Regional increases in unemployment in infancy associated with development of behavioral problems

Jan 5th – American adolescents whose families weathered recessions during their infancy were more likely to engage in substance abuse. [tabs tab1=”2MM Rundown” tab2=”Full 2MM Report” tab3=”About the Authors”]

[tab]

Image: PD

1. American adolescents whose families weathered recessions during their infancy (in the early 1980s) were more likely to engage in substance abuse and delinquent behaviors. 

2. Household financial stability did not affect the likelihood of behavioral problems.

Exposure to higher unemployment rates in infancy is associated with increased odds of substance abuse and delinquent behavior in adolescence. These findings suggest policymakers should consider the short- and long-term mental health consequences of disparities in societal resources.

Limitations to the study include the retrospective survey design and the use of unemployment rates as a proxy for exposure to economic crisis. Using unemployment rates as the sole indicator neglected the effect of underemployment (working less than desired), which could have biased results toward the null. Other limitations may have biased results away from the null: not considering history of parental substance abuse or conduct disorders (expected to be higher in exposed children) and not accounting for the provision of public aid (likely less in the exposed group given the timing of Reagan’s Medicaid cuts). Lastly, study authors assessed exposure at only certain ages (birth, 6mo, 12mo, 18mo), disallowing assessment of the length of exposure. Notwithstanding, the findings of this study are robust, with a trend that held true at both regional and macroeconomic levels even after accounting for individual family wealth.

Click to read the study in Archives of General Psychiatry

[/tab]

[tab]

Image: PD

1. American adolescents whose families weathered recessions during their infancy (in the early 1980s) were more likely to engage in substance abuse and delinquent behaviors. 

2. Household financial stability did not affect the likelihood of behavioral problems.

Primer: Social determinants of health are the circumstances in which people are born, grow, live, work, and age (1). One phenomenon influencing these determinants is the distribution of money, power, and resources within a society. Regardless of overall wealth, societies with greater disparities in resources have poorer health outcomes than societies with lesser disparities (2). This holds true at the individual level such that even wealthy members of societies with large disparities achieve worse health outcomes.

Unemployment is one social determinant associated with adverse short- and long-term outcomes for adults and their children. Unemployed adults have higher morbidity and mortality from mental health problems such as substance abuse, depression and suicide (4, 5), while the children of these unemployed adults are more likely to be abused and to develop behavioral problems (3).

Research suggests recessions can adversely affect child development. A study conducted during the 1991 Finnish recession suggests that economic difficulties increase family distress, leading to children’s behavioral problems (6). A longitudinal study of Australian children identified early exposure to economic hardship as risk factors for adolescent substance abuse (6). In the United States, the recent recession, characterized by high unemployment rates, has prompted interest in the effects on child development.

To probe the long-term effects of the 1980 and 1981-1982 recessions, the present study examines behavioral problems in American adolescents exposed to high regional unemployment rates during infancy.

Background reading:

1. WHO – Social determinants of health
2. Social determinants of health inequalities
3. Effects of unemployment on mental health in the contemporary family
4. Is unemployment pathogenic? A review of current concepts with lessons for policy planners
5. The health effects of economic decline
6. Children’s mental health in times of economic recession: replication and extension of the family economic stress model in Finland
7. Early childhood predictors of early substance use and substance use disorders: prospective study

This [retrospective cohort] study compared children born during the early 1980s recession (those exposed to a 1% increase in the mean regional unemployment rate at 1 year of age, about 25%) to those born after.

Adolescents whose families weathered recession during their infancy (birth-18mo) were significantly more likely to abuse mood-altering substances (OR: 1.09, 1.07, and 1.06 for marijuana, smoking, and alcohol, respectively; p<0.01) and exhibit delinquent behaviors like arrest and major theft (OR: 1.17, 1.11, resp; p<0.01). Controlling for individual family wealth did not alter findings.

In sum: Exposure to higher unemployment rates in infancy is associated with increased odds of substance abuse and delinquent behavior in adolescence. These findings suggest policymakers should consider the short- and long-term mental health consequences of disparities in societal resources.

Limitations to the study include the retrospective survey design and the use of unemployment rates as a proxy for exposure to economic crisis. Using unemployment rates as the sole indicator neglected the effect of underemployment (working less than desired), which could have biased results toward the null. Other limitations may have biased results away from the null: not considering history of parental substance abuse or conduct disorders (expected to be higher in exposed children) and not accounting for the provision of public aid (likely less in the exposed group given the timing of Reagan’s Medicaid cuts). Lastly, study authors assessed exposure at only certain ages (birth, 6mo, 12mo, 18mo), disallowing assessment of the length of exposure. Notwithstanding, the findings of this study are robust, with a trend that held true at both regional and macroeconomic levels even after accounting for individual family wealth.

Click to read the study in Archives of General Psychiatry

By [CH] and [LH]

More from this author: Intensive lifestyle intervention in overweight adults associated with higher remission rates of Type 2 Diabetes, Dietary salt intake associated with greater consumption of sugar-sweetened beverages in children, Clinically integrated e-learning course improves evidence-based practice in ObGyn trainees in low- and middle-income countries

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain.

[/tab]

[tab]

Leah Hawkins: Leah is a 5th year M.D./MPH candidate at Harvard Medical School.

Caroline Huang: Caroline is a 3rd year Ph.D. candidate in Public Health at the University of Oxford’s Ethox Centre, where she is a Rhodes Scholar.

[/tab]

[/tabs]