How financial hardship is associated with the onset of mental health problems over time

The mediating role of financial well-being in the relationship between housing affordability and mental health

This study examines the mediating role of financial well-being in the relationship between housing affordability and mental health across the European Union. Utilizing data from the 2018 EU Statistics on Income and Living Conditions, the analysis incorporates both objective and subjective measures of housing affordability and financial well-being. The findings reveal that financial well-being acts as a mechanism that links housing pressure to mental health, proxied by the MHI-5 Mental Health Inventory. Notably, the effect is stronger for subjective indicators, which exhibit a more pronounced mediating effect than do objective financial well-being indicators. The results underscore the importance of considering both objective and subjective dimensions in understanding the complex interplay between housing affordability, financial well-being, and mental health. The study contributes to the literature by providing insights into the underlying mechanisms through which housing affordability impacts mental health, with implications for policy interventions aimed at alleviating the negative impacts of housing affordability issues on mental health and overall well-being.

Optimism, Lifetime Financial Stressors, and Mental Health Among Racially, Sexually, and Gender Minoritized Emerging Adults

BACKGROUND

Although racially, sexually, and gender minoritized (RSGM) persons experience chronic and sometimes severe financial life stressors that increase their risk of mental health problems across the life course, no studies in this population have examined psychological resilience factors, such as optimism, that may mitigate these negative effects.

PURPOSE

To investigate how exposure to financial stressors is associated with symptoms of anxiety, depression, and somatization, and whether optimism moderates these associations.

METHOD

Two hundred and eighty-five RSGM emerging adults (Mage = 25.18, SD = 1.94) completed the Stress and Adversity Inventory and Brief Symptom Inventory online. Participants were Black (22.1%), Latinx (57.9%), and biracial Black-Latinx (20%), and they primarily identified as male (94.7%) and gay (74.2%).

RESULTS

As hypothesized, multiple regression analyses with interaction terms indicated that more frequent and severe acute and chronic lifetime financial stressors were related to greater anxious, depressive, and somatic symptoms. Moreover, greater optimism was associated with fewer mental health symptoms. Additionally, greater optimism was associated with fewer somatic symptoms than lower optimism when exposed to more financial stressors. Similarly, greater optimism attenuated the negative effects of greater financial stressors' severity on depressive symptoms.

CONCLUSIONS

Financial stressors are related to worse mental health among RSGM emerging adults, and optimism may mitigate these effects. Screening for lifetime financial stressors and bolstering optimism may help reduce mental health disparities related to financial stressors in this population.

Move, connect and go outside! A randomized controlled trial of two online interventions and analysis of helpful coping strategies in COVID-19 "homestayers"

The COVID-19 pandemic has led to a global health crisis and a significant increase in psychological distress and psychopathological symptoms. We conducted a randomized controlled trial with two online interventions derived from positive psychology (PP) and acceptance and commitment therapy (ACT) in N = 138 "homestayers" during the first lock-down period in Germany. PP exercises had a positive impact on anxiety scores, which decreased significantly during the intervention, particularly in participants without access to a garden. Direct or indirect social contact, movement/exercise, and exposure to nature were the most frequently reported helpful coping strategies. We conclude that low-threshold online interventions with a focus on positive aspects of people's lives may be helpful to support mental health during pandemic crises. From a mental health perspective, the results also reinforce the approach of countries that allow their citizens to, for example, still go for walks during periods of contact restrictions, compared to full lock-down conditions.

Tooth loss explains income inequalities in dementia

OBJECTIVES

Socioeconomic inequalities in oral health and dementia exist worldwide. This study investigated the mediating effects of tooth loss on the association between income and dementia.

METHODS

This study used data from the Japan Gerontological Evaluation Study, which targeted people aged ≥65 years. The explanatory variable was equivalent income in 2010. The outcome variable was dementia incidence between 2010 and 2022. Cox proportional hazard regression was used to examine the association between income and dementia incidence, adjusting for confounders. We performed causal mediation analyses to evaluate the extent to which the number of natural teeth mediates the association.

RESULTS

Among the 21,306 participants, the mean age was 73.4 years, and 53.5 % were females. The cumulative incidence of dementia was 19.7 % for people with higher incomes and 24.0 % for those with lower incomes. People with lower incomes had fewer teeth (the prevalence of having ≥20 teeth: 42.2 % in higher incomes and 31.1 % in lower incomes). Lower income was associated with dementia after adjusting for confounders (Hazard ratio (HR) [95 % confidence interval (CI)]: 1.18 [1.10; 1.26]), which was partially attenuated by controlling for the number of teeth (HR [95 % CI]: 1.17 [1.09; 1.25]). Causal mediation analysis demonstrated that the proportion mediated by the number of teeth was 6.6 %.

CONCLUSIONS

Our study found that tooth loss partially mediated the association between income and dementia. Preventing tooth loss appears to reduce inequalities in dementia among older people.

CLINICAL SIGNIFICANCE

Tooth loss has mediating effects on the association between income and dementia. Strategies for maintaining natural teeth seem effective in reducing the socioeconomic inequalities of dementia.

Evaluating the impact of financial worry on mental health: a cross-sectional study among Kenyan radiographers

BACKGROUND

Psychological distress is a major public health concern that has many influencing factors. One of them is the financial capability of an individual. Despite the integral role of radiographers in healthcare delivery, there is limited literature about radiographers in Kenya and more so regarding their mental well-being. A descriptive cross-sectional study was conducted to evaluate the effect of perceived financial worry on mental health among Kenyan radiographers.

METHODS

Data was collected from registered radiographers in Kenya through an online survey conducted between December 2023 and January 2024. Multivariable binary logistic regression was used to evaluate the association between financial worry and psychological distress.

RESULTS

Out of the 2055 radiographers invited to participate in the survey, 245 responded (11.92% response rate). The gender distribution of the respondents was 39.2% female and 60.8% male, closely mirroring the latest data on registered radiographers (37.3% female and 62.7% male). Most respondents in our study were under 30 years old (56.7%). The majority of radiographers (62.4%) reported poor social support. Additionally, most radiographers experienced some level of financial concern across various issues, with an average financial worry score of 16.75 (standard deviation: 4.97; minimum 3, maximum 24). A significant proportion (36.7%) also showed signs of psychological distress. Individuals with higher levels of financial worry were noted to be more likely to experience psychological distress after adjusting for the socioeconomic and health-related variables (adjusted odds ratio, AOR 1.20, 95% confidence interval, CI 1.10-1.31, p < 0.001). Furthermore, individuals with at least moderate social support (AOR: 0.39; 95% CI 0.18-0.86, p = 0.019) and larger families (AOR: 0.11; 95% CI 0.02-0.78, p = 0.027) were less likely to experience psychological distress compared to their peers.

CONCLUSIONS

A significant number of radiographers reported experiencing financial worry which was associated with an increased likelihood of psychological distress. This emphasizes the need for policies and mechanisms to address financial worry and psychological distress to have a more resilient medical workforce in Kenya.

Mood, Quality of Life, and Immune Fitness During the COVID-19 Pandemic of Young Adults in Germany

Background: The COVID-19 pandemic has profoundly affected young adults' lives globally, including those in Germany. This study investigated mental health and quality of life during the pandemic, with a particular focus on mood. Immune fitness, the body's capacity to respond to health challenges (such as infections) by activating an appropriate immune response, was assessed as a physical health indicator. Methods: Data were collected from 317 participants, aged 18 to 35, via an online survey conducted between November 2021 and March 2022. Participants included 103 men (32.5%) and 214 women (67.5%), with a mean age of 25.5 years (SD = 4.1). Results: Compared to pre-pandemic levels, significant declines in mood, quality of life, immune fitness, and sleep quality were observed during the lockdown periods of the COVID-19 pandemic (p < 0.0125). The most pronounced effects were observed during the second lockdown, with declines extending into the second no-lockdown period for fatigue, depression, happiness, optimism, and immune fitness (p < 0.0125). Significant sex differences were found for the magnitude of mood effects (anxiety, depression, stress). No significant differences were found according to age or occupational status (student vs. work). Conclusions: The COVID-19 pandemic and associated lockdown periods had a significant negative effect on the mood, immune fitness, and well-being of young adults living in Germany.

Prescription charge policy acceptance among UK adults with and without long-term health conditions: a mixed-method survey

OBJECTIVES

Since their introduction in 1952, per-prescribed item charges in England have continually risen. This study investigated the acceptability and impact of per-prescribed item charges, and awareness and use of initiatives designed to reduce prescription charge financial burden (the prescription prepayment certificate (PPC) initiative), in people living with and without long-term health conditions (LTHCs) in the UK.

DESIGN

Cross-sectional mixed-method survey of people with and without an LTHC across the UK.

PARTICIPANTS

381 people, 267 people with an LTHC and 114 people without an LTHC, participated.

OUTCOME MEASURES

Acceptability and impact of prescription charge policy, awareness and use of the PPC.

RESULTS

Over half (53.2 %) of participants disagreed with current per-prescribed item charges. In most domains, the impact of prescription charges did not differ between people with and without LTHCs. However, people with LTHCs were more likely to report financial burden and deviate from prescribed medication regimes. 35.29% of respondents were aware of the PPC, with people with LTHCs being more likely to be aware of and use this initiative. Qualitative findings indicate perceived inequalities in current policy with themes including (1) the need for re-evaluation; (2) the burden of prescription charges; (3) inconsistencies and inequalities in current policy; and (4) positive reflections of prescription charge policy.

CONCLUSIONS

Inconsistencies in current policy and a lack of public support may suggest that a re-evaluation of current policy is required. The lack of difference in the impact of prescription charge policy between people with and without LTHCs indicates that the effects of such policy are not constrained to people with LTHCs. Thus, policy amendments would benefit the wider population. Systematic efforts to increase awareness of the PPC and reduce inequalities in medical exemption criteria are suggested.

TRIAL REGISTRATION NUMBER

Study protocol and analysis strategy are preregistered on Open Science Framework (https://shorturl.at/IrvnS).

Harms from Other People's Gambling: Associations with an Individual's Own Gambling Behaviours, Health Risk Behaviours, Financial Problems, General Health, and Mental Wellbeing

This study aimed to explore relationships between being an 'affected other' (AO) and an individual's own gambling, health risk behaviours, financial problems, poor general health, and low mental wellbeing. A cross-sectional survey using representative and supplementary convenience samples was undertaken with 1234 residents of a British Island aged 16 + years. Being an AO was measured as having a partner or relative who has been gambling regularly in the past 12 months. PGSI was used to assess gambling severity. Health risk behaviours included: poor diet, low physical activity, daily smoking, and binge drinking. Other measures included experiencing financial problems, poor general health, and low mental wellbeing. Analyses were performed using χ2 and binary logistic regressions. 11.0% of participants were AOs. AOs were more likely to gamble at at-risk/problem-gambling levels and experience financial problems compared to those who were not affected others. The significant relationship between being an AO and low mental wellbeing was mediated by experiencing financial problems. The relationship between being an AO and engaging in two or more health risk behaviours was no longer significant after controlling for sociodemographics and an individual's own gambling. The relationship between being an AO and poor general health was no longer significant after controlling for sociodemographics, health risk behaviours and an individual's own gambling. AOs experienced risks to health and wellbeing, with findings not limited to AOs specifically with a relationship to an individual with problem-gambling. Therefore, support for AOs should be more widely available, aiming to address AOs' needs holistically.

Trajectory classes of depressive symptoms among middle-aged and older adults following the transition to living alone

This study identified the trajectory classes of depressive symptoms after transitioning to living alone and the factors affecting these trajectories. Data from the initial to the seventh waves of the Korean Longitudinal Study of Aging were analyzed, focusing on four consecutive waves. We selected 369 participants aged ≥45 who transitioned to living alone between consecutive waves (T1 and T2). They were followed up for six years (T1 to T4) while living alone from T2 to T4. Using latent class growth modeling, three trajectories emerged: low-lessening, moderate-lessening, and high-stable. The highly stable class was associated with older age, more chronic diseases, lower satisfaction with health and financial status, and less frequent social interactions at T1 than the low-lessening class. These findings underscore the importance of community-based interventions for middle-aged and older adults with risk factors as they face an increased risk of depression over time after transitioning to living alone.

A Microfinance Intervention With or Without Peer Support to Improve Mental Health Among Transgender and Nonbinary Adults (the Creating Access to Resources and Economic Support Study): Protocol for a Randomized Controlled Trial

BACKGROUND

Transgender and nonbinary (TNB) people experience economic and psychosocial inequities that make them more likely to be subject to financial and mental health harms exacerbated by the COVID-19 pandemic. Sustainable, multilevel interventions are needed to address these harms. The onset of the COVID-19 pandemic galvanized many TNB-led organizations to provide emergency financial and peer support for TNB people negatively impacted by the pandemic. However, the efficacy of these interventions has not been evaluated. The Creating Access to Resources and Economic Support (CARES) study seeks to assess the efficacy of feasible, acceptable, and community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of the COVID-19 pandemic.

OBJECTIVE

The study aims to (1) compare the efficacy of microgrants with peer mentoring with that of microgrants without peer mentoring in reducing psychological distress, (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress, and (3) explore participants' intervention experiences and perceived efficacy.

METHODS

We will enroll 360 TNB adults into an embedded, mixed methods, 3-arm, and 12-month randomized controlled trial. Participants will be randomized 1:1:1 to arm A (enhanced usual care), which will receive a single microgrant plus monthly financial literacy education, arm B (extended microgrants), which will receive enhanced usual care plus monthly microgrants, or arm C (peer mentoring), which will receive extended microgrants combined with peer mentoring. All intervention arms last for 6 months, and participants complete semiannual, web-based surveys at 0, 6, and 12 months as well as brief process measures at 3 and 6 months. A subset of 36 participants, 12 (33%) per arm, will complete longitudinal in-depth interviews at 3 and 9 months.

RESULTS

Full recruitment began on January 8, 2024, and, as of July 26, 2024, a total of 138 participants have enrolled. Recruitment is expected to be completed no later than March 31, 2025, and the final study visit will take place in March 2026.

CONCLUSIONS

This national, web-based study will demonstrate whether an intervention tailored to reduce material hardship and improve peer support among TNB adults will reduce psychological distress. Its equitable, community-academic partnership will ensure the rapid dissemination of study findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05971160; https://clinicaltrials.gov/study/NCT05971160.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63656.

Unpaid overtime and mental health in the Canadian working population

BACKGROUND

Unpaid overtime-describing a situation where extra hours are worked but not paid for-is a common feature of the labor market that, together with other forms of wage theft, costs workers billions of dollars annually. In this study, we examine the association between unpaid overtime and mental health in the Canadian working population. We also assess the relative strength of that association by comparing it against those of other broadly recognized work stressors.

METHODS

Data were drawn from a survey administered to a heterogeneous sample of workers in Canada (n = 3691). Generalized linear models quantified associations between unpaid overtime, stress, and burnout, distinguishing between moderate (1-5) and excessive (6 or more) hours of unpaid overtime.

RESULTS

Unpaid overtime was associated with higher levels of stress and burnout. Relative to those working no unpaid overtime, men working excessive unpaid overtime were 85% more likely to report stress (prevalence ratios [PR]: 1.85, 95% confidence interval [CI]: 1.26-2.72) and 84% more likely to report burnout (PR: 1.84, 95% CI: 1.34-2.54), while women working excessive unpaid overtime were 90% more likely to report stress (PR: 1.90, 95% CI: 1.32-2.75) and 52% more likely to report burnout (PR: 1.52; 95% CI: 1.12-2.06). The association of excessive unpaid overtime with mental health was comparable in magnitude to that of shift work and low job control.

CONCLUSIONS

Unpaid overtime may present a significant challenge to the mental health of working people, highlighting the potential role of wage theft as a neglected occupational health hazard.

Examining temporal trends in psychological distress and the co-occurrence of common substance use in a population-based sample of grade 7-12 students from 2013 to 2019

PURPOSE

Characterizing trends and correlates of adolescent psychological distress is important due to observed global increases over the last 20 years. Substance use is a commonly discussed correlate, though we lack an understanding about how co-occurrence of these concerns has been changing over time.

METHODS

Data came from repeated, representative, cross-sectional surveys of grade 7-12 students across Ontario, Canada conducted biennially from 2013 to 2019. Poisson regression with robust standard errors was used to examine changes in the joint association between psychological distress (operationalized as Kessler-6 [K6] scores ≥ 13) and substance use over time. Weighted prevalence ratios (PR) and their 99% confidence intervals were estimated, where p < 0.01 denotes statistical significance.

RESULTS

The prevalence of psychological distress doubled between 2013 and 2019, with adjusted increases of about 1.2 times each survey year. This biennial increase did not differ based on sex, perceived social standing, school level, or any substance use. Students using substances consistently reported a higher prevalence of psychological distress (between 1.2 times and 2.7 times higher). There were similarly no differential temporal trends based on substance use for very high distress (K6 ≥ 19) or K6 items explored individually.

CONCLUSION

Psychological distress steeply increased among adolescents and substance use remains important to assess and address alongside distress. However, the magnitude of temporal increases appears to be similar for adolescents reporting and not reporting substance use.

COVID-19-Related Financial Hardship Is Associated With Depression and Anxiety in Substance Use Treatment Across Gender and Racial Groups

ABSTRACT

Many individuals lost their employment during the COVID-19 pandemic and experienced financial hardship. These experiences may increase risk for co-occurring conditions, including substance use disorders (SUDs) and related symptoms of depression and anxiety. This study aimed to examine the associations between COVID-19-related financial hardship and/or job loss and co-occurring symptoms, across gender and racial groups. Respondents (N = 3493) included individuals entering SUD treatment in the United States in March-October of 2020. Results demonstrated that COVID-19-related financial hardship and unemployment in the household was associated with greater depression and anxiety severity among people in SUD treatment (p's < 0.05). Our findings highlight financial hardship and loss of employment as risk factors for co-occurring depression and anxiety. However, additive effects between marginalized identity status and COVID-19 economic hardship on co-occurring symptoms were not observed.

Precarious employment and mental health in the Belgian service voucher system: the role of working conditions and perceived financial strain

INTRODUCTION

Jobs in domestic cleaning are often conceived as 'precarious employment' (PE)-i.e. a multidimensional concept referring to accumulated adverse characteristics of employment due to workers' weak bargaining position. Against this background, the Belgian service voucher system (SVS) was implemented aimed at creating formal and stable, subsidized domestic services jobs.

PURPOSE

The current study assesses the relationship between PE and mental health (WHO5) in the Belgian SVS, accounting for the potential mediating role of working conditions and perceived financial strain at the household level.

METHODS

We analysed a cross-sectional sample of 1,115 Belgian SVS domestic cleaners, collected in 2019 through an online survey. A mediation model was estimated.

RESULTS

The crude effect of PE on adverse mental health was strong (ß 0.545-S.E. 0.063). However, 50% of the association between PE and mental well-being was mediated by work task characteristics (quantitative demands, physical demands, task variation and autonomy) and 25% by household-level perceived financial strain. The remaining direct effect of PE on adverse mental well-being is ß 0.066 (S.E. 0.032-25% of the total effect).

CONCLUSION

These findings are the first based on the Belgian Employment Precariousness Scale (EPRES-BE) and are consistent with earlier-made-but seldom simultaneously tested-assumptions on the mechanisms relating PE to adverse mental health-i.e. involving direct associations and indirect associations via adverse working conditions and material deprivation. Based on the results, we recommend more democratic and higher-quality management practices in the SVS, in addition to higher wages and working time reduction.

When money and mental health problems pile up: The reciprocal relationship between income and psychological distress

Background

Longitudinal studies suggest that socioeconomic status (SES) and mental health have a bidirectional relationship such that SES declines lead to a deterioration of mental health (social causation), while worsening mental health leads to SES declines (social drift). However, the dynamic relationship between income and psychological distress has not been sufficiently studied.

Methods

We use cross-lagged panel models with unit fixed effects (FE-CLPM) and data from a five-wave representative panel (n = 3103) of working-age (18-64) New York City adults. Yearly measures include individual earnings, family income (income-to-needs), and psychological distress. We also examine effects by age, gender, education, and racial/ethnic identification.

Results

We find significant bidirectional effects between earnings and distress. Increases in past-year individual earnings decrease past-month psychological distress (social causation effect [SCE], standardized β= -0.07) and increases in psychological distress reduce next-year individual earnings (social drift effect [SDE], β= -0.03). Family income and distress only have a unidirectional relationship from past-year family income to distress (SCE, β= -.03). Strongest evidence of bidirectional effects between earnings and distress is for prime working-age individuals (SCE, β= -0.1; SDE, β= -0.03), those with less than bachelor's degrees (SCE, β= -0.08; SDE, β= -0.05), and Hispanics (SCE, β= -0.06; SDE, β= -0.08). We also find evidence of reciprocal effects between family income and distress for women (SCE, β= -0.03; SDE, β= -0.05), and Hispanics (SDE, β= -0.04; SDE, β= -0.08).

Conclusions

Individual earnings, which are labor market indicators, may be stronger social determinants of mental health than family income. However, important differences in social causation and social drift effects exist across groups by age, education, gender, and racial/ethnic identities. Future research should examine the types of policies that may buffer the mental health impact of negative income shocks and the declines in income associated with worsening mental health, especially among the most vulnerable.

Material Hardship Predicts Response Bias in Loss-Averse Decisions: The Roles of Anxiety and Cognitive Control

Income poverty is associated with an enhanced tendency to avoid losses in economic decisions, which can be driven by a response bias (risk avoidance) and a valuation bias (loss aversion). However, the impact of non-income dimensions of poverty on these biases remains unclear. The current study tested the impact of material hardship on these biases, and the mediating effects of anxiety, depression, and cognitive control in these associations. Healthy adults (N = 188) completed questionnaire and behavioral measures of the variables. Results of regression-based analyses showed that participants who reported higher material hardship exhibited greater response bias, but not valuation bias. This effect was mediated by anxiety. Although material hardship predicted lower cognitive control, cognitive control did not mediate the association between material hardship and either type of bias. These findings suggest that material hardship may lead to economic decision-making biases because it impacts emotional states rather than cognitive control.

Financial satisfaction, food security, and shared meals are foundations of happiness among older persons in Thailand

The objective of this study was to investigate the association between happiness and food-related behaviours and other potential factors among older persons in Thailand. This was a cross-sectional study with multistage random sampling. In total, 1,197 older (age 60 + years) persons participated in this study. Face-to-face interviews were conducted to obtain information about socio-demographic characteristics, health status, household chores, home gardening, financial situation, family meals, and food security. Descriptive and multivariate regression analyses were performed for data analysis. The analysis found that age, health status, household chores, and home gardening were found to be significantly associated with happiness. Statistically-significant associations of financial situation, family meals, and food insecurity with happiness were also observed. People who were not dissatisfied with their financial situation were happier than people who were unhappy with their financial situation. Older people who ate every meal with a family member(s) were happiest. People who had severe food insecurity were less happy than those with food security. The findings suggest the need for investment priorities on food and nutrition with a long-term policy to ensure financial self-sufficiency and food security among older persons and their family.

Impact of the COVID-19 pandemic on army families: Household finances, familial experiences, and soldiers' behavioral health

The Coronavirus Disease 2019 (COVID-19) pandemic has significantly impacted employment and finances, childcare, and behavioral health across the United States. The Behavioral Health Advisory Team assessed the pandemic's impact on the behavioral health of U.S. Army soldiers and their families. Over 20,000 soldiers at three large installation groups headquartered in the northwestern continental U.S., Republic of Korea, and Germany participated in the cross-sectional survey. Multivariable logistic regression models indicated that key demographics (gender, rank), severity of household financial impact, changes in work situation due to childcare issues, and family members' difficulty coping (both self and spouse/partner and/or child) were independently and consistently associated with greater odds of screening positive for probable clinical depression and generalized anxiety, respectively. These findings highlight how Army families were impacted similarly by the pandemic as their civilian counterparts. Army leadership may action these findings with targeted support for soldiers and their families to ensure they are utilizing supportive services available to them, and that military services continually evolve to meet soldier and family needs during times of crisis and beyond.

Inflation hardship, gender, and mental health

Inflation hit a 40 year high in the United States in 2022, yet the impact of inflation related hardships on distress is poorly understood, particularly the impact on women, whose income is already more limited. Using data from the US Household Pulse Survey (September-November 2022), we test whether exposure to inflation hardships is associated with greater distress and whether this association is moderated by gender (n = 119,531). We draw on a list of eighteen inflation related hardships (e.g., purchasing less food, working additional jobs, delaying medical treatment) to construct an ordinal measure of exposure to inflation hardship ranging from "no inflation hardship" to "five or more inflation hardships." We observe that an increasing number of inflation hardships is associated with higher levels of distress. We find no evidence of gender differences in the magnitude of that association at lower levels of inflation hardship (four inflation hardships or less). However, our findings suggest that exposure to five or more inflation hardships is more strongly associated with distress among men compared to women. The current study provides new insights into the cumulative burden of inflation hardships on mental health and the role that gender plays in this association.

Association of Catastrophic Health Expenditure With the Risk of Depression in Chinese Adults: Population-Based Cohort Study

BACKGROUND

Depression is one of the most common mental illnesses, and it may have a lasting effect on one's whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and the risk of depression is insufficient.

OBJECTIVE

This study aimed to explore the relationship between CHE and the risk of depression among Chinese adults.

METHODS

In this study, we used 3 waves of the China Family Panel Studies (CFPS) from 2012, 2016, and 2018. The CFPS are a nationally representative study covering 25 of 31 provinces in Chinese mainland and representing nearly 94.5% of the total population. We selected eligible household heads as participants, divided them into 2 groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE), and followed them up. Households with CHE were defined as having out-of-pocket medical expenditures exceeding 40% of the total household nonfood expenditure, and people with depression were identified by the 8-item Centre for Epidemiological Studies Depression Scale (CES-D). We first described the baseline characteristics and used logistical regression to estimate their effects on CHE events. Then, we used Cox proportional hazard models to estimate adjusted hazard ratios and 95% CIs of depression among participants with CHE compared with those without CHE. Finally, we analyzed the subgroup difference in the association between CHE and depression.

RESULTS

Of a total of 13,315 households, 9629 were eligible for analysis. Among them, 6824 (70.9%) were men. The mean age was 50.15 (SD 12.84) years. Only 987 (10.3%) participants had no medical insurance. The prevalence of CHE at baseline was 12.9% (1393/9629). Participants with a higher family economic level (adjusted odds ratio [aOR] 1.15, 95% CI 1.02-1.31) and with the highest socioeconomic development level (aOR 1.18, 95% CI 1.04-1.34) had a higher prevalence of CHE than reference groups. During a median of 71 (IQR 69-72) person-months of follow-up, the depression incidence of participants with CHE (1.41 per 1000 person-months) was higher than those without CHE (0.73 per 1000 person-months). Multivariable models revealed that the adjusted hazard ratio for the incidence of depression in participants with CHE was 1.33 (95% CI 1.08-1.64), and this association appeared to be greater in participants without outpatient services (for interaction, P=.048).

CONCLUSIONS

CHE was significantly associated with increased risk of depression among Chinese adults. Concentrated work should be done to monitor CHE, and more efforts to ensure financial protection need to be made to prevent depression, especially for people with high health care needs.

Unemployment and underemployment are causes of suicide

Epidemiological studies indicate that labor underutilization and suicide are associated, yet it remains unclear whether this association is causal. We applied convergent cross mapping to test for causal effects of unemployment and underemployment on suicidal behavior, using monthly data on labor underutilization and suicide rates in Australia for the period 2004-2016. Our analyses provide evidence that rates of unemployment and underemployment were significant drivers of suicide mortality in Australia over the 13-year study period. Predictive modeling indicates that 9.5% of the ~32,000 suicides reported between 2004 and 2016 resulted directly from labor underutilization, including 1575 suicides attributable to unemployment and 1496 suicides attributable to underemployment. We conclude that economic policies prioritizing full employment should be considered integral to any comprehensive national suicide prevention strategy.

Private renters in shared housing: investigating housing conditions and mental well-being in Australia during COVID-19

Lockdowns were the major policy response to COVID-19 containment in many countries, and subsequently many people spent abnormal amounts of time at home. Research has found that housing conditions affected more peoples' mental health during the COVID-19 crisis than prior to it, and vulnerable groups were especially affected. One group that may be particularly vulnerable is private renters in shared housing. Using a socio-economic lens, our research examined to what extent mental well-being outcomes were associated with housing conditions in shared housing under COVID-19 restrictions in Australia. Data about private renters were obtained from the Australian Rental Housing Conditions Dataset (n = 1908), collected in mid-2020 during the easing of the first lockdown restrictions. Respondents living in shared arrangements reported higher levels of worry and anxiety (8.5-13.2%) and loneliness and isolation (3.7-18.3%) compared to other household types. Binary logistic regressions showed that COVID-19-related mental and financial well-being variables were the main contributors in COVID-19-related worry/anxiety and loneliness/isolation models. Accumulated housing problems were the only housing condition measure that was significant in the worry/anxiety model. Participants who had more than two people living in a household felt 1.4 times lonelier/isolated compared to those who lived with four or more people. Males and participants who reported good mental health were less likely to feel COVID-19-related worry/anxiety and loneliness/isolation. Our analysis demonstrates the importance of measures for mental health and income during a pandemic and concludes with recommendations of support for shared housing renters during and beyond crisis events.

Parents of children with hearing loss: Impact and exposure of COVID-19 on mental health

The aim of this study was to evaluate the impact and exposure of COVID-19 on parent mental health (e.g., depression, anxiety, and post-traumatic stress disorder (PTSD), for parents of children with hearing loss. The survey was distributed via an electronic survey to families subscribed to a pediatric program listserv as part of a university medical center. Fifty-five percent of parents reported elevated symptoms of anxiety, while 16% scored in the clinically significant range for depression. In addition, 20% of parents reported elevated symptoms of PTSD. Liner regressions found that impact of COVID-19 predicted anxiety symptoms, while both impact and exposure predicted depression and PTSD symptoms. In addition, both impact and exposure predicted COVID related parental distress. Exposure and impact of COVID-19 has had negative consequences on parents of children with hearing loss. Although exposure influenced parental mental health, impact uniquely affected depression and PTSD. Results highlight the need for mental health screening, as well implementation of psychological interventions using telehealth or in-person consultations. Future work should focus on post-pandemic challenges, including long-term psychological functioning due to the established relationship between parental mental health and pediatric outcomes.

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.

The COVID-19 Pandemic: Implications for Maternal Mental Health and Early Childhood Development

Women are particularly susceptible to mental health challenges during the perinatal period. With the onset of the COVID-19 pandemic in 2020, much concern was raised about the impact that the associated isolation, uncertainty, grief, loss and economic upheaval would have on mental health. Women experienced a disproportionate amount of environmental strain during this time, including economic stress and challenges associated with being essential workers; stressors were perhaps most prevalent in communities of color and immigrant groups. For women who were pregnant during the height of the pandemic, it is clear that stress, anxiety, and depression were increased due to changes in medical care and decreases in social support. Increased mental health challenges in the perinatal period have been shown to impact social-emotional, cognitive and behavioral health in infants and children, so the potential consequences of the COVID-19 era are great. This paper discusses these potential impacts and describes important pathways for future research.

Adult life-course trajectories of psychological distress and economic outcomes in midlife during the COVID-19 pandemic: evidence from the 1958 and 1970 British birth cohorts

PURPOSE

Financial adversity in times of economic recession have been shown to have an unequal effect on individuals with prior mental health problems. This study investigated the relationship between mental health groupings across the adult life-course and change in financial situation and employment status during the COVID-19 pandemic, as well as the use of financial measures to mitigate the economic shock.

METHODS

Using two nationally representative British birth cohorts, the National Child Development Study (1958) n = 17,415 and 1970 British Cohort Study n = 17,198, we identified 5 different life-course trajectories of psychological distress from adolescence to midlife which were similar but not identical across the two cohorts. We explored their relation to changes in financial and employment circumstances at different stages during the pandemic from May 2020 to March 2021, applying multinomial logistic regression and controlling for numerous early life covariates, including family socio-economic status (SES). In addition, we ran modified Poisson models with robust standard errors to identify whether different mental health trajectories were supported by government and used other methods to mitigate their financial situation.

RESULTS

We found that the financial circumstances of pre-pandemic trajectories of psychological distress with differential onset, severity, and chronicity across the life-course were exacerbated by the COVID-19 economic shock. The 'stable-high' (persistent severe symptoms) and 'adult-onset' (symptoms developing in 30s, but later decreasing) groups were vulnerable to job loss. Compared to pre-pandemic trajectory groupings with no, minor, or psychological distress symptoms in early adulthood, the 'stable-high', 'midlife-onset' (symptoms developing in midlife), and 'adult-onset' trajectory groups were more likely to seek support from the UK governments economic response package. However, trajectories with pre-pandemic psychological distress were also at greater risk of reducing consumption, dis-saving, relying on increased financial help from family and friends, and also taking payment holidays (agreements with lenders to pause mortgage, credit card or loan payments for a set period) and borrowing.

CONCLUSION

This work highlights different trajectories of pre-pandemic psychological distress, compared to groups with no symptoms were more vulnerable to pandemic-related economic shock and job loss. By adopting unsustainable mitigating measures (borrowing and payment holidays) to support their financial circumstances during COVID-19, these mental health trajectories are at even more risk of lasting adverse impacts and future economic difficulties.

Financial Hardship, Depression, and Self-Esteem: Temporal Analysis Using a Korean Panel Study

OBJECTIVE

Financial hardship influences depression risk, however, the pathway of the effect of financial hardship on depression and the role of self-esteem remain unclear. This study examined whether changes in financial hardship affected depression, and whether self-esteem mediated by this relationship.

METHODS

Data from 99,588 observations of 15,331 individuals were extracted from 10 waves of the Korean Welfare Panel Study. The association between changes in financial hardship and depression was investigated using a generalized estimation equation, and the extent to which these associations were mediated by self-esteem was assessed.

RESULTS

The results indicated that changes in financial hardship were associated with depression, with varying magnitude. Experiencing severe financial hardship over two consecutive years (odds ratio [OR]: 3.87, 95% confidence interval [CI]=3.09-4.85) or increased financial hardship over the previous year strongly influenced depression (e.g., OR: 3.88, 95% CI=3.09-4.86 for low financial hardship at t-1 year and high at t year). Self-esteem plays a mediating role in the relationship between changes in financial hardship and depression, where persistent financial hardship is associated with low self-esteem, leading to depression.

CONCLUSION

These findings highlighted the importance of monitoring and intervention for financial hardship and psychological problems to help manage depression.

More income, less depression? Revisiting the nonlinear and heterogeneous relationship between income and mental health

This paper uses a large-scale nationally representative dataset to examine the nonlinear effect of income on mental health. To investigate their causal relationship, the exogenous impact of automation on income is utilized as the instrument variable (IV). In addition, to explore their nonlinear relationship, both income and its quadratic term are included in regressions. It is found that the impact of income on mental health is U-shaped rather than linear. The turning point (7.698) of this nonlinear relation is near the midpoint of the income interval ([0, 16.113]). This suggests that depression declines as income increases at the lower-income level. However, beyond middle income, further increases in income take pronounced mental health costs, leading to a positive relationship between the two factors. We further exclude the possibility of more complex nonlinear relationships by testing higher order terms of income. In addition, robustness checks, using other instrument variables and mental health indicators, different IV models and placebo analysis, all support above conclusions. Heterogeneity analysis demonstrates that males, older workers, ethnic minorities and those with lower health and socioeconomic status experience higher levels of depression. Highly educated and urban residents suffer from greater mental disorders after the turning point. Religious believers and Communist Party of China members are mentally healthier at lower income levels, meaning that religious and political beliefs moderate the relationship between income and mental health.

To what extent do post-traumatic mental health and other problems reflect pre-existing problems? Findings from the prospective comparative population-based VICTIMS-study

BACKGROUND

Findings from prospective studies question the assumption that mental health problems observed in traumatized adults mainly reflect the effects of potentially traumatic events.

AIMS

Aim of the present comparative prospective study is to clarify the extent to which victims of potentially traumatic events with mental health, social, financial, and/or legal problems, already suffered from such problems before these events.

METHOD

Data was extracted from three surveys of the prospective VICTIMS-study (T1 = 2018, T2 = 2019, T3 = 2020), conducted with the population-based longitudinal LISS-panel. Differences between victims (n = 340, victimized by violence, accidents, and serious threats in the 12 months before T3) and nonvictims (n = 3,872, not victimized by such events in this period), were examined using multivariate logistic regression analyses.

RESULTS

The large majority of victims with current (at T3) anxiety and depression symptomatology (74%), general mental health problems (71%), partner/family (67%), financial (76%), and legal problems (58%), and lack of support (79%), already had these problems (at T1 and/or at T2). A similar pattern was observed among nonvictims. Of the victims with current probable PTSD (at T3), 87% already had any mental health problem. At T3, among both groups, the incidence of problems was substantially lower than their prevalence. The large majority of victims with post-event mental health, social, financial, and legal problems already suffered from these problems in the past.

CONCLUSIONS

When victims seek help for their problems, professional care providers should be aware that in most cases, as among nonvictims, these problems are chronic/re-current rather than new problems.

Prevalence of mental distress and associated factors among university students in Ethiopia: a meta-analysis

BACKGROUND

Mental distress is an important public health problem and is becoming common health problems among university students.

AIMS

This study aimed to provide a pooled prevalence of mental distress and associated factors among university students in Ethiopia.

METHOD

We systematically searched PubMed, EMBASE and PsycINFO databases. A further search was performed at Google Scholar search engine for additional studies. All observational studies reporting the prevalence of mental distress and/or associated factors among university students in Ethiopia were included. Pooled prevalence with 95% confidence interval (95% CI) were calculated using random effects and quality effects models. Subgroup and sensitivity analyses were performed. Heterogeneity between studies and evidence of publication bias were assessed.

RESULTS

The pooled prevalence of mental distress was 35% (95% CI; 28%-43%). Being female, participating in religious programmes, having close friends, experiencing financial distress, alcohol use, khat use, conflict with friends, lack of interest in their field of study and a family history of mental illness were factors associated with mental distress among students. We found significant heterogeneity, but no evidence of publication bias.

CONCLUSIONS

More than one third of university students in Ethiopia have suffered with mental distress. The finding provides evidence that university students are at risk population for mental health problems and suggests the need for early intervention to prevent severe mental illness.

Assessing Patient-Reported Financial Hardship in Patients With Cancer in Routine Clinical Care

PURPOSE

Financial hardship (FH) in cancer care is a growing challenge for patients, their caregivers, and health care providers with impact on morbidity and mortality. In this study, we report on a standardized approach to describe the prevalence and predictors for FH as part of routine clinical workflow. We also report on the association of FH with survival in our cancer patient population.

METHODS

This study includes patients who completed a FH screen at least once between 2018 and 2020. Demographics, disease state, and mortality data were extracted from the medical records. Multivariable logistic regression models were used to examine association of sociodemographic and disease variables with FH. By using propensity score weighting to account for differences in demographic and clinical factors between patients with and without FH, we then fit Cox proportional hazards models to examine the relationship between FH and survival.

RESULTS

The study cohort included 31,154 patients. FH was reported by 14% (n = 4,250) of the patients. A significantly higher likelihood of having FH (P < .001 for all) was reported by racial/ethnic minority patients; those who were unemployed/disabled, single, or divorced; patients from disadvantaged neighborhoods; and those who were self-pay or had government insurance. Older age, being retired, and living farther from the cancer center were associated with significantly less likelihood of endorsing FH. Patients who endorsed FH had a lower survival (hazard ratio for mortality 1.46).

CONCLUSION

Our study identified key groups more likely to report FH in a relatively affluent population at a large cancer center and showed an adverse association between FH and survival. Further research is needed to develop clinical care pathways for patients at high risk for worse financial and clinical outcomes.

Changes in Social, Economic, and Health Risk Factors Across the Lifespan during the COVID-19 Pandemic: A Latent Transition Analysis

The COVID-19 pandemic led to unique, pervasive, and changing global impacts. It is imperative to characterize groups of individuals based on modifiable factors, and to describe how groups have been impacted by the continuing pandemic in the United States to promote health and well-being and to inform preventive interventions. We used latent transition analysis to identify subgroups of modifiable psychosocial, economic, and health risk factors; to explore subgroup shifts across time; and to assess the prevalence of non-modifiable factors associated with subgroup membership. We recruited 450 participants 18 years and older living in the United States to complete a longitudinal survey exploring health during the pandemic. Participants completed three waves of data collection from April to November 2020. We used latent transition analysis to identify statuses, shifts in prevalence over three waves, and the relationships of non-modifiable covariates with each status. Five statuses were identified: high risk together, low risk together, high risk alone, low risk alone, and financial risk together. Statuses were relatively stable over time; the majority (60%-66%) of participants were in statuses categorized by multiple indicators of high modifiable risk, and the largest transitions were to lower risk subgroups. Increasing age, being male, and living in an urban area were the only non-modifiable covariates associated with status membership. It is imperative to continue to scale up targeted interventions aimed at promoting resilience, well-being, financial well-being, delays in healthcare use, food insecurity, and depression among individuals in higher-risk subgroups to promote health and well-being.

Racial differences in Financial Hardship and depressive symptoms among older adults

BACKGROUND

The purpose of this study was to examine the association between three specific indicators of financial hardship (difficulty paying bills, food insecurity, reduced medication use due to cost) and depressive symptoms by race.

METHODS

This was a cross sectional study using the Health and Retirement Study to analyze the data by conducting a logistic regression (N = 3014).

RESULTS

When stratified by race, White participants who were food insecure had nearly a 3.0 higher odds of high depressive symptoms (95% CI: 1.59-5.51) and African Americans who took less medication due to cost had a 5.1 higher odds of reporting higher depressive symptoms (95% CI: 2.30-11.2) compared to those who did not report these hardships.

CONCLUSIONS

This research highlights the important role expanded socioeconomic measures such as hardship play in the lives of older adult populations. It further elucidates the differences in the specific measures of hardship that impact older adults by race.

Association between adhesive capsulitis and depression: A five-year retrospective cohort study including 58,516 adults from Germany

BACKGROUND

Little is known on the longitudinal relationship between adhesive capsulitis and depression. Therefore, the aim of this study was to investigate the association between adhesive capsulitis and the five-year cumulative incidence of depression in adults from Germany.

METHODS

The present retrospective cohort study included all adults aged ≥18 years with a first diagnosis of adhesive capsulitis in one of 1198 general practices in Germany between January 2010 and December 2018 (index date). Patients with adhesive capsulitis were matched to those without adhesive capsulitis using a propensity score based on age, sex, index year, average number of visits per year, and diagnoses documented prior to or at the index date (i.e., thyroid gland disorders, diabetes mellitus, coronary heart disease, cerebrovascular diseases, and Parkinson's disease and secondary parkinsonism). In individuals without adhesive capsulitis, the index date was a randomly selected visit date.

RESULTS

This study included 29,258 patients with and 29,258 patients without adhesive capsulitis (mean [SD] age 55.9 [15.6] years; 53.2% men). Within five years of the index date, there were 17.5% of patients with adhesive capsulitis and 8.7% of those without adhesive capsulitis diagnosed with incident depression (log-rank p-value<0.001). This result was corroborated in the Cox regression analysis, as there was a positive and significant association between adhesive capsulitis and the cumulative incidence of depression (HR = 1.86, 95% CI: 1.78-1.95).

CONCLUSION

In this study, adhesive capsulitis was associated with an increased cumulative incidence of depression. Further research is warranted to better understand the mediating factors involved in this relationship.

Surviving in Crisis Mode: The Effect of Material Hardship and Social Support on Emotional Wellbeing Among People in Poverty During COVID-19

The COVID-19 pandemic triggered a sudden economic crisis that led to increases in hardship and poverty. Motivated by the concern that people living in long-term poverty have few reserves to draw upon in times of crisis and may experience severe consequences, this study focuses on the association between material hardship and emotional wellbeing among people in poverty. The data were collected in two waves of telephone surveys during the pandemic (n = 88). Participants for the study were recruited through social service departments in six cities in Northern Israel. The findings show that COVID-19 increased material hardship, and that material hardship has detrimental effects on the four measures of emotional wellbeing selected (stress, anxiety, depression, and physical symptoms). Informal social support has positive effects on emotional wellbeing but it does not counter the negative effects of material hardship. Policy implications are discussed.

Mental health and periodontal and peri-implant diseases

Mental health disorders, particularly depression and anxiety, affect a significant number of the global population. Several pathophysiological pathways for these disorders have been identified, including the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and the immune system. In addition, life events, environmental factors, and lifestyle affect the onset, progression, and recurrence of mental health disorders. These may all overlap with periodontal and/or peri-implant disease. Mental health disorders are associated with more severe periodontal disease and, in some cases, poorer healing outcomes to nonsurgical periodontal therapy. They can result in behavior modification, such as poor oral hygiene practices, tobacco smoking, and alcohol abuse, which are also risk factors for periodontal disease and, therefore, may have a contributory effect. Stress has immunomodulatory effects regulating immune cell numbers and function, as well as proinflammatory cytokine production. Stress markers such as cortisol and catecholamines may modulate periodontal bacterial growth and the expression of virulence factors. Stress and some mental health disorders are accompanied by a low-grade chronic inflammation that may be involved in their relationship with periodontal disease and vice versa. Although the gut microbiome interacting with the central nervous system (gut-brain axis) is thought to play a significant role in mental illness, less is understood about the role of the oral microbiome. The evidence for mental health disorders on implant outcomes is lacking, but may mainly be through behaviourial changes. Through lack of compliance withoral hygiene and maintenance visits, peri-implant health can be affected. Increased smoking and risk of periodontal disease may also affect implant outcomes. Selective serotonin reuptake inhibitors have been linked with higher implant failure. They have an anabolic effect on bone, reducing turnover, which could account for the increased loss.

Financial hardship and mental health conditions in people with underlying health conditions during the COVID-19 pandemic in Bangladesh

Background

Financial hardship is a major concern for patients who are suffering from long-term underlying health conditions. It is likely that emergencies such as the COVID-19 pandemic would impose increased financial distress and lead to the development or exacerbation of mental health conditions.

Objective

The present study aimed to explore the relationship between financial hardship and mental health conditions (loneliness, anxiety, and depression) among patients with underlying health conditions in Bangladesh.

Methods

An e-survey based cross-sectional study was conducted among purposively selected 971 patients (50.1% male; mean age = 42.29 [SD = 15.86]) with underlying health conditions between November 2020 and January 2021. Depression, anxiety, and loneliness were measured using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and UCLA loneliness scale, respectively. Multiple logistic regression analyses were performed to determine any associations between financial hardship and mental health conditions (loneliness, anxiety, and depression).

Results

46.2% of participants reported experiencing financial difficulties, and a number of respondents (12.3%) had lost their jobs during the COVID-19 pandemic. The prevalence of anxiety, depression and loneliness were 35.2%, 38.9%, and 47.68%, respectively. In the multiple logistic regression analysis, age, gender, occupation, marital status, monthly income, self-reported health status and financial hardship were significantly associated with mental health conditions.

Conclusions

Mental health problems were prevalent among people with underlying health conditions and were also associated with financial difficulties. The findings suggest that care facilities should be strengthened by including psychosocial support components delivered with lower costs, particularly for patients with underlying health conditions.

Impact of income on mental health during the COVID-19 pandemic: Based on the 2020 China family panel survey

Since December 2019, the COVID-19 has continued to rage, and epidemic prevention policies have limited contact between individuals, which may has a great influence on the income of individuals, exacerbate anxiety and depression, and cause serious mental health problems. The current study aims to examine the association between income and mental health during the COVID-19 pandemic by using the data of 9,296 observations from the 2020 China Family Panel Studies. Employing ordinary least squares regression and two-stage least squares regression, we find the significant positive effect of income on Chinese mental health during this pandemic. In addition, the number of cigarettes smoked per day has significant negative effects on mental health. Education levelˎmarriage and exercise frequency have significant positive correlation with mental health. Furthermore, the impact of income on individuals of different groups is heterogeneous during this pandemic. The impact of income for well-educated individuals is less strong than their less-educated counterparts. People who exercise regularly respond less strongly to changes in income than those who do not exercise. Finally, individuals’ salary satisfaction and interpersonal relationship are shown to be the potential mechanism for the effect of income on Chinese mental health.

Low income and schizophrenia risk: a narrative review

Despite decades of research, the precise etiology of schizophrenia is not fully understood. Ample evidence indicates that the disorder derives from a complex interplay of genetic and environmental factors during vulnerable stages of brain maturation. Among the plethora of risk factors investigated, stress, pre- and perinatal insults, and cannabis use have been repeatedly highlighted as crucial environmental risk factors for schizophrenia. Compelling findings from population-based longitudinal studies suggest low income as an additional risk factor for future schizophrenia diagnosis, but underlying mechanisms remain unclear. In this narrative review, we 1) summarize the literature in support of a relationship between low (parental) income and schizophrenia risk, and 2) explore the mediating role of chronic stress, pre- and perinatal factors, and cannabis use as established risk factors for schizophrenia. Our review describes how low income facilitates the occurrence and severity of these established risk factors and thus contributes to schizophrenia liability. The broadest influence of low income was identified for stress, as low income was found to be associated with exposure to a multitude of severe psychological and physiological stressors. This narrative review adds to the growing literature reporting a close relationship between income and mental health.

The longitudinal relationships among poverty, material hardship, and maternal depression in the USA: a latent growth mediation model

This study aims to understand the direct and indirect effects of poverty trajectories on maternal depression trajectories mediated by material hardship trajectories. A latent growth mediation model was tested using a predominantly low-income and mostly unmarried sample of mothers from the Fragile Families and Child Wellbeing Study, a national birth cohort of racially diverse mothers (N = 3999). Measures included family poverty, material hardship, and maternal depression from 5 waves of data which tracked mothers starting 1 year after childbirth until the child reached 15 years of age. The results revealed that (1) family poverty was associated with material hardship and maternal depression, and material hardship was related to maternal depression at the trajectory level and the rate of change, with the exception of the relationships between the rate of change in family poverty and the rate of change in maternal depression; (2) material hardship mediated the relationship between family poverty and maternal depression at the initial trajectory levels, and the rate of change in material hardship fully mediated the relationship between the rate of change in poverty and the rate of change in maternal depression. This study provides further evidence that alleviating material hardship might be a promising avenue to reducing maternal depression.

Parenting practices, stressors and parental concerns during COVID-19 in Pakistan

BACKGROUND

COVID-19 is a global crisis that has added fear, uncertainty, and stress to parents. Parents are going through several challenges related to school closure, financial insecurity and working remotely. These stressors are affecting the mental health of parents.

OBJECTIVES

This study aimed to observe major stressors along with the impact of COVID-19 on parental concerns and practices during lockdown.

PARTICIPANTS

Sample (N = 923) was selected through purposive sampling from parents attending Out Patients Departments of hospitals in three provincial capital cities of Pakistan having a high burden of COVID-19, i.e. Lahore, Karachi and Peshawar. Parents having at least one child younger than 18 years were included in the study.

METHODS

A quantitative design was used using a COVID-19 Parenting Response Scale (α = 0.74). It was used as a self-administered tool for parents who knew how to read and write Urdu/English language, however it was conducted as a structured interview for those who could not read/write. Data was analyzed by applying descriptive statistics (frequency, mean, percentage), independent sample t-test and Pearson Product Moment Correlation.

RESULTS

Findings of the current study showed several stressful factors for parents during COVID-19 pandemic, mainly financial burden, children's education, uncertainty of the situation, and many others. The study also suggests an association of parental concerns during COVID-19 with parenting practices.

CONCLUSION

COVID-19 pandemic presents a global crisis not only of the health of the people but also on family relations and mental well-being. Findings of this research indicate the need for targeted and accessible interventions for mental health of parents especially during these challenging circumstances so that they can cope with the challenges in an effective way and be able to take care of their children better.

Financial Hardship Impacts Depression and Anxiety Among U.S. Patients with Sinusitis

BACKGROUND

Mental health conditions are common in the United States, and recent efforts have examined the development of mental health conditions among patients with sinusitis.

OBJECTIVES

The purpose of this study was to investigate the association between depression, anxiety, and financial hardship among patients with sinusitis.

METHODS

Cross-sectional study using the 2018 National Health Interview Survey (NHIS). Data regarding demographics, perceived financial hardship, self-reported depression and anxiety, mental healthcare utilization, and treatment compliance were obtained.

RESULTS

Among patients with sinusitis (N = 28 million adults), 9% reported depression and 24% reported anxiety. Sinusitis patients with depression and anxiety reported an increased severity of financial insecurity (p < 0.001). On multivariable logistic regression, worsening financial insecurity increased the odds of depression and anxiety. Patients reporting the highest financial insecurity severity had the highest odds of depression (OR = 3.88, 95% CI = 3.84-3.93, p < 0.001) and anxiety (OR = 2.09, 95% CI = 2.08-2.10, p < 0.001) among measures of financial stress. Specific financial stressors were independently associated with patient-reported depression and anxiety. Sinusitis patients with increased financial insecurity were more likely to require mental health services and treatment (p < 0.001), but were also more likely to report cost-related treatment noncompliance (p < 0.001) and reduced access to mental healthcare due to costs (p < 0.001).

CONCLUSION

Perceived financial hardship is associated with self-reported depression and anxiety among patients with sinusitis. Sinusitis patients with financial hardship also face challenges in accessing and maintaining mental health services and treatment due to costs. Understanding the burden of financial insecurity on mental health and access to treatment may improve quality of care through the development of screening tools and individualized treatment strategies.

Protecting mental health during periods of financial stress: Evidence from the Australian Coronavirus Supplement income support payment

This paper investigates whether the Australian government's Coronavirus Supplement, a temporary income support payment for unemployed jobseekers during the height of the COVID-19 pandemic, protected mental health (frequency of feeling anxious or depressed during the past week) by lowering financial stress (how comfortable people are in paying for essential services). We use unique nationally representative repeated cross-sectional data on 3843 unemployed Australian adults over the period April 6, 2020 to May 10, 2021. We find that the Coronavirus Supplement payment significantly reduced reported financial stress, and lower financial stress was associated with lower mental distress. Though the Coronavirus Supplement was designed to reduce financial stress, we find the Supplement was also successful in protecting community mental health indirectly via its ability to reduce financial stress. The findings provide support for income support packages to protect mental health during economic shocks. However, transitory support measures also tend have short-lived positive effects on mental health, suggesting that more permanent income support reform may have longer-term mental health benefits.

How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis

BACKGROUND

Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16-64 years).

METHODS

For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379.

FINDINGS

Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (-0·30 to -0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I²=79-87%). GRADE certainty was low or very low.

INTERPRETATION

Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged.

FUNDING

Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.

COVID Feel Good: Evaluation of a Self-Help Protocol to Overcome the Psychological Burden of the COVID-19 Pandemic in a German Sample

The COVID-19 pandemic has severe consequences for physical as well as mental well-being. In times of restricted social contact, online self-help programs offer a low-threshold first aid to cope with the psychological burden. This current study evaluates the online self-help protocol “COVID Feel Good” in a German sample. The multicentric study was designed as a single cohort with a waiting list control condition. The convenience sample consisted of 38 German individuals who experienced at least two months of restrictions during the COVID-19 pandemic. The 7-day self-help protocol included the VR video “Secret Garden” as well as a social or cognitive exercise each day. General distress, depression, anxiety, stress, and hopelessness were assessed as primary outcomes. Social connectedness and fear of coronavirus were measured as secondary outcomes. Results showed a significant decrease in all primary outcomes except for hopelessness. Furthermore, the results indicated a significant improvement in social connectedness. Treatment effects on general distress, depression, stress, and anxiety persisted for two weeks after participation. The present study indicates that VR-based self-help protocols can mitigate the psychological burden associated with the pandemic, supporting recent findings.

The link between food insecurity and psychological distress: The role of stress exposure and coping resources

This study examines the association between food insecurity and mental health over a 3-year period. It also assesses the salience of life stressors and psychosocial coping resources for this association. We utilize data from a two-wave community survey of Miami-Dade County, Florida residents (N = 1488). Findings from SEM analysis reveal that greater food insecurity at W1 is associated with greater depressive symptoms at W2, lending credence to characterizations of food insecurity as a chronic stressor. This association is partly mediated by variation over the study period in social support and mastery. However, no significant mediating effects are observed for the social stress indicators assessed. Food insecurity is associated with diminished psychosocial coping resources, which leads to greater psychological distress. We discuss how these findings extend a stress and coping model of food insecurity, and implications for research and practice.

Prevalence and determinants of probable depression and anxiety during the COVID-19 pandemic in seven countries: Longitudinal evidence from the European COvid Survey (ECOS)

BACKGROUND

Our aim was to present data on the prevalence of probable depression and anxiety and to determine their correlates during the COVID-19 pandemic in seven European countries using a longitudinal approach.

METHODS

Longitudinal data (wave 4 in November 2020: n = 7,115; wave 5 in January 2021: n = 7,068; wave 6 in April 2021: n = 7,204) were taken from the European COvid Survey (ECOS), a representative sample of non-institutionalized inhabitants from Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy aged 18+. Probable depression and anxiety were quantified using the established and validated PHQ-4 (2-item depression scale, PHQ-2 / 2-item anxiety scale, GAD-2).

RESULTS

In wave 4 (wave 5; wave 6), 26.6% (25.5%; 23.8%) of all respondents had probable depression and 25.7% (23.6%; 22.1%) had probable anxiety. Prevalence rates for probable depression and probable anxiety differed significantly between countries. Among all countries and waves, particularly high prevalence rates were found among individuals aged 18 to 29 years. Longitudinal analysis showed that the likelihood of probable depression was positively associated with increasing age, great income difficulties and lower health-related quality of life. The likelihood of probable anxiety was positively associated with income difficulties, and lower health-related quality of life.

LIMITATIONS

Screening tool was used to quantify the outcomes.

CONCLUSION

The magnitude of probable depression and anxiety during the COVID-19 pandemic in European countries was highlighted. Moreover, determining the factors associated with probable depression or anxiety (e.g., income difficulties, worse health-related quality of life) may assist in identifying individuals at increased risk.

Material Hardships, Perceived Stress, and Health among Low-Wage Hospital Workers

Many service, clerical, and technical hospital workers deemed essential during the pandemic have wages that do not reflect the essential nature of their work and do not earn enough income to cover basic expenses. Thus, many experience material hardships related to food, housing, and medical care. Previous studies have shown strong relationships between material hardships and health; however, they do not fully explain the role of stress as an intervening mechanism. This cross-sectional study analyzes an online survey with 257 lower-wage hospital workers to examine the relationships between hardships and health, and how perceived stress mediates these relationships. Path analysis revealed that financial and food hardships were related to mental health through perceived stress, while medical hardship was directly associated with physical health. These findings add to the evidence that workers' hardships either directly or indirectly contribute to negative mental and physical health outcomes through perceived stress. Future investigations should further examine relationships among material hardships, stress, and health, and advocacy efforts should focus on raising wages for essential hospital workers.