She Works Hard for Her Money

Generalized anxiety disorder in low income moms more related to poverty than mental issues

(RxWiki News) It's no secret that not having enough money to live day to day can increase parents’ anxiety. But is an insecure financial situation enough to cause someone to have an anxiety disorder?

A recent study looked at this very question in trying to determine whether low-income mothers - who are more likely to be diagnosed with generalized anxiety disorder (GAD) - tend to have the disorder because of their poverty or because of an underlying psychiatric issue.

"Share your life circumstances with your therapist."

The study, led by Judith C. Baer, an associate professor in the School of Social Work at Rutgers University, found that moms with GAD experience symptoms because of their poverty, not because of a brain disorder.

In fact, the mothers may not actually have clinical GAD, so much as they are responding in fairly normal ways to extreme circumstances.

To reach this conclusion, the researchers studied the data from families enrolled in the Fragile Families and Child Wellbeing Study at Princeton University.

This study followed 4,898 children - including 3,712 children whose parents were unmarried - born between 1998 and 2000 and living with their families in an urban area in one of 77 different US cities.

The parents had been interviewed when the children were born and completed surveys at 1, 3 and 5 years old, with good response rates (82 to 87 percent).

Using the data from the 3-year follow-up surveys, the researchers looked specifically at a subset of 2,338 mothers and their children.

They found that the mothers who answered yes to specific questions indicating severe financial troubles (disconnected utilities, inability to pay bills, moving in with others) were also more likely to have been diagnosed with GAD.

Those who had received free food, for example, were 2.5 times more likely to have been labeled GAD. Those who had trouble paying utilities bills were 2.4 times as likely to receive that diagnosis.

The diagnoses were based on the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the reference used by mental health professionals to determine whether someone meets the definition of a particular disorder.

Several of the symptoms that describe GAD, however, are also feelings and responses that may be typical for any person - regardless of their mental health - dealing with severe financial stress.

That is precisely what these researchers found with the women studied in this research. They determined this by looking at how well the mothers cared for their children and met their needs.

A person with an underlying psychiatric problem would likely display "harmful dysfunction," which means they can't perform their daily functions because of the mental condition.

"In the case of poor mothers, there is no evidence for a malfunction of some internal mechanism," the authors wrote, based on their findings. "There is physical need in the real world that is unmet and produces anxiety."

The importance of this finding relates to the kind of treatment and services the mothers may need.

"The distinction is important because there are different ways to treat the problem," Dr. Baer said. "While supportive therapy and parent skills training are often helpful, sometimes the most appropriate intervention is financial aid and concrete services."

Another issue that concerned the researchers was that receiving a psychiatric diagnosis that is based on symptoms which may be more related to life circumstances than an underlying psychiatric condition is that it can create an unnecessary stigma for the patient.

"Our findings suggest that anxiety in poor mothers is usually not a psychiatric problem but a reaction to severe environmental deficits," Dr. Baer said. "Thus, assessment should include careful attention to contextual factors and environmental deficits as playing a role in the presentation of symptoms. Labeling an individual with a diagnosis, especially if it is inaccurate, has a serious social stigma."

The study was published May 15 in the journal Child and Adolescent Social Work. No information was available regarding funding and disclosures.

Review Date: 
July 24, 2012