The effect of disparity between the rich and poor on the psychological well-being of Hong Kong Chinese children : a survey study

Abstract

Background: The problem of poverty in Hong Kong is worsening, particularly the disparity between the rich and poor. Although much of the public concern about this problem has concentrated on the physical development of children, the effect of disparity between the rich and poor on their psychological well-being remains relatively underexplored. A review of the literature revealed that most studies on the psychological effect of disparity between the rich and poor have been conducted in Western countries only. This study aimed to bridge this gap. Its objectives were (1) to compare the self-esteem, depressive symptoms and quality of life (QoL) of children from low- and high-income families, (2) to identify the socioeconomic and demographic characteristics affecting the psychological well-being of children, (3) to compare the livelihoods of children from low- and high-income families, and (4) to examine the effectiveness of adventure-based programme in promoting the psychological well-being of children living in poverty. Methods: This study consisted of a survey study and a pilot RCT. The survey study was conducted in 12 primary schools from the three highest and the three lowest median household income districts. A total of 1,725 children were recruited, with 898 from low-income families and 827 from high-income families. The self-esteem, depressive symptoms and QoL of them were assessed and compared. Additional 42 children were chosen to have semi-structured interviews. As for the pilot RCT, it was conducted in two primary schools in Kwai Chung Estate. A total of 120 children were recruited, of whom 56 were randomly assigned to the experimental group to receive adventure-based programme and 64 to the control group to have placebo programme. Results: For the survey study, the results showed that the children from low-income families scored significantly lower on self-esteem and QoL, and higher on depressive symptoms than the children from high-income families. Moreover, the disparity between the rich and poor was found to have the greatest impact on children's self-esteem. Regression analyses showed that housing type made the largest contribution to children's self-esteem, depressive symptoms and QoL. Additionally, the daily lives of children from low-income families were seriously affected in terms of living environment, physical health, social lives and ability to function at school. Concerning the pilot RCT, mixed between-within subjects ANOVA showed that the children in experimental group scored significantly lower on depressive symptoms and higher self-esteem than those in control group. However, such a significant effect was not found on QoL. Conclusion: The survey study provides further evidence that disparity between the rich and poor has a negative effect on children's psychological well-being. Additionally, the pilot RCT demonstrated the effectiveness of adventure-based programme in promoting the psychological well-being of children living in poverty. Implications for practice: It is vital for healthcare professionals to develop and implement appropriate interventions that promote the psychological well-being of this vulnerable group. Moreover, healthcare professionals should go beyond their normal roles to build multidisciplinary partnerships with schools and the community to promote psychological well-being among children living in poverty.