Background Lone mothers and their children are known to suffer disproportionate levels of poor physical and mental health, connected to poverty and worklessness. Many high income countries have introduced employment requirements and restrictions on benefits eligibility for lone parents. There is evidence to support the protective effect of employment on health among the general population. However, little is known about the impact of such ‘welfare to work’ interventions on the health of lone parents and their children. In this international policy context it is crucial to understand how these interventions might affect health.
Methods We conducted a Cochrane systematic review of randomised controlled trials which reported the impact of welfare to work interventions on physical and mental health, employment and income for lone parents and their children. Seventeen bibliographic databases were searched, in addition to extensive handsearching. Risk of bias was independently assessed by two reviewers. Data were meta-analysed using random effects models.
Results A total of 15,481 references were identified by the searches. 154 full text articles were screened and 12 large RCTs were included in the review. Although all studies were assessed as at high risk of bias on at least one domain, these were large and well-conducted trials. Across all studies and outcomes, few impacts were large or statistically significant. At 60–72 months post-intervention meta-analysis of three studies showed a statistically significant positive impact on maternal mental health (standardised mean difference [SMD] -0.11; 95% CI -0.17 to -0.04); however, two further studies showed a statistically non-significant effect. At this time point, there were no other statistically significant effects on physical or mental health for parents or children. There was a small increase in employment (RR 1.05; 95% CI 1.01 to 1.10) and income (SMD 0.05; 95% CI 0.01 to 0.10).
Conclusion This review found 12 RCTs of complex social interventions and as such represents an unusual body of evidence in this field. These welfare to work interventions for lone parents appear to have very small effects on employment, income and adult or child health. Further research on the employment and health impacts of increasing employment requirements for this group is required to establish whether policy makers’ expectations are likely to be fulfilled.
- systematic review
- welfare to work
- lone parents