How does income affect mental health and health behaviours? A quasi-experimental study of the earned income tax credit

State Minimum Wage and Mental Health Among Children and Adolescents

Importance

Mental health disorders are increasing for children and adolescents in the US, with those in poverty having especially high rates. More evidence is needed about the association between economic policies, such as the minimum wage, and children's mental health.

Objective

To test the association between minimum wages and the mental health of children and adolescents.

Design, Setting, and Participants

This repeated cross-sectional, population-based US study used data from 2001 to 2022. Participants included state-representative, stratified random samples of children from the National Survey of Children's Health and adolescents from the Youth Risk Behavior Surveillance System. Data analysis was performed from January 2023 to August 2024.

Exposure

State minimum wage policies.

Main Outcomes and Measures

A total of 15 outcomes reported by caregivers or adolescents from survey data were evaluated: depression, anxiety, attention deficit disorder and/or attention-deficit/hyperactivity disorder, behavior disorders, mood symptoms, gastrointestinal symptoms, considered and attempted suicide, any unmet health care and mental health care, alcohol and marijuana use, physical fights, school absenteeism, and paid employment. The associations between minimum wage policies and mental health were tested using 2-way fixed-effects models, lifetime minimum wage models, and difference-in-differences models with event studies, all with state, year, and birth cohort fixed effects. Additional controls included individual-level demographics and state-level health insurance and welfare policies.

Results

Analyses included 239 534 children (aged 3-17 years; 117 111 girls [48.9%]) from the 2016 to 2022 National Survey of Children's Health, and 1 453 043 adolescents (aged 12-18 years; 711 380 girls [49.0%]) from the 2001 to 2021 Youth Risk Behavior Surveillance System. Across diverse modeling approaches, increases in minimum wages were not associated with clear, consistent improvements in mental health. For example, in 2-way fixed-effects models, a $1 increase in the minimum wage was not associated with changes in rates of depression (0.06 percentage points [pp]; 95% CI, -0.11 to 0.23 pp; P = .48), unmet mental health care (0.13 pp; 95% CI, -0.04 to 0.30 pp; P = .14), or attempted suicide (-0.17 pp; 95% CI, -0.47 to 0.13 pp; P = .26). There also were no clear improvements when stratifying by household income, parental education, race and ethnicity, nativity, or urbanicity.

Conclusions and Relevance

In this repeated cross-sectional study, changes in minimum wage policies over the past 2 decades were not accompanied by clear improvements in children's and adolescents' mental health. More evidence is needed on policy approaches to improve the mental well-being of children, particularly those from economically disadvantaged families.

The Role of Social Determinants of Health in Self-Reported Psychological Distress among United States Adults Post-COVID-19 Pandemic

Psychological distress, an emotional condition with symptoms of anxiety and depression, leads to impaired function, behavior, and personal traits. The current study examined the association between social determinants of health and the severity of psychological distress among adults in the United States after the COVID-19 pandemic. Using multinomial multivariable logistic regression, we analyzed data from 5106 (n = 5106) participants in the Health Information National Trends Survey (HINTS) 6. Compared to non-Hispanic Whites, African Americans (AOR = 0.62, CI = 0.42-0.93) had lower odds of reporting mild psychological distress rather than no stress. Other variables associated with a higher likelihood of reporting moderate to severe psychological distress, rather than no distress, are being in the 50-64 years age group (AOR = 2.77, CI = 1.45-5.28), divorced (AOR = 2.50, CI = 1.70-3.69), and widowed (AOR = 3.78, CI = 2.15-6.64). Respondents living in an urban area had lower odds of reporting moderate to severe psychological distress (AOR = 0.56, CI = 0.39-0.80) compared to those living in rural areas. Our findings identify several risk factors for psychological distress by sociodemographic characteristics such as age, race, marital status, and urban living, providing empirical evidence for interventions in behavioral health. These findings suggest there is an utmost need for a multi-sectoral approach to address the social determinants of health associated with psychological distress post-COVID-19 pandemic.

No change in substance use disorders or overdose after implementation of state Earned Income Tax Credit (EITC)

BACKGROUND

Inadequate income is associated with higher likelihood of experiencing a substance use disorder (SUD). This study tests whether the earned income tax credit (EITC), which issues supplemental income for workers with children in the U.S., is associated with lower rates of SUD and fatal overdose.

METHODS

We examined the effects of state-level refundable EITC presence and generosity (i.e., state EITC rate as a % of federal rate) on SUD-related outcomes (SUD prevalence and intentional and unintentional fatal overdose) using a difference-in-difference methodology, with both two-way fixed-effects models and event study plots. Several sensitivity analyses were conducted to assess the robustness of findings. Five data sources were used to create a combined state-level longitudinal dataset.

RESULTS

We did not find significant effects of refundable EITC presence or generosity on unintentional or intentional fatal overdose or SUD prevalence in two-way models. Event study models detected a very slight upward shift in SUD prevalence following refundable EITC implementation (not seen in sensitivity analyses) and no significant effects of EITC implementation on any of the fatal overdose outcomes.

CONCLUSIONS

Evidence regarding income support programs is being highly sought by policy makers as income support programs have become increasingly popular policy levers since the start of the COVID-19 pandemic. Our study indicates EITC policies likely have no impact on SUD or overdose, however, other income support programs without family restrictions are important to investigate further.

For Whom and for How Long Does the "Be a Mom" Intervention Work? A Secondary Analysis of Data From a Randomized Controlled Trial Exploring the Mid-Term Efficacy and Moderators of Treatment Response

This study explored clinical and sociodemographic moderators of treatment response to "Be a Mom", an internet-based cognitive behavioral therapy (iCBT) intervention, from baseline to postintervention, in women at high risk for postpartum depression (PPD). The study also assessed the stability of women's treatment gains from baseline to 4-months postintervention (follow-up). This open-label randomized controlled trial (RCT) involved a sample of 1,053 postpartum Portuguese women identified as being at high risk for PPD (i.e., having a score of 5.5 or higher on the Postpartum Depression Predictors Inventory-Revised); participants were allocated to "Be a Mom" intervention group or a waiting-list control group, and completed self-report measures at baseline, postintervention, and a 4-month follow-up (554 women completed follow-up assessments). Depressive and anxiety symptoms were measured using the Edinburgh Postnatal Depression Scale and the anxiety subscale of the Hospital Anxiety and Depression Scale, and flourishing/positive mental health was assessed with the Mental Health Continuum. Regression models and linear mixed models were used to examine moderators of treatment and the mid-term efficacy of the "Be a Mom" intervention, respectively. The results revealed that treatment completion, higher depression scores at baseline, and higher income levels were linked to greater symptom reduction and positive mental health enhancement. Moreover, the efficacy of the "Be a Mom" intervention was supported at the 4-month follow-up. The "Be a Mom" intervention appears to be an effective iCBT tool for reducing psychological distress and enhancing positive mental health in women at risk for PPD, with therapeutic improvements maintained over a 4-month period.

Potential profiling of self-management skills in older co-morbid patients

BACKGROUND

Under the general trend of global aging, geriatric comorbidity is increasingly common, which may have some impact on the quality of life of the older people. Self-management can effectively improve patient compliance, subjective initiative, and improve patient quality of life. However, the present situation of self-management in different old people is different. Therefore, this study classifies older co-morbid patients through potential profiling analysis, understands the category characteristics of self-management level of older co-morbid patients, and discusses the influencing factors of self-management level of different categories of older co-morbid patients, which can provide reference for personalized intervention programs for different comorbidity characteristics of elderly people in the future.  METHOD: Through a cross-sectional study, 616 cases of older co-morbid patients in three districts of Zhengzhou City, Henan Province, were selected as survey subjects by using the whole cluster sampling method. The General Information Questionnaire, Chronic Disease Self-Management Scale, Health Literacy Scale, Electronic Health Literacy Scale, Collaborative Social Support Scale, and Health Empowerment Scale were used to conduct the survey.

RESULTS

The result of LPA shows that the self-management characteristics of older co-morbid patients should be classified into 3 categories: good self-management (19.4%), medium self-management(27.9%), and low self-management (52.7%). The results of multivariate logistic regression analyses show that literacy, religiosity, health literacy, e-health literacy, appreciative social support, and health empowerment are influential factors for self-management among older co-morbid patients (p < 0.05).

CONCLUSION

There is obvious heterogeneity in the self-management level of older co-morbid patients. It is recommended that healthcare professionals give targeted interventions for their weaknesses according to the self-management characteristics of different categories of patients in order to enhance the self-management level of this population and improve their quality of life.

Racial inequalities in mental healthcare use and mortality: a cross-sectional analysis of 1.2 million low-income individuals in Rio de Janeiro, Brazil 2010-2016

INTRODUCTION

Mental health inequalities across racial and ethnic groups are large and unjust in many countries, yet these inequalities remain under-researched, particularly in low-income and middle-income countries such as Brazil. This study investigates racial and socioeconomic inequalities in primary healthcare usage, hospitalisation and mortality for mental health disorders in Rio de Janeiro, Brazil.

METHODS

A cohort of 1.2 million low-income adults from Rio de Janeiro, Brazil with linked socioeconomic, demographic, healthcare use and mortality records was cross-sectionally analysed. Poisson regression models were used to investigate associations between self-defined race/colour and primary healthcare (PHC) usage, hospitalisation and mortality due to mental disorders, adjusting for socioeconomic factors. Interactions between race/colour and socioeconomic characteristics (sex, education level, income) explored if black and pardo (mixed race) individuals faced compounded risk of adverse mental health outcomes.

RESULTS

There were 272 532 PHC consultations, 10 970 hospitalisations and 259 deaths due to mental disorders between 2010 and 2016. After adjusting for a wide range of socioeconomic factors, the lowest PHC usage rates were observed in black (adjusted rate ratio (ARR): 0.64; 95% CI 0.60 to 0.68; compared with white) and pardo individuals (ARR: 0.87; 95% CI 0.83 to 0.92). Black individuals were more likely to die from mental disorders (ARR: 1.68; 95% CI 1.19 to 2.37; compared with white), as were those with lower educational attainment and household income. In interaction models, being black or pardo conferred additional disadvantage across mental health outcomes. The highest educated black (ARR: 0.56; 95% CI 0.47 to 0.66) and pardo (ARR: 0.75; 95% CI 0.66 to 0.87) individuals had lower rates of PHC usage for mental disorders compared with the least educated white individuals. Black individuals were 3.7 times (ARR: 3.67; 95% CI 1.29 to 10.42) more likely to die from mental disorders compared with white individuals with the same education level.

CONCLUSION

In low-income individuals in Rio de Janeiro, racial/colour inequalities in mental health outcomes were large and not fully explainable by socioeconomic status. Black and pardo Brazilians were consistently negatively affected, with lower PHC usage and worse mental health outcomes.

Understanding the Predictors of Low Take-Up of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): A Nationwide Longitudinal Study

INTRODUCTION

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among eligible individuals) has steadily declined in the past decade. This study addresses gaps in our knowledge regarding predictors of WIC take-up during this time.

METHODS

Data were drawn from the 1998-2017 waves of the National Health Interview Study (NHIS), a serial cross-sectional study of the U.S.

POPULATION

The analytic sample included 23,645 children and 10,297 women eligible for WIC based on self-reported demographic characteristics. To investigate predictors of WIC take-up, we regressed self-reported WIC receipt on a range of individual-level predictors (e.g., age, nativity, income) and state- level predictors (e.g., unemployment rate, governor's political affiliation) using multivariable logistic regression. In secondary analyses, results were additionally stratified by race/ethnicity, time period, and age (for children).

RESULTS

For both women and children, older maternal age and higher educational attainment were associated with decreased take-up of WIC. Associations differed by race/ethnicity, time period, and state characteristics including caseload of other social programs (e.g., Medicaid).

DISCUSSION

Our study identifies groups that are less likely to take up WIC benefits for which they are eligible, thereby contributing important evidence to inform programs and policies to increase WIC participation among groups with lower take-up. As WIC evolves past the COVID-19 pandemic, special attention will be needed to ensure that resources to encourage and support the participation of racially and economically marginalized individuals are equitably distributed.

Comparing the health of refugee and asylee patients with that of non-refugee immigrant and US-born patients in a large Urban clinic

OBJECTIVES

To compare disease burden in refugee/asylee, non-refugee immigrant, and US-born patients in the largest safety net clinic in San Francisco, California.

METHODS

This is a retrospective chart review including 343 refugee/asylee, 450 immigrant, and 202 US-born patients in a San Francisco clinic from January 2014 to December 2017. Using electronic medical records, we compared prevalence of several diseases by immigration status. Using Poisson regression models with robust variance, we assessed association of diseases with immigration status, adjusting for sociodemographic characteristics.

RESULTS

Diagnoses of non-communicable chronic diseases were less common in refugees/asylees, who had a greater risk of being diagnosed with mental health conditions. In Poisson regression models adjusted for sociodemographic characteristics, compared with refugees/asylees, US-born patients were more likely to have hypertension (IRR[CI] = 1.8 [1.0, 3.7]) and less likely to have depression (IRR[CI] = 0.5 [0.3, 0.8]). US-born (IRR[CI] = 0.06 [0.01, 0.2]) and immigrant patients (IRR[CI] = 0.1 [0.06, 0.2]) were less likely to have post-traumatic stress disorder.

CONCLUSIONS

We uncover differences in burden of non-communicable chronic diseases and mental health by immigration status. These results highlight the importance of clinical screenings and research on disease burden in refugees.

Potential mechanisms linking poverty alleviation and health: an analysis of benefit spending among recipients of the U.S. earned income tax credit

BACKGROUND

The earned income tax credit (EITC) is the largest U.S. poverty alleviation program for low-income families, disbursed annually as a lump-sum tax refund. Despite its well-documented health impacts, the mechanisms through which the EITC affects health are not well understood. The objective of this analysis was to examine self-reported spending patterns of tax refunds among EITC recipients to clarify potential pathways through which income may affect health.

METHODS

We first examined spending patterns among 2020-2021 Assessing California Communities' Experiences with Safety Net Supports (ACCESS) study participants (N = 241) and then stratified the analysis by key demographic subgroups.

RESULTS

More than half of EITC recipients reported spending their tax refunds on bills and debt (52.3%), followed by 49.4% on housing, and 37.8% on vehicles. Only 3.3% reported spending on healthcare. (Note: respondents could list more than one possible spending category.) Participants ages 30 + were more likely to spend on bills and debt relative to those ages 18-29 (57.6% versus 39.4%, respectively). Other subgroup analyses did not yield significant findings.

CONCLUSIONS

Our findings suggest that EITC recipients primarily use their refunds on bills and debt, as well as on household and vehicle expenses. This supports the idea of the EITC as a safety net policy which addresses key social determinants of health.

Managing patients with sex-, race-, or ethnicity-based cardiovascular health inequities

ABSTRACT

Cardiovascular health inequities are experienced among cisgender women, gender minorities, Black and Indigenous people, and people with lower socioeconomic status. Early identification and treatment of patients at risk for disparate and adverse cardiac health outcomes are essential.

Unconditional cash transfers and mental health symptoms among parents with low incomes: Evidence from the 2021 child tax credit

The COVID-19 pandemic increased anxiety and depression in the U.S. population, particularly among low-income households, parents, and Black and Hispanic adults. To address the negative impacts of the pandemic, Congress temporarily expanded the Child Tax Credit (CTC) in 2021, providing a near-universal, unconditional cash transfer to families with children. Using a quasi-experimental, parameterized difference-in-differences research design, we examine the effects of the 2021 monthly CTC on symptoms of anxiety and depression in a large, national sample of parents with low incomes (N∼15,000). We study potential differences in the associations by race/ethnicity and consider whether CTC effects were stronger after a longer treatment period (for instance, due to greater dosage or delayed effects). We find some evidence that the monthly credit reduced parental anxiety and depression symptoms, although the results were not robust throughout all model specifications. Analyses stratified by race/ethnicity show stronger associations for non-Hispanic Black parents than for non-Hispanic White parents or Hispanic parents, although differences were small. We also find the credit reduced anxiety (but not depression) symptoms after three months of payments, suggesting that it took some time for the CTC to affect mental health symptoms. Overall, this study suggests that recurring cash transfers to families in poverty in the U.S. may have small beneficial effects on parental mental health.

Impact of economic shocks on mental health during COVID-19: A longitudinal study of adult residents of Indian metropolitan cities

Background

The causal impact of income shocks on mental well-being in developing countries is an under-researched area. The COVID-19 pandemic, along with the economic recession caused by the lockdowns to reduce transmission, provides a natural experimental setting to examine the causal impact of a decline in monthly per capita expenditure (MPCE) on mental health of the general population in India during the pandemic.

Aim

To evaluate the impact of income shocks on mental health of adults in metro cities during the COVID-19 pandemic.

Materials and Methods

The data were collected using the abridged version of the Depression Anxiety Stress Schedule administered through a telephonic survey on adult residents of six metropolitan cities in September-August 2020 and July-August 2021.

Results

In the present study, 994 adults participated from six metropolitan cities. Average treatment effects were estimated using Propensity Score Matching. The mean normalized scores are significantly higher for respondents whose MPCE had fallen (treated) vis-à-vis respondents whose MPCE had remained same or increased (control): anxiety (0.21 for treated vs -0.19 for control), stress (0.16 vs -0.14), and depression (0.04 vs -0.19). Propensity score matching reveals that the normalized scores for anxiety, stress, and depression were 33 (95% confidence intervals, CI: 20.0-46.7), 25 (95% CI: 12.9-36.9), and 36 (95% CI: 18.6-53.1) higher among the treated group vis-a-vis control group. The ATET was 34 (95% CI: 18.9-48.9), 26 (95% CI: 10.1-42.9), and 32 (955 CI: 12.3-50.7) for these three outcomes, respectively. The post-estimation tests indicated that the results are valid.

Conclusions

The study advocates that policies to ensure income security should be made an integral part of the response packages to tackle pandemics like COVID-19.

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

Does Education Influence Life-Course Depression in Middle-Aged and Elderly in China? Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

Mental health problems have become a major public health problem worldwide and are more common among middle-aged and elderly people in China. Research on the effect of education on depression is limited, and whether the relationship between education and depression changes over the life course remains unclear. This study was based on the cross-sectional data of 15,767 middle-aged and elderly individuals in the 2018 tracking survey (Wave 4) of the China Health and Retirement Longitudinal Study (CHARLS) database. Multiple linear regression and bootstrap methods were developed to detect the mediating effect of education on depression. In all samples or different age groups, education was significantly positively associated with depression. Three mediators (economic level, health-related lifestyle, and cognitive level) were significantly positively associated with depression, and cognitive level had a greater effect on depression than economic level and health-related lifestyle. The total, direct, and indirect effects of the whole samples and elderly samples were significant; however, the direct effect of the middle-aged samples was insignificant, and the total and indirect effects of the three mediating pathways were all significant, that is, economic level, health-related lifestyle, and cognitive level should produce complete mediation. The multiple linear regression and bootstrap methods could successfully detect the mediating effect of education on depression. On the basis of the education, economic level, health-related lifestyle, cognitive level, and depression of middle-aged and elderly people, we established and compared the total, direct, and mediating effects of education on depression under the life course. The mediating variables should be further increased, and the measurement methods of depression should be developed to improve the credibility of the research results.

Effects Of The 2021 Expanded Child Tax Credit On Adults' Mental Health: A Quasi-Experimental Study

The US Congress temporarily expanded the Child Tax Credit (CTC) during the COVID-19 pandemic to provide economic assistance for families with children. Although formerly the CTC provided $2,000 per child for mostly middle-income parents, during July-December 2021 it provided up to $3,600 per child. Eligibility criteria were also expanded to reach more economically disadvantaged families. There has been little research evaluating the effect of the policy expansion on mental health. Using data from the Census Bureau's Household Pulse Survey and a quasi-experimental study design, we examined the effects of the expanded CTC on mental health and related outcomes among low-income adults with children, and by racial and ethnic subgroup. We found fewer depressive and anxiety symptoms among low-income adults. Adults of Black, Hispanic, and other racial and ethnic backgrounds demonstrated greater reductions in anxiety symptoms compared to non-Hispanic White adults with children. There were no changes in mental health care use. These findings are important for Congress and state legislators to weigh as they consider making the expanded CTC and other similar tax credits permanent to support economically disadvantaged families.

Rectal Foreign Bodies: Surgical Management and the Impact of Psychiatric Illness

Background

Entrapped rectal foreign bodies can be a challenge to manage and are being encountered by acute surgical teams with increasing frequency. The aims of our study were to (a) ascertain the population demographics of patients presenting with this problem in our local area of East Kent, (b) see if an association could be drawn between this presentation and proposed risk factors such as a psychiatric illness or socioeconomic deprivation, and (c) to review how foreign bodies are being removed in the East Kent Hospital University Foundation NHS Trust, United Kingdom and to highlight best practice with regards to this in line with the latest guidelines.

Methodology

Between 2017 and 2021, 32 cases of entrapped rectal foreign bodies were diagnosed and managed at our NHS Trust. Retrospective data taken from the theatre directory and electronic patient records were used to audit patient demographics, co-morbidities, the type of foreign body, and the extraction technique.

Results

The majority of patients (90%) were male (n = 29). The patients’ age ranged from 15 to 95 years, with a median age of 48 years. In total, 12 (37.5%) patients had a medical history of a psychiatric illness. The most common foreign bodies removed were sex toys or vibrators (n = 8) and roll-on deodorant bottles (n = 7). Kent Area B (n = 10) and Kent Area A (n = 9) were the areas with the highest number of cases. Twenty-two (68.8%) patients underwent examination under a general anaesthetic for removal, seven (21.8%) patients had the object manually removed without sedation, and three (9.4%) required a laparotomy with or without bowel resection.

Conclusions

Cases of an entrapped rectal foreign body in this local region typically involved male patients between 40 and 50 years old. A high proportion of this group had a history of a psychiatric illness supporting an association between this presentation and mental health. We have proposed some explanations for this association including the anal canal nervous system interplay with the “brain-gut axis.” Lower socioeconomic status and unemployment may also be risk factors for this surgical problem. A trans-anal approach for management is successful in the majority of cases; however, almost 10% of patients required emergency surgical management. We have highlighted best practice guidelines for the investigation and management of the entrapped rectal foreign body as part of our discussion.

Characterizing the Landscape of Safety Net Programs and Policies in California during the COVID-19 Pandemic

The COVID-19 pandemic prompted rapid and innovative policymaking around the world at the national, regional, and local levels. There has been limited work to systematically document and characterize new and expanded local U.S. pandemic-era policies, which is imperative to better understand the policy variation and resulting health impacts during this unprecedented time. California, the most populous U.S. state, provides a case example of a particularly active policy response. The aim of this Brief Report is to summarize the creation and potential areas of application of a newly created publicly available California- and US-based COVID-19 policy database. We generated an extensive list of California and US policies that were modified or created in response to the COVID-19 pandemic. From July-November 2021, we searched current and historical California and federal government websites, press releases, social media, and news sources and recorded detailed information on these policies, including coverage dates, eligibility criteria, and benefit amounts. This comprehensive dataset includes 39 public health, economic, housing, and safety net programs and policies implemented at both federal and state levels and provides details of the complex and multifaceted policy landscape in California from March 2020 to November 2021. Our database is publicly available. Future investigators can leverage the information systematically recorded in this database to rigorously assess the short- and long-term effects of these policies, which will in turn inform future preparedness response plans in California and beyond.

State earned income tax credits and depression and alcohol misuse among women with children

About 30% of single mothers in the US live at or below the poverty line. Poverty is associated with higher risk of depression and substance use. We investigated associations between state earned income tax credit (EITC) policies and reported depressive symptoms and alcohol misuse among birthing parents who responded to Pregnancy Risk Assessment Monitoring Survey spanning 1990-2017. Nearly half of birthing parents reported no more than a high school education (45.4%; 95% CI: 45.3%-45.6%). An estimated 28.5% of birthing parents reported binge drinking in the three months prior to conception (95% CI: 28.3-28.8%). Among birthing parents, each 10 percentage-point increase in the generosity of state EITC relative to the federal EITC was associated with a lower prevalence of binge drinking (prevalence ratio = 0.96; 95% CI: 0.93-0.99) prior to conception. This association was more pronounced among birthing parents with no more than high school education (prevalence ratio = 0.92; 95% CI: 0.88-0.97). There was no association between state EITC and number of reported depressive symptoms prior to conception or after birth, except among those with lower educational attainment (prevalence ratio = 0.94; 95% CI: 0.89-0.99). Anti-poverty policies such as EITC may reduce the burden of alcohol misuse, especially among people with children.

The effect of job insecurity, employment type and monthly income on depressive symptom: analysis of Korean Longitudinal Study on Aging data

Background

In modern society, depression is serious issue that causes socioeconomic and family burden. To decrease the incidence of depression, risk factors should be identified and managed. Among many risk factors for depression, this study examined socioeconomic risk factors for depression.

Methods

We utilized first (2006), second (2008), and third (2010)-wave data from the Korean Longitudinal Study of Aging (KLoSA). Depressive symptom was measured with the 10-item Center for Epidemiological Studies Depression Scale, Short Form (CES-D-10) in the survey in 2008 and 2010. Three risk factors including job security, employment type and monthly income were measured in the survey in 2006. The association between risk factors and depressive symptom was analyzed by Cox proportional-hazard model.

Results

We analyzed data from 1,105 workers and hazard ratios (HRs) for 3 risk factors were significant entirely. In addition, regular worker with high income group is the most vulnerable group of poor job insecurity on depression among male workers (HR: 1.73; 95% confidence interval [CI]: 1.07–2.81). Finally, HRs for 7 groups who had at least 1 risk factor had higher HRs compared to groups who had no risk factors after stratifying 3 risk factors. In the analysis, significantly vulnerable groups were total 5 groups and the group who had highest HR was temporary/daily workers with poor job security (HR: 2.51; 95% CI: 1.36–4.64). The results concerning women, regardless of job type, were non-significant.

Conclusions

This study presented one or more risk factors among poor job security, low income, temporary/daily employment type increase hazard for depressive symptom in 2 or 4 years after the exposure. These results inform policy to screen for and protect against the risk of depression in vulnerable groups.

Mental health in the Austrian general population during COVID-19: Cross-sectional study on the association with sociodemographic factors

INTRODUCTION

The impact of the Coronavirus disease (COVID-19) pandemic and the associated governmental restrictions on mental health have been reported in different countries. This cross-sectional study evaluated mental health during the COVID-19 pandemic in Austria and the association with sociodemographic factors (i.e., age, sex, education, income, employment status, partnership status, and migration background).

METHODS

A representative sample (N = 1,031) of the Austrian general population was surveyed online end of April 2022. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), alcohol abuse (CAGE), eating disorders (SCOFF), and stress (PSS-10).

RESULTS

1,031 participants completed the online survey (50.3% women; mean age: 45.6 ± 17.23 years). Cut-offs for clinically relevant depression were exceeded by 28%. 16% scored above the cut-off for clinically relevant anxiety symptoms, 15% for clinical insomnia, 18% for alcohol abuse, 26% for eating disorders, and 65% for moderate to high stress. Comparisons with another cross-sectional representative Austrian sample recruited during the first weeks of the COVID-19 pandemic in Austria (April 2020) revealed increases in depression (from 21 to 28%) but no significant changes in anxiety, insomnia, and moderate to high stress. Multivariable logistic regression showed the strongest associations of mental health indicators with age, income, and sex. Increasing age and income were associated with lower odds of mental health symptoms. Being female compared to male increased the odds of depressive symptoms while decreasing the odds of alcohol abuse.

DISCUSSION

The COVID-19 crisis seems particularly stressful for younger adults (<35 years) and people with low income (<€2,000 net household income per month). Policymakers need to consider the high social and economic costs of lockdowns and think of optimal intervention methods for mental disorders among young and low-income individuals.

Employment Status and Its Association With Psychological Distress and Alcohol Consumption

Purpose: The objective of this analysis was to find an association between employment status, psychological distress, and alcohol consumption.

Methods: Data from the 2020 Health Information National Trends Survey (HINTS) data was used. Patient health questionnaire-4 (PHQ-4) data and an average number of drinks per week were used to assess psychological distress and drinking status.

Results: Out of the 3865 people who answered the survey in the year 2020, 1890 (59.11%) were employed in one or multiple jobs during the time of the survey. The sample included 1561 men and 2204 women with an average age of 48.4 years. More than half (58.7%) of them were Non-Hispanic White followed by Hispanic and Non-Hispanic Black at 15.73% and 10.32%, respectively. Bivariate analysis showed a significant association between employment, psychological distress (p value=0.032), and alcohol drinking (p value=0.002); 60.59% of participants reporting severe distress (PHQ-4 score of 9-12) were unemployed. Alternatively, 73.1% of the employed respondents reported no stress (PHQ-4 score of 0-2). While more than half (75.97%) of those who were unemployed consumed only 1-2 drinks per week on an average, 7.27% consumed >13 drinks per week on an average. After adjusting for covariates, the regression analysis showed a highly significant association (p value< 0.001) between unemployment and psychological distress (OR=1.55; 95% CI 1.03, 2.31), and alcohol consumption (OR=0.67; 95% CI 0.48, 0.92).

Conclusion: Unemployment is associated with outcomes like psychological distress and alcohol consumption. However, being employed was found to be more strongly associated with alcohol drinking. We do not know if the coronavirus disease 2019 (COVID-19) pandemic was a risk factor for the given outcomes.