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Study: Poverty is a Risk Factor for Emotional Disturbance in White Children, not in American Indians

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Duke Health News 919-660-1306

DURHAM, N.C. -- A study conducted in the mountains of North
Carolina has found that poor white children are three to four
times more likely to suffer from serious emotional disturbance
than poor American Indian children, suggesting that poverty is
only one among many causes of such disorders.

The researchers said depression, anxiety, substance abuse
and conduct disorders can have dire consequences, such as
dropping out of school, arrests and convictions, teen pregnancy
and suicide attempts.

The Duke University Medical Center study of more than 1,400
families also found that only one in five children with these
disturbances received help for their condition.

The findings of the four-year study are published in the May
issue of the American Journal of Public Health. The project was
funded by the National Institute of Mental Health and is
expected to follow these 9-, 11- and 13-year-old children until
they are 22 years old.

Duke psychologist Jane Costello, lead author of the study,
said the findings should ultimately help professionals identify
children and adolescents at risk for emotional disturbances by
predicting the risk factors that contribute to their
development.

"We know the risk factors for heart disease, diabetes and
other chronic illnesses, but we know much less about how mental
health problems develop," Costello said. "You can't prevent
emotional disturbances until you know what the early warning
signs are."

In the study, researchers wanted to determine how many
children suffer from various emotional disturbances, what
factors cause them, how many kids get help and what barriers
exist to getting help. Researchers selected the Great Smoky
Mountains region because of its well-developed mental health
care system, figuring that a good system would better reflect
persistent and widespread problems common to all systems.

One of the major findings was that poverty put white
children at risk for emotional disturbance but had little
effect on American Indian children. This was the case despite
the fact that Indians had a much higher poverty rate than
whites: one-fourth of the white children were poor, whereas
two-thirds of the Indian children were poor.

Costello theorizes that widespread poverty may have a less
harmful effect on certain populations where it is a socially
accepted norm.

"There may be an attitude that, 'we're all poor, so there's
no stigma attached to it and therefore less stress associated
with it,'" she said. The stress of poverty, racism, and type-A
personalities has been linked to increased risk of heart
disease and early death in adults, according to Duke studies
conducted by Dr. Redford Williams.

The study showed that poverty had no effect on children's
physical health. The height, weight and general health status
of poor children were equivalent to those of middle-class kids,
and the poor children had no higher incidence of infectious
diseases.

On the issue of access to mental health care, researchers
found that only one in five rural children with emotional
disturbance received help for their condition, a ratio similar
to that found in major cities. In Pittsburgh, for example,
Costello found that only one in seven children received
appropriate mental health care.

Of the children who received help in the North Carolina
study, 75 percent of them received it through school
counselors. The remaining 25 percent sought help mainly through
the professional mental health system, including psychiatrists,
psychologists and social workers in the community.

"That finding concerned us, because if families aren't able
to get mental health services in an area where good resources
exist, what does that say about regions where mental health
care is scarce or hard to access?"

When they looked at why kids weren't getting help,
researchers received surprising answers from parents. The top
reason parents listed was the fear of losing their child to the
state or of losing parental rights, a fear that Costello said
is generally unfounded, since a main goal of mental health and
child welfare services is to keep families together.

The study found other barriers to care were lack of
information, cost factors, lack of time, and the shame and
stigma associated with mental illness.

Researchers had expected cost to be a bigger factor in
blocking access, Costello said. But the study showed that
children with private insurance were no more likely to get
mental health care than kids with no insurance. Children with
Medicaid were twice as likely to get mental health care,
possibly because they were identified through government social
service agencies.

Costello said that cost was important in relation to its
burden on the family and society as a whole. Having a child
with a serious emotional disturbance is costly to the family
because many parents cannot work with a sick child or must go
on welfare to cope financially. Costello said the cost to
society is both a social and financial burden.

"By the age of 16, kids with serious emotional disturbance
are four times more likely to have been convicted of a crime,"
she said. "These kids are going to be a major economic burden
on the state. If we could identify them early and treat them,
we could reduce that burden dramatically."

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