Academic journal article New Zealand Journal of Psychology

Can Poverty Drive You Mad? 'Schizophrenia', Socio-Economic Status and the Case for Primary Prevention

Academic journal article New Zealand Journal of Psychology

Can Poverty Drive You Mad? 'Schizophrenia', Socio-Economic Status and the Case for Primary Prevention

Article excerpt

In his 2004 address to the World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders, in Auckland, American psychologist George Albee opened with 'I wrote my first paper emphasizing the necessity of prevention of mental disorders nearly 50 years ago'. After demonstrating in some detail the numerical and economic impossibility of trying to provide mental health services to all those who need them, he went on to say:

The principle source of stress worldwide is poverty. Poverty is at the root of many of the stresses that have been identified as the cause of emotional distress. Poverty has been identified as the 'the cause of the causes' (Joffe, 1988). ....

--Poverty dampens the human spirit creating despair and hopelessness.

--Poverty underlies multiple problems facing families, infants, children, adolescents, adults, and the elderly.

--Poverty directly affects infant mortality, mental retardation, learning disabilities, and drug and alcohol abuse.

--Poverty is a major factor in homelessness.

--Poverty increases the incidence of racial, ethnic, and religious hatred.

--Poverty increases abuse against women and children.

--Poverty results in suicide, depression, and severe mental illness.

--Poverty is directly linked to violence.

.... We believe that the eradication of poverty is the first step in primary prevention. (Albee, 2006, p. 451)

After briefly discussing the relationship between poverty and mental health in general, this paper will (i) examine some of the problems arising from the current dominance of a rather simplistic bio-genetic paradigm, (ii) summarise the extensive research demonstrating the causal relationship between poverty and both psychosis in general and 'schizophrenia' in particular, and (iii) delineate some of the implications at both clinical and primary prevention levels.

The causal role played by poverty in a range of mental health problems is well established, including, for example, in relation to depression (Heflin & Iceland, 2009; Talala, Huurre, Aro, Martelin, & Prattala, 2009), drug abuse (Daniel et al., 2009) and suicidality (Bolton, Belik, Enns, Cox, & Sareen, 2008). The relationship between poverty and poor mental health is, of course, complex and is mediated by variables that are themselves related to poverty such as child abuse and neglect, unemployment, gender, ethnicity, maladaptive coping strategies etc. (Barker-Collo & Read, 2003).

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For example, the Christchurch Health and Development study, a prospective birth cohort study of approximately a thousand New Zealanders, found that the elevated rates of mental disorder among Maori involve an interaction between socioeconomic disadvantage and childhood adversity, with secure cultural identity operating as a protective factor (Marie, Fergusson, & Boden, 2008).

Furthermore, poverty (like mental health) can, of course, be measured in multiple ways, at multiple life stages. Another longitudinal birth cohort study, by the Dunedin Multidisciplinary Health and Development Research Unit, found that poverty before age 11 (as well as low IQ at age 5, and antisocial behaviour) predicted PTSD at ages 26 and 32 (Koenen, Moffitt, Poulton, Martin, & Caspi, 2007). The same study also found that while alcohol abuse in adulthood was related to low socioeconomic status in childhood, this was not the case for depression, which was instead related to low socioeconomic status in adulthood (Poulton et al., 2002). A study of over two million New Zealand adults found that over a three year period the age-adjusted odds ratios for suicide among unemployed people, compared to people in employment, was 2.46 for women and 2.63 for men (Blakely, Collings, & Atkinson, 2003). Another New Zealand study, of over 15,000 families, focussed, rather unusually, on asset wealth (eg home ownership and savings) and found that those in the lowest quintile were three times more likely to report high psychological distress than those in the highest quintile, and that the difference remained statistically significant even after controlling for age, gender, prior health status, and--perhaps surprisingly--income (Carter, Blakely, Collings, Gunasekara, & Richardson, 2009). …

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