intro’d to Jane here:
..in 1996, the Eastern Band of Cherokee Indians in North Carolina’s Great Smoky Mountains opened a casino, Jane Costello, an epidemiologist at Duke University Medical School, saw an opportunity.
What precisely did the income change? Ongoing interviews with both parents and children suggested one variable in particular.
The money, which amounted to between one-third and one-quarter of poor families’ income at one point, seemed to
improve parenting quality.
Mostly, though, the energy once spent fretting over such things was freed up. That “helps parents be better parents,” she said.
A parallel study at the University of North Carolina at Chapel Hill also highlights the insidious effect of poverty on parenting. The Family Life Project, now in its 11th year, has followed nearly 1,300 mostly poor rural children in North Carolina and Pennsylvania from birth.
Early-life stress and poverty correlated with a shrunken hippocampus and amygdala, brain regions important for memory and emotional well-being, respectively. Again, parental nurturing seemed to protect children somewhat.
When it came to hippocampal volume in particular, parental warmth mattered more than material poverty.
Yet in observational human studies, it’s difficult to rule out the possibility that the unwell become poor, or that some primary deficiency stresses, impoverishes and sickens. This very uncertainty is one reason, in fact, that Professor Costello’s findings are so intriguing, however modest her study size. A naturally occurring intervention ameliorated psychiatric outcomes. A cash infusion in childhood seemed to lower the risk of problems in adulthood. That suggests that poverty makes people unwell, and that meaningful intervention is relatively simple.
But if giving poor families with children a little extra cash not only helps them, but also saves society money in the long run, then, says Professor Costello, withholding the help is something other than rational.
I run the Center for Developmental Epidemiology in conjunction with Adrian Angold. The Center brings together researchers from different disciplines in order to advance our understanding of the origins, course, and prevention of mental illness across the life course. My own program of empirical and theoretical work is designed to integrate developmental science and epidemiology, with the goal of improving the understanding, treatment, and prevention of psychiatric disorders in childhood and adolescence. I am also associate director of research at Duke’s Center for Child and Family Policy.
In my work as an epidemiologist, I use data sets available through the Center for Developmental Epidemiology to develop a model of child psychopathology that will help us to integrate findings about the causes of mental illness (“etiologic epidemiology”) with a better understanding of risk factors and the options for prevention (“public health epidemiology”). An important aim is to use findings from this work as the basis for developing a set of propositions about how public health can use a primary care/primary prevention model to improve the emotional and behavioral development of children.
2012 panel at university of michigan
A Public Health Approach to Depression on Campuses
Panel discussion held at the 2011 Depression on College Campuses Conference
Kenneth Warner, PhD, Avedis Donabedian Distinguished University Professor of Public Health and Professor, Department of Health Management and Policy, University of Michigan School of Public Health
William Beardslee, MD, Gardner/Monks Professor of Child Psychiatry, Harvard Medical School; Director, Baer Prevention Initiatives, Department of Psychiatry, Children`s Hospital Boston
E. Jane Costello, PhD, Co-Director, Center for Developmental Epidemiology, Duke University Health System; Professor, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
Jane starts at 7:15 (brief intro of cherokee study)
epidemiologist: study of patterns of disease in time and space, what we can learn from those patterns to first prevent and then treat disease… want to talk about those patterns, esp patterns in time..
question here – impact of going to college on depression – compare to cherokee study because there are too few study that track over time
two types of programs.. look very different
universal prevention – seat belts – clean water (made for everyone.. not just those at risk)
target (high risk) preventions – children whose parents have died/divorced
13:40 – starts talking about nc cherokee study
17 min – people who went to college and didn’t complete degree – most depressed over time
25 min – need to make an impact on early childhood depression (if we want people to attend/complete college)
wishing it wasn’t focused on college..
1:07 – increase in depression over years is popular myth?…. from 1960 – there is only evidence to show – there has been no change?
1:09:15 – i think it’s most unethical to screen people for a condition if you don’t have the services in place to treat them
(they were specifically talking about screening for depression at college)
most obvious prenatal intervention: every child is a welcome child
screening is not diagnosis…. when we use word screening… we need to be sure we aren’t assuming a diagnosis. a high score on screening must be followed by clinical evaluation..
The primary purpose of screening tests is to detect early disease or risk factors for disease in large numbers of apparently healthy individuals.
The purpose of a diagnostic test is to establish the presence (or absence) of disease as a basis for treatment decisions in symptomatic or screen positive individuals (confirmatory test).
1:13 – preventive measures are universal – for different problems..
1:18:40 – suicide – interaction between violence and suicide – of 1400 kids 23 have died..in the course of this study – hard to distinguish between homicide and suicide…
things don’t happen in a vacuum..so we need to address prevention et al.. accordingly…
policy and environmental interventions – more reach..?
what we can do for individual family interventions – in a wide spread basis – in a cost effective manner.. to achieve what we know is possible..
unconditional basic income – ness