Socioeconomic status, neighborhood disadvantage, and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families

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Abstract

Living with persistent poverty is toxic for one’s psychological health. This study examined SES, income, neighborhood disadvantage, and poverty-related stress as predictors of a wide range of psychological problems including anxiety, depression, aggression, relationship problems, physical problems, and trouble with the law. Longitudinal analyses were conducted with a low-income multiethnic sample of 98 families recruited from the greater Denver, CO metropolitan area (300 family members: 136 adults, 82 preadolescents, 82 adolescents) using hierarchical linear modeling to predict all eight ASEBA narrow band syndromes. Analyses showed that poverty-related stress was directly related to anxious/depressed symptoms and social problems and interacted with prior symptoms, contributing to worsening symptoms for delinquency, attention problems, somatic complaints, and anxious/depressed symptoms. Hollingshead SES also had direct predictive effects for certain syndromes, though these effects were in the opposite direction predicted. In contrast, lower income-to-needs predicted more problems as expected. Neighborhood disadvantage also predicted psychological syndromes. Developmental differences are discussed. Our data show that parents are not the only family members who are affected by stress from living in poverty. SES, neighborhood disadvantage and poverty-related stress take a toll on children, adolescents, and adults.

Introduction

Living with persistent poverty damages one’s psychological health. Social causation studies show that poverty contributes to the development of a wide range of psychopathology (Miech, Caspi, Moffitt, Wright, & Silva, 1999). Understanding how poverty translates to psychopathology for children and adults is critical for developing effective intervention and advocating for sound policy. Socioeconomic status (SES) and low income contribute to negative outcomes by limiting financial resources and opportunities for higher paying employment. In addition, low SES and income are associated with mental health disorders such as depression, because of the stress of living with less money than one needs (Siefert, Bowman, Heflin, Danziger, & Williams, 2000). Living in a poor neighborhood is also a chronic stressor whereby poverty, unemployment and residential mobility create neighborhoods with fewer resources, less cohesiveness, and higher crime (Britt, 1994, Brooks-Gunn et al., 1997). Poor individuals and families experience more chronic and uncontrollable life events and stressors than the general population (Ennis, Hobfoll, & Schroder, 2000) and these day-to-day stressors are related to poor psychological health (Wadsworth et al., 2008). Thus, poverty contributes to poor psychological health via inadequate income, low socioeconomic status, neighborhood disadvantage, and poverty-related stress (e.g., Attar, Guerra, & Tolan (1994); McLoyd, 1998, Wadsworth et al., 2008).

Though it is clear that SES, neighborhood disadvantage, and poverty-related stress contribute to poor mental health, few studies have examined these predictors in the same model or across such a range of psychopathology and developmental level. The current study examines the predictive utility of income, SES, neighborhood disadvantage, and poverty-related stress in explaining psychological problems including anxiety, depression, physical problems, relationship problems, trouble with the law, hostility, and difficulty concentrating. We examine the relationship between these predictors and outcomes across time, taking into account prior levels of symptoms. We also examine these relationships in a multiethnic sample that includes children, adolescents, and adults.

There is clear evidence that low SES and income are linked to poor psychological and physical health outcomes, showing a clear gradient whereby more health problems are experienced with each step down the SES ladder. Explanations involving social selection and differences in life-style risk factors are limited in their ability to explain this SES-health gradient. The incidence of smoking, drinking, obesity, poor diet, and sedentary lifestyles do increase among lower SES individuals. However, these explanations only account for a small portion of the SES-health gradient (Sapolsky, 2004). In addition, access to healthcare is a real problem faced by many low-income families, but this explanation has also failed to fully explain the SES-health gradient. The gradient exists even in countries with socialized healthcare, and for diseases that are not affected by preventative health care (Sapolsky, 2004). Social causation theory posits that poor people develop psychological and physical health problems as a result of living with poverty-related hardship. Indeed, the SES-health gradient is strongest for diseases with sensitivity to stress such as heart disease, diabetes, metabolic disorders, and psychological disorders (Sapolsky, 2004). Studies comparing social causation of psychological disorders with alternative models such as social selection generally find strong support for the social causation of psychological disorders such as depression and anxiety (e.g., Wadsworth & Achenbach, 2005). Poverty is chronic and toxic, taxing mental and physical resources, ultimately resulting in higher mortality rates for those in poverty (e.g., Rehkopf et al., 2006). Low SES also takes its toll on children and adolescents, with familial SES predicting anxiety at age 15 (Miech et al., 1999). Furthermore, increases in income, or emergence out of poverty, have been linked to declines in psychological problems such as aggression (Costello, Compton, Keeler, & Angold, 2003). Poverty’s damage occurs at multiple levels. Poor families are exposed to more dangerous and deteriorating neighborhoods, more crowded and noisier homes, more conflict and instability in the family, and more polluted air and water (Evans, 2004). These multiple risks in turn affect children and adults leading to an array of psychological and physical morbidity (Evans, 2004). The current study examines SES and income as distal predictors of psychological syndromes in conjunction with more proximal predictors such as neighborhood disadvantage and poverty-related stress.

Strong evidence shows the chronicity and stress of poverty account for a significant portion of the negative effects of living in poverty. Neighborhood disadvantage is one type of chronic stress that has been investigated in relation to poor outcomes. Community-level stressors including high poverty rates, low levels of education, high unemployment rates, and high residential mobility in the community are chronic and affect all members of a given community. Attar et al. (1994) coined the term “neighborhood disadvantage” which they measured using a variety of indicators including percentage of families receiving public aid, income levels, and housing. The current study uses census data that provides multiple indicators of neighborhood disadvantage including poverty level, education levels, unemployment, and residential mobility at the zip code level. Previous research has shown that neighborhood disadvantage creates “cumulative risk” (Evans & English, 2002), which intensifies the negative effects of daily stressors on psychological problems (Attar et al., 1994). In addition, children from more affluent neighborhoods with more community resources are less likely to engage in juvenile delinquency (Brooks-Gunn et al., 1997). Though we know that neighborhood disadvantage is a key part of how poverty connotes negative outcomes to poor children and adults, few studies have examined its relevance across such a wide age span or such an array of psychological syndromes. Thus the current study also explores whether neighborhood disadvantage is related to all syndromes or if it is a key predictor of only certain types of psychological problems, such as delinquency.

An additional contribution to psychological problems is made by individual stressors, which tend to aggregate in conditions of poverty. Poverty creates a context of stress in which stressors build on one another and contribute to further stress. Economic strain (the day-to-day hassles that arise when living with less money than one needs) is one example of this type of stress. Additional stressors that affect poor children and adults adversely include conflict among family members (e.g., Wadsworth & Compas, 2002), exposure to violence (Evans & English, 2002), frequent moves and transitions (e.g., Attar et al., 1994), and exposure to discrimination and other traumatic experiences (Simons et al., 2002). We term the multitude of stressors associated with poverty “poverty-related stress” (Wadsworth and Berger, 2006, Wadsworth et al., 2008). Poor families experience disproportionate numbers of these stressful life events as compared to their middle-class counterparts (e.g., Attar et al., 1994), making stress an important proximal process through which poverty exerts its deleterious effects. Such stress is associated with symptoms of depression, anxiety, hostility, and aggression among poor children and adolescents (Evans and English, 2002, Hammack et al., 2004, Wadsworth et al., 2008). This study expands on prior research by examining poverty-related stress in conjunction with SES and neighborhood disadvantage in relation to psychological symptoms over time and across children, adolescents and adults.

With this age span, we can make developmental comparisons of the role of poverty-related stress in placing poor individuals at risk for psychological problems. Developmental level may moderate the associations among SES, stress, and the outcomes of interest. Poverty adversely affects both children and adults (e.g., Cutrona et al., 2006, Wadsworth et al., 2005), though some evidence suggests poverty-related stressors may be most harmful for children and adolescents (Hammack et al., 2004, Mistry et al., 2002, Wadsworth and Santiago, 2008). Children should be no more or less likely to be exposed to the moves, changes, transitions, and conflict that comprise poverty-related stress or to the chronic stress resulting from neighborhood disadvantage. Still, adults are responsible for the family’s finances, which place a unique burden on parents.

The current study uses a longitudinal design. Thus we can control for prior symptoms and examine effects of SES, neighborhood disadvantage and poverty-related stress across time above the effects of symptom stability. This design also allows for testing of interactive effects with previous symptoms. Poverty is a cycle whereby chronic stressors continue to build with little or no relief, ultimately resulting in psychopathology. However, the resulting psychopathology contributes to this continued cycle by making stressors even more difficult to manage or more stressful. Thus, the current study is a snapshot of this cycle that examines how symptom levels at one point in time may interact with poverty predictors to contribute to worsening symptoms.

Previous literature clearly demonstrates that low SES and income are associated with a range of psychological problems and provides good evidence for social causation of psychological problems (e.g., Sapolsky, 2004, Wadsworth and Achenbach, 2005). In addition, previous research shows that neighborhood disadvantage is one pathway whereby poverty leads to psychological problems, especially delinquency (e.g., Attar et al., 1994). Finally, poverty-related stress is another mechanism associated with psychological symptoms and problem behaviors (e.g., Wadsworth et al., 2008). The current study extends this literature in a number of ways. First, we test these predictors, both distal and proximal, concurrently in the same model to examine whether each predictor makes unique contributions to psychological outcomes. Second, we examine these predictors across a range of outcomes testing whether the predictors are relevant for all outcomes or only certain types of problems. Studies often examine broadband psychological difficulties or focus narrowly on depression and/or delinquency as outcomes. In previous cross-sectional research, it is clear that poverty-related stress is linked to a variety of psychological problems ranging from depression, anxiety and attention difficulties to thought problems and aggression (Wadsworth et al., 2008). The current study builds on this prior research to examine all eight ASEBA (Achenbach System of Empirically Based Assessment) narrow band syndromes (e.g., anxious/depressed, aggression). Some symptoms may be more strongly associated with poverty-related stress (e.g., depression) while others may be better explained by neighborhood disadvantage (e.g., delinquency). Third, we examine these predictors among a sample of multiethnic families that includes children, adolescents, and parents living in poverty, shedding light on how poverty predictors affect children and adults. Fourth, the current study examines the predictors within a low-income sample. There is ample research examining poverty-related predictors across a range of SES, but there is less understanding of how these predictors operate within a constrained sample in which everyone is experiencing poverty. Finally, we utilize an analytical approach that allows us to take into account family and neighborhood context, which is better suited for the study’s research questions than a simple regression approach conducted only at the individual level.

The current study was designed to test family-level poverty predictors including SES, income-to-needs, neighborhood disadvantage, and poverty-related stress on eight narrow band psychological syndromes in a sample of 300 parents and children. We also examined individual-level predictors: age, sex, and previous levels of symptoms, which allowed us to test for interactive effects among family/neighborhood poverty predictors and individual predictors of outcomes. Based on previous literature highlighting the damaging nature of these poverty predictors, we hypothesized that lower income and SES, along with higher levels of neighborhood disadvantage and poverty-related stress would predict more psychological symptoms controlling for initial levels. Consistent with the cycle of poverty whereby stressors create distress, which in turn makes future stressors more difficult to manage, creating more distress, we hypothesized that previous symptoms would interact with poverty predictors, exacerbating symptoms across time. With regard to specificity we hypothesized that SES would be associated with anxious/depressed and delinquency and that neighborhood disadvantage would be associated with delinquency based on previous research demonstrating these links (e.g., Belle and Doucet, 2003, Brooks-Gunn et al., 1993, Farrington and Loeber, 2000). Poverty-related stress, on the other hand, has shown links to a variety of problems (Wadsworth et al., 2008). Thus, we hypothesized that poverty-related stress would be associated with a range of psychological problems.

Section snippets

Participants and procedure

Participants were 98 low-income families (300 total participants; at least 1 child and 1 parent or guardian per family; family size range 2–7). A total of 164 children/adolescents participated in the study (44% female; 82 children (ages 6–10) and 82 adolescents (ages 11–18). Ninety-eight primary caregivers participated in the study (95% female, mean age = 34.9 years, SD = 7.45). For households with two caregivers in the home, efforts were made to recruit spouses or partners. Thirty-eight secondary

Preliminary analyses

Descriptive statistics and correlations among variables are reported in Table 1. The data were checked for skewness and kurtosis as well as extreme outliers before primary analyses were conducted. Twenty-nine families that completed Time 1 did not complete Time 2 due to factors such as relocation out of state, death, and incarceration. Attrition analyses comparing families that completed and those that did not complete the study found no significant differences on any key variables, including

Discussion

This study examined the relationships between socioeconomic status, neighborhood disadvantage, poverty-related stress, and psychological functioning in a sample of poor families. Neighborhood disadvantage, poverty-related stress, and income clearly contribute to psychological problems among poor children and adults. However, within a constrained sample of lower SES families, those with higher status actually show worse functioning.

McMahon, Grant, Compas, Thurm, and Ey (2003) emphasize the

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