Citation

Nemeroff CB. Am. J. Psychiatry 2021; 178(4): 282-284.

Copyright

(Copyright © 2021, American Psychiatric Association)

DOI

10.1176/appi.ajp.2020.21010087

PMID

unavailable

Abstract

The prescient words of Martin Luther King ring true today, and each of the "great problems" he cites is a major source of early-life trauma. In 2018, 38 million people in the United States lived in poverty, defined as a family of four with an annual income of less than $25,700. That year, 16.2% of children (11.9 million), or one in six, lived in poverty (1). Because of the COVID-19 pandemic, poverty will rise to levels unseen in a decade worldwide (2). There is a vast body of evidence that poverty, as one form of childhood maltreatment, is associated with poor health outcomes and with increases in both major medical and psychiatric disorders. These data include large macro studies that have documented evidence of causal relationships between poverty and mood and anxiety disorders--primarily major depression and generalized anxiety disorder--and, not surprisingly, suicide rates. These studies also have reliably documented reductions in psychiatric morbidity associated with interventions to reduce poverty (3).

It is in this context, and that of the literature on the particularly egregious effects of poverty on children (4), that Miller and colleagues conducted their seminal study published in this issue of the Journal (5). Similar to many studies that represent incremental advances, this study is characterized by its straightforward experimental design and exciting and somewhat unexpected findings. Fundamentally, this investigation sought to test the authors' "neuroimmune network" hypothesis, which posits an important role for chronic early-life stress in increasing peripheral inflammation, which acts on brain pathways that mediate threat and reward processing. The persistent increase in "cross-talk" between the peripheral inflammatory network and the CNS is believed to increase vulnerability to mood and other psychiatric disorders.

The authors used standard criteria to classify a sample of 277 eighth graders in Chicago (ages 13-14, all English speaking and in good health) by socioeconomic status (poverty, low-income, middle income, and higher income). Morning blood samples were obtained for measurement...

Language: en

Keywords

Poverty; Stress; Disease; Inflammation; Environmental Risk Factors