Associations of deprivation and income-poverty with anxiety and stress among Hong Kong adults: a longitudinal household survey.

objectivesTo explore the cross-sectional and longitudinal associations of poverty, assessed by deprivation index (DI) and income, with anxiety and stress among adults

designLongitudinal cohort observational study

settingA cohort of adults established in 2014-2015 (T1) in Hong Kong.

participants493 participants (177 men, median age 56 years) were followed up in the third wave of household survey in 2021-2022 (T3).

main outcome measuresSelf-reported equivalised household income and DI, measured as material and social deprivation, were recorded. Anxiety and stress were assessed using the Depression, Anxiety and Stress Scale-21 items (Chinese) version.

resultsBeing deprived in T3 is significantly associated with higher anxiety and stress score in T3 as compared with being non-deprived cross-sectionally. Income status did not show significant association with anxiety and stress score cross-sectionally in T3. Increased deprivation status since baseline is significantly associated with higher anxiety and stress score in T3 than persistent non-deprivation. Being able to afford one less basic necessity throughout T1-T3 is significantly associated with 0.31-unit higher anxiety score (95% CI 0.18 to 0.45) and 0.36-unit higher stress score (95% CI 0.18 to 0.55) across time.Subgroup analyses further showed that income-poor younger adults aged less than 60 years tended to have higher anxiety and stress scores than their non-income-poor counterparts in the same age group in T3 cross-sectionally. Younger adults with occasional non-income-poverty throughout T1-T3 also had higher anxiety and stress scores in T3 than persistently non-income-poor younger adults. This relationship of income-poverty with anxiety and stress was not significant among older adults aged 60 years or above.

conclusionsIndividual deprivation and increased deprivation over time were associated with higher anxiety and stress scores in T3 cross-sectionally and longitudinally respectively. Young adults' anxiety and stress scores tended to be more affected by income-poverty than their older counterparts. Nevertheless, sample attrition may occur as a proportion of participants dropped out throughout the 7 years of follow-up.Age-specific poverty measurement tools may be developed to assess the age-specific standard of living. Policymakers may consider deprivation, in addition to income, as well as change in poverty status, in healthcare and social welfare policymaking to better address the mental health of the population and health inequality in the region.