Discussion

This study investigated the financial hardship and related mental health experiences of Australian families during 3 years of the COVID-19 pandemic. These were captured with Australia’s only nationally representative, repeated cross-sectional survey about families conducted during this period. Low income and deprivation (financial hardship) were common, experienced by between one-fifth and two-thirds of all caregivers depending on demographic subgroup. Low household income declined over the three-year period, whereas deprivation increased. Poor mental health was common for caregivers with low income and even more so for those experiencing deprivation. After a collective peak in poor mental health with lockdowns during the July 2021 survey, there was substantial recovery by April 2023 for caregivers who were not experiencing financial hardship. In contrast, poor mental health was more persistent for caregivers experiencing low income or deprivation, suggesting a widening of mental health disparities over time. Children in households with low income or deprivation were more likely to have poorer caregiver-reported mental health during 2021–2022 but distributions were similar, and mostly equivalent in June 2020 and April 2023.

The finding that low income increased while deprivation increased was somewhat counter-intuitive. It is likely that wage growth during the pandemic period outpaced the increase in the Australian government’s low-income threshold, which was used to calculate the low income variable in this study. The base rate for the government threshold for a household with one child has varied with indexation and the pandemic income supplements.³⁸ However, payments for additional children have remained the same over time and not increased with inflation or wage growth. Alternatively, the finding that low income decreased over time may be a by-product of the measurement used. The income variable was relatively crude, collected using 11 categories (see Table 1), and the low-income variable was calculated according to the best fit of the income category to the low income threshold. This study shows the added value of measuring the lived experience of money (i.e. deprivation) and not just a measure of poverty or low income. The two measures of financial hardship followed different patterns over time, with deprivation experienced by a broader cross-section of the population than low income.

In our study, food insecurity and utility bills were the most common deprivations, consistent with other Australian data collected from adults^{Reference Botha, Gamara and Payne39} and parents^{Reference Price, White and Burley40} during the pandemic period. In a nationally representative Canadian study of adults in four survey rounds in 2020–2021, more than one in seven participants reported stress or worry related to having enough food for their household, and this was higher for subgroups including those with children or financial concerns. By December 2021, however, less than four percent reported accessing a food bank. A qualitative study of 24 Australians in 2020, who were using income support before the COVID-19 pandemic, found that food was often more insecure because it was deemed a flexible priority compared with housing, employment and education.^{Reference Zorbas, Browne and Chung41} In our study, as is well-established across the literature, low income and deprivation followed social gradients. Our findings are also consistent with representative, longitudinal Australian data that show that high levels of poverty are disproportionately experienced by sole caregivers, and there are substantial drops in household income associated with the first five years of parenting, which are predominately borne by women.^{Reference Gamara and Price42}

In our earlier analysis of mental health experiences,^{Reference Price, Measey, Hoq, Rhodes and Goldfeld28} the recovery in poor mental health (Kessler-6) during the post-lockdown periods was apparent across demographic subgroups including caregiver gender, home language, regionality and university educated and multi-caregiving households.^{Reference Price, Measey, Hoq, Rhodes and Goldfeld28} While poor mental health reduced overall for sole caregivers from 36% in June 2020 to 25% in September 2022, it had increased to 29% by April 2023.^{Reference Price, Measey, Hoq, Rhodes and Goldfeld28} This is similar to the trajectory for low income in the current study and may reflect the high proportion of sole parents who experience poverty relative to multi-caregiver households.^{25,Reference Gamara and Price42} Unfortunately, deprivation was not collected by the RCH Poll in September 2022 to enable the same comparison. In our earlier analysis,^{Reference Price, Measey, Hoq, Rhodes and Goldfeld28} poor mental health increased for caregivers with high school education or less, from 16% in June 2020 to 26% in April 2023. When considered collectively with the current study, these findings highlight important subgroups such as sole caregivers, caregivers of younger children and those with lower education, who are experiencing the cumulative adversities of financial hardship and poor mental health.⁴³ Notably, the cut-point for suboptimal caregiver mental health on the Kessler-6 (19 or more) was higher than many international studies of adults.^{Reference Prochaska, Sung, Max, Shi and Ong44} While our scoring aligned with Australian normative data and previous studies using the same dataset,^{Reference Price, Measey, Hoq, Rhodes and Goldfeld28,Reference Furukawa, Kessler, Slade and Andrews36} this high scoring may mean the findings represent the most severe forms of distress, and that other relationships would be evident for lesser, but still important, levels of poor mental health.^{Reference Prochaska, Sung, Max, Shi and Ong44}

Strengths of this study included the large cross-sectional and nationally representative surveys, which employed a robust methodology (surveys piloted and included the validated Kessler-6); collected data on caregiver and child mental health; surveyed female and male caregivers and achieved good response proportions. The study also had limitations. There were no pre-pandemic data to evaluate changes in financial hardship and mental health from before to during the pandemic. In our study, poor caregiver K6 was higher in April 2023 (13%) than representative Australian adult data collected pre-pandemic (8% in 2017) or during the first national lockdown (11%),^{Reference Biddle, Edwards, Gray and Sollis45} which suggests that child rearing was associated with poorer mental health during the pandemic. Other studies demonstrated that, compared with pre-pandemic levels, there were reductions in financial hardship²⁵ and improvements in well-being for low-income households^{Reference Lycett, Frkyberg, Crowe and Capic46} related to the temporary income supports in 2020–2021, but rebounds in hardship subsequently. We could find no study that investigated whether the caregiver mental health disparities associated with financial hardship were increasing before the pandemic, to understand whether our findings were specific to the pandemic period, or whether the data collection period shone a light on a pre-existing pattern. The number of surveys was insufficient to conduct a time-series analysis, so future polls are necessary for evaluating whether mental health disparities related to financial hardship continue to increase in the post-pandemic period, and whether these translate into effects on children’s health and development outcomes.

Further limitations included the reliance on caregiver-report, from only one caregiver per household, which means the child rating may be biased by caregiver perception. The RCH Poll eligibility criteria and sampling approach mean the findings are unlikely to generalise to caregivers without final-year primary/elementary school English, internet access or who are younger than 18, and 12.5% of families did not report income. However, the similarities in pandemic mental health experiences and increasing cost of living across high-income countries mean our findings are likely to generalise to families raising children in similar settings.

Inequities in children’s learning and development existed before the pandemic in Australia,⁴⁷ and our study suggests that the pandemic exacerbated the causal pathways. We found a strong and persistent relationship between financial hardship and mental health for caregivers, over and above the mental health impacts of the pandemic. In Australia, the recent increase in cost of living has been met with increasing use of and pressure on social services and supports, such as financial counselling and hardship concessions, as well as reduced household savings.⁴⁸ It is important to consider whether addressing financial hardship can decrease the need for mental health services and explore policy opportunities for testing this, such as income supplements, and the integration of financial support into universal platforms such as primary healthcare.^{Reference Goldfeld, Price and Al-Yaman30,48} This study has important implications for post-pandemic recovery including finding ways to accelerate prevention and early intervention pathways for addressing the contemporary issues of increasing cost of living and limited mental health supports and services.^{12,43,Reference Hall49}