Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The Mental Health Benefits of Work: Do They Apply to Welfare Mothers with a Drinking Problem?


A longstanding tradition of employment-related research has shown the mental health advantages of employment. However, given welfare reform mandates for employment and a welfare population with disproportionately high rates of depression and co-occurring substance abuse problems, it is unclear if women on welfare reap this advantage. This analysis draws on 4 years of data from the Welfare Client Longitudinal Study to examine the mental health benefits of employment among women on welfare (N = 419) and to assess whether drinking problems alter the relationship. Repeated measures analyses suggest that women who enter welfare with a drinking problem may not experience the same decline in depression symptoms following employment. Improving the connections between welfare and treatment services for women with alcohol problems may, however, have important implications for their mental health.

This is a preview of subscription content, log in to check access.

Figure 1


  1. 1.

    Gore S, Mangione TW. Social roles, sex roles and psychological distress: additive and interactive models of sex differences. Journal of Health and Social Behavior. 1983;24(4):300–312.

  2. 2.

    Kessler RC, McRae J, James A. The effect of wives’ employment on the mental health of married men and women. American Sociological Review. 1982;47(2):216–227.

  3. 3.

    Matthews S, Power C. Socio-economic gradients in psychological distress: a focus on women, social roles and work–home characteristics. Social Science and Medicine. 2002;54:799–810.

  4. 4.

    Ross CE, Mirowsky J. Does employment affect health. Journal of Health and Social Behavior. 1995;36:230–243.

  5. 5.

    Dooley D, Fielding J, Levi L. Health and unemployment. Annual Review of Public Health. 1996;17:449–465.

  6. 6.

    DeParle J. American Dream: Three Women, Ten Kids, and a Nation's Drive to End Welfare. New York: Penguin Group; 2004.

  7. 7.

    Blank RM, Haskins R. The New World of Welfare. Washington, DC: Brookings Institution Press; 2001.

  8. 8.

    Schmidt L, Zabkiewicz D, Henderson S, Wiley J, Jacobs L. On the declining health and well being of the welfare population: emerging dilemmas in serving the poor. Journal of Health and Social Policy. 2008;(in press).

  9. 9.

    Speiglman R, Dasinger LK, Norris JC. Alameda County CalWORKS needs assessment and outcomes study: the prevalence and impact of physical, mental, and behavioral health barriers on work and welfare outcomes over 27 months. Berkeley: Public Health Institute; June 23, 2003. Report #6.

  10. 10.

    Zedlewski S. Work and Barriers to Work Among Welfare Recipients in 2002. Washington, DC: The Urban Institute; 2003.

  11. 11.

    Moffitt R, Cherlin A. Disadvantage Among Families Remaining on Welfare. Chicago: Joint Center for Poverty Research; 2002 February.

  12. 12.

    Kessler R, House J, Turner B. Unemployment and health in a community sample. Journal of Health and Social Behavior. 1987;28(1):51–59.

  13. 13.

    Warr P, Jackson P. Factors influencing the psychological impact of prolonged unemployment and of re-employment. Psychological Medicine. 1985;15:795–807.

  14. 14.

    Aneshensel CS, Frerichs RR, Clark VA. Family roles and sex differences in depression. Journal of Health and Social Behavior. 1981;22:379–393.

  15. 15.

    Graetz B. Health consequences of employment and unemployment: longitudinal evidence for young men and women. Social Science and Medicine. 1993;36(6):715–724.

  16. 16.

    Claussen B, Bjorndal A, Hjort PF. Health and re-employment in a two year follow up of long term unemployed. Journal of Epidemiology and Community Health. 1993;47:14–18.

  17. 17.

    Claussen B. Health and re-employment in a five-year follow-up of long-term unemployed. Scandinavian Journal of Public Health. 1999;2:94–100.

  18. 18.

    Kessler R, Turner B, House J. Unemployment, reemployment, and emotional functioning in a community sample. American Sociological Review. 1989;54(4):648–657.

  19. 19.

    Wanberg C. Antecedents and outcomes of coping behaviors among unemployed and reemployed individuals. Journal of Applied Psychology. 1997;82(5):731–744.

  20. 20.

    Kessler RC, Turner JB, House JS. Effects of unemployment on health in a community survey: main, modifying, and mediating effects. Journal of Social Issues. 1988;44(4):69–85.

  21. 21.

    Edin K, Lein L. Making Ends Meet: How Single Mother Survive Welfare and Low-wage Work. New York, NY: Russell Sage Foundation; 1997.

  22. 22.

    Wilson WJ. When Work Disappears. New York: Alfred A. Knopf; 1996.

  23. 23.

    Lennon MC, Rosenfield S. Women and mental health: the interaction of job and family conditions. Journal of Health and Social Behavior. 1992;33:316–327.

  24. 24.

    Cleary PD, Mechanic D. Sex differences in psychological distress among married people. Journal of Health and Social Behavior. 1983;24(2):111–121.

  25. 25.

    Gyamfi P, Brooks-Gunn J, Jackson A. Associations between employment and financial and parental stress in low-income single black mothers. Women and Health. 2001;32(1–2):119–135.

  26. 26.

    Danziger SK, Carlson MJ, Henly JR. Post-welfare employment and psychological well-being. Women and Health. 2001;32(1–2):47–78.

  27. 27.

    Ali J, Avison WR. Employment transitions and psychological distress: the contrasting experiences of single and married mothers. Journal of Health and Social Behavior. 1997;38(4):345–362.

  28. 28.

    Baker D, North K, Team AS. Does employment improve the health of lone mothers? Social Science and Medicine. 1999;49:121–131.

  29. 29.

    Artazcoz L, Borrell C, Benach J, Cortes I, Rohlfs I. Women, family demands and health: the importance of employment status and socio-economic position. Social Science and Medicine. 2004;59:263–274.

  30. 30.

    Artazcoz L, Borrell C, Benach J. Gender inequalities in health among workers: the relation with family demands. Journal of Epidemiology and Community Health. 2001;55:639–647.

  31. 31.

    Kandel DB, Davies M, Raveis VH. The stressfulness of daily social roles for women: marital, occupational and household roles. Journal of Health and Social Behavior. 1985;26:64–78.

  32. 32.

    Ross C, Mirowsky J. Child care and emotional adjustment to wives’ employment. Journal of Health and Social Behavior. 1988;29:127–138.

  33. 33.

    Ross CE, Mirowsky J, Goldsteen K. The impact of the family on health: the decade in review. Journal of Marriage and the Family. 1990;52(4):1059–1078.

  34. 34.

    Marchand A, Demers A, Durand P, Simard M. Occupational variations in drinking and psychological distress: a multilevel analysis. Work. 2003;21:153–163.

  35. 35.

    Marchand A, Demers A, Durand P, Simard M. The moderating effect of alcohol intake on the relationship between work strains and psychological distress. Journal of Studies on Alcohol. 2003;64:419–427.

  36. 36.

    Brown GW, Harris T. Social Origins of Depression: A Study of Psychiatric Disorder in Women. New York: The Free Press; 1978.

  37. 37.

    Lennon MC, Blome J, English K. Depression and low-income women: challenges for TANF and welfare-to-work policies and programs: National Center for Children in Poverty, Mailman School of Public Health, Columbia University; March 2001.

  38. 38.

    Riolo SA, Nguyen TA, Greden JF, King CA. Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III. American Journal of Public Health. 2005;95(6):998–1000.

  39. 39.

    Bassuk EL, Buckner JC, Perloff JN, Bassuk SS. Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. American Journal of Psychiatry. 1998;155(11):1561–1564.

  40. 40.

    Callahan SR. Understanding Health-Status Barriers That Hinder the Transition from Welfare to Work. Washington, DC: National Governors’ Association; 1999.

  41. 41.

    Rosen D, Spencer MS, Tolman R, Williams D, Jackson JS. Psychiatric disorders and substance dependence among unmarried low-income mothers. Health and Social Work. 2003;28(2):157–165.

  42. 42.

    Zaslow MJ, Hair EC, Dion MR, Ahluwalia SK, Sargent J. Maternal depressive symptoms and low literacy as potential barriers to employment in a sample of families receiving welfare: are there two-generational implications? In: Lennon MC, ed. Welfare, Work, and Well-Being. New York: The Haworth Medical Press; 2001:211–251.

  43. 43.

    CalWORKS Project. Mental Health, Domestic Violence and Substance Abuse: Need for and Use of Services Among Adult Female TANF Participants. Sacramento: California Institute for Mental Health; 2002 April. 1.

  44. 44.

    Siefert K, Bowman PJ, Heflin CM, Danziger S, Williams DR. Social and environmental predictors of maternal depression in current and recent welfare recipients. American Journal of Orthopsychiatry. 2000;70(4):510–522.

  45. 45.

    Danziger S, Kalil A, Anderson NJ. Human capital, health and mental health of welfare recipients: co-occurrence and correlates. Journal of Social Issues. 2000;54(4):637–656.

  46. 46.

    Danziger S, Corcoran M, Danziger SH, et al. Barriers to the employment of welfare recipients. In: Cherry R, Rodgers III WM, eds. Prosperity for All? The Economic Boom and African Americans. New York: Russell Sage Foundation; 2000:245–278.

  47. 47.

    Department of Health and Human Services. Substance Use and Mental Health Characteristics by Employment Status. Rockville, MD: Department of Human and Health Services—Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 1999 June.

  48. 48.

    Jayakody R, Danziger S, Pollack H. Welfare reform, substance use and mental health. Journal of Health Politics, Policy and Law. 2000;25(4):623–652 (August).

  49. 49.

    Jayakody R, Stauffer D. Mental health problems among single mothers: implications for work and welfare reform. Journal of Social Issues. 2000;56:617–634.

  50. 50.

    Schmidt L, McCarty D. Welfare reform and the changing landscape of substance abuse services for low-income women. Alcoholism: Clinical and Experimental Research. 2000;24(8):1298–1311.

  51. 51.

    Speiglman R, Fugiwara L, Norris J, Green RS. Alameda County CalWORKs Needs Assessment: A Look at Potential Health-related Barriers to Self-sufficiency. Berkeley, CA: Social Services Agency and Department of Behavioral Health Care Services, County of Alameda; 1999 August 30.

  52. 52.

    Green RS, Fujiwara L, Norris J, Kappagoda S, Driscoll A, Speiglman R. Barriers to Working and Summaries of Baseline Status. Berkeley: Public Health Institute; 2000 February 10.

  53. 53.

    Metsch LR, McCoy CB, Miller M, McAnany H, Pereyra M. Moving substance-abusing women from welfare to work. Journal of Public Health Policy. 1999;2(1):36–55.

  54. 54.

    Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction. 2003;98:1209–1228.

  55. 55.

    Kessler RC, Nelson CB, McGonagle KA, Edlund MJ, Frank RG, Leaf PJ. The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilization. American Journal of Orthopsychiatry. 1996;66(1):17–31 January.

  56. 56.

    Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions. Alcohol Research and Health. 2006;29(2):107–120.

  57. 57.

    Caetano R. Alcohol use and depression among U.S. Hispanics. Addiction. 1987;82(11):1245.

  58. 58.

    Lipton RI. The effect of moderate alcohol use on the relationship between stress and depression. American Journal of Public Health. 1994;84(12):1913–1917.

  59. 59.

    Lipton R. The relationship between alcohol, stress, and depression in Mexican Americans and non-Hispanic Whites. Behavioral Medicine. 1997;23(3):101–112.

  60. 60.

    Pavetti LA, Bloom D. Sanctions and time limits: state policies, their implementation and outcomes for families. Paper presented at: The New World of Welfare: Shaping a Post-TANF Agenda for Policy; February, 2001; Washington, D.C.

  61. 61.

    Zedlewski S, Loprest P. Will TANF work for the most disadvantaged families? In: Blank R, Haskins R, eds. The New World of Welfare. Washington, DC: Brookings Institution Press; 2001:311–334.

  62. 62.

    CalWORKS Project Research. Alcohol and Other Drugs, Mental Health, and Domestic Violence Issues: Need, Incidence, and Services. Sacramento: California Institute for Mental Health; 2002 February.

  63. 63.

    Zabkiewicz D, Schmidt L. Patterns of welfare receipt: the role of substance abuse and depression. Paper presented at: American Public Health Association 129th Annual Meeting; October, 2001; Atlanta, GA.

  64. 64.

    Zabkiewicz D, Schmidt LA. Behavioral health problems as barriers to work: results from a 6-year panel study of welfare recipients. Journal of Behavioral Health Services and Research. 2007;34(2):168–185 March.

  65. 65.

    Odierna D. Learning to see the invisible: marginalization, attrition, and health disparities in a study of welfare and substance use. A School of Public Health Dissertation. 2006:211, University of California, Berkeley.

  66. 66.

    Odierna DH, Schmidt LA. Lost and found: on the effects of failure to include hard-to-reach respondents in public health research. American Journal of Public Health. 2008;(in press).

  67. 67.

    Derogatis LR. The Brief Symptom Inventory (BSI) Administration, Scoring and Procedures Manual-II. Towson, MD: Clinical Psychometric Research, Inc.; 1992.

  68. 68.

    Morlan KK, Tan S-Y. Comparison of the brief psychiatric rating scale and the brief symptom inventory. Journal of Clinical Psychology. 1998;547(7):885–894.

  69. 69.

    Derogatis LR, Cleary P. Confirmation of the dimensional structure of the SCL-90: a study in construct validation. Journal of Clinical Psychology. 1977;33(4):981–989.

  70. 70.

    Broday S, Mason J. Internal consistency of the brief symptom inventory for counseling-center clients. Psychological Reports. 1991;68:94.

  71. 71.

    Moffitt RA, Cherlin AJ, Burton L, King M, Roff J. The Characteristics of Families Remaining on Welfare. Baltimore, MD: Johns Hopkins University and Pennsylvania State University; 2002 February.

  72. 72.

    Dooley D, Catalano R, Wilson G. Depression and unemployment: panel findings from the epidemiologic catchment area study. American Journal of Community Psychology. 1994;22(6):745–765.

  73. 73.

    Saarijarvi S, Salminen JK, Toikka TB. Alexithymia and depression: a 1-year follow-up study in outpatients with major depression. Journal of Psychosomatic Research. 2001;51:729–733.

  74. 74.

    Hale D, Cochran C. Age differences in self-reported symptoms of psychological distress. Journal of Clinical Psychology. 1992;48(5):633–637.

  75. 75.

    Acosta F, Nguyen L, Yamamoto J. Using the Brief Symptom Inventory to profile monolingual Spanish speaking psychiatric outpatients. Journal of Clinical Psychology. 1994;50(5):723–726.

  76. 76.

    Ahluwalia SK, McGroder SM, Zaslow MJ, Hair EC. Symptoms of Depression Among Welfare Recipients: A Concern for Two Generations. Washington, DC: Child Trends; 2001 December.

  77. 77.

    Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients. Journal of American Medical Association. 1989;262(7):914–919.

  78. 78.

    Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. Journal of the American Medical Association. 1990;264(19):2524–2528.

  79. 79.

    Weisner C, Schmidt L. Alcohol and drug problems among diverse health and social service populations. American Journal of Public Health. 1993;83(6):824–829.

  80. 80.

    Weisner C, Schmidt L. The community epidemiology laboratory: studying alcohol problems in community and agency-based populations. Addiction. 1995;90:329–342.

  81. 81.

    Clark W, Hilton M, eds. Alcohol in America: Drinking Practices and Problems in a National Survey. New York, NY: State University of New York Press; 1991.

  82. 82.

    Wilsnack SC, Klassen AD, Schur BE, Wilsnack RW. Predicting onset and chronicity of women's problem drinking: a five-year longitudinal analysis. American Journal of Public Health. 1991;81(3):305–318.

  83. 83.

    Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the national comorbidity survey replications (NCS-R). Journal of the American Medical Association. 2003;289(23):3095–3105.

  84. 84.

    Guelzow MG, Bird GW, Koball EH. An exploratory path analysis of the stress process for dual-career men and women. Journal of Marriage and the Family. 1991;53(1):151–164.

  85. 85.

    Allen TD, Herst DE, Bruck CS, Sutton M. Consequences associated with work-to-family conflict: a review and agenda for future research. Journal of Occupational Health Psychology. 2000;5(2):278–308.

  86. 86.

    Jackson AP. Effects of concerns about child care among single, employed black mothers with preschool children. American Journal of Community Psychology. 1997;25(5):657–673.

  87. 87.

    Atkinson JS, Montoya ID, Trevino RA, Richard AJ. Labor force participation in a sample of substance users. American Journal of Drug and Alcohol Abuse. 2000;26(3):355–367.

  88. 88.

    Montoya ID, Bell DC, Atkinson JS, Nagy CW, Whitsett DD. Mental health, drug use, and the transition from welfare to work. The Journal of Behavioral Health Services and Research. 2002;29(2):144–156 May.

  89. 89.

    Montoya ID, Brown VL. The association between EIC receipt and employment in a sample of drug using and non-drug using TANF recipients. The American Journal of Drug and Alcohol Abuse. 2006;32:189–201.

  90. 90.

    Montoya ID, Atkinson JS, Struse HM. A comparison of psychosocial barriers among welfare recipients: implications for drug treatment. Substance Use and Misuse. 2001;36(6 and 7):771–788.

  91. 91.

    Leshner AI. Drug abuse and mental disorders: comorbidity is reality. NIDA Notes. 1999;14(4).

  92. 92.

    Henderson S, Dohan D, Schmidt L. Barriers to identifying substance abuse in the reformed welfare system. Social Service Review. 2006;80(2):217–238 June.

  93. 93.

    Zivot M, Jacobs L. Welfare Client Longitudinal Study: Demographic Changes in Our Study County, 1989–2001. Berkeley: Alcohol Research Group; 2004 March.

  94. 94.

    Jacobs L, Schmidt L, Wiley J. The welfare system's new response to addiction and mental illness. San Francisco: Paper presented at The American Public Health Association 131st Annual Meeting; November 15–19 2003.

Download references

Author information

Correspondence to Denise Zabkiewicz PhD, MPH.

Additional information

This study was made possible by grants from the U.S. National Institutes on Health, National Institute on Alcohol Abuse and Alcoholism to the Alcohol Research Group, Public Health Institute, including: Center Grant (AA-05595), R01 Project Grant (AA-10015), R21 Grant for Secondary Analysis of Existing Health Services Data (AA-12159) and T32 Training Grant (AA-007240). A previous version of this paper was presented at the Addiction Health Services Research (AHSR) Conference, “Understanding the Community Perspective,” Little Rock, AR, October 23–25, 2006.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Zabkiewicz, D., Schmidt, L.A. The Mental Health Benefits of Work: Do They Apply to Welfare Mothers with a Drinking Problem?. J Behav Health Serv Res 36, 96–110 (2009). https://doi.org/10.1007/s11414-008-9148-9

Download citation


  • mental health
  • depression
  • welfare
  • employment
  • alcohol problems
  • problem drinking