Summary: A study finds a link between poverty in early life and childhood adversity and an increased risk of developing externalizing disorders during adolescence and early adulthood, especially in women.
Fountain: FAPESP
A study published in December in an article in European Child and Adolescent Psychiatry shows an association between childhood poverty and a higher propensity to develop externalizing disorders during adolescence and early adulthood, especially among girls.
According to psychiatrists, externalizing disorders are characterized by poor impulse control, rule breaking, aggression, impulsiveness, attention deficit and hyperactivity, among other forms of behavior.
The researchers who conducted the study concluded that multidimensional poverty and exposure to stressful life events, including frequent deaths and family conflict, were preventable risk factors that needed to be addressed in childhood to reduce the impact of mental health problems on children. adult life. The analysis took into account parents’ education, access to basic services, and housing conditions and family infrastructure, among other variables.
For nearly seven years, 1,590 students enrolled in public schools in Porto Alegre and São Paulo (Brazil) were evaluated in three stages, the last in 2018-19. The students are participants in the Brazilian High Risk Cohort Study for Child Psychiatric Disorders (BHRC), a major community survey that involved 2,511 families with children ages 6 to 10 when it began in 2010.
Considered one of the most ambitious child mental health surveys ever conducted in Brazil, the BHRC, also known as Proyecto Conexión—Mentes del Futuro, is led by the National Institute of Developmental Psychiatry (INPD), which is supported by the FAPESP and the Council for Scientific and Technological Development (CNPq). Its main researcher is Eurípedes Constantino Miguel Filho, professor at the Department of Psychiatry at the Faculty of Medicine of the University of São Paulo (FM-USP). More than 80 university professors and researchers affiliated with 22 institutions in Brazil and elsewhere are involved in its activities.
“It seems common sense to say that poverty is correlated with the future development of mental health problems, but this is the first survey carried out in Brazil that analyzes the mental health of children and young adults based on psychiatric evaluations carried out in more than an occasion. . We designed our study to be able to collect data on mental health in adolescence and early adulthood,” said Carolina Ziebold, first author of the article. Ziebold is a researcher at the Department of Psychiatry at the Federal University of São Paulo (UNIFESP).
The researchers used the Developmental and Well-Being Assessment (DAWBA), a package of interviews, questionnaires, and scoring techniques, to elicit psychiatric diagnoses in childhood (9-10), adolescence (13-14), and early adulthood ( 18-19). They aimed to detect both internalizing disorders, such as depression and anxiety, and externalizing ones, although the former did not constitute a significant proportion of the overall results.
They used a specific questionnaire to assess the socioeconomic level of the families, concluding that 11.4% of the sample lived in conditions of poverty.
“The three-stage psychiatric evaluation produced consistent results by tracking variations over time. Children from poor families had lower levels of externalizing disorders than non-poor children in the first stage, but after a few years the curve inverted and disorders increased steadily among poor children, with a 63% chance of developing disorders. , while they decreased among poor children. the non-poor,” Ziebold said.
gender inequality
Stratification by gender showed that child poverty had particularly adverse consequences for women. “This finding was especially surprising and can be considered one of the most significant,” Ziebold said.
“Externalizing disorders are generally more common in men. We hypothesize that mental health problems are less likely to be diagnosed early in poor girls, either in the family or at school. In addition, they tend to take on more housework from an early age, such as caring for younger siblings and sick family members. This additional burden exposes them more to stressful life events, increasing the likelihood that they will develop mental health disorders in adulthood.”
Externalizing disorders were particularly damaging to women in terms of their impact on educational achievement, leading to repetition, dropout, and age distortion, as a study by the group recently published in the journal Epidemiology and Psychiatric Sciences.
Also using data from the BHRC, the study concluded that at least ten out of 100 girls over the appropriate age for their school grade could have followed their age group if mental health problems, especially externalizing disorders, had been prevented. or treated. In the case of grade repetition, five out of every 100 girls would not have failed.
“Children and young adults with externalizing disorders may be more likely to fall behind in learning, social development, and the job market, increasing the likelihood of poverty in later adult life,” Ziebold said.
In Brazil, children are twice as likely to repeat their parents’ low educational level as in the United States, for example, and well above the average for the 38 countries of the Organization for Economic Co-operation and Development ( OECD). Nearly six out of ten Brazilians (58.3%) whose parents did not complete secondary education also dropped out of school. In the US and the OECD, the proportion is 29.2% and 33.4% respectively, according to the analysis of intergenerational mobility by the Institute for Mobility and Social Development (IMDS).
In the labor market, the probability of children finding qualified and well-paid jobs increases according to the educational level of their parents. For parents with college degrees, their children are 3.3 times more likely than average to be in high-skilled jobs and nearly 9 times more likely than children of parents with little formal schooling.
Pandemic
Because of the long-term impact of externalizing disorders on health and social outcomes in adult life, the researchers’ findings reinforce the importance of anti-poverty interventions in early childhood, according to Ziebold.
“When we emphasize the need to reduce poverty in order to reduce the prevalence of mental health disorders, we are thinking about the issue in a multidimensional way,” he said.
See also
“There are no quick fixes. Immediate actions, such as waiving school fees and providing cash transfers and economic assistance to poor families, are important, but broader measures involving promotion of socio-emotional skills, stress reduction , access to education and access to mental health services”.
The proportion of the population living in poverty has grown alarmingly during the COVID-19 pandemic, it added. According to a report issued by UNICEF, 100 million more children have fallen into multidimensional poverty around the world, for an increase of 10% since 2019.
The report also says that by October 2020, the pandemic had disrupted or halted critical mental health services in 93% of countries and that more than 13% of girls and boys aged 10-19 are living with a mental health disorder. diagnosed mental. Even in the best of cases, he adds, it will take seven to eight years to recover and return to pre-pandemic levels of child poverty.
About this research news on poverty and mental health
Author: Luciana Constantine
Fountain: FAPESP
Contact: Luciana Constantino – FAPESP
Image: The image is in the public domain.
original research: Closed access.
“Childhood poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study” by Caroline Ziebold et al. European Child and Adolescent Psychiatry
Abstract
Childhood poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study
Bottom
We examine the association between childhood poverty and mental health disorders (MHD) in childhood and early adulthood. We also investigated whether the association between childhood poverty and MHD is mediated by exposure to stressful life events (SLE).
Methods
We used data from a prospective community cohort of youth assessed at baseline (M = 9.7 years, SD = 1.9), first (M = 13.5 years, SD = 1.9), and second (M = 18.2 years). years, SD = 2.0) after -UPS (North= 1,590) in Brazil. Poverty was assessed using a standardized classification. Exposure to 20 different SLEs was measured using the Life History instrument. Psychiatric diagnoses were assessed using the Developmental and Well-Being Assessment. Latent growth models investigated the association between baseline poverty and growth in any MHD, externalizing and internalizing disorders. Mediation models evaluated whether the association between childhood poverty and MHD in early adulthood was mediated by SLE exposure.
Results
Poverty affected 11.4% of the sample at baseline and was associated with a higher propensity to have externalizing disorders in adolescence or early adulthood (standardized estimate = 0.27, P= 0.016). This association was not significant for any internalizing disorder(s). Childhood poverty increased the likelihood of externalizing disorders in early adulthood through increased exposure to SLE (OR = 1.07, 95% CI 1.01-1.14). The results were only replicated among women in stratified analyses.
Conclusions
Childhood poverty had detrimental consequences on externalizing MHD in adolescence, especially among females. Poverty and SLE are preventable risk factors that must be addressed to reduce the burden of externalizing disorders in youth.
