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Socioeconomic determinants of depression amid the anti-extradition bill protests in Hong Kong: the mediating role of daily routine disruptions
  1. Francisco Tsz Tsun Lai1,
  2. Brian J Hall2,
  3. Li Liang3,
  4. Sandro Galea4,
  5. Wai Kai Hou3,5
  1. 1 The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China
  2. 2 Department of Psychology, University of Macau, Macau SAR, China
  3. 3 Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
  4. 4 School of Public Health, Boston University, Boston, Massachusetts, USA
  5. 5 Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
  1. Correspondence to Wai-Kai Hou, Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China; wkhou{at}


Background Previous research has suggested a socioeconomic gradient of mental health in the face of potentially traumatic events. Nevertheless, few studies examined the intermediary mechanisms of this gradient. This study tested a hypothesised mediating effect of disruptions to daily routines (eg, eating/sleeping habits) between socioeconomic status (SES) and depression among participants and non-participants of the anti-extradition bill protests in summer 2019 in Hong Kong.

Methods A territory-wide telephone survey was conducted during the movement in the first 3 weeks of July 2019 to collect self-report data from 1112 Cantonese-speaking Hong Kong citizens. Stratified by participation in the anti-extradition bill protests, logistic regression was conducted to examine the inverse relationship between SES and depression. Subsequently, path analysis was conducted to test the hypothesised indirect effect through daily routine disruptions.

Results In total, 581 (52.2%) respondents participated in the anti-extradition bill protests. Logistic regression showed that higher educational attainment was protective of depression among both participants and non-participants, while the protective effect of household income level HK$40 000–HK$79 999 (compared with <HK$20 000) was only observed among participants. Path analysis showed that 50.3% of the socioeconomic gradient was explained by daily routine disruptions among participants, compared with 8.3% among non-participants.

Conclusions Daily routine disruptions partially explain the association between low SES and depression, especially among participants of the anti-extradition bill protests. To improve population mental health, such disruptions should be mitigated.

  • Depression
  • Health inequalities
  • Mental health
  • Psychological stress
  • Social science

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  • Contributors FTTL designed the study, planned and conducted the statistical analysis, drafted the initial manuscript, and reviewed and revised the manuscript. LL contributed to the study design and statistical analysis plan, conducted the statistical analysis, and reviewed and revised the manuscript. BJH and SG contributed to the study design and statistical analysis plan, and reviewed and revised the manuscript. WKH conceptualised and designed the study, obtained funding, oversaw the statistical analysis and initial manuscript draft, and reviewed and revised the manuscript. All authors have read and approved the final manuscript.

  • Funding This work was supported by Internal Research Grant (RG84/2018-2019R), The EdUHK, and Public Policy Research Funding Scheme (Special Round), Policy Innovation and Co-ordination Office, The Government of the HKSAR, Hong Kong SAR, China (Wai-Kai Hou).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study has been approved by the Ethics Committee of the Education University of Hong Kong (Ref: 2018-2019-029).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available from the corresponding author on request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.