Psychological factors associated with financial hardship and mental health: A systematic review

The reciprocal relationships between economic status and mental health: Investigating the between-person and within-person effects in a three-wave longitudinal study

BACKGROUND

Social drift/selection (i.e., mental health symptoms cause low economic status) and social causation theories (i.e., low economic status causes mental health symptoms) specify reciprocal relationships between economic status and mental health. Little is known regarding the disaggregation of within-person and between-person effects in the relationship between economic status and mental health in the long run. The current study sought to examine the reciprocal relationships between economic status and mental health over 20 years of adulthood, disaggregating within-person and between-person effects.

METHODS

Data were from three waves (7108 participants) of the Midlife Development in the United States study. Participants reported information about objective and subjective measures of economic status as well as a wide range of indicators of mental health on the positive dimension, including subjective, social, and psychological well-being, and on the negative side, depression, anxiety, panic attack, anhedonia, somatic amplification, alcohol abuse, and negative affect. Cross-lagged panel models were estimated.

RESULTS

At between-person levels, both social drift/selection and social causation hypotheses were confirmed when considering subjective measures of economic status. When using objective measures of economic status (i.e., income), the results showed decreased support for social drift/selection and social causation hypotheses. At within-person levels, social drift/selection and social causation hypotheses were generally not supported, with some notable exceptions.

LIMITATIONS

Restriction of the sample to one country limits the generalizability of the findings.

CONCLUSIONS

Social causation and social drift/selection processes act simultaneously mainly at a population level, but much less when considering individual changes. Policy and programs should be targeted at addressing inequality in income and mental health within a nation or a community.

Prevalence of Depression and Generalized Anxiety Among LGBTQ+ Medical Students in Thailand

This study evaluated the prevalence and associated factors of depression and generalized anxiety among LGBTQ+ in five medical schools in Thailand. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess major depressive disorder (MDD) and generalized anxiety disorder (GAD), respectively, and multivariable logistic regression was employed to identify associated factors. Of 1,322 students, 412 (31.16%) identified as LGBTQ+. The prevalence for MDD and GAD among LGBTQ+ students were 32.77% and 17.23%, respectively. Significant associated factors for both MDD and GAD were a history of psychiatric illness (AOR for MDD = 2.32, p = .020; AOR for GAD = 3.67, p < .001), educational problems (AOR for MDD = 6.62, p < .001; AOR for GAD = 5.12, p < .001), and dissatisfaction with gender identity or sexual orientation (AOR for MDD = 1.92, p = .019; AOR for GAD = 2.47, p = .005). Additional factors associated with MDD were preclinical years (AOR = 2.30, p = .023), financial struggles (AOR = 2.05, p = .021), and inadequate peer support (AOR = 2.57, p = .044). In conclusion, nearly one-third and one-fifth of Thai LGBTQ+ medical students suffer from MDD and GAD, respectively. Our findings suggest that Thai medical schools should promote LGBTQ+ inclusivity to enhance students' identity satisfaction. Peer support groups should be encouraged, especially for preclinical LGBTQ+ students who face educational and financial challenges.

Creating a resilient pedagogy: Character strengths intervention for aspiring educators

Teachers play a crucial role in guiding learners through life's challenges. They face educational and socio-economic shifts while striving to teach for a better future. Our study focuses on equipping future teachers, called pre-service teachers, with resilience-building resources during their teacher training program. A potential antecedent to resilience, which facilitates cognitive strategies and attentional processes, is cognitive flexibility. We first tested whether cognitive flexibility predicts resilience. Next, relying on the tenets of positive psychology, which studies resilience, we developed and tested the effectiveness of character strengths intervention in enhancing pre-service teachers' resilience and cognitive flexibility. An individual's belief in their ability to change personal resources could influence how an intervention manifests. Hence, we studied how mindset impacts the intervention's effect on cognitive flexibility and, thus, resilience. We adopted a multi-method approach, guided by Polk's theory of resilience, to test out objectives. Using a cross-sectional design, study one (n = 273) found that cognitive flexibility significantly predicted resilience. Study two (N = 193; nexp = 133, ncont = 60) was a multi-site field experiment. We found that intervention significantly enhanced resilience (experimental group M = 29.62, control group M = 28.33) and cognitive flexibility (experimental group M = 54.42, control group M = 52.01). Further, a growth mindset, was found to moderate the indirect effect of character strengths intervention on resilience via cognitive flexibility. The study contributes to theoretical and practical advancements in resilience. Taken together, the findings highlight the cognitive-affective-behavioural makeup of resilience and, importantly, the role of cognitive flexibility. The intervention can be seamlessly integrated into teacher training curricula for a resilient future.

The Relationship between Meaning in Life and Mental Health in Chinese Undergraduates: The Mediating Roles of Self-Esteem and Interpersonal Trust

To explore the association and the underlying process between meaning in life and psychological health, a stratified random sampling was conducted on undergraduate students from five universities in Fujian Province from March to April 2022, with the Meaning in Life Questionnaire, the Self-Esteem Scale, the Interpersonal Trust Scale, and the Kessler10 Scale. The results indicated that 34.5% of Chinese undergraduates were in poor or worse mental health. There were significant positive correlations among meaning in life, self-esteem, and interpersonal trust; meaning in life, self-esteem, and interpersonal trust were all significantly and positively correlated with mental health. Self-esteem and interpersonal trust played a chain mediating role between meaning in life and mental health. Schools and families should conduct appropriate activities to help them enhance meaning in life so as to improve the level of mental health.

Labor market discrimination and suicidal ideation: A longitudinal study of Korean women

This study investigates the impact of gender discrimination in the labor market on suicidal ideation among Korean women, taking into consideration women's multiple social locations and their discriminatory experiences across various aspects of employment. Analysis using waves 4 to 8 data of the Korean Longitudinal Survey of Women and Family, with response rates ranging from 68.3% to 78.2%, indicates that gender discrimination in hiring, dismissal, promotion, job allocation, training, wage, and sexual harassment is strongly associated with suicidal thoughts among women. This relationship remains significant even after controlling for stress, depression, and other forms of discrimination. Subgroup analysis further highlights that women with lower income levels are particularly susceptible to the adverse effects of gender discrimination. The findings underscore the importance of policy intervention to mitigate labor market discrimination against women as a crucial step in preventing suicides among Korean women.

People Living With Mental Illness Perceptions of Physical Health, Mental Health and Well-Being

Understanding the perspectives of regional people living with mental illness is crucial to adapting services, improving holistic care and meeting individual needs. This study explored people living with mental illness perceptions of physical health, mental health and well-being. A descriptive qualitative study design underpinned by empowerment theory was conducted. Qualitative data were collected verbally via semi-structured interviews, with demographic details provided verbally at the end of the interview. Thematic analysis was utilised to identify themes. The COREQ checklist was used for reporting. Fourteen participants admitted to regional mental health inpatient units aged between 25 and 84 years old were interviewed. Participants felt their overall well-being was good despite feeling their physical health or mental health was suboptimal, suggesting that their perceived well-being is influenced by factors beyond their physical and mental health. Most participants reported looking after their physical health, mental health and well-being and identified various behavioural lifestyle strategies they found helpful. Thematic analysis identified three themes: functioning well, feeling in control and meeting basic needs. Mental health services and clinicians play an important role in empowering people with mental illness to improve their physical health, mental health and well-being while admitted to inpatient services; however, it is acknowledged resources can be limited. Mental health services may consider referring people with mental illness to social prescribing programmes to meet their individualised needs on discharge.

The Relationship Between Gender Identity, Economic Stressors, Social Support, Concurrent Substance Use and Suicidal Ideation

Purpose

To examine a comprehensive list of demographic, substance use, economic, and social factors associated with suicidal ideation (SI) among middle-aged adults.

Methods

Cross-sectional data were obtained from a national sample of middle-aged adults between February and November 2022. The study's final sample include 1,337 respondents who represented the adult population of persons aged 40-60 years in the United States. Bivariate and multivariate statistics were employed to identify significant factors associated with past year SI, in particular single vs. multiple instances of SI.

Results

Of the sample, 140 (10.4%) reported SI in the past year. Among those, more than half (60.0%, n = 84) reported SI multiple times in the past year. Multivariable logistic regression indicated that those who were a gender minority, engaged in concurrent substance use, or had financial stressors had significantly higher odds of past SI. Multinomial regression found that concurrent substance use (adjusted odds ratio [aOR] 3.17; 95% confidence interval [CI] 1.76-5.70) and having a lower standard of living than their parents/caregivers (aOR 2.99; 95% CI 1.39-6.41) predicted repeated past year SI whereas higher social support was protective against multiple SI experiences (aOR 0.65; 95% CI 0.55-0.78).

Conclusion

Gender minorities and those reporting concurrent substance use had the highest odds of past year SI. Findings underscore the need to develop public health and clinical interventions tailored to these highest-risk middle-aged adults in order to prevent suicide.

The Perceived Economic Scarcity Scale: A valid tool with greater predictive utility than income

This article introduces the Perceived Economic Scarcity Scale (PESS), a novel instrument measuring the subjective evaluation and experience of economic scarcity (the feeling of having insufficient financial resources to meet one's needs). We conducted three high-powered preregistered studies (total N = 1900) to rigorously evaluate the PESS's psychometric properties. In Study 1, we generated a pool of items and used both Principal Component Analysis and Exploratory Factor Analysis to select the most appropriate items. In Study 2, we examined the PESS's construct validity, demonstrating that it measures a distinct construct from related constructs such as subjective social class. In Study 3, we examined the PESS's predictive validity, demonstrating that it is a robust predictor of both affective outcomes (e.g. anxiety-depressive symptoms) and cognitive outcomes (e.g. economic risk-taking). Critically, we found that the PESS not only has incremental validity over and above income but also has greater predictive utility than income. We also found that the PESS score varies depending on the distance-to-pay and has excellent test-retest reliability. Overall, the PESS appears to be a valid and reliable instrument for assessing perceived economic scarcity, and we encourage researchers to use it to better understand the psychological consequences of 'not having enough'.

Farmers' Mental Health: The Mediating Role of Chronic Fatigue

The agricultural environment is known to be particularly harmful to farmers' psychological health. To better understand how its impact is modulated, this study mainly focuses on the mediating role of chronic fatigue between A) loneliness at work, autonomy, workload, government regulations and policies and financial hardship, and B) life satisfaction, positive affect and psychological distress. The study is based on a sample of 453 Canadian dairy farmers. Structural equation modeling analyses confirmed the mediating role of chronic fatigue in the relationships between the factors studied, with the exception of financial hardship. Implications for research and the psychological burden affecting agricultural workers are discussed.

The impact of housing insecurity on mental health, sleep and hypertension: Analysis of the UK Household Longitudinal Study and linked data, 2009-2019

BACKGROUND

Housing insecurity is an escalating problem in the UK but there is limited evidence about its health impacts. Using nationally representative panel data and causally focussed methods, we examined the effect of insecure housing on mental health, sleep and blood pressure, during a period of government austerity.

METHODS

We used longitudinal survey data (2009-2019, n = 11,164 individuals with annual data) from the UK Household Longitudinal Study. Outcomes were probable common mental disorder (GHQ-12), sleep disturbance due to worry, and new diagnoses of hypertension. The primary exposure was housing payment problems in the past year. Using doubly robust marginal structural models with inverse probability of treatment weights, we estimated absolute and relative health effects of housing payment problems, and population attributable fractions. In stratified analyses we assessed potentially heterogeneous impacts across the population, and potential modifying effects of government austerity measures. A negative control analysis was conducted to detect bias due to unmeasured confounding.

RESULTS

Housing payment problems were associated with a 2.5 percentage point increased risk of experiencing a common mental disorder (95% CI 1.1%, 3.8%) and 2.0% increased risk of sleep disturbance (95% CI 0.7%, 3.3%). Estimates were larger for renters, younger people, less educated, households with children, and people living in areas most affected by austerity-related cuts to housing support services. We did not find consistent evidence for an association with hypertension (risk difference = 0.4%; 95% CI -0.1%, 0.9%). The negative control analysis was not indicative of unmeasured confounding.

CONCLUSIONS

Housing payment problems were associated with worse mental health and sleep disturbance in a large UK sample. Households at risk of falling into rent or mortgage arrears need more support, especially in areas where housing support services have been diminished. Substantial investment is urgently needed to improve supply of social and affordable housing.

Enhancing immigrant families' mental health through the promotion of structural and community-based support

Immigrant communities in the United States are diverse and have many assets. Yet, they often experience stressors that can undermine the mental health of residents. To fully promote mental health and well-being among immigrant communities, it is important to emphasize population-level policies and practices that may serve to mitigate stress and prevent mental health disorders. In this paper, we describe the stressors and stress experienced by immigrant families, using Sunset Park, Brooklyn as an example. We discuss ways to build structures and policies in support of equitable environments that promote mental health at the population level and enable families and their children to thrive.

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.

Mattering and Self-Esteem as Bulwarks Against the Consequences of Financial Strain for Loneliness in Later Life: Differentiating Between- and Within-Person Processes

Financial strain likely constitutes a principal risk for loneliness in later-life, but a strong sense of mattering and self-esteem may mitigate these consequences by both offsetting and buffering the influence of financial strain. We test these arguments using data from a national longitudinal survey of older adults gathered between 2021 and 2022 (N = 2384), as nations emerged from the COVID-19 pandemic. Application of a within-between modelling strategy facilitates differentiation of inter-individual (i.e., between-person) and intra-individual (i.e., within-person) factors. Between-person financial strain is associated with greater loneliness, but within- and between-person mattering and self-esteem offset this association by forestalling loneliness. Between-person mattering buffers between-person financial strain, but between-person self-esteem buffers within-person financial strain. Consequently, within-person financial strain is associated with greater loneliness only at low levels of between-person self-esteem. In summary, accruing a strong sense of worth contributes to protecting older adults from the adverse consequences of financial strain for loneliness.

Examining evidence for a relationship between human-animal interactions and common mental disorders during the COVID-19 pandemic: a systematic literature review

Introduction

COVID-19 lockdowns, shelter in place, closures of transportation and mental health services, and dearth of mental health providers created new barriers to obtaining support for mental health needs at a time of increased rates of anxiety and depression. During the pandemic, a record number of households owned and adopted pets, opening a potential avenue to investigate the relationship between pets and mental health. This systematic literature review examined the question: What is the evidence for a relationship between human-animal interaction and/or animal ownership and common mental disorders among adults who interacted with pets compared to adults who did not during the COVID-19 pandemic?

Methods

To address this question, four databases were searched: Medline, PsycINFO, Web of Science, and SCOPUS for peer-reviewed literature published between 2020 and July 2023. Of the 1,746 articles identified by the searches, 21 studies were included in this review.

Results

Results suggest that there exists a relationship between animal ownership and strong pet attachment and pet interaction, though the directionality of the relationship was not investigated by the included studies. There was an association between having a stronger relationship with a pet and lower feelings of depression and other mental health symptoms. There was also evidence of an association between anxiety and higher levels of animal attachment.

Conclusion

Understanding the association between human-animal interaction and common mental disorders may be helpful to clinicians assessing the mental health of clients. Clinicians may glean additional insight about stressors, risk factors, social supports, and lifestyle of clients based on the client's status as a pet owner. Future research could further explore the direction of the causal relationship of human-animal interaction and/or animal ownership on common mental disorders; this could further inform how the HAI relationship can be used to support clients with mental health struggles.

How, when, and why is social class linked to mental health and wellbeing? A systematic meta-review

RATIONALE

Meta-reviews synthesising research on social class and mental health and wellbeing are currently limited and focused on specific facets of social class (e.g., social capital) or mental health and wellbeing (e.g., mental health disorders), and none sought to identify mechanisms in this relationship.

OBJECTIVES

The present meta-review sought to (1) assess the overall relationship between social class and mental health and wellbeing, (2) determine the mechanisms that act in this relationship, and (3) evaluate the strength of evidence available.

METHODS

The protocol was prospectively registered on PROSPERO (CRD42021214731). We systematically searched twelve databases in September 2022 and identified 149 eligible reviews from 38,257 records screened. Quality of evidence was assessed with the JBI levels of evidence and risk of bias with the ROBIS tool.

RESULTS

A large but low-quality evidence base points to class-based inequalities in mental health and wellbeing, with the strongest available evidence linking lower social positions to an increased risk of depression. In terms of different facets of stratification, the best available evidence suggests that deprivation (e.g., poverty), socioeconomic status, income, and subjective social status are consequential for individuals' mental health and wellbeing. However, high-quality evidence for the roles of education, occupation, other economic resources (e.g., wealth), and social capital is currently limited. Most reviews employed individual-level measures (e.g., income), as opposed to interpersonal- (e.g., social capital) or community-level (e.g., neighbourhood deprivation) measures. Considering mechanisms, we found some evidence for mediation via subjective social status, sense of control, and experiences of stress and trauma. There was also some evidence that higher socioeconomic status can provide a buffer for neighbourhood deprivation, lower social capital, and lower subjective social status.

CONCLUSIONS

Future research employing experimental or quasi-experimental methods, and systematic reviews with a low risk of bias, are necessary to advance this area of research.

The Cost-Benefit of Aging: Financial Capability and Well-Being across Age Groups in Brazil

A large proportion of older persons in developing countries do not have access to pension, which also constrains their ability to afford healthcare services and entails extensive challenges to the well-being of older people. This study aimed to analyze the financial preparedness of different age groups for retirement in Brazil. Data were derived from a survey to empirically validate the proposed relationships between preparedness for retirement and resilience for the future (financial well-being (FWB) outcomes) on the one hand and among demographic and socioeconomic aspects, behaviors and attitudes, knowledge and experience, and "key" psychological factors on the other hand. The sample consisted of 412 individuals aged between 22 and 79 years. FWB was measured using the financial capability and well-being model and regressed on a number of sociodemographic and psychological variables using linear regression analyses. The results demonstrated that preparedness for retirement was strongly related to older age. Additionally, age was correlated with resilience for the future close to zero, which indicates no relationship. Knowledge and the psychological factors of self-control and confidence were positively and strongly related to better financial behavior for all age groups. In addition, grit and resilience for the future were positively related to better financial behavior in the older age group. Furthermore, the variables of retirement contribution were seemingly not viewed as important to the older group compared with their young and mature counterparts. Multidimensional interventions, especially targeting behaviors and psychological patterns, could, therefore, be recommended in advance to young and mature groups to prepare them to secure their old age and achieve FWB.

Self-Stigma and Mental Health in Divorced Single-Parent Women: Mediating Effect of Self-Esteem

Numerous studies have addressed the issue of "self-stigma" among divorced single-parent women. However, there is a scarcity of quantitative data available on this subject. Moreover, while self-esteem is a crucial factor throughout life, it has been extensively studied in the context of "children" from single-parent families, but not from the perspective of parents themselves. To address this gap, the present study aimed to explore the relationship between self-stigma, self-esteem, and mental health in 347 divorced, single-parent women. The online survey recruited participants randomly, with a specific focus on single mothers who were divorced and had more than one child under the age of 18. The analysis involved utilizing SPSS 25.0 (IBM Co., Armonk, NY, USA) and PROCESS Macro Version 4.1 (Model 4) to conduct descriptive statistics, frequency analysis, reliability assessment, correlation analysis, and mediating analysis. The findings revealed that self-esteem played a partial mediating role in the relationship between self-stigma and mental health. In other words, higher levels of self-stigma among divorced, single-parent women were associated with poorer mental health outcomes. Additionally, the study discovered that engaging in more self-stigma was linked to lower self-esteem and increased mental health distress. These results underscore the significance of internal factors, such as self-stigma and self-esteem, and highlight their relevance in formulating policies aimed at supporting divorced single-parent women. Policymakers should take these factors into account to develop effective strategies to aid this specific group.

Whole Person Modeling: a transdisciplinary approach to mental health research

The growing global burden of mental illness has prompted calls for innovative research strategies. Theoretical models of mental health include complex contributions of biological, psychosocial, experiential, and other environmental influences. Accordingly, neuropsychiatric research has self-organized into largely isolated disciplines working to decode each individual contribution. However, research directly modeling objective biological measurements in combination with cognitive, psychological, demographic, or other environmental measurements is only now beginning to proliferate. This review aims to (1) to describe the landscape of modern mental health research and current movement towards integrative study, (2) to provide a concrete framework for quantitative integrative research, which we call Whole Person Modeling, (3) to explore existing and emerging techniques and methods used in Whole Person Modeling, and (4) to discuss our observations about the scarcity, potential value, and untested aspects of highly transdisciplinary research in general. Whole Person Modeling studies have the potential to provide a better understanding of multilevel phenomena, deliver more accurate diagnostic and prognostic tests to aid in clinical decision making, and test long standing theoretical models of mental illness. Some current barriers to progress include challenges with interdisciplinary communication and collaboration, systemic cultural barriers to transdisciplinary career paths, technical challenges in model specification, bias, and data harmonization, and gaps in transdisciplinary educational programs. We hope to ease anxiety in the field surrounding the often mysterious and intimidating world of transdisciplinary, data-driven mental health research and provide a useful orientation for students or highly specialized researchers who are new to this area.

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.

Financial Hardship and Psychological Distress During the Pandemic: A Nationally Representative Survey of Major Racial-Ethnic Groups in the United States

Introduction

While financial hardship has been consistently linked to psychological distress, little research exists on associations between financial hardship experienced during the pandemic and mental health.

Methods

We conducted a nationally representative, online survey of American Indian/Alaska Native, Asian, Black/African American, Latino (English and Spanish speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults, 12/2020-2/2021 (n=5500). Six financial hardship domains were measured (lost income, debt, unmet expenses, unmet health care expenses, housing insecurity, and food insecurity). Psychological distress measures included anxiety-depression symptoms (Patient Health Questionnaire-4), perceived stress (modified Perceived Stress Scale), and loneliness-isolation ("In the past month, how often have you felt lonely and isolated?"). Associations between financial hardship and psychological distress were estimated using multinomial logistic regression.

Results

Overall, 70.3% of participants reported experiencing financial hardship (substantial hardship: 21.3%; some hardship: 27.4%; and a little hardship: 21.6%), with Spanish-speaking Latino (87.3%) and Native Hawaiian/Pacific Islander (79.2%) adults being most likely. Debt (57.6%), lost income (44.5%), and unmet expenses (33.7%) were the most common. There was a dose-response association between financial hardship and moderate/severe anxiety-depression symptoms (a little hardship: adjusted odds ratio [aOR]=1.42, 95% confidence interval [CI]=1.12-1.80; some hardship: aOR=3.21, 95% CI=2.58-3.98; and substantial hardship: aOR=8.15, 95% CI=6.45-10.29). Similar dose-response trends were observed with perceived stress and loneliness-isolation. No racial-ethnic difference in the association between financial hardship during the pandemic and psychological distress was seen.

Discussion

Financial hardship has had a major impact on psychological distress during the pandemic; moreover, while no racial-ethnic difference in the effect of financial hardship was observed, because racial-ethnic minorities experienced greater hardship, financial hardship may exacerbate psychological distress disparities.

Delicate dining with a date and burger binging with buddies: impression management across social settings and consumers' preferences for masculine or feminine foods

Consumers often use their food choices as an impression management strategy to signal desirable aspects about themselves to others, especially in public places like restaurants and cafeterias, where the presence of others can promote certain consumption choices and preference patterns. In mating contexts, people prefer gender-typical traits and characteristics in a potential partner. Food options can also be classified according to their gender typicality, with certain alternatives perceived as feminine (e.g., salad, seafood) and with other options perceived as more masculine (e.g., steak, burger). Drawing on impression management theories from the drinking and dining domain and literature on sex differences in human mate preferences, we present a high-powered experiment investigating whether consumers' preferences for masculine or feminine foods depend on the social setting in which the food consumption takes place: dining with an attractive date (mating) or meeting and eating with friends (non-mating). Participants (N = 162, 46.9% females, 53.1% males; age M = 41.8  years, SD = 14.5) were randomly assigned to one of the two experimental conditions (mating vs. non-mating) and were asked to indicate their food preferences for 15 dishes that differed markedly in perceived femininity/masculinity. Consistent with our theorizing, females (males) generally had a stronger preference for foods perceived as more feminine (masculine), thereby supporting the gender-typicality thesis at the aggregate level. Furthermore, females in the mating condition-but not females in the non-mating condition-reported significantly stronger preferences for more feminine food alternatives. However, in direct contrast to our theorizing, males preferred more masculine meals in the non-mating condition (i.e., when dining with friends), whereas this gender-typical tendency did not emerge in the mating condition (i.e., when dining with an attractive date). We discuss the theoretical and practical implications of these findings and present a set of fruitful avenues for future research.

Financial adversity and subsequent health and wellbeing during the COVID-19 pandemic in the UK: A qualitative interview study

Aims

There are concerns that the economic impacts of the COVID-19 pandemic, including employment inactivity and job loss, will have consequences for the UK population's health and wellbeing. However, there is limited qualitative research into how financial adversity contributes to poor health outcomes in this context. This study aimed to explore forms of financial adversity experienced during the pandemic and their subsequent impacts for health and wellbeing.

Methods

Qualitative semi-structured interviews with 20 people who experienced a form of financial adversity during the pandemic and six service providers employed in social welfare support services. Data were analysed using reflexive thematic analysis.

Results

Two main sources of financial adversity were identified: reductions in household incomes and increased living costs which engendered emotional and physical burdens. Coping strategies included increased financial borrowing, support from informal and formal networks and cutting back on energy use, food and non-essential items.

Conclusion

Our study highlighted exposure to multiple financial adversities because of the pandemic and how these experiences led to poor mental and physical health. The findings underline the importance of measures attending to the immediate needs of individuals, including accessible, co-located financial and psychological services, as well as broader measures that seek to reduce social and economic inequalities.

COVID-19: Academic, Financial, and Mental Health Challenges Faced by International Students in the United States Due to the Pandemic

Background and objective Many international students often face challenges regarding their mental health, finances, and academics. The coronavirus disease 2019 (COVID-19) outbreak may have presented unprecedented challenges to many foreign students in these aspects. Our study examined the academic, financial, and mental health challenges encountered by international students residing in the United States due to the COVID-19 pandemic. It also examined the association between the mental health of the respondents and the academic and financial challenges they encountered. Method The study involved international students enrolled at Texas A&M University, who identified themselves as non-US citizens or non-permanent residents. We conducted a cross-sectional study by using Qualtrics® to explore the three domains of the study. Questions included in previous studies were modified to assess the academic and financial status while the Patient Health Questionnaire-4 (PHQ-4) score was used to assess the mental health of the respondents. We presented descriptive statistics for all domains and used an ordered logistic regression to further analyze the effect of the other domains on the mental health of the respondents. Results Of the 281 respondents, the majority (79%) experienced challenges with online classes; 91% reported having negative emotions and some students (24%) lost funding due to the pandemic. The inability to pay bills resulted in a three-fold increase in the likelihood of reporting higher mental distress [adjusted odds ratios (aOR): 3.051, 95% CI: 1.665-5.591; p<0.001], and experiencing academic challenges led to a seven-fold increase in the likelihood of reporting higher mental distress (aOR: 7.236, 95% CI: 3.168-12.530; p<0.001). Conclusion The COVID-19 pandemic posed a major challenge to international students and its impact on the mental health of the participants was aggravated by concurrent academic and financial hardships.

History of "Serve and Return" and a Synthesis of the Literature on its Impacts on Children's Health and Development

Parent/caregiver sensitivity and responsiveness are important for children's health and development. The "serve and return" metaphor was created to help providers and caregivers understand the importance of sensitive and responsive early caregiving. In this review, we explain the concept of "serve and return", outline historical and theoretical principles that culminated in this metaphor, highlight parent and child constructs associated with "serve and return" interactions, and synthesize literature on sensitive and responsive caregiving and children's health and developmental outcomes. Nurses and other healthcare professionals in public policy, clinical, community, education, and research roles need knowledge of "serve and return" interactions.

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.

Campus outdoor environment, learning engagement, and the mental health of college students during the COVID-19 pandemic: From the perspective of students in different grades

Introduction

During COVID-19, the mental health of Chinese university students has been a pressing concern. But the internal mechanism of perceived campus outdoor environment and learning engagement affecting college students' mental health during the COVID-19 pandemic has not been fully discussed.

Methods

The current study used cross-sectional data from 45 Chinese universities to explore the relationship among perceptions of campus outdoor environments, learning engagement, and college student mental health, and focused on differences among college students in different grades.

Results

Our study revealed the mental health problems of Chinese college students during the COVID-19 pandemic were more severe. The mental health of postgraduates was generally poor, and their risk of depression was higher than that of undergraduates. More importantly, for postgraduates, the direct impact of the perceived campus outdoor environment on their mental health was stronger. For undergraduates, the indirect impact of learning engagement on the effect of the perceived campus outdoor environment on their mental health was stronger.

Conclusion

The results of the study have implications for campus planners, landscape architects, and university planners to pay particular attention to the needs of postgraduates for campus outdoor environments, which is of great significance to improve the overall mental health of students during the COVID-19 pandemic.

Financial hardship and change in emotional well-being before to during COVID-19 pandemic among middle-aged and older Americans: Moderating effects of internal coping resources

OBJECTIVE

The purpose of this study was to investigate associations between financial hardship and change in emotional well-being-positive and negative affect-before to during the COVID-19 pandemic among middle-aged and older Americans and to examine the extent to which associations were moderated by internal coping resources-dispositional mastery and optimism.

METHOD

Data derived from the Leave-Behind Questionnaire in the 2016 and 2020 waves of the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults aged 51 and older (N = 1312). We estimated multivariate ordinary least squares regression models with interaction terms to evaluate prospectively the benefits of mastery and optimism as internal coping resources for middle-aged and older adults.

RESULTS

Dispositional mastery moderated the effects of financial hardship on changes in negative and positive affect, respectively, before to during the COVID-19 pandemic; however, optimism did not significantly moderate the effects of financial hardship on change in negative and positive affect before to during the COVID-19 pandemic.

CONCLUSIONS

Our findings have implications for interventions aimed at improving middle-aged and older adults' emotional well-being by promoting internal coping resources. Specifically, interventions should focus on financial hardship and mastery for vulnerable middle-aged and older adults in the context of public health crises.

A cotwin control study of associations between financial hardship and binge eating phenotypes during COVID-19

BACKGROUND

COVID-19 was associated with significant financial hardship and increased binge eating (BE). However, it is largely unknown whether financial stressors contributed to BE during the pandemic. We used a longitudinal, cotwin control design that controls for genetic/environmental confounds by comparing twins in the same family to examine whether financial hardship during COVID-19 was associated with BE.

METHODS

Female twins (N = 158; Mage  = 22.13) from the Michigan State University Twin Registry rated financial stressors (e.g., inability to afford necessities) daily for 49 consecutive days during COVID-19. We first examined whether financial hardship was associated with BE phenotypes across the full sample. We then examined whether cotwins who differed on financial hardship also differed in BE.

RESULTS

Participants who experienced greater mean financial hardship across the study had significantly greater dimensional BE symptoms, and participants who experienced greater financial hardship on a given day reported significantly more emotional eating that day. These results were replicated in cotwin control analyses. Twins who experienced more financial hardship than their cotwin across the study reported greater dimensional BE symptoms than their cotwin, and participants who experienced more financial hardship than their cotwin on a given day reported greater emotional eating that day. Results were identical when restricting analyses to monozygotic twins, suggesting associations were not due to genetic confounds.

CONCLUSIONS

Results suggest that BE-related symptoms may be elevated in women who experienced financial hardship during COVID-19 independent of potential genetic/environmental confounds. However, additional research in larger samples is needed.

PUBLIC SIGNIFICANCE

Little is known regarding how financial difficulties during the COVID-19 pandemic may have contributed to increased binge eating (BE). We found preliminary evidence that financial hardship during COVID-19 may be associated with greater rates of BE-related symptoms even when comparing twins from the same family. While additional research is needed, results suggest that people who experienced financial hardship during COVID-19 may be at increased risk for BE.

Association between asthma and work absence in working adults in the United States

The present study aimed to investigate the association between asthma and work absence in a large sample of US working adults, while controlling for several sociodemographic and health characteristics. This study used data from the 2019 Health and Functional Capacity Survey of the RAND American Life Panel (ALP). Work absence corresponded to the number of days of absence from work for health-related reasons in the past 12 months. Current asthma was self-reported and was included in the analyses as a dichotomous variable. Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, and number of chronic physical or psychiatric conditions. Finally, the association between asthma and work absence was analyzed using logistic regression models. This study included 1,323 adults aged 22-65 years (53.1% males; mean [SD] age 43.1 [11.7] years). Individuals with asthma were more likely to report at least one (81.5% versus 56.8%, p-value <0.001) or three days of absence (56.9% versus 31.3%, p-value =0.003) from work in the past 12 months than those without asthma. These findings were corroborated in the regression analyses, as asthma was positively and significantly associated with work absence after adjusting for all control variables (at least one day of absence: OR =3.24, 95% CI =1.44-7.29; at least three days of absence: OR =2.61, 95% CI =1.26-5.40). This US study of working adults showed that asthma was a risk factor for work absence. Further research is warranted to better understand the factors predisposing to work absence in the asthma population.

Socioeconomic differences in major depressive disorder onset among adults are partially explained by lifestyle factors: A longitudinal analysis of the Lifelines Cohort Study

BACKGROUND

Major depressive disorder (MDD) onset varies by socioeconomic position (SEP), this could be explained by lifestyle factors, but little is known about this pathway. Our study aims to disentangle the interplay between SEP measures (i.e., education, income and occupational prestige) and MDD onset and to examine to what extent these associations are mediated by lifestyle (i.e., occupational- and leisure time physical activity, smoking, alcohol intake, diet quality, sleep and central adiposity).

METHODS

A subsample (n = 76,045) of the Lifelines Cohort Study without MDD at baseline was included. MDD onset was measured after a median follow-up time of 3.8 years with the Mini International Neuropsychiatric Interview (MINI). Direct associations between SEP, lifestyle and MDD onset were estimated using logistic regression analyses. Mediating percentages were estimated using the Karlson-Holm-Breen method.

RESULTS

1864 participants (2.5 %) showed MDD at follow-up. SEP was inversely associated with MDD onset, with education showing the strongest association. Educational, income and occupational differences in MDD onset were for 18.7 %, 5.9 % and 21.7 % explained by lifestyle factors (mainly smoking, alcohol intake and central adiposity).

LIMITATIONS

SEP and lifestyle factors were measured simultaneously at baseline. MDD status (only based on a screening tool) was only measured at baseline and 3.8 years later.

CONCLUSIONS

Compared to their lower SEP counterparts, higher SEP individuals had a lower risk of MDD onset. This was partially explained by a healthier lifestyle (mainly less smoking, alcohol intake and central adiposity) of the higher SEP individuals.

Income disparities in mental health: investigating the role of food insecurity by disability status

OBJECTIVE

To investigate whether food insecurity helps explain the association between income and psychological distress and if its role differs by disability status.

DESIGN

Using 2011-2017 National Health Interview Survey cross-sectional data (n 102 543), we conducted linear regression models, fully interacted with disability status, to estimate the association between income-to-poverty ratio (IPR) (<1, 1-<2, 2-<4, ≥4) and psychological distress (Kessler 6 (K6) Scale, range: 0-24). Base models adjusted for socio-demographic factors. We then added food security (secure, low and very low), interacted with disability, and conducted post-estimation adjusted Wald tests.

SETTING

USA.

PARTICIPANTS

Nationally representative sample of non-institutionalised adults 18 years and older.

RESULTS

The association between income and psychological distress was stronger for people with disabilities. Compared to those in the highest income category (IPR ≥4), poor individuals (IPR < 1) with and without disabilities scored 2·10 (95 % CI (1·74, 2·46)) and 0·81 (95 % CI (0·69, 0·93)) points higher on the K6 Scale, respectively. Accounting for food insecurity reduced the estimated income disparity in psychological distress significantly more among individuals with disabilities (0·96 points or 46 %) than without disabilities (0·34 points or 42 %), decreasing the difference in the income disparity between those with and without disabilities by 48 % (0·62 points). Further, food insecurity more strongly predicted psychological distress for individuals with disabilities independent of socio-economic disadvantage.

CONCLUSIONS

Food insecurity plays a more important role in shaping patterns of psychological distress for people with disabilities, explaining more of the association between income and psychological distress among those with than without disabilities. Improving food security may reduce mental health disparities.

Financial Distress and Psychological Well-Being During the COVID-19 Pandemic

Objective: We examine the impact of financial distress caused by the COVID-19 pandemic on mental health and psychological well-being.

Methods: We analyze cross-sectional survey data (n = 2,545) from the Life during Pandemic study in Chile. We estimate linear probability models to analyze the relationship between economic fragility, financial distress, and psychological well-being.

Results: Our findings show unemployment and income loss are highly predictive of experiencing a range of financial problems, such as a lack of savings, as well as difficulties paying bills, consumer debt, and mortgage loans. In turn, financial distress leads to a higher prevalence of poor well-being and mental health deterioration, and sleep problems.

Conclusion: Expansion of mental health assistance services are needed, as new diagnosis of mental health conditions has increased, but treatment has not, pointing to a barrier in the access to some mental health care services during the pandemic. Policies designed with the objective of improving financial education are necessary to increase precautionary savings and financial resilience, and alleviate the psychological burden of debt in the future.

Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 "Lockdown" in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data

The widespread psychological effects of contagion mitigation measures associated with the novel coronavirus disease 2019 (COVID-19) are well known. Phases of "lockdown" have increased levels of anxiety and depression globally. Most research uses methods such as self-reporting that highlight the greater impact of the pandemic on the mental health of females. Emergency medical data from ambulance services may be a better reflection of male mental health. We use ambulance data to identify unusual clusters of high rates of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national "lockdown" and to explore factors that may explain clusters. Analysis of more than 5,000 cases of male mental health emergencies revealed 19 unusual spatial clusters. Binary logistic regression analysis (χ2 = 787.22, df = 20, p ≤ .001) identified 16 factors that explained clusters, including proximity to "healthy" features of the physical landscape, urban and rural dynamics, and socioeconomic condition. Our findings suggest that the factors underlying vulnerability of males to severe mental health conditions during "lockdown" vary within and between rural and urban spaces, and that the wider "hinterland" surrounding clusters influences the social and physical access of males to services that facilitate mental health support. Limitations on social engagement to mitigate effects of the pandemic are likely to continue. Our approach could inform delivery of emergency services and the development of community-level services to support vulnerable males during periods of social isolation.

The Acceptability and Initial Effectiveness of “Space From Money Worries”: An Online Cognitive Behavioral Therapy Intervention to Tackle the Link Between Financial Difficulties and Poor Mental Health

Background

Previous research has shown a strong relationship between financial difficulties and mental health problems. Psychological factors such as hope and worry about finances appear to be an important factor in this relationship.

Objective

To develop an online based psychological intervention (Space from Money Worries) to tackle the psychological mechanisms underlying the relationship between poor mental health and financial difficulties, and to conduct an initial evaluation of the acceptability and preliminary efficacy of the intervention.

Materials and Methods

30 participants accessing Increasing Access to Psychological Therapies (IAPT) services completed GAD-7 to measure anxiety and PHQ-9 to measure depression upon signing up to the online intervention and again 4 to 8 weeks after this. Participants also completed a measure of perceived financial distress/wellbeing and a “Money and Mental Health Scale” constructed for the evaluation.

Results

Overall, 77% (n = 23) completed the intervention and follow-up assessments. Intent to Treat Analysis showed that there were statistically significant improvements in symptoms of depression, anxiety, improved perceived financial wellbeing and reduced scores on the money and mental health scale. The vast majority of participants rated each module positively.

Conclusions

Space from Money Worries appears to be acceptable and may lead to improvements in mental health, perceived financial wellbeing and a reduced relationship between financial difficulties and poor mental health. However, future research with a larger sample and a control group are needed to confirm that these changes are due to the intervention.

A Systematic Review of the Impact of the First Year of COVID-19 on Obesity Risk Factors: A Pandemic Fueling a Pandemic?

Obesity is increasingly prevalent worldwide. Associated risk factors, including depression, socioeconomic stress, poor diet, and lack of physical activity, have all been impacted by the coronavirus disease 2019 (COVID-19) pandemic. This systematic review aims to explore the indirect effects of the first year of COVID-19 on obesity and its risk factors. A literature search of PubMed and EMBASE was performed from 1 January 2020 to 31 December 2020 to identify relevant studies pertaining to the first year of the COVID-19 pandemic (PROSPERO; CRD42020219433). All English-language studies on weight change and key obesity risk factors (psychosocial and socioeconomic health) during the COVID-19 pandemic were considered for inclusion. Of 805 full-text articles that were reviewed, 87 were included for analysis. The included studies observed increased food and alcohol consumption, increased sedentary time, worsening depressive symptoms, and increased financial stress. Overall, these results suggest that COVID-19 has exacerbated the current risk factors for obesity and is likely to worsen obesity rates in the near future. Future studies, and policy makers, will need to carefully consider their interdependency to develop effective interventions able to mitigate the obesity pandemic.

Exploring the Impact of the COVID-19 Pandemic on Male Mental Health Emergencies Attended by Ambulances During the First National "Lockdown" in the East Midlands of the United Kingdom

The novel coronavirus disease 2019 (COVID-19) pandemic and associated mitigation strategies such as “lockdown” are having widespread adverse psychological effects, including increased levels of anxiety and depression. Most research using self-reported data highlights the pandemic’s impact on the psychological well-being of females, whereas data for mental health emergency presentations may reflect the impact on male mental health more accurately. We analyzed records of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national “lockdown.” We computed two binary logistic regression models to (a) compare male mental health emergencies occurring during “lockdown,” 2020 (5,779) with those occurring in the same period in 2019 (N = 4,744) and (b) compare male (N = 5,779) and female (N = 7,695) mental health emergencies occurring during “lockdown.” Comparisons considered the characteristics of mental health emergencies recorded by ambulance clinicians (Primary Impressions), and the socioeconomic characteristics of communities where emergencies use the Index of Multiple Deprivation. We found that during “lockdown,” male emergencies were more likely to involve acute anxiety (odds ratio [OR]: 1.42) and less likely to involve intentional drug overdose (OR: 0.86) or attempted suicide (OR: 0.71) compared with 2019. Compared with females, male emergencies were more likely to involve acute behavioral disturbance (OR: 1.99) and less likely to involve anxiety (OR: 0.67), attempted suicide (OR: 0.83), or intentional drug overdose (OR: 0.76). Compared with 2019, and compared with females, males experiencing mental health emergencies during “lockdown” were more likely to present in areas of high deprivation. Understanding the presentation of male mental health emergencies could inform improved patient care pathways.

Associations between Coronavirus Crisis Perception, Perceived Economic Risk of Coronavirus, General Self-Efficacy, and Coronavirus Anxiety at the Start of the Pandemic: Differences by Gender and Race

The coronavirus pandemic has escalated rates of anxiety in the general U.S. population. Understanding how factors associated with coronavirus anxiety at the start of the pandemic differed among populations hardest impacted by coronavirus anxiety is key to effectively remediating negatively associated health outcomes and to better understand how to address concerns of the public at the start of a global pandemic. This study was a secondary analysis of data from a cross-sectional online survey of 1165 Prolific users between 13 and 15 March 2020. Data were collected from a stratified sample of U.S. adults aged 20 or older and currently living in the United States. The sample was stratified for age, gender, and race. Coronavirus anxiety was assessed as the dependent variable, alongside three independent variables: coronavirus crisis perception, perceived economic risk of coronavirus, and general self-efficacy. Multiple linear regression assessed the associations between the independent variables and coronavirus anxiety. Interactions between independent variables and two sociodemographic variables (i.e., gender, race) were also explored. The models were adjusted for age, gender, race, education, employment, and income. The average age of participants was 45.6 ± 15.7. The majority (76%) identified as White, approximately half identified as female and reported obtaining a bachelor's degree or higher. Coronavirus crisis perception and perceived economic risk of coronavirus were positively associated with coronavirus anxiety (β = 0.46, 95% CI = 0.41, 1.00; β = 0.14, 95% CI = 0.09, 1.00, respectively). General self-efficacy was negatively associated with coronavirus anxiety (β = -0.15, 95% CI = -1.00, -0.11). Gender and race both moderated the association between coronavirus crisis perception and anxiety. Race moderated the association between perceived economic risk and coronavirus crisis perception. These results provide a foundation to further explore cognitive factors in subgroups disproportionately affected by anxiety during the pandemic.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.

The Psychosocial Burden of Families with Childhood Blood Cancer

Cancer is the second leading cause of death for children, and leukemias are the most common pediatric cancer diagnoses in Chile. Childhood cancer is a traumatic experience and is associated with distress, pain, and other negative experiences for patients and their families. Thus, psychosocial costs represent a large part of the overall burden of cancer. This study examines psychosocial experiences in a sample of 90 families of children with blood-related cancer in Chile. We provide a global overview of the family experience, focusing on patients, caregivers, and siblings. We find that most families report a negative impact upon diagnosis; disruptions in family dynamics; a range of negative feelings of the patient, such as depression, discouragement, and irritability; and difficulty with social lives. Additionally, they report negative effects in the relationship between the siblings of the patient and their parents, and within their caregivers' spouse/partner relationship, as well as a worsening of the economic condition of the primary caregiver. Furthermore, over half of the families in the sample had to move due to diagnosis and/or treatment. Promoting interventions that can help patients, siblings, and parents cope with distress and promote resilience and well-being are important.

Mental health in Lebanon: Tomorrow's silent epidemic

Lebanon is a middle-income country that has been recently crippled by several tragedies including the economic collapse, COVID-19, and the fourth of August Beirut port explosion, the world's most powerful non-nuclear explosion of the twenty-first century. Recent data on mental health from Lebanon is summarised, and other topics such as the psychological impact of cumulative adversities and the role of international support in Lebanon are examined. Data from Lebanon shows severe levels of distress among the people, in a country with minimal resources. Given current adversities in Lebanon, recent data in the country, and the literature on adversity and mental health outcomes of man-made disasters, Lebanon is most likely going to face an epidemic in poor mental health. A call is made for the wider scientific community and international organizations to support the mental health field in the country and help prevent further negative mental health outcomes. Understanding how to better navigate mental health in places with extreme adversity and emergencies can be beneficial to other communities which might face similar challenges.

Stress of COVID-19, Anxiety, Economic Insecurity, and Mental Health Literacy: A Structural Equation Modeling Approach

The COVID-19 pandemic is currently a global health threat attributed to negatively affecting the mental health and well-being of people globally. The purpose of the current study is to examine the mediating roles of economic insecurity and mental health literacy in the relationship between stress about COVID-19 and anxiety. Results from the current study using a large sample of Chinese college students (N = 1,334) showed that stress of COVID-19 was positively associated with economic insecurity and anxiety while negatively associated with mental health literacy, which in turn was negatively associated with anxiety. These results elucidate our understanding of the role of mediators in stress about COVID-19 and anxiety. The findings are useful in terms of providing evidence for tailoring interventions and implementing preventative approaches to mitigate anxiety due to stress of COVID-19. Based on the present findings and within the context of COVID-19, the potential utility of promoting MHL to reduce the psychopathological consequences of COVID-19 is discussed.

Early Warning Signs of a Mental Health Tsunami: A Coordinated Response to Gather Initial Data Insights From Multiple Digital Services Providers

Introduction: The immediate impact of coronavirus 2019 (COVID-19) on morbidity and mortality has raised the need for accurate and real-time data monitoring and communication. The aim of this study is to document the initial observations from multiple digital services providers during the COVID-19 crisis, especially those related to mental health and well-being. Methods: We used email and social media to announce an urgent call for support. Digital mental health services providers (N = 46), financial services providers (N = 4), and other relevant digital data source providers (N = 3) responded with quantitative and/or qualitative data insights. People with lived experience of distress, as service users/consumers, and carers are included as co-authors. Results: This study provides proof-of-concept of the viability for researchers and private companies to work collaboratively toward a common good. Digital services providers reported a diverse range of mental health concerns. A recurring observation is that demand for digital mental health support has risen, and that the nature of this demand has also changed since COVID-19, with an apparent increased presentation of anxiety and loneliness. Conclusion: Following this study, we will continue to work with providers in more in-depth ways to capture follow-up insights at regular time points. We will also onboard new providers to address data representativeness. Looking ahead, we anticipate the need for a rigorous process to interpret insights from an even wider variety of sources in order to monitor and respond to mental health needs.

Help-seeking intentions in the U.S. population during the COVID-19 pandemic: Examining the role of COVID-19 financial hardship, suicide risk, and stigma

The primary goal of this study was to increase understanding of help-seeking intentions in the U.S. population during the COVID-19 pandemic and to examine influencing factors such as COVID-19 financial hardship, suicide risk, and stigma in order to contribute to effective theory-based help-seeking and suicide prevention campaigns. In a representative sample of U.S. adults (N = 5,010), this research tested whether COVID-19 financial hardship was associated with higher levels of depression and suicidal ideation (supported), and whether the reasoned action framework could usefully predict help-seeking intentions in this context (supported). The reasoned action framework explained 36% of the variance in help-seeking intentions in the U.S. population and identified injunctive norm (social support) as primary determinant of intention. Neither suicidal ideation, COVID-19 financial hardship, or self-stigma of seeking help influenced determinants of help-seeking. Future research should test injunctive norm as causal predictor of help-seeking in the U.S. population to usefully inform effective help-seeking campaigns, particularly among those who have experienced COVID-19 financial hardship. Additionally, effective dissemination strategies for help-seeking campaigns should be tested and identified, such as broader targeted approaches as well as intentional mis-targeting techniques.

The Impact of U.S. Housing Type and Residential Living Situations on Mental Health during COVID-19

Residential environments could be associated with the mental health of residents, in general, and during the COVID-19 pandemic. However, limited studies have investigated the relationship between these two. This study used data from the Household Pulse Survey, collected between 23 April 2020 and 23 November 2020 to explore the relationship between mental health status as perceived by the residents and housing tenure (own or rent), building type, and the number of household members, while accounting for sociodemographic characteristics, general health-related variables, and week-specific unobserved heterogeneities. The findings suggest that renters had higher odds of experiencing mental health issues than homeowners. Residents in multifamily housing units had higher odds of experiencing mental health problems than single-family units. Further, more people in the household were associated with lower odds of experiencing mental health episodes during the COVID-19 pandemic.

Financial Strain and Loneliness among Young Adults during the COVID-19 Pandemic: The Role of Psychosocial Resources

The COVID-19 (2019 novel coronavirus) pandemic, which has been accompanied by an economic crisis and multiple restrictions on our lives, has sparked renewed interest in the topic of loneliness as well as its determinants. We examined (1) the association between financial strain, occurring upon the outbreak of the virus, and loneliness among Israeli young people (aged 20–35); (2) the associations between cognitive social capital, psychological resources, and loneliness; and (3) whether these social and psychological resources were moderators in the financial strain–loneliness link. A real-time survey based on snowball sampling was conducted during April 2020 (N = 426). Hierarchical linear models were employed to explore associations between financial strain, cognitive social capital, psychological resources, and loneliness. Financial strain emerging during the pandemic was associated with greater loneliness. Cognitive social capital and optimism decreased loneliness. Sense of mastery moderated the financial strain–loneliness link. Policymakers must develop and extend mental health initiatives aimed at alleviating the psychological consequences of the pandemic and must also combat financial strain via unemployment compensation and social assistance programs. In line with the United Nations sustainable development goals, these tasks should be viewed as an integral part of promoting public health.

The impact of economic crisis on mortality due to mental health illnesses

BACKGROUND

The financial crisis affected several aspects of health. The aim of this study is to explore the impact of the crisis on mortality of mental illnesses in Greece and the socioeconomic determinants of mortality trends.

METHODS

Mortality data of 2000-16 were analyzed and sex-and-age-standardized death rates (SDRs) were calculated. The Average Annual Percent Change (AAPC) before and after the time point of slope change was computed. The crisis impact on SDRs was explored with interrupted time series analyses and standardized rate ratios (SRRs). The correlation of mortality with socioeconomic and healthcare-related variables was investigated with correlation and regression analyses.

RESULTS

A significant change in SDR trend was observed after 2012. The AAPC reversed from -2.9% to 94.5%, while the SRR was calculated at 6.1 (5.5-6.7). Income reduction, unemployment rise and health budget cuts were found to be significantly correlated with mortality rise.

CONCLUSIONS

Financial crisis had a significant impact on mortality due to mental illnesses, especially in females and elderly. The findings indicate that mortality increase is more driven by socioeconomic and healthcare-related factors that affect access to appropriate healthcare than by morbidity trends. The findings have implications in planning interventions to provide appropriate healthcare to patients living with mental illness.

Do Psychological Needs Play a Role in Times of Uncertainty? Associations with Well-Being During the COVID-19 Crisis

Across the world, measures were taken to contain the spreading of the COVID-19 virus. Many of these measures caused a sudden rupture in people's daily routines, thereby eliciting considerable uncertainty and potentially also hampering the satisfaction of individuals' psychological needs for autonomy, relatedness, and competence. Drawing upon Maslow's Hierarchical Need Theory and Self-Determination Theory, this study examined the unique role of felt insecurity and the psychological needs, as well as their dynamic interplay, in the prediction of mental health. A large and heterogeneous sample of adults (N = 5118; Mage = 43.45 years) was collected during the first ten days of the lockdown period in Flanders, Belgium. A subsample (N = 835, Mage = 41.39) participated during a second wave one week later. Hierarchical regression analyses indicated that felt insecurity, need satisfaction and need frustration all independently predicted various positive (life satisfaction, sleep quality) and negative indicators depressive symptoms, anxiety) of mental health, with little systematic evidence for interactions between the predictors. The pattern of findings obtained concurrently largely held in the longitudinal analyses. Finally, results showed that associations between felt insecurity and lower concurrent and prospective mental health were partially mediated by need satisfaction and frustration, with especially psychological need frustration predicting changes in mental health over time. Overall, the findings suggest that satisfaction of the psychological needs for autonomy, competence, and relatedness is not just a 'luxury good'. Satisfaction of these needs is important also in times of insecurity, while need frustration represents a risk factor for maladjustment during such times.

The Potential Role of Awe for Depression: Reassembling the Puzzle

Recently, interest in the unique pathways linking discrete positive emotions to specific health outcomes has gained increasing attention, but the role of awe is yet to be elucidated. Awe is a complex and transformative emotion that can restructure individuals' mental frames so deeply that it could be considered a therapeutic asset for major mental health major issues, including depression. Despite sparse evidence showing a potential connection between depression and awe, this link has not been combined into a proposal resulting in specific intervention guidelines. The aim of this perspective was three-fold: (i) to provide a new unifying model of awe's functioning-the Matryoshka model; (ii) to show systematic and explicit connections between this emotion and depression; and (iii) to suggest specific guidelines of intervention utilizing the potential therapeutic role of awe for mental health, specifically for depression. This theoretical endeavor in its entirety has been framed within the health domain.

The Use of the Intensive Longitudinal Methods to Study Financial Well-Being: A Scoping Review and Future Research Agenda

Financial well-being is a positive financial condition that has an objective (e.g., income) and a subjective (e.g., financial satisfaction) side. Much research has examined financial well-being using cross-sectional and classic longitudinal designs. More recently, researchers have begun to examine financial well-being using intensive longitudinal designs, collecting data in a repeated (at least five measurements) and intensive (short time interval between measurements) way. The goal of the current study was to systematically review all published research on financial well-being using intensive longitudinal methods, summarize themes from this work, and suggest future research directions. Searching three databases (Scopus, PsycINFO, Econpapers), we found nine articles that respected inclusion and exclusion criteria. From each selected article, we extracted information about (1) research field diffusion, (2) data collection methods, (3) financial well-being's definition and operationalization, (4) research questions addressed and (5) data analysis. Findings showed that most of the studies adopted an interval-contingent research design, collecting data once a day; that both the objective and subjective sides of the construct were assessed, and that, most of the time, the construct was conceptualized as financial stress (lack of financial well-being). Different kinds of research questions were addressed across studies and these were often analyzed using multilevel analysis. In the discussion section, future research directions are suggested.

Temporal dynamics of the association between financial stress and depressive symptoms throughout the emerging adulthood

BACKGROUND

Emerging adulthood is a life stage with elevated risk for both mental disorders and financial distress. Although a positive link between financial stress and depressive symptoms has been identified, there is a lack of delineation on the temporal dynamics of this link spanning the entire stage of emerging adulthood (roughly ages 18 to 29).

METHODS

Using a statistical approach that partitions between-person from within-person variation and based on four waves of data from a college cohort (N = 2,098) throughout emerging adulthood, this study addresses this gap.

RESULTS

Latent growth curve model analyses indicate that the trajectory of financial stress throughout emerging adulthood followed an inverted "U" shape, whereas that of depressive symptoms displayed a linear, decreasing trend. The positive correlations of both intercepts and slopes between financial stress and depressive symptoms indicated a co-development pattern. Classical, cross-lagged panel model analyses (i.e., a model aggregating between-person and within-person variation) demonstrated a reciprocal positive association between financial stress and depressive symptoms across waves. Random intercept, cross-lagged panel model analyses (i.e., a model disaggregating between-person and within-person effects) indicated a unidirectional positive within-person effect from depressive symptoms to financial stress across waves, controlling for between-person effects.

LIMITATIONS

Shared-method and shared-informant variance may inflate the identified associations, and the correlational data precludes casual inferences.

CONCLUSION

Improving young adults' mental well-being, specifically intervening depressive symptoms, could be an avenue for reducing their financial stress. Future research is pressing to examine mechanisms via which depression symptoms manifest as financial stress during transition to adulthood.