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Deprivation is associated with anxiety and stress. A population-based longitudinal household survey among Chinese adults in Hong Kong
  1. Roger Yat-Nork Chung1,2,
  2. Michael Marmot2,3,
  3. Jonathan Ka-Long Mak1,4,
  4. David Gordon5,
  5. Dicken Chan1,
  6. Gary Ka-Ki Chung1,2,
  7. Hung Wong2,6,
  8. Samuel Y S Wong1,2
  1. 1 JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
  2. 2 CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong
  3. 3 Department of Epidemiology and Public Health, UCL, London, UK
  4. 4 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  5. 5 University of Bristol School for Policy Studies, Bristol, UK
  6. 6 Department of Social Work, The Chinese University of Hong Kong, Hong Kong
  1. Correspondence to Roger Yat-Nork Chung, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China; rychung{at}


Background Mental illness is a major disease burden in the world and disproportionately affects the socially disadvantaged, but studies on the longitudinal association of poverty with anxiety and stress are rare, especially in Asia. Using data from Hong Kong, we aimed to (1) assess the cross-sectional association of poverty with anxiety and stress at baseline, and (2) to examine whether baseline poverty and change in poverty status over time are associated with a subsequent change in anxiety and stress.

Methods Data were obtained from two waves of a territory-wide longitudinal survey in Hong Kong, with sample sizes of n=1970 and n=1224 for baseline and follow-up, respectively. Poverty was measured with a Deprivation Index and income-poverty. Anxiety and stress symptoms were assessed using Chinese Depression, Anxiety and Stress Scale—21 Items. We conducted cross-sectional and longitudinal analyses on the association of poverty with anxiety and stress.

Outcomes Deprivation, but not income-poverty, was significantly associated with both outcomes at baseline. Increased deprivation over time was associated with greater score and increased risk of anxiety and stress. Persistent deprivation over time was associated with greater anxiety and stress, and increased risk of incident anxiety.

Interpretation Deprivation could have significant independent effects on anxiety and stress, even after adjusting for the effects of income-poverty. Greater attention should be paid to deprivation in policymaking to tackle the inequalities of mental health problems, especially since stress and anxiety are precursors to more severe forms of mental illness and other comorbidities.

  • Poverty
  • Deprivation
  • Stress
  • Mental health
  • Health inequalities

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  • Contributors All authors contributed to the write-up of the manuscript. Additionally, RYC oversaw the research, and was responsible for the study design, data collection, data analysis and data interpretation; MM, JKM, DG and DC contributed to the data analysis and interpretation; GKC contributed to the literature review and data interpretation; HW and SYSW contributed to the study design, data collection and data interpretation.

  • Funding Fully supported by Central Policy Unit of the Government and the Research Grants Council of the Hong Kong SAR, China (Project No. 4003-SPPR-11).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement The data that support the findings of this study are available on request from the corresponding author, RYC. The data are not publicly available due to containing information that could compromise the privacy of research participants.

  • 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.