Mental Illness as a Risk Factor for Uninsurance Among Mothers of Infants

  • Kelly NoonanEmail author
  • Anne Carroll
  • Nancy E. Reichman
  • Hope Corman


The objective of this study was to assess the extent to which maternal prenatal mental illness is associated with mothers’ health insurance status 12–18 months after giving birth. The sample consisted of 2,956 urban, mostly unwed, mothers who gave birth in 20 large U.S. cities between 1998 and 2000 and participated in the Fragile Families and Child Wellbeing birth cohort study. Multinomial logistic regression models were used to assess associations between maternal prenatal mental illness and whether the mother had private, public, or no insurance one year after the birth. Covariates included the mother’s and child’s physical health status, the father’s physical and mental health status, and numerous other maternal, paternal, and family characteristics. Potential mediating factors were explored. The results showed that mothers with prenatal diagnosed mental illness were almost half as likely as those without mental illness diagnoses to have private insurance (vs. no insurance) one year after the birth. Among mothers who did not have a subsequent pregnancy, those with prenatal mental illness were less likely than those without mental illness diagnoses to have public insurance than to be uninsured. Screening positive for depression or anxiety at one year decreased the likelihood that the mother had either type of insurance. Policies to improve private mental health care coverage and public mental health services among mothers with young children may yield both private and social benefits. Encounters with the health care and social service systems experienced by pregnant and postpartum women present opportunities for connecting mothers to needed mental health services and facilitating their maintenance of health insurance.


Health insurance Mental illness Maternal health Infant health Medicaid 



This research was supported by grants #R01-HD-45630 and #R01-HD-35301 from the National Institute of Child Health and Human Development.


  1. 1.
    Hadley, J. (2002). Sicker and poorer: The consequences of being uninsured. Medical Care Research and Review, 60, 3S–75S. doi: 10.1177/1077558703254101.CrossRefGoogle Scholar
  2. 2.
    Kasper, J. D., Giovanni, T. A., & Hoffman, C. (2000). Gaining and losing health insurance: Strengthening the evidence on access to care and health outcomes. Medical Care Research and Review, 57, 298–318. doi: 10.1177/107755870005700302.CrossRefPubMedGoogle Scholar
  3. 3.
    Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A., & Zaslavsky, A. M. (2000). Unmet health needs of uninsured adults in the United States. Journal of the American Medical Association, 284, 2061–2069. doi: 10.1001/jama.284.16.2061.CrossRefPubMedGoogle Scholar
  4. 4.
    Newacheck, P. W., Stoddard, J. J., Hughes, D. C., & Pearl, M. (1998). Health insurance and access to primary care for children. The New England Journal of Medicine, 338, 513–519. doi: 10.1056/NEJM199802193380806.CrossRefPubMedGoogle Scholar
  5. 5.
    Currie, J., & Gruber, J. (1996). Health insurance eligibility, utilization of medical care, and child health. The Quarterly Journal of Economics, 111, 431–466. doi: 10.2307/2946684.CrossRefGoogle Scholar
  6. 6.
    Busch, S. H., & Duchovny, N. (2005). Family coverage expansions, impact on insurance coverage and health care utilization of parents. Journal of Health Economics, 24, 876–890. doi: 10.1016/j.jhealeco.2005.03.007.CrossRefPubMedGoogle Scholar
  7. 7.
    Olson, L. M., Tang, S. S., & Newacheck, P. (2005). Children in the United States with discontinuous health insurance coverage. The New England Journal of Medicine, 353, 382–391. doi: 10.1056/NEJMsa043878.CrossRefPubMedGoogle Scholar
  8. 8.
    Aiken, K. D., Freed, G. L., & Davis, M. M. (2004). When insurance status is not static: Insurance transitions of low-income children and implications for health and health care. Ambulatory Pediatrics, 4, 237–243. doi: 10.1367/A03-103R.1.CrossRefPubMedGoogle Scholar
  9. 9.
    Levy, H., & Meltzer, D. (2001). What do we really know about whether health insurance affects health? Ann Arbor, MI: Economic Research Initiative on the Unisured, EIRU Working Paper 6.Google Scholar
  10. 10.
    Lyons-Ruth, K., Wolfe, R., Lyubchik, A., & Steingard, R. (2000). Depressive symptoms in parents of children under age 3: Sociodemographic predictors, current correlates, and associated parenting behaviors. In N. Halfon, K. McLeam & M. Schuster (Eds.), Child rearing in America; Challenges facing parents with young children (pp. 217–259). Cambridge, England: Cambridge University Press.Google Scholar
  11. 11.
    Miranda, J., & Green, B. L. (1999). The need for mental health services research focusing on poor young women. The Journal of Mental Health Policy and Economics, 2, 73–80. doi:10.1002/(SICI)1099-176X(199906)2:2<73::AID-MHP40>3.0.CO;2-3.CrossRefPubMedGoogle Scholar
  12. 12.
    Jayakody, R., Danziger, S., & Pollack, H. A. (2000). Welfare reform, substance use and mental health. Journal of Health Politics, Policy and Law, 25, 623–651. doi: 10.1215/03616878-25-4-623.CrossRefPubMedGoogle Scholar
  13. 13.
    Teitler, J., Reichman, N. E., & Nepomnyaschy, L. (2004). Sources of support, child care, and hardship among unwed mothers, 1999–2001. Social Service Review, 78, 125–148. doi: 10.1086/380770.CrossRefGoogle Scholar
  14. 14.
    DeKlyen, M., Brooks-Gunn, J., McLanahan, S., & Knab, J. (2006). The mental health of married, cohabiting, and non-coresident parents with infants. American Journal of Public Health, 96, 1836–1841. doi: 10.2105/AJPH.2004.049296.CrossRefPubMedGoogle Scholar
  15. 15.
    Dawson, G., Ashman, S., Panagiotides, H., Hessl, D., Self, J., Yamada, E., et al. (2003). Preschool outcomes of children of depressed mothers: Role of maternal behavior, contextual risk, and children’s brain activity. Child Development, 74, 1158–1175. doi: 10.1111/1467-8624.00599.CrossRefPubMedGoogle Scholar
  16. 16.
    McLearn, K. T., Minkovitz, C. S., Strobino, D. M., Marks, E., & Hou, W. (2006). Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Archives of Pediatrics and Adolescent Medicine, 160, 279–284. doi: 10.1001/archpedi.160.3.279.CrossRefPubMedGoogle Scholar
  17. 17.
    Perry, C. (2008). Does treating maternal depression improve child health management? The case of pediatric asthma. Journal of Health Economics, 27, 157–173. doi: 10.1016/j.jhealeco.2007.03.005.CrossRefPubMedGoogle Scholar
  18. 18.
    Druss, B. G., & Rosencheck, R. A. (1998). Mental disorders and access to medical care in the United States. The American Journal of Psychiatry, 155, 1775–1777.PubMedGoogle Scholar
  19. 19.
    Blumberg, L. J., & Nichols, L. M. (2001). The health status of workers who decline employer-sponsored coverage. Health Affairs, 20, 180–187. doi: 10.1377/hlthaff.20.6.180.CrossRefPubMedGoogle Scholar
  20. 20.
    Emptage, N., Sturm, R., & Robinson, R. (2005). Depression and comorbid pain as predictors of disability, employment, insurance status, and health. Psychiatric Services (Washington, D.C.), 56, 468–474. doi: 10.1176/ Scholar
  21. 21.
    Masaquel, A., & Ettner, S. (2005). How does the persistence of depression influence the continuity, type and generosity of health insurance coverage? Economic research initiative on the uninsured. Ann Arbor: University of Michigan.Google Scholar
  22. 22.
    Private Health Insurance. (2002). Access to Individual Market Coverage May be Restricted for Applicants with Mental Disorders. Washington, DC: United States General Accounting Office, GAO-02-339.Google Scholar
  23. 23.
    Harris, K. M., Carpenter, C., & Bao, Y. (2006). The effects of state parity laws on the use of mental health care. Medical Care, 44, 449–505. doi: 10.1097/01.mlr.0000215813.16211.00.CrossRefGoogle Scholar
  24. 24.
    Reichman, N. E., Teitler, J. O., Garfinkel, I., & McLanahan, S. (2001). Fragile families: Sample and design. Children and Youth Services Review, 23, 303–326. doi: 10.1016/S0190-7409(01)00141-4.CrossRefGoogle Scholar
  25. 25.
    Carroll, A., Corman, H., Noonan, K., & Reichman, N. E. (2007). Why do poor children lose health insurance in the SCHIP era? The role of family health. American Economic Review Papers and Proceedings, 97, 398–401.Google Scholar
  26. 26.
    Mirwosky, J., & Ross, C. (2001). Age and the effect of economic hardship on depression. Journal of Health and Social Behavior, 42, 132–150. doi: 10.2307/3090174.CrossRefGoogle Scholar
  27. 27.
    Kessler, R., Andrews, G., Mroczek, D., Ustun, T., & Wittchen, H. (1998). The World Health Organization composite international diagnostic interview short-form (CIDI-SF). International Journal of Methods in Psychiatric Research, 7, 171–185. doi: 10.1002/mpr.47.CrossRefGoogle Scholar
  28. 28.
    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4 ed.). Washington, DC: American Psychiatric Association.Google Scholar
  29. 29.
    Barry, C. L., Gabel, J. R., Frank, R. G., Hawkins, S., Whitmore, H. H., & Pickreign, J. D. (2003). Design of mental health benefits: Still unequal after all these years. Health Affairs, 22, 127–137. doi: 10.1377/hlthaff.22.5.127.CrossRefPubMedGoogle Scholar
  30. 30.
    Zuvekas, S. H., & Meyerhoefer, C. D. (2006). Coverage for mental health treatment: Do the gaps still persist? The Journal of Mental Health Policy and Economics, 9, 155–163.PubMedGoogle Scholar
  31. 31.
    Rowland, D., Garfield, R., & Elias, R. (2003). Accomplishments and challenges in Medicaid mental health. Health Affairs, 22, 78–83.Google Scholar
  32. 32.
    Feinberg, E., Swartz, K., Zaslavsky, A., Gardner, J., & Walker, D. (2002). Language proficiency and the enrollment of Medicaid-eligible children in publicly funded health insurance programs. Maternal and Child Health Journal, 6, 5–18. doi: 10.1023/A:1014308031534.CrossRefPubMedGoogle Scholar
  33. 33.
    Medicaid and SCHIP Eligibility for Immigrants. (2006). Kaiser Commission on Medicaid and the Uninsured. Accessed September 21, 2008 at
  34. 34.
    Ettner, S. L., Frank, R. G., & Kessler, R. C. (1997). The impact of psychiatic disorders on labor market outcomes. Industrial and Labor Relations Review, 51, 64–81. doi: 10.2307/2525035.CrossRefGoogle Scholar
  35. 35.
    Marcotte, D. E., & Wilcox-Gök, V. (2001). Estimating the employment and earnings costs of mental illness: Recent developments in the United States. Social Science and Medicine, 53, 21–27. doi: 10.1016/S0277-9536(00)00312-9.CrossRefPubMedGoogle Scholar
  36. 36.
    Rost, K., Smith, J. L., & Dickinson, M. (2004). The effect of improving primary care depression management on employee absenteeism and productivity: A randomized trial. Medical Care, 42, 1202–1210. doi: 10.1097/00005650-200412000-00007.CrossRefPubMedGoogle Scholar
  37. 37.
    Minkovitz, C. S., Strobino, D., Scharfstein, D., Hou, W., Miller, T., Mistry, K., et al. (2005). Maternal depressive symptoms and children’s receipt of health care in the first 3 years of life. Pediatrics, 115, 306–314. doi: 10.1542/peds.2004-0341.CrossRefPubMedGoogle Scholar
  38. 38.
    Coiro, M. (1997). Maternal depressive symptoms as a risk factor for the development of children in poverty. In: Moore K. A. (Ed.) Factors in the development of children in welfare families: An ecological perspective. Symposium presented at the meetings of the Society for Research in Child Development. Washington, DC.Google Scholar
  39. 39.
    Connelly, C. D., Baker, M., Hazen, A., & Mueggenborg, M. G. (2007). Pediatric health care providers’ self-reported practices in recognizing and treating maternal depression. Pediatric Nursing, 33, 165–173.PubMedGoogle Scholar
  40. 40.
    Gjerdingen, D. K., & Yawn, B. P. (2007). Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. Journal of the American Board of Family Medicine, 20, 280–288. doi: 10.3122/jabfm.2007.03.060171.CrossRefPubMedGoogle Scholar
  41. 41.
    Rost, K., Pyne, J. M., Dickinson, L. M., & LoSasso, A. T. (2005). Cost-effectiveness of enhancing primary care depression management on an ongoing basis. Annals of Family Medicine, 3, 7–14. doi: 10.1370/afm.256.CrossRefPubMedGoogle Scholar
  42. 42.
    LoSasso, A., Rost, K., & Beck, A. (2006). Modeling the impact of enhanced depression treatment on workplace functioning and costs: A cost benefit approach. Medical Care, 44, 352–358. doi: 10.1097/01.mlr.0000204049.30620.1e.CrossRefGoogle Scholar
  43. 43.
    Salkever, D. S., Shinogle, J. A., & Goldman, H. (2003). Return to work and claim duration for workers with long-term mental disabilities: Impacts of mental health coverage, fringe benefits, and disability management. Mental Health Services Research, 5, 173–186. doi: 10.1023/A:1024495402862.CrossRefPubMedGoogle Scholar
  44. 44.
    Schillerstrom, J. E. (2002). Executive control function in psychiatric and medical illness. Journal of Psychiatric Practice, 8, 160–169. doi: 10.1097/00131746-200205000-00005.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Kelly Noonan
    • 1
    Email author
  • Anne Carroll
    • 2
  • Nancy E. Reichman
    • 3
  • Hope Corman
    • 1
  1. 1.Rider University and National Bureau of Economic Research, Department of EconomicsRider UniversityLawrencevilleUSA
  2. 2.Department of FinanceRider UniversityLawrencevilleUSA
  3. 3.Department of Pediatrics, Robert Wood Johnson Medical SchoolUniversity of Medicine and Dentistry of New JerseyNew BrunswickUSA

Personalised recommendations