The influence of perceived stress and income on mental health in China and Germany

Ruihua Li; Shuyan Liu; Chuanning Huang; Debora Darabi; Min Zhao; Stephan Heinzel

doi:10.1016/j.heliyon.2023.e17344

The influence of perceived stress and income on mental health in China and Germany

Heliyon. 2023 Jun 16;9(6):e17344. doi: 10.1016/j.heliyon.2023.e17344. eCollection 2023 Jun.

Authors

Ruihua Li^{1

2}, Shuyan Liu³, Chuanning Huang¹, Debora Darabi³, Min Zhao^{1

4

5}, Stephan Heinzel⁶

Affiliations

¹ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Shandong Mental Health Center, Shandong University, Jinan, China.
³ Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin (Campus Charité Mitte), Berlin, Germany.
⁴ Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China.
⁵ CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Sciences, Shanghai, China.
⁶ Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.

Abstract

Background: Mental health issues affect rich and poor, young and old, and are widespread in Asia as well as in Europe. However, few studies have investigated the influence of perceived stress and income on mental health among general population in China and in Germany.

Methods: We conducted an online survey from December 2021 to February 2022 to investigate how perceived stress and income affect mental health among the general population in China (N = 1123) and in Germany (N = 1018). Accordingly, we used the 10-item Perceived Stress Scale (PSS-10) and the 12-item General Health Questionnaire (GHQ-12). We ran a multiple linear regression model to investigate the relationship between perceived stress, income, and mental health.

Results: Overall, we found that 53.4% participants reported mental health issues (GHQ-12 score ≥12). The proportion of our sample who reported mental health issues was higher in Germany (60.3%) than in China (44.8%). The regression model revealed that a higher perceived stress score was associated with more mental health issues in both countries (b = 0.60, p < 0.01). Individuals with a low income reported poorer mental health in Germany than those in China. Interestingly, the situation was reversed when incomes were high: individuals with a high income reported worse mental health in China than in Germany (b = -0.40, p < 0.01).

Conclusion: Perceived stress has a negative impact on mental health, while income has differential effects. Mental health promotion programmes may involve teaching stress management, while considering differences in mental health outcomes in developed and developing countries.

Keywords: 12-Item general health questionnaire; Developed and developing countries; Emotional strain and pressure; Mental health; Socioeconomic status.