The Relationship Between Financial Worries and Psychological Distress Among U.S. Adults

Mapping computational cognitive profiles of aging to dissociable brain and sociodemographic factors

Aging is associated with declines in cognition and brain structural integrity. However, there is equivocality over (1) the specificity of affected domains in different people, (2) the location of associated patterns of brain structural deterioration, and (3) the sociodemographic factors contributing to 'unhealthy' cognition. We aimed to identify cognitive profiles displayed by older adults and determine brain and sociodemographic features potentially shaping these profiles. A sample of Southeast-Asian older adults (N = 386) participated in a multi-session study comprising cognitive testing, neuroimaging, and a structured interview. We used computational models to extract latent mechanisms underlying cognitive flexibility and response inhibition. Data-driven methods were used to construct cognitive profiles based on standard performance measures and model parameters. We also investigated grey matter volume and machine-learning derived 'brain-ages'. A profile associated with poor set-shifting and rigid focusing was associated with widespread grey matter reduction in cognitive control regions. A slow responding profile was associated with advanced brain-age. Both profiles were correlated with poor socioeconomic standing and cognitive reserve. We found that the impact of sociodemographic factors on cognitive profiles was partially mediated by total grey and white matter, and dorsolateral prefrontal and cerebellar volumes. This study furthers understanding of how distinct aging profiles of cognitive impairment uniquely correspond to specific vs. global brain deterioration and the significance of socioeconomic factors in informing cognitive performance in older age.

Stress and Quality of Life of Parents of Children With POLR3-Related Leukodystrophy: A Cross-Sectional Pilot Study

Background: RNA polymerase III (POLR3)-related leukodystrophy is a rare, neurodegenerative disorder characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism. Despite the challenges of caring for a child with POLR3-related leukodystrophy, few studies have examined parents' disease burden. We sought to investigate quality of life and stress levels amongst parents of children with POLR3-related leukodystrophy. Methods: 43 parents of 32 children completed questionnaires on demographics, stress, quality of life, coping mechanisms, and experience of injustice. Detailed clinical data was collected from all patients. Results: Mothers (t[27] = -8.66, P < .001) and fathers (t[16] = -4.47, P < .001) had lower quality of life scores compared to the normative population, yet 80% of parents' stress scores fell within the normal stress range. Parents' experience of injustice scores were high (>60). Correlations were found between and within parents' scores. Years since disease onset and certain life circumstances correlated to mothers' quality of life scores; however, no correlation was found between modifiable factors and fathers' quality of life scores. Helpful coping mechanisms included those that allowed parents to be involved in their child's life. Conclusions: This is the first study to assess stress and quality of life in this population. These results shed light on the importance of implementing services and social support to improve the well-being of parents.

The Impact of Closing Medicare Part D Coverage Gap on Mental Health of Adults Over Age 65

Using Medical Expenditure Panel Survey data from 2006 to 2019, this study assessed the effect of closing Medicare Part D coverage gap on mental health of older adults. We employed difference-in-differences and compared mental health outcomes of older adults on Medicare with those on private insurance before and after the 2011 policy change. Findings showed a 0.447-point reduction in the Kessler Index 6 (K-6) score after closure. These findings were mainly attributable to women, Hispanics, individuals with multiple chronic conditions, and those in Traditional Medicare. A reduction in out-of-pocket (OOP) expenditures appeared to be the primary mechanism for this finding. Our analysis was robust to several specifications, including using different measures of mental health and alternate constructions of treatment and control groups. The closure of the Medicare Part D coverage gap improved mental health among beneficiaries, potentially by reducing financial strain associated with high OOP expenditures.

Impact of Individual Budgets on Work and Financial Well-Being of Supported Employment Recipients With Serious Mental Illness

OBJECTIVE

The authors sought to determine whether providing recipients of supported employment with individual budgets from which they could purchase employment-related goods and services would improve employment and financial outcomes.

METHODS

Sixty study participants were recruited from an individual placement and support (IPS) program and randomly assigned (1:1) to receive IPS services only (N=32) or IPS services with a 12-month $950 flexible fund called a career account (N=28). Participants receiving IPS and a career account met with staff who helped them identify employment goals and create a budget for purchases directly tied to these goals. The primary outcome was competitive employment; secondary outcomes included job tenure, days worked, total earnings, and financial well-being. Outcomes were analyzed by using adjusted generalized linear models (GLMs) with binary logistic, negative binomial, and linear distributions.

RESULTS

The proportion of participants who achieved competitive employment was largely similar for those in the career account+IPS group (54%) and in the IPS-only group (47%). However, the GLM analysis revealed that career account+IPS participants had significantly longer job tenure, more total days of employment, and higher total earnings than IPS-only participants. Feelings of financial well-being increased significantly among career account participants, whereas financial well-being declined among control participants. The amount of career account dollars participants spent was positively and significantly associated with longer job tenure, more days employed, and higher total earnings.

CONCLUSIONS

Combining flexible funds with IPS-supported employment achieved some superior outcomes compared with IPS only. Further research is needed to assess the longer-term effects of this practice and its cost-effectiveness.

Coping strategies mediated the relationship between perceived stress and hair cortisol among socioeconomically marginalized parents

Objective

This study aimed to (1) examine coping strategies and their relationship with demographics, perceived stress, and hair cortisol; and (2) explore whether coping partially mediated the relationship between perceived stress and hair cortisol.

Methods

Baseline data from 191 socioeconomically marginalized parents enrolled in two community-based clinical trials were used. The IBM SPSS Statistics Version 27 and Mplus Version 8 were used for data analyses.

Results

Parents' engagement in various coping strategies differed by age, ethnicity, race, marital status, education level, and number of children living in the household. Parents' use of problem-focused (instrumental support, planning), emotion-focused (venting, self-blame), and avoidant coping (self-distraction, denial, behavioral disengagement) increased from having low to moderate stress. However, when perceived stress increased from moderate to high, their use of emotion-focused and avoidant coping increased significantly, but problem-focused coping did not. Emotion-focused coping lowered the influence of perceived stress on hair cortisol, while avoidant coping increased the relationship between perceived stress and hair cortisol.

Conclusions

Although needing future investigation with longitudinal studies, the results suggest the need of promoting adaptive emotion-focused coping (emotional support, venting, and humor) to help socioeconomically marginalized parents manage their appraised overwhelming and uncontrollable stressors of food, house, and income insecurity.

A longitudinal study on impact of emergency cash transfer payments during the COVID pandemic on coping among Australian young adults

The coronavirus (COVID-19) pandemic has caused financial hardship and psychological distress among young Australians. This study investigates whether the Australian Government's emergency cash transfer payments-specifically welfare expansion for those unemployed prior to the pandemic (known in Australia as the Coronavirus Supplement) and JobKeeper (cash support for those with reduced or stopped employment due to the pandemic)-were associated with individual's level of coping during the coronavirus pandemic among those with and without mental disorders (including anxiety, depression, ADHD and autism). The sample included 902 young adults who participated in all of the last three waves (8, 9C1, 9C2) of the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Modified Poisson regression models were used to assess the impact of emergency cash transfer payments on 18-22-year-old's self-rated coping level, stratifying the analysis by those with and without mental disorders. All models were adjusted for gender, employment, location, family cohesion, history of smoking, alcohol intake, and COVID-19 test result. Of the 902-person sample analysed, 41.5% (n = 374) reported high levels of coping, 18.9% (n = 171) reported mental disorders, 40.3% (n = 364) received the Coronavirus Supplement and 16.4% (n = 148) received JobKeeper payments. Analysing the total sample demonstrated that participants who received the JobKeeper payment were more likely to have a higher level of coping compared to those who did not receive the JobKeeper payment. Stratified analyses demonstrated that those with pre-existing mental disorder obtained significant benefit from the JobKeeper payment on their level of coping, compared to those who did not receive JobKeeper. In contrast, receipt of the Coronavirus Supplement was not significantly associated with higher level of coping. Among those with no mental health disorder, neither the Coronavirus Supplement nor JobKeeper had a statistically significant impact on level of coping. These findings suggest the positive impacts of cash transfers on level of coping during the pandemic were limited to those with a pre-existing mental disorder who received JobKeeper.

Health and non-health benefits and equity impacts of individual-level economic relief programs during epidemics/pandemics in high income settings: a scoping review

BACKGROUND

Economic relief programs are strategies designed to sustain societal welfare and population health during a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity.

METHODS

We conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3, 2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and economic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in duplicates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach.

RESULTS

We identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19 and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9) were most common. Individual-level economic relief programs were reported to have varying degrees of impact on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave programs had the highest number of studies reporting health-related outcomes and positively impacted public health measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services). Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food security, financial resilience, and job security.

CONCLUSIONS

Our findings suggest that individual-level economic relief programs can have significant impacts on public health measures, population health outcomes and equity. As countries prepare for future pandemics, our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal when designing pandemic preparedness policies.

Association between financial hardship and psychological burden and the role of social and mental health support: An observational study

We aimed to assess the association between medical financial hardship and psychological burden and the moderating role of social and mental health support. 2021 United States National Health Interview Survey was used. Financial hardship was defined as having financial worry, material hardship, or cost-related care nonadherence. Psychological burden was measured using perceived general health status, satisfaction with life, and serious psychological distress (SPD). Of 29,370 included adults, 49% experienced financial hardship in the last 12 months. Financial hardship was associated with a higher psychological burden (odds ratio [OR], 3.58; 95% confidence interval [CI], 2.43-5.47 for SPD). Eleven percent received counseling/therapy from mental health professionals, and 90% had experienced frequent social support. Frequent social support was associated with lower financial hardship (OR, 0.71; 95% CI, 0.63-0.80) and psychological burden (OR, 0.28; 95% CI, 0.19-0.42 for SPD). Previous mental health support was associated with higher financial hardship (OR,1.40; 95% CI, 1.28-1.54) and psychological burden (OR, 9.75; 95% CI, 6.97-13.94 for SPD). Those experiencing financial hardship had lower odds of SPD if they received mental health support in the last 12 months (OR, 0.57; 95% CI, 0.39-0.85). Future interventions should also focus on improving social support and mental health for patients as a way of mitigating medical financial hardship.

The Associations Between Physical Activity and Mental Health Problems in Middle-aged Indonesians

OBJECTIVES

Mental health issues have become a growing concern worldwide. Research has shown that regular physical activity (PA) can positively affect mental health. This study investigated the associations between PA and mental health problems (MHPs) in middle-aged Indonesians.

METHODS

The study utilized data from the 2018 Indonesian Basic Health Research Survey and used a cross-sectional approach. The participants included individuals aged 40-60 years who completed the 20-question Self-Reporting Questionnaire. A logistic regression was performed to analyze a sample of 263 930 data points.

RESULTS

Nearly 10.4% of the participants suffered from mental health issues. Notably, among those who did not engage in moderate and vigorous PA, a sign of MHPs was found in 12.5% of participants. Those who met World Health Organization standards for PA were less likely to experience MHPs (10.1%). This study found a significant association between PA and mental health. After adjusting for smoking, alcohol consumption, non-communicable diseases, and socio-demographic variables like age, sex, education, occupation, marital status, and residence, the connection between PA and mental health became even stronger (adjusted odds ratio, 0.81; 95% confidence interval, 0.78 to 0.85; p<0.001).

CONCLUSIONS

Regular PA has been shown to affect mental health positively. Therefore, it is important to improve health education and efforts to raise awareness among middle-aged Indonesians about the importance of PA in maintaining good mental health.

Social Impacts of the COVID-19 Pandemic on Women's Health in the Greater Los Angeles Area

Background: Since the COVID-19 pandemic started, women have experienced more job loss owing to an increase in household and caregiving responsibilities. Gender inequities coupled with pandemic-related stressors have resulted in poor health outcomes among women. Globally, women have reported higher levels of anxiety, depression, and stress in response to the pandemic. Evidence suggests that social determinants of health have contributed to women's poor health outcomes. Materials and Methods: We used the Understanding America Study to describe the social impacts women have experienced during the COVID-19 pandemic when compared with men and to explore the association between partnership status and social impacts in Los Angeles. We hypothesize that women experienced greater social impacts than men and that partnership status modified these social impacts. Results: In a sample of predominantly racial and ethnic minorities, we found that women experienced more social impacts related to housing insecurity compared with men. When exploring how partnership status modified these social impacts, we found that women without partners experienced more social impacts specific to financial hardships when compared with women who were in a partnership. Conclusions: It is likely that the COVID-19 relief efforts helped women mitigate social impacts but not housing or financial security. The overall goal is to inform policies so that better measures can be implemented to prepare for the next public health disaster or global health threat.

Raising Hopes, Facing Challenges: Understanding Parental Well-Being in the Midst of Autism in Saudi Arabia

BACKGROUND

This study aimed to investigate the levels of anxiety, depression, and quality of life among parents of children with autism spectrum disorder. It also compared the difference in these levels between mothers and fathers. Additionally, it quantifies the association between parental anxiety, depression, and quality of life, with various sociodemographic factors.

METHODS

This analytical, cross-sectional study was carried out between June and December 2022. An online questionnaire was completed by a sample of 394 parents of children with ASD (autism spectrum disorder) residing in Saudi Arabia. Three scales were used to assess depression, anxiety, and quality of life (QoL), respectively: Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF).

RESULTS

Most parents (70.8%) were mothers with an average age of 39 years, typically ranging from 30 to 48 years. Parents' overall quality of life was 57.72 out of 100, indicating moderate satisfaction. Anxiety levels showed that 32% had mild, 17.8% moderate, and 14.7% severe anxiety. Similarly, depression levels revealed that 34.5% had minimal, 32.2% mild, and 18% moderate depression. Higher anxiety and depression scores were linked to a lower perceived QoL (quality of life). Moreover, the socioeconomic status index (SESi) was significantly and positively correlated with higher depression and lower quality of life.

CONCLUSIONS

Autism Spectrum Disorder imposes a strain on parents of the autistic child. The responsibilities linked to the disability amplify the occurrence of depression and anxiety among parents, leading to a diminished quality of life.

Psychological distress and sleep quality among Sri Lankan medical students during an economic crisis

OBJECTIVES

This study examined the evidence of the prevalence of psychological distress and poor sleep among medical students and its associations during an economic crisis.

DESIGN

This was a cross-sectional study using an online questionnaire. It included the Depression Anxiety Stress Scales and Pittsburgh Sleep Quality Index (PSQI).

SETTING AND PARTICIPANTS

This study included medical undergraduates from a large metropolitan university in Sri Lanka.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed the prevalence of psychological distress, sleep quality, and factors associated with psychological distress. To evaluate the associations, we used logistic regression.

RESULTS

The majority (69.2%) had some form of distress (depression, anxiety or stress), while 23% had distress in all three. Anxiety was the most prevalent (50.7%). Poor sleep quality was reported in 41%. The highest contribution to global PSQI was from sleep latency, duration, and daytime dysfunction subscales. In bivariate analysis, sleep quality was directly related to depression (t245.65 = -6.75, p<0.001)., anxiety (t313.45 = -6.45, p <0.001), and stress (t94.22 = -5.14, p <0.001). In multinomial logistic regression models, sleep quality was independently associated with depression, anxiety and stress. In addition, frequent contact with friends was inversely associated with depression and anxiety. Also, social media use was inversely linked to depression, anxiety and stress. Clinical-year students had lower depression and anxiety than non-clinical students. Engaging in mindfulness activities was inversely associated with depression. However, models explained only a moderate amount of variance (Nagelkerke R-squared values were 0.21, 0.18, and 0.13 for depression, anxiety and stress, respectively).

CONCLUSIONS

Poor sleep quality and psychological distress are high among the undergraduates. The findings emphasize the importance of addressing sleep quality and psychological wellbeing in medical undergraduates. Further research with larger and more diverse samples is needed for a more comprehensive understanding of the factors associated with psychological distress among undergraduates.

Do the benefits of homeownership on mental health vary by race and poverty status? An application of doubly robust estimation for causal inference

While empirical studies have observed that homeownership is associated with improved mental health conditions, research indicates that this relationship might vary by race. Moreover, such a White-Black disparity in the impacts of homeownership on mental health could be complexed by poverty status, as maintaining one's homeownership could be a financial burden for people living in poverty status, defined by the US official poverty threshold. We add to the existing literature by analyzing the impacts of homeownership on psychological distress, simultaneously disaggregating by race and poverty status using survey data from the Panel Study on Income Dynamics from the 2017 and 2019 waves (N = 7059). Propensity score weighting and doubly robust estimation are applied to estimate causal inference for the impact of 2017 homeownership on 2019 psychological distress using negative binomial models. First, we found the impacts of homeownership on reducing psychological distress are significant for White Americans, not for Black Americans. Second, we found such a White-Black disparity is only observable for populations not living in poverty. On the other hand, for populations living in poverty, homeownership no longer lowers psychological distress for either race. Findings suggest that financial support and mental health support are needy to address inequality in the impacts of homeownership on mental health, which could simultaneously vary by poverty status and race. Implications are discussed.

Unveiling the patterns: exploring social and clinical characteristics of frequent mental health visits to the emergency department-a comprehensive systematic review

BACKGROUND

Frequent presenters (FPs) are a group of individuals who visit the hospital emergency department (ED) frequently for urgent care. Many among the group present with the main diagnosis of mental health conditions. This group of individual tend to use ED resources disproportionally and significantly affects overall healthcare outcomes. No previous reviews have examined the profiles of FPs with mental health conditions.

AIMS

This study aims to identify the key socio-demographic and clinical characteristics of patients who frequently present to ED with a mental health primary diagnosis by performing a comprehensive systematic review of the existing literature.

METHOD

PRISMA guideline was used. PubMed, PsycINFO, Scopus and Web of Science (WOS) were searched in May 2023. A manual search on the reference list of included articles was conducted at the same time. Covidence was used to perform extraction and screening, which were completed independently by two authors. Inclusion and exclusion criteria were defined.

RESULTS

The abstracts of 3341 non-duplicate articles were screened, with 40 full texts assessed for eligibility. 20 studies were included from 2004 to 2022 conducted in 6 countries with a total patient number of 25,688 (52% male, 48% female, mean age 40.7 years old). 27% were unemployed, 20% married, 41% homeless, and 17% had tertiary or above education. 44% had a history of substance abuse or alcohol dependence. The top 3 diagnoses are found to be anxiety disorders (44%), depressive disorders (39%) schizophrenia spectrum and other psychotic disorders (33%).

CONCLUSION

On average, FPs are middle-aged and equally prevalent in both genders. Current data lacks representation for gender-diverse groups. They are significantly associated with high rates of unemployment, homelessness, lower than average education level, and being single. Anxiety disorder, depressive disorder, and schizophrenia spectrum disorders are the most common clinical diagnoses associated with the group.

Hope, resilience and subjective happiness among general population of Paraguay in the post COVID-19 pandemic

BACKGROUND

Positive mental health includes not only the absence of mental disorders but also the presence of subjective well-being, good coping strategies for life stress, and strategies for adapting to community life. It is well known that the COVID-19 pandemic has challenged mental health in general population worldwide. However, research has not measured protective factors for mental health in the general population after the declared end of pandemic by the World Health Organization.

METHODS

This observational, cross-sectional study surveyed 591 Paraguayan participants aged ⩾18 years, who were recruited through an online survey. Demographic characteristics, socioeconomic status were collected as well as mental health and validated tools for hope, resilience, subjective happiness were administered.

RESULTS

Of the participants, 81.6% were women, 54% were married or in a relationship and 90.7% reported an university education. The main source of stress was economic issues (30.3%). A total of 22.7% had been previously diagnosed with a mental disorder, 22.2% had consulted a mental health professional and 10.8% had consumed prescription drugs. 42.6% reported flourishing, 36.2% reported moderate and 21.2% reported languishing mental health.

CONCLUSIONS

This large survey has shown that most of participants reported a flourishing mental health with high ratings at hope, resilience, and subjective happiness scales. Also, the main sources of stress were economic issues, not consequently related to the pandemic. This may add evidences to the international debate on the long term effects of the global pandemic and probably suggests that recovery processes have been collectively adopted in Paraguay.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

The mediating role of depression in the association between perceived financial wellbeing and somatization: a study in the context of Lebanon's financial crisis

The objectives of this study were to examine the association between financial wellbeing and somatization, in addition to the mediating effect of anxiety, depression and stress. To test such hypotheses, a cross-sectional study was carried out between September and October 2021; 403 participants (264 females; age = 32.76 ± 13.24 years) were recruited. Depression mediated the association between financial wellbeing and somatization. A worse financial wellbeing was significantly associated with more depression, which was associated with more somatization. Moreover, a worse financial wellbeing was significantly and directly associated with more somatization. Our study adds to the narrow body of research revolving around the relationship between financial wellbeing and somatization in Lebanese adults. Understanding that the effects of, depression are aggravated in a country such as Lebanon would help establish more preventative guidelines and mental health awareness campaigns. Identifying the correlates of somatization can also be translated into improved interventions.

Evaluating the Quality of Life of Beneficiaries After Providing Financial Aid by a Multi-specialty Tertiary Care Hospital

Background Financial aid programs offered by multi-specialty tertiary care hospitals play a crucial role in ensuring equitable access to healthcare. This study investigates the effect of financial aid on the quality of life (QoL) of beneficiaries, aiming to provide a comprehensive understanding of the multifaceted relationship between healthcare support and overall well-being. Aim The study's objectives included assessing changes in pre- and post-aid QoL, identifying influencing factors, understanding beneficiary experiences, and evaluating the effectiveness of financial aid programs. Methods The study adopted quantitative assessments through QoL questionnaires developed based on the WHO BREF questionnaire and insights obtained through interviews. A representative sample of beneficiaries was selected, informed consent was obtained, and an institutional ethical certificate was also obtained. Results The findings overwhelmingly support the alternative hypothesis. The alternative hypothesis was that after receiving financial support, recipients' quality of life would increase. Quantitative analysis revealed a statistically significant enhancement in the QoL of beneficiaries across physical, mental, and social well-being domains. The quality of life scores of patients before and after receiving the support was statistically tested using a paired t-test, and the quality of life score has improved significantly with a p-value of 4.156 × 10-28 (p value<0.001). The comparison of quality of life scores of the control group with the patient's group before getting the support was tested using an independent sample t-test and found to be non-significant (p=0.496), while a similar comparison between the control group and the patient's group after receiving the support was found to be statistically highly significant with a p-value of 8.721 × 10-28 (p-value<0.001). Conclusions This research demonstrates the substantial impact of financial aid on the QoL of beneficiaries in a multi-specialty tertiary care hospital setting. It underlines the importance of addressing economic barriers and providing patient-centered, holistic support. These insights have broader implications for healthcare policy and practice, promoting a more comprehensive approach to patient well-being.

COVID-Related Stressors and Psychological Distress Among Chicago Residents: the Moderating Role of Race

BACKGROUND

Racial and ethnic minorities have been disproportionately affected by the COVID-19 pandemic and have experienced greater financial loss, housing instability, and food insecurity due to COVID-related restrictions. As a result, Black and Hispanic communities may be at greater risk of experiencing psychological distress (PD).

METHODS

Using data collected between October 2020 and January 2021from 906 Black (39%), White (50%), and Hispanic (11%) adults, we assessed racial/ethnic differences in the effect of three COVID-related stressors-employment stress, housing instability, and food insecurity-on PD using ordinary least square regression.

RESULTS

Black adults reported lower PD levels compared to White adults (β =  - 0.23, P < 0.001), but Hispanic adults did not differ significantly from White adults. COVID-related housing instability (β = 0.46, P < 0.001), food insecurity (β = 0.27, P < 0.001), and employment stress (β = 0.29, P < 0.001) were associated with higher PD. Employment stress was the only stressor to differentially affect PD by race/ethnicity. Among those that reported employment stress, Black adults had lower levels of distress compared to Whites (β =  - 0.54, P < 0.001) and Hispanics (β =  - 0.04, P = 0.85).

CONCLUSION

Despite relatively high exposure to COVID-related stressors, Black respondents had lower levels of PD compared to Whites and Hispanics which may reflect differences in race-specific coping mechanisms. Future research is needed to elucidate the nuances of these relationships and identify policies and interventions that prevent and minimize the impact of employment, food, and housing-related stressors and support coping mechanisms that promote mental health among minority populations, such as policies that support easier access to mental health and financial and housing assistance.

Pain mechanisms in the transgender individual: a review

Specific Aim

Provide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research.

Methods

A team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research.

Results

While transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain.

Conclusions

While significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.

The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada

BACKGROUND

Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days.

METHODS

Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors.

RESULTS

Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use.

CONCLUSIONS

The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.

Unmasking the Pandemic's Hidden Challenge

In the COVID-19 pandemic, a new challenge emerges in the digital realm – a surge in cyberbullying fuelled by social isolation. This chapter explores the intricate connection between isolation measures and the alarming rise in online harassment. Lockdowns and distancing have turned the online space into both a refuge and a battlefield, revealing unique consequences of isolation. The pandemic has reshaped cyberbullying, with increased screen time, online education, and heightened social media engagement playing complex roles. As social isolation heightens vulnerability, the line between physical and digital blurs, exposing individuals to online harassers. The chapter acknowledges the profound impact of social isolation on mental health, with pandemic stressors and online anonymity fostering anxiety among cyberbullying victims. Educational settings, grappling with remote learning challenges, also experience the ripple effects of cyberbullying. Despite these challenges, coping strategies and support mechanisms emerge, aiding individuals in navigating the digital landscape safely.

Housing hardship and maternal mental health among renter households with young children

Maternal mental health is crucial to healthy family functioning and child well-being. Housing hardship may increase risk for mood disorders among mothers of young children in renter households. The present study used latent class analysis to investigate manifestations of housing hardship during the postpartum year in a sample of renter mothers in the United States (N = 2,329), as well as whether housing hardship types were associated with subsequent maternal depression and anxiety. The majority of mothers were relatively stably housed ("Stable"), one in six made do with governmental rental assistance ("Rent-Assisted"), and more than one in ten struggled to afford or maintain stable housing ("Cost-Burdened" or "Housing Insecure"). The most severe housing hardship was associated with the greatest depression risk, whereas the best determinant of anxiety risk was whether rent was paid each month; mothers whose rent was paid with government assistance did not differ on anxiety risk compared to those who paid their rent independently. Findings suggest that different types of housing hardship are linked with distinct mental health sequelae. Widely available housing assistance may reduce cost burden and prevent displacement, with the potential to reduce mental disorder among low-income mothers of young children.

Income, stress, and sex ratios over 1895-2010

The medical literature has shown that populations under high stress have a lower sex ratio at birth (i.e. number of males for every 100 females). In this paper, I examine the relationship between income, as a source of economic stress, and the sex ratio at a subnational level for the 1895-2010 period. For this, I use census microdata from Argentina -a developing country that experienced rapid growth at the end of the 19th century and stagnated in recent decades- and I estimate from a two-way fixed effects model that exploits the wide temporal and geographic variability in income. The results show that as per capita income increases, the sex ratio at birth also increases. In particular, for every US$ 1,000 increase in per capita income, the sex ratio increases between 0.3 and 0.6 points. These findings make it possible to quantify the lost boys (i.e. those boys who were not born due to high economic stress on their parents) and constitute a call for attention in favor of the implementation of prenatal care policies -especially in periods of stagnation or income decline- to maintain a more balanced sex ratio.

Adaptation and validation of the financial stress scale in social conflict contexts: a study conducted with small and medium-sized Peruvian entrepreneurs

Introduction

Social conflicts have repercussions on the mental health of the economically active population.

Objective

To adapt and validate the Financial Stress Scale in the context of social conflicts (ESECPS).

Method

An instrumental study involving 2,242 owners of small and medium enterprises (50.9% women), aged between 18 and 74 years old, selected through a non-probabilistic purposive sampling. The participants were recruited across three regions of Peru during periods of protests and strikes against the incumbent Peruvian government. The instrument for adaptation was the financial stress scale EFEmp-Cov19, created in the context of the COVID-19 pandemic's impact.

Results

All items proved to be clear, relevant, and representative (V > 0.70). Exploratory Factor Analysis (EFA) revealed the existence of one underlying factor across the 11 items (KMO = 0.962, Bartlett = 5434.3; df = 55; p < 0.001). However, for Confirmatory Factor Analysis (CFA), items 4 and 11 were removed, resulting in support for a unidimensional model with 9 items (χ2 = 262.73, df = 23, p < 0.001; RMR = 0.022; TLI = 0.972; CFI = 0.980; and RMSEA = 0.072). Regarding reliability, a very high value was found (ω = 0.92).

Conclusion

The ESECPS demonstrates adequate psychometric properties, making it a suitable measure to assess financial stress among Peruvian entrepreneurs facing economic instability and financial threats in the context of social conflicts.

Solutions-Based Approach to Urban Cat Management-Case Studies of a One Welfare Approach to Urban Cat Management

Urban free-roaming cats create concern about their impacts on wildlife and human health, leading to the use of trap-adopt-kill methods to manage these populations. This method is ineffective at decreasing the free-roaming cat population and has a negative impact on cat caregivers' well-being. Using semi-structured interviews, this study explored the relationship that semi-owners (people who feed cats but do not perceive ownership) and owners of multiple cats have with the cats they care for, and the social and psychological impacts of an alternative assistive-centered approach to urban cat management. This approach to semi-owned and owned cats provided free sterilization and preventative healthcare. Our findings demonstrate that the caregivers had a strong emotional bond with the cats they cared for. The caregivers also experienced a positive impact on their quality of life, and indicated an improvement in the cats' welfare after having the cats sterilized through this program. Additionally, the cat caregivers indicated that they had a negative view of agencies, such as the municipal council. It is recommended that an assistive-centered approach to urban cat management be prioritized by local councils and welfare agencies to improve caregivers' quality of life and psychological well-being, whilst also improving cat welfare. The implementation of this assistive-centered management approach could improve the relationship between communities and the agencies involved, leading to the continuous reporting of free-roaming cats for sterilization. This assistive-centered approach has the potential to reduce the free-roaming cat population, their effects on wildlife, nuisance complaints, and council impoundments, and is aligned with the One Welfare philosophy.

Diet and Lifestyle in the Spanish Population and Their Relationship with Sociodemographic Variables: A Descriptive Study

A healthy lifestyle and proper nutrition have a major impact on the well-being of a population. Therefore, the aim of this research is to describe the behavior of these habits in relation to sociodemographic variables to provide data on the development of effective training and awareness-raising actions.

METHODS

An observational, descriptive and cross-sectional study was carried out. To study the behavior of a series of variables related to eating habits and lifestyle, a questionnaire was designed and validated and subsequently disseminated online, by means of nonprobabilistic snowball sampling, relying on social networks. The sample collected consisted of 18,070 young adults of Spanish nationality. Bivariate comparative analyses were performed using t-test independent samples, and the effect size (ES) was calculated by determining Cohen's D coefficient. A multivariate analysis were conducted using linear regression and principal component analysis.

RESULTS

Adults eat better but have a poorer quality of rest and are more sedentary than young people. No gender differences were found in nutritional habits; however, men engage in more sports and sleep better. People with a higher educational level have better nutritional and sleep habits, but are more sedentary, as are people of a higher socioeconomic level.

CONCLUSIONS

Higher socioeconomic and educational levels seem to favor a healthier lifestyle. The Spanish population aged 18-45 years needs to make dietary changes but leads an active lifestyle.

Exploring the influence of behavioral factors on depression and anxiety scores during the COVID-19 pandemic: insights from the Virginia statewide COVIDsmart longitudinal study

BACKGROUND

Amidst the COVID-19 pandemic, there has been growing concern about the declining mental health and healthy behaviors compared to pre-pandemic levels. Despite this, there is a lack of longitudinal studies that have examined the relationship between health behaviors and mental health during the pandemic. In response, the statewide COVIDsmart longitudinal study was launched. The study's main objective is to better understand the effects of the pandemic on mental health. Findings may provide a foundation for the identification of public health strategies to mitigate future negative impacts of the pandemic.

METHODS

Following online recruitment in spring of 2021, adults, ages 18 to 87, filled out social, mental, economic, occupational, and physical health questionnaires on the digital COVIDsmart platform at baseline and through six monthly follow-ups. Changes in the participant's four health behaviors (e.g., tobacco and alcohol consumption, physical activity, and social media use), along with sex, age, loneliness score, and reported social and economic (SE) hardships, were analyzed for within-between group associations with depression and anxiety scores using Mixed Models Repeated Measures.

RESULTS

In this study, of the 669 individuals who reported, the within-between group analysis indicated that younger adults (F = 23.81, p < 0.0001), loneliness (F = 234.60, p < 0.0001), SE hardships (F = 31.25, p < 0.0001), increased tobacco use (F = 3.05, p = 0.036), decreased physical activity (F = 6.88, p = 0.0002), and both positive and negative changes in social media use (F = 7.22, p = 0.0001) were significantly associated with worse depression scores. Additionally, females (F = 6.01, p = 0.015), younger adults (F = 32.30, p < 0.0001), loneliness (F = 154.59, p < 0.0001), SE hardships (F = 22.13, p < 0.0001), increased tobacco use (F = 4.87, p = 0.004), and both positive and negative changes in social media use (F = 3.51, p = 0.016) were significantly associated with worse anxiety scores. However, no significant changes were observed in the within-between group measurements of depression and anxiety scores over time (p > 0.05). Physical activity was not associated with anxiety nor was alcohol consumption with both depression and anxiety (p > 0.05).

CONCLUSIONS

This study demonstrates the longitudinal changes in behaviors within the context of the COVID-19 pandemic. These findings may facilitate the design of preventative population-based health approaches during the COVID-19 pandemic or future pandemics.

Gamified Problem Gambling and Psychological Distress: The Mediated-Moderated Roles of Cognitive and Economic Motives

Economic and non-economic motives for gambling may amplify anxiety and depression among young adults. On the grounds that online gambling is highly addictive, it is imperative to assess significant contributory factors in gambling that aggravate financial harm and psychological distress. The study examines gamified problem gambling and psychological distress among young adults in Ghanaian universities. The study further explores the mediating role of cognitive biases and heuristics as well as financial motive for gambling between gamified problem gambling and psychological distress. Through a cross-sectional design and convenience sampling technique, the study employed (n = 678) respondents who took part in different forms of gambling events in the last 2 years. Instruments for construct assessment include problem gambling severity, cognitive biases and heuristics, financial motive for gambling and psychological distress scales. Control variables include gender, age, income source and type of gambling patronized in the last 2 years. Using hierarchical regression, gamified problem gambling was found to have a positive effect on psychological distress. Also, cognitive biases & heuristics partially mediates between gamified problem gambling and psychological distress. Finally, financial motive for gambling moderates between gamified problem gambling and psychological distress. The outcomes bring to bear economic and non-economic motives that exacerbate psychological distress among young adults. Based on the vulnerability of problem gamblers in developing countries, the researchers recommend a need for stricter regulations to somewhat control online gambling frequency among young adults.

Mental health and well-being in the first year of the COVID-19 pandemic among different population subgroups: evidence from representative longitudinal data in Germany

OBJECTIVES

To examine potential deteriorations in mental health and well-being in the first COVID-19 pandemic year compared with the previous decade focusing on the following vulnerable subgroups in Germany: women with minor children in the household, those living without a partner, younger and older adults, those in a precarious labour market situation, immigrants and refugees, and those with pre-existing physical or mental health risks.

DESIGN

Analyses of secondary longitudinal survey data using cluster-robust pooled ordinary least squares models.

PARTICIPANTS

More than 20 000 individuals (aged 16+ years) in Germany.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mental Component Summary Scale (MCS) of the 12-item Short-Form Health Survey measuring mental health-related quality of life, single item on life satisfaction (LS).

RESULTS

We find a decline in the average MCS in the 2020 survey that is not particularly striking in the overall time course, still resulting in a mean score below those of all preceding waves since 2010. We find no change in LS from 2019 to 2020 against the background of a general upward trend. Regarding vulnerability factors, only the results on age and parenthood are partially in line with our expectations. In 2020, LS declined among the youngest adults; MCS declined among mothers (and women and men without children) but not fathers. Unlike respective comparison groups, refugees, those unemployed before the pandemic and those with pre-existing mental health risks experienced no MCS declines in 2020, whereas persons living without a partner, the eldest, and those with pre-existing health risks exhibited continued increases in LS.

CONCLUSIONS

There is no evidence for substantial breakdowns in mental health or subjective well-being in the first pandemic year in the German population or its subgroups, particularly when considering developments of the previous decade. Since the majority of hypothesised vulnerable groups to pandemic stressors showed more stable MCS and LS, our results warrant further study.

Coping Strategies, well-being and inequalities during the COVID-19 pandemic period

As a response to the outbreak of the COVID-19 pandemic, governments around the globe have carried on strict lockdown measures affecting millions of jobs, public life, and the well-being of people. This study examines people's subjective well-being, such as the perception of the economic situation and mental well-being, who made adjustments to cope with the earning losses. We estimate the well-being cost, which is the money required to compensate people because of the reduction in earnings or employment loss and the coping strategy followed to bring their well-being to the levels of those who have not adopted any coping strategy. We examine two outcomes; the perception of the economic situation and a mental well-being index. We employ data from the ERF COVID-19 MENA Monitor Surveys for Egypt, Jordan, Morocco and Tunisia. The results show that coping strategies with earning losses impact well-being and are associated with high costs. In most cases, the coping strategies of borrowing from banks and selling assets present the highest well-being costs. Furthermore, the estimates highlight significant discrepancies across gender and types of workers, such as those employed in the informal sector and temporary contracts.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04710-1.

'Staying Afloat': A Mixed Methods Study of the Financial and Psychological Well-being of Early Childhood Educators

Early childhood educators play a critical role in the lives of young children, especially through their sensitive interactions. Educators' capacities to engage in high-quality interactions are shaped by their mental health. Studies examining early childhood educators' mental health often focus on psychopathology or negative aspects of mental health, despite the importance of understanding mental health through a well-being lens. This study explores the connection between two important areas of well-being: psychological and financial well-being. Using mixed methods, we examined 123 early childhood educators' financial well-being and psychological well-being. Financial well-being predicted psychological well-being, but the relationship was curvilinear; those with the highest and lowest financial well-being had the highest psychological well-being. Qualitative findings suggest possible buffers for psychological well-being among educators with low-financial well-being and highlight struggles of those with low psychological well-being. Implications for how early childhood educators' well-being might be supported with policy and practice initiatives are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10643-022-01429-9.

Earning Too Little And Worrying Too Much: The Role Of Income And Financial Worries On Parents' Well-Being In Hong Kong And Bangkok

Research has shown that financial worries are key determinants of parents' well-being. However, less is known about the relative role of income and financial worries on parents' well-being; especially from a cross-cultural perspective. Guided by need and aspiration theories, we examined the roles of income and financial worries on happiness and distress among parents from Hong Kong (N = 258) and Bangkok (N = 190). Bayesian structural equation modelling revealed that greater income and lower financial worries were correlated, on a bivariate level, with higher levels of happiness and lower levels of distress in both societies. However, regressing happiness on both income and financial worries shows that income is uniquely associated with happiness in Bangkok, but not in Hong Kong. Financial worries uniquely explained variance in distress in both societies. These findings suggest that income and financial worries play different roles in parents' psychological well-being in the two cities. To promote parents' well-being, future policy or intervention programs should target financial worries in Hong Kong. Targeting income and financial worries are more likely to be efficacious in Bangkok.

Diagnosis and Management of Perinatal Depression

Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.