Casino impact: as family income rises, child mental health improves.

The arrival of a casino at an American Indian reservation gave Duke University researchers an opportunity to test the relationship between poverty and psychopathology.

The research team set out to examine the competing theories of Social causation (adversity and stress) vs social selection (downward mobility from familial liability to mental illness). The study focussed on a period of time beginning four years before the casino opened and four years after. It also compared non-native to the adjacent rural community.

The longitudinal study found that 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; The effect was strongest in relation to symptoms of conduct and oppositional defiant disorders.

However, anxiety and depression symptoms were unaffected. Similar results were found in non-Indian children whose families moved out of poverty during the same period:

The researchers concluded that: "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."

The researchers are: E. Jane Costello, PhD; Scott N. Compton, PhD; Gordon Keeler, MS; Adrian Angold, MRCPsych. The report is found in the Journal of the American Medical Association, October 15, 2003.