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Judith A. Cook, PhD; Lynne O. Mock, PhD; Jessica A. Jonikas, MA; Jane K. Burke-Miller, PhD; Tina M. Carter, BA; Amanda Taylor, MA; Carol A. Petersen, MEd; Dennis D. Grey, BA; David Gruenenfelder, MA

Arch Gen Psychiatry. 2009;66(3):249-258.

Context  In the 1990s, US welfare reform legislation imposed a 5-year lifetime limit on financial support for low-income families with young children (younger than 18 years). With increasing numbers of single mothers and their children reaching the end of their welfare eligibility, there is concern about potentially high rates of untreated psychiatric and substance use disorders in this population.

Objective  To determine the prevalence, correlates, and likelihood of treatment for mental and substance use disorders in a population of urban single mothers receiving Temporary Assistance for Needy Families (TANF).

Design  In-person diagnostic assessments were conducted from November 1, 2003, to October 31, 2004.

Setting  Cook County, Illinois.

Participants  Female TANF recipients and residents of Cook County (N = 333) who were randomly sampled during the final 24 months of their eligibility for TANF.

Main Outcome Measure  Prevalence rates of DSM-IV mental and substance use disorders using the World Health Organization's Composite International Diagnostic Interview.

Results  Lifetime prevalence of Composite International Diagnostic Interview disorders was 61.0% (95% confidence interval [CI], 55.7%-66.3%); 12-month prevalence was 46.8% (41.5%-52.2%). Lifetime prevalence of mental disorders was 53.2% (95% CI, 47.8%-58.5%); 12-month prevalence was 44.1% (38.8%-49.5%). Lifetime prevalence of substance use disorders was 29.1% (95% CI, 23.9%-33.8%); 12-month prevalence was 9.0% (6.8%-12.0%). Lifetime prevalence of comorbid mental/substance use disorders was 21.3% (95% CI, 16.9%-25.7%); 12-month prevalence was 6.3% (3.7%-8.9%). Only 21.7% (95% CI, 14.8%-28.5%) of participants with 12-month mental disorders received treatment for mental disorders; 41.4% (22.3%-60.4%) of participants with 12-month substance abuse disorders received treatment for substance use disorders.

Conclusions  Despite the high prevalence of psychiatric and substance use disorders in this population, many remain untreated. The consequences of terminating welfare assistance are worthy of further investigation, given the potential for adverse effects on both mothers and their young children.

Author Affiliations: Department of Psychiatry (Drs Cook and Burke-Miller, Mss Jonikas and Carter, and Mr Grey) and The Wellness Center (Ms Petersen), University of Illinois at Chicago, and Research Department, Community Mental Health Council (Dr Mock), Chicago, Illinois; Department of Human Development and Family Sciences, Oregon State University, Corvallis (Ms Taylor); and Institute for Legal and Policy Studies, University of Illinois at Springfield (Mr Gruenenfelder).

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