A Policy Prescription for Mental Wellness: Evaluating the Impacts of State Health Policy Generosity on the Relationship Between Maternal and Child Mental Health

Abstract

ABSTRACT With nearly one in every eight new mothers experiencing mood or anxiety disorders during pregnancy, maternal mental illness has received increased attention in public health and policy conversations. Though the immediate implications are profound for women’s health, evidence of the diffusive adverse effects on the children of those suffering has been substantiated in research, with a prominent focus on subsequent child behavioral issues. Despite lacking causal evidence, the common justification for this relationship is the belief that mothers struggling with mental illness exemplify negative behaviors that their children see, learn, and emulate. This has led to a plethora of policy intervention strategies targeted at directly addressing maternal mental health, raising concerns regarding the limited scope of this approach and the feasibility of these efforts to “prevent” maternal mental illness. Thus, this study is motivated by the potential of alternative mechanisms of justification and, thus, alternative policy approaches to ameliorate this intergenerational relationship. With the prominent theme throughout the literature of mental illness compromising a mother’s parenting capabilities, this study posits that mentally struggling mothers have less capacity to support, care, and advocate for the needs and outcomes of their children. Under this interpretation, this study explores the notion that policy environments that provide and connect mothers and children to health supports could help relieve the burdens on mothers by helping them meet their children’s basic needs, while also providing children with avenues to external support their mothers cannot provide. This paper thus seeks to evaluate whether the presence and quality of maternal and child-supportive policies can attenuate (or at minimum offset) the relationship between maternal mental illness and adverse child behavioral outcomes. To evaluate the diverse health policy landscapes resulting from the US Federalist regime, I developed a health policy generosity index to assess state-level choices in coverage and accessibility within three basic-needs-meeting health policies: Medicaid, CHIP, and WIC. To assess how discrepancies in state health policy environments affect individual mother-child dyads, I merged geographic identifier data with mental and behavioral health indicators from the core maternal questionnaires of the nationally representative Future of Families and Child Wellbeing Study. I then conducted linear regressions to evaluate the effects of maternal mental illness and state policy generosity on reports of child behavior problems. Though the results do not support the original hypothesis of maternal and child-supportive policy landscapes attenuating the relationship between maternal mental illness and child behavioral problems, they suggest that the benefit to child behavioral outcomes of policy-supportive environments could be enough to offset the effects of maternal mental illness. Children living in the most generous policy environment received 0.42 and 0.48 lower behavior problem scores than children living in the least generous policy environment in the standard and interaction model regressions, respectively. This offset the effects of maternal mental illness, which was associated with a 0.2 higher score on the behavior problem scale, and acted as a steady predictor of child behavior problems across all policy generosity contexts. The findings of this study legitimize the basic conceptual logic of the ability of supportive policy environments to yield better outcomes for children, regardless of the mental health of their mothers. This adds a critical new policy perspective into the current landscape of maternal-targeted interventions, offering a complimentary policy approach to ensure comprehensive support for both members of the mother-child dyad.