Mechanisms connecting objective and subjective poverty to mental health: Serial mediation roles of negative life events and social support

Abstract

Background: Mental health and poverty remain pressing global challenges yet, their relationship has been neglected by international development policies, even in high income societies. This study aims to investigate the relationship between objective/subjective poverty and mental health and its potential mechanism. Methods: A population-based data including 1,605 household heads extracted from the Hong Kong Panel Survey for Poverty Alleviation in 2015 were used. Multiple linear regression was conducted to examine the associations among poverty, negative life events, social support and mental health. Serial multiple mediation models were analyzed by the bootstrapping method to assess whether negative life events and social support mediate the relationship between objective/subjective poverty and mental health. Results: Subjective and objective poverty were significantly associated with higher risks of negative life events, less social support and mental distress (p < 0.001). Negative life events and social support in serial partially mediated the relationship between subjective poverty and mental health (total effect: Standardized β = 0.41,Standardized SE = 0.05, β = 2.07, 95% CI [1.59, 2.55]; total direct effect: Standardized β = 0.26, Standardized SE = 0.04, β = 1.34, 95% CI [0.86, 1.81]; total indirect effect: Standardized β = 0.14, Standardized SE = 0.04, β = 0.73, 95% CI [0.51,0.97]). By contrast, even though the total direct effect of objective poverty on mental distress was not statistically significant (Standardized β = 0.08, Standardized SE = 0.05, β = 0.41, 95% CI [-0.12, 0.94]), this relationship was also mediated by negative life events and social support (total effect: Standardized β = 0.21, Standardized SE = 0.06, β = 1.08, 95% CI [0.52, 1.65]; total indirect effect: Standardized β = 0.13, Standardized SE = 0.02, β = 0.67, 95% CI [0.43, 0.92]). Conclusions: Social support including informational, instrumental and financial could be effective buffers that confer resilience against the negative effects of poverty and adverse life events on mental health. In addition, reducing perceived poverty seemed to be more effective in improving mental health compared to the objective poverty alleviation, and further research are needed to confirm this conclusion. © 2020