Bi-Directional Relationship Between Poverty and Mental Illness

Jul 10, 2021
6 min read

Updated: Jul 10, 2021

By: Zaeen Iqbal

Extreme poverty is defined by the World Bank as earning less than USD 1.90 a day, accompanied by hunger, poor living conditions, and lack of access to health services, education, or employment. Historically, mental health has not been considered a priority by economists and policymakers, nor has it been considered a tool to alleviate poverty. However, recent research in the scope of global health has highlighted the causal relationship between poverty and mental illness.

It is a vicious cycle. Poverty increases the risk of mental illness, which in turn increases the risk of economic stress on the individual and family.

Individuals with mental illness are stigmatized and often lose career opportunities. With 4% of the global population suffering from depression and anxiety, the two account for the most common mental illnesses worldwide, yet on average most countries only spend 1.7% of their health budgets on mental health. Low and middle-income countries are especially at risk of higher mental illness due to even smaller budgets.

The UN has estimated that 2% of the world's population experience severe poverty, while 7.7% are vulnerable to becoming impoverished.

Why does poverty lead to mental illness? Why does mental illness in turn also lead to poverty? The relationship may seem simple, but its mechanisms are complex. It is crucial to understand both ends of this bidirectional relationship if we want to make informed decisions and policies.

Effect of Poverty on Mental Illness

Homelessness and lack of income are known risk factors for mental illness. There is an abundance of existing evidence for this around the globe:

Indonesia: Reduced agricultural outputs during seasonal extremities led to increased rates of depression and suicide in rural communities.
Austria: Plant closures led to increased antidepressant use and mental health-related hospitalizations.
India: Individuals with the lowest incomes in a given community suffer nearly 3 times more from depression or anxiety than the highest income members.

What Mechanisms Cause Poverty to Lead to Mental Illness?

1. Environment:

People living in poverty are more exposed to environmental irritants like pollution, extreme temperatures, and uncomfortable sleep environments.
Studies have previously linked extreme heat with higher rates of self-harm and suicide.
Sleep deprivation is commonly known to lead to mental health deterioration and increased depression.
Air pollution leads to lower physical activity for health reasons, which in turn, declines mental health.

2. Lower Access to Healthcare:

Poverty increases the risk of environmental factors, while simultaneously co-occurring with common physical illnesses such as chronic pain
This combination is detrimental when considering that individuals with such physical and mental burdens most often do not have access to healthcare or insurance. This in turn exacerbates mental illness symptoms.

3. Education and Employment:

Higher levels of education are associated with better employment opportunities, yet people living in poverty do not have access to this basic resource. They acquire lower levels of education or outdated job skills which keep them trapped in low-income jobs.
Minimum wage jobs are often insufficient to enable unrealistic standards of living.

4. Trauma, Violence, and Crime:

Poverty disproportionately exposes individuals to crime and violence. People are more likely to suffer traumatic events such as the deaths of loved ones, while women and children are more likely to be affected by domestic violence. This leaves a lasting effect on mental health, with lifelong ramifications.

5. Early-Life Conditions

Effects of poverty can lead to mental illness as early as when a fetus is in utero. Pregnant mothers are exposed to malnutrition and harmful substances.
Experiencing stressful events during pregnancy is a predictor of depression and anxiety in their children.

Effect of Mental Illness on Poverty

A diagnosis of mental illness has shown to lead to falls in employment rates and incomes by as much as 50%. Mental illness creates lifetime barriers that prevent individuals from securing financial stability.

What Mechanisms Cause Mental Illness to Lead to Poverty?

1. Cognitive Function

Depression and anxiety are believed to have economic effects due to reduced work abilities.
Cognitive symptoms of depression and anxiety include distorted memories, self-beliefs, and excessive rumination. These in turn affect economic outcomes because they impact a variety of behaviour such as job-hunting or saving money.
Anhedonia is another cognitive symptom that reduces sensitivity or ability to feel pressure, may lead depressed individuals to make less active choices about their future and careers.
Depressed individuals who experience distorted beliefs often fixate on negative stimuli and information, leading to pessimism about their futures.
Anxiety leads to overestimations of risks, which cause individuals to be wary of seeking new career opportunities.

2. Health Expenditures

People living in poverty are most likely to pay for health costs out of pocket.
150 million people around the world are estimated to have exorbitant yearly health expenditures.
Depression and anxiety pose a greater threat due to its co-occurrence with other health conditions such as heart disease, leading to even higher healthcare costs.
Studies have shown that treating depression alone can reduce overall healthcare costs.

3. Stigma

The media has exaggerated negative social stereotypes of mental illness. This can lead to discrimination in employment and school applicants. This in turn lowers wages and limits employment opportunities.
Individuals with mental illness are often excluded from disability benefit schemes.
The social stigma surrounding mental illness also leads to greater reluctance to interact with such individuals, affecting vital networking opportunities.

Implications for Research, Policy, and Practice

Research:

Mental health and poverty are complexly linked and require interdisciplinary research. Studies have shown that mental health interventions in low and middle-income countries such as psychotherapy were as successful, if not more beneficial, for employment than economic interventions such as cash transfers. This is an important consideration for future research when recognizing that psychiatric resources are more cost-effective than economic interventions. In fact, combining psychological and economic interventions may create a result that is greater than the sum of its parts. Further research should be conducted on the impact of mental health improvement and increased decision-making and productivity in the labour market. Alongside, evaluations of economic interventions to measure impacts on mental health should be conducted as well.

Resources:

People living in poverty encounter severe limitations when trying to access mental health care, especially in low-income countries. Studies have shown that in such countries, more than 90% of individuals diagnosed with a mental illness cannot receive treatment as a result of inadequate resources.

It is estimated India has 0.75 psychiatrists per 100, 000 people.

Zimbabwe, a nation with 14 million people, has only 13 psychiatrists.

Structural barriers of this magnitude require international economic support, as well as alternative approaches to in-person psychological treatment such as digital therapy.

Practice & Policy:

Psychiatrists and psychologists can indeed become more equipped to treat individuals living in poverty by increasing their knowledge of social welfare systems and referring clients to necessary resources to maximize income. However, addressing social determinants of mental health through the healthcare system alone is only a fraction of the solution. Systemic barriers to escape poverty require macro-level interventions and policy changes that prevent poverty traps. They need to address the economic aspect of this relationship by allowing for fairer immigration policies, better housing, or income equality. They also need to equally address psychological factors such as social support promotion to lift individuals out of poverty. This requires interventions that promote community emotional support, financial support such as financial advice, and instrumental support such as tangible, behavioural assistance.

Why Should You Care?

According to the UN, poverty alleviation has slowed down in the last 5 years. The situation is becoming particularly alarming in areas such as sub-Saharan Africa where the World Bank has expected to see a rise in extreme poverty from 37.8% in 2020, to 42% in 2021. The pandemic has disproportionately affected vulnerable communities and will have lasting effects on their economic and mental well-being for a lifetime. It has been predicted that major depressive disorder will increase by 7% worldwide.

Investment in mental health was desirable pre-COVID-19 but in recent times it has become an absolute necessity. By April 2020, about half of the nation was under some form of lockdown, due to which more people are experiencing mental health deterioration and accumulated economic stresses. A lack of global vaccine equity in the developing world, combined with the introduction of the COVID-19 Delta variant will most likely lead to further lockdowns and restrictions. To make matters worse, COVID-19 has disrupted mental health services in 93% of countries worldwide according to the World Health Organization. The global population emerging out of lockdown and quarantine will inevitably face the consequences of a shrunken economy, but we must consider how we will afford the psychological ramifications as well.

Sources:

Ridley, M., Rao, G., Schilbach, F., & Patel, V. (2020). Poverty, depression, and anxiety: Causal evidence and mechanisms. Science, 370(6522). https://doi.org/10.1126/science.aay0214

Kumar, M., & Kumar, P. (2020). Impact of the pandemic on mental health in lower- and middle-income countries (LMICs). Global Mental Health, 7. https://doi.org/10.1017/gmh.2020.28

World Health Organization (2020c) COVID-19 disrupting mental health services in most countries, WHO survey. Retrieved October 8, 2020, from https://www.who.int/news-room/detail/ 05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey.

World Bank (2020a) Updated estimates of the impact of COVID-19 on global poverty. Retrieved August 7, 2020, from https://blogs.worldbank.org/opendata/updated-estimates-impact-covid-19- global-poverty.