Welfare to work does not improve mental health

November 14, 2000

GAINESVILLE, Fla.---While studies have shown paid employment is good for women's mental health, new University of Florida research suggests that may not hold true for those women moving from welfare to low-wage work.

The study, published this month in the Western Journal of Nursing Research, shows no differences on several mental health indicators between women who remained on cash assistance compared with those who had left the rolls.

"Current government policy assumes that women achieving the goal of leaving public assistance for paid employment may also have improved psychosocial health," said author Shawn M. Kneipp, an assistant professor in the UF College of Nursing. "As a result, the federal government only requires states to measure how many welfare recipients leave the program for work, not the effect it has on their health. But this research shows that assumption may be incorrect."

The research is based on data collected before the 1996 welfare reform legislation limiting the amount of time a person can receive benefits.

Kneipp, who received her doctorate in nursing science in 1998 from the University of Washington in Seattle, analyzed data collected for the Washington State Family Income Study. Out of a group of 1,848 women, ages 18 to 80, Kneipp was able to match 218 women for the comparison between those who had moved into jobs from welfare and those remaining on public assistance. As part of that state income study, the women answered questions about their self-esteem, levels of depression, perceived emotional support and feelings of self-efficacy -- the belief that one can finish whatever is started.

The sample group reflected the state's population with the majority of women in their late 20s or early 30s. Slightly more than 80 percent of the women were white, which also is similar to the racial composition in that state.

"Results demonstrate that there were no significant differences in depression, self-esteem, self-efficacy or perceived emotional support scores between the women who continued to receive Aid to Families with Dependent Children and those who left welfare for work," Kneipp said. Most prior research studies, which had demonstrated a mental health benefit to paid employment, had focused on married, middle-class, white American women, Kneipp said.

Although her current research also included predominantly women who are white, Kneipp's groups consisted mostly of single mothers with less education who were unemployed or had low-paying jobs, a group on whom little research has been done.

"Prior to 1996, there was little research done on the effects of welfare," Kneipp said. "Since reform, few studies have focused on women's health compared to a multitude of studies examining the economic effects of the current welfare-to-work policy."

Previous studies also have shown a high correlation between stress-related illnesses, such as heart disease, high blood pressure and gastrointestinal disorders, and employment that lacks authority, is not interesting, not challenging and is repetitious. Those characteristics are frequently found in the low-wage jobs typically available to welfare recipients looking for work, Kneipp said. In addition, such jobs often do not include benefits, such as health insurance, and can interfere with family responsibilities, including caring for a sick child.

The majority of studies conducted since 1996 have focused on child health and well-being or parent-child interactions, Kneipp said. That reflects a common perception that women on welfare are not individuals, but rather only conduits to the children, who are intended to be the real beneficiaries of income support.

"Evaluating the consequences of welfare reform on children should not preclude studying the effects that these regulations will have on the mothers' well-being," Kneipp said. "Obviously, more research needs to be done."

In a commentary accompanying Kneipp's research article, Agatha A. Quinn, an associate professor in the division of health experience and technology at the University of Colorado Health Sciences Center in Denver, called for additional research on the topic using broader definitions of health, including measures of stress, practices to reduce stress, and histories of sexual abuse, substance dependency and anxiety.

"As changes in public policy affect the health of our minority and economically constrained populations, nursing needs to become more rigorous in its study of the social implications on health," Quinn wrote. "Working at any job at any price to family health and security is not preferable to dependency on government subsidy."

Kneipp noted that one goal of the federal government's Healthy People 2010 report is to eliminate socioeconomic disparities in health status.

"We need to better understand what moving these women into employment is doing to their health," Kneipp said. "Does it make it better over time or worse? If the multiple challenges that they have, the role strain they are encountering and all of that stress is deteriorating their health further, then it is moving us farther away, as a nation, from the goals that we set out for ourselves."

University of Florida

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