Mental Health and Health-related Quality of Life of Low-Income Families in Hong Kong

Abstract

Introduction: The growing prevalence of mental health problems in Hong Kong warrants a better understanding of its underlying factors. Poverty is a known significant social determinant of mental health and health-related quality of life (HRQoL), with wide-ranging effects across the life course. This systematic review aimed to appraise the literature on the mental health and HRQoL of low-income families in Hong Kong. Methodology: Original pieces of research conducted in Hong Kong that examined low-income populations and assessed mental health or HRQoL were identified according to PRISMA guidelines. PubMed, PsycINFO and SCOPUS were searched using controlled keywords, including (1)‘low-income’, ‘poverty’ or ‘socioeconomic’, (2)‘Hong Kong’ and (3)‘mental health’, ‘depression’, anxiety’, psychosocial’, ‘domestic violence’ or ‘health-related quality of life’. Results: 543 studies were identified, 88 were screened, and 14 were included (4 cohort studies and 10 cross-sectional studies). Children in poverty experience more anxiety and depression, lower psychological wellbeing and reduced happiness. Poverty negatively affects self-rated health and HRQoL in adults, with having income <50% of HK household median as the threshold for impairment. In particular, low-income mothers have lower HRQoL, which is shown to have spillover effects in their children, who then have more behavioural problems and experience worse physical and psychosocial health. Furthermore, low socioeconomic-status and living-alone is significantly associated with geriatric depression, which is expected to increase with the rapidly ageing population and growing elderly population living in poverty. Conclusions: Low-income populations across all age-groups in Hong Kong experience worse mental health, and HRQoL. Primary care doctors should be better equipped to manage mental and psychosocial health issues of low-income groups, including depression and loneliness in elderly, anxiety/depression in children, HRQoL and intimate partner abuse, which has spillover effects in children and may contribute to intergenerational poverty. This can improve accessibility of mental health services in the community and reduce stigma of seeking help.