Financial Strain and Mental Health Among Older Adults During the Great Recession

The impact of resilience and coping strategies on depressive symptoms among Korean American older adults during COVID-19

OBJECTIVES

This study examined how resilience and coping strategies were associated with depressive symptoms among Korean American older adults during COVID-19. The prevalent depressive symptoms and low use of mental health services in this population have raised significant concerns among healthcare professionals. Therefore, this study aims to understand the relationships between resilience and coping types on depressive symptoms and provide valuable insights into addressing these issues within this ethnic group.

METHOD

A cross-sectional survey was conducted with 132 Korean American older adults. Hierarchical linear regression analyses were performed to assess the effect of sociodemographic factors (age, gender, marital status, years of living in the U.S., self-rated health, financial security), resilience, and coping strategies (problem-focused coping, emotion-focused coping, avoidant coping) on depressive symptoms. Next, the interactions between resilience and three coping strategies for depressive symptoms were tested.

RESULTS

The findings show that depressive symptoms were associated with financial security and avoidant coping. Also, resilience interacted with avoidant coping and emotion-focused coping. Among the participants with low resilience, depressive symptoms increased rapidly when avoidant and emotion-focused coping strategies increased, respectively.

CONCLUSION

This study emphasizes the importance of culturally tailored interventions to promote resilience and decrease avoidant and emotion-focused coping among Korean American older adults.

The association between financial strain and mental health: The mediating and moderating roles of sleep problems in the UK household longitudinal study (UKHLS)

BACKGROUND

Financial strain is a well-documented stressor that negatively affects mental health, yet the mechanisms underlying this relationship remain insufficiently understood. This study examines the roles of sleep problems as both mediators and moderators, utilizing the frameworks of stress proliferation and amplification as outlined in the stress process model.

METHODS

Data from four waves of the UK Household Longitudinal Study (UKHLS)-Wave 4 (2012-2013), Wave 7 (2015-2016), Wave 10 (2018-2019), and Wave 13 (2021-2022)-were used, covering 34,156 individuals and 103,589 person-years. Fixed effects regression models were employed to analyze changes within individuals over time.

RESULTS

Financial strain was associated with deteriorating mental health. Sleep problems-including poor sleep quality, frequent use of sleep medication, sleep disturbance, daytime dysfunction, and longer sleep latency-were also associated with poorer mental health. Importantly, these sleep problems not only mediated the impact of financial strain on mental health but also exacerbated its negative effects.

LIMITATIONS

The study could not eliminate the possibility of reverse causality, where deteriorating mental health may influence financial strain or worsen sleep problems.

CONCLUSIONS

These findings highlight the importance of addressing financial strain as a key driver of poor mental health. Interventions aimed at improving sleep health may simultaneously mitigate the harmful effects of financial strain, offering dual benefits for mental health. By reducing financial strain and promoting healthier sleep, public health strategies can bolster resilience in populations vulnerable to both financial and psychological stress.

Whose assets? Individual and household income and savings and mental health in a longitudinal cohort

While there is a growing understanding of the link between financial assets and mental health, the literature is lacking in two dimensions. First, although wealth (including savings) may better inform ability to cope with life's stressors than income alone, the role of wealth in shaping health is substantially understudied relative to income. Second, most studies measure income at the household level instead of the individual level. Using five waves of the nationally representative CLIMB survey collected in Spring 2020, 2021, 2022, 2023, and 2024, we estimated the odds of probable depression (Patient Health Questionnaire, PHQ-9≥10) and anxiety (GAD-7≥10) across individual and household level income and savings using generalized estimating equations to account for clustering over time at the individual level and to account for baseline mental health. Our sample included 1,314 participants across the five waves of the CLIMB survey. The average age of participants was 46.5 years [sd: 16.4] in 2020. When controlling for demographic variables, each financial asset was independently associated with mental health. In fully adjusted models where savings and income at the individual and household level were included, for every $10,000 more that an adult reported in individual annual income, they had 0.95 times the odds of probable depression (95%CI: 0.92, 0.99) and 0.95 time the odds of probable anxiety (95%CI: 0.91, 0.99), translating to 5% lower odds. Having $10,000 more in individual savings was associated with 0.95 times the odds of probable anxiety (95%CI: 0.91, 0.99). These findings suggest that 1) financial assets were each independently associated with mental health, 2) having higher individual income was associated with mental health even when adjusting for financial assets at the household and individual level, and 3) higher individual savings were associated with lower probable anxiety. Individual-level financial assets may be associated with mental health differently than household-level financial assets.

Financial strain measures and associations with adult health: A systematic literature review

Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.

Stress Due to Inflation and Its Association with Anxiety and Depression Among Working-Age Adults in the United States

Inflation generates stress, which may lead to high rates of anxiety and depression. Given the recent surge and subsequent decline in the inflation rate in the United States, the prevalence of stress due to inflation may vary, as well as its relationship with anxiety and depression. Therefore, we investigated the prevalence of stress due to inflation and its association with anxiety and depression over time among working-age adults in the United States. We conducted a repeated cross-sectional analysis using Household Pulse Survey (HPS) data for the following weeks: Week 50 (5-17 October 2022) and Week 57 (26 April-8 May 2023). The HPS includes questions about individuals' stress levels due to price increases in the past two months. We used logistic regressions to examine the association of stress (moderate or high stress versus little or no stress) due to inflation with depression and anxiety among working-age adults controlling for several factors, including demographic factors and social determinants of health. From October 2022 to April-May 2023, the prevalence of stress due to inflation affected more than three quarters of the population (77.7% and 78.7%, respectively). In logistic regressions, we found a significant positive association of stress due to inflation with depression (adjusted odds ratio (AOR) [95% CI] = 2.22 [1.92, 2.57]) and anxiety (AOR [95% CI] = 2.50 [2.18, 2.86]). Despite a decline in the prevalence of both depression and anxiety by three percentage points over the study period, the associations between stress, due to inflation on the one hand, and anxiety and depression, on the other, persisted over time. Stress due to inflation affects more than three-quarters of Americans, and is significantly associated with depression and anxiety. Stress due to inflation is a significant and persistent public health issue.

Financial assets and mental health over time

Financial, material, and social assets are core drivers of access to salutary resources. However, there is a paucity of research about how non-income financial assets shape mental health. We explore the relation of financial assets with symptoms of depression and of anxiety using a nationally representative, longitudinal survey of U.S. adults fielded annually from 2020 to 2023 (n = 1,296 unique participants). We used multivariable logistic regression models to estimate the association of financial assets and financial stress separately and together with symptoms of depression (PHQ-9 > 9), anxiety (GAD-7 > 9), and their co-occurrence, controlling for demographic indicators and year fixed effects. We found, first, that adults with <$5,000 in accrued financial assets reported over two times the odds of positive screen for depression, anxiety, and co-occurring depression and anxiety, respectively, as adults with ≥$100,000 in financial assets. Second, when controlling for accrued financial assets, annual household income was not associated with symptoms of anxiety. Third, the gap in positive screen for depression between household financial assets groups stayed consistent and did not differ significantly over the study period. Annual income alone does not capture the influence of all financial assets on mental health.

Quarantine Experience-Based Differences in Factors Associated with Depression Among Koreans During the COVID-19 Pandemic

BACKGROUND/OBJECTIVES

The strict preventive measures implemented globally during the COVID-19 pandemic affected mental health, with most countries reporting a rise in depression and suicide. This study examined factors affecting depression among Korean adults based on quarantine experiences during 2020 and identified key areas for mental health support.

METHODS

Data were obtained from South Korea's 2020 Community Health Survey. Responses from 219,228 adults (1893 with quarantine experience and 217,335 without) to questions about quarantine experience, depression (Korean version of PHQ-9 score ≥ 10 or a response of 'several days' or more on item 9), and individual/environmental factors were analyzed. Complex sampling analysis, including descriptive statistics and logistic regression, was conducted using SPSS 29.0.

RESULTS

This study found that 158 (weighted 7.5%) of those with quarantine experience, and 12,833 (weighted 5.8%) without quarantine experience, reported depression. Regardless of quarantine, being female, having a low income, a history of depression, and increased stress were associated with a higher depression rate, while good subjective health was linked to lower depression rates. Smoking, living-alone, and a lack of sleep among non-quarantined individuals were linked to increased depression risk, while adequate physical activity was linked to reduced risk. Interestingly, alcohol consumption and being overweight (BMI 23-<25) were associated with lower depression rates. Environmental factors, like unmet medical needs and reduced daily activity, were linked to increased depression. Strong social support and social distancing adherence were associated with reduced depression.

CONCLUSIONS

These findings underscore the importance of targeted interventions considering quarantine experiences to reduce depression during pandemics.

Associations between Recession Hardships and Subjective and Objective Sleep Measures in the Midlife in the United States Study: Race and Gender Differences

Objectives

This study investigates the associations of retrospective reports of Recession hardships with 10-year changes in subjective and objective indicators of sleep, and whether these associations differ by race and gender.

Methods

501 adults (14.57% Black; 54.49% female) from the Midlife in the United States (MIDUS) study reported on the subjective Pittsburgh Sleep Quality Index (PSQI) across two waves (pre-Recession, collected 2004-2009; post-Recession, collected 2017-2022), as well as Recession hardships since 2008. A sub-sample of 201 adults (25.37% Black; 58.21% female) provided objective actigraphy-measured sleep data (total sleep time, sleep onset latency, sleep efficiency) across the two waves.

Results

Descriptive analyses revealed Black participants had higher average Recession hardships, poorer post-Recession PSQI scores, and poorer post-Recession actigraphy sleep quantity and quality compared to white participants. Females had higher average Recession hardships compared to males; and reported poorer post-Recession PSQI, but had better objective post-Recession sleep quantity and quality compared to males. Regression models showed Recession hardships (across overall events, and sub-domains of financial and housing hardships) were associated with poorer PSQI and actigraphy-measured sleep efficiency following the Recession, adjusting for sociodemographic covariates, corresponding pre-Recession sleep variables, and pre-Recession chronic conditions. There was no evidence for significant moderation by race on sleep outcomes. However, gender moderation indicated associations between housing hardships and poorer actigraphy-measured sleep efficiency were more apparent for females than for males.

Conclusions

Findings indicate that Recession hardships (particularly in financial and housing domains) may be manifested in poor sleep. Racial and gender groups may have differential exposure and sleep-related reactivity to Recession hardships.

Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the "Taiwan Longitudinal Study on Aging (TLSA)," which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach's α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.

The impact of national and international financial crises on mental health and well-being: a systematic review

BACKGROUND

Evidence suggests that financial crises and poor mental health are reciprocally related, but no systematic review has been conducted to synthesise the existing literature on the impact of national and international financial crises on population-level mental health and well-being.

AIMS

The aim of this study was to systematically review the available literature on the global impact of financial crises on mental health and well-being outcomes.

METHODS

After registration on PROSPERO, a systematic search was conducted in PsycINFO, MEDLINE, Wiley, and Web of Science for papers published until 21 November 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, 98 papers were identified as meeting eligibility criteria. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and results were presented in a formal narrative synthesis.

RESULTS

Our findings show that financial crises are significantly associated with well-being and occurrence of psychological conditions. Several socio-demographic, cultural, and country-specific characteristics played a crucial role in the prevention of population mental health decline in periods of financial crises.

CONCLUSIONS

Based on the findings of this review, evidence-based recommendations were developed to guide the design of policy actions that protect population mental health during and after financial crises.

Income or Job Loss and Psychological Distress During the COVID-19 Pandemic

Importance

Given the expiration of expanded unemployment and other benefits during the COVID-19 pandemic, it is important to understand the association between pandemic income or job loss and long-term implications on mental health.

Objective

To evaluate the association between income or job loss due to the COVID-19 pandemic and later psychological distress.

Design, Setting, and Participants

This cohort study used 5 waves of nationally representative, longitudinal survey data (September 16, 2019, through September 18, 2022) from the Pew Research Center's American Trends Panel. Doubly robust propensity score-weighted quasi-Poisson models were used to estimate the association of self or household income or job loss during the early phase of the COVID-19 pandemic with later psychological distress, while controlling for pre-income loss characteristics (demographics, finances, and psychological distress). The study sample comprised US working-age adults (aged 18-64 years) who had not experienced income or job loss due to the COVID-19 pandemic by March 24, 2020.

Exposure

Participant-reported self or household income or job loss (ie, reduced hours or demand for work) due to the COVID19 pandemic between March 24, 2020, and August 16, 2020.

Main Outcome and Measures

Psychological distress was measured using a composite scale of 0 to 15 based on participants' reported frequency of feeling depressed, on edge, sleepless, lonely, and hopeless in the past week in March 2020, February 2021, and September 2022.

Results

Of 1392 working-age adults (survey weighted 52.7% male and 47.7% aged 30-49 years) who had not reported income or job loss before March 24, 2020, a survey weighted 35.7% reported job or income loss between March 24 and August 16, 2020. Early-phase pandemic income or job loss was associated with higher distress in February 2021 (estimated ratio, 1.09; 95% CI, 1.01-1.18; P = .03) and September 2022 (estimated ratio, 1.11; 95% CI, 1.02-1.22; P = .02) among participants who experienced job or income loss between March 24 and August 16, 2020, compared with the propensity score-weighted mean in the group who did not experience income loss.

Conclusions and Relevance

These small but significant within-person associations between early-phase pandemic household income or job loss and psychological distress up to 29 months later suggest that policies are needed to support people with income or job loss to help mitigate the long-term adverse mental health outcomes of economic disruption.

Depression and assets during the COVID-19 pandemic: A longitudinal study of mental health across income and savings groups

The prevalence of depression in U.S. adults during the COVID-19 pandemic has been high overall and particularly high among persons with fewer assets. Building on previous work on assets and mental health, we document the burden of depression in groups based on income and savings during the first two years of the COVID-19 pandemic. Using a nationally representative, longitudinal panel study of U.S. adults (N = 1,271) collected in April-May 2020 (T1), April-May 2021 (T2), and April-May 2022 (T3), we estimated the adjusted odds of reporting probable depression at any time during the COVID-19 pandemic with generalized estimating equations (GEE). We explored probable depression-defined as a score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9)-by four asset groups, defined by median income (≥$65,000) and savings (≥$20,000) categories. The prevalence of probable depression was consistently high in Spring 2020, Spring 2021, and Spring 2022 with 27.9% of U.S. adults reporting probable depression in Spring 2022. We found that there were four distinct asset groups that experienced different depression trajectories over the COVID-19 pandemic. Low income-low savings asset groups had the highest level of probable depression across time, reporting 3.7 times the odds (95% CI: 2.6, 5.3) of probable depression at any time relative to high income-high savings asset groups. While probable depression stayed relatively stable across time for most groups, the low income-low savings group reported significantly higher levels of probable depression at T2, compared to T1, and the high income-low savings group reported significantly higher levels of probable depression at T3 than T1. The weighted average of probable depression across time was 42.9% for low income-low savings groups, 24.3% for high income-low savings groups, 19.4% for low income-high savings groups, and 14.0% for high income-high savings groups. Efforts to ameliorate both savings and income may be necessary to mitigate the mental health consequences of pandemics.

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.

Psychosocial stressors associated with frailty in community-dwelling older adults in the United States

BACKGROUND

Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway.

METHODS

This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway.

RESULTS

Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant.  CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty.

Quality of Life among LGBTQ Older Adults in the United States: A Systematic Review

BACKGROUND

Sexual and gender minorities constitute a rapidly growing part of the older adult population in the United States and may face quality of life (QOL) challenges in older adulthood. Research on quality of life among lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults has increased dramatically since 2010. Common findings indicate that LGBTQ older adults face challenges related to personal experiences of discrimination, anticipated discrimination in health care settings, and lack of family support. Research designs were primarily nonprobability surveys, with a small number of qualitative designs and surveys using representative probability samples.

AIM

To identify and summarize research on QOL among LGBTQ older adults conducted in the United States between January 1, 2000 and December 31, 2020.

METHOD

Four scholarly databases were searched to identify studies addressing QOL in LGBTQ older adult populations.

RESULTS

The database search produced a total 568 unique results. Of these, 54 research articles were identified that met all inclusion criteria for the review. Appraisal of evidence was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology.

CONCLUSIONS

Care for mental health of LGBTQ older adults should be sensitive to issues including lifetime history of discrimination, anxiety about anticipated discrimination from health care providers, and potential lack of family support. Focus can also be given to common areas of strength, including strengthening nonfamily social networks.

Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review

PURPOSE

Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic.

METHODS

We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations.

RESULTS

Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups.

CONCLUSION

This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.

Association of perceived childhood socio-economic status and health with depressive symptoms among middle-aged and older adults in India: using data from LASI Wave I, 2017-2018

BACKGROUND

Childhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people's life remains still unclear and needs to generate more evidence, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms amongst middle- aged and older adults in India.

METHODS

The data for the study was drawn from national representative survey "Longitudinal Ageing Study in India (LASI)" Wave I, 2017-2018 in order to conduct cross-sectional study. Multivariable regression analysis was used to examine the association of childhood socioeconomic status and health with depressive symptoms in the older population.

RESULTS

Poor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.56, CI: 1.19, 2.04). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.16 CI: 1.01, 1.34). In addition to this, the odds of having depressive symptoms increased significantly among the average (AoR: 1.28 CI: 1.08, 1.51) and poor childhood socioeconomic status group (AoR: 1.31 CI: 1.11, 1.55) as compared to the higher socioeconomic category.

CONCLUSIONS

Childhood socioeconomic status and health have a significant role in determining mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.

Income Loss and Mental Health during the COVID-19 Pandemic in the United States-Investigating the Moderating Role of Race and Metro-Level Co-ethnic Density

The COVID-19 pandemic has significantly impacted individuals' financial well-being and mental health. This study investigates the relationship between income loss and mental health outcomes during the pandemic, as well as the heterogeneity in this relationship by race/ethnicity and co-ethnic density in the metropolitan area. Using nationally representative Household Pulse Survey data, this study finds that income loss is associated with a heightened risk of depression and anxiety, even after controlling for individual and metropolitan-level characteristics. Co-ethnic density in metropolitan areas worsens the effects of income loss on depression and anxiety for Hispanics and non-Hispanic Blacks while residing in a metropolitan area with more Whites cushions the impact of income loss on depression and anxiety for non-Hispanic Whites. Overall, the study underscores the importance of considering the intersection of race/ethnicity and metropolitan-level co-ethnic density in exploring the influence of economic stressors on mental health.

Affective reactivity to daily stressors and immune cell gene expression in the MIDUS study

Affective reactivity to stress is a person-level measurement of how well an individual copes with daily stressors. A common method of measuring affective reactivity entails the estimation of within-person differences of either positive or negative affect on days with and without stressors present. Individuals more reactive to common stressors, as evidenced by affective reactivity measurements, have been shown to have increased levels of circulating pro-inflammatory markers. While affective reactivity has previously been associated with inflammatory markers, the upstream mechanistic links underlying these associations are unknown. Using data from the Midlife in the United States (MIDUS) Refresher study (N = 195; 52% female; 84% white), we quantified daily stress processes over 10 days and determined individuals' positive and negative affective reactivities to stressors. We then examined affective reactivity association with peripheral blood mononuclear cell (PBMC) gene expression of the immune-related conserved transcriptional response to adversity. Results indicated that individuals with a greater decrease in positive affect to daily stressors exhibited heightened PBMC JUNB expression after Bonferroni corrections (p-adjusted < 0.05). JUNB encodes a protein that acts as a transcription factor which regulates many aspects of the immune response, including inflammation and cell proliferation. Due to its critical role in the activation of macrophages and maintenance of CD4+ T-cells during inflammation, JUNB may serve as a potential upstream mechanistic target for future studies of the connection between affective reactivity and inflammatory processes. Overall, our findings provide evidence that affective reactivity to stress is associated with levels of immune cell gene expression.

Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices

OBJECTIVES

This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression.

METHODS

Data were from the Leave-Behind Questionnaire in the 2016 (N = 4293) and 2018 (N = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples.

RESULTS

Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders.

CONCLUSION

This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.

Inflation hardship, gender, and mental health

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

Two sides of the same coin? Absolute income and perceived income inadequacy as social determinants of health

BACKGROUND

Absolute income is commonly used in studies of health inequalities, however it does not reflect spending patterns, debts, or expectations. These aspects are reflected in measures concerning perceived income inadequacy. While health inequities by absolute income or perceived income inadequacy are well established, few studies have explored the interplay of absolute income and perceived income inadequacy in relation to health.

METHODS

Multiple data sources were linked into a nationally representative dataset (n = 445,748) of Dutch adults (18 +). The association between absolute income, perceived income inadequacy and health (self-reported health, chronic disease and psychological distress) was tested using logistic and Poisson regressions, controlling for various potential confounders (demographics, education) and mastery. Interactions were tested to check the association between perceived income inadequacy and health for different absolute income groups.

RESULTS

Perceived income inadequacy was reported at every absolute income group (with 42% of individuals in the lowest income group and 5% of individuals in the highest income group). Both absolute income and perceived income inadequacy were independently associated with health. The adjusted relative risk (RR) for lowest absolute income group is 1.11 (1.08-1.1.14) and 1.28 (1.24-1.32) for chronic disease and self-reported health respectively, and the Odds Ratio (OR) for psychological distress is 1.28 (1.16-1.42). For perceived income inadequacy the RR's were 1.41 (1.37-1.46) and 1.49 (1.44-1.54) and the OR for psychological distress is 3.14 (2.81-3.51). Mastery appeared to be an important mediator for the relationship between perceived income inadequacy, poor self-rated health and psychological distress.

CONCLUSIONS

Absolute income and perceived income inadequacy reflect conceptually different aspects of income and are independently associated with health outcomes. Perceived income inadequacy may be accounted for in health inequality studies, alongside measures of absolute income. In policy-making, targeting perceived income inadequacy might have potential to reduce health inequalities.

Financial strain and depression in the U.S.: a scoping review

While the association between assets and depression has been established, less is known about the link between financial strain and depression. Given rising financial strain and economic inequity due to the COVID-19 pandemic, understanding the role that financial strain plays in shaping population depression in the United States is particularly salient. We conducted a scoping review of the peer-reviewed literature on financial strain and depression published from inception through January 19, 2023, in Embase, Medline via PubMed, and PsycINFO, PsycArticles, SocINDEX, and EconLit via Ebsco. We searched, reviewed, and synthesized the literature on longitudinal studies on financial strain and depression conducted in the United States. Four thousand and four unique citations were screened for eligibility. Fifty-eight longitudinal, quantitative articles on adults in the United States were included in the review. Eighty-three percent of articles (n = 48) reported a significant, positive association between financial strain and depression. Eight articles reported mixed results, featuring non-significant associations for some sub-groups and significant associations for others, one article was unclear, and one article reported no significant association between financial strain and depression. Five articles featured interventions to reduce depressive symptoms. Effective interventions included coping mechanisms to improve one's financial situation (e.g., mechanisms to assist in finding employment), to modify cognitive behavior (e.g., reframing mindset), and to engage support (e.g., engaging social and community support). Successful interventions were tailored to participants, were group-based (e.g., they included family members or other job seekers), and occurred over multiple sessions. While depression was defined consistently, financial strain was defined variably. Gaps in the literature included studies featuring Asian populations in the United States and interventions to reduce financial strain. There is a consistent, positive association between financial strain and depression in the United States. More research is needed to identify and test interventions that mitigate the ill effects of financial strain on population's mental health.

Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults?

OBJECTIVE

Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress.

METHODS

This cross-sectional study included 7,679 community-dwelling older adults (≥ 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role.

RESULTS

The frailty prevalence was 22%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship.

CONCLUSION

Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.

Associations among Financial Well-Being, Daily Relationship Tension, and Daily Affect in Two Adult Cohorts Separated by the Great Recession

Financial well-being may be an important context for daily emotional reactivity to relationship tension (e.g., arguments) whose salience varies across historical time or as a function of exposure to economic downturns. This study investigated how emotional reactivity, operationalized as daily fluctuations in negative and positive affect associated with the occurrence of daily relationship tension, varied by financial well-being among those who were and were not exposed to the Great Recession of 2008. Two matched, independent subsamples of partnered individuals from the National Study of Daily Experiences completed identical 8-day diary protocols, one before the Great Recession (n = 587) and one after (n = 351). Individuals reported higher negative affect and lower positive affect on days when relationship tension occurred. Further, results indicated that negative affect reactivity, but not positive affect reactivity, was moderated by both financial well-being and cohort status. For the pre-recession cohort, negative affect reactivity was stronger among those with lower financial well-being. However, among the post-recession cohort, financial well-being did not moderate negative affect reactivity to relationship tension. Findings highlight the utility of considering major societal events, such as economic downturns, to understand variability in emotional reactivity to day-to-day relationship tension in the context of financial well-being, as the salience of financial well-being in the ways relationship tension and negative affect are related on a daily basis appears to vary by historical context.

Socioeconomic Background and Self-Reported Sleep Quality in Older Adults during the COVID-19 Pandemic: An Analysis of the English Longitudinal Study of Ageing (ELSA)

The COVID-19 pandemic negatively impacted sleep quality. However, research regarding older adults' sleep quality during the pandemic has been limited. This study examined the association between socioeconomic background (SEB) and older adults' sleep quality during the COVID-19 pandemic. Data on 7040 adults aged ≥50 were acquired from a COVID-19 sub-study of the English Longitudinal Study of Ageing (ELSA). SEB was operationalized using educational attainment, previous financial situation, and concern about the future financial situation. Sociodemographic, mental health, physical health, and health behavior variables were included as covariates. Chi-squared tests and binary logistic regression were used to examine associations between SEB and sleep quality. Lower educational attainment and greater financial hardship and concerns were associated with poor sleep quality. The relationship between educational attainment and sleep quality was explained by the financial variables, while the relationship between previous financial difficulties and sleep quality was explained by physical health and health behavior variables. Greater financial concerns about the future, poor mental health, and poor physical health were independent risk factors for poor sleep quality in older adults during the pandemic. Healthcare professionals and service providers should consider these issues when supporting older patients with sleep problems and in promoting health and wellness.

What makes Americans fall behind in their finances? Evidence from the national well-being survey

The question of how often Americans fall behind on their finances is analyzed using the National Financial Well-Being survey of the United States Consumer Financial Protection Bureau. An ordered logit model is proposed to study the effect of individual and household characteristics on the likelihood of falling behind in one's finances. The analysis shows that traditional variables such as income, age, education, and health are statistically significant predictors of falling behind in one's finances. In addition, the study shows that the volatility of income, saving habits, and individuals' financial knowledge significantly contribute to the explanation of Americans' economic behavior.

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.

The intersection of race and financial strain: The pain of social disconnection among women in the United States

Objectives: Considerable attention has been directed at increased social isolation and loneliness during the COVID-19 pandemic and their impact on later-life psychological well-being. There is a dearth of research on the effect of financial strain and associated psychosocial mechanisms on loneliness among women across racial groups. It is unclear how racial status and financial strain intersect to impact later-life loneliness amid immense uncertainty, social isolation, and anxiety induced by the pandemic.Methods: Based on our nationwide Web-based survey (n = 1,301), we used ordinary least square regression to examine the effects of financial strain on loneliness among Black and White women and assessed the role of emotional support in contributing to such effects.Results: We found that Black women face significantly more financial strain than White women but also receive more emotional support and experience less loneliness. Findings show that women experiencing financial strain report increased loneliness, but the negative effects of financial strain are significantly greater for Black women than for White women. Our mediation analysis revealed that emotional support made a significant contribution to the effects of financial strain on loneliness in White women but not in Black women.Discussion: Despite shared vulnerability and social isolation across the general population, our findings suggest that negative effects of financial strain on loneliness among women continue to differ across race, even amid the pandemic. Our findings demonstrate how emotional support explains the relationship between financial strain and later-life loneliness in a racially distinct manner.

Racial differences in Financial Hardship and depressive symptoms among older adults

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The home environment: influences on the health of young-old and old-old adults in Australia

The physical and societal characteristics of home have been established as important in influencing the health and wellbeing of older adults, yet these have rarely been explored together. There is also limited research into variation across age groups, with older adults often examined as a homogenous group of those 65 years and over. This study advances the knowledge base by using the concept of person–environment (P-E) fit to analyse differences in personal and home environment (physical and societal) characteristics between young-old (65–74 years) and old-old (75 and above) age groups, and to assess how these characteristics influence their self-perceived health. This cross-sectional study draws upon survey data from 1,999 older adult participants from the Australian Housing Conditions Dataset. Descriptive statistics and inferential analysis were used to assess for significant differences between age groups and a binomial logistic regression was utilised to examine influences on health. The analysis found that the factors which influence health varies appreciably between age groups. For the young-old financial strain, being on the fixed-income pension and hypertension were important contributing factors, in contrast for the old-old gender (being male), having depression and the home being modified for disability were key influences. For both age groups heart disease was a contributing factor to perceived health. The results indicate the important contribution to knowledge of incorporating a wide range of person and environment characteristics when exploring P-E fit for older adults. The inclusion of societal aspects, such as financial strain, fixed-income pension, tenure and access to community aged care services when exploring influences on health, arises as a key conclusion of the study. In terms of impact, this research is significant given rising inequalities globally and specifically in the Australian context, the need for policy measures to address income inequality, and its health and social implications for older households.

Financial Problems in Established Adulthood: Implications for Depressive Symptoms and Relationship Quality with Parents

Using two waves of data from the Family Exchanges Study (2008 and 2013), this study examined changes in financial problems before and after the Great Recession and investigated the implications for adults' depressive symptoms and relationship quality with parents. Participants in established adulthood (N = 170, age 30-46 in 2013) provided information about their financial difficulties and depressive symptoms, as well as negative relationship quality with each parent (parent-child tie; N = 316) at baseline and 5 years later. Results showed that a growing number of participants experienced financial problems between the two waves, rising from 16 to 72% of participants. Moreover, 14% of participants indicated continuing financial problems and 33% reported decreased income over the 5 year observation period. Financial problems at baseline, continuing financial problems across the observation period, and decreased income over time were associated with participants' increased depressive symptoms, after controlling for their baseline depressive symptoms. Results from multilevel models also revealed that adult participants had more strained relationships with their parents if they experienced more financial problems at the follow-up interview. The harmful effect of financial problems on relationship quality with parents was partially explained by adult participants' depressive symptoms. Findings of this study highlight the important role of financial hardship for persons in established adulthood and their intergenerational ties.

Modeling the impact of financial hardship and age on self-rated health and depressive symptoms pre/post the great recession

Stressful life events such as a recession, could be devastating on a macro and micro level. Although there have been a number of articles written examining the health effects of the recession, little is known about age differences in the relationship between financial stressors and health pre and post the 2008 recession. Using the Health and Retirement study, we investigated the relationship between two forms of financial hardships, mental and physical health among middle aged (N = 4403) and older adults) (N = 2709). Our findings indicate that with regard to financial hardships experienced pre/post recessionary periods there are differences by age. Specifically, older adults tend to report having less financial hardship than their younger counterparts. Additionally, reduced medication use due to costs was a significant predictor of poor self-rated health among middle aged participants compared to older adults. These results highlight the selective impact of recessions on certain age groups. They also suggests that economic recessions may also produce short-term procyclical health effects. Future research should focus on the relationship between other sources of financial hardship among middle-aged and older adults pre/post-recession at shorter time intervals.

Dynamics of Financial Hardship in the United States: Health and Retirement Study 2006-2016

The purpose of this study was to examine the temporal trends and dynamics of financial hardship among older adults in the U.S. between 2006 and 2016 using the Health and Retirement Study. Sample included a total of 13,537 eligible person observations with a median age of 68 years. Financial hardship included measures of difficulty paying bills, food insecurity, taking less medication due to cost, and ongoing financial strain. Regression analyses were performed using a three-wave quadrennial model to estimate the prevalence of financial hardship over time, to explore temporal patterns and identify persistent hardship. Findings reveal that 51% of respondents who experienced food insecurity at one or more waves were transient. This pattern was similar to respondents who experienced ongoing financial strain (52% transient). Respondents who reported difficulty paying bills (68%) and reduced medications due to cost (62%) were also transient. Significant predictors across all four domains of financial hardship include age, years of education, marital status, self-rated health. Being African American was positively associated with reduced medication use and food insecurity. This study provides insight into the temporal dynamics of financial hardship in later life. It also highlights the contiguous, intermediate and transient nature of financial hardship among older adult populations.

Life course trajectories of chronic financial strain and acute stress reactivity: Steeling in response to recovery from strain

The steeling hypothesis suggests experiencing moderate strain may improve an individual's ability to cope with future strain, whereas crisis theory suggests that experiencing temporary strain will reduce the effect of future strain. The current study improves on past research by utilizing data from two independent prospective panel studies (one of 553 white rural Midwesterner women and 451 men and one of 624 African American women) spanning 26 and 22 years, respectively. We utilize growth mixture modeling to identify latent groups based on trajectories of financial strain and test interactions between class membership and later acute stressful events on chronic illness and physical health using three subscales from the RAND SF-12. We find being a group that experienced a period of temporary strain weakened the effect of later acute stressors on physical health for both samples and chronic illness for the African American sample. Results support crisis theory and highlight the importance of considering chronic strain as a life course process.

Wealth and depression: A scoping review

INTRODUCTION

The inverse relation between income and depression is well established. Less is understood about the relation between wealth and depression. We therefore conducted a scoping review to answer the question: What is known from the existing literature about the relation between wealth and depression?

METHODS

We searched for studies and articles in Medline (via PubMed), Embase, PsycINFO, PsycArticles, EconLit, and SocINDEX from inception through July 19, 2020. Ninety-six articles were included in our review. Key article characteristics were year of publication, sample size, country, study design, definition of depression, definition of wealth, and association between wealth and depression. Thirty-two longitudinal articles were included in a detailed charted review.

RESULTS

Depression was defined in a relatively standard manner across articles. In contrast, definitions and measurements of wealth varied greatly. The majority of studies in the full review (n = 56, 58%) and half of the studies in the longitudinal charted review (n = 16, 50%) reported an inverse relation between wealth and depression. The longitudinal charted review showed that (1) macro-economic events influenced depression, (2) wealth status influenced depression across the lifecourse, (3) wealth protected against depression in the face of stressors such as job loss, (4) subjective or psychosocial factors such as perception of wealth, relative comparison, and social status modified the relation between wealth and depression, and (5) savings interventions were successful in reducing depression and varied by context.

CONCLUSION

These findings suggest that wealth should be included in our consideration of the forces that shape mental health.

Financial Stressors and Resources Associated With Financial Exploitation

Background and Objectives

The prevalence of older adult financial exploitation (FE) is increasing. Population-based survey estimates of FE in the older adult population range from 5% to 11%. Given the growing prevalence of FE victimization in older adult populations, understanding the population's vulnerability to FE has increased in importance. This study investigates a conceptual framework in an attempt to understand how financial stressors and resources are associated with substantiated FE in a sample consisting largely of Black older adults.

Research Design and Methods

The study uses a cross-sectional design to investigate group differences among a total sample of 142 community-dwelling older adult participants, 62 of whom sought services to address FE and 80 with no history of FE.

Results

The group of older adults who sought services to address FE was more likely to be unmarried and had fewer years of education. Measures of financial literacy and perceived financial vulnerability had protective and risk effects, respectively.

Discussion and Implications

The present study found that sociodemographic and financial stress and resource measures have significant relationships with FE. These findings support the conceptual framework describing their relationship. This new conceptual framework provides a guiding factor in better understanding vulnerability to FE in older adults. The study also adds to the paucity of research completed on FE with Black older adults.

Income inequalities, social support and depressive symptoms among older adults in Europe: a multilevel cross-sectional study

This study analysed the association between income inequality and depression from a multilevel perspective among older adults in Europe, including an examination of the role of social support. The data came from Eurostat’s European Health Interview Survey (EHIS). Selected participants were aged 65 years or above (n = 68,417) and located in 24 European countries. The outcome variable (depression) was measured using the eight-item Patient Health Questionnaire (PHQ-8). The resulting dataset included individual-level (level-1) and aggregate-level (level 2) exposure variables. Level-1 included income quintiles and social support as exposure variables and sex, age, living alone, limitation in activities of daily living and general activity limitation as control variables. Level 2 included the Gini coefficient, healthcare expenditure and dependency ratio. A multilevel linear regression analysis was performed with maximum likelihood (ML) estimation. All the income quintiles from 1 to 4 showed higher average scores for depression than quintile 5 (the highest). Higher social support scores were associated with lower scores for depression. An interaction was found between income quintile and social support, with higher levels of social support associated with lower scores for depression in quintiles 1 and 2. Higher Gini coefficient scores were associated with higher scores for depression. A significative random slope for social support was also found, meaning that the relationship between social support and depression differed across countries. No significant interaction was found between the Gini coefficient and social support. The study findings suggest that more unequal societies provide a less favourable context for the mental health of older adults. There are also significant country-dependent differences in terms of the relationship between support and mental health among older adults.

Associations Between Financial Strain and Emotional Well-Being With Physiological Responses to Acute Mental Stress

OBJECTIVE

This study aimed to investigate associations between financial strain and emotional well-being, health, and physiological responses to acute mental stress.

METHODS

Participants were 542 healthy men and women aged 53 to 76 years from the Whitehall II study divided into those who reported no (n = 316), some (n = 135), or moderate/severe (n = 91) financial strain. Emotional well-being and self-reported health were assessed at baseline and 3 years later. Laboratory mental stress testing involved assessment of blood pressure (BP), heart rate, and lipid reactivity and recovery, and plasma interleukin 6 responses to challenging behavioral tasks. Analyses adjusted for objective financial status, age, sex, socioeconomic status (SES), and marital status.

RESULTS

Financial strain was positively associated with more depressive symptoms; lower positive affect; greater loneliness; lower optimism, self-esteem, and sense of control; and poorer self-reported physical health, mental health, and sleep (all, p < .001). Longitudinally, financial strain predicted poorer outcomes 3 years later, but associations were attenuated after baseline levels were taken into account. Financial strain was associated with reduced systolic and diastolic BP reactivity to acute stress (mean systolic BP increase = 32.34 [15.2], 28.95 [13.1], and 27.26 [15.2] mm Hg in the none, some, and moderate/severe financial strain groups), but not with heart rate, interleukin 6, or lipid responses.

CONCLUSIONS

Financial strain was correlated with a range of emotional and health-related outcomes independently of objective financial status. The diminished BP reactions to acute mental stress suggest that financial strain may contribute to dynamic chronic allostatic load.

Community interventions for improving adult mental health: mapping local policy and practice in England

BACKGROUND

Public mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention.

METHOD

We adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers' insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020.

RESULTS

407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated.

CONCLUSIONS

There was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.

The Association between Dietary Habits, Substance Use, and Mental Distress among Adults in Southern Norway: A Cross-Sectional Study among 28,047 Adults from the General Population

The aim of the present study was to examine associations between dietary habits, substance use, and mental distress among adults. This cross-sectional study was conducted in 2019 using an online questionnaire and included 28,047 adults (≥18 years) from Southern Norway. Multivariable logistic regression models stratified by gender were used to examine the associations between different lifestyle behaviors and mental distress. The results showed increased odds of mental distress among males and females with low consumption of vegetables (OR:1.26; 95% CI:1.08–1.47 and 1.14; 1.02–1.28) and fish (1.28; 1.12–1.46 and 1.36; 1.22–1.52), and among females, but not males, with high consumption of sugar-sweetened beverages (1.25; 1.06–1.48) compared to those with a healthier consumption of these foods and beverages. The results also showed increased odds of mental distress among male and female smokers (1.38; 1.19–1.60 and 1.44; 1.26–1.64), and among females, but not males, reporting current use of smokeless tobacco (1.20; 1.03–1.40), compared to male and female non-smokers and female non-users of smokeless tobacco. Overall, unhealthy dietary habits, smoking and the use of smokeless tobacco was associated with increased odds of mental distress, but the relationship varied according to gender. Future studies are needed to confirm any possible causal relationships.

Financial Strain and Intimate Partner Violence Against Married Women in Postreform China: Evidence From Chengdu

The primary goal of this study is to link both subjective and objective indicators of financial strain to two distinct dimensions of intimate partner violence (IPV) against women-the husband's violent behavior and gendered control-in postreform China. The data for this study were drawn from a community survey conducted in Chengdu, the capital of Sichuan province, in 2017 (N = 340). By utilizing the family stress model and quantitative methods, the following results emerged from a series of multivariate statistical analyses: (a) among married women, self-perceived financial strain is significantly and positively associated with the risk of experiencing the husband's perpetration of violent behavior and financial control; (b) low family income significantly elevates the likelihood of the husband's exertion of personal and financial control over the wife, albeit the effect is weaker for financial control; and (c) unemployment of the husband significantly increases the likelihood of the husband's exertion of financial controlling behavior against his wife. These results underscore the importance of gender and income inequalities in research on IPV against women in postreform China. These findings also cross-culturally substantiate the family stress model that has been utilized previously to examine the multifaceted associations between economic hardship and IPV in the U.S. Policy makers, academic researchers, and health practitioners are urged to recognize both subjective and objective financial strains as social and psychological determinants of IPV against women in postreform China.

Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States

Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.

The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review

In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.

Catastrophic health expenditure and mental health in the older Chinese population: The moderating role of social health insurance

OBJECTIVES

Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the relationships between CHE and people's mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether the association differs between those with and without social health insurance (SHI).

METHODS

The data came from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, and 2015, N = 13,166). We focused on older people aged 60 and above. We built panel data regression and quantile regression models to analyse the data.

RESULTS

Incurring CHE is significantly associated with poor mental health. The association is weakened among older people receiving SHI, which indicates that SHI has a protective effect. Moreover, the association between CHE and mental health and the protective effect of SHI are stronger among those with mild or moderate mental health problems.

DISCUSSION

Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for older people with greater healthcare needs.

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress

BACKGROUND

Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI).

METHODS

Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, social- and health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2-5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression.

RESULTS

Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94-1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80-1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement.

CONCLUSIONS

The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress.

The Lived Experience of Already-Lonely Older Adults During COVID-19

Background and Objectives

From the outset of the coronavirus disease 2019 (COVID-19) pandemic, analysts warned that older populations, due to their age, chronic illnesses, and lack of technological facility, would suffer disproportionately from loneliness as they sheltered in place indefinitely. Several studies have recently been published on the impact of COVID-19-related loneliness among older populations, but little has been written about the experiences of already-lonely older individuals; those who had lived with persistent loneliness before the advent of COVID-19. This qualitative study sought to understand how already-lonely older individuals navigated and endured the social isolation of the pandemic.

Research Design and Methods

Twelve semistructured interviews were conducted with individuals aged 65 or older who scored a 6 or above on the 3-item UCLA Loneliness Risk screening tool. Interviews were coded using the constant comparative method. Themes and understandings of loneliness that reoccurred within and across interviews were identified and collected.

Results

Already-isolated older interviewees did not necessarily experience the abject loneliness hypothesized by analysts. Most interviewees used longstanding arrangements, in place to mitigate loneliness and endure social isolation, to manage the social deprivation of COVID-19. As a result, their loneliness did not compound during long bouts of mandated social isolation. To the contrary, loneliness during the pandemic appeared to carry a new valence for interviewees, as COVID-19 imbued their isolation with new meaning, rendering their loneliness necessary and responsible.

Discussion and Implications

Exploring individuals’ subjective perceptions of loneliness can help provide a deeper understanding of what it means to be isolated and alone during COVID-19 and aid in designing strategies to mitigate loneliness.

Suicide Distribution and Trends Among Male Older Adults in the U.S., 1999-2018

INTRODUCTION

This study examines the distribution and trends in suicide death rates among male adults aged ≥65 years in the U.S. from 1999 to 2018.

METHODS

Suicide mortality data were derived from Multiple Cause of Death from the Center for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research database. Suicides were identified from the underlying causes of death. Joinpoint regression examined the distribution and shift in suicide age-adjusted death rates overall and by age groups, race/ethnicity, method of suicide, and urbanicity. Analyses were conducted in 2020.

RESULTS

Between 1999 and 2018, a total of 106,861 male adults aged ≥65 years died of suicide (age-adjusted rate=31.4 per 100,000 population, 95% CI=31.2, 31.6). Suicide rates showed a V-shaped trend. They were declining annually by 1.8% (95% CI= -2.4, -1.2); however, starting in 2007, there was a shift upward, increasing significantly by 1.7% per year for the next decade (95% CI=1.0, 1.6). Suicide rates were highest among those aged ≥85 years (48.8 per 100,000 population with an upward shift in 2008), Whites (35.3 per 100,000 population with an upward shift in trend in 2007), and the most rural communities (39.0 per 100,000 population). Most suicides were due to firearms (78.3% at a rate of 24.7 per 100,000 population), especially in rural areas, and shifted upward after 2007.

CONCLUSIONS

Increases in suicide rates among male older adults in the U.S., particularly after the 2007-2008 economic recession, are concerning. Tailored suicide prevention intervention strategies are needed to address suicide-related risk factors.

Job transitions and mental health outcomes among US adults aged 55 and older during the COVID-19 pandemic

Objectives

Adults around retirement age are especially vulnerable to the effects of the recent economic downturn associated with COVID-19. This study investigated disturbances to working life and mental health among Americans aged ≥55 during early months of the pandemic.

Methods

Using data from the nation-wide COVID-19 Coping Study (N=6,264), we examined rates of job loss, furloughs, hour/income reductions, and work-from-home, along with unchanged work status, by age, gender, race/ethnicity, educational attainment, and occupation. We next described sources of worry by job transition group and tested the adjusted associations of COVID-19-related job transitions with life satisfaction, loneliness, depressive symptoms, and anxiety symptoms.

Results

Most job loss occurred among respondents under age 65 and those without college degrees. Job loss and reduced hours/income were more common among Hispanics compared to other racial/ethnic groups, and work-from-home transitions were most common among respondents with high educational attainment and jobs in government- and education-related occupations. Workers who lost their jobs had the lowest life satisfaction and the highest loneliness and depressive symptoms, followed by workers who were furloughed and workers with reduced hours/income. Work-from-home was associated with more anxiety than unchanged work.

Discussion

COVID-19-related job transitions are detrimental to mental health, even when they might keep workers safe. These results enhance our understanding of the potentially long-term mental health effects of social and economic aspects of the COVID-19 pandemic and highlight the need for economic and mental health support for aging Americans.

Older Adults' Experience of the COVID-19 Pandemic: A Mixed-Methods Analysis of Stresses and Joys

Background and Objectives

The Coronavirus Disease–2019 (COVID-19) pandemic is experienced differently across individuals, and older adults’ different life experiences lead to a variety of ways of coping. The present study explores older adults’ reports of what about the pandemic is stressful, and what brings joy and comfort in the midst of stress

Research Design and Methods

An online survey asked 825 U.S. adults aged 60 and older to complete questionnaires assessing three psychological well-being indicators: perceived stress, negative affect, and positive affect. Participants also responded to open-ended questions about what was stressful and what brought joy or comfort at the time of the survey. A mixed-method approach first qualitatively analyzed the open-ended responses, content analysis identified themes most frequently reported, and quantitative analysis examined the associations between various stressors and joys and the psychological well-being indicators

Results

Qualitative analysis revealed 20 stress categories and 21 joy/comfort categories. The most commonly reported stressors were confinement/restrictions, concern for others, and isolation/loneliness; the most commonly reported sources of joy/comfort were family/friend relationships, digital social contact, and hobbies. Demographic comparisons revealed variations in experience. Independent t-tests revealed stress from concern for others, the unknown future, and contracting the virus to be significantly associated with poorer psychological well-being; faith, exercise/self-care, and nature were associated with more positive psychological well-being

Discussion and Implications

Results are discussed in the context of stress and coping theory, highlighting the importance of understanding the unique stress experience of each individual for effective distress intervention