Urban single mothers nearing the end of their welfare eligibility appear more likely to have substance use and psychiatric disorders than women in the general population, and often do not receive treatment, according to a report in the March issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

In 1996, U.S. welfare reform legislation created the Temporary Assistance for Needy Families (TANF) program, according to background information in the article. Unlike previous programs, TANF imposed a five-year limit on financial support for families with children younger than age 18. The new regulations also involved stricter requirements for employment and work-related activities. “These changes were intended to enhance self-sufficiency and reduce long-term reliance on public income support,” the authors write.

Concerns about the new legislation have emerged from findings regarding the mental health vulnerabilities of low-income families headed by women. Judith A. Cook, Ph.D., of the University of Illinois at Chicago, and colleagues surveyed 333 urban single mothers in the final 24 months of their eligibility for TANF, part of a random sample of 1,000 women selected by the Illinois Department of Human Services. Participants were all “work eligible,” meaning they had not been exempted from employment requirements by factors such as pregnancy, substance use treatment or disability. Between 2003 and 2004, in-person interviews were conducted to detect psychiatric and substance use disorders and assess whether women with these conditions received treatment.

A total of 61 percent of the women had a psychiatric or substance use disorder during their lifetime and 46.8 percent had at least one disorder in the 12 months preceding the interview. Psychiatric disorders—the most common being anxiety and mood disorders—affected 53.2 percent of the women over their lifetime and 44.1 within the previous 12-months. A total of 29.1 percent had lifetime substance use disorders and 9 percent had substance use disorders within the previous 12 months.

These rates are significantly higher than those of U.S. women in the general population, the authors note. For example, depression in the previous 12 months was more than twice as common in the study sample as in a recent national study of women in the general population (17.4 percent vs. 8.6 percent), prevalence of anxiety disorders was 60 percent higher (39 percent vs. 23.4 percent), drug abuse estimates were five times higher (5.4 percent vs. 0.7 percent) and alcohol abuse and dependence estimates were almost three times higher (5.1 percent vs. 1.8 percent). In addition, 21.3 percent of the participants on TANF had both substance use and other mental health disorders over their lifetime, including 6.3 percent in the previous 12 months.

“These results confirm what has long been suspected on the basis of earlier research, namely, mothers of young children remaining on TANF near the end of their lifetime eligibility face significant behavioral health challenges within the context of poverty, single parenthood and low human capital in the way of formal education and job skills,” the authors write.

“Despite the high prevalence of psychiatric and substance use disorders in this population, many remain untreated,” they continue. Only 21.7 percent of those with psychiatric disorders in the previous 12 months received treatment, whereas 41.4 percent of those with 12-month substance abuse disorders received treatment. “The consequences of terminating welfare assistance are worthy of further investigation, given the potential for adverse effects on both mothers and their young children.”
(Arch Gen Psychiatry. 2009;66[3]:249-258. Available pre-embargo to the media at www. jamamedia.org.)

Editor’s Note: This study was jointly funded by a cooperative agreement from the National Institute on Disability and Rehabilitation Research of the U.S. Department of Education, and the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Source: American Medical Association (AMA)