Twenty five years ago, there were 2 groups of children. Some were poor, others were not.
They all lived in a rural region, and their families agreed for regular annual research interviews for 8 years to track symptoms of mental illnesses.
All was well for 4 years, and then an interesting thing happened. A portion of this rural community suddenly had a significant increase in their income, as a new casino opened in their neighbourhood, and the casino’s operators distributed their profits to every family, every 6 months. Many other businesses came to that region, supporting the casino, and eventually nearly half of the families living in that locality were not poor anymore.
Moving out of poverty had an immense effect on the children. The frequency of psychiatric symptoms considerably dropped over the next 4 years; by the fourth year the symptom level was the same in children who moved out of poverty as in children who were never poor. But adding to the income of those families who were never poor in the first place had no effect on the frequency of psychiatric symptoms.
Income intervention improved behavioural symptoms, but did not have much effect on the emotional symptoms.
This fascinating ‘quasi-experimental’ study is called The Great Smoky Mountains Study1. It was led by Elizabeth Jane Costello of Duke University, and published in 2003 in the JAMA. Cited more than 1200 times, it is a classical paper that argues strongly for us to do what we can to provide social interventions to our patients.
What do you think about this study? Does this change your perception of social interventions in psychiatry?
More on this in our next blog post!