A new study showed an association between child poverty and a heightened propensity to develop externalising disorders during adolescence and early adulthood.
According to psychiatrists, externalising disorders are characterised by poor impulse control, rule-breaking, aggression, impulsivity, attention deficit and hyperactivity, amongst other forms of behaviour. The researchers analysed the impact child poverty has on the development of mental disorders.
The study was published in European Child & Adolescent Psychiatry.
Analysing the impact of child poverty
The researchers who conducted the study concluded that multidimensional child poverty and exposure to stressful life events, including frequent deaths and family conflicts, were avoidable risk factors that should be addressed in childhood to reduce the impact of mental health problems in adult life. The analysis accounted for parental education, access to basic services, housing conditions and family infrastructure, amongst other variables.
For about seven years, 1,590 students enrolled at 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 Childhood Psychiatric Disorders (BHRC), a major community-based survey involving 2,511 families with children aged 6 to 10 when it began in 2010.
“It seems common sense to say that poverty correlates with the future development of mental health problems, but this is the first survey ever conducted in Brazil to analyse child and young adult mental health based on psychiatric assessments carried out on more than one 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 in the Department of Psychiatry at the Federal University of São Paulo (UNIFESP).
The researchers used the Development and Wellbeing Assessment (DAWBA), which includes interviews, questionnaires, and rating techniques, to obtain psychiatric diagnoses in childhood (9 years to 10 years), adolescence (13 years to 14 years) and early adulthood (18 years to 19 years). They aimed to uncover internalising disorders, such as depression and externalising disorders.
The team of researchers used a specific questionnaire to assess the socio-economic status of the families, concluding that 11.4% of the sample were living in conditions of poverty.
“The three-stage psychiatric assessment produced consistent results thanks to the tracking of variations over time. Children of poor families had lower levels of externalising disorders than non-poor children in the first stage, but after a few years, the curve was inverted and disorders steadily increased among poor children, with a 63% probability of developing disorders, while they decreased among the non-poor,” Ziebold said.
Stratification by gender showed that child poverty had particularly adverse consequences for women. “This finding was especially striking and can be considered one of the most significant,” Ziebold said. “Externalising disorders are generally more frequent in males. Our hypothesis is 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 responsibility for more domestic work from an early age, such as caring for younger siblings and sick family members. This extra burden exposes them more to stressful life events, increasing the likelihood of their developing mental health disorders in adulthood.”
Externalising disorders were particularly harmful to women in terms of their impact on educational attainment, leading to repetition, drop out and age-grade distortion, as shown by a study by the group published recently in the journal Epidemiology and Psychiatric Sciences.
Using BHRC data, the study concluded that at least ten out of every 100 girls older than the appropriate age for their school grade could have accompanied their age group if mental health problems, especially externalising disorders, were prevented or treated. In the case of grade repetition, five out of every 100 girls would not have been failed.
“Children and young adults with externalising 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, the odds that children will repeat their parents’ low education attainment are double the odds in the United States and well above the average for the 38 countries in the Organization for Economic Cooperation and Development (OECD). Almost six in every ten Brazilians (58.3%) whose parents did not complete their secondary education have also dropped out of school. In the US and 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 job market, the probability that children will find skilled and well-paid jobs increase in step with their parents’ educational attainment. In the case of parents with university degrees, their children are 3.3 times more likely than average to be in highly skilled jobs and almost nine times more likely than the children of parents with little formal schooling.