The impact of poverty on mental illness: Emerging evidence of a causal relationship

Abstract

Introduction: The link between poverty and mental illness has sparked discussions about the role of poverty as a risk factor for mental health. If poverty is indeed confirmed as a causal factor for mental illness, it would have profound implications for our comprehension of mental well-being and guide efforts to address the growing occurrence of mental health disorders. Methods: Building on the recent breakthrough discovery of heritability of poverty traits and utilizing large-scale genome-wide association studies of mental illness, we used Mendelian randomization (MR) and Genomic structural equation modeling to investigate evidence of causality of the relationship between poverty and mental illness. We examined nine distinct mental disorders, namely attention deficit and hyperactivity disorder (ADHD), anorexia nervosa (AN), anxiety disorders (ANX), autism spectrum disorders (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and schizophrenia (SZ). Joint measures of poverty derived from household income (HI), occupational income (OI), and social deprivation (SD) were examined while accounting for the influence of cognitive ability (CA). Results: Our analysis highlights HI as the most pertinent poverty measure when compared to OI and SD. Bidirectional MR investigations of the poverty common factor was consistent with the existing paradigm that mental illness leads to poverty. New was evidence that poverty increases the likelihood of developing ADHD (Inverse Variance Weighted Odds Ratio [IVW OR]=4.26[95%CI:3.42-5.29]), MDD (IVW OR=1.49[95%CI:1.29-1.72]), and SZ (IVW OR=1.53[95%CI:1.35-1.73]), while decreasing the risk of AN (IVW OR=0.50[95%CI:0.40-0.62]). This support for a causal relation held strong after adjusting for CA, albeit with reduced effect sizes. Conclusion: Our research indicates that poverty plays a causal role in the development of SZ, MDD, and ADHD, while resulted inversely associated to risk of AN. Notably, CA explains a significant portion of the impact of poverty, echoing prior reports highlighting the contribution of impaired cognitive function to severe mental illnesses. Given that income and education are malleable factors in the population, our study provides compelling evidence to examine income-based policies as a means of promoting better mental health outcomes in the population. This underscores the importance of developing targeted interventions that address the root causes of mental illness and advance health equity.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study used only openly available human data that were originally located at: https://pgc.unc.edu/ and https://www.ukbiobank.ac.uk/

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The lead SNPs list and summary statistics of the common factor poverty GWAS is available as Supplementary File 2. The full GWAS summary statistics is available upon reasonable request to the lead author (MM). The codes for replicating the analyses can be accessed here: https://github.com/MattiaMarchi/Common-factor-GWAS---MR

https://github.com/MattiaMarchi/Common-factor-GWAS---MR

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