Investing in Wellbeing: Three Studies on Public Benefits, Family Processes, and Mental Health in the US

Abstract

My dissertation includes three studies that examine whether public benefits affect the mental health of parents and kids. The first two studies evaluate whether the Community Eligibility Provision—which expands access to free school breakfast and lunch—affects family processes, child behavioral outcomes, parent mental distress, and child mental health diagnoses. The third study evaluates whether Washington's Paid Family and Medical Leave Program affects depression and anxiety among mothers following the birth of a child. All three studies shed light on whether U.S. social safety net programs affect mental health outcomes. In Chapter I, I investigate whether expansions in access to free school meals affect measures of child and parent wellbeing. The Community Eligibility Provision (CEP) is a federal policy passed in 2010 allowing US schools and districts serving a high proportion of low-income families to provide free breakfast and lunch to all students. Eligible schools that opt into the CEP must provide free meals to all students at the school and stop tracking student-level free meal eligibility. Beyond the direct effects of the CEP on child food security, the policy may act as an in-kind transfer to families, and, in doing so, affect both parent and child wellbeing. Using the Early Childhood Longitudinal Study, Kindergarten Class of 2010–11 (N=4,400) and a difference-in-differences design, this study estimated the effect of CEP exposure on measures of parent wellbeing, investments in children, and child behavioral outcomes among a national cohort of families whose children attended CEP-eligible elementary schools during school years 2010-11 through 2015-16. Overall, I found null effects of CEP exposure on these outcomes, although CEP exposure was associated with a small increase in parent mental distress for higher-income families in the sample. Coupled with the existing CEP literature, results highlight the potential for universal free school meal programs to occupy a unique place in the social safety net, complementing other policies by supporting child nutrition at school with modest impacts on household budgets. In Chapter II, I investigate whether expansions in free school meals via the CEP affect child mental health diagnoses. The diagnostic prevalence of ADHD, anxiety, and depression diagnoses among K-12 students in the U.S. has increased over recent decades, exposing mental health challenges faced by children and youth. As a result, supporting child mental wellbeing is increasingly a priority for public health agencies, schools, and policy makers. Despite evidence that income instability and low socioeconomic status negatively influence child mental health, little research assesses whether U.S. food assistance programs—which provide meals and food subsidies to low-income families—affect the symptoms or diagnosis of child mental health conditions. I evaluate whether implementing universal free school meals impacts the likelihood of child ADHD, anxiety, and depression diagnoses among a population of children visiting Federally Qualified Health Centers. My identification strategy leverages the rollout of the Community Eligibility Provision using a difference-in-differences design which allows for staggered policy adoption. Results indicate that CEP exposure is associated with a 3.3% (0.34 percentage point) decrease in the likelihood of ADHD diagnosis, not associated with anxiety diagnosis, and associated with a 9.0% (0.27 percentage point) decrease in the likelihood of depression diagnosis for male students. In Chapter III, I investigate whether paid family leave affects the likelihood of new mothers being treated for depression or anxiety following the birth of a child. Research indicates that when workers have paid time off to care for themselves and others, they have more stable economic circumstances and improved physical health. However, less is known about the effect of access to paid leave on mental health, particularly among parents using leave around a birth. Building on the existing paid leave literature, I evaluate the impact of paid family leave on the likelihood of parents receiving care for depression and anxiety in the quarter following childbirth. My study leverages a quasi-random feature of Washington's Paid Family and Medical Leave eligibility rules—the work-hour eligibility threshold— using regression discontinuity designs to estimate the policy's impact on the likelihood of parents submitting depression and anxiety-related insurance claims. My dataset links paid leave administrative data from Washington with medical insurance claims from the WA All Payer Claims Database. Results suggest that access to Washington's Paid Family and Medical Leave program reduces the likelihood of mothers submitting medical claims related to depression by approximately 26.5%, with larger impacts among leave users. I find no discernable impact on insurance claims related to anxiety. This study is the first in the U.S. to evaluate paid leave's impact on measures of mental health care or diagnosis and speaks directly to the efficacy of state paid leave programs at supporting the wellbeing of working parents. All three studies speak to social policy's effect on parent and child mental health. My research questions address the efficacy of social safety net programs at supporting the health and wellbeing of working families, while adding to our understanding of how investments in families might produce economic benefits over the medium or long term. To motivate my research questions and analyses, I draw on concepts from fields including child development, social epidemiology, demography, and labor economics. I use novel data sources including administrative data, insurance claims, and electronic medical records coupled with causal inference methods. I apply an interdisciplinary perspective to this work in order to motivate causally focused research on how public benefits affect parents, children, and interaction within families, with the goal of producing rigorous social science that speaks to current policy debates.