely to have job loss/instability, less reserves, less utilisation and more concerns of PPE. After adjustments for potential confounders, being deprived was associated with having greater risk of low reserve of face masks, being worried about the disease and job loss/instability. Being deprived had worse physical (β=-0.154, p<0.001) and mental health (β=-0.211, p<0.001) and had an indirect effect on mental health via worry and job loss/instability (total indirect effect: β=-0.027, p=0.017; proportion being mediated=11.46%). In addition, significant interaction between deprivation and change of economic activity status was observed on mental health-related quality of life.

CONCLUSION

Even if the COVID-19 incidence was relatively low, part of the observed health inequality can be explained by people's concerns over livelihood and economic activity, which were affected by the containment measures. We should look beyond the incidence to address COVID-19 related health inequalities.

Socioeconomic disadvantages over the life-course and their influence on obesity among older Hong Kong Chinese adults

BACKGROUND

The life-course perspective on socioeconomic inequality in health is a burgeoning field of research. Nonetheless, the three classic life-course models (i.e. sensitive period, cumulative risk and social mobility models) have rarely been simultaneously applied to studies on obesity. Therefore, this study examined the associations of socioeconomic positions (SEPs) across life stages and their associated life-course models with both general and abdominal obesity.

METHODS

Face-to-face interviews were conducted among 1077 community-dwelling adults aged 50 or above during 2014-15 in Hong Kong. Experiences of poverty, educational attainment and deprivation of necessities represented respondents' SEP in childhood, early adulthood and late adulthood, respectively. General and abdominal obesity were defined as body mass index ≥25 kg m-2 and waist-to-height ratio >0.5. Multivariable modified Poisson regression with a robust error variance was performed.

RESULTS

Respondents with low childhood SEP tended to have reduced risk of general obesity [relative risk (RR) = 0.85; 95% confidence interval (CI) = 0.72-1.00], whereas those with low childhood SEP and low late-adulthood SEP tended to have increased risk of abdominal obesity (RR = 1.10; 95% CI = 1.00-1.21 and RR = 1.14; 95% CI = 1.03-1.26, respectively). Cumulative socioeconomic disadvantages showed a dose-response relationship with abdominal obesity. Also, those with upward socioeconomic mobility had lower risk of abdominal obesity, whereas those with downward socioeconomic mobility had greater risk.

CONCLUSIONS

Low SEP, especially in childhood, exerted contrasting effects on general and abdominal obesity among older Hong Kong Chinese adults. The three life-course models operated simultaneously in determining the risk of abdominal obesity, while support for cumulative risk and social mobility models was weak in general obesity.

Socioeconomic Deprivation Index Is Associated With Psychiatric Disorders: An Observational and Genome-wide Gene-by-Environment Interaction Analysis in the UK Biobank Cohort

BACKGROUND

Psychiatric disorders are among the largest and fastest-growing categories of the global disease burden. However, limited effort has been made to further elucidate associations between socioeconomic factors and psychiatric disorders from a genetic perspective.

METHODS

We randomly divided 501,882 participants in the UK Biobank cohort with socioeconomic Townsend deprivation index (TDI) data into a discovery cohort and a replication cohort. For both cohorts, we first conducted regression analyses to evaluate the associations between the TDI and common psychiatric disorders or traits, including anxiety, bipolar disorder, self-harm, and depression (based on self-reported depression and Patient Health Questionnaire scores). We then performed a genome-wide gene-by-environment interaction study using PLINK 2.0 with the TDI as an environmental factor to explore interaction effects.

RESULTS

In the discovery cohort, significant associations were observed between the TDI and psychiatric disorders (p < 4.00 × 10^-16), including anxiety (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.07-1.10), bipolar disorder (OR = 1.42, 95% CI = 1.36-1.48), self-harm (OR = 1.21, 95% CI = 1.19-1.23), self-reported depression (OR = 1.22, 95% CI = 1.20-1.24), and Patient Health Questionnaire scores (β = .07, SE = 0.004). We observed similar significant associations in the replication cohort. In addition, multiple candidate loci were identified by the genome-wide gene-by-environment interaction study, including rs10886438 at 10q26.11 (GRK5) (p = 5.72 × 10^-11) for Patient Health Questionnaire scores and rs162553 at 2p22.2 (CYP1B1) (p = 2.25 × 10^-9) for self-harm.

CONCLUSIONS

Our findings suggest the relevance of the TDI to psychiatric disorders. The genome-wide gene-by-environment interaction study identified several candidate genes interacting with the TDI, providing novel clues for understanding the biological mechanism of associations between the TDI and psychiatric disorders.

Public mental health under the long-term influence of COVID-19 in China: Geographical and temporal distribution

BACKGROUND

The mental health status caused by major epidemics is serious and lasting. At present, there are few studies about the lasting mental health effects of COVID-19 outbreak. The purpose of this study was to investigate the mental health of the Chinese public during the long-term COVID-19 outbreak.

METHODS

A total of 1172 online questionnaires were collected, covering demographical information and 8 common psychological states: depression, anxiety, somatization, stress, psychological resilience, suicidal ideation and behavior, insomnia, and stress disorder. In addition, the geographical and temporal distributions of different mental states were plotted.

RESULTS

Overall, 30.1% of smokers increased smoking, while 11.3% of drinkers increased alcohol consumption. The prevalence rates of depression, anxiety, mental health problems, high risk of suicidal and behavior, clinical insomnia, clinical post-traumatic stress disorder symptoms, moderate-to-high levels of perceived stress were 18.8%, 13.3%, 7.6%, 2.8%, 7.2%, 7.0%, and 67.9%, respectively. Further, the geographical distribution showed that the mental status in some provinces/autonomous regions/municipalities was relatively more serious. The temporal distribution showed that the psychological state of the participants was relatively poorer on February 20, 24 to 26 and March 25, especially on March 25.

LIMITATIONS

This cross-sectional design cannot make causal inferences. The snowball sampling was not representative enough.

CONCLUSION

Our findings suggest that the prevalence rate of mental disorders in the Chinese public is relatively low in the second month of the COVID-19 pandemic. In addition, people's mental state is affected by the geographical and temporal distributions.

The Family Health Scale: Reliability and Validity of a Short- and Long-Form

Families strongly influence the health of communities and individuals across the life course, but no validated measure of family health exists. The absence of such a measure has limited the examination of family health trends and the intersection of family health with individual and community health. The purpose of this study was to examine the reliability and validity of the Family Health Scale (FHS), creating a multi-factor long-form and a uniform short-form. The primary sample included 1,050 adults recruited from a national quota sample Qualtrics panel. Mplus version 7 was used to analyze the data using a structural equation modeling framework. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) confirmed a 32-item, 4-factor long-form scale. The four factors included (1) family social and emotional health processes; (2) family healthy lifestyle; (3) family health resources; and (4) family external social supports. A 10-item short-form of the FHS was also validated in the initial sample and a second sample of 401 adults. Both the long-form and short-form FHS correlated in the expected direction with validated measures of family functioning and healthy lifestyle. A preliminary assessment of clinical cutoffs in the short-form were correlated with depression risk. The FHS offers the potential to assess family health trends and to develop accessible, de-identified databases on the well-being of families. Important next steps include validating the scale among multiple family members and collecting longitudinal data.

Impact of house price growth on mental health: Evidence from China

Background

Housing boom has raised global attention in the past two decades. A number of studies attempted to analyse the effect of house price increase. However, little is known about the health consequence as a result of housing boom, likely due to the scarcity of the data. The objective of this paper is to investigate the relationship between housing affordability and mental health as a result of house price increase.

Methods

Based on a panel dataset of 32 Chinese cities from January 2013 to December 2017, we used a fixed effect model adjusting for per capita disposable income to estimate the impact of house price growth rate on mental health, and applied the Instrumental Variable (IV) method to address the endogeneity problem.

Results

From both Ordinary Least Squares (OLS) and IV estimations, the results suggested that a one standard deviation increase in house price increase rate in the past three months is associated with a 0.443 standard deviation increase in people consulting with doctors about their mental disorders in the city. This effect does not vary by gender, but was more pronounced in residents older than 40 years.

Conclusion

These results revealed the potential negative consequences in people's mental health due to house price increase, necessitate appropriate policy responses.

Deprivation is associated with anxiety and stress. A population-based longitudinal household survey among Chinese adults in Hong Kong

BACKGROUND

Mental illness is a major disease burden in the world and disproportionately affects the socially disadvantaged, but studies on the longitudinal association of poverty with anxiety and stress are rare, especially in Asia. Using data from Hong Kong, we aimed to (1) assess the cross-sectional association of poverty with anxiety and stress at baseline, and (2) to examine whether baseline poverty and change in poverty status over time are associated with a subsequent change in anxiety and stress.

METHODS

Data were obtained from two waves of a territory-wide longitudinal survey in Hong Kong, with sample sizes of n=1970 and n=1224 for baseline and follow-up, respectively. Poverty was measured with a Deprivation Index and income-poverty. Anxiety and stress symptoms were assessed using Chinese Depression, Anxiety and Stress Scale-21 Items. We conducted cross-sectional and longitudinal analyses on the association of poverty with anxiety and stress.

OUTCOMES

Deprivation, but not income-poverty, was significantly associated with both outcomes at baseline. Increased deprivation over time was associated with greater score and increased risk of anxiety and stress. Persistent deprivation over time was associated with greater anxiety and stress, and increased risk of incident anxiety.

INTERPRETATION

Deprivation could have significant independent effects on anxiety and stress, even after adjusting for the effects of income-poverty. Greater attention should be paid to deprivation in policymaking to tackle the inequalities of mental health problems, especially since stress and anxiety are precursors to more severe forms of mental illness and other comorbidities.

Relative deprivation, social exclusion, and quality of life among Chinese internal migrants

OBJECTIVES

Factors contributing to diminishing quality of life (QOL) of migrants have been examined, but little is known about the impact of relative deprivation. This study aimed to clarify the effects of relative deprivation on QOL and mediating effects of social exclusion among Chinese internal migrants.

STUDY DESIGN

This is a secondary data analysis of a nationally representative survey.

METHODS

We obtained data from 14,816 internal immigrants, aged 15-59 years, throughout China using the 2014 China Migrants Dynamic Survey (CMDS). We measured relative deprivation via a modified Yitzhaki Index, social exclusion using a four-point Likert scale, and QOL using the Kessler Psychological Distress Short Scale, the Satisfaction with Life Scale, and a subscale of the 36-item Short-Form Health Survey. Survey data of 15,996 local residents were also retrieved and analyzed to make possible comparisons between the local and migrant population. Furthermore, we used descriptive and statistical analyses with data from the CMDS to identify relative deprivation and social exclusion.

RESULTS

The results show relative deprivation both directly and indirectly influences Chinese internal migrants' QOL. Specifically, compared with the local population, relative deprivation triggers serious social exclusion (β = 0.008, P < 0.001), ultimately deteriorating QOL. Social exclusion partially mediated the total effects of relative deprivation on mental illness (β = 0.004, P < 0.001), self-rated health (β = -0.285, P < 0.001), and life satisfaction (β = -0.020, P < 0.001) among Chinese internal migrants.

CONCLUSION

Relative deprivation significantly impacts QOL by exacerbating mental illness, eroding self-rated health, and inhibiting life satisfaction. Relative deprivation is significantly directly associated with various indicators of QOL and indirectly affects QOL through social exclusion. In addition, our results demonstrate that the relative deprivation theoretical approach and the modified Yitzhaki Index are worthy of future investigation in studies of migrants' health.

The independent role of deprivation in abdominal obesity beyond income poverty. A population-based household survey in Chinese adults

BACKGROUND

Individual-level deprivation takes into account the non-monetary aspects of poverty that neither income poverty nor socio-economic factors could fully capture; however, it has rarely been considered in existing studies on social inequality in obesity. Therefore, we examined the associations of deprivation, beyond income poverty, with both general and abdominal obesity.

METHODS

A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed via face-to-face household interviews between 2014 and 2015. Deprivation was assessed by a Deprivation Index specific to the Hong Kong population. General obesity was defined as body mass index (BMI) ≥ 25 kg/m2, while abdominal obesity was defined as waist circumference (WC) ≥ 90 cm/80 cm for male/female. Multivariable binary logistic regressions were performed.

RESULTS

Deprivation was independently associated with abdominal obesity (odds ratios (OR) = 1.68; 95% confidence intervals (CI): 1.27-2.22); however, no significant association was found with general obesity (OR=1.03; CI: 0.77-1.38). After additional adjustment for BMI, deprivation remained strongly associated with abdominal obesity (OR=2.00; CI: 1.41-2.83); and after further adjustment for WC, deprivation had a marginal inverse association with general obesity (OR=0.72; CI: 0.51-1.01).

CONCLUSIONS

Deprivation is an important risk factor of abdominal obesity and plays a critical role in capturing the preferential abdominal fat deposition beyond income poverty.

Poverty and health-related quality of life: a cross-sectional study in rural China

BACKGROUND

The association between poverty and health has been widely assessed. However, whether the association between poverty and health-related quality of life (HRQOL) holds among different groups is unknown. This study aimed to 1) assess the association between poverty and HRQOL among rural residents in China and 2) examine whether the association holds among different populations, thereby supporting policy-making and implementation.

METHODS

A multistage, stratified, random household survey was conducted with self-administered questionnaires. Matched samples were generated by the censored exact matching method to reduce selection bias between the poverty and comparison groups. We applied Tobit and ordinal logit regression models to evaluate the association between poverty and HRQOL measured by the EQ-5D-3 L among different groups.

RESULTS

The health utility score of the poverty group was 6.1% lower than that of comparison group (95% CI = - 0.085, - 0.037), with anxiety/depression being most common (95% CI = 1.220, 1.791). The association between poverty and HRQOL was significantly stronger among residents from central China, males, people who were middle-aged, elderly, highly educated, married, or widowed, those living far from healthcare facilities, and those without chronic disease. Male and highly educated subjects reported worse mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions than the other respondents. Middle-aged (95% CI = 1.692, 2.851) and married respondents (95% CI = 1.692, 2.509) and respondents with chronic diseases (95% CI = 1.770, 2.849) were most affected in the anxiety/depression.

CONCLUSIONS

The HRQOL of individuals living in poverty is lower than that of the general population, and the mental health dimension is most affected by poverty among respondents who are middle-aged or married and respondents with chronic diseases. The identification of populations that are more affected by poverty is critical to improve their HRQOL. Various associations have indicated the need for integrated policies and specific decision-making.

Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong

BACKGROUND

Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong.

METHODS

Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism.

RESULTS

In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders.

CONCLUSIONS

The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.

Housing affordability effects on physical and mental health: household survey in a population with the world's greatest housing affordability stress

BACKGROUND

We examined the association of housing affordability with physical and mental health in Hong Kong, where there is a lack of related research despite having the worst housing affordability problem in the world, considering potential mediating effect of deprivation.

METHODS

A stratified random sample of 1978 Hong Kong adults were surveyed. Housing affordability was defined using the residual-income (after housing costs) approach. Health-related quality of life was assessed by the Short-Form Health Survey version 2 (SF-12v2), from which the physical component summary (PCS) and mental component summary (MCS) measures were derived. Multivariable linear regressions were performed to assess associations of housing affordability with PCS and MCS scores, adjusting for sociodemographic, socioeconomic and lifestyle factors. Mediation analyses were also conducted to assess the mediating role of deprivation on the effect of housing affordability on PCS or MCS.

RESULTS

Dose-response relationships were observed between housing affordability and mean PCS score (β (95% CI) compared with the highest affordable fourth quartile: -2.53 (-4.05 to -1.01), -2.23 (-3.54 to -0.92), -0.64 (-1.80 to 0.51) for the first, second and third quartiles, respectively) and mean MCS score (β (95% CI): -3.87 (-5.30 to -2.45), -2.35 (-3.59 to -1.11), -1.28 (-2.40 to -0.17) for the first, second and third quartiles, respectively). Deprivation mediated 34.3% of the impact of housing unaffordability on PCS and 15.8% of that on MCS.

CONCLUSIONS

Housing affordability affects physical and mental health, partially through deprivation, suggesting that housing policies targeting deprived individuals may help reduce health inequality in addition to targeting the housing affordability problem.

Comparing income poverty gap and deprivation on social acceptance: A mediation model with interpersonal communication and social support

In many developed countries or regions, wide income disparities increase the difficulty in reducing poverty. In their day‐to‐day lives, poor people often feel less accepted by the society. The failures in communicating with social groups and receiving social support lead to negative consequences on individual well‐being and higher level of social exclusion. Based on the debate upon alternative approaches to conceptualizing and operationalizing poverty, this study attempts to verify a mediation model with data from a household survey (N= 1,202) in Hong Kong. The results of structural equation modelling reveal that deprivation is a more powerful indicator than income poverty for specifying the negative relations of poverty with interpersonal communication, social support, and social acceptance; the negative impact of deprivation on social acceptance can be reduced by two significant mediators of interpersonal communication and social support. The results are discussed in terms of directions for future research and policy and welfare intervention.

Educational inequality in physician-diagnosed hypertension widened and persisted among women from 1999 to 2014 in Hong Kong

Gender differences in the trend of educational inequality in hypertension have been observed especially in the Asian populations, indicating the increasing importance of education as a social determinant of hypertension among women. This study examined the gender-specific trends of educational inequality in physician-diagnosed hypertension in Hong Kong between 1999 and 2014. Based on a series of eight government-led territory-wide household surveys conducted between 1999 and 2014, 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were analysed. The extent and trend of gender-specific educational inequality in self-reported physician-diagnosed hypertension were estimated by regression-based Relative Index of Inequality and age-standardised Slope Index of Inequality. Over the study period, age-standardised prevalence of self-reported hypertension increased in both genders, with the greatest prevalence among the least educated women. Educational inequalities in hypertension significantly widened in female from 1999 to 2009 and persisted thereafter; nonetheless, the respective inequality was negligible in male. Further adjustment for household income did not attenuate the observed inequality. To conclude, a widened and then persistent discrepancy in hypertension across education levels was observed among women, but not among men, in Hong Kong. The gender perspective should be carefully considered when designing hypertension prevention strategies and related health policies.

The Role of Individual and Neighborhood Characteristics on Mental Health after a Period of Economic Crisis in the Lisbon Region (Portugal): A Multilevel Analysis

Mental health is an intrinsic dimension of health influenced by individual and contextual factors. This cross-sectional study analyzes the association between the individual, neighborhood characteristics, and one’s self-assessed mental health status in the Lisbon region after an economic crisis. Via the application of multilevel regression models, the study assesses the link between one’s neighborhood environment—deprivation, low self-assessed social capital, and low self-assessed satisfaction with the area of residence—and mental health regardless of one’s individual characteristics. Constraints related to the economic crisis play an important role in the explanation of poor mental health.

Stacking Up With the Stars: Relative Deprivation and Excessive Admiration of Celebrities

The purpose of this study was to investigate whether celebrity admiration is associated with personal relative deprivation, impulsivity, and materialism. We gave the Celebrity Attitude Scale, the Personal Relative Deprivation Scale, the MacArthur Scale of Subjective Social Status, a subscale from the Consideration of Future Consequences-14, and the Material Values Scale, to 149 respondents recruited through Mechanical Turk. We found a weak but significant association between personal relative deprivation and celebrity attitudes. We successfully replicated earlier research showing that celebrity attitudes were positively correlated with material values and impulsivity. Personal relative deprivation also correlated positively with both material values and impulsivity. These findings suggest that the constructs of personal relative deprivation and celebrity attitudes appear to have much in common as both are associated with poor quality of life.