Elsevier

Psychiatry Research

Volume 200, Issues 2–3, 30 December 2012, Pages 917-920
Psychiatry Research

Association between poverty and psychiatric disability among Chinese population aged 15–64 years

https://doi.org/10.1016/j.psychres.2012.05.026Get rights and content

Abstract

Psychiatric disability is an important public health problem in China, and poverty may be positively correlated with disability. Little study in the existing literatures has explored the contribution of poverty to the psychiatric disability among Chinese population. Using a nationally representative data, this paper aims to investigate the association between poverty and psychiatric disability in Chinese population aged 15–64 years. We used the second China National Sample Survey on Disability, comprising 1.8 million people aged 15–64 years. Identification and classification for psychiatric disability was based on consensus manuals. We used standard weighting procedures to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted numbers, weighted proportions, and the adjusted Odd Ratios (OR) were calculated. For people with psychiatric disability aged 15–64 years, more than 4 million were below the poverty level in China. After controlling for other demographic variables, poverty was found to be significantly associated with psychiatric disability (OR=2.25, 95% Confidence Interval (CI) 2.15–2.35). Given China is undergoing rapid social-economic transition and psychiatric diseases become a leading burden to the individuals, community, and health care systems, poverty reduction programs are warranted to prevent psychiatric disability and/or improve the lives for persons with psychiatric disability.

Introduction

Poverty may be positively correlated with disability (Elwan, 1999, Wittenburg and Favreault, 2003, Yeo and Moore, 2003, US Census Bureau, 2004, Hoogeveen, 2005). In the United States (US), approximately 12% of disability-free persons were living below the poverty level, whereas poverty was over-presented among disabled population, i.e., 14% of those mildly disabled and 24% of those severely disabled were living below poverty level (US Census Bureau, 2004). In developing countries, approximately 10% of the overall population were disabled and about 20% of the people living below poverty level were disabled (Braithwaite and Mont, 2009). In China, the most populous country in the world, there were about 25 million disabled persons living below the poverty level in 1998 (China Disabled Persons' Federation, 1998). Poverty related indicators such as inadequate income to purchase basic life necessities, malnutrition, lack of health care access, more risky physical working environment, and residing in polluted environment may contribute to elevated risk of disability (Elwan, 1999). On the other hand, disability may increase the exposure to negative living stress, social deprivation, and insufficient treatment of illness, thus result in poverty (Elwan, 1999, Druss et al., 2000). However, this poverty–disability circle has been largely overlooked in the population health agenda especially in developing countries.

In China, psychiatric disability accounts for approximately 9% of all disabilities (Zheng et al., 2011). The World Health Organization also indicated that psychiatric diseases had become one of the most important causes of disease burden in China, which would account for one fifth of the total disease burden by 2020 (National Bureau of Statistics of China, 2007, Phillips, 2004). Given China is undergoing rapid social and economical transitions, there is a need to describe the role of poverty in psychiatric disability so as to inform future prevention and rehabilitation strategies.

In this study, using the nationally representative data from the second China National Sample Survey on Disability conducted in 2006 (Zheng et al., 2011), we aimed to provide a social-demographic snapshot for persons with psychiatric disability and investigate the association between poverty and psychiatric disability in Chinese population aged 15–64 years. We hypothesized that poverty was correlated with psychiatric disability in Chinese population. The findings may increase understanding of the role of poverty in relation with psychiatric disability and facilitate initiatives to improve strategy and policy making to combat psychiatric disability.

Section snippets

Study population and sampling

This study was derived from a national representative population-based data of the second China National Sample Survey on Disability conducted in 2006. This national survey aimed to describe the prevalence and causes of disability, and to explore the characteristics of people with disabilities in China, which cover all provincial administrative areas in mainland China excluding Hong Kong, Macau, and Taiwan. Multistage stratified and clustering sampling scheme was used in the survey and sampling

Study population characteristics

The study population comprises a weighted estimate of 6.7 million persons aged 15–64 years suffering with psychiatric disability. Less than half (41.0%) of those without disability were below the poverty level, compared with 64.3% of those with psychiatric disability were below the poverty level (Table 1).

Psychiatric disability among people aged 15–64 years

Schizophrenia, schizotypal and delusional disorders accounted for 58.9% (weighted n=3.9 million) of all the psychiatric disability, followed by organic mental disorders (weighted n=0.9

Discussion

Consistent with the other studies (Elwan, 1999, Hitchen, 2006, Lustig and Strauser, 2007; Lund et al., 2010), this study indicates that poverty was positively correlated with psychiatric disability in China's setting. Filling the existing knowledge gap in the Chinese literatures, this is the first study demonstrating the association between poverty and psychiatric disability in Chinese population aged 15–64 years. Although some mental health impairments may not be identifiable, the use of

Acknowledgments

This study was supported by the State Key Development Program of Basic Research of China973 (no. 2007CB511901), Yang Zi Program of MOE, State Key Funds of Social Science Project (Research on Disability Prevention Measurement in China, no. 09&ZD072). WD is supported by an NHMRC exchange program.

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