A Casino Benefits the Mental Health of Cherokee Children

Jane Costello, a mental health researcher, was at work on a long-term study of psychiatric symptoms of children in rural North Carolina, about a quarter of them from a Cherokee reservation. Midway through the study, the Cherokees opened a casino on the reservation, providing profit-sharing payments to reservation families—suddenly lifting them out of poverty. Unexpectedly, Costello and her fellow researchers found themselves with a unique opportunity to observe the causal effect of ending poverty on the mental health of children (Costello, Compton, Keeler, & Angold, 2003).1 Costello’s results showed that among the children lifted out of poverty by the casino payments, conduct and oppositional disorders improved substantially, yet anxiety and depression did not. Poverty causes (at least in part) conduct and oppositional disorders, Costello and her colleagues could conclude, but not anxiety or depression. This was an interesting finding with important public health and social policy implications. Researchers had long observed the correlation between poverty and poor mental health, among both children and adults, but they didn’t know if poverty caused psychiatric problems (and which ones), if psychiatric problems caused low income, or if other factors caused both. But in Costello’s study, the change in income came from a completely outside (exogenous) source, the new casino. This created a natural experiment in which additional income was suddenly added to a poor community, independent of the efforts and characteristics of the families, allowing a clearer look at the pure effect of poverty on the mental health of the children.