Anxiety in poor mothers not a psychiatric problem but a reaction to severe environmental deficits

Poor mothers are more likely to be classified as having the mental illness known as generalized anxiety disorder (GAD) because they live in poverty - not because they are suffering from a psychiatric disorder, according to Rutgers researchers.

Judith C. Baer, an associate professor in the School of Social Work, and her team, in the study, "Is it Generalized Anxiety Disorder or Poverty? An Examination of Poor Mothers and Their Children," published online in Child and Adolescent Social Work, argue that although high levels of stress over long periods can lead to psychological problems, there is no evidence that generalized anxiety disorder in poor mothers is because of an "internal malfunction."

The findings confirm earlier studies that the poorest mothers have the greater odds of being classified as having generalized anxiety disorder. But Baer and her team wrote, "...there is no evidence for a malfunction of some internal mechanism. Rather, "there is a physical need in the real world that is unmet and produces anxiety."

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

Rutgers researchers argue that changing and broadening definitions for GAD have caused, in some cases, mental health experts to categorize the reactions of these mothers to the extreme conditions they face daily as symptoms of the anxiety disorder.

Baer's team has been exploring relationships between poor mothers and their children and whether links between poverty and maternal anxiety might play a part in their offspring developing anxiety of their own.

The latest research by Baer and colleagues MiSung Kim, who completed her doctorate in May, and Bonnie Wilkenfeld, a doctoral candidate, analyzed data from the ongoing Fragile Families and Child Wellbeing Study with 4,898 participants conducted at Princeton University, consisting of surveys and home observations when children were 3-years-old. It confirmed that the poorest mothers had greater odds of being classified as having GAD but that the path from anxiety to parenting stress was not supported.

"This suggests that mothers can be poor and anxious, but still provide positive parenting for their children," Baer said.

Currently, psychiatric diagnoses are based on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which uses symptom-based criteria to determine disorders. Recent versions do not consider context, such as poverty conditions, in determining diagnoses, Baer said.

"Our findings suggest that anxiety in poor mothers is usually not a psychiatric problem but a reaction to severe environmental deficits," she continued. "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."