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Psychological damage and physical abuse linked to poverty

In the last couple of weeks we have seen new studies which have put more flesh on the bones of what we already know about the link between economic circumstances and mental health issues. One study  [1] by Judith Baer and colleagues from Rutgers University looked at 5,000 parents. Mothers who received free food or had a difficult time paying their bills were nearly 2.5 times more likely to have symptoms that would warrant a diagnosis of generalized anxiety disorder, compared with those who were in better financial situations. Interestingly what the researchers seem to have found, using a structural equation model, is that it is the economic circumstances that were the main trigger for psychological symptoms which are quite serious. Poverty and not knowing where the next meal is coming from, not surprisingly in itself is a major contributor to anxiety levels.

 

Maybe even more worrying is a large 10 year study from Philadelphia  [2] that found a very strong correlation between the rate of physical abuse detected and factors such as unemployment levels and mortgage foreclosure. The study, just published in the Journal Pediatrics, looked at data from 38 hospitals. For example traumatic brain injuries increased 3%  year on year between 2000 and 20009.  Extraordinarily they found that for every 1 percent increase in 90-day mortgage default over a one-year period they saw a 3 percent increase in hospital admissions due to child physical abuse and a 5 percent increase in admissions due to traumatic brain injury which was suspected to be child abuse.

Of course these are both broad, macro studies and do not explain the exact way such stressors affect family functioning, nor what resilience factors some families parents might have to protect them. However we do know that poverty, deprivation, living in deprived or crime ridden neighbourhoods, all predict worse mental health.  For example living in poorer neighbourhoods predicts worse health [3], and worse psychological health, and indeed in families with similar economic levels, the number of boarded up homes alone predicts all kinds of  serious health issues. Another recent study has  illustrated a psychobiological mediating factor here, finding that in areas with more boarded up homes and broken windows we see higher levels of the stress hormone cortisol  [4].

We also know that at the same time that economic stressors have been increasing we are seeing a serious reduction in public services in the UK. One of the worries about this is that it is often outreach services that are being cut, while clinic based ones deemed essential are preserved, and so we might well be increasingly missing serious warning signs. For example, putting psychological services into schools, as many of us have done in recent years, can be a very preventative intervention, but it is also costly. The cost is not just the staff time and support structures, but the fact that such services then tend to unearth all kinds of problems that then require referral on to more specialist services, those which are more expensive to run, such as multi-disciplinary teams with psychiatric support. Yet the cost of not having such services is much higher in psychological terms, and also in terms of the future costs for society.

[1]        J. C. Baer, M. S. Kim, and B. Wilkenfeld, ‘Is it Generalized Anxiety Disorder or Poverty? An Examination of Poor Mothers and Their Children’, Child and Adolescent Social Work Journal, pp. 1–11, 2012.

[2]        J. N. Wood, S. P. Medina, C. Feudtner, X. Luan, R. Localio, E. S. Fieldston, and D. M. Rubin, ‘Local Macroeconomic Trends and Hospital Admissions for Child Abuse, 2000–2009’, Pediatrics, 2012.

[3]        D. A. Cohen, K. Mason, A. Bedimo, R. Scribner, V. Basolo, and T. A. Farley, ‘Neighborhood physical conditions and health’, Journal Information, vol. 93, no. 3, 2003.

[4]        R. A. Karb, M. R. Elliott, J. B. Dowd, and J. D. Morenoff, ‘Neighborhood-level stressors, social support, and diurnal patterns of cortisol: The Chicago Community Adult Health Study’, Social Science & Medicine, vol. 75, no. 6, pp. 1038–1047, Sep. 2012.

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Monday, 30 November 2020

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