Poverty in childhood is linked to mental disorders in adulthood, research points out

Research published in December in the scientific journal European Child & Adolescent Psychiatry shows an association between child poverty and a greater propensity to develop externalizing disorders, such as attention deficit hyperactivity disorder, in youth, especially among women.

The researchers concluded that multidimensional poverty and exposure to stressful situations, including death and family conflicts, are preventable risk factors that need to be addressed in childhood to reduce the impact of mental disorders in adulthood. The educational level of parents, housing conditions and infrastructure of families, access to basic services, among others, were taken into account.

The work followed, for about seven years, 1,590 students from public schools in Porto Alegre (RS) and São Paulo, who participated in three stages of evaluation, the last of which between 2018 and 2019. These students are part of a large community-based research, which, since 2010, has followed 2,511 families with children and young people, aged between 6 and 10 at the time, within the Brazilian High-Risk Cohort Study for Child Psychiatric Disorders (BHRC).

Also known as the Connection Project – Minds of the Future, the BHRC is considered one of the main monitoring programs on the risks of mental disorders in children and adolescents already developed in Brazilian psychiatry. It is carried out by the National Institute of Developmental Psychiatry for Children and Adolescents (INPD), supported by FAPESP and by the National Council for Scientific and Technological Development (CNPq).

The institute’s general coordinator is a professor from the Department of Psychiatry at the Faculty of Medicine of the University of São Paulo (FMUSP) Eurípedes Constantino Miguel Filho. It has more than 80 professors and scientists from 22 Brazilian and international universities.

“It seems common sense to say that poverty can have a future impact on the development of mental health problems. However, there was still no research in Brazil that would allow the analysis of child development until early adulthood based on psychiatric assessments made in more than one The way we carried out the work, it was possible to observe the trend both in adolescence and in early adulthood”, explains researcher Carolina Ziebold, from the Department of Psychiatry at the Federal University of São Paulo (Unifesp), and first author of the article .

Psychiatric diagnoses were obtained through the Assessment of Development and Well-being (DAWBA), applied in childhood, then adolescence (when students had an average age of 13 years and 5 months) and in the age group of 18 years. The study took into account both externalizing and internalizing disorders, such as depression and anxiety. However, in the case of the latter there was no significant record in the overall result.

To analyze the needs of families, the scientists applied socioeconomic questionnaires. In total, 11.4% of the sample was classified in poverty levels.

“This psychiatric evaluation in three moments allowed us to obtain a consistent result. This is because there was variation over time. Children from poor families even had lower levels of externalizing disorders than those from non-poor at the beginning of the follow-up. years, the curve reversed, with a steady increase in disturbances among children from poor families. The probability of having problems among them was 63%, while among those from non-poor families it decreased in the period”, says Ziebold.

gender inequality

The article’s authors highlighted that, in gender-stratified analyses, child poverty had detrimental consequences especially for women.

“This result drew a lot of attention and should be one of the most relevant. Externalizing disorders are generally more common in men. Our hypothesis is that poor girls are less likely to be diagnosed early on problems, whether in the family or at school. , they take on more tasks from an early age at home, such as taking care of younger siblings and sick people. This overload exposes them to more stressful events, which increase the chances of having mental problems as adults”, says the researcher.

Externalizing disorders were also particularly harmful to women in terms of educational outcomes, especially in relation to school delay, as shown by another work by the group, recently published in the journal Epidemiology and Psychiatric Sciences.

This research, carried out on the same basis as the BHRC, concluded that at least ten out of every hundred girls who were outside the appropriate school grade for their age could have followed the class if mental disorders, especially externalizing ones, had been prevented or treated. In the case of repetition, five out of every one hundred students would not have failed.

“Children and young people with externalizing problems may have a greater chance of having a negative impact on learning, on social development, on the labor market, thus increasing the possibility of remaining in poverty as adults”, adds Ziebold.

In Brazil, the chance of a child repeating the low level of education of the parents is twice the probability of this happening in the United States, for example, and well above the average of the Organization for Economic Cooperation and Development (OECD), a group of 38 rich and emerging countries. Almost six out of ten Brazilians (58.3%) whose parents did not have completed high school also stopped studying before completing this stage. Among Americans, the percentage drops to 29.2% and in the OECD it is 33.4%, according to a study by the Mobility and Social Development Institute (IMDS), which analyzed educational transformations between generations.

On the other hand, in the labor market, the chances of children reaching the stratum of more sophisticated occupations and with better incomes increase as parents become more educated. Children whose parents have higher education are 3.3 times more likely to be in the most sophisticated stratum of the market compared to the population average and almost nine times more likely than children of uneducated parents.

Pandemic

Ziebold points out that because externalizing disorders can have long-term impacts on health and social outcomes during adulthood, the study’s findings reinforce the importance of antipoverty interventions early in life.

“When we say that it is necessary to reduce poverty to reduce the chances of mental illness, we are thinking about the issue in a multidimensional way. It is not a quick solution. Immediate actions, such as granting scholarships and assistance so that families have income, are important, but it is also necessary to think about broader measures, involving the promotion of socio-emotional skills, stress reduction, access to education and health services, including mental.”

The researcher recalls that the Covid-19 pandemic ended up increasing the percentage of people living in poverty to alarming levels. A report released by UNICEF, the United Organizations (UN) body for childhood issues, estimated that 100 million more children are living in multidimensional poverty in the world, an increase of 10% since 2019.

According to the document, in October 2020, 93% of countries even interrupted or suspended essential care services for mental disorders, problems that affect more than 13% of girls and boys aged 10 to 19 worldwide. The report projected that, even under the best of scenarios, it will take seven to eight years to recover and return to pre-pandemic levels of child poverty.

The article Childhood poverty and mental health disorders in early adulthood: evidence from a Brazilian cohort study, by researchers Carolina Ziebold, Sara Evans-Lacko, Mário César Rezende Andrade, Maurício Hoffmann, Laís Fonseca, Matheus Barbosa, Pedro Mario Pan, Euripedes Constantino Miguel Son, Rodrigo Bressan, Luis Augusto Rohde, Giovanni Salum, Julia Schafer, Jair de Jesus Mari and Ary Gadelha, can be read at https://link.springer.com/article/10.1007%2Fs00787-021-01923-2.