Mothers’ Mental Health Challenges Predated COVID-19, Medicaid Policy and Other Solutions Needed, Report Finds

American families with children faced significant challenges during the pandemic due to school closures, lost jobs and isolation, and mothers reported higher rates of anxiety than fathers as they took on more caregiving responsibilities or even left their paid jobs. A full 50 percent of women ages 18 to 64 reported needing mental health services in the past two years, compared with 35 percent of men.

New research from the Urban Institute finds that the pandemic-related stresses came on top of an already challenging mental health landscape where many mothers with symptoms of depression and anxiety could not access counseling or treatment. The rates of moderate to severe anxiety and depression were more prevalent among mothers enrolled in Medicaid and CHIP coverage compared to mothers with employer-based coverage, yet both groups struggled to access care. The authors based their findings on data from the 2019 National Health Interview Survey.

Among the top findings:

  • “In 2019, 13.5 percent of mothers ages 19 to 64, or about 4.9 million mothers, reported symptoms of moderate or severe anxiety, and 4.8 percent, or about 1.7 million mothers, reported symptoms of moderate or severe depression. About 1.2 million mothers experienced both moderate or severe anxiety and moderate or severe depression.
  • Prevalence of anxiety and depression among mothers varied by age, income, and other demographic and socioeconomic characteristics, with younger mothers having much higher rates of anxiety than older mothers, and mothers with lower incomes having higher rates of both anxiety and depression than mothers with higher incomes.
  • Mothers with Medicaid or Children’s Health Insurance Program (CHIP) coverage had about twice the rate of moderate or severe anxiety (21.0 percent) compared with mothers with employer coverage (10.5 percent), and the rate of moderate or severe depression among mothers with Medicaid/CHIP was more than three times higher than that for mothers with employer coverage (8.1 versus 2.5 percent).
  • Almost two-thirds of mothers with moderate or severe anxiety or depression had not received counseling or therapy from a mental health professional in the past 12 months, and 23.0 percent, or 1.2 million mothers, reported an unmet need for counseling or therapy due to cost in the past 12 months. An estimated 69.6 percent of mothers with Medicaid/CHIP and 61.4 percent of mothers with employer coverage did not receive counseling or therapy from a mental health professional, and about 20 percent of mothers in both groups reported unmet needs for counseling or therapy.”

The authors also make the important connection between mothers’ mental health and their children’s mental health. As my colleagues shared in Say Ahhh! last year, several leading children’s health experts, including the American Academy of Pediatrics, declared a national state of emergency in children’s mental health in 2021, citing “…soaring rates of mental health challenges among children, adolescents, and their families over the course of the COVID-19 pandemic, exacerbating the situation that existed prior to the pandemic.”

These mental health challenges for mothers and children predate the pandemic, and almost certainly got worse as mothers shouldered a disproportionate amount of caregiving responsibility for their children, who also faced grief from losing family members and disruptions in learning. And as the pandemic has progressed, new threats to women’s health have emerged, including the Supreme Court’s decision in Dobbs, which allows states to restrict access to abortion. The nation’s maternal mortality rate also continued to increase during the COVID-19 pandemic for all women, and Black women remain nearly three times as likely to die from complications related to pregnancy and childbirth than their White peers.

Taken together, these findings call out for significant attention from policymakers, particularly as the nation prepares for the end of the COVID-19 continuous coverage protection in April 2023 and millions of people–including mothers–may be at risk of losing their coverage. To make systemic change, the authors recommend implementing a broad array of policy changes that target not only coverage rates but also regulations and other characteristics of the health care delivery system.

These include increasing routine mental health screening and mental health care providers, improving network adequacy standards, increasing provider payment rates, ensuring adequate covered benefits and cost-sharing policies, and enforcing mental health parity regulations, and specifically boosting access to mental health care in Medicaid and CHIP.  They also point to larger social policy changes, such as paid family leave, increases in minimum wage and other structural changes that would help relieve some financial burdens on low-income young mothers, who are more likely to experience moderate to severe depression and anxiety.

Policymakers have made some progress in prioritizing maternal and child mental health, including the passage of several provisions in the Consolidated Appropriations Act, 2023 that begin to invest in increased screening, expanded access to treatment, and coordination among federal and state governments to address maternal mental health needs. Congress also made permanent the option to extend 12 months of postpartum coverage in Medicaid, which will help more new mothers access mental health care. These report findings make it clear that it will take sustained, multifaceted effort from all levels to better support the mental health needs of mothers and their children so they can thrive.

Maggie Clark is a former staff member at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.