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

Throughout the COVID-19 pandemic, there was a fast rise in nervousness and depressive signs, disproportionately affecting economically deprived households and Black and Hispanic individuals.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 threat for persistent stress throughout the pandemic, as they had been extra prone to expertise monetary hardships and exacerbations of long-standing inequities in earnings, housing, and different social determinants of psychological well being.37 As a result of poverty and monetary hardship are main threat elements for stress and psychological well being issues, it’s crucial to determine population-level polices 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 brought on by the pandemic, in July 2021 the US authorities quickly expanded the Youngster Tax Credit score (CTC), an financial help program for households with youngsters, as a part of the American Rescue Plan Act.13 The CTC was established in 1997 to supply monetary reduction for middle-income households. Though previously the CTC offered as much as $2,000 per little one, as a part of the short-term 2021 enlargement it offered a most of $3,600 per little one and was accessible to low-income and unemployed dad and mom as effectively. 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 routinely transferred into the financial institution accounts of eligible households who had filed taxes in 2019 or 2020. Earlier than the CTC enlargement, the credit score was not absolutely refundable—consequently, one-third of American youngsters 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, youngsters dwelling in rural areas, Black and Hispanic youngsters, and kids in bigger households had been disproportionally ineligible.14,15 In distinction, about 90 % of kids 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 results of the expanded CTC, with research suggesting that it decreased little one poverty by almost half, in addition to decreasing 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 youngsters, the Earned Revenue Tax Credit score (EITC). For instance, the EITC has been proven to enhance household earnings, housing, and entry to medical insurance, in addition to to enhance stress and psychological well being.2330 Research recommend that the EITC has notably benefited Black households.8,31 But the EITC is disbursed as an annual refund, fairly than month-to-month funds, and folks should 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 crucial hole by analyzing whether or not the 2021 CTC enlargement improved psychological well being amongst adults with youngsters, particularly amongst low-income individuals and members of racial and ethnic minority teams. Due to historic marginalization and structural racism, these teams have much less wealth and decrease earnings, on common, than higher-income and White individuals and due to this fact might 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 enlargement everlasting, whereas state governments take into account their very own comparable 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 by means of the current.33 The Census Bureau randomly selects survey contributors from the Grasp Handle File; contributors then full an internet-based survey. We used knowledge from waves 28–41 (April 14, 2021–January 10, 2022) (N=944,189). 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 observe, a ultimate bigger lump-sum CTC fee was made throughout the spring of 2022 to those that filed taxes or claimed financial impression funds; our strategy excluded observations throughout this era due to the paradox 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 accessible deidentified knowledge. Moral approval was not required.


CTC-eligible adults with youngsters 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 increased incomes.

Particularly, the 2021 enlargement elevated CTC advantages from a most of $2,000 to a most of $3,600 per little one for kids youthful than age six and as much as $3,000 per little one 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 accessible 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 yr. This included these with zero earned earnings. The credit score was phased out when earnings exceeded these thresholds. The primary phase-out occurred when earnings exceeded these thresholds however was under $400,000 (married submitting collectively) or $200,000 (all different submitting statuses). The full credit score per little one was decreased by $50 for every $1,000 (or a fraction thereof). The credit score wouldn’t be decreased under $2,000 underneath this phase-out. The second phase-out utilized to taxpayers with earnings greater than $400,000 (married submitting collectively) or $200,000 (different submitting statuses). On this phase-out, the entire credit score per little one was decreased $50 for every $1,000, and the credit score may drop under $2,000 till it reached $0. Earlier than the 2021 enlargement the CTC was not accessible 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 adjustments to eligibility standards made in 2021, about 90 % of American households with youngsters (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 strategy much 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 strategy might have concerned a point of measurement error. As well as, prior work has indicated that self-reported receipt of safety-net advantages is unreliable; this will likely particularly be the case if individuals 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 typically they’ve been bothered by having little curiosity or pleasure in doing issues and feeling down, depressed, or hopeless. Solutions vary from “in no way” to “almost day by day.” The 2 gadgets are usually mixed, and scores of three or increased point out excessive threat for despair.39 Second, the two-item Generalized Anxiousness Dysfunction (GAD-2) scale is a quick screening instrument for generalized nervousness dysfunction. Persons are requested whether or not they’re feeling nervous, anxious, or on edge and never capable of management or cease worrying previously two weeks, and once more how typically they expertise these signs.40 A GAD-2 rating of three or increased is taken into account excessive threat for nervousness.

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


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

Major Evaluation

We first calculated descriptive statistics stratified by whether or not households included youngsters and whether or not the interview was carried out after the CTC enlargement. We then estimated the impact of the enlargement utilizing a difference-in-difference-in-differences (that’s, triple-difference) strategy. Triple-difference evaluation builds on conventional difference-in-differences evaluation, which is a quasi-experimental method suited to analyzing the results of coverage adjustments whereas accounting for underlying tendencies.41,42 These strategies evaluate pre-post adjustments in outcomes amongst a “therapy” group (adults with youngsters) whereas “differencing out” underlying secular tendencies in outcomes in a “management” group (adults with out youngsters). Triple-difference evaluation allows additional refinement of the therapy and management teams to estimate the results 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 earnings was lower than $35,000. It’s because the lowest-income households had been the first beneficiaries of the expanded CTC, as they had been extra prone to be newly eligible and to obtain the biggest 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 enlargement, an indicator variable for adults with (versus with out) youngsters, and an indicator variable for whether or not the individual 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 higher impression on psychological well being amongst racial and ethnic subgroups that could be extra prone to profit from the earnings enhance. 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 enlargement and adults with versus with out youngsters).

Sensitivity Analyses:

We carried out two sensitivity analyses. First, we assessed whether or not there have been adjustments 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 primary evaluation to incorporate a categorical variable for the biweekly survey wave as an alternative of utilizing a binary pre-post variable to signify 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 adjustments in particular people’ psychological well being after they obtained CTC advantages as we may 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 may not 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 might have been residual confounding based mostly on contemporaneous coverage adjustments or different exposures that differentially affected the therapy and management teams; we evaluated a number of mannequin assumptions to reduce considerations about this problem (see the appendix).11

Research Outcomes

Pattern Traits

The ultimate pattern included adults with youngsters (the therapy group; 112,862 observations earlier than and 145,429 after the CTC enlargement) and adults with out youngsters (the management group; 237,901 observations earlier than and 316,122 after the enlargement) (exhibit 1). Adults with youngsters had been extra prone to be youthful, married, much less educated, Black, and Hispanic in comparison with adults with out youngsters. Indicators of psychological well being had been worse amongst adults with youngsters. Importantly, difference-in-differences evaluation doesn’t require that traits of the therapy and management teams be comparable, however fairly that tendencies (that’s, slopes) in outcomes be parallel throughout 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 youngsters (n = 112,862) Adults with out youngsters (n = 237,901) Adults with youngsters (n = 145,429) Adults with out youngsters (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
Revenue, %
 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
 Anxiousness signs rating (steady), imply (SD) 2.1 (2.0) 1.8 (1.9) 1.9 (2.0) 1.5 (1.9)
 Anxiousness signs rating ≥3, % 25.5 20.1 29.3 21.6
 Use of psychological well being providers, % 21.8 16.5 23.3 18.4
 Psychological well being prescription, % 23.6 22.4 24.6 23.9

Results Of CTC Growth

The CTC enlargement was related to decreased depressive (−1.7 share factors; 95% confidence interval: −2.6, −0.7) and nervousness (−3.4 share factors; 95% CI: −4.5, −2.4) signs amongst low-income adults with youngsters (exhibit 2). We didn’t observe an affiliation with using psychological well being providers or prescriptions.

Exhibit 2 Results of the 2021 Youngster Tax Credit score (CTC) enlargement 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 enlargement, a binary variable representing adults with (versus with out) youngsters, 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, earnings, marital standing, variety of youngsters, and stage of training, in addition to mounted results for biweekly waves. Depressive and nervousness signs scores are described within the exhibit 1 notes. ***p<0.01

Secondary Analyses

In subgroup analyses by race and ethnicity (exhibit 3), there was a bigger lower in nervousness signs amongst Black adults with youngsters than amongst White adults with youngsters (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 higher reductions in nervousness 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) enlargement 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 nervousness signs scores are described within the exhibit 1 notes. Racial teams, together with “different,” are non-Hispanic. ***p<0.01

Within the secondary evaluation wherein we examined whether or not the psychological well being results of month-to-month CTC funds modified over time, nervousness 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 critical antagonistic psychological well being end result, started lowering after a number of funds had been disbursed. Within the secondary evaluation wherein we imputed lacking values for earnings, the outcomes had been much like findings for the primary evaluation, suggesting that full case evaluation omitting these with lacking incomes didn’t contribute to bias (appendix reveals A7 and A8).11


Throughout the COVID-19 pandemic the CTC was quickly expanded to thousands and thousands of households for the primary time, permitting twenty-seven million extra youngsters from essentially the most economically deprived households to obtain the total profit quantity.43 Our research examined the results of this elevated earnings on psychological well being amongst adults with youngsters, utilizing a big serial cross-sectional nationwide knowledge set and rigorous quasi-experimental analyses. We discovered that the expanded CTC was related to decreased nervousness signs amongst low-income adults with youngsters, in addition to higher psychological well being advantages amongst Black and Hispanic individuals than amongst White individuals. 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 nervousness signs (–3.4 share factors) represents a 13.3 % discount from baseline nervousness ranges (25.5 %) amongst adults with youngsters. Though this can be a modest change in threat on the particular person stage, it represents a significant change within the distribution on the inhabitants stage,46 notably 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 in step with prior analysis discovering that the opposite main US antipoverty program administered by means of the tax code—the EITC—additionally improves long-run psychological well being amongst recipients.23,47 Actually, one prior paper discovered no short-term impacts of the EITC on psychological well being;48 it might be that the extra common funds of the expanded CTC had been more practical on this respect. As well as, though receipt of some public advantages might result in emotions of stigma that scale back participation or worsen psychological well being,4951 the expanded CTC profit was almost 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 enlargement on psychological well being, together with amongst low-income households;53 the latter used completely different measures of life satisfaction, despair, and nervousness; employed a distinct analytic method; and had a smaller pattern dimension than our research, which can clarify the completely different findings.

The psychological well being advantages of the CTC enlargement 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 enlargement had been largest amongst adults of Black, Hispanic, and different (non-Asian) racial and ethnic backgrounds. Of observe, these teams stood essentially the most to achieve from the expanded CTC. Throughout the COVID-19 pandemic, Black and Hispanic households reported increased charges of job loss—44 % and 38 % in October 2021, respectively—in contrast with 23 % for White households, with comparable disparities throughout earlier durations.54 Due to historic and present structural racism and marginalization, these teams even have much less wealth, and due to this fact much less skill to face up to acute and persistent financial adversity.8,31,55 Hispanic households are additionally extra prone 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 barely accessible to US residents and everlasting residents, whereas the CTC was accessible to households with blended immigration standing so long as the kid had a Social Safety quantity. In distinction, we discovered that Asian individuals benefited equally to White individuals. Though Asian individuals total are prone to be in the next socioeconomic place than Black and Hispanic individuals, this will likely masks disparities inside this heterogeneous group.

When analyzing one potential mechanism by means of which the elevated earnings from the CTC might have improved psychological well being, we discovered no adjustments in psychological well being care use or prescriptions, suggesting that these weren’t the first pathways explaining the reductions in depressive and nervousness signs, no less than within the brief time period and within the context of altered patterns of well being care use throughout the pandemic. Nevertheless, latest research utilizing this knowledge set and comparable 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 skill to pay for housing.18,56 That is in step with prior research which have additionally proven that meals sufficiency and decreased monetary hardship are related to improved psychological well being.5759


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

The 2021 CTC enlargement decreased little one poverty by half, however its expiration brought about thousands and thousands of kids to fall again into poverty.19 Our research provides to a small however rising physique of labor that reveals that the CTC not solely elevated meals sufficiency but additionally improved psychological well being amongst adults with youngsters, notably among the many most marginalized teams. By decreasing monetary hardships, this coverage has the potential to enhance the environments wherein weak low-income youngsters develop up. This research used a big serial cross-sectional numerous 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 necessary for Congress and state legislators to weigh as they take into account making the CTC and different comparable tax credit everlasting to help economically deprived households, notably because the financial restoration from the pandemic drags on and as already marginalized households proceed to be left behind.


This analysis was funded partly 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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