This week, I found an article on how stigma around poverty and the caste system affects people with mental illnesses in India. The article is called “Mental illness, poverty and stigma in India: a case-control study”.  Their research question or statement, while not stated directly, was “how does discrimination and stigma affect people with mental illness in regards to their status as impoverished or not?”.  They hypothesize that in India, the social-stigma and exclusion towards people with serious mental illnesses leads to low self esteem and worse life conditions over time, hindering their ability to receive help or treatment. For example, people with mental illnesses may be treated a burden to the family and unable to fulfill their prescribed duties under cultural/social norms, leading to low self esteem, learned helplessness, etc. They may be discriminated against by others due to stigma around mental illness and denied job opportunities or a proper social life (exclusion). Education, health, shelter, and food were also taken into consideration when evaluating the lifestyles and poverty status of individuals. Their method of choice was to do a case study, comparing mentally ill people to a non-mentally ill control group through the Department of Psychiatry of the Dr Ram Manohar Lohia Hospital in New Delhi. The ill participants were recruited through the hospital by being told about the study and choosing whether or not to participate, and then be referred to a researcher for informed consent. They were matched to randomly selected non-ill people who were around the same age as them and lived in the same area. Participants were interviewed on demographics, health, accessibility, employment, education, food security, socioeconomic factors, income,  physical safety (measured through perception), material well-being, social life. One-way analyses were used to look for significance in discrimination and poverty levels between the two groups, as well as adjusting for gender, age, and caste. Difference in access to employment, income, food security, and house ownership were high when comparing the two main groups, with the patients experiencing these dimensions of their lives negatively. When controlling for gender, women were more deprived and experienced more poverty, especially if they were from the hospital group. When controlling for caste, ‘scheduled castes’, ‘scheduled tribes’, and ‘other backward castes’ were more likely to be poor.  When it came to the relationship between poverty and stigma, the p value was always < .0001 regardless of gender, caste, and age controls.

Trani, J., Bakhshi, P., Kuhlberg, J., Narayanan, S., Venkataraman, H., Mishra, N., Groce, N., Jadhav, S., Deshpande, S. (2015). Mental illness, poverty and stigma in India: a case-control study. BMJ Open. doi:10.1136/bmjopen-2014-006355

My article for this week is called “Poverty and Mental Health Practice: Within and Beyond the 50-Minute Hour” by Lisa Goodman, Meghan Pugach, Avy Skolnik, and Laura Smith. It is suggested that there are several dimensions to the issue of poverty and mental health practice that need to be addressed in order to get impoverished mentally ill people the help that they need and keep them on said treatment or program. These include exclusion and isolation of poor people, limited access and use of mental health services by low-income adults, and the structure of practice and accommodation for poor people that is currently in place. The article first discusses the relationship between mental health problems and poverty. Prolonged living in stress leads to anger, fear, hopelessness, and isolation. The stressful living situation and isolation leads to feelings of powerlessness and low levels of feeling that they are in control or have a sense of autonomy. These states of being and the mindsets acquired as a result indicate high risk for developing mental illnesses. Lack of insurance, cost of treatment, service hours, transportation, and limited accommodations for low-income individuals act as barriers to accessing mental health services and treatment. If a low-income client is able to make it to a service in the first place they may be met by unwilling clinicians, which research shows causes low-income adults to give up seeking treatment. Low-income clients who make it to a therapy session may also be unwilling to fully disclose important information to their therapist out of the concern that someone from a different class than them would not be able to understand or help them. The article lists suggestions to combat these issues. The solutions include “transportation to and from therapy, home visits, childcare, and flexible scheduling, as well as case management that involves assessing clients’ external stressors and instrumental needs and developing intervention to address them” (Goodman, 2012). It is also important to train mental health professionals to overcome any discomfort they might have in regards to their low-income clients, because it can lead to the professional avoiding certain topics. The article suggests this can be combated through “increasing self-awareness of own class, awareness of assumptions about poverty, knowledge of poverty’s psycho-social impact, and knowledge of the effective interventions for addressing the negative psycho-social consequences of poverty” (Goodman, 2012). This is important to my topic because several contributing factors to the issue of mental health service access and poverty are discussed (+how this facilitates mental illness) and possible solutions are suggested, giving me more perspectives to explore when it comes to formulating my final research proposal.

Goodman, L., Pugach, M., Skolnik, A., Smith, L. (2012). Poverty and Mental Health Practice: Within and Beyond the 50-Minute Hour. Journal of Clinical Psychology. (Vol. 69, Iss. 2). doi: https://doi-org.ezproxy.redlands.edu/10.1002/jclp.21957

For this week, I had a bit of a difficult time finding an article through the library database, so I turned to other ways of finding articles. I used backtracking to find a really interesting article that relates directly to my research question and might be able to help me better develop my proposal. The article is call “An epigenetic mechanism links socioeconomic status to changes in depression-related brain functions in high-risk adolescents” by J. R. Swartz, A. R. Hariri, and D. E. Williamson. The article investigates the biological factors behind the development of mental illness and how life stressors can trigger them more readily in certain people, depending on their situation.  Specifically, it previously had been found that increased risk for developing a mental illness due to life stressors can be triggered through methylation of gene regulatory regions, which results in epigenetic modification of gene expression. With this information in mind, the authors asked “is differential gene methylation a function of adversity that contributes to the emergence of individual risk for mental illness?”. They used the neuroimaging and behavioral data of 132 adolescents. It was found that lower socioeconomic status during childhood is related to an increase in methylation of the serotonin transporter gene. This causes the amygdala to be more sensitive and exhibit more threat-related activity, which increases risk for depression. It was also found that there is an association between increases in this type of activity from the amygdala due to life stressors and having a  family history of depression. The article states that “these initial results suggest a specific biological mechanism through which adversity contributes to altered brain function, which in turn moderates the emergence of general liability as individual risk for mental illness.”.

Swartz, J. R., Hariri, A. R., Williamson, D. E. (2017). An Epigenetic Mechanism Links Socioeconomic Status to Changes in Depression-Related Brain Function in High-Risk Adolescents. Molecular Psychiatry. (Vol. 22, pp. 209-214.)

The article I found this week is called “Poverty and Serious Mental Illness: Toward Action on a Seemingly Intracatable Problem” by John Sylvestre (2017). It is a literature review that argues for community health programs that address larger groups of people rather than just individuals. The program would utilize collaboration of expertise between community psychologists and practitioners from other various fields. The question the article wants to answer is “what would be an effective strategy to combat poverty on a large scale?” and uses previous research that has been done to argue their points. When discussing the definition of what constitutes poverty and how it comes about, the author focuses on the lack of voice people stuck in poverty have and the shame and stigma they have experienced as a result. He claims that the relationship between serious mental illness and poverty is due to marginalization of people who suffer from them, resulting in lack of opportunities to advocate for themselves or find a way of making an income in order to meet their basic needs. The article suggests improving methods of tracking poverty throughout the country and taking steps towards the CMH community adopting a policy that benefits these people that matches the level of investment put into individual-level interventions. Inaction on a community level by CMH services and the government ignores the root issue of what causes poverty for people who suffer from serious mental illnesses. I found this article really interesting and found that it made a lot of good points that I am interested in including while further developing my research project proposal. I did think the article could have been a bit more organized regarding the points the author was trying to make. While the community based psychology programs and getting to the root of what the authors pinpoint to be the cause of poverty for people with mental illnesses, there were a lot of other sub-points that were mixed in and easy to gloss over or side-tracked from finishing a previous thought (at least that’s how I saw it, it could just be me).

Sylvestre, J., Notten, G., Kerman, N., Polillo, A., Czechowki, K. (2017). Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem. American Journal of Community Psychology. (Volume 61, Iss. 1-2, pp. 153-165).

The article I found for Research Example #2 is called “Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study” by Sophie Wickham, Ben Barr, and David Taylor-Robinson. This study was done in response to ambiguity regarding whether or not poverty is related to maternal and child mental health issues because while it is usually assumed that they are, there have not been enough studies or analyses on studies on the matter to come to a conclusion. The UK Millennium Cohort study that was analyzed consisted of 5877 individuals being occasionally tested for poverty levels, maternal psychological distress, and child socioemotional behavioral problems as they aged from 9 months to 11 years old. The study had found that maternal psychological distress from the individuals’ mothers and socioemotional behavioral problems in children were related to  household income dipping below 60% of the national average. This specific analysis of the study adjusted for confounding factors to find that the transition into what was defined as poverty was linked to direct increase in maternal psychological distress and socioemotional behavioral problems in children. Maternal psychological distress was then also controlled for and it was found that transition into poverty and socioemotional behavioral problems in children were not correlated, as the statistical findings were nonsignificant. Therefore, the maternal psychological distress that mothers were experiencing during their transition into poverty was affecting the expression of socioemotional behavior in their children. I found this article really interesting and useful to my topic because it dealt with the relationship between mother and child and poverty. Distinguishing between what is causing psychological or emotional distress within those groups is important to studying the relationship between poverty and mental health

Wickham, S., Barr, B., Taylor-Robinson, D. (2016). Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study. The Lancet, suppl. Supplement 2. (Vol. 388, pp. s4).

The article I found is called “Money and Mental Illness: A Study of the Relationship Between Poverty and Serious Psychological Problems” (Ljungqvist, 2016). The researchers had evaluated previous studies done on the relationships between mental problems and economic issues along with isolaton and were interested in exploring the effects of social initiatives on the condition of people with previously diagnosed mental health issues. Their research question was: Can the addition of modest financil support for social and recreational activities have an impact on social intercourse, sense of self, symptoms, and functional level among persons with SMI?”. Their method included giving financial aid to 100 individuals with mental illnesses for a period of time and comparing them to a control group. Their study concluded that the financial aid improved symptoms of depression and anxiety in the group of people that had been previously diagnosed. Data for this study would include self reports of one’s symptoms and state of mind/being before, during and after they participated in the study and were given financial aid. The assessments were categorized as symptoms, functional level, social networks, sense of self, and overall quality of life. Their self assessment tools included “Hospital Anxiety and Depression Scale”, “Global Function Assessment Scale”, “Manchester Short Assessment of Quality of Life”, “The Visual Analogue Scale”, and “Lancashire Quality of Life Profile”. All categories showed statistically significant improvement except for functionality under the “Global Function Assessment Scale”. The data was analyzed with Wilcoxon matched-paires signed-ranks test for non-normally distributed values. Unpaired groups were analyzed using the Wilcoxon rank-sum test. I enjoyed reading this research and think it was really well done. I think it was really important that they used so many different ways of evaluating their participants mental health and well-being, giving deeper insight into how exactly poverty can affect people and how having more resources improves – or does not improve – those different facets of how mental illnesses are expressed in those who have been previously diagnosed. One thing to note is that the sample size was fairly small, so if the study were re-done with a larger sample the results could differ.

Ljungqvist, I., Topar, A., Forssell, H., Svensson, I., Davidson, L. (2016). Money and Mental Illness: A Study of the Relationship Between Poverty and Serious Psychological Problems. Community Mental Health Journal (Vol. 52, Iss. 7, pp. 842-850).

While I was unable to find a printed research article in the Armacost Library regarding the relationship between mental illness and socioeconomic status, which is my research topic, I did find a few research articles on education strategies that can increase the future success rate of children from low income families to match that of children from other economic backgrounds. I felt that this was related to my topic in that the articles focused on pinpointing a specific factor that contributes to socioeconomic stratification, quality of available education, and offered realistic solutions. I found these articles in the Journal of Education Psychology and have decided to focus on the article “Low-Income Immigrant Pupils Learning Vocabulary Through Digital Picture Storybooks” by Marian J. A. J. Verhallen and Adriana G. Bus. The study was done in the Netherlands and the main questions the researchers wanted to answer were “does presentation format effect the development of vocabulary for preliterate, immigrant children?” and “are receptive vocabulary and expressive vocabulary differentially affected by presentation format?”. Demographic data and shallow reports of acts were needed to answer these questions. Participants were acquired by contacting teachers and school administrations for information regarding their students’ backgrounds in order to determine which students fit into their demographic requirements (5 years old, used Moroccan-Berber or Turkish at home, were of a low-income family, etc.). Students that met demographic requirements were then tested academically in their Dutch language abilities and non-verbal intelligence. The remaining students that met the criteria were exposed to different story-telling presentations through CD-ROM. One story was told with static illustration, while the other was a video. Their results, analyzed through covariance (ANCOVAs), found that while both types of story-telling were effective, the video version of the story was more effective in teaching new vocabulary to the students. There was no difference between receptive vocabulary and expressive vocabulary between the two formats, although it was determined that receptive vocabulary is acquired more easily than expressive vocabulary regardless of exposure format. I personally felt that the study was thorough and well-done, as it even mentioned ways in which to expose this demographic of students to video story-telling in order to increase their vocabulary which translates into better understanding of their school material. This would hypothetically increase their chances of success later in their education if they were exposed to video story-telling. Although I think that whether or not the results of the study would be taken seriously by schools with a large minority population and give children access to those resources is critical to the research findings having any effect. It is possible that lack of willingness to accommodate minority children is a factor in their stunted vocabulary development that could have been tested for or taken into consideration

Verhallen, M., Bus, A. (2010). Low-Income Immigrant Pupils Learning Vocabulary Through Digital Picture Storybooks. Journal of Educational Psychology. (Vol. 102, No. 1, pp. 54-61).