Survey Design for TANF Caseload Project: Summary Report and Recommendations. Rational for Why the Topic Was Chosen


Researchers have found that mental health conditions can limit or prevent employment. Lower rates of labor force participation, reduced work hours, and lower earnings have been found to be associated with mental illness. In many cases, attendance is affected; for example, individuals with depression have been found to use as many as four times the number of sick days used by individuals who are not depressed (Broadhead et al. 1990; and Wells et al. 1989). Moreover, some behaviors associated with a mental illness are not conducive to working, including problems with social functioning and coping with day-to-day stress. Added to these difficulties, people with mental health conditions may face stigma and potential discrimination by employers. Gaining the support of the employer can be critical to the success of the mentally ill person in the workplace; yet many affected individuals fear that employers will be reluctant to accommodate their needs.

Mental health problems, especially depression, are considered more prevalent among low-income and welfare recipients than in the general population. For example, more than one-quarter of the sample of welfare recipients in the WES suffered from a major depressive disorder, compared with 13 percent nationally. Moreover, in the WES, major depression was found to be significantly associated with employment. Using the same diagnostic measure of depression, the CalWORKS Prevalence Project found that 22 percent of recipients in Kern County and 36 percent of applicants in Stanislaus County could be classified as having major depression.

Generalized Anxiety Disorder (GAD) is estimated to be present in about 4 percent of women in the general population, according to the National Co-Morbidity Study (NCS), the largest nationally representative epidemiological study of mental health in the United States. Recent studies of welfare recipients find higher rates of this disorder: about 7 percent in both the WES and a study of welfare recipients in Utah, and 9 to 10 percent in the CalWORKS Prevalence Project. GAD often coexists with other mental health conditions.

Many welfare recipients experience such traumas as domestic violence and rape, which put them at high risk of Post-Traumatic Stress Disorder (PTSD); see Curcio (1996). The rate of 12-month PTSD in the WES was more than 14 percent; the rate was 13 percent in each site of the CalWORKS Prevalence Project. The rate of PTSD in the NCS was 3.9 percent; this figure, however, includes men, who have a lower prevalence rate than women. The CalWORKS Prevalence Project found that more than 80 percent of women with PTSD had another mental health diagnosis as well.

Among other mental health diagnoses that could interfere with employment are such forms of depression as dysthymia and manic-depression, as well as several forms of anxiety disorders, including specific phobias, social phobias, panic disorders, and agoraphobia. When combined, the prevalence of specific anxiety disorders among welfare recipients in the CalWORKS Prevalence Project was 35 percent in Kern County and 23 percent among applicants in Stanislaus County. Women may also suffer from adjustment problems, such as eating and sleep disorders. With the exception of the anxiety disorders listed above, most studies of welfare recipients have not attempted to measure the prevalence of these other disorders.

Dimensional scales are measures that assess the severity of symptoms associated with a mental health diagnosis (The Center for Epidemiologic Studies Depression Scale (CES-D) is a good example). They differ from diagnostic assessments, which result in a report of the proportion of individuals with a positive diagnosis of a specific condition. Dimensional scales have often been used as screening measures in the past. Although they do not constitute an assessment, they are considered useful because they provide more information than a dichotomous classification of diagnostic prevalence.

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