Relationship between wealth and emotional well-being before, during, versus after a nationwide disease outbreak: a large-scale investigation of disparities in psychological vulnerability across COVID-19 pandemic phases in China

Abstract

Objectives: This research investigated whether certain population segments might be more psychologically vulnerable in different phases of a pandemic. Specifically, the research examined how disparities in wealth might be associated with differences in emotional well-being before, during, versus after the nationwide COVID-19 outbreak in China.

Setting, participants and outcome measures: In this large-scale cross-sectional study, three rounds of nationally representative data collection (N=27 760) were conducted immediately before (December 2019), in the midst of (February 2020), versus immediately after (April 2020) the countrywide COVID-19 outbreak in China. Participants' emotional well-being, wealth (income, property ownership) and demographic information were measured using established instruments. Statistical analyses examined relationships between disparities in different types of wealth and emotional well-being across the pandemic phases.

Results: Although the onset of the coronavirus outbreak substantially degraded emotional well-being, having a higher income was associated with better emotional well-being during the outbreak. Property owners experienced a larger drop in emotional well-being during the outbreak than non-owners; however, the former was not emotionally worse off than the latter during the outbreak. After the nationwide COVID-19 outbreak had been contained and the economy reopened, those with more wealth of either type again became better off in emotional well-being than those with less. The highest income segment even experienced better emotional well-being after the end of the nationwide outbreak than prior to the outbreak. In contrast, the lowest income segment became worse off in emotional well-being after the nationwide outbreak ended than before the outbreak began.

Conclusion: People with less wealth tend to be emotionally worse off throughout the different phases of a disease outbreak. In particular, even after an outbreak has been contained, the poor are less able to restore their psychological well-being. Policies and interventions are needed to address disparities in mental health in the age of pandemics.

Keywords: COVID-19; health economics; mental health; public health.