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THE IMPACT
OF SOCIO-ECONOMIC STATUS ON MENTAL HEALTH
CHAPTER
ONE
INTRODUCTION
Background
of the study
Mental
health, health status and socioeconomic status are important determinants of an
individual’s wellbeing. There are thought to be important interactions between
these dimensions of wellbeing, with causal links running in both directions.
Poor health and poor mental health can reduce earnings ability, through their
effects on education and employment, and poverty can lead to lower educational
attainment, poorer physical health and depression (Ardington and Case, 2010).
Das et al.
(2007) examine the correlates of mental health in five developing countries,
finding that being older, female, widowed, and in poor physical health are
consistently related to poorer mental health outcomes. However, their reading
of their evidence on the relationship between socio-economic status (SES) and
mental health is mixed. They find education to be positively associated with
better mental health in a majority (but not all) of the countries that they
study. Witoelar et al (2009) analyse data from the fourth wave of the
Indonesian Family Life Survey and find that education is protective against
depression among Indonesians aged 45 and older but, controlling for education,
they find no association between per capita expenditure and mental health for
this group.
A survey of
11 smaller community based studies in six low and middle income countries finds
a negative association between education and common mental disorders in all but
one study (Patel and Kleinman 2003). Results for other indicators of
socioeconomic status such as employment and income were more mixed. In two
localized South African studies, Case and Deaton (2009) find different aspects
of SES protect in different ways: in their sites, education appears to protect
health status, but has little effect on anxiety or depression, while assets
protect against depression, but not against poor health.
One of the
most consistent findings in the study of mental health in both developed and
developing countries is that the risk of depression increases with age. Although
the relationship between socioeconomic status and mental health has received
considerable attention in the literature, particularly among the elderly, there
is very little research that directly addresses whether the correlates of
depression change as people grow older (Ardington and Case, 2010).
Considerable
and growing evidence shows that mental health and many common mental disorders
are shaped to a great extent by social, economic and environmental factors. A
review of global evidence by Patel et al (2010) for the WHO Commission on
Social Determinants of Health reported convincing evidence that low
socioeconomic position is systematically associated with increased rates of
depression. Gender is also important, mental disorders are more common in
women, they frequently experience social, economic and environmental factors in
different ways to men.
Taking
action to improve the conditions of daily life from before birth, during early
childhood, at school age, during family building and working ages, and at older
ages provides opportunities both to improve population mental health and reduce
the risk of those mental disorders that are associated with social
inequalities. While comprehensive action across the life course is needed,
scientific consensus is considerable that giving every child the best possible
start will generate the greatest societal and mental health benefits (WHO,
2014).
The
prevalence and social distribution of mental disorders has been reasonably well
documented in high-income countries. While there is growing recognition of the problem
in low- and middle-income countries, a significant gap still exists in research
to measure and describe the problem, and in strategies, policies and
programmes to prevent mental disorders. There is a considerable need to raise
the political, and strategic priority given to the prevention of mental
disorders and to the promotion of mental health through action on the social
determinants of health (WHO, 2014).
1.2 Statement of the Problem
Socioeconomic
status is one of the most prominent environmental risk factors of mental
health. People with high income, occupational status, and education tend to be
happier and less likely to suffer from depression and other psychiatric
disorders than people with low socioeconomic status (Clark, Frijters, & Shields,
2008; Lorant et al., 2003). In other words, income appears to be important for
subjective well-being insofar as it helps people to satisfy their basic
material needs but becomes less crucial beyond this point (Clark et al., 2008).
People with
mental disorders, such as schizophrenia, bipolar disorder and depression are
far more likely than the general population to die as a consequence of their
untreated mental or physical health problems (WHO, 2008, Roshanaei and Katon,
2009). For example, people with schizophrenia and major depression have an
overall increased risk of mortality 1.6 and 1.4 times, respectively, greater
than for the general population, and people with schizophrenia have two- to
three-fold higher mortality rates compared with the general population
corresponding to 10-25-year reductions in life expectancy (Laursen et al.,
2012).
One of the
most striking reasons for higher mortality rates among people with mental
disorders is the inequitable care and treatment that these individuals receive
for both mental and physical illnesses. Between 75% and 85% of people with
severe mental disorders are unable to access the treatment they need for their
mental health problem in LMICs, compared with 35% and 50% of people in
high-income countries (Demyttenaere, 2004; OECD, 2012).
Mental
disorders have diverse and far-reaching social impacts, including homelessness,
higher rates of imprisonment, poor educational opportunities and outcomes, lack
of employment and limited income-generating opportunities. Moreover, the
stigma, myths and misconceptions surrounding mental illness are the root cause
of much of the discrimination and human rights violations experienced by people
with mental disabilities on a daily basis (Baldwin and Marcus, 2011).
People with mental
disorders are at much higher risk of descending into poverty than other people.
They may not be able to work because of their illness. If employed, their
illness may result in more sick days or reduced productivity, in turn reducing
income, promotion chances, entitlements to employment-related pensions or
health insurance coverage (Ssebunnya et al., 2009, Thornicroft et al., 2009).
It this against this backdrop that this study examines the impact of low
socio-economic status on mental health with special reference to Oto-Awori
Local Council Development Area of Lagos State (LCDA).
1.3 Objective of the Study
The general
objective of this study is to explore the impact of low socio-economic status
on mental health. Other specific objectives of this study are to:
a.To examine
the effect of low socioeconomic status on psychiatric disorders
b.To assess
the relationship between standard of living and discrimination against the
poor.
c.To
investigate the link between low socioeconomic status and homelessness in
Oto-Awori LCDA.
.To find out
the health implications of living in low socioeconomic status.
1.4 Research Questions
The
undertaking of this research project will beam a searchlight on the following
research questions;
1. What is the effect of low socioeconomic
status on psychiatric disorders?
2. What is the relationship between standard
of living and discrimination against the poor?
3. What is the link between low
socioeconomic status and homelessness in Oto-Awori LCDA?
4. What are the health implications of
living in low socioeconomic status?
1.5 Research Hypotheses
The
researcher intends to test the following hypotheses at 0.05 level of
significance:
Hypothesis
one:
H0: There is no significant effect of low
socioeconomic status on psychiatric disorders.
H1: There is a significant effect of low
socioeconomic status on psychiatric disorders
Hypothesis
Two:
H0: There is no significant relationship
between standard of living and discrimination against the poor
H1: There is a significant relationship
between standard of living and discrimination against the poor
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