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Socioeconomic inequality in mental well-being associated with COVID-19 containment measures in a low-incidence Asian globalized city.

ABSTRACT: The COVID-19 pandemic exposes and amplifies pre-existing inequalities even in places with relatively well-controlled outbreaks such as Hong Kong. This study aimed to explore whether the socioeconomically disadvantaged fare worse via various types of worry in terms of their mental health and well-being. Between September and October 2020, 1067 adults in Hong Kong were recruited via a cross-sectional population-wide telephone survey. The inter-relationship between deprivation, types of worry, mental health disorders, and subjective well-being was assessed using structural equation modelling. Results showed significant total effects of deprivation on worries about being infected (p = 0.002), economic activities and livelihood (p < 0.001), and personal savings (p < 0.001), as well as mental health disorders (p < 0.001) and subjective well-being (p < 0.001). Specifically, worry about economic activities and livelihood partly mediated the total effect of deprivation on mental health disorders (p = 0.004), whereas worry about personal savings and worry about economic activities and livelihood partially mediated the total effect of deprivation on subjective well-being (p = 0.007 and 0.002, respectively). Socioeconomic inequality, particularly in mental health and well-being, could be exacerbated via people's economic concerns during the pandemic, which was largely induced by the COVID-19 containment measures rather than the pandemic per se given the relatively low COVID-19 incidence in Hong Kong.

SUBMITTER: Chung RY

PROVIDER: S-EPMC8633192 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundWe aimed to explore socioeconomic inequality, health inequity, and the well-being of transgender people during the COVID-19 crisis in Nigeria.MethodsBetween June and December 2021, a cross-sectional survey was conducted collaboratively with community-based organisations in Nigeria. Participants living with or at risk of HIV were recruited voluntarily, online and face-to-face, using a combination of venue-based and snowball sampling. We assessed the association between gender identity (transgender and vulnerable cisgender women), and (i) socioeconomic inequality measured with socioeconomic status, social status, economic vulnerability, macrosocial vulnerability; (ii) health inequity measured with self-assessment of health, recency of HIV test, access to HIV and sexual and reproductive health services, gender-affirming care, financial and non-financial barriers to accessing health services; and (iii) well-being, measured with gender-based violence, mental health, psychoeconomic preferences. We used multivariable logistic regressions and controlled for interactions and confounders.ResultsThere were 4072 participants; 62% were under 30, and 47% reported living with HIV. One in ten (11.9%; n = 485) was transgender, and 56.5% reported living with HIV. Compared to vulnerable cisgender women, the results showed significantly higher odds (aOR:3.80) of disruption in accessing HIV services in transgender participants; gender-based violence (aOR:2.63); severe (aOR:2.28) symptoms of anxiety and depression. Among the barriers to accessing health and HIV services, transgender had three-time higher odds of reporting additional non-official fees compared to vulnerable cisgender women. The disclosure of their gender identity or sexual orientation was the most important non-financial barrier to accessing health services (aOR:3.16). Transgender participants faced higher housing insecurity (aOR: 1.35) and lower odds of using drugs (aOR:0.48). Importantly, they are more likely to have performed a recent HIV test and less likely to not know their HIV status (aOR:0.38) compared to vulnerable cisgender women.ConclusionsSocioeconomic inequality, health and well-being inequity in transgender people appear to be exacerbated by the COVID-19 pandemic in Nigeria. Interventions are necessary to mitigate socioeconomic challenges, address structural inequality, and ensure equitable access to health services to meet the Sustainable Development Goals for transgender people.

Project description:Background: Subjective well-being refers to the extent to which a person believes or feels that her life is going well. It is considered as one of the best available proxies for a broader, more canonical form of well-being. For over 30 years, one important distinction in the conceptualization of subjective well-being is the contrast between more affective evaluations of biological emotional reactions and more cognitive evaluations of one's life in relation to a psychologically self-imposed ideal. More recently, researchers have suggested the addition of harmony in life, comprising behavioral evaluations of how one is doing in a social context. Since measures used to assess subjective well-being are self-reports, often validated only using Classical Test Theory, our aim was to focus on the psychometric properties of the measures using Item Response Theory. Method: A total of 1000 participants responded to the Positive Affect Negative Affect Schedule. At random, half of the participants answered to the Satisfaction with Life Scale or to the Harmony in life Scale. First, we evaluate and provide enough evidence of unidimensionality for each scale. Next, we conducted graded response models to validate the psychometric properties of the subjective well-being scales. Results: All scales showed varied frequency item distribution, high discrimination values (Alphas), and had different difficulty parameters (Beta) on each response options. For example, we identified items that respondents found difficult to endorse at the highest/lowest point of the scales (e.g., "Proud" for positive affect; item 5, "If I could live my life over, I would change almost nothing," for life satisfaction; and item 3, "I am in harmony," for harmony in life). In addition, all scales could cover a good portion of the range of subjective well-being (Theta): -2.50 to 2.30 for positive affect, -1.00 to 3.50 for negative affect, -2.40 to 2.50 for life satisfaction, and -2.40 to 2.50 for harmony in life. Importantly, for all scales, there were weak reliability for respondents with extreme latent scores of subjective well-being. Conclusion: The affective component, especially low levels of negative affect, were less accurately measured, while both the cognitive and social component were covered to an equal degree. There was less reliability for respondents with extreme latent scores of subjective well-being. Thus, to improve reliability at the level of the scale, at the item level and at the level of the response scale for each item, we point out specific items that need to be modified or added. Moreover, the data presented here can be used as normative data for each of the subjective well-being constructs.

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Socioeconomic inequality in mental well-being associated with COVID-19 containment measures in a low-incidence Asian globalized city.

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