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J Child Fam Stud

DOI 10.1007/s10826-017-0960-9


Understanding the Relationship between Poverty and Children’s

Mental Health in Poverty-Stricken Area of China: Social
Causation or Social Selection?
Chunkai Li ●
Shan Jiang1 Xican Yin1

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Abstract This study aimed to explore the relationship 2014). Meanwhile, mental illness, which can reduce indi-
between poverty and children’s mental health in the social vidual abilities or even lead to disability and suicide, is also
context of China. Data were consisted of 1314 children, regarded as a global problem (World Health Organization
which were collected with a multi-stage cluster random 2012). The negative correlation between poverty and chil-
sampling method in Xiushui, a typical poverty city in dren’s mental health (Perna et al. 2010; Wickham et al.
China. Structural equation modeling was adopted to test the 2016) has been certified by numerous studies, whereas the
hypothesized model. Results showed that both social cau- causality between them remains inconclusive.
sation model and social selection model could explain the The causal relationship between poverty and mental
relationship between poverty and children’s mental health in health can be explained by social causation and social
Mainland China. The implications of these findings on selection theories. The former argues that mental health
theory and social work services were also discussed. problems are the result of socioeconomic deprivation
(Dohrenwend and Dohrenwend 1969). Accordingly, poverty,
Keywords Social causation Social selection Poverty
● ● ●
as an important indicator of socioeconomic status, can lead to
Mental health Children

individual psychological problems through life adversity
(McLaughlin et al. 2011; Reiss 2013). On the contrary, social
selection theory, also known as the downward drift hypoth-
esis, illustrates that mental illness and psychological pro-
blems result in low socioeconomic status (Eaton 1980).
Based on different perspectives, the two theories above
Introduction can be used to explain the relationship between poverty and
children’s mental health with the support of abundant
To date, the global problem of child poverty has continued empirical research (McLaughlin et al. 2011; Wickham et al.
to exist. According to United Nations Children’s Fund 2016). Numerous empirical studies have supported the
(UNICEF), approximately 77 million children live in pov- rationality of social causation theory by suggesting that
erty, and worse, the rate of child poverty increased by over poverty negatively impacts children’s mental health (Davis
50% in some countries (UNICEF 2016). A survey of the et al. 2010; Hanandita and Tampubolon 2014). Children
nutritional status of impoverished children in Gansu (China) living in poverty are more likely to suffer from mental
revealed that 36% of children still experienced hunger health problems than those from affluent families (Melchior
because of inadequate food and money (Hannum et al. et al. 2010).
The negative impact of poverty on children’s mental
health was also proved from a dynamic aspect. For exam-
* Chunkai Li ple, Fitzsimons et al. (2017) suggested that long-term
poverty significantly influenced children’s mental health.
School of Social and Behavioral Sciences, Nanjing University, Such a conclusion has been verified by Wickham et al.
Nanjing, China (2016) who demonstrated that children who moved into
J Child Fam Stud

poverty are more likely to suffer from social, emotional, and The research gap existing in current knowledge is that
behavioral problems. most studies were conducted in Western countries. How-
To make matters worse, childhood poverty has a long- ever, relevant research in the context of Mainland China has
term impact on the different stages of individual life, as been rarely investigated. There were few studies verifying
proven by McLaughlin et al. (2011), who used 5692 the relationship between poverty and mental health with
nationally representative samples to analyze the impact of quantitative research methods in China. To fill in the
childhood poverty on the mental health of individuals at knowledge gap in the Chinese context, the current research
different periods of life. Their results showed that the eco- aimed to: (1) investigate the poverty and mental health
nomic difficulties experienced in childhood led to poor condition of Chinese children, (2) explore the relationship
mental disorders, such as anxiety, as well as mood, beha- between poverty and children’s mental health, and (3) test
vioral, and substance disorders in childhood, adolescence, whether social causation and social selection theory can
early adulthood, and mid-later adulthood. Similarly, Kim explain the relationship between poverty and children’s
et al. (2015) indicated that child poverty was associated mental health in the Chinese context.
with stress disorder, which could then lead to externalized
and internalized psychological problems in their later life.
Compared with social causation theory, fewer empirical Method
studies have been published in support of social selection
theory. The effect of mental health on poverty is a com- Participants
plicated, long-term dynamic process that includes various
mechanisms, such as education attainment and work abil- The data used in this study were collected by conducting a
ity (Cardano et al. 2004; Das et al. 2007; De et al. 2012). school-based survey in 2015 through a multi-stage cluster
Although conducting a longitudinal study is difficult, random sampling method in Xiushui, a poverty-stricken city
mental illness has been proven to be associated with in Mainland China. A total of 1440 children were selected
poverty by existing studies (Chatterjee 2009; Li et al. from 36 classes of 12 schools selected from two townships
2012). For instance, Kleinman and Hall–Clifford (2009) in Xiushui. 1364 students were involved as participants, and
claimed that mental illness is the leading cause of disability the effective response rate was 96.3%. Of all the partici-
and poverty. Similarly, Fone et al. (2013) showed that pants, 585 (44.5%) were male and 729 (55.5%) were
income deprivation can be regarded as a main risk result of female. The entire descriptive statistical results of social
mental problems and disorders. In addition, we are unable demographic variables are presented in Table 1.
to ignore social selection theory because the adverse
impacts of mental health problem on poverty can last Procedure
through a lifetime, suggesting that children’s mental health
problem can lead to declined competitiveness, professional Before the formal survey, the participants were asked
status, and income, until they finally drift down into whether they were willing to participate in the investigation.
poverty in their adulthood (Wadsworth and Achenbach Their parents would be informed and sign the consent form
2005). if the participants were involved in the survey. Respondents
Overall, both interpretations of social causation and were required to complete the self-reported questionnaire
social selection theories rationally explain the relationship independently. If they had any misunderstanding during the
between poverty and children’s mental health. It is seemed completing process, they could consult the investigators on
that social causation theory and social selection theory is the spot. We handed out 1440 questionnaires based on the
opposite in the cross-sectional study. However, social sampling produce.
causality and social selection are not mutually exclusive The steps of the multi-stage cluster random sampling
during one’s dynamic life course (Reiss 2013). Furthermore, method are as follows. First, based on the economic rank-
poverty and mental health would interact during one’s life ings (i.e., good, medium, and poor) provided by the statis-
course. In particular, poverty will lead to the formation of tical department, we selected two townships in each given
psychological problems in early childhood, reflecting the category, thus six townships were chosen randomly in
process of social causation. The mental health problems of Xiushui City. Second, one primary school and one junior
poor children would continue into adulthood, which will high school were randomly selected in each township. As a
lead to their low competitiveness in the labor market and result, six primary schools and six junior high schools were
result in lower socioeconomic status, finally drifting down extracted. Third, 1 class was chosen in each grade (grade
into poverty again in adulthood. This dynamic process 4–6 in primary school and grade 7–9 in junior high school)
reflects the social selection theory (Melchior et al. 2012; randomly. Finally, 40 students in each class were selected
Wadsworth and Achenbach 2005). randomly. Thus, a total of 1440 children were selected to
J Child Fam Stud

Table 1 Sociodemographic characteristics (N = 1314) esteem and self-efficacy. The measurement of children’s self-
Frequency (N) Percentage (%) esteem was mainly based on Rosenberg’s Children’s Self-
Esteem Scale (Rosenberg 1965), which was a 10-items scale
with 5-point scoring, from “very nonconforming” to “very
Male 585 44.5
consistent”. Previous studies showed the high validity and
Female 729 55.5
reliability of the Chinese version of CSES (Ren and Ye 2009).
Grade 4 227 17.3
The Cronbach’s alpha of CSES was 0.695 in our study.
Grade 5 211 16.1 Children’s self-efficacy was mainly identified by utilizing
Grade 6 229 17.4 the Chinese version of General Self-Efficacy Scale devised
Grade 7 233 17.7 by Schwarzer (1993). It includes a total of 10 items with 5
Grade 8 190 14.5 points for each item. The Chinese version of GSES indi-
Grade 9 224 17.0 cated good internal consistency and validity (Wang et al.
Education level (father) 2001; Hu et al. 2014). The Cronbach’s alpha was 0.793 in
Illiterate 213 16.2 our study.
Primary school 336 25.6 Negative mental health was mainly measured on the
Junior high school 374 28.5 basis of children’s anxiety and depression. Children’s
Senior high school and above 70 5.4 anxiety was quantified by using the Social Anxiety Scale for
Education level (mother) Children, which was developed by Greca and Lopez (1998).
Illiterate 241 18.3 Li et al. (2006) have already proved that the Chinese ver-
Primary school 350 26.6 sion of SASC has good reliability and validity. The Cron-
Junior high school 298 22.7 bach’s alpha was 0.783 in our study.
Senior high school and above 55 4.2 Children’s depression was evaluated on the basis of the
Occupation (father)
Center for Epidemiologic Studies Depression Scale for
Civil servants 39 3.0
Children (Fendrich et al. 1990). Many studies showed that
Business affairs 184 14.0
the Chinese version of CDI had good reliability and valid-
Migrant worker 767 58.4
ity, and was suitable for domestic use on Chinese children
Farmer 221 16.8
(Wu et al. 2010; Yu and Li 2000). The Cronbach’s alpha
Retirement 5 0.4
was 0.837 in our study.
Unemployment 74 5.6
Multidimensional child poverty was considered a pov-
Occupation (mother)
Civil servants 43 3.3
erty concept based on the seven dimensions of children’s
Business affairs 127 9.7
deprivation: food, water, hygienic facilities, health care,
Migrant worker 630 47.9 housing, education, and information. According the depri-
Farmer 229 17.4 vation of multidimensional child poverty measurement, the
Retirement 12 0.9 scores in each deprivation dimension were added to calcu-
Unemployment 251 19.1 late the level of multidimensional child poverty. The
Single-parent status obtained child deprivation scores exhibited a normal dis-
Yes 102 7.8 tribution with a mean of 0.287 and a standard error of 0.167.
No 1177 89.6 The social-demographic variables controlled in this study
Left-behind status comprised gender, grade, parent’s education level, parent’s
Yes 625 47.6 occupation, single-parent status, left-behind status and region
No 670 51.0 type. Gender (female = 1), grade (4th–9th), single-parent
status (yes = 0 vs. no = 1), left-behind status (yes = 0 vs no
= 1) and region type (good = 0 vs. medium = 1 vs. poor = 2)
form the sample in our study. The research process, the
were self-explanatory. Parent’s education level was assessed
investigation of informed consent and measurement tools
in four categories ranging from “Illiterate” to “senior high
have been reviewed and approved by the Ethics Committee
school and above”. Parent’s occupation was reflected by six
of the Chinese University of Hong Kong.
categories, including “civil servants”, “business affairs”,
“migrant worker”, “farmer”, “retirement” and “unemployment”.
Data Analyses
The measurement of mental health were mainly divided into
positive mental health and negative mental health. Positive Structural equation model was adopted with Amos 21.0 to
mental health was determined in terms of children’s self- analyze the data and test the model. The analyses included
J Child Fam Stud

two stages. First, the measurement model was tested via Test of Structural Model
confirmatory factor analysis (CFA). In the next stage,
structural model was verified to examine whether the Model 1: Social causation model
research hypotheses could be empirically supported. The
goodness-of-fit indices were the main points in the eva- Social Causation Model reflects the causality between
luation of the data to the hypothesized model. In this study, poverty and children’s mental health. In this study, all the
χ2, CFI and RMSEA were used to evaluate the modeling control variables, latent variables and other observed vari-
fitness: (1) χ2. The smaller χ2 indicates that the theoretical ables are incorporated into the structural equation model to
model is more suitable for the actual data, and the non- verify the structural model through Amos 21.0.
significant (P > 0.05) χ2 indicates that the theoretical model Despite the chi-square value was large and significant,
is well fitted to the sample data (Bollen 1989). However, the mainly on account of its sensitivity to large sample size (N
χ2 is very sensitive to the size of sample. The larger the = 1314), other goodness-of-fit indices demonstrated satis-
sample size is, the more likely that χ2 is significant, resulting fying results: CFI (0.989) was above 0.90, and RMSEA
in the theoretical modeling being rejected. Therefore, if the (0.034) was lower than 0.05. In other words, the structural
sample size is large, it would be difficult to test the degree model provides a good fit to the data (χ2 = 53.516, df = 21,
of modeling fitness by the χ2 (Byrne 2001). (2) CFI. The p < 0.001). A total of 12.8% of the negative mental health
value of CFI is between 0 and 1, and the value above 0.9 (anxiety and depression) and 5.0% of the positive mental
indicates that the model is good (Bentler 1990). (3) health (self-esteem and self-efficacy) were explained by this
RMSEA. Value below 0.05 indicates that the model is close model respectively.
to fit (Kline 2005). The standardized solution for the test of the structural
model is presented in Fig. 1. Poverty has a significant
positive predictive effect on negative mental health of
children, indicating that higher levels of poverty were
Results associated with higher negative mental health score of
children, which is reflected on the higher level of anxiety
Test of Measurement Model and depression (β = .238, p < 0.001). Likewise, poverty
also has a significant negative predictive effect on positive
Before the structural model validation, the verification mental health of children (β = −155, p < 0.001), the higher
model of the two latent variables, including negative mental the children’s poverty index is, the lower the positive mental
health and positive mental health, should be performed first. health scores of the children are. That is, poverty reduced
The results show that the measurement model has a good fit children’s self-esteem and self-efficacy.
(χ2 = 7.880, df = 3, p = 0.049, CFI = 0.996, RMSEA = Among the social-demographic control variables, only
0.035) with CFI greater than 0.90 and RMSEA smaller than two of them (gender and grade) have a significant influence
0.05. All the observed variables in the model that make up on children’s negative mental health outcomes, indicating
the latent variable are significant loading on the latent that female children (β = .059, p < 0.05) and higher grades
variable. The value of the standard factor loading for all the children (β = .226, p < 0.001) have higher levels of anxiety
observed variables constituting the latent variable is and depression. However, the others (parental education,
between 0.457 and 0.993 (see Table 2) and the acceptable parental occupation, single-parent, left-behind and region)
factor load is 0.3 or more (Agnew 1991). Thus the observed have no remarkable effect on negative mental health of
variables effectively reflect the intrinsic structure of the children. Also, the factor loadings of them are lower. Only
latent variables, indicating that the model is better fitted. grade and region have a significant effect on the positive
mental health of children, indicating that higher grades
children (β = −.149, p < 0.001) and poorer region children
Table 2 Standard factor loading of all the observation variables that
make up the latent variable
Variable Factor loading

Negative mental health

Anxiety 0.613
Depression 0.993
Positive mental health
Self-esteem 0.975
Self-efficacy 0.457 Fig. 1 Standardized solutions for the structural model of poverty and
children’s mental health (***p < 0.001)
J Child Fam Stud

(β = .074, p < 0.01) have lower self-esteem and self- grade, parental education, mother’s occupation and single-
efficacy outcomes. At the same time, the others (gender, parent) have no significant influence on children’s poverty
parental education, parental occupation, single-parent and conditions, and their factor loadings are relatively low.
left-behind) have no significant influence on positive mental
health of children. Also, the factor loadings of them are
relatively low. Discussion

Model 2: Social selection model This study aimed to validate the applicability of social
causation and social selection theories in the context of
The social selection model reflects the impact of children’s Mainland China. Based on data of 1314 impoverished
mental health effects on poverty. This model validates all children in the poverty-stricken city of Xiushui, this study
the control variables, latent variables and the observed explored the relationship between poverty and children’s
variables into the structural equation model for structural mental health. Our findings were interpreted in details and
model validation, of which goodness-of-fit indices demon- the theoretical and practical implications were suggested.
strate satisfying results, with CFI (0.989) higher than 0.90 First, the social causation model was established to
and RMSEA (0.034) lower than 0.05. Even if the chi square investigate the effect of poverty on children’s mental health.
value is large and significant, given its sensitivity to large Our study showed that poverty has a significant impact on
sample size (N = 1314), the social selection model yields a children’s negative and positive mental health. This finding
good fit to the data (χ2 = 53.516, df = 21, < 0.001). A total is consistent with previous researches, which suggested
of 9.1% of poverty was explained by this model. poverty was a cause of mental health problems among
The standardized results of the structural model of chil- children, such as anxiety and depression (Davis et al. 2010;
dren’s positive and negative mental health impact on pov- Flouri and Sarmadi 2016). Therefore, the model of social
erty are shown in Fig. 2. For simplicity, the graph only causality theory is applicable to poor children in the Chi-
shows the relationship between the independent variable nese context.
and the dependent variable, without the control variable. Second, we established the model based on social
Considering the relevant path coefficient in the figure and selection theory to test the impact of children’s mental
its significance, negative mental health of children has a health on poverty. We found that only the negative psy-
significant positive predictive effect on poverty (β = .237, p chological health of children has a significant impact on
< 0.001), indicating that the higher the negative mental poverty. The predictive role of children’s positive mental
health outcomes of children are, the poorer the children are health in poverty remains unremarkable. This result is
after controlling other variables. In other words, children partially consistent with those reported by existing empiri-
with higher levels of anxiety and depression are often cal studies. Although studies on the influence of children’s
accompanied with higher levels of poverty. However, there mental health on poverty have been relatively limited, some
is not a significant correlation between children’s positive works demonstrated that low mental health of children led
mental health and poverty, namely, the role of self-esteem to their poverty status (Kleinman and Hall–Clifford 2009;
and self-efficacy in poverty prediction is not obvious. Li et al. 2012).
Among the social-demographic control variables, three Third, although the theoretical models of social causality
of them (father’s occupation, left-behind and region) have a and social selection theories have been established, the
remarkable effect on children’s poverty outcomes, sug- explanations of the two theoretical models remain different.
gesting that lower salary of father’s work (β = .125, p < In the model of social causality theory, the impacts of
0.001), left-behind children (β = −.062, p < 0.05) and poverty on both negative and positive mental health are
poorer region children (β = .099, p < 0.001) have higher significant, with an overall model interpretation rate of
levels of poverty outcomes. However, the others (gender, 17.8%. In the model of social selection theory, only
negative mental health has a significant effect on poverty,
and the overall model interpretation rate is only 9.1%.
Therefore, even though the interpretation rate between the
two models was different, both social causality and
social selection theories were supported by empirical evi-
dence in our study. Consequently, it was possible that an
interaction effect existed, which supported the two
models concurrently. That is, poverty led to adverse mental
Fig. 2 Standardized solutions for the structural model of children’s health outcome, and thereby induced high level of poverty
mental health and poverty (***p < 0.001) in turn.
J Child Fam Stud

Implications Compliance with Ethical Standards

Conflict of Interest The authors declare that they have no compet-

On the theoretical level, the main findings of this study have ing interests.
responded to the controversy over social causality and
social selection theories. First, we verified the relationship Ethical Approval All procedures performed in studies involving
between poverty and children’s mental health in the Chinese human participants were in accordance with the ethical standards of
the Chinese University of Hong Kong and with the 1964 Helsinki
context. Furthermore, we analyzed the applicability and declaration and its later amendments or comparable ethical standards.
feasibility of social causality and social selection theories on
the relationship between poverty and mental health, which Informed Consent Informed consent was obtained from all indivi-
helped fill the knowledge gap in the Chinese academia. The dual participants included in the study.
results also provided a feasible theoretical analysis frame-
work by which to study the relationship between poverty
and mental health in other groups.
On the practical level, our results provide important References
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