A Systematic Review and Meta-Analysis of Depression Prevalence in U.S. Women Welfare Recipients

Background and Purpose:
Depression is a leading cause of disability worldwide (World Health Organization, 2021), and women generally have higher rates than men (Salk, Hyde & Abramson, 2017). Various explanations for this gender gap are given, but one factor is the greater risk of women living in poverty (Le et al., 2003). In the U.S., there were 2.8 million recipients of Temporary Assistance to Needy Families TANF (Falk & Landers, 2023); 6,260,000 of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (USDA, 2022); 87,062,629 of Medicaid (Medicaid.gov, 2023); and 70,000 families with Healthy Families (Healthy Families America, 2022). Depression in this population is important to study, not only because of undue suffering and potential negative impact but also due to the effect on children from having a mother who is depressed.

The last published review of depression in women receiving welfare limited their focus to Aid to Dependent Children (AFDC) and TANF. Lennon, Blome, and English (2001) relied on the Center for Epidemiological Depression Studies Scale (CED-S); women had high levels of depression, ranging from 24.9 to 56.7 percent (Lennon et al., 2001). Because that study did not use meta-analysis, the average effect is unknown. A need, therefore, has been established for a more principled and updated prevalence estimate for depression in U.S. women living on welfare. This study, therefore, systematically reviews and meta-analyzes the prevalence of depression in this population, examining moderators that may influence prevalence rates.

Methods:
A comprehensive search strategy was implemented, assisted by an academic librarian, to identify studies reporting the prevalence of depression among U.S. women on welfare. Electronic databases included PubMed, PsycINFO, and Scopus, and the grey literature was searched, as well. Eligible studies provided empirical prevalence data on this population. Data extraction and methodological appraisal were conducted systematically. Statistical analyses were performed using the meta and metafor packages in R, employing the metaprop function for meta-analysis. Given significant heterogeneity indicated by Q-statistics, a random-effects model was applied to account for within- and between-study variance.

Results:
Fifty studies encompassing 225,010 participants met inclusion criteria. The meta-analysis revealed a statistically significant prevalence of depression among women on welfare (prop = 0.2993, 95% CI 0.2451 – 0.3598, p < 0.001). This suggests that, on average, nearly one in three women in this demographic experience clinical depression. Despite extensive moderator analysis, no variable significantly accounted for heterogeneity across studies.

Conclusions and Implications:
Women on welfare face compounding disadvantages that exacerbate mental health disparities. Given the high prevalence of depression, systematic screening and access to evidence-based treatment should be integrated into welfare programs. Mental health interventions for depression may have the additional advantage of producing economic benefits for families (Lund et al., 2011). Additionally, and given that income support may help reduce depression (Cooper & Stewart, 2020; West & Castro, 2023), strengthening income support for low-income women may be a promising avenue for decreasing depression prevalence in this population.