Effects of multidimensional child poverty on children's mental health in Mainland China

Estimating weight for multidimensional health poverty using Delphi method and analytic hierarchy process: a case of China

BACKGROUND

Traditionally, poverty assessment has relied on a single income criterion, which is inadequate in contexts where absolute poverty has been mitigated. This study developed a weighting scheme for the Multidimensional Health Poverty Index (MHPI) based on sustainable livelihood framework (SLF), aimed at enhancing the accuracy of poverty identification in China.

METHODS

A two-round Delphi process was used to determine the indicators of the index system. The weight of each indicator was calculated using the analytic hierarchy process (AHP) method. The multidimensional poverty index incorporates SLF's five dimensions: financial, natural, physical, social, and human capital.

RESULTS

The initial 46 indicators formed an indicator pool for the Delphi questionnaire. Based on the final consensus of the expert panel, the Delphi consultation resulted in an index system comprising six first-level and 23 second-level indicators. The weight values of the first-level indicators (economic security, health status, education, social capital, healthcare utilisation, and living conditions) were 0.2715, 0.2593, 0.0855, 0.0657, 0.1812, and 0.1363, respectively.

CONCLUSION

This study established a scientific and effective index to evaluate generate weight for estimating multidimensional health poverty in China. Economic security, health status, and healthcare utilisation are the most crucial aspects of multidimensional health poverty. Moreover, the results indicated that vocational training and social capital should be emphasised.

The Association between Perceived Family Financial Stress and Adolescent Suicide Ideation: A Moderated Mediation Model

Nowadays, suicide (especially adolescents' suicide) has been an increasingly prominent social problem worldwide; suicide ideation, as an important predictor, has been the focus of relevant studies and practices. Against this background, the present study aimed to examine the association between perceived family financial stress and adolescents' suicidal ideation, as well as the potential roles of depression and parent-child attachment. A sample of 526 junior middle school students was recruited voluntarily to participate in this cross-sectional study, and the results indicated that the prevalence of suicidal ideation among junior high school students was 15.45%; perceived family financial stress was positively associated with suicidal ideation, and depression could significantly mediate this relation; parent-child attachment significantly moderated the mediating effect of depression (in particular, the relation between depression and suicidal ideation); specifically, this relation was stronger among adolescents with lower values of parent-child attachment. These findings could deepen our understanding of the influences of perceived family financial condition and the risky factors of adolescents' suicidal ideation, which could provide guidance for the prevention and intervention of adolescents' depression and suicidal ideation.

War exposure, post-traumatic stress symptoms and hair cortisol concentrations in Syrian refugee children

Altered secretion of cortisol, the primary effector of the hypothalamus-pituitary-adrenal axis, has been proposed as a means by which traumatic experiences compromise later mental health. However, despite the popularity of cortisol as a potential biomarker for stress and adversity, findings are inconsistent, and little is known about the impact of war-related trauma on stress physiology of children and adolescents. Here we aimed to evaluate the relationships between war exposure, current living conditions, hair cortisol concentrations (HCC) and post-traumatic stress disorder (PTSD) symptoms in a large cohort of Syrian refugee children and adolescents (6-18 years) and their caregiver. This longitudinal observational study assessed Syrian refugee children and adolescents in two waves, 1 year apart, within informal tented settlements in Lebanon. The relationships between war exposure, time since leaving Syria, PTSD symptoms and HCC were investigated using linear mixed-model regression utilising both waves of data collected (Y1: N = 1574, Y2: N = 923). Hair cortisol concentration was positively, but weakly associated with the number of war-related events experienced. This was limited to those who were at least 12 years old at the time of war exposure. Conversely, HCC decreased with time since leaving Syria. HCC was also associated with PTSD symptoms but not with the quality of their current living conditions. This study revealed that changes to hypothalamic-pituitary-adrenal axis activity may accompany both earlier war exposure and current PTSD symptoms in children and adolescents. Additionally, early adolescence may be a particularly sensitive time in terms of trauma-related changes to the hypothalamic-pituitary-adrenal axis.

The relationship between multidimensional poverty, income poverty and youth depressive symptoms: cross-sectional evidence from Mexico, South Africa and Colombia

Whereas monetary poverty is associated with increased risk of depressive symptoms in young people, poverty is increasingly understood as a multidimensional problem. However, it is yet to be understood how the associations between different dimensions of poverty and youth mental health differ across countries. We examine the relationship between multidimensional, as well as income poverty, and depressive symptoms in young people (age 11-25 years) across three middle-income countries. Based on harmonised data from surveys in Colombia, Mexico and South Africa (N=16 173) we constructed a multidimensional poverty index that comprised five deprivations We used Poisson regression to examine relationships between different forms of poverty with depressive symptoms across the countries. Multidimensional poverty was associated with higher rates of depressive symptoms in the harmonised dataset (IRR (incidence rate ratio)=1.25, 95% CI 1.10 to 1.42), in Mexico (IRR=1.34, 95% CI 1.11 to 1.64) and Colombia (IRR=2.01, 95% CI 1.30 to 3.10) but not in South Africa, a finding driven by a lack of associations between child labour and health insurance coverage with depressive symptoms. There was only an association with income poverty and depressive symptoms in South Africa, not in Colombia or Mexico. Depressive symptoms were associated with individual deprivations such as school lag, child labour and lack of access to health services in the harmonised dataset, but not with household deprivations, such as parental unemployment and housing conditions, though the opposite pattern was observed in South Africa. Our findings suggest that the importance of specific dimensions of poverty for mental health varies across countries, and a multidimensional approach is needed to gain insights into the relationship between youth depression and poverty.

The mediating effect of self-esteem on the relationship of living environment, anxiety, and depression of underprivileged children: A path analysis in Chinese context

This study aimed to explore the relationships of living environment, self-esteem, anxiety, and depression of children in poverty. A sample of 1314 children (grades 4–9) was collected by a school-based survey in Xiushui city, Mainland China. Structural equation modeling was adopted to analyze the data and verify the hypothesized model. Results showed that living environment was negatively correlated with poor children’s anxiety and depression levels, and self-esteem had a mediating effect on the relationship between living environment and the mental health of underprivileged children. Based on these findings, we proposed relevant theoretical and practical implications.

Development and validation of the Stressful Experiences in Transit Questionnaire (SET-Q) and its Short Form (SET-SF)

Background: Previous studies have demonstrated that traumatic experiences from countries of origin (so-called pre-migratory factors), as well as stressors in countries of destination (so-called post-migratory factors), are related to the extent of mental health difficulties and psychological well-being of refugees. However, numerous risks that this population is exposed to during transit have so far been neglected. Objective: The aim of this research was to construct and validate a questionnaire for assessing stressful and traumatic experiences in transit as well as its short form, which would at the same time provide information on one's stressful experiences as well as existing risks that refugees are exposed to on their journey. Method: The study was realized in three phases - item construction, item revision and instrument validation. In the validation phase, a total of 226 refugees completed the Stressful Experiences in Transit Questionnaire (SET-Q), along with Harvard Trauma Questionnaire (HTQ) Parts I and IV, Hopkins Symptom Checklist-25 (HSCL-25) and Beck Depression Inventory - II (BDI-II). Results: Refugees were exposed to an average of 13 stressful events during transit. SET-Q total score was positively correlated with HTQ Part IV Post-Traumatic Stress Disorder (PTSD) and Self-Perception of Functioning scales (SPFS) while the number of stressful experiences with the local population was positively related to BDI-II depression symptoms. Moreover, SET-Q scores were significant predictors of PTSD and SPFS even after traumatic experiences in the country of origin, assessed by HTQ Part I, were taken into account. A short form of the questionnaire (SET-SF) has also been developed. Conclusions: SET-Q is a valid instrument for measuring the scope of stressful experiences refugees have been exposed to during transit, targeted for this population specifically. Furthermore, SET-SF has the potential to assess the same extent of stressful experiences with a significantly reduced number of items.

The longitudinal associations among grandparent-grandchild cohesion, cultural beliefs about adversity, and depression in Chinese rural left-behind children

This study examined the effects of grandparent-grandchild cohesion on the cross-lagged associations between depression and cultural beliefs about adversity in a sample of 625 rural left-behind children in China. Grandparent-grandchild cohesion was concurrently and longitudinally associated with children's depression and cultural beliefs about adversity. Cultural beliefs about adversity mediated the associations between grandparent-grandchild cohesion and children's depression, while depression mediated the associations between grandparent-grandchild cohesion and children's beliefs about adversity. Left-behind status differences were also found in mediation models. These findings suggest the important role of grandparent-grandchild cohesion in left-behind children's adjustment.

Young people with left-behind experiences in childhood have higher levels of psychological resilience

This study investigated the development of psychological capital and its relationship with adult attachment in Chinese college students with left-behind experiences in childhood. The results show that the psychological capital of left-behind experiences in childhood was moderate, and their self-efficacy, optimism, hope, and overall psychological capital were significantly lower than those without left-behind experiences. However, their psychological resilience was remarkably higher than the latter. As for adult attachment, their attachment anxiety and attachment avoidance were also remarkably higher. The findings suggest that left-behind experiences impaired the development of the emotional-motivation system of left-behind experiences in childhood, but facilitated the development of their survival-protection system.

The mediating effect of self-esteem on the relationship of living environment, anxiety, and depression of underprivileged children: A path analysis in Chinese context

This study aimed to explore the relationships of living environment, self-esteem, anxiety, and depression of children in poverty. A sample of 1314 children (grades 4-9) was collected by a school-based survey in Xiushui city, Mainland China. Structural equation modeling was adopted to analyze the data and verify the hypothesized model. Results showed that living environment was negatively correlated with poor children's anxiety and depression levels, and self-esteem had a mediating effect on the relationship between living environment and the mental health of underprivileged children. Based on these findings, we proposed relevant theoretical and practical implications.