Children’s mental health: Is poverty the diagnosis?

ABSTRACT: The case of a 6-year-old boy who was referred to a physician by his school counselor for investigation of anxiety and possible attention deficit hyperactivity disorder illustrates the need to consider the role of poverty when addressing mental health concerns. After determining that income insecurity could be contributing to the boy’s symptoms, the physician used a poverty intervention tool to screen for the effects of poverty and make recommendations to prevent adverse health outcomes. Mental health and behavioral concerns are common in children and youth presenting with undifferentiated complaints in both pediatric and primary care settings. Psychiatric disorders are frequently multifactorial and require a comprehensive assessment of the patient’s environmental context, including the family’s socioeconomic status. Poverty is a risk factor for mental health conditions in childhood and is associated with lower academic achievement and impaired cognitive development secondary to direct effects on the developing hypothalamic-pituitary-adrenal axis and indirect effects on a child’s environment. British Columbia’s childhood poverty rate is well above the national average and is compounded by significant unmet core housing need and widening provincial income disparity. We recommend screening for poverty with office-based interventions and accounting for income insecurity in all mental health diagnoses and treatment plans. We also strongly recommend implementing a national poverty reduction strategy to address social determinants of health in the early years and improve the health of future generations.

Issue: BCMJ, Vol. 58, No. 8, October 2016, page(s) 454-460 Articles
Ivana Jakovljevic, MD, Ashley P. Miller, MDCM, FRCPC, Barbara Fitzgerald, MD, FRCPC

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