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Cited by 1,079Child and Adolescent Psychosocial and Emotional DevelopmentHealth disparities and outcomesMental Health Treatment and Access

Relationships Between Poverty and Psychopathology: A Natural Experiment

Costello, E. Jane, Compton, Scott N., Keeler, Gordon, Angold, Adrian·2003·JAMA
DOI 10.1001/jama.290.15.2023
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Abstract

Context Social causation (adversity and stress) vs social selection (downward mobility from familial liability to mental illness) are competing theories about the origins of mental illness. Objective To test the role of social selection vs social causation of childhood psychopathology using a natural experiment. Design Quasi-experimental, longitudinal study. Population and setting A representative population sample of 1420 rural children aged 9 to 13 years at intake were given annual psychiatric assessments for 8 years (1993-2000). One quarter of the sample were American Indian, and the remaining were predominantly white. Halfway through the study, a casino opening on the Indian reservation gave every American Indian an income supplement that increased annually. This increase moved 14% of study families out of poverty, while 53% remained poor, and 32% were never poor. Incomes of non-Indian families were unaffected. Main outcome measures Levels of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, psychiatric symptoms in the never-poor, persistently poor, and ex-poor children were compared for the 4 years before and after the casino opened. Results Before the casino opened, the persistently poor and ex-poor children had more psychiatric symptoms (4.38 and 4.28, respectively) than the never-poor children (2.75), but after the opening levels among the ex-poor fell to those of the never-poor children, while levels among those who were persistently poor remaine…

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  • Income intervention that moved families out of poverty was associated with a decrease in frequency of children's behavioral disorders (conduct disorder or oppositional defiant disorder) compared to families who were never poor or families that remained poor despite the intervention.

    “Analogous results were provided by Costello, Compton, Keeler, and Angold (2003), who showed that income intervention that moved families out of poverty was associated with a decrease in frequency of children's behavioral disorders (conduct disorder or oppositional defiant disorder) compared to families who were never poor or families that remained poor despite the intervention.”

    From Heritability for adolescent antisocial behavior differs with socioeconomic status: gene–environment interaction (2006) · cites this paper as Costello, Compton, Keeler, and Angold (2003)

  • In the Great Smoky Mountain Study, declining rates of deviant and aggressive behavior were found among adolescents whose families received additional income, with the level of psychiatric symptoms for those who had received cash supplements for four years being similar to those of adolescents who had never been poor.

    “The study found declining rates of deviant and aggressive behavior among adolescents whose families received additional income, with the level of psychiatric symptoms for those who had received the cash supplements for four years being similar to those of adolescents who had never been poor [28].”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [28]

  • Some limited research indicates that income supplementation to racial minorities can lead to improved health and the reduction of at least some racial differences in health.

    “Some limited research also indicates that income supplementation to racial minorities can lead to improved health and the reduction of at least some racial differences in health.”

    From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [28]

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Authors
Costello, E. J., Compton, S. N., Keeler, G., & Angold, A.
Affiliations
Duke University (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-10-15
Volume
290
Issue
15
Pages
2023
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.290.15.2023
OpenAlex
W2129497832
Cited by
1,079
References
5
Citations by year
2026: 20 · 2025: 32 · 2024: 27 · 2023: 41 · 2022: 32 · 2021: 46 · 2020: 58 · 2019: 40 · 2018: 44 · 2017: 68 · 2016: 60 · 2015: 58 · 2014: 50 · 2013: 47 · 2012: 70
FWCI
36.65
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Mental Health (MH-63671, R01MH063970, R01MH048085, MH-63970, MH-48085, R01MH063671)
  • National Institute on Drug Abuse (DA/MH11301)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
poverty, childhood psychopathology, social causation, social selection, conduct disorder, oppositional defiant disorder, anxiety, depression, additional income, Native American children, rural children, household income
MeSH terms
Adolescent, Anxiety, Mental Disorders, Black or African American, Child, Child Behavior Disorders, Depression, Humans, Indians, North American, Longitudinal Studies, North Carolina, Poverty, Psychopathology, Rural Population, Socioeconomic Factors, Stress, Psychological, Conduct Disorder, White People

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