Mental health among U.S. mothers declines sharply between 2016 and 2023

A new study published in JAMA Internal Medicine reveals a concerning decline in self-reported mental health among mothers in the United States between 2016 and 2023. Conducted by researchers at the Columbia University Mailman School of Public Health, the study also found modest but measurable declines in self-reported physical health during the same period.

This large-scale analysis examined data from 198,417 mothers who participated in the National Survey of Children's Health (NSCH), a nationally representative annual survey of households with children aged 0–17. Most participating mothers were over age 30, and over half had a privately insured or a non-Hispanic white child.

Although high rates of maternal morbidity and mortality have been well documented, national data on the health status of mothers beyond pregnancy and the first year postpartum is lacking."

Jamie Daw, PhD, assistant professor of Health Policy and Management at Columbia Mailman School

The findings show that the percentage of mothers reporting excellent mental health dropped sharply from 38 percent in 2016 to 26 percent in 2023. Similarly, the proportion reporting excellent physical health declined from 28 percent to 24 percent.

Most notably, the percentage of mothers rating their mental health as fair or poor rose by 3.5 percentage points over the 8 year-period, representing a 63.6 percent increase from the baseline prevalence of 5.5 percent in 2016. Declines in maternal mental health originated prior to the COVID-19 pandemic and were observed in nearly every socioeconomic subgroup examined.

Among fathers, the percentage reporting excellent physical health declined as well-from 30 percent to 26.4 percent; the changes in mental health were less pronounced. However, fathers reported substantially better mental and physical health than mothers in all years of the study.

The authors also examined disparities in maternal mental and physical health and found that the prevalence of fair and poor mental and physical health was considerably higher among mothers of lower educational attainment, single mothers, and those whose children have Medicaid or are uninsured.

Daw and colleagues emphasize the intergenerational consequences of poor parental mental health, including increased risks for adverse birth outcomes, developmental delays, and mental health issues in children. "Maternal mood disorders, in particular, can have long-term effects on children, directly by affecting development, and indirectly, by increasing the chance of exposure to co-occurring risks such as parental substance use and lower household resources." Daw explained.

"Our results highlight the rising tide of worsening mental health among parenting women as a key target for efforts to improve maternal and child health in the U.S.,"Daw said. "We found consistently worse health outcomes for mothers compared to fathers, suggesting that mothers may need additional consideration and attention in policies aimed at supporting parental health and especially mental health.

In all cases, our study underscores the need for more comprehensive research on the health and well-being of U.S. parents more broadly, and we urge support for more interventions that support prevention, diagnosis and treatment of mental health outcomes."

Co-authors are Colleen L. MacCallum-Bridges, PhD, and Lindsay K. Admon, MD, MSc, University of Michigan.

The study was supported by the Agency for Healthcare Research and Quality (R01HS029159).