Low assets predict persistent depression through living difficulties amid large-scale disasters: A cohort study

BACKGROUND: In face of large-scale disasters, persons with fewer assets are at greater risk of persistent poorer mental health than persons with more assets. Everyday daily routine disruptions and financial hardship could mediate this association. METHODS: This prospective population-representative study in Hong Kong aimed to investigate the relation between assets during the acute phase of COVID-19 (February–August 2020, T1) and persistent probable depression from T1 to March–August 2021 (T2), as well as the mediating effects of daily routine disruptions and financial hardship on the assets-depression association. RESULTS: Low assets at T1 prospectively related to persistent probable depression from T1 to T2. Primary routine disruptions (i.e., healthy eating and sleep) at T1 and financial hardship at T2 were found to fully mediate the association between T1 assets and persistent probable depression. LIMITATIONS: Persistent probable depression reported on the PHQ-9 should be further verified with clinical diagnoses/interviews. CONCLUSIONS: The COVID-19 pandemic was accompanied by a global economic downturn. Persons who have fewer assets could be at greater risk of depression during this period. Our findings suggest a need to provide behavioral and financial assistance to persons with fewer assets in the short run and a need to ensure that everyone has adequate assets to mitigate the mental health consequences of the COVID-19 pandemic in the long run.