Lone parents, health, wellbeing and welfare to work: a systematic review of qualitative studies

Can the return of rural labor improve the physical health of left-behind parents-evidence from rural China

Objectively In objective terms, the return of rural labor force shortens the spatial distance with parents, leading to changes in caregiving support, emotional support, and financial support for parents, thereby affecting the health status of parents. This article, using data from the Chinese Family Panel Studies, analyzes the characteristics of the health status of parents with and without returning migrant children. By employing multiple linear regression models, PSM models, and IV-2SLS methods to address endogeneity bias, the study preliminarily explores the impact of rural labor force return on parental health. The results show that: (1) among the 5,760 older adult individuals, 1866 of them have returning migrant chil-dren, while the remaining 3,894 do not have returning migrant children. (2) Parents' health status generally follows a normal distribution, with a small proportion of parents having very poor or very good health. The proportions of parents with relatively poor, fair, and relatively good health status range between 20 and 40%. Among parents with returning chil-dren, 40.12% have relatively poor health status, 45.01% have fair health status, and a small proportion have very poor or very good health status. In contrast, among parents without returning children, the proportions of parents with relatively poor, fair, and rela-tively good health status are 21.69, 33.21, and 38.45%, respectively. When parents tran-sition from not having returning children to having returning children, their health status decreases by 0.541 levels, indicating a negative impact of rural labor force return on par-ents' health. Based on the analysis results, this article provides policy recommendations from three aspects: how to increase the income of returning labor force, improve the rural pension system, and enhance the concept of children supporting their parents.

Mental health and service use of parents with and without borderline intellectual functioning

BACKGROUND

People with borderline intellectual functioning (BIF) encounter greater social adversities than the general population and have an increased prevalence of mental illness. However, little is known about the socio-demographic characteristics and mental health of parents with BIF.

METHODS

A secondary data analysis of the Adult Psychiatric Morbidity Survey 2014 was conducted. Logistic regression models were fitted to compare differences in socio-demographic, mental health and service-use characteristics between parents and non-parents with and without BIF, and to investigate if the relationship between parent status and mental health outcomes was modified by BIF status, sex, and employment.

RESULTS

Data from 6872 participants was analyzed; 69.1% were parents. BIF parents had higher odds of common mental disorder, severe mental illness, post-traumatic stress disorder, self-harm/suicide and were more likely to see their General Practitioner (GP) and to receive mental health treatment than non-BIF parents. BIF parents did not have a higher prevalence of mental health problems than BIF non-parents. Being a parent, after adjusting for BIF status and other confounders, was associated with increased odds of having a common mental disorder, visits to see a GP and treatment for mental health. Female parents had higher odds of treatment for mental health problems.

CONCLUSIONS

Being a parent is associated with elevated rates of common mental disorders. There is a higher burden of mental health problems and service use in people with BIF. A greater provision of specialist support services including ascertainment is indicated for this group.

A guaranteed income intervention to improve the health and financial well-being of low-income black emerging adults: study protocol for the Black Economic Equity Movement randomized controlled crossover trial

Background

Economic inequity systematically affects Black emerging adults (BEA), aged 18-24, and their healthy trajectory into adulthood. Guaranteed income (GI)-temporary, unconditional cash payments-is gaining traction as a policy solution to address the inequitable distribution of resources sewn by decades of structural racism and disinvestment. GI provides recipients with security, time, and support to enable their transition into adulthood and shows promise for improving mental and physical health outcomes. To date, few GI pilots have targeted emerging adults. The BEEM trial seeks to determine whether providing GI to BEA improves financial wellbeing, mental and physical health as a means to address health disparities.

Methods/design

Using a randomized controlled crossover trial design, 300 low-income BEA from San Francisco and Oakland, California, are randomized to receive a $500/month GI either during the first 12-months of follow-up (Phase I) or during the second 12-months of a total of 24-months follow-up (Phase II). All participants are offered enrollment in optional peer discussion groups and financial mentoring to bolster financial capability. Primary intention-to-treat analyzes will evaluate the impact of GI at 12 months among Phase I GI recipients compared to waitlist arm participants using Generalized Estimating Equations (GEE). Primary outcomes include: (a) financial well-being (investing in education/training); (b) mental health status (depressive symptoms); and (c) unmet need for mental health and sexual and reproductive health services. Secondary analyzes will examine effects of optional financial capability components using GEE with causal inference methods to adjust for differences across sub-strata. We will also explore the degree to which GI impacts dissipate after payments end. Study outcomes will be collected via surveys every 3 months throughout the study. A nested longitudinal qualitative cohort of 36 participants will further clarify how GI impacts these outcomes. We also discuss how anti-racism praxis guided the intervention design, evaluation design, and implementation.

Discussion

Findings will provide the first experimental evidence of whether targeted GI paired with complementary financial programming improves the financial well-being, mental health, and unmet health service needs of urban BEA. Results will contribute timely evidence for utilizing GI as a policy tool to reduce health disparities.

Clinical trial registration

https://clinicaltrials.gov, identifier NCT05609188.

Self-Stigma and Mental Health in Divorced Single-Parent Women: Mediating Effect of Self-Esteem

Numerous studies have addressed the issue of "self-stigma" among divorced single-parent women. However, there is a scarcity of quantitative data available on this subject. Moreover, while self-esteem is a crucial factor throughout life, it has been extensively studied in the context of "children" from single-parent families, but not from the perspective of parents themselves. To address this gap, the present study aimed to explore the relationship between self-stigma, self-esteem, and mental health in 347 divorced, single-parent women. The online survey recruited participants randomly, with a specific focus on single mothers who were divorced and had more than one child under the age of 18. The analysis involved utilizing SPSS 25.0 (IBM Co., Armonk, NY, USA) and PROCESS Macro Version 4.1 (Model 4) to conduct descriptive statistics, frequency analysis, reliability assessment, correlation analysis, and mediating analysis. The findings revealed that self-esteem played a partial mediating role in the relationship between self-stigma and mental health. In other words, higher levels of self-stigma among divorced, single-parent women were associated with poorer mental health outcomes. Additionally, the study discovered that engaging in more self-stigma was linked to lower self-esteem and increased mental health distress. These results underscore the significance of internal factors, such as self-stigma and self-esteem, and highlight their relevance in formulating policies aimed at supporting divorced single-parent women. Policymakers should take these factors into account to develop effective strategies to aid this specific group.

Lone parents' employment policy and adolescents' socioemotional development: Quasi-experimental evidence from a UK reform

Studies suggest that welfare-to-work programmes increase lone mother's employment, but their impact on child and adolescent socioemotional development is unclear. The lone parent obligation (LPO) reform introduced a requirement for lone mothers entitled to unconditional Income Support (IS) to seek paid work actively as a condition to receive benefits. We use data from the UK Millennium Cohort Study to examine the impact of work search requirements for lone parents on child and adolescent socioemotional development. We apply a difference-in-differences approach that exploits gradual changes from 2008 to 2017 in children's maximum eligibility age to receive IS and assess effects on child and adolescent Strengths and Difficulties Questionnaire (SDQ) scores. We find that the LPO reform led to a ten-percentage point increase in lone mothers' employment but no change in the risk of family poverty. The reform led to a small but statistically significant increase in adolescents' SDQ scores, which indicated worse mental health and was largely driven by increased emotional problems. It also led to an increase in mothers' distress and poor self-rated health, and mothers' reports that time spent with children was insufficient. Our findings highlight the need to consider trade-offs between employment gains and child and adolescent socioemotional development in assessing the net impact of welfare-to-work policies targeting lone parents.

Stressors and coping strategies among single mothers during the COVID-19 pandemic

OBJECTIVES

Increased levels of stress have been reported among parents due to the factors associated with the COVID-19 pandemic. Although social support is known as a protective factor for the stressors, restrictions due to the pandemic could influence the provision and forms of social support. To date, few qualitative studies have examined the stressors and coping strategies in detail. In particular, the role of social support for single mothers during the pandemic remains largely unclear. The purpose of this study is to explore the stressors and coping strategies of single parents during the COVID-19 pandemic, with a focus on social support as a coping strategy.

METHODS

In-depth interviews with 20 single mothers were conducted in Japan between October and November 2021. Data were deductively coded using thematic coding based on codes related to stressors and coping strategies, focusing on social support as a coping strategy.

RESULTS

Most interviewees recognized additional stressors after the COVID-19 outbreak. Five stressors were mentioned by the participants: (1) fear of infection, (2) financial concerns, (3) stress caused by interactions with their children, (4) restrictions on childcare facilities, and (5) stress related to staying at home. The major coping strategies were (1) informal social support from family, friends, and coworkers, (2) formal social support from municipalities or nonprofit organizations, and (3) self-coping strategies.

CONCLUSION

Single mothers in Japan recognized additional stressors after the COVID-19 outbreak. Our results support the importance of both formal and informal social support for single mothers, either in-person or online, to cope with stress during the pandemic.

Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: A qualitative meta-ethnography

Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are mothers with young children, pregnant women, and lone parents (the majority of whom are women). This systematic review and meta-ethnography of qualitative studies focused on women's experiences of food insecurity and how it affects their nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched from January 1, 2008-July 10, 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,589 unique records; we included 23 publications reporting data from 22 unique studies involving 647 women. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified two key themes - accessing sufficient food and embodying food insecurity - comprising seven sub-themes. Our meta-ethnography provides a progressive 'storyline' of women's experiences of food insecurity. This includes the ways in which women attempt to access sufficient food, are unable to meet their nutritional needs, and the ways in which this is embedded into their everyday lives and embodied in unhealthful physical, social, and mental nutritional health and wellbeing impacts. Our review emphasises that food insecurity directly and tangibly impacts women's nutritional health and wellbeing. It concludes that there needs to be greater recognition of the psychosocial impact of food insecurity on vulnerable women in addition to its impact on their nutritional health and wellbeing.

Mental health promotion and protection relating to key life events and transitions in adulthood: a rapid systematic review of systematic reviews

BACKGROUND

During the decades representing working-age adulthood, most people will experience one or several significant life events or transitions. These may present a challenge to mental health.

AIM

The primary aim of this rapid systematic review of systematic reviews was to summarise available evidence on the effectiveness of interventions to promote and protect mental health relating to four key life events and transitions: pregnancy and early parenthood, bereavement, unemployment, and housing problems. This review was conducted to inform UK national policy on mental health support.

METHODS

We searched key databases for systematic reviews of interventions for working-age adults (19 to 64 years old) who had experienced or were at risk of experiencing one of four key life events. Titles and abstracts were screened by two reviewers in duplicate, as were full-text manuscripts of relevant records. We assessed the quality of included reviews and extracted data on the characteristics of each literature review. We prioritised high quality, recent systematic reviews for more detailed data extraction and synthesis.

RESULTS

The search and screening of 3997 titles/abstracts and 239 full-text papers resulted in 134 relevant studies, 68 of which were included in a narrative synthesis. Evidence was strongest and of the highest quality for interventions to support women during pregnancy and after childbirth. For example, we found benefits of physical activity and psychological therapy for outcomes relating to mental health after birth. There was high quality evidence of positive effects of online bereavement interventions and psychological interventions on symptoms of grief, post-traumatic stress, and depression. Evidence was inconclusive and of lower quality for a range of other bereavement interventions, unemployment support interventions, and housing interventions.

CONCLUSIONS

Whilst evidence based mental health prevention and promotion is available during pregnancy and early parenthood and for bereavement, it is unclear how best to support adults experiencing job loss, unemployment, and housing problems.

Partner bereavement when parenting dependent children: What factors influence adjustment?

Little is known about those who are widowed while raising dependent children. This study aimed to explore the factors which influence adjustment to partner death. Seven fathers and five mothers were interviewed, and constructivist grounded theory was used. Three interrelated themes were identified: Interpersonal influences, Intrapersonal influences, and Contextual influences. Dependent children meant sole responsibility and increased demands, yet ultimately provided widowed parents a purpose. Participants highlighted the need for increased awareness of young widowhood at a systemic and cultural level, to improve communication around death and young widowhood. Implications included social, financial and therapeutic interventions.

Getting Better or Getting Worse? A Population-Based Study on Trends in Self-Rated Health among Single Mothers in Germany between 1994 and 2018

BACKGROUND

While numerous studies suggest that single motherhood is associated with socioeconomic disadvantages and poor health, few studies have analyzed how these conditions have evolved over time. Addressing this gap, we examined the temporal development of self-rated health (SRH) among single compared to partnered mothers, and the role of socioeconomic factors that may have influenced this trend.

METHODS

We used representative longitudinal data from the German Socioeconomic Panel Survey (G-SOEP) between 1994 and 2018, consisting of 83,843 women with children, aged 30-49 years (13,664 single and 70,179 partnered mothers). Time trends in SRH and socioeconomic factors were analyzed by means of logistic regression analyses. We applied the Karlson-Holm-Breen (KHB) method for decomposing the total time effect into direct and indirect parts via socioeconomic mediators.

RESULTS

The predicted probabilities of good SRH decreased in single mothers from 57.0% to 48.4%, while they increased in partnered mothers from 54.8% to 61.3%. Similarly, predicted probabilities of poor SRH rose from 15.0% to 22.7% in single mothers while decreasing slightly from 12.0% to 11.4% in partnered mothers. Moreover, socioeconomic factors worsened over time for single mothers, while they mostly improved for partnered mothers. Decomposing the time trend revealed that the deterioration of single mothers' health was partly explained by the worsening of socioeconomic disadvantages, of which the decline in full-time employment, the rise in low incomes, and in unemployment contributed most.

CONCLUSIONS

The alarming rise in socioeconomic and health disadvantages among single mothers in Germany shows that action is needed to counter this trend.

Women's Lived Experiences with Temporary Assistance for Needy Families (TANF): How TANF Can Better Support Women's Wellbeing and Reduce Intimate Partner Violence

Women experiencing poverty are more likely to face intimate partner violence (IPV), poor health, and stigma. IPV survivors are overrepresented among those who receive Temporary Assistance for Needy Families (TANF), a conditional cash program serving families experiencing poverty. More generous TANF policies may be protective against IPV, but a greater insight into TANF's effect could be gleaned through a contemporaneous study that examines intersecting determinants of wellbeing and engages community interpretation of findings. Using an adapted Family Stress Model framework and analyzing data through an intersectional and community-based lens, we explore the impact of TANF on women's wellbeing through in-depth, semi-structured interviews during the COVID-19 pandemic with 13 women who had TANF experience in three U.S. states. Data were analyzed using thematic analysis in MAXQDA and researchers facilitated three member-checking events to enhance validity of result interpretation. Four themes emerged: (1) Low cash and conditional benefits provided limited short-term "relief" but contributed to poverty and hard choices; (2) TANF benefit levels and conditions increased women's dependence on others, straining relationships; (3) Women undertook extraordinary measures to access TANF, largely to fulfill their roles as mothers; and (4) TANF stigma creates psychological stress, differentially experienced by African Americans. Increasing TANF cash benefits and other cash transfers for those experiencing poverty, adopting solely state funded TANF programs, increasing funding for TANF administration, addressing TANF stigma and racialized narratives, and allowing optional child support participation or a larger "pass-through" of child support are important steps toward making TANF more protective against IPV.

What Matters for the Wellbeing of Mothers and Children in Material Hardship? Application of a Modified Indicator Framework

We examine determinants of subjective wellbeing (SWB) for mothers of dependent children in material hardship, using a modification of the New Zealand Treasury's Living Standards Framework (LSF) and data from the General Social Survey. We convert the LSF-an indicator dashboard-into a tool for prioritising social policies by placing SWB at the head of a hierarchy of wellbeing domains. Several determinants of these mothers' SWB conform to standard findings; however, two important differences stand out. One is the lack of a protective effect from employment on SWB for this group (unlike the protective effect for males). The other is a positive relationship between a mother's SWB and satisfaction with her own skills/knowledge; this effect is particularly strong for sole mothers in hardship, dominating any effect of qualifications on SWB. The analysis demonstrates both a practical use of a modified LSF, and the value of taking a gender-specific approach to analysing wellbeing.

Association between Temporary Assistance for Needy Families (TANF) and child maltreatment among a cohort of fragile families

BACKGROUND

Child maltreatment disproportionately affects families experiencing poverty and structural discrimination, including African American (AA) families. The generosity of Temporary Assistance for Needy Families (TANF) may reduce child maltreatment disparities.

OBJECTIVE

Our aim is to understand TANF's impact on the mother's perpetration of child maltreatment and whether the effect differs across AA and White mothers.

PARTICIPANTS AND SETTING

Participants are 2457 primary caregiving mothers participating in waves 3 (2001-2003), 4 (2003-2006), and 5 (2007-2010) of the U.S.-based Fragile Families and Child Wellbeing birth cohort study.

METHODS

We use a difference-in-differences study design to estimate overall and race-specific effects of TANF policies on caregivers' self-report of child neglect and physical and psychological maltreatment measured by the Child-Parent Conflict Tactics Scale. State-level TANF policy exposures include the TANF-to-Poverty Ratio (TPR), maximum cash benefits, time limits, sanctions, diversion payments, and family caps.

RESULTS

A $100 increase in TANF benefits was associated with a reduction of 1.8 reported physical abuse events (Beta = -1.80, 95% CI (-3.29, -0.31)). Imposing a time limit on TANF receipt was associated with an increase of 2.3 reported physical abuse events (Beta = 2.27, 95% CI (0.04, 4.50)). No significant differences were found for AA mothers versus White mothers.

CONCLUSIONS AND RELEVANCE

Increasing TANF cash benefits should be prioritized to reduce poverty-related child maltreatment disparities. TANF time limits should be reconsidered.

Incidence of and improvement in inappropriate parental behaviors of mothers with young children: a retrospective cohort study conducted in collaboration with a local government

Background

Inappropriate parental behaviors of mothers toward young children require further study; few epidemiological studies have utilized longitudinal analysis of region-based cohorts. This study examined the frequency of incidence of and improvements in inappropriate parental behaviors of mothers with young children and related factors.

Methods

Among the mothers who underwent a checkup in Fukushima City in 2017, 586 mothers with data from 4-, 18-, and 42-month-old checkups were included in analysis. In this retrospective cohort study, an anonymous database was created by transcribing and matching health checkup records with questionnaires stored at the city health center. Data were analyzed using chi-square tests and logistic regression analysis, using the SPSS Ver.20.0.

Results

In 28.5% of mothers, inappropriate parental behaviors were not reported in the 18-month-old data but were reported in the 42-month-old data. In 3.8%, inappropriate parental behaviors were reported in the 18-month-old data but were not reported in the 42-month-old data. The most common inappropriate parental behavior reported was “yelling at the child using emotional words” (18-month-old data, 16.2%; 42-month-old data, 39.5%). Mothers with financial difficulties were 2.19 times (95%CI: 1.13–4.26) more likely to begin inappropriate parental behaviors between 18 and 42 months. Improvements in parental behaviors were significantly higher in mothers under 30 years old (p = 0.03).

Conclusions

It is necessary to identify mothers with financial difficulties early and to examine how to provide childcare and financial support from a local government at the time of child health checkup.

The effects of social protection policies on health inequalities: Evidence from systematic reviews

Background: The welfare state distributes financial resources to its citizens - protecting them in times of adversity. Variations in how such social protection policies are administered have been attributed to important differences in population health. The aim of this systematic review of reviews is to update and appraise the evidence base of the effects of social protection policies on health inequalities. Methods/design: Systematic review methodology was used. Nine databases were searched from 2007 to 2017 for reviews of social policy interventions in high-income countries. Quality was assessed using the Assessment of Multiple Systematic Reviews 2 tool. Results: Six systematic reviews were included in our review, reporting 50 unique primary studies. Two reviews explored income maintenance and poverty relief policies and found some, low quality, evidence that increased unemployment benefit generosity may improve population mental health. Four reviews explored active labour-market policies and found some, low-quality evidence, that return to work initiatives may lead to short-term health improvements, but that in the longer term, they can lead to declines in mental health. The more rigorously conducted reviews found no significant health effects of any of social protection policy under investigation. No reviews of family policies were located. Conclusions: The systematic review evidence base of the effects of social protection policy interventions remains sparse, of low quality, of limited generalizability (as the evidence base is concentrated in the Anglo-Saxon welfare state type), and relatively inconclusive. There is a clear need for evaluations in more diverse welfare state settings and particularly of family policies.

Effects of restrictions to Income Support on health of lone mothers in the UK: a natural experiment study

BACKGROUND

In the UK, lone parents must seek work as a condition of receiving welfare benefits once their youngest child reaches a certain age. Since 2008, the lower age limit at which these Lone Parent Obligations (LPO) apply has been reduced in steps. We used data from a nationally representative, longitudinal, household panel study to analyse the health effects of increased welfare conditionality under LPO.

METHODS

From the Understanding Society survey, we used data for lone mothers who were newly exposed to LPO when the age cutoff was reduced from 7 to 5 years in 2012 (intervention group 1) and from 10 to 7 years in 2010 (intervention group 2), as well as lone mothers who remained unexposed (control group 1) or continuously exposed (control group 2) at those times. We did difference-in-difference analyses that controlled for differences in the fixed characteristics of participants in the intervention and control groups to estimate the effect of exposure to conditionality on the health of lone mothers. Our primary outcome was the difference in change over time between the intervention and control groups in scores on the Mental Component Summary (MCS) of the 12-item Short-Form Health Survey (SF-12).

FINDINGS

The mental health of lone mothers declined in the intervention groups compared with the control groups. For intervention group 1, scores on the MCS decreased by 1·39 (95% CI -1·29 to 4·08) compared with control group 1 and by 2·29 (0·00 to 4·57) compared with control group 2. For intervention group 2, MCS scores decreased by 2·45 (-0·57 to 5·48) compared with control group 1 and by 1·28 (-1·45 to 4·00) compared with control group 2. When pooling the two intervention groups, scores on the MCS decreased by 2·13 (0·10 to 4·17) compared with control group 1 and 2·21 (0·30 to 4·13) compared with control group 2.

INTERPRETATION

Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health.

FUNDING

UK Medical Research Council, Scottish Government Chief Scientist Office, and National Health Service Research Scotland.

Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Mental health has been included in the UN Sustainable Development Goals. However, uncertainty exists about the extent to which the major social determinants of mental disorders are addressed by these goals. The aim of this study was to develop a conceptual framework for the social determinants of mental disorders that is aligned with the Sustainable Development Goals, to use this framework to systematically review evidence regarding these social determinants, and to identify potential mechanisms and targets for interventions. We did a systematic review of reviews using a conceptual framework comprising demographic, economic, neighbourhood, environmental events, and social and culture domains. We included 289 articles in the final Review. This study sheds new light on how the Sustainable Development Goals are relevant for addressing the social determinants of mental disorders, and how these goals could be optimised to prevent mental disorders.

Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children

BACKGROUND

Lone parents in high-income countries have high rates of poverty (including in-work poverty) and poor health. Employment requirements for these parents are increasingly common. 'Welfare-to-work' (WtW) interventions involving financial sanctions and incentives, training, childcare subsidies and lifetime limits on benefit receipt have been used to support or mandate employment among lone parents. These and other interventions that affect employment and income may also affect people's health, and it is important to understand the available evidence on these effects in lone parents.

OBJECTIVES

To assess the effects of WtW interventions on mental and physical health in lone parents and their children living in high-income countries. The secondary objective is to assess the effects of welfare-to-work interventions on employment and income.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, PsycINFO EBSCO, ERIC EBSCO, SocINDEX EBSCO, CINAHL EBSCO, Econlit EBSCO, Web of Science ISI, Applied Social Sciences Index and Abstracts (ASSIA) via Proquest, International Bibliography of the Social Sciences (IBSS) via ProQuest, Social Services Abstracts via Proquest, Sociological Abstracts via Proquest, Campbell Library, NHS Economic Evaluation Database (NHS EED) (CRD York), Turning Research into Practice (TRIP), OpenGrey and Planex. We also searched bibliographies of included publications and relevant reviews, in addition to many relevant websites. We identified many included publications by handsearching. We performed the searches in 2011, 2013 and April 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of mandatory or voluntary WtW interventions for lone parents in high-income countries, reporting impacts on parental mental health, parental physical health, child mental health or child physical health.

DATA COLLECTION AND ANALYSIS

One review author extracted data using a standardised extraction form, and another checked them. Two authors independently assessed risk of bias and the quality of the evidence. We contacted study authors to obtain measures of variance and conducted meta-analyses where possible. We synthesised data at three time points: 18 to 24 months (T1), 25 to 48 months (T2) and 49 to 72 months (T3).

MAIN RESULTS

Twelve studies involving 27,482 participants met the inclusion criteria. Interventions were either mandatory or voluntary and included up to 10 discrete components in varying combinations. All but one study took place in North America. Although we searched for parental health outcomes, the vast majority of the sample in all included studies were female. Therefore, we describe adult health outcomes as 'maternal' throughout the results section. We downgraded the quality of all evidence at least one level because outcome assessors were not blinded. Follow-up ranged from 18 months to six years. The effects of welfare-to-work interventions on health were generally positive but of a magnitude unlikely to have any tangible effects.At T1 there was moderate-quality evidence of a very small negative impact on maternal mental health (standardised mean difference (SMD) 0.07, 95% Confidence Interval (CI) 0.00 to 0.14; N = 3352; studies = 2)); at T2, moderate-quality evidence of no effect (SMD 0.00, 95% CI 0.05 to 0.05; N = 7091; studies = 3); and at T3, low-quality evidence of a very small positive effect (SMD -0.07, 95% CI -0.15 to 0.00; N = 8873; studies = 4). There was evidence of very small positive effects on maternal physical health at T1 (risk ratio (RR) 0.85, 95% CI 0.54 to 1.36; N = 311; 1 study, low quality) and T2 (RR 1.06, 95% CI 0.95 to 1.18; N = 2551; 2 studies, moderate quality), and of a very small negative effect at T3 (RR 0.97, 95% CI 0.91 to 1.04; N = 1854; 1 study, low quality).At T1, there was moderate-quality evidence of a very small negative impact on child mental health (SMD 0.01, 95% CI -0.06 to 0.09; N = 2762; studies = 1); at T2, of a very small positive effect (SMD -0.04, 95% CI -0.08 to 0.01; N = 7560; studies = 5), and at T3, there was low-quality evidence of a very small positive effect (SMD -0.05, 95% CI -0.16 to 0.05; N = 3643; studies = 3). Moderate-quality evidence for effects on child physical health showed a very small negative effect at T1 (SMD -0.05, 95% CI -0.12 to 0.03; N = 2762; studies = 1), a very small positive effect at T2 (SMD 0.07, 95% CI 0.01 to 0.12; N = 7195; studies = 3), and a very small positive effect at T3 (SMD 0.01, 95% CI -0.04 to 0.06; N = 8083; studies = 5). There was some evidence of larger negative effects on health, but this was of low or very low quality.There were small positive effects on employment and income at 18 to 48 months (moderate-quality evidence), but these were largely absent at 49 to 72 months (very low to moderate-quality evidence), often due to control group members moving into work independently. Since the majority of the studies were conducted in North America before the year 2000, generalisabilty may be limited. However, all study sites were similar in that they were high-income countries with developed social welfare systems.

AUTHORS' CONCLUSIONS

The effects of WtW on health are largely of a magnitude that is unlikely to have tangible impacts. Since income and employment are hypothesised to mediate effects on health, it is possible that these negligible health impacts result from the small effects on economic outcomes. Even where employment and income were higher for the lone parents in WtW, poverty was still high for the majority of the lone parents in many of the studies. Perhaps because of this, depression also remained very high for lone parents whether they were in WtW or not. There is a lack of robust evidence on the health effects of WtW for lone parents outside North America.

A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study

BACKGROUND

Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

METHODS

A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

RESULTS

Mean PPWR decreased in the (I) group (-1.2 kg) and the C2 group (-1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (-6.4 cm) compared to C1 (-1.1 cm; P = 0.002) and C2 (-3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

CONCLUSIONS

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

Welfare-to-work interventions and their effects on the mental and physical health of lone parents and their children

BACKGROUND

Lone parents in high-income countries have high rates of poverty (including in-work poverty) and poor health. Employment requirements for these parents are increasingly common. 'Welfare-to-work' (WtW) interventions involving financial sanctions and incentives, training, childcare subsidies and lifetime limits on benefit receipt have been used to support or mandate employment among lone parents. These and other interventions that affect employment and income may also affect people's health, and it is important to understand the available evidence on these effects in lone parents.

OBJECTIVES

To assess the effects of WtW interventions on mental and physical health in lone parents and their children living in high-income countries. The secondary objective is to assess the effects of welfare-to-work interventions on employment and income.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, PsycINFO EBSCO, ERIC EBSCO, SocINDEX EBSCO, CINAHL EBSCO, Econlit EBSCO, Web of Science ISI, Applied Social Sciences Index and Abstracts (ASSIA) via Proquest, International Bibliography of the Social Sciences (IBSS) via ProQuest, Social Services Abstracts via Proquest, Sociological Abstracts via Proquest, Campbell Library, NHS Economic Evaluation Database (NHS EED) (CRD York), Turning Research into Practice (TRIP), OpenGrey and Planex. We also searched bibliographies of included publications and relevant reviews, in addition to many relevant websites. We identified many included publications by handsearching. We performed the searches in 2011, 2013 and April 2016.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of mandatory or voluntary WtW interventions for lone parents in high-income countries, reporting impacts on parental mental health, parental physical health, child mental health or child physical health.

DATA COLLECTION AND ANALYSIS

One review author extracted data using a standardised extraction form, and another checked them. Two authors independently assessed risk of bias and the quality of the evidence. We contacted study authors to obtain measures of variance and conducted meta-analyses where possible. We synthesised data at three time points: 18 to 24 months (T1), 25 to 48 months (T2) and 49 to 72 months (T3).

MAIN RESULTS

Twelve studies involving 27,482 participants met the inclusion criteria. Interventions were either mandatory or voluntary and included up to 10 discrete components in varying combinations. All but one study took place in North America. Although we searched for parental health outcomes, the vast majority of the sample in all included studies were female. Therefore, we describe adult health outcomes as 'maternal' throughout the results section. We downgraded the quality of all evidence at least one level because outcome assessors were not blinded. Follow-up ranged from 18 months to six years. The effects of welfare-to-work interventions on health were generally positive but of a magnitude unlikely to have any tangible effects.At T1 there was moderate-quality evidence of a very small negative impact on maternal mental health (standardised mean difference (SMD) 0.07, 95% Confidence Interval (CI) 0.00 to 0.14; N = 3352; studies = 2)); at T2, moderate-quality evidence of no effect (SMD 0.00, 95% CI 0.05 to 0.05; N = 7091; studies = 3); and at T3, low-quality evidence of a very small positive effect (SMD -0.07, 95% CI -0.15 to 0.00; N = 8873; studies = 4). There was evidence of very small positive effects on maternal physical health at T1 (risk ratio (RR) 0.85, 95% CI 0.54 to 1.36; N = 311; 1 study, low quality) and T2 (RR 1.06, 95% CI 0.95 to 1.18; N = 2551; 2 studies, moderate quality), and of a very small negative effect at T3 (RR 0.97, 95% CI 0.91 to 1.04; N = 1854; 1 study, low quality).At T1, there was moderate-quality evidence of a very small negative impact on child mental health (SMD 0.01, 95% CI -0.06 to 0.09; N = 2762; studies = 1); at T2, of a very small positive effect (SMD -0.04, 95% CI -0.08 to 0.01; N = 7560; studies = 5), and at T3, there was low-quality evidence of a very small positive effect (SMD -0.05, 95% CI -0.16 to 0.05; N = 3643; studies = 3). Moderate-quality evidence for effects on child physical health showed a very small negative effect at T1 (SMD -0.05, 95% CI -0.12 to 0.03; N = 2762; studies = 1), a very small positive effect at T2 (SMD 0.07, 95% CI 0.01 to 0.12; N = 7195; studies = 3), and a very small positive effect at T3 (SMD 0.01, 95% CI -0.04 to 0.06; N = 8083; studies = 5). There was some evidence of larger negative effects on health, but this was of low or very low quality.There were small positive effects on employment and income at 18 to 48 months (moderate-quality evidence), but these were largely absent at 49 to 72 months (very low to moderate-quality evidence), often due to control group members moving into work independently. Since the majority of the studies were conducted in North America before the year 2000, generalisabilty may be limited. However, all study sites were similar in that they were high-income countries with developed social welfare systems.

AUTHORS' CONCLUSIONS

The effects of WtW on health are largely of a magnitude that is unlikely to have tangible impacts. Since income and employment are hypothesised to mediate effects on health, it is possible that these negligible health impacts result from the small effects on economic outcomes. Even where employment and income were higher for the lone parents in WtW, poverty was still high for the majority of the lone parents in many of the studies. Perhaps because of this, depression also remained very high for lone parents whether they were in WtW or not. There is a lack of robust evidence on the health effects of WtW for lone parents outside North America.