A responsive evaluation of mental health treatment in Cambodia: Intentionally addressing poverty to increase cultural responsiveness in therapy

The relationship between poverty and mental health has received considerable attention in the recent literature. However, the associations presented in existing studies typically rely on limited samples of individuals and on proxy indicators for poverty such as education, the lack of tap water, or being unemployed. We revisit the relationship between poverty and mental health using data from nationally representative household surveys in Bosnia and Herzegovina, Indonesia and Mexico, along with special surveys from India and Tonga. As in previous studies, we find that individuals who are older, female, widowed, and in poor health are more likely to report worse mental health outcomes. Individuals living with others with poor mental health are significantly more likely to report worse mental health themselves. The size of the coefficients and their significance are comparable across the five countries. In contrast to previous studies, the relationship between higher education and better mental health is weak or non-existent. Furthermore, there is no consistent association between consumption poverty and mental health - in two countries mental health measures are marginally worse for the poor; in two countries there is no association; and in one country mental health measures are better for the poor compared to the non-poor. Moreover, the sizes of the coefficients for both education and consumption poverty are small compared to other factors considered here. While the lack of an association between consumption poverty and mental health implies that poor mental health is not a "disease of affluence", neither is it a disease of poverty. Changes in life circumstances brought on, for instance, by illness may have a greater impact on mental health than levels of poverty. Effective public health policy for mental health should focus on protecting individuals and households from adverse events and on targeted interventions following such adverse changes.