COVID-19 & parental mental health: Part two
Three recent studies detailing the pandemic's continued consequences on our mental and physical well-being
Remember sanitizing door knobs and groceries? Remember wondering whether you should mask while you jog outside? Remember the never-ending feeling of dread and despair as our already-tattered-to-shreds social safety net became non-existent and the privileged among us realized maybe for the first time that the various institutions that we had placed so much investment and trust in truly did not care if we lived or died?
The pandemic is not over, nor is its effects on our mental health. I last wrote about the effects of the COVID-19 pandemic and parental mental health back in September 2021. As we enter the fourth (!) year of COVID-19’s existence, research continues to be published on how the pandemic affected us. Here are three recent studies from the past few months that I found interesting.
COVID-19 stress affected pregnant women’s mental health more than other women
Songco and colleagues (2023) reported in the Journal of Affective Disorders their findings comparing the mental health consequences of the pandemic on pregnant versus nonpregnant women. They analyzed online survey data collected between May 2020 and April 2021 from Australia, the UK, and the US. A total of 742 pregnant women were compared to 742 nonpregnant women who were matched on various demographic characteristics (age, education, racial background). They used a brief questionnaire to assess COVID-19 related stress, including assessing concerns around catching the disease, transmitting the disease to someone else, and the financial and social consequences of the pandemic.
When comparing across countries, the researchers found that women living in countries with higher levels of government-mandated COVID restrictions experienced higher rates of COVID-19 stress (regardless of actual number of COVID-19-related outbreaks). This makes sense - stricter restrictions ultimately make one feel like there is danger to be avoided and pose barriers to things we know are ultimately good for our mental health (e.g., in-person interactions). The researchers argue for the importance of assessing both physical and mental health consequences that public health measures might have in the short- and long-term, something that I’m sure we are all thinking about as we continue to deal with the pandemic’s consequences.
The researchers also found that COVID-19 related stress was significantly related to depression and anxiety symptoms, but more so for pregnant than nonpregnant women. Factors like loneliness, decreases in social support since the onset of the pandemic, tendency to worry, and difficulties with tolerating uncertainty were all associated with more severe depression and anxiety symptoms, and these relationships were stronger for pregnant versus nonpregnant women. In other words, things like feeling lonely or worrying about the future negatively affected the mental health of pregnant women to a greater extent compared to other women.
Pregnancy is already a time filled with so much uncertainty. Being a pregnant person during the first year of the pandemic (which I was) made it so much worse. There was news story after news story about pregnant people on ventilators, which made me so anxious. I remember mandatory telehealth appointments and monitoring my blood pressure at home. I remember worrying about when my newborn would be able to interact with other people indoors. When the first vaccines arrived, there were incredibly mixed messages around whether pregnant people should “take the risk.” It was tough. It makes sense that factors that we already know affect our mental health (loneliness, social support, worry, intolerance to uncertainty) would be particularly salient when pregnant during the pandemic. I know they mattered a lot to me. Additionally, it’s clear now that pregnant people had very real reasons to worry…
2021 peak in maternal mortality rates
The CDC recently reported that maternal mortality rates (including deaths during pregnancy or within 42 days of giving birth) saw a 40% increase in the US in 2021 compared to the previous year - this is about 32.9 deaths per 100,000 live births in the country. This is a really upsetting statistic, especially when compared to other “high income” countries with rates of approximately 2-3 deaths per 100,000 live births (e.g., in Japan and Australia). Maternal mortality rates in addition to the aforementioned relationship between COVID-19 stress and mental health during pregnancy makes it easy to imagine that rates of postpartum depression and other mental health concerns also skyrocketed during this year as well, though this is a difficult thing to quantify.
This peak made a grim situation even grimmer in the US: before the pandemic, 2019 statistics reported 20.1 maternal deaths per 100,000 live births (higher than the previous year), with a death rate 2.5 times higher for non-Hispanic Black women. While we might hope that in a post-vaccine world these rates will go down, we unfortunately also live in a post-Roe world. I fear things are only going to get worse.
The 2021 Expanded Child Tax Credit helped improve parent mental health
OK, so the pandemic sucked and continues to suck. Clearly. But what has helped parental mental well-being in this difficult time? Batra, Jackson, and Hamad (2023) reported in Health Affairs their findings that the 2021 Expanded Child Tax Credit (CTC), a tax credit to help offset financial hardships caused by the pandemic, was associated with a decrease in anxiety and depression symptoms in parents who received it. If you’ve read my thoughts on money and mental health before, you can probably guess how absolutely *shocking* I find this.
In case you’re unaware: the Expanded CTC started in July 2021 and ended in December of that same year. It increased the maximum benefit for eligible families1 from $2000 to $3600 per child for children younger than six and up to $3000 per child ages 6-17. It also allowed families to receive monthly payments rather than as one big chunk of change during tax refund time. In 2021, approximately 90% of American families were eligible to receive these payments.
The researchers collected their sample of responses from the Census Bureau’s Household Pulse Survey, a nationally representative survey that began in April 2020 and is continued to be administered weekly. They used data from April 14, 2021-January 10, 2022, a time frame that included responses before and after the Extended CTC was in effect. They only included participants who reported on the mental health outcomes they were interested in: depression symptoms, anxiety symptoms, and mental health care use (e.g., whether someone was in therapy or using psychiatric medications). They analyzed the data to try to understand whether mental health outcomes changed over time, and whether these changes differed between parents vs. nonparents.
This data set was huge, comparing parents (112,862 observations before and 145,429 after the CTC expansion) versus adults without children (237,901 observations before and 316,122 after the expansion). This is a cross-sectional study, which means that the same people that were examined before the CTC expansion were not included in the group examined after the CTC expansion. So, unfortunately, this data cannot tell us whether receiving the tax credit improved a specific individual’s mental health over time. Instead, the researchers relied on the very large number of participants to make inferences about whether, on average, the CTC expansion helped improve mental health for parents.
The researchers found that the tax credit was associated with decreased depression and anxiety symptoms among low-income2 parents compared to nonparents. The researchers did not find a relationship with the tax credit and use of mental health services. There was a larger decrease in anxiety symptoms among Black, Hispanic, and parents who identified as an “Other” (non-Asian) racial category compared to White parents; on the other hand, there were no differences in anxiety symptom reductions comparing Asian and White parents. It also appeared that anxiety symptoms lessened soon after payments started and remained stable over time for all parents, while depression symptoms began decreasing only after several payments were made.
So why did the tax credit help improve parent mental health? The authors note that other studies, including studies that used this same data set, have found what we probably already know: when people are able to more easily afford necessities like food and housing, which they were with the Expanded CTC, their mental health improves. The fact that mental health service use (like psychiatric medication use) didn’t change with the tax credit also supports the idea that it was likely the reduction in financial difficulties that appeared to improve parent mental health (versus, say, more people taking psychiatric medications). The pandemic was hard on everyone, but particularly on already marginalized communities. For example, Black and Hispanic families experienced significantly higher rates of job loss in 2021 compared to White families. It makes total sense that the tax credit would have a larger impact on the mental health of parents who were experienced the most financial hardship.
It must be said (/screamed from the rooftops) that the CTC expansion cut childhood poverty in half. IN HALF. After it ended, millions of children ended up back in poverty. So, regardless of any mental health benefits, this tax credit had a huge positive impact on families. This study adds to the growing body of research that shows the benefits of similar policies on the mental health of parents, especially low-income parents and parents of color. When parent mental health improves, the lives of children improve as well. It’s a win-win situation.
Eligible families for the Expanded CTC included single filers with incomes less than $75K, heads of household with incomes less than $112.5K, and married couples filing jointly less than $150K.
“Low-income” was defined as households with an annual income less than $35K.