The COVID-19 pandemic has been especially challenging for American families with children. The US Surgeon General as well as the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a children’s mental health crisis in late 2021, citing school closures, social isolation, grief over lost community and family members, and challenges accessing needed care as contributing factors. Parents, and especially mothers, have also borne significant caregiving, health, and health care access burdens that likely contributed to observed increases in mental health challenges since the pandemic began. Importantly, however, women and mothers were already facing significant mental health challenges before the pandemic, and those challenges are likely to persist and evolve as the most acute pandemic stressors subside and new threats to women’s health and well-being arise. Moreover, maternal mental health has important implications for children, and understanding mental health challenges among mothers will be critical to addressing the mental health crisis among children.

To better support the mental health and well-being of mothers and children in the aftermath of the pandemic, it is important to understand the patterns that existed before the crisis. In this report, we analyze national patterns of self-reported symptoms of anxiety and depression among custodial mothers of children younger than 18. We use data from the 2019 National Health Interview Survey and self-reported measures based on the Washington Group on Disability Statistics Extended Set on Functioning, which asks about the frequency of feeling worried, nervous, anxious, or depressed and the intensity of those feelings the last time they were experienced. Following guidance from the Washington Group, we combine those with such feelings daily at medium or high intensity or weekly at high intensity to identify groups we refer to as having moderate or severe anxiety and moderate or severe depression. We find the following:

• In 2019, 13.5 percent of mothers ages 19 to 64, or about 4.9 million mothers, reported symptoms of moderate or severe anxiety, and 4.8 percent, or about 1.7 million mothers, reported symptoms of moderate or severe depression. About 1.2 million mothers experienced both moderate or severe anxiety and depression.
• Among mothers with moderate or severe anxiety in 2019, about 36 percent had severe anxiety, and among mothers with moderate or severe depression, about 38 percent had severe depression.
• Prevalence of anxiety and depression among mothers varied by age, income, and other demographic and socioeconomic characteristics, with younger mothers having much higher rates of anxiety than older mothers, and mothers with lower incomes having higher rates of both anxiety and depression than mothers with higher incomes.
• Mothers with Medicaid or Children’s Health Insurance Program (CHIP) coverage had about twice the rate of moderate or severe anxiety (21.0 percent) compared with mothers with employer coverage (10.5 percent), and the rate of moderate or severe depression among mothers with Medicaid/CHIP was more than three times higher than that for mothers with employer coverage (8.1 versus 2.5 percent).
• Almost two-thirds of mothers with moderate or severe anxiety or depression had not received counseling or therapy from a mental health professional in the past 12 months, and 23.0 percent, or 1.2 million mothers, reported an unmet need for counseling or therapy due to cost in the past 12 months. An estimated 69.6 percent of mothers with Medicaid/CHIP and 61.4 percent of mothers with employer coverage did not receive counseling or therapy from a mental health professional, and about 20 percent of mothers in both groups reported unmet needs for counseling or therapy.

Our findings indicate that many mothers reported symptoms of anxiety and depression even before increases in the stressors facing American families, including the COVID-19 pandemic, economic downturn, and recent threats to women’s reproductive autonomy under the Dobbs v. Jackson Women's Health Organization decision that restricted abortion access. They also show that many mothers, including those with insurance coverage, were already reporting unmet needs for mental health services. These findings suggest that addressing mental health challenges among mothers will likely require both maintaining and improving health insurance coverage rates and improving the availability, accessibility, and affordability of mental health services among those with coverage. Mental health coverage could be improved with changes to network adequacy standards, provider payment rates, covered benefits and cost-sharing policies, and scope of practice regulations; enforcement of mental health parity regulations; and increasing the size of the behavioral health workforce. In addition, broader policy interventions including universal early education and care, paid parental leave, pay equity, and flexible workplace policies could help relieve some of the social factors that can contribute to maternal anxiety and depression. Given the effects of maternal well-being on children in both the short and long terms, better supporting the mental health needs of mothers could also help support children as they continue to grapple with the consequences of the pandemic on their mental and physical health.