Relationships between poverty and psychopathology - A natural experiment
Relationships between poverty and psychopathology - A natural experiment
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DOI：
10.1001/jama.290.15.2023
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发表时间：
2003-10-15
影响因子：
120.7
通讯作者：
Angold, A
中科院分区：
文献类型：
--
作者：
Costello, EJ;Compton, SN;Angold, A
社会因果关系（逆境和压力）vs社会选择（从家庭责任到精神疾病的向下流动）是关于精神疾病起源的相互竞争的理论。目的使用自然实验来测试儿童精神病理学的社会选择与社会因果关系的作用。设计准实验，纵向研究。人口和设置一个代表性的人口样本的1420名农村儿童，年龄在9至13岁的摄入量进行了8年（1993年至2000年）的年度精神病评估。四分之一的样本是美洲印第安人，其余的主要是白色。在研究进行到一半的时候，印第安人保留地的一家赌场给了每个美国印第安人每年增加的收入补贴。这一增长使14%的研究家庭摆脱了贫困，53%的家庭仍然贫困，32%的家庭从未贫困过。结果赌场开业前，长期贫困儿童和曾经贫困的儿童有更多的精神病症状，而在赌场开业后的4年中，长期贫困儿童和曾经贫困的儿童有更多的精神病症状（分别为4.38和4.28）比从不贫穷的孩子（2.75），但在开放后，曾经贫困的儿童的水平下降到从未贫困的儿童的水平，而那些长期贫困的儿童的水平仍然很高（比值比，1.50; 95%置信区间，1.08-2.09;比值比，0.91; 95%置信区间，0.77-1.07）。这种效果是特定的行为和对立违抗性障碍的症状。焦虑和抑郁症状不受影响。类似的结果被发现在非印度儿童的家庭搬出贫困在同一时期。结论的收入干预，使家庭摆脱贫困的原因，不能归因于家庭的特点有一个重大的影响，对某些类型的儿童的精神疾病，但不是对其他。结果支持社会因果关系的解释行为和对立障碍，但不是焦虑或抑郁。
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 remained high (odds ratio, 1.50; 95% confidence interval, 1.08-2.09; and odds ratio, 0.91; 95% confidence interval, 0.77-1.07, respectively). The effect was specific to symptoms of conduct and oppositional defiant disorders. Anxiety and depression symptoms were unaffected. Similar results were found in non-Indian children whose families moved out of poverty during the same period.Conclusions An income intervention that moved families out of poverty for reasons that cannot be ascribed to family characteristics had a major effect on some types of children's psychiatric disorders, but not on others. Results support a social causation explanation for conduct and oppositional disorder, but not for anxiety or depression.