Mental Health of the Center-based Child Care and Early Education Workforce

This snapshot reports updated findings on the well-being of the CCEE workforce using the 2019 NSECE Center-based Workforce Survey. The 2019 NSECE examined workers’ mental health using a measure of depression, rather than a measure of nonspecific psychological distress as in the 2012 NSECE. This snapshot describes workers’ levels of depressive symptoms that indicate risk for clinical depression and aims to help researchers, policymakers, and CCEE programs understand which members of the CCEE workforce may be at greater risk for clinical depression.  

• In 2019, 10 percent of center-based CCEE workers who served children under age 6, not in kindergarten, reported levels of depressive symptoms indicating an elevated risk for clinical depression.  
• Center-based CCEE workers in certain groups tended to have an elevated risk for clinical depression.
  • CCEE workforce members in centers that served at least one child participating in the Child Care and Development Fund (CCDF) program—but did not serve children participating in Head Start or public pre-K programs—tended to have an elevated risk for clinical depression. This risk was relative to workers in centers that served children participating in Head Start and/or public pre-K but not CCDF, and relative to workers in centers that did not serve children participating in CCDF, Head Start, or public pre-K.  
  • Workers who had private insurance through their employer or a partner’s employer, public insurance (e.g., Medicaid), another type of insurance, or were uninsured tended to have an elevated risk for clinical depression. This risk was compared to those who had private insurance purchased directly from the marketplace. 

Data were from the 2019 National Survey of Early Care and Education (NSECE) Center-based Workforce Survey. The sample included 4,491 CCEE workforce members, who represented 1,288,206 workforce members nationwide. Respondents included teachers, lead teachers, aides, and assistant teachers who worked with children ages 0-5, not yet in kindergarten.  

We described the average level of depressive symptoms that CCEE workers experienced, measured by the Center for Epidemiologic Studies Depression Scale short form (CES-D-SF) scores. We also conducted bivariate analyses using a chi-square test to examine the relationships between CCEE workers’ elevated risk for clinical depression (i.e., CES-D-SF score of eight or higher) and their center, job-related, and household financial characteristics (i.e., center auspice and sponsorship, center receipt of public funding, worker role, ages of children the worker primarily worked with, worker household income, and worker health insurance coverage). If there was a significant relationship between CCEE workers’ elevated risk for clinical depression and a characteristic, we conducted pairwise comparisons among different categories within that characteristic.

In 2019, the average level of depressive symptoms reported by the center-based CCEE workers was low. However, one in ten CCEE workers reported levels of depressive symptoms that indicated an elevated risk for clinical depression—a rate slightly higher than that of the national adult (7%) or female (8%) population.  

Importantly, the associations between elevated risk for depression and certain characteristics of workers and centers are not causal, but they signal important needs of workers working in those types of centers. Workers who are at risk for clinical depression or have high levels of depressive symptoms may benefit from additional support to improve their psychological well-being. For example, analyses from the 2012 NSECE found that workers had less psychological distress when the workplace had a more positive climate (e.g., feelings of respect and teamwork).  Moreover, the analyses did not control for other factors that might be related to the characteristics examined and workers’ depressive symptoms. Future research could examine the role of other characteristics of the center (e.g., wages, turnover), families served, and the community where the program is located in the relationship between center receipt of public funding and workers’ depressive symptoms.

Lin, Y-C., Richards, K., Amadon, S., Aceves, L., & Madill, R. (2025). Mental Health of the Center-based Child Care and Early Education Workforce. OPRE Report #2025-115. Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.  

Figure 1. Percentage of 2019 center-based CCEE workers, by CES-D-SF scores 

Note: The shaded blue area reflects the percentage of CCEE workers with a CES-D-SF score of 8 or higher, indicating an elevated risk for clinical depression.

Source: Results from the 2019 NSECE Center-based Workforce Survey.  

Alt Text: This bar graph shows CCEE workers’ levels of depressive symptoms, measured by the Center for Epidemiologic Studies Depression Scale short form (CES-D-SF) scores. The scores range from 0 to 21. About 10% of workers had a score of 8 or higher, indicating elevated risk for clinical depression.