Tag Archives: mental health

News from No Family For You

Inequality comes in many forms in modern societies. On this blog I’ve written about poverty as a lack of income or wealth; people also lack for jobs, health care, or food, among other things. But the more human care and well-being depend on family-based support and labor, the more we need to think about “having” a family — or the family of one’s choice — as a matter of inequality as well.

I’ve gone through some old posts and added a “no family” tag to a series that focus on absence, loss or denial of family relationships as problems of inequality — for example, the deportation of legally married spouses in homogamous couples, state eugenics programs, and the drug war’s father-removal consequences.

Once you start reading the news with this problem in mind, the stream seems endless. (For example, what about the future marriage consequences of unbalanced sex ratios resulting from sex selective abortions?) To keep up, I need to do a digest post.

No Family Update

Deportation: The first time I wrote about “Who Gets a Family?” was back in my Huffington Post days, in a story about the parents of U.S.-citizen children being deported. At the time I was shocked that, “Over the 10 years up to 2007, the U.S. deported 108,434 adults whose children were U.S. citizens.” Now we learn from the Applied Research Center’s government document investigation that 46,000 such deportations took place in just the first half of this year.

This is a family loss for both the allegedly illegal immigrant parents and their U.S.-citizen children, many of whom end up in foster care. Some people aren’t sorry for the parents, since coming to the U.S. was their risk. Others aren’t sorry for the children, because it’s their parents’ fault rather than the government’s. (Feeling justified in punishing children for the actions of their parents is one perspective on human rights I can’t get behind.) In any event it clearly shows that the birthright citizenship of these children does not include the right to keep their parents here.

Abduction: Two horrific stories of state-sponsored child abduction made the news for this roundup.

Manoli Pagador's first-born son was taken from her at birth -- the doctor said he died.

In Spain, we are gradually learning that thousands — maybe hundreds of thousands — of children were stolen from their mothers at birth by Catholic nuns and priests in cahoots with the Franco dictatorship, and sold to other families. The BBC has run a series of reports, describing how a program that started out something like American eugenics — except taking away children from socially marginal women rather than sterilizing them — developed into a profit-driven criminal enterprise under the protection of the dictatorship and the cover of Church authority.

This boy spent a year and a half in foster care before being returned to his family.

In South Dakota, hundreds of American Indian children are removed from their family homes every year and placed in White homes or group homes, in violation of the federal law requiring every effort to place them with native families. A heart-rending NPR series revealed that American Indians are 13% of the state’s children but 53% of the children in foster care. Further, the South Dakota system is using their child removals to gain federal funds and funnel money to home operators with deep connections at the highest levels of state government.

James Taylor drowned in a bathtub when he was left unattended at his group home in Schenectady, NY.

Aberration? Finally, the New York Times has a long story on deaths from neglect (my layperson’s term) in privately operated group homes, where adults with disabilities are cared for at state (and federal) expense. The Times looked into the inexcusable or unexplained deaths of hundreds of residents from choking, drowning, fire and other causes. How does this fit? The group homes in New York, as in other states, are the post-deinstitutionalization system of non-family care for people whose developmental or psychiatric disabilities prevent them from living on their own or with their families — given their economic resources. When the family can’t care, who cares? As this story shows, it’s the state that cares — sort of.

(This one struck close to home for me, since I was once a 19-year-old high school graduate working as a counselor in a group home in New York for adults with developmental disabilities. I dispensed medication, supervised household chores and relationships, cooked and cleaned with the residents, and counseled a little. Sometimes I was the only staffer with eight residents or so, even overnight, and now I’m thinking how glad I am nothing awful happened. I had a few days training, and I was very conscientious, and everyone was fine, but it might not have been.)

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Income gradient for children’s mental health

Lining them up (by income) and knocking them down.

I didn’t realize how strong the income gradient is for children’s emotional and behavioral problems. This new graph from the CDC combines data from 6 years of the National Health Interview Survey, and shows a steep relationship at all ages:

Percentage of Children with Serious Emotional or Behavioral Difficulties, by Age Group and Family: U.S., 2004-2009

The question asked was, “Overall, do you think that [child] has any difficulties in one or more of the following areas: emotions, concentration, behavior, or being able to get along with other people?” Children are included here if the parent said “yes, definite difficulties” or, “yes, severe difficulties.”

As background: I’ve posted before on the income gradient for asthma, overall health, diagnosis timing, mammographypregnancy, and women generally. That makes me curious, but not an expert. That is probably a good description for the authors of this recent review article, Janet Currie and Wanchuan Lin, who conclude:

Low-income children are in worse health than other children are. This paper explores the extent to which insults to health and activity limitations are responsible. In the most recent National Health Interview Survey (NHIS) data, low-income children are more likely than other children to have virtually every measured chronic or acute condition and are more likely to be limited by these conditions. Mental health conditions are particularly common and limiting. But the higher incidence of measured conditions and limits does not explain all of the relationships between income and overall health status, which suggests that unmeasured illnesses and injuries are also involved.

And finally, this reminds me of a good research tip. To get started on your subject, find a review article that’s a few years old or older, and then see which articles cite it — that should help bring you up to date. In this case, you could get these, which look highly relevant:

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Income inequality in mental illness

In South Korea, rising inequality, mental illness — and inequality in mental illness.

South Korea has a high and rising suicide rate, which doubled from 1997 to 2008, becoming the worse of any country in the Organization for Economic Cooperation and Development (OECD). During that time, income inequality also increased.

A new paper in the journal World Psychiatry (the source of those figures) shows that the concentration of mental illness among poorer people in South Korea also increased during that period. That is, the income inequality in mental illness grew worse. Using a large survey of self-reported mental health and income, the authors, Jihyung Hong and colleagues, calculated he distribution of illness along the income distribution, like a Lorenz curve and its related Gini coefficient.

I have rescaled their numbers, so that zero equals equality (same rates of illness at all income levels) and 1 equals complete inequality (all illness among the poor), and plotted the trends here:

South Korea had a major economic crisis at the end of the 1990s, the shocks from which reverberated in many social aspects of the society. For example, that high rate of economic inequality in suicide attempts in 1998 took place in a year that saw a big jump in suicide attempts nationwide.

Inequality has not increase continuously for all three measures during this period, but they are all substantially higher in 2007 than they were 10 years earlier — and they all show considerable economic inequality in major mental illness.

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Depressing inequality

What is down must feel down.

The latest Morbidity and Mortality Weekly Report from the CDC falls under the category of when-it-rains-it-pours. Depression, according to two different measures, follows the pattern of at least four major indicators of inequality: gender, race/ethnicity, education, and employment status.

Source: My graph from the report.

One could argue the depression contributes to employment problems, and educational failure as well. So on those the causality may run both directions. But that’s not the case with gender and race/ethnicity.

For a handy debunking of the idea that people in dire straights should just buck up, I recommend Bright-sided: How Positive Thinking is Undermining America, by Barbara Ehrenreich.

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Institutional discrimination is bad for mental health

The culture wars are all fun and games until someone’s mental health is damaged. Here’s new evidence that’s what’s happening.

In the 2004 election cycle 16 states passed amendments banning homogamous marriage (two of those were in 2005). Fortunately, the National Epidemiologic Survey on Alcohol and Related Conditions had conducted a large survey in 2001-2, and then followed up with the same respondents in 2004-5, including a question on sexual orientation. The sample was large enough (more than 30,000) to capture a substantial group of gay, lesbian and bisexual adults in both the states that did and those that did not pass anti-gay amendments. Researchers writing in the American Journal of Public Health reported:

Psychiatric disorders … increased significantly between waves 1 and 2 among LGB respondents living in states that banned gay marriage for the following outcomes: any mood disorder (36.6% increase), generalized anxiety disorder (248.2% increase), any alcohol use disorder (41.9% increase), and psychiatric comorbidity (36.3% increase). These psychiatric disorders did not increase significantly among LGB respondents living in states without constitutional amendments. Additionally, we found no evidence for increases of the same magnitude among heterosexuals living in states with constitutional amendments.

So, mental health worsened more for the GLB folks in the amendment states than for their hetero neighbors, and more than for the GLB respondents in the non-amendment states. Here are the results for mood disorders:

Source: My chart from the article. (Numbers are percentages with a mood disorder.)

The authors can’t prove the amendments (and the anti-gay/lesbian political agitation and climate leading up to them) caused the worsening of mental health, but it’s not a bad hypothesis — especially given evidence that discrimination experienced at a personal level has negative mental health effects.

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Finding autism

When higher rates are better?

An early-release from the journal Autism Research (subscription required to get past the abstract), by researchers at U.C. Davis, shows 10 population clusters of autism cases in California – places where the autism rates are much higher than average. These areas are strongly correlated with local education levels (higher) and race/ethnicity (Whiter). The story was also reported in the papers, and on NPR.

The suggestion from the authors – consistent with individual-level analysis in other studies – is that parents with higher education may be more likely to have their kids’ autism diagnosed. So the higher rates are good in these areas, relatively speaking.

The researchers failed to find any environmental explanation for the wide variation in autism rates – but they stress their method wouldn’t work for finding universal environmental factors that are not locally varying: “The findings from this study do not preclude a role for environmental exposures that cluster around nonpoint sources, such as traffic, or that are not clustered spatially because they are widely distributed, such as household products.”

Figure from fightingautism.org. It shows rising incidence or autism per 10,000 births (the drop off in the last few years is because those kids aren't old enough to all be diagnosed yet).

The conclusion implies that the low-autism areas are underserved and therefore underdiagnosed. The association of education with autism rates has been found in other places, they note, but not Denmark, where everyone is screened for autism. Partly for that reason, they don’t believe Whites or people with high education are more likely to have children with autism. Still, that’s possible:

It remains possible that the associated demographic characteristics are surrogates for some other yet-to-be defined/confirmed risk factors, such as subfertility, accumulated exposures, genetic susceptibility, or access to optional medical interventions like assisted reproduction or scheduled casarean sections.

Their findings and interpretation seem plausible to me. But it’s not the whole autism story. First, they don’t suggest that this could account for the increase in autism rates in recent decades altogether (see figure). Second, there are other apparent cases of autism clusters, for example among Somalis in Minnesota, that don’t seem related to the parents high education or other pro-diagnosis factors. So some of the story remains to be told.

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Latina teen suicide

A small story about a young young woman, Cecilia Casas, apparently committing suicide on a Los Angeles freeway the other day led me to refresh myself on gender, ethnicity and suicide.

CNN did a story in October about Latinas in particular, with some statistics and interviews. More generally, a recent review in the journal Aggression and Violent Behavior showed that among young adults in all race-ethnic groups, women are more likely to attempt suicide than men:

One-year percentages of suicide attempts among 10–24 year olds. Gender ratios (males:females) are presented below each group.

…but men are much more likely to succeed.

One-year rates of suicide deaths per 100,000 among 10–24 year olds from 1999 to 2005. Note. Gender ratios (males:females) are presented below each group.

Suicide attempts are going to be counted much less accurately than completed suicides, so reconciling these is not simple. However, mental health data on teenagers shows that girls are much more likely than boys to have major depressive episodes:

PERCENTAGE OF YOUTH AGES 12–17 WHO EXPERIENCED A MAJOR DEPRESSIVE EPISODE IN THE PAST YEAR BY AGE AND GENDER, 2004–2007

On consequence of the attempt/completion ratio difference between men and women is that mental health practitioners are better able to intervene with women, since they’re more likely to have an unsuccessful attempt as a trigger for treatment. It’s not as effective to rely on self-reported suicidal thoughts, which is more often necessary with men. In any case, access to regular medical care – a usual doctor or other provider, not an emergency room – seems like a necessary condition for identifying and preventing suicide.

Coincidentally, Dr. Perri Klass has a post today – with good links to resources – about how to handle depression and suicidal thoughts in a discussion with students.

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