Welfare stigma as a risk factor for major depressive disorder: Evidence from the Supplemental Nutrition Assistance Program

Abstract

Background: Negative public attitude about welfare is known to impair feelings of self-worth and psychological well-being in welfare recipients. What is missing in the extant literature is whether the stress of being on welfare increases the risk for clinically severe depression. To fill this gap, the present study examines the association between participation in the food stamp program and major depressive disorder.

Methods: Study data is drawn from the 2008-2014 waves of the Health and Retirement Study (N = 67076). Depressive symptom is assessed with the Composite International Diagnostic Interview - Short Form, and modeled by a continuous score of major depressive symptoms (0-7) and a binary indicator for three or more symptoms. A fixed effects regression is used to estimate changes in depressive symptoms explained by the food stamp participation, adjusted for confounding covariates.

Results: Food stamp participation was associated with an average of 19% increases in depressive symptoms (p < 0.001) and 29% higher odds of having major depression (p < 0.01). The associations were statistically significant only for men, middle-aged adults, Whites, and those without disability - groups that are more likely to be stigmatized by the social norm for not being able to rise above poverty.

Limitations: Depression outcomes are self-reported. Causality remains not established. The recession during the study periods may have dampened the stigma effects.

Conclusions: Welfare participation is a risk factor for clinical depression in a low-income setting. Depressive symptoms induced by welfare stigma need to be clinically targeted through counseling and cognitive therapy programs.

Keywords: CIDI-SF; Food stamp; Longitudinal analysis; Major depression; Welfare stigma.