UCSF

Over 19 million adults in the U.S. experienced at least one major depressive episode in 2019, representing 7.8% of the population. One of the strongest risk factors for mental health problems is financial hardship. Studies have shown that financial security is positively associated with self-reported measures of mental health, while financial distress is negatively associated. Increasingly, evidence points to economic interventions as a way to reduce mental distress and related social disparities.

Since poverty and financial hardship are major risk factors for stress and mental health problems, it is imperative to identify population-level policies to improve mental wellbeing, especially among at-risk groups. This dissertation examines the role of income support programs on mental wellbeing among at-risk groups. It evaluates whether U.S. population-level poverty alleviation policies like the Earned Income Tax Credit (EITC) or the 2021 temporary expansion of the Child Tax Credit (CTC) can improve mental wellbeing among economically disadvantaged and racial/ethnic minoritized subgroups.

Chapter 1 examines the effects of the temporary pandemic-era expansion of the CTC, which provided economic assistance for families with children. A rigorous quasi-experimental difference-in-differences approach using the Census Household Pulse Survey was used to examine the effects on mental health and related outcomes among low-income adults with children and racial/ethnic subgroups. There were fewer depressive and anxiety symptoms among low-income adults, with Black adults showing greater reductions in depressive symptoms compared to White adults, and adults of Black, Hispanic and other racial/ethnic backgrounds showing greater reductions in anxiety symptoms. These findings are important for Congress and state legislators to weigh when considering making the CTC and other similar tax credits permanent.

Chapter 2 explores how state-level factors could modify the impact of federal policies through the example of the CTC. Using a quasi-experimental triple-differences approach and nationally representative data from the Census Household Pulse Survey, this study provides new evidence regarding how state policy environments may contribute to geographical disparities in mental health. Black adults demonstrated greater reductions in depressive symptoms compared with White adults, and adults of Black, Hispanic and other racial/ethnic backgrounds demonstrated greater reductions in anxiety symptoms.

Chapter 3 investigates the impact of two child-related tax benefit policies, the EITC and CTC, on postpartum health outcomes. Using data from the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System from 2004 to 2021, we conducted a regression discontinuity design comparing outcomes among those born just before and after the December 31 cutoff for benefit receipt. Findings showed that benefit receipt resulted in decreased breastfeeding, increased postpartum depression among Hispanic women, and reduced postpartum visits for “other” racial subgroups. Future work is needed to understand the specific impacts of child-related tax benefits on different subgroups of women.