Child Tax Credit, Spending Patterns, and Mental Health: Mediation Analyses of Data from the U.S. Census Bureau’s Household Pulse Survey during COVID-19

This study examined the relationship between the receipt of COVID-19 child tax credit and adult mental health problems in the United States, and we explored whether and the extent to which a wide range of spending patterns of the credit—15 patterns regarding basic necessities, child education, and household expenditure—mediated the relationship. We used COVID-19-specialized data from the U.S. Census Bureau’s Household Pulse Survey, a representative population sample (N = 98,026) of adult respondents (18 and older) who participated between 21 July 2021 and 11 July 2022. By conducting mediation analyses with logistic regression, we found relationships between the credit and lower levels of anxiety (odds ratio [OR] = 0.914; 95% confidence interval [CI] = 0.879, 0.952). The OR was substantially mediated by spending on basic necessities such as food and housing costs (proportion mediated = 46% and 44%, respectively). The mediating role was relatively moderate in the case of spending on child education and household expenditure. We also found that spending the credit on savings or investments reduces the effect of the child tax credit on anxiety (−40%) while donations or giving to family were not a significant mediator. Findings on depression were consistent with anxiety. The child tax credit–depression relationships were substantially mediated by spending on food and housing (proportion mediated = 53% and 70%). These mediation analyses suggested that different patterns of credit spending are important mediators of the relationship between the receipt of the child tax credit and mental illnesses. Public health approaches to improve adult mental health during and after the COVID-19 pandemic need to consider the notable mediating role of spending patterns.