Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States. Higher-Than-Average Incidence of Mental Health Conditions among Welfare Recipients


Compared to the general population, welfare recipients have higher-than-average rates of mental health conditions (see Table I.2). Approximately 6.5 percent of the general population is diagnosed with major depression in a given year. Fewer individuals are diagnosed with PTSD (3.6 percent) or generalized anxiety disorder (3.4 percent) (U.S. Department of Health and Human Services 1999).

Disorder U.S. General Adult Population Female Welfare Recipients in Michigan Long-Term Welfare Recipients in Utah
Major Depression 6.5% 26.7% 42.3%
Post-Traumatic Stress Disorder 3.6% 14.6% 15.1%
Generalized Anxiety 3.4% 7.3% 6.7%
Sources:  U.S. Department of Health and Human Services (1999), Danziger et al. (1999), Barusch et al. (1999).

There is wide variation in the reported rates of mental health conditions among welfare recipients. Estimates differ depending on how mental health conditions are defined and measured, and by the population studied. In the National Survey of America's Families, 35 percent of low-income families reported having poor mental health using scales measuring anxiety, depression, loss of emotional control, and psychological well-being (Zedlewski 1999). Researchers in Michigan found similar rates of mental health conditions (36 percent) among welfare recipients (Danziger et al. 1999). In a look at the prevalence of mental health, substance abuse, and domestic violence issues among California's CalWORKs participants, Chandler and Meisel (2000) found that more than one-third of these individuals had at least one diagnosable mental disorder in the previous 12 months, and about 20 percent had two or more. Of those with a mental disorder, more than one-fourth indicated their disorder interfered "a lot" with life or daily activities.

Major depression is the most common mental disorder among welfare recipients, followed by PTSD and generalized anxiety disorder. The prevalence of depression is startlingly high. In a Michigan study of barriers to employment faced by female welfare recipients, 27 percent of the study sample screened positive for clinical depression (Danziger et al. 1999). Researchers in Utah, using the measure for depression used in the Michigan study, found that 42 percent of long-term welfare recipients in Utah had clinical depression in the year before the interview (Barusch et al. 1999). This rate is nearly seven times that of the general adult population. Barusch et al. also found that 57 percent of these long-term welfare recipients were currently at risk for depression. Other researchers have found sizable differences in the rates of depression between welfare recipients and nonrecipients (Olson and Pavetti 1996, Leon and Weissman 1993).

While it is clear that depression is the most widespread mental health condition among the welfare population, what is not clear is the extent to which the depression precedes unemployment and receipt of cash assistance or vice versa, the depression being a product of the stress and frustration associated with those experiences. Regardless of which comes first, the symptoms of depression   sleeplessness, loss of self-esteem, social withdrawal, apathy, and fatigue   often interfere with the ability to find and keep a job and to support a family.

In addition to depression, generalized anxiety disorder and PTSD are prevalent among the welfare population and are often a result of childhood maltreatment, domestic violence, and other traumatic experiences. Welfare recipients experience generalized anxiety disorder and PTSD at rates substantially higher than the general population (see Table I.2). In-person interviews of women on welfare in Michigan revealed that the incidence of PTSD is four times that of the general population (Danziger et al. 1999). And the rate of generalized anxiety disorder among these women is twice as high as in the general population. Using the same measures as the researchers in Michigan, researchers in Utah found similar results among long-term welfare recipients (Barusch et al. 1999).

View full report


"TANF-MH01.pdf" (pdf, 763.2Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®