Context and Poverty: Mental Health

An observation about American political life that leaves me perplexed and saddened is that we, as a society, seem to ignore the influence of context on individuals. I generally consider “context” in this discussion to mean factors both internal and external to the individual over which they have no control. This observation is most readily detected in debates surrounding poverty in which some argue that the impoverished are responsible for their plight. Yet, contextual factors are strong. For instance, perhaps two children have similar medical conditions that affect school performance but only the family of child A can afford insurance. Child B may not have the same educational opportunities later due to interference from their untreated ailment. Loss of educational opportunities may, in turn, leave child B vulnerable to financial strain or extended poverty. This is an extreme hypothetical case, but we can all find less salient examples of the influence of contextual factors if we are honest about our own lives.

There exist tangled webs of relationships and befuddling patterns of causation that surround the development and maintenance of poverty. To explore this may induce headaches, but it is worth doing. Why, you might ask? If we fully reject the influence of context and instruct the impoverished to “pull themselves up by the bootstraps,” then we write them off as a loss and do not feel compelled to help. This is misguided at best and inhumane at worst. Yet, intuitively we know that contextual factors are not the only ones involved. Reality lies somewhere between these extremes. Exploration of this issue through research allows us to better understand the complex nature of poverty and to develop more effective ways of addressing this social ill. I am planning on posting multiple times regarding this issue, but I thought that I would start by examining mental health and poverty.

A social gradient in mental and physical health exists (Reiss, 2013), which means that health status depends on socioeconomic status such that the poorest citizens have the worst health. Unfortunately, this phenomenon can be observed around the world in both poor and rich nations (World Health Organization, 2014). Please see the graph below for an example of the social gradient. It shows self-reported health status by income for the state and select cities. The data in this graph come from the Massachusetts Community Health Information Profile (MassCHIP), which is managed by the Massachusetts Department of Health.

Consistent with the social gradient, research suggests that poverty-related stress increases the risk for mental illness and that severe mental illness increases the risk of experiencing poverty (DeCarlo Santiago, Kaltman, & Miranda, 2013). The former illustrates the power of the external context of poverty (e.g., increased stress, lack of social support) over the individual, and the latter underscores the impact of “internal context.” Again, I define “internal context” as an attribute of the individual over which they have no control. Moreover, this bi-directional relationship suggests a vicious cycle in which an individual could easily become trapped in poverty. This may have the strongest effect on children in poverty, as development of a mental illness as a child would likely have lifelong negative effects. What can research tell us about the social gradient in mental health in children?

Reiss (2013) reviewed studies published in either English or German that examined the relationship between low socioeconomic status (SES) and mental health issues in individuals between the ages of four and 18. Of the 55 studies reviewed, 52 found an inverse relationship between SES and mental health such that children experiencing poverty were two to three times more likely to develop mental health issues than their peers. Sadly, the review also found that the gradient was strongest in early childhood. Importantly, mental health problems were reduced by an increase in SES, suggesting that societal intervention can be beneficial to children in poverty. Thus, we can short-circuit the bi-directional relationship mentioned above.

In sum, there are complex relationships surrounding the issue of poverty in America. While we often downplay the role of context in our political debates, it is an influential force in the generation and perpetuation of poverty. Development of a mental illness is not a choice, but rather the result of an intricate set of interactions between genetic predispositions and physical and social context. The social context of poverty contributes to the development of mental illness, but mental illness itself is a contextual factor in the social condition of poverty. This bi-directional relationship can be overcome, which has strong and positive implications for efforts to raise children out of poverty.

-Jason Wright

References
DeCarlo Santiago, C., Kaltman, S., & Miranda, J. (2013). Poverty and mental health: How do low-income adults and children are in psychotherapy? Journal of Clinical Psychology: In Session, 69, 115-126. doi: 10.1002/jclp.21951

MassCHIP, Massachusetts Department of Health. (2014). Behavioral Risk Factor Surveillance System: General health status. Retrieved from http://www.mass.gov/eohhs/researcher/community-health/masschip/general-health-status.html

Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science and Medicine, 90, 24-31. doi: 10.1016/j.socscimed.2013.04.026

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