J Child Fam Stud
DOI 10.1007/s10826-017-0960-9
ORIGINAL PAPER
Understanding the Relationship between Poverty and Children’s
Mental Health in Poverty-Stricken Area of China: Social
Causation or Social Selection?
1
Chunkai Li ●
Shan Jiang1 Xican Yin1
●
© Springer Science+Business Media, LLC, part of Springer Nature 2017
Abstract This study aimed to explore the relationship
between poverty and children’s mental health in the social
context of China. Data were consisted of 1314 children,
which were collected with a multi-stage cluster random
sampling method in Xiushui, a typical poverty city in
China. Structural equation modeling was adopted to test the
hypothesized model. Results showed that both social cau-
sation model and social selection model could explain the
relationship between poverty and children’s mental health in
Mainland China. The implications of these findings on
theory and social work services were also discussed.
Keywords Social causation Social selection Poverty
● ●
Mental health Children
●
Introduction
To date, the global problem of child poverty has continued
to exist. According to United Nations Children’s Fund
(UNICEF), approximately 77 million children live in pov-
erty, and worse, the rate of child poverty increased by over
50% in some countries (UNICEF 2016). A survey of the
nutritional status of impoverished children in Gansu (China)
revealed that 36% of children still experienced hunger
because of inadequate food and money (Hannum et al.
* Chunkai Li
njuckli@nju.edu.cn
1
School of Social and Behavioral Sciences, Nanjing University,
Nanjing, China
2014). Meanwhile, mental illness, which can reduce indi-
vidual abilities or even lead to disability and suicide, is also
regarded as a global problem (World Health Organization
2012). The negative correlation between poverty and chil-
dren’s mental health (Perna et al. 2010; Wickham et al.
2016) has been certified by numerous studies, whereas the
causality between them remains inconclusive.
The causal relationship between poverty and mental
health can be explained by social causation and social
selection theories. The former argues that mental health
problems are the result of socioeconomic deprivation
(Dohrenwend and Dohrenwend 1969). Accordingly, poverty,
●
as an important indicator of socioeconomic status, can lead to
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
can be used to explain the relationship between poverty and
children’s mental health with the support of abundant
empirical research (McLaughlin et al. 2011; Wickham et al.
2016). Numerous empirical studies have supported the
rationality of social causation theory by suggesting that
poverty negatively impacts children’s mental health (Davis
et al. 2010; Hanandita and Tampubolon 2014). Children
living in poverty are more likely to suffer from mental
health problems than those from affluent families (Melchior
et al. 2010).
The negative impact of poverty on children’s mental
health was also proved from a dynamic aspect. For exam-
ple, Fitzsimons et al. (2017) suggested that long-term
poverty significantly influenced children’s mental health.
Such a conclusion has been verified by Wickham et al.
(2016) who demonstrated that children who moved into

poverty are more likely to suffer from social, emotional, and
behavioral problems.
To make matters worse, childhood poverty has a long-
term impact on the different stages of individual life, as
proven by McLaughlin et al. (2011), who used 5692
nationally representative samples to analyze the impact of
childhood poverty on the mental health of individuals at
different periods of life. Their results showed that the eco-
nomic difficulties experienced in childhood led to poor
mental disorders, such as anxiety, as well as mood, beha-
vioral, and substance disorders in childhood, adolescence,
early adulthood, and mid-later adulthood. Similarly, Kim
et al. (2015) indicated that child poverty was associated
with stress disorder, which could then lead to externalized
and internalized psychological problems in their later life.
Compared with social causation theory, fewer empirical
studies have been published in support of social selection
theory. The effect of mental health on poverty is a com-
plicated, long-term dynamic process that includes various
mechanisms, such as education attainment and work abil-
ity (Cardano et al. 2004; Das et al. 2007; De et al. 2012).
Although conducting a longitudinal study is difficult,
mental illness has been proven to be associated with
poverty by existing studies (Chatterjee 2009; Li et al.
2012). For instance, Kleinman and Hall–Clifford (2009)
claimed that mental illness is the leading cause of disability
and poverty. Similarly, Fone et al. (2013) showed that
income deprivation can be regarded as a main risk result of
mental problems and disorders. In addition, we are unable
to ignore social selection theory because the adverse
impacts of mental health problem on poverty can last
through a lifetime, suggesting that children’s mental health
problem can lead to declined competitiveness, professional
status, and income, until they finally drift down into
poverty in their adulthood (Wadsworth and Achenbach
2005).
Overall, both interpretations of social causation and
social selection theories rationally explain the relationship
between poverty and children’s mental health. It is seemed
that social causation theory and social selection theory is
opposite in the cross-sectional study. However, social
causality and social selection are not mutually exclusive
during one’s dynamic life course (Reiss 2013). Furthermore,
poverty and mental health would interact during one’s life
course. In particular, poverty will lead to the formation of
psychological problems in early childhood, reflecting the
process of social causation. The mental health problems of
poor children would continue into adulthood, which will
lead to their low competitiveness in the labor market and
result in lower socioeconomic status, finally drifting down
into poverty again in adulthood. This dynamic process
reflects the social selection theory (Melchior et al. 2012;
Wadsworth and Achenbach 2005).
J Child Fam Stud
The research gap existing in current knowledge is that
most studies were conducted in Western countries. How-
ever, relevant research in the context of Mainland China has
been rarely investigated. There were few studies verifying
the relationship between poverty and mental health with
quantitative research methods in China. To fill in the
knowledge gap in the Chinese context, the current research
aimed to: (1) investigate the poverty and mental health
condition of Chinese children, (2) explore the relationship
between poverty and children’s mental health, and (3) test
whether social causation and social selection theory can
explain the relationship between poverty and children’s
mental health in the Chinese context.
Method
Participants
The data used in this study were collected by conducting a
school-based survey in 2015 through a multi-stage cluster
random sampling method in Xiushui, a poverty-stricken city
in Mainland China. A total of 1440 children were selected
from 36 classes of 12 schools selected from two townships
in Xiushui. 1364 students were involved as participants, and
the effective response rate was 96.3%. Of all the partici-
pants, 585 (44.5%) were male and 729 (55.5%) were
female. The entire descriptive statistical results of social
demographic variables are presented in Table 1.
Procedure
Before the formal survey, the participants were asked
whether they were willing to participate in the investigation.
Their parents would be informed and sign the consent form
if the participants were involved in the survey. Respondents
were required to complete the self-reported questionnaire
independently. If they had any misunderstanding during the
completing process, they could consult the investigators on
the spot. We handed out 1440 questionnaires based on the
sampling produce.
The steps of the multi-stage cluster random sampling
method are as follows. First, based on the economic rank-
ings (i.e., good, medium, and poor) provided by the statis-
tical department, we selected two townships in each given
category, thus six townships were chosen randomly in
Xiushui City. Second, one primary school and one junior
high school were randomly selected in each township. As a
result, six primary schools and six junior high schools were
extracted. Third, 1 class was chosen in each grade (grade
4–6 in primary school and grade 7–9 in junior high school)
randomly. Finally, 40 students in each class were selected
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
Gender
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
Grade
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”.
Measures
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

two stages. First, the measurement model was tested via
confirmatory factor analysis (CFA). In the next stage,
structural model was verified to examine whether the
research hypotheses could be empirically supported. The
goodness-of-fit indices were the main points in the eva-
luation of the data to the hypothesized model. In this study,
χ2, CFI and RMSEA were used to evaluate the modeling
fitness: (1) χ2. The smaller χ2 indicates that the theoretical
model is more suitable for the actual data, and the non-
significant (P > 0.05) χ2 indicates that the theoretical model
is well fitted to the sample data (Bollen 1989). However, the
χ2 is very sensitive to the size of sample. The larger the
sample size is, the more likely that χ2 is significant, resulting
in the theoretical modeling being rejected. Therefore, if the
sample size is large, it would be difficult to test the degree
of modeling fitness by the χ2 (Byrne 2001). (2) CFI. The
value of CFI is between 0 and 1, and the value above 0.9
indicates that the model is good (Bentler 1990). (3)
RMSEA. Value below 0.05 indicates that the model is close
to fit (Kline 2005).
Results
Test of Measurement Model
Before the structural model validation, the verification
model of the two latent variables, including negative mental
health and positive mental health, should be performed first.
The results show that the measurement model has a good fit
(χ2 = 7.880, df = 3, p = 0.049, CFI = 0.996, RMSEA =
0.035) with CFI greater than 0.90 and RMSEA smaller than
0.05. All the observed variables in the model that make up
the latent variable are significant loading on the latent
variable. The value of the standard factor loading for all the
observed variables constituting the latent variable is
between 0.457 and 0.993 (see Table 2) and the acceptable
factor load is 0.3 or more (Agnew 1991). Thus the observed
variables effectively reflect the intrinsic structure of the
latent variables, indicating that the model is better fitted.
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
J Child Fam Stud
Test of Structural Model
Model 1: Social causation model
Social Causation Model reflects the causality between
poverty and children’s mental health. In this study, all the
control variables, latent variables and other observed vari-
ables are incorporated into the structural equation model to
verify the structural model through Amos 21.0.
Despite the chi-square value was large and significant,
mainly on account of its sensitivity to large sample size (N
= 1314), other goodness-of-fit indices demonstrated satis-
fying results: CFI (0.989) was above 0.90, and RMSEA
(0.034) was lower than 0.05. In other words, the structural
model provides a good fit to the data (χ2 = 53.516, df = 21,
p < 0.001). A total of 12.8% of the negative mental health
(anxiety and depression) and 5.0% of the positive mental
health (self-esteem and self-efficacy) were explained by this
model respectively.
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
associated with higher negative mental health score of
children, which is reflected on the higher level of anxiety
and depression (β = .238, p < 0.001). Likewise, poverty
also has a significant negative predictive effect on positive
mental health of children (β = −155, p < 0.001), the higher
the children’s poverty index is, the lower the positive mental
health scores of the children are. That is, poverty reduced
children’s self-esteem and self-efficacy.
Among the social-demographic control variables, only
two of them (gender and grade) have a significant influence
on children’s negative mental health outcomes, indicating
that female children (β = .059, p < 0.05) and higher grades
children (β = .226, p < 0.001) have higher levels of anxiety
and depression. However, the others (parental education,
parental occupation, single-parent, left-behind and region)
have no remarkable effect on negative mental health of
children. Also, the factor loadings of them are lower. Only
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
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-
efficacy outcomes. At the same time, the others (gender,
parental education, parental occupation, single-parent and
left-behind) have no significant influence on positive mental
health of children. Also, the factor loadings of them are
relatively low.
Model 2: Social selection model
The social selection model reflects the impact of children’s
mental health effects on poverty. This model validates all
the control variables, latent variables and the observed
variables into the structural equation model for structural
model validation, of which goodness-of-fit indices demon-
strate satisfying results, with CFI (0.989) higher than 0.90
and RMSEA (0.034) lower than 0.05. Even if the chi square
value is large and significant, given its sensitivity to large
sample size (N = 1314), the social selection model yields a
good fit to the data (χ2 = 53.516, df = 21, < 0.001). A total
of 9.1% of poverty was explained by this model.
The standardized results of the structural model of chil-
dren’s positive and negative mental health impact on pov-
erty are shown in Fig. 2. For simplicity, the graph only
shows the relationship between the independent variable
and the dependent variable, without the control variable.
Considering the relevant path coefficient in the figure and
its significance, negative mental health of children has a
significant positive predictive effect on poverty (β = .237, p
< 0.001), indicating that the higher the negative mental
health outcomes of children are, the poorer the children are
after controlling other variables. In other words, children
with higher levels of anxiety and depression are often
accompanied with higher levels of poverty. However, there
is not a significant correlation between children’s positive
mental health and poverty, namely, the role of self-esteem
and self-efficacy in poverty prediction is not obvious.
Among the social-demographic control variables, three
of them (father’s occupation, left-behind and region) have a
remarkable effect on children’s poverty outcomes, sug-
gesting that lower salary of father’s work (β = .125, p <
0.001), left-behind children (β = −.062, p < 0.05) and
poorer region children (β = .099, p < 0.001) have higher
levels of poverty outcomes. However, the others (gender,
Fig. 2 Standardized solutions for the structural model of children’s
mental health and poverty (***p < 0.001)
grade, parental education, mother’s occupation and single-
parent) have no significant influence on children’s poverty
conditions, and their factor loadings are relatively low.
Discussion
This study aimed to validate the applicability of social
causation and social selection theories in the context of
Mainland China. Based on data of 1314 impoverished
children in the poverty-stricken city of Xiushui, this study
explored the relationship between poverty and children’s
mental health. Our findings were interpreted in details and
the theoretical and practical implications were suggested.
First, the social causation model was established to
investigate the effect of poverty on children’s mental health.
Our study showed that poverty has a significant impact on
children’s negative and positive mental health. This finding
is consistent with previous researches, which suggested
poverty was a cause of mental health problems among
children, such as anxiety and depression (Davis et al. 2010;
Flouri and Sarmadi 2016). Therefore, the model of social
causality theory is applicable to poor children in the Chi-
nese context.
Second, we established the model based on social
selection theory to test the impact of children’s mental
health on poverty. We found that only the negative psy-
chological health of children has a significant impact on
poverty. The predictive role of children’s positive mental
health in poverty remains unremarkable. This result is
partially consistent with those reported by existing empiri-
cal studies. Although studies on the influence of children’s
mental health on poverty have been relatively limited, some
works demonstrated that low mental health of children led
to their poverty status (Kleinman and Hall–Clifford 2009;
Li et al. 2012).
Third, although the theoretical models of social causality
and social selection theories have been established, the
explanations of the two theoretical models remain different.
In the model of social causality theory, the impacts of
poverty on both negative and positive mental health are
significant, with an overall model interpretation rate of
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
health outcome, and thereby induced high level of poverty
in turn.

Implications
On the theoretical level, the main findings of this study have
responded to the controversy over social causality and
social selection theories. First, we verified the relationship
between poverty and children’s mental health in the Chinese
context. Furthermore, we analyzed the applicability and
feasibility of social causality and social selection theories on
the relationship between poverty and mental health, which
helped fill the knowledge gap in the Chinese academia. The
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
empirical bases for social work intervention and social
policy towards poor children. These findings are conducive
to the fundamentally targeted solutions for the survival and
psychological problems of poor children.
This study found that the influence of poverty on chil-
dren’s negative mental health (12.8%) is stronger than that
on positive mental health (5.0%), indicating that poverty
affects more negative factors, such as anxiety and depres-
sion in children. Therefore, the mental health intervention
project at the social work service level should focus on the
negative mental health elements among poor children, in
order to enhance the mental health level of the children.
In addition, our finding illustrated that only children’s
negative mental health has significant effects on poverty.
Therefore, social work services can serve as a predictive
role of anxiety and depression and other negative mental
health factors in inducing poverty. We further found that
“left-behind” children with lower economic status, and those
whose fathers have lower salary, experienced high degrees
of poverty. Thus, interventions for poor children can focus
on their fathers’ occupations and on the left-behind
experience.
Limitations
This study also has some limitations. First, the research
objects are solely from a poverty-stricken city in China.
Thus, the research conclusions should be further examined.
Second, the research method is the cross-sectional study,
and thus, the conclusion is only about the correlation
between poverty and children’s mental health. Further
follow-up studies are still necessary to clarify the causal
relationship between poverty and mental health.
Author Contributions C.L.: designed and executed the study, per-
formed the statistical analysis, and wrote the paper. S.J.: collaborated
with the study and revised the manuscript. X.Y.: collaborated in the
writing and editing of the final manuscript.
J Child Fam Stud
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no compet-
ing interests.
Ethical Approval All procedures performed in studies involving
human participants were in accordance with the ethical standards of
the Chinese University of Hong Kong and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards.
Informed Consent Informed consent was obtained from all indivi-
dual participants included in the study.
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