Material Hardship and Primary Caregivers' Depression: An Analysis of Pre-and-during-COVID-19 Experiences

Depression is a significant public health concern, particularly among individuals experiencing material hardship, including financial instability, food insecurity, difficulty paying utilities, housing difficulties, and challenges accessing healthcare. The COVID-19 pandemic intensified these material hardships, leading to a surge in depression rates. Prior to the pandemic, 8.5% of U.S. adults reported depressive symptoms, which increased to 27.8% during the pandemic, with those facing material hardship nearly three times more likely to experience depression (Briggs et al., 2021; Ettman et al., 2020). Existing research has established a bidirectional relationship between material hardship and mental health, where hardship increases risks for depression; depression, in turn, limits employment opportunities and financial stability, reinforcing material hardship (Allen & Alpass, 2020; Katz et al., 2018; Modini et al., 2016). Although public benefit and entitlement programs have been shown to mitigate economic distress (Maguire-Jack et al., 2022; Shrivastava & Patel, 2023), their effectiveness in reducing depression remains uncertain. This study examined the relationship between material hardship (pre-and-during COVID-19) and depression, along with the role of public benefit and entitlement programs. Such research may better inform intervention strategies.

Methods

This study analyzed data from the Future of Families and Child Wellbeing Study (FFCWS), focusing on primary caregivers who participated in Wave 7 (22 years after wave 1) of the survey. Depression was measured using a composite score based on eight symptom-related questions from the Composite International Diagnostic Interview – Short Form (CIDI-SF), aligning with DSM-IV criteria. Material hardship was assessed separately for pre-COVID, and during-COVID periods Multiple linear regression models were estimated to examine the impact of material hardship on depression incorporating public benefit and entitlement programs (including SNAP, TANF, Social Security benefits, COVID-19 cash support, and unemployment insurance). Data analysis was conducted using R and Stata 18.

Findings

Results revealed that material hardship pre-COVID (β = 0.213, p < .001) and during-COVID (β = 0.091, p < .05) were both significantly associated with higher depression scores among primary caregivers. Primary caregiver (PCG) age (β = -0.016, p < .01), unmarried status (β = 0.044, p < .01), and higher education (β = 0.072, p < .05) were also significantly linked to increased depressive symptoms. While most public benefit variables did not reach statistical significance, their negative coefficients suggest potential protective effects.

Implications and Conclusion

The findings highlight the need for integrated economic and behavioral health interventions to support primary caregivers. Public benefit and entitlement programs should be paired with behavioral health services to address both economic and psychological distress. Younger PCGs may require targeted support, including stable employment opportunities, childcare assistance, and access to counseling. Future research should consider an experimental study to test the impact of public benefit programs on material hardship and their corresponding influence on depression. Additionally, a longitudinal design is needed to address whether material hardship precedes depression and vice versa. In conclusion, material hardship remains a key determinant of depression, both pre-existing and pandemic-related—exerting significant mental health burdens.