CHAPTER ONE
BACKGROUND TO THE STUDY
1.1 Introduction
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
