May is Mental Health Awareness Month. As we break the stigma surrounding mental health, it's important that we also learn about communities, such as those in poverty, who are more at risk of developing certain psychiatric disorders.
In 2011, at least 46.2 million people in the U.S lived below the official poverty line set by the government. In 2014, 20% of U.S children, meaning over 16 million people, lived in poverty. Another 25% lived only slightly above the poverty line, classified as "near poor." Besides all of the obvious physical health problems which can come from living in poverty, there is another common medical complication:
Neurobehavioral disorders are significantly more prevalent for individuals in poverty. Study after study show that all manner of psych disorders are more common. Anxiety and depression are more common due to generally higher prevalence of environmental stressors, along with general socializing problems and attention problems. Symptoms like “pervasive negative thinking," though not always directly diagnosable or immediately dangerous, are more common even in individuals without recognized psych problems.
Interestingly, psych disorders generally thought to be more influenced by “nature” and less by “nurture” are also more prevalent. ADHD is more prevalent in children below the poverty level. Learning disorders, as well as mental or social developmental disabilities, are also more common. What factors of poverty could cause these shifts?
Four major causal factors of psychological and developmental disorders in poverty are: malnutrition, environmental factors, stress, and lack of resources. Specific examples of each would be protein-energy and micronutrient deficiency, lack of early sensory stimulation, environmental toxins, the negative effects of long-term exposure to stress hormones, and lack of toys or opportunity for social interaction with peers.
Each of these are extra impactful for a developing child during pregnancy. Malnutrition in the mother majorly increases the child’s likelihood of developmental disabilities, including later communication and social abilities. Elevated stress hormone levels impact the development of the prefrontal cortex, and can lead to problems with executive function. Strangely (or perhaps not), being raised in noisy, crowded, and/or unstable/unpredictable homes also contributes to similar performance problems. Poverty also tends to reduce children's opportunities for cognitive enrichment, due to overworked parents and lack of money for toys or time for excursions.
Autism is also more common in impoverished populations, and tends to be more severe. This second effect is due to the fact that early intervention by professional psych services can reduce the severity of autism in children. This effect is seen across many other psych disorders: they tend to be more severe in poor populations because psych treatment is expensive.
All of this sounds scary and bleak, and it is, but don’t think we can’t do anything about it. Since 2001, the APA has started paying more attention to the role of poverty in mental health, and new programs to elevate people from poverty are taking these mental health statistics more seriously. People are paying more attention, which is good.
Lastly, it is extremely important to note that the causality here, on a statistical level, is one-way: people tend to have mental health problems because they’re impoverished, not the other way around. Victim blaming is the last thing we need right now. The APA’s official statement makes it very clear that "Poverty touches not just mental health or economics, and people aren't in poverty because they are weak or lazy. There are structural reasons for poverty in our country, and structural reasons why it's difficult to alleviate."