Stressors of Low-income Parents in Hong Kong – A Cross-sectional Study

Abstract

Introduction: Economic hardship predisposes to parental stress, family problems and consequent ill health of both parents and children. Identification of modifiable stressors is crucial to promote health of low-income parents. This cross-sectional study aims to explore the association between personal, child and family factors and stress among lowincome parents in Hong Kong. Methodology: 217 low-income parent-child pairs were recruited from two less affluent districts in Hong Kong between March 2016 and October 2017. Face-to-face interviews were conducted. Stress-subscale of Depression-Anxiety-Stress-Scale21(DASS-21) was used to measure parental stress. Depression level was assessed by Patient-Health-Questionnaire9(PHQ-9). Child behavioral problems were evaluated by Strength-and-Difficulties-Questionnaire(SDQ). Socioeconomic confounders and potential family factors contributing to parental stress were collected: household income, education, employment and marital status, presence of intimate partner abuse assessed by Abuse-AssessmentScreen-5(AAS-5), family harmony by Family-Harmony-Scale-5(FHS-5), parenting style by Authoritative-ParentingStyle-subscale of Parenting-Style-and-Dimension-Questionnaire(PSDQ), social cohesion by NeighbourhoodCollective-Efficacy-Scale(NCES), and parent-child conflict tactics by Child-Physical-Assault-and-Neglect-subscale of the Conflict-Tactics-Scale-for-Parent-and-Child-Scale(CTSPC). Results: 38 parents experienced stress (i.e.DASS≥8), who were significantly more likely to be single parent (39.5%vs.19.0%,p=0.004), victim of intimate partner abuse (26.3%vs.8.4%,p=0.002) and depressed (27.0%vs.4.8%,p<0.001), suffer from mental illness (26.3%vs.5.6%,p<0.001) and have child with behavioural problems (mean SDQ-score(SD):15.47(6.54)vs.9.32(5.30),p<0.001). Family harmony (mean FHS-5-score(SD):17.22(4.91) vs.19.81(2.91),p<0.001) and neighbourhood support (mean NCES-score(SD):29.83(7.46)vs.33.46(7.56),p=0.010) were significantly lower among stressed parents. They were also more likely to physically punish (mean PhysicalAssault-subscale (SD):3.74(5.34)vs.1.92(2.79),p=0.005) or neglect (mean Neglect-subscale (SD):7.51(8.84) vs.3.39(4.80),p<0.001) their children. After adjusting for covariates, personal history of mental illness (Odds Ratio(OR)=10.91,p=0.010), child behavioral problem (Odds Ratio(OR)=1.16,p=0.005), authoritarian parenting style (Odds Ratio(OR)=0.94,p=0.049) and child neglect (Odds Ratio(OR)=1.24,p=0.010) were significantly associated with parental stress. Conclusions: Personal mental illness, child behavior and parenting style (i.e. authoritarian style and neglect) were significantly associated with parental stress. Bi-directional and causal relationship between parental stress and these factors should be further explored in order to develop an optimal intervention to reduce stress of the low-income parents.