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Boost From Poverty Helps Kids' Mental Health

Casino windfall leads to unique study

TUESDAY, Oct. 14, 2003 (HealthDayNews) -- Climbing out of poverty significantly reduces the likelihood of childhood mental illness, says a new study that looked at the effects of a casino opening on Indian tribal welfare.

The study, which appears in the Oct. 15 issue of the Journal of the American Medical Association, compared rates of poverty and mental health among Native American and other children living in rural North Carolina between 1993 and 2000. Before the opening of the casino on land belonging to the Eastern Band of Cherokee Indians, poor children in that tribe were about twice as likely as wealthier youth to suffer from emotional and behavioral disorders.

After the gaming began, the impact of the new revenue on the tribe's mental health was dramatic. Rates of rebellious and aggressive behavior among children lifted from poverty by the annual distribution of casino money fell to those among children who'd never been poor at all.

Economic improvement didn't reduce rates of depression or anxiety disorders, which may have strong genetic causes. Nor did the infusion of cash reduce rates of mental illness in Indian children whose families had never been poor. However, moving out of poverty reduced the prevalence of certain emotional problems in non-Indian children living in the same area of North Carolina, suggesting that the benefits of wealth on mental health are the same regardless of ethnicity.

"Several studies have looked at impact of income supplements on children's behavior, but it's rare that you can deal with it experimentally," says study leader Elizabeth Jane Costello, a Duke University psychiatric epidemiologist. "Since everybody in one community received an income supplement, you could rule out the possibility that any change in a child's behavior" was associated with changes in the qualities of their parents.

However, nearly all the effect of income on childhood mental illness was due to its impact on the ability of parents to supervise their children, the researchers say. Poor families that suddenly received money reported less "time stress" at home, Costello says. The opening of the casino also reduced the number of new single-parent families in the group who moved out of poverty, but the researchers declined to speculate as to why.

The eight-year study followed 1,420 children, aged 9 to 13, living on or near Cherokee land. A quarter of the children belonged to the tribe. Four years into the research project the tribe opened its casino, earning a windfall for every tribal family; children under 18 had the money put in trust. That money was enough to boost 14 percent of the families in the study -- all Cherokees -- out of poverty. Of the rest, 53 percent stayed poor and 32 percent were never poor.

Non-Indians didn't get an annual payout, but some of those families moved out of poverty anyway.

Symptoms of behavior problems plunged 40 percent in children lifted from poverty by the arrival of the casino. Rates of acting out didn't change after the casino opened in children who stayed poor or who weren't poor to begin with.

Psychiatric illness is notoriously rife on reservations and among Indian tribes. A recent study, for example, found that 30 percent of men and 18 percent of women who belong to seven tribes in Wisconsin, Oklahoma, Oregon, Maine and Arizona had some form of diagnosable alcohol problem. The study, reported in the September issue of the American Journal of Preventive Medicine, found high rates of child abuse in tribe members with alcohol issues.

Mary P. Koss, a public health researcher at the University of Arizona who led that study, calls the latest work a "magnificent opportunity" to assess the impact of poverty on child health. However, Koss says, it leaves important questions unanswered.

Some poor families, for example, were helped more than others by money. What distinguishes the families that money couldn't help from those for whom it made such a difference? "It's not just money, it's how people use money," she says.

Of the 562 federally recognized tribal governments, 201 engage in some form of gaming, according to the National Indian Gaming Association. In 2001, Indian casinos and other gaming facilities generated $12.7 billion in revenue.

More information

For more on Indian health and welfare, visit the Indian Health Services. And for more on Indian gaming, try the National Indian Gaming Association.

SOURCES: Elizabeth Jane Costello, Ph.D., professor, medical psychology, Duke University School of Medicine, Durham, N.C.; Mary P. Koss, Ph.D., professor, public health, University of Arizona, Tucson; Oct. 15, 2003, Journal of the American Medical Association
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