Welfare Participation and Depression Among Youth: A Synthesis of the Evidence

Background: Welfare programs, especially health-related programs, play important roles in the lives of vulnerable populations. These programs allow those with limited or no income to have access to health care. Since their inception, welfare programs have been accompanied by contentious debate about their advantages and disadvantages as strategies for alleviating poverty and the beneficial versus harmful effect of welfare participation on recipients’ well-being. Objective: This study sought to identify and synthesize the relationship between welfare participation and the prevalence of depression among youth between 16 and 24 years. Method: A systematic review was undertaken following the PRISMA guidelines, and the review protocol was registered on Prospero (CRD42017056645). Relevant literature published between 1997 and 2017 was identified through a search of 9 electronic databases, and the Google search engine was used to identify the grey literature on relevant topics. Once identified, the literature was screened using a priori eligibility inclusion and exclusion criteria. Results: The searches yielded 1,798 citations. After screening the abstracts, 160 reports were retained for a full-text review. Of these, 17 reports met criteria for study inclusion. Conclusions: Four descriptive studies reported mixed findings, suggesting the prevalence of depression among welfare youth varied by the study sample size, type of welfare program, geographic location, and participants’ gender and racial/ethnic status. Of the 13 comparison studies, 11 studies found consistent findings that participation in welfare programs was associated with a higher vulnerability for depression. However, two studies compared welfare recipients with non-welfare recipients among the most vulnerable population (e.g., AIDS-orphaned or homeless youth), and found participating welfare programs was associated with lower risk for depression. Discussion includes the effects of stigma related to welfare and mental health treatment, and the implications for policy makers, social workers, and future research.