The interconnected nature of poverty and mental disorder – and how to break them apart

Introduction

Can having pockets of cash buy one’s happiness? Upon inspection of the inverse relationship between poverty and mental well-being, it seems that this age-old question may bear some slight truth.

Poverty, described fundamentally as a condition in which one’s ‘family income fails to meet a federally established threshold’ (Unesco), forms a more tangled reality than just financial dearth. Often, it is accompanied by a host of impediments to an enjoyable quality of life – such as those regarding housing, education, and particularly to our interest, mental health. Mental disorder, in turn, is characterized by behavioural and psychological patterns associated with present distress or disability (DSM-IV). We see this manifested in abnormal thoughts, behaviour, emotions, and moods which can affect one’s livelihood. It is straightforward to imagine poverty being correlated with a higher prevalence of mental disorder, but in which direction does this relationship flow? And more importantly, why should we care?

The nature of the relationship between poverty and mental disorders

A fair amount of medical research has suggested that low socioeconomic status is intimately linked to the prevalence of mental disorders (Weich and Lewis (1998); Butterworth (2009)). The bidirectional aspect of this association has been proposed to consist of two parts: social causation and social selection. Social causation, as its name suggests, explains mental disorder as a consequence of low socioeconomic status. It can be summarised to attribute economic stress, brought on by poverty, unemployment or housing unaffordability, as the most significant cause. Social selection explains the flipped side of the relationship, where low socioeconomic status is a consequence of mental disorder. Related hospitalisations and loss of work often accompany mental disorder, whereas genetic predispositions of the disorder may also contribute to low socioeconomic status across generations (poverty cycle).

Local relevance and possible resolutions

With around 1 in 7 Hong Kong citizens living in poverty (14.3%), this issue is highly relevant to us and those within our community. A local survey has confirmed that participants who are unemployed, live in public housing and said they have financial difficulties are more likely to suffer from common mental disorders (especially depression) than their financially stable counterparts. The same study also found that participants suffering from common mental disorders had ‘impaired psychosocial functioning, poor quality of life, higher physical health burden and aversive socioeconomic situations’, which evidently hints at the poverty-mental disorder association’s bidirectional nature.

It is necessary to tackle the tie between poverty and mental disorder. Like any other illness, mental disorder takes a toll on our day-to-day lives. Interpersonal relationships involving family, close friends and colleagues can be adversely affected; discrimination, social stigma and job performance are only a few of the struggles a patient may face. Perhaps the most compelling reason to battle this challenge of all, however, is that mental disorder can be treated.

Studies suggest to approach this issue by reducing poverty. Government policies regarding improvements in distribution of income and income gap may ameliorate the socioeconomic status of those living with extreme financial stress. Alternatively, the focus can be shifted to reduction of mental disorder incidence. Rectification in the accessibility to psychiatric healthcare is one option, but advocacy of stress reduction techniques (exercise, mindfulness) can be a simple and effective line of action as well.

Conclusion

The interrelationship of poverty and mental disorder burdens the everyday lives of a significant portion of our community. It therefore rests that we must commit to abolishing the unfair cycle so that each member of society can have access to what Mandela once described as the most fundamental human right – ‘the right to dignity and a decent life’ (qtd. In ‘In pursuit of dignity’).

Author: Heidi Chen 

 

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