Results Of The 2021 Expanded Youngster Tax Credit score On Adults’ Psychological Well being: A Quasi-Experimental Research

Results Of The 2021 Expanded Youngster Tax Credit score On Adults’ Psychological Well being: A Quasi-Experimental Research

Through the COVID-19 pandemic, there was a speedy rise in anxiousness and depressive signs, disproportionately affecting economically deprived households and Black and Hispanic folks.1 In June 2020, 37.8 % of White adults reported antagonistic psychological or behavioral well being signs, in contrast with 44.2 % of Black adults and 52.1 % of Hispanic adults.2 Racial and ethnic minority teams had been at elevated danger for continual stress through the pandemic, as they had been extra more likely to expertise monetary hardships and exacerbations of long-standing inequities in revenue, housing, and different social determinants of psychological well being.37 As a result of poverty and monetary hardship are main danger components for stress and psychological well being issues, it’s crucial to establish population-level insurance policies to enhance psychological well-being amongst at-risk teams. Financial insurance policies have the potential to have an effect on psychological well being by addressing social determinants of psychological well being similar to poverty, meals insecurity, and well being care entry810 (see the conceptual diagram in on-line appendix exhibit A1).11 These mechanisms and psychological well being itself can then have an effect on bodily well being in the long term.12

In response to the monetary hardship attributable to the pandemic, in July 2021 the US authorities briefly expanded the Youngster Tax Credit score (CTC), an financial help program for households with kids, as a part of the American Rescue Plan Act.13 The CTC was established in 1997 to offer monetary reduction for middle-income households. Though previously the CTC offered as much as $2,000 per youngster, as a part of the momentary 2021 growth it offered a most of $3,600 per youngster and was obtainable to low-income and unemployed dad and mom as nicely. As well as, as an alternative of being transferred within the type of an annual tax refund, in 2021 it was disbursed as month-to-month advance funds that had been mechanically transferred into the financial institution accounts of eligible households who had filed taxes in 2019 or 2020. Earlier than the CTC growth, the credit score was not absolutely refundable—consequently, one-third of American kids didn’t obtain the total worth of the profit as a result of their households didn’t earn sufficient.14 In different phrases, these with low or no tax legal responsibility didn’t obtain the funds. Kids with single dad and mom, kids dwelling in rural areas, Black and Hispanic kids, and kids in bigger households had been disproportionally ineligible.14,15 In distinction, about 90 % of youngsters had been eligible for the expanded CTC, which was absolutely refundable, and advantages had been bigger for lower-income households.16

There was restricted work analyzing the consequences of the expanded CTC, with research suggesting that it lowered youngster poverty by practically half, in addition to lowering materials hardship and meals insufficiency.1722 There’s extra proof on the well being results of one other main poverty alleviation program for low-income households with kids, the Earned Earnings Tax Credit score (EITC). For instance, the EITC has been proven to enhance household revenue, housing, and entry to medical insurance, in addition to to enhance stress and psychological well being.2330 Research recommend that the EITC has significantly benefited Black households.8,31 But the EITC is disbursed as an annual refund, fairly than month-to-month funds, and folks have to be employed to obtain it, so EITC research don’t essentially generalize to the potential impacts of the expanded CTC, with its month-to-month funds and near-universality (together with broader protection of immigrant households).

This research addressed this important hole by analyzing whether or not the 2021 CTC growth improved psychological well being amongst adults with kids, particularly amongst low-income folks and members of racial and ethnic minority teams. Due to historic marginalization and structural racism, these teams have much less wealth and decrease revenue, on common, than higher-income and White folks and due to this fact could have benefited extra from this new monetary useful resource. The expanded CTC expired on the finish of 2021, and Congress continues to debate whether or not to make the growth everlasting, whereas state governments take into account their very own related packages.32 Proof is due to this fact urgently wanted to tell such conversations.

Research Knowledge And Strategies


The pattern was drawn from the Census Bureau’s Family Pulse Survey, a nationally consultant repeated cross-sectional web survey that started in April 2020 and continues weekly via the current.33 The Census Bureau randomly selects survey members from the Grasp Tackle File; members then full an internet-based survey. We used knowledge from waves 28–41 (April 14, 2021–January 10, 2022) (


). As a result of the primary month-to-month fee for the expanded CTC was made July 15, 2021 (simply earlier than wave 34), and the final fee was made December 15, 2021 (throughout wave 41), this offered six waves of prepolicy knowledge and 7 waves of postpolicy knowledge. Of be aware, a ultimate bigger lump-sum CTC fee was made through the spring of 2022 to those that filed taxes or claimed financial affect funds; our method excluded observations throughout this era due to the anomaly concerning the definition of the publicity interval and potential recipients. Lastly, we restricted the pattern to respondents who offered responses on the psychological well being outcomes of curiosity, for a ultimate pattern dimension of 812,314.

This research concerned publicly obtainable deidentified knowledge. Moral approval was not required.


CTC-eligible adults with kids youthful than age eighteen whose interviews occurred throughout July 2021–January 2022 had been thought of “uncovered” to the expanded CTC. Moreover, these with decrease incomes had been thought of to have obtained the strongest publicity, as their advantages had been bigger than these of individuals with larger incomes.

Specifically, the 2021 growth elevated CTC advantages from a most of $2,000 to a most of $3,600 per youngster for kids youthful than age six and as much as $3,000 per youngster for kids ages 6–17. As a substitute of being disbursed as a part of an annual tax refund, the fee mode was modified to month-to-month advance funds. The total credit score was obtainable to single filers, heads of family, and married {couples} submitting collectively with modified adjusted gross incomes decrease than $75,000, $112,500, and $150,000, respectively, for the 2021 tax 12 months. This included these with zero earned revenue. The credit score was phased out when revenue exceeded these thresholds. The primary phase-out occurred when revenue exceeded these thresholds however was under $400,000 (married submitting collectively) or $200,000 (all different submitting statuses). The entire credit score per youngster was lowered by $50 for every $1,000 (or a fraction thereof). The credit score wouldn’t be lowered under $2,000 beneath this phase-out. The second phase-out utilized to taxpayers with revenue greater than $400,000 (married submitting collectively) or $200,000 (different submitting statuses). On this phase-out, the whole credit score per youngster was lowered $50 for every $1,000, and the credit score might drop under $2,000 till it reached $0. Earlier than the 2021 growth the CTC was not obtainable to these with earnings under $2,500, and people with decrease incomes didn’t earn sufficient to qualify for the total quantity (that’s, it was not absolutely refundable).34 Due to the modifications to eligibility standards made in 2021, about 90 % of American households with kids (roughly thirty-nine million households) had been eligible to obtain funds starting July 15, 2021.35

This evaluation is analogous to an intent-to-treat design, wherein we captured the typical therapy impact on the eligible US inhabitants, nearly all of whom obtained the credit score however a fraction of whom didn’t.36 That is an method just like prior research of the EITC and different safety-net packages for which administrative knowledge on profit receipt are unavailable.8,25,26,37 Notably, 65.4 % of our pattern who appeared eligible on the idea of their self-reported demographic traits reported that they obtained the CTC, which signifies that our method could have concerned some extent of measurement error. As well as, prior work has indicated that self-reported receipt of safety-net advantages is unreliable; this may occasionally particularly be the case if folks weren’t conscious of the automated deposits into their financial institution accounts.38


We included a number of psychological well being outcomes measured within the Family Pulse Survey. First, depressive signs had been captured utilizing the two-item Affected person Well being Questionnaire (PHQ-2). Within the PHQ-2, respondents are requested how usually they’ve been bothered by having little curiosity or pleasure in doing issues and feeling down, depressed, or hopeless. Solutions vary from “by no means” to “practically on daily basis.” The 2 objects are usually mixed, and scores of three or larger point out excessive danger for despair.39 Second, the two-item Generalized Nervousness Dysfunction (GAD-2) scale is a quick screening instrument for generalized anxiousness dysfunction. Persons are requested whether or not they’re feeling nervous, anxious, or on edge and never capable of management or cease worrying up to now two weeks, and once more how usually they expertise these signs.40 A GAD-2 rating of three or larger is taken into account excessive danger for anxiousness.

We additionally included two binary outcomes capturing psychological well being care use, together with psychological well being counseling or remedy throughout the previous 4 weeks and drugs to assist with feelings, habits, or focus.


We adjusted fashions for variables representing potential confounders of the connection between CTC receipt and the outcomes: intercourse, marital standing, training, revenue, race and ethnicity, and variety of kids. We additionally included fastened results for biweekly survey wave to account for secular tendencies in psychological well being that occurred throughout this era on account of underlying components affecting all members.

Main Evaluation

We first calculated descriptive statistics stratified by whether or not households included kids and whether or not the interview was carried out after the CTC growth. We then estimated the impact of the growth utilizing a difference-in-difference-in-differences (that’s, triple-difference) method. Triple-difference evaluation builds on conventional difference-in-differences evaluation, which is a quasi-experimental method suited to analyzing the consequences of coverage modifications whereas accounting for underlying tendencies.41,42 These strategies examine pre-post modifications in outcomes amongst a “therapy” group (adults with kids) whereas “differencing out” underlying secular tendencies in outcomes in a “management” group (adults with out kids). Triple-difference evaluation allows additional refinement of the therapy and management teams to estimate the consequences on subgroups most affected by the coverage. Particularly, we included an extra set of interplay phrases between the first publicity variable and a binary variable for whether or not an individual’s revenue was lower than $35,000. It is because the lowest-income households had been the first beneficiaries of the expanded CTC, as they had been extra more likely to be newly eligible and to obtain the most important funds.

The triple-interaction time period in difference-in-difference-in-differences fashions was due to this fact composed of three variables: an indicator for whether or not the interview occurred after (versus earlier than) the CTC growth, an indicator variable for adults with (versus with out) kids, and an indicator variable for whether or not the particular person belonged to a lower-income (versus higher-income) group. The equation for the evaluation and extra particulars about mannequin assumptions are within the appendix, together with appendix reveals A2–A4.11

Secondary Analyses

Subgroup Analyses:

We evaluated whether or not the CTC had a larger affect on psychological well being amongst racial and ethnic subgroups that could be extra more likely to profit from the revenue increase. To take action, we carried out extra difference-in-difference-in-differences analyses, together with an interplay time period between race and ethnicity and the first publicity variable (that’s, the interplay between pre-post growth and adults with versus with out kids).

Sensitivity Analyses:

We carried out two sensitivity analyses. First, we assessed whether or not there have been modifications within the results of the month-to-month CTC funds over time (for instance, whether or not psychological well being improved initially however then returned to baseline). To take action, we modified the principle evaluation to incorporate a categorical variable for the biweekly survey wave as an alternative of utilizing a binary pre-post variable to symbolize time. Second, to account for lacking values for key covariates, we carried out a number of imputation utilizing chained equations (see the appendix).11


This research had a number of limitations. One was that the Family Pulse Survey is a repeated cross-sectional survey, so we couldn’t observe modifications in particular people’ psychological well being after they obtained CTC advantages as we might in a panel knowledge set. As well as, the Family Pulse Survey suffers from a excessive fee of nonresponse, as seen with many different nationwide surveys; outcomes due to this fact won’t generalize to these not included on this research. One other limitation was that covariates and outcomes had been self-reported and should endure from customary reporting biases. Lastly, as with all difference-in-differences evaluation, there could have been residual confounding primarily based on contemporaneous coverage modifications or different exposures that differentially affected the therapy and management teams; we evaluated a number of mannequin assumptions to minimize considerations about this difficulty (see the appendix).11

Research Outcomes

Pattern Traits

The ultimate pattern included adults with kids (the therapy group; 112,862 observations earlier than and 145,429 after the CTC growth) and adults with out kids (the management group; 237,901 observations earlier than and 316,122 after the growth) (exhibit 1). Adults with kids had been extra more likely to be youthful, married, much less educated, Black, and Hispanic in comparison with adults with out kids. Indicators of psychological well being had been worse amongst adults with kids. Importantly, difference-in-differences evaluation doesn’t require that traits of the therapy and management teams be related, however fairly that tendencies (that’s, slopes) in outcomes be parallel through the preeexpansion interval. Descriptions of the outcomes of analyses to judge the validity of mannequin assumptions are within the appendix.11

Exhibit 1 Pattern traits of respondents to the Family Pulse Survey, April 2021–January 2022

Earlier than July 15, 2021

After July 15, 2021

Traits Adults with kids (n = 112,862) Adults with out kids (n = 237,901) Adults with kids (n = 145,429) Adults with out kids (n = 316,122)
Age, imply years (SD) 44.8 (11.9) 57.3 (15.3) 44.0 (11.9) 56.1 (15.9)
Male, % 36.9 42.7 36.6 42.9
Married, % 70.7 53.9 69.9 52.7
Lower than highschool or highschool training, % 13.1 11.9 13.2 12.2
Earnings, %
 Lower than $25,000 8.9 10.7 9.5 11.7
 $25,000–$34,999 7.6 8.9 7.5 9.3
 $35,000–$49,999 8.9 10.9 9.0 11.4
 $50,000–$74,999 14.9 18.2 14.6 18.1
 $75,000–$99,999 13.9 14.8 13.7 14.6
 $100,000–$149,999 20.4 17.9 20.3 17.3
 $150,000–$199,999 10.6 8.8 10.8 8.2
 $200,000 or extra 14.8 9.8 14.5 9.5
Race and ethnicity, %
 White 68.9 79.3 68.6 78.9
 Black 8.5 6.3 8.7 6.4
 Asian 6.8 4.5 6.5 4.4
 Hispanic 10.2 6.0 10.4 6.4
 Different 5.7 3.9 5.8 3.9
Psychological well being outcomes
 Depressive signs rating (steady), imply (SD) 1.6 (1.8) 1.5 (1.8) 1.4 (1.8) 1.3 (1.7)
 Depressive signs rating ≥3, % 18.4 16.4 19.9 17.2
 Nervousness signs rating (steady), imply (SD) 2.1 (2.0) 1.8 (1.9) 1.9 (2.0) 1.5 (1.9)
 Nervousness signs rating ≥3, % 25.5 20.1 29.3 21.6
 Use of psychological well being companies, % 21.8 16.5 23.3 18.4
 Psychological well being prescription, % 23.6 22.4 24.6 23.9

Results Of CTC Enlargement

The CTC growth was related to decreased depressive (−1.7 proportion factors; 95% confidence interval: −2.6, −0.7) and anxiousness (−3.4 proportion factors; 95% CI: −4.5, −2.4) signs amongst low-income adults with kids (exhibit 2). We didn’t observe an affiliation with the usage of psychological well being companies or prescriptions.

Exhibit 2 Results of the 2021 Youngster Tax Credit score (CTC) growth on psychological well being and psychological well being care use amongst low-income dad and mom, April 2021–January 2022

Exhibit 2

SOURCE Authors’ evaluation of information from the Census Bureau’s Family Pulse Survey, April 14, 2021–January 10, 2022. NOTES Coefficients are plotted as level estimates with 95% confidence intervals (whiskers). Coefficients are derived from difference-in-difference-in-differences fashions wherein the first publicity is a triple-interaction time period between an indicator for whether or not the interview occurred after (versus earlier than) the CTC growth, a binary variable representing adults with (versus with out) kids, and a binary variable for whether or not the interviewee belonged to a lower-income (versus higher-income) group. All regressions adjusted for intercourse, race and ethnicity, revenue, marital standing, variety of kids, and stage of training, in addition to fastened results for biweekly waves. Depressive and anxiousness signs scores are described within the exhibit 1 notes. ***


Secondary Analyses

In subgroup analyses by race and ethnicity (exhibit 3), there was a bigger lower in anxiousness signs amongst Black adults with kids than amongst White adults with kids (interplay time period coefficient for Black versus White, −2.3; 95% CI: −3.9, −0.7). Hispanic adults and adults from different racial and ethnic teams additionally skilled larger reductions in anxiousness in contrast with White adults (interplay time period coefficient for Hispanic adults, −2.3 [95% CI: −3.9, −0.7]; interplay time period coefficient for different racial and ethnic teams, −3.3 [95% CI: −5.2, −1.4]). There have been no variations for Asian households in contrast with White households for any outcomes (exhibit 3), and there have been no important variations by race and ethnicity in psychological well being care use (appendix exhibit A5).11

Exhibit 3 Race and ethnicity variations within the results of the 2021 Youngster Tax Credit score (CTC) growth on psychological well being amongst low-income dad and mom, April 2021–January 2022

Exhibit 3

SOURCE Authors’ evaluation of information from the Census Bureau’s Family Pulse Survey, April 14, 2021–January 10, 2022. NOTES The strategies behind this determine are described within the exhibit 2 notes. Depressive and anxiousness signs scores are described within the exhibit 1 notes. Racial teams, together with “different,” are non-Hispanic. ***


Within the secondary evaluation wherein we examined whether or not the psychological well being results of month-to-month CTC funds modified over time, anxiousness signs lessened, on common, quickly after the funds began and remained comparatively steady over time (appendix exhibit A6).11 Depressive signs, that are arguably a extra severe antagonistic psychological well being consequence, started reducing after a number of funds had been disbursed. Within the secondary evaluation wherein we imputed lacking values for revenue, the outcomes had been just like findings for the principle evaluation, suggesting that full case evaluation omitting these with lacking incomes didn’t contribute to bias (appendix reveals A7 and A8).11


Through the COVID-19 pandemic the CTC was briefly expanded to thousands and thousands of households for the primary time, permitting twenty-seven million extra kids from probably the most economically deprived households to obtain the total profit quantity.43 Our research examined the consequences of this elevated revenue on psychological well being amongst adults with kids, utilizing a big serial cross-sectional nationwide knowledge set and rigorous quasi-experimental analyses. We discovered that the expanded CTC was related to lowered anxiousness signs amongst low-income adults with kids, in addition to larger psychological well being advantages amongst Black and Hispanic folks than amongst White folks. Earlier research have additionally proven a hyperlink between monetary hardship and psychological well being.44,45 Within the total pattern and amongst every subgroup, there was no change in psychological well being care visits or prescriptions, suggesting that well being care use was not the first pathway explaining the outcomes.

The discount within the prevalence of clinically significant anxiousness signs (–3.4 proportion factors) represents a 13.3 % discount from baseline anxiousness ranges (25.5 %) amongst adults with kids. Though this can be a modest change in danger on the particular person stage, it represents a significant change within the distribution on the inhabitants stage,46 significantly contemplating the difficult pandemic-related circumstances throughout which it was carried out and the potential cumulative results if the profit had been to be prolonged. The impact dimension is according to prior analysis discovering that the opposite main US antipoverty program administered via the tax code—the EITC—additionally improves long-run psychological well being amongst recipients.23,47 The truth is, one prior paper discovered no short-term impacts of the EITC on psychological well being;48 it could be that the extra common funds of the expanded CTC had been simpler on this respect. As well as, though receipt of some public advantages could result in emotions of stigma that cut back participation or worsen psychological well being,4951 the expanded CTC profit was practically common with few administrative burdens amongst those that obtained automated advantages, maybe permitting it to be extra impactful for psychological well being.52 These outcomes distinction with these of 1 prior research that discovered no short-term results of the CTC growth on psychological well being, together with amongst low-income households;53 the latter used totally different measures of life satisfaction, despair, and anxiousness; employed a distinct analytic method; and had a smaller pattern dimension than our research, which can clarify the totally different findings.

The psychological well being advantages of the CTC growth had been largest amongst adults of Black, Hispanic, and different (non-Asian) racial and ethnic backgrounds.

We additionally discovered that the psychological well being advantages of the CTC growth had been largest amongst adults of Black, Hispanic, and different (non-Asian) racial and ethnic backgrounds. Of be aware, these teams stood probably the most to achieve from the expanded CTC. Through the COVID-19 pandemic, Black and Hispanic households reported larger charges of job loss—44 % and 38 % in October 2021, respectively—in contrast with 23 % for White households, with related disparities throughout earlier intervals.54 Due to historic and present structural racism and marginalization, these teams even have much less wealth, and due to this fact much less capacity to resist acute and continual financial adversity.8,31,55 Hispanic households are additionally extra more likely to be ineligible for different safety-net insurance policies due to immigration standing, maybe making the CTC a extra salient program for them. For instance, the federal EITC is just obtainable to US residents and everlasting residents, whereas the CTC was obtainable to households with combined immigration standing so long as the kid had a Social Safety quantity. In distinction, we discovered that Asian folks benefited equally to White folks. Though Asian folks total are more likely to be in the next socioeconomic place than Black and Hispanic folks, this may occasionally masks disparities inside this heterogeneous group.

When analyzing one doable mechanism via which the elevated revenue from the CTC could have improved psychological well being, we discovered no modifications in psychological well being care use or prescriptions, suggesting that these weren’t the first pathways explaining the reductions in depressive and anxiousness signs, not less than within the quick time period and within the context of altered patterns of well being care use through the pandemic. Nonetheless, current research utilizing this knowledge set and related research designs have famous that the month-to-month CTC funds resulted in reductions in markers of monetary hardship, with improved meals sufficiency and extra confidence within the capacity to pay for housing.18,56 That is according to prior research which have additionally proven that meals sufficiency and lowered monetary hardship are related to improved psychological well being.5759


The expanded CTC has the potential to enhance the environments wherein susceptible low-income kids develop up.

The 2021 CTC growth lowered youngster poverty by half, however its expiration triggered thousands and thousands of youngsters to fall again into poverty.19 Our research provides to a small however rising physique of labor that exhibits that the CTC not solely elevated meals sufficiency but additionally improved psychological well being amongst adults with kids, significantly among the many most marginalized teams. By lowering monetary hardships, this coverage has the potential to enhance the environments wherein susceptible low-income kids develop up. This research used a big serial cross-sectional various nationwide knowledge set and a rigorous quasi-experimental research design, offering well timed proof on a coverage that’s actively being debated by federal and state legislatures. These findings are vital for Congress and state legislators to weigh as they take into account making the CTC and different related tax credit everlasting to help economically deprived households, significantly because the financial restoration from the pandemic drags on and as already marginalized households proceed to be left behind.


This analysis was funded partially by the Robert Wooden Johnson Basis and by the Nationwide Institutes of Well being (Grant No. U01MH129968, awarded to Rita Hamad). To entry the authors’ disclosures, click on on the Particulars tab of the article on-line.


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