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Walker-Pow R, Bruun A, Kupeli N, Bosco A, White N. A systematic review on the impact of financial insecurity on the physical and psychological well-being for people living with terminal illness. Palliat Med 2024; 38:692-710. [PMID: 38835188 PMCID: PMC11290032 DOI: 10.1177/02692163241257583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND People living with terminal illness are at higher risk of experiencing financial insecurity. The variance in definitions of financial insecurity, in addition to its impact on the well-being of this population has not yet been systematically analysed. AIM To understand the definition, prevalence and impact of financial insecurity on the physical and psychological well-being of people living with terminal illness. DESIGN A systematic review with a narrative synthesis (prospectively registered; CRD42023404516). DATA SOURCES Medline, Embase, CINAHL, AMED, PsycINFO, ProQuest Central and Cochrane Central Register of Controlled Trials, from inception to May 2023. Included studies had to measure or describe the impact of financial insecurity on an aspect of participants' physical or mental well-being. Study quality was assessed using the Hawker tool. RESULTS A total of 26 studies were included in the review. Financial insecurity was defined using many different definitions and terminology. Out of 4824 participants, 1126 (23%) reported experiencing high levels of financial insecurity. Nine studies reported 21 unique analyses across three domains of physical well-being. Out of those 21 analyses, 10 (48%) reported a negative result (an increase in financial insecurity was reported with a decrease in physical well-being). Twenty-one studies reported 51 unique analyses across nine domains of psychological well-being. Out of these analyses, 35 (69%) reported a negative result (an increase in financial insecurity was reported with a decrease in psychological well-being). CONCLUSIONS People living with terminal illness require support with their financial situation to ensure their well-being is not negatively impacted by financial insecurity.
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Affiliation(s)
- Ross Walker-Pow
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Alessandro Bosco
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Hämmig O. Overindebtedness, unemployment, and poor mental health - and the role of sense of control: a population-based Swiss study. Front Public Health 2024; 12:1324402. [PMID: 38711763 PMCID: PMC11073489 DOI: 10.3389/fpubh.2024.1324402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/01/2024] [Indexed: 05/08/2024] Open
Abstract
Background Both overindebtedness and unemployment are critical life events that can result in or lead to poor mental health. What is less known is that the two partly interrelated events frequently go along with a feeling of loss or lack of control in life, which could be the main reason why they are associated with poor mental health. This has not been examined in previous research, particularly not in this combination. Methods This study used and merged two cross-sectional data sets. Data collected in 2019 on 219 overindebted clients of the four official debt advisory centers in the Canton of Zurich were linked with a comparable subsample of 1,997 respondents from the Swiss Health Survey of 2017. The entire study population covered 2,216 adult individuals living in the Canton of Zurich. Results The prevalence of no or low sense of control, medium to high psychological distress, and moderate to major depression was much higher among the 44 solely unemployed (36/30/12%), the 189 solely overindebted (73/83/53%), and particularly among the 30 unemployed and overindebted (93/97/60%) than among all 1,953 other survey participants (21/13/7%). Unemployment, overindebtedness, and a (resulting) lack or loss of control were all found to be strong risk factors for the two mental health outcomes under study. Associations, or rather negative health effects, were partly but not fully mediated by the sense of control. Overindebtedness much more strongly predicted psychological distress (ß = -0.37) and depression (ß = 0.17) than unemployment (ß = -0.05/0.01). The sense of control turned out to be an independent explanatory factor for poor mental health and even the strongest of all (ß = 0.49/-0.59). Conclusion Improving a person's control beliefs could be a promising measure for preventing mental health disorders in general and in people who are unemployed and/or overindebted in particular.
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Affiliation(s)
- Oliver Hämmig
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zürich, Switzerland
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Chen H, Zhang Y, Cao K. Housing debt and depressive symptoms: evidence from the China family panel studies. BMC Psychol 2024; 12:186. [PMID: 38581029 PMCID: PMC10996272 DOI: 10.1186/s40359-024-01667-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/16/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND There is limited evidence on the association between housing debt and depressive symptoms in China. This study aimed to examine the impact of housing debt on depressive symptoms and explore the heterogeneous impacts arising from two sources of housing debt and two types of housing demands. METHODS Using data from the 2016 and 2018 China Family Panel Studies (CFPS), this study included 25,232 Chinese individuals. Depressive symptoms were assessed using the eight-item Center for Epidemiological Studies Depression Scale (CES-D8). Housing debt was measured by dummy variables, indicating whether an individual had housing debt, and continuous variables, which were the logarithm of the total amount of housing debt. The two-way fixed effects model was used to examine the relationship. RESULTS Housing debt had a significant positive impact on depressive symptoms in China. Individuals with housing debt had a 0.176-point higher depressive symptom score than those without housing debt. A 10% increase in the total amount of housing debt led to a 0.16-point increase in depressive symptoms. Non-bank housing loans significantly increased the level of depressive symptoms with a larger coefficient (coef = 0.289), while the impact of bank housing loans was small and not statistically significant. In terms of the types of housing demands, a positive impact was observed only among individuals who had only one property meeting their housing consumption demands. CONCLUSIONS This study found a significant positive impact of housing debt on depressive symptoms, primarily driven by non-bank housing loans. Furthermore, housing debt increased the depressive symptoms among individuals with consumption demands, while those with investment demands did not show a significant impact. Government interventions should prioritize easing formal financial constraints and providing support for individuals with housing consumption demands.
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Affiliation(s)
- Huan Chen
- School of Public Affairs, Zhejiang University, 310058, Hangzhou, China
| | - Yuehua Zhang
- School of Public Affairs, Zhejiang University, 310058, Hangzhou, China
- Innovation Center of Yangtze River Delta, Zhejiang University, 314100, Jiaxing, China
| | - Kang Cao
- Department of Regional and Urban Planning, Zhejiang University, 310058, Hangzhou, China.
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Grewal A, Hepburn KJ, Lear SA, Adshade M, Card KG. The impact of housing prices on residents' health: a systematic review. BMC Public Health 2024; 24:931. [PMID: 38561729 PMCID: PMC10983630 DOI: 10.1186/s12889-024-18360-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Rising housing prices are becoming a top public health priority and are an emerging concern for policy makers and community leaders. This report reviews and synthesizes evidence examining the association between changes in housing price and health outcomes. METHODS We conducted a systematic literature review by searching the SCOPUS and PubMed databases for keywords related to housing price and health. Articles were screened by two reviewers for eligibility, which restricted inclusion to original research articles measuring changes in housing prices and health outcomes, published prior to June 31st, 2022. RESULTS Among 23 eligible studies, we found that changes in housing prices were heterogeneously associated with physical and mental health outcomes, with multiple mechanisms contributing to both positive and negative health outcomes. Income-level and home-ownership status were identified as key moderators, with lower-income individuals and renters experience negative health consequences from rising housing prices. This may have resulted from increased stress and financial strain among these groups. Meanwhile, the economic benefits of rising housing prices were seen to support health for higher-income individuals and homeowners - potentially due to increased wealth or perception of wealth. CONCLUSIONS Based on the associations identified in this review, it appears that potential gains to health associated with rising housing prices are inequitably distributed. Housing policies should consider the health inequities born by renters and low-income individuals. Further research should explore mechanisms and interventions to reduce uneven economic impacts on health.
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Affiliation(s)
- Ashmita Grewal
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada.
| | - Kirk J Hepburn
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
| | - Marina Adshade
- Vancouver School of Economics, University of British Columbia, Vancouver, BC, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, 8888 University Dr. , Burnaby, BC, V5A 1S6, Canada
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Tang W, Chen J, Wang S, Jiang X, Lu Y, Wu S, Yang L, Tian M, Zhang H, Zhang Y, Xu J, Sun Z. Debt, sleep deprivation and psychological distress among online ride-hailing drivers: evidence from China. Gen Psychiatr 2024; 37:e101332. [PMID: 38495074 PMCID: PMC10941107 DOI: 10.1136/gpsych-2023-101332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Affiliation(s)
- Wanjie Tang
- Mental Health Centre, Sichuan University, Chengdu, Sichuan, China
- Department of Child & Adolescent Psychiatry, King's College London Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Jingyue Chen
- Sichuan University Business School, Chengdu, Sichuan, China
| | - Simiao Wang
- Department of Psychology, King's College London Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Xianglan Jiang
- Sichuan University Business School, Chengdu, Sichuan, China
| | - Yi Lu
- Sichuan University Business School, Chengdu, Sichuan, China
| | - Siqi Wu
- Sichuan University West China School of Medicine, Chengdu, Sichuan, China
| | - Luyu Yang
- The University of Edinburgh School of Health in Social Science, Edinburgh, Edinburgh, UK
| | - Meng Tian
- Department of Psychology, University of Warwick, Coventry, UK
| | - Han Zhang
- Division of Psychiatry, University College London Faculty of Brain Sciences, London, UK
| | - Yinan Zhang
- Wuxi Mental Health Center, Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jiuping Xu
- Sichuan University Business School, Chengdu, Sichuan, China
| | - Zeyuan Sun
- Department of Child & Adolescent Psychiatry, King's College London Institute of Psychiatry Psychology & Neuroscience, London, UK
- King's College London Centre for the Developing Brain, London, UK
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Kim C, Bai Y, Dusing GJ, Nielsen A, Chum A. The impact of minimum wage increase on suicidal ideation in South Korea: a difference-in-differences analysis using nationally representative panel data. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02646-w. [PMID: 38429540 DOI: 10.1007/s00127-024-02646-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND South Korea had the highest suicide rates in the OECD and one of the largest (16.4%) increases in the minimum wage in 2018. Prior studies have provided evidence that increases in minimum wage reduce suicide rates in the population, but no study examined the effects of the policy change on individual-level suicidal behaviour. METHODS Our study sample was built using the 2015-2019 waves of the Korean Welfare Panel Survey, a population-representative longitudinal survey. The sample consisted of 5146 participants, including those earning above minimum wage (control) and minimum wage earners (treatment) based on their 2018/19 earnings. The outcome of the study was suicidal ideation, which is an important precursor to other suicidal behaviours, and was captured using self-reported measures. We examined the impact of the 2018 minimum wage hike in Korea on suicidal ideation, using a difference-in-differences design. RESULTS The minimum wage increase was associated with a 1.6% points reduction (95% CI: -2.8% to -0.5%) in self-reported suicidal ideation. Stronger policy effects were shown among women and older age groups. CONCLUSIONS Our study demonstrates that public policies employing a population-based approach, such as increasing minimum wages, could serve as an effective intervention to mitigate suicidal ideation among low-income workers.
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Affiliation(s)
- Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Yihong Bai
- Department of Economics, McMaster University, Hamilton, ON, Canada
- Western University Ontario, London, Canada
| | - Gabriel John Dusing
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Andrew Nielsen
- Canadian Institute for Health Information, Ottawa, ON, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada.
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Abdelwahab MM, Abonazel MR, Semary HE, Abdel-Rahman S. Implications of labour market disruptions on subjective wellbeing during the COVID-19 pandemic in MENA countries. Heliyon 2024; 10:e25665. [PMID: 38390117 PMCID: PMC10881308 DOI: 10.1016/j.heliyon.2024.e25665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
COVID-19 has caused a global health crisis and severe economic and social consequences. Unprecedented economic disruption and high unemployment are the pronounced impacts of the pandemic. The current study is primarily concerned with the effects of COVID-19-induced labour market outcomes on workers' subjective wellbeing in four MENA countries using the Combined COVID-19 MENA Monitor Household Survey. The study documented that COVID-19-induced labour market changes negatively affected workers' subjective wellbeing after controlling for work characteristics, risks, social distancing, and socio-demographic variables. Job loss, income reduction, and wage delay were the most significant labour changes that deteriorated workers' subjective wellbeing. Our findings underscore the need for policy responses that reduce workers' vulnerability and sustain their livelihoods. Mental health services and income support policies are important tools to enhance subjective wellbeing of economically affected workers.
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Affiliation(s)
- Mahmoud M Abdelwahab
- Department of Mathematics and Statistics, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11432, Saudi Arabia
- Department of Basic Sciences, Higher Institute of Administrative Sciences, Osim, Cairo, 12961, Egypt
| | - Mohamed R Abonazel
- Department of Applied Statistics and Econometrics, Faculty of Graduate Studies for Statistical Research, Cairo University, Giza, 12613, Egypt
| | - H E Semary
- Department of Mathematics and Statistics, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 11432, Saudi Arabia
- Statistics and Insurance Department, Faculty of Commerce, Zagazig University, 44519, Egypt
| | - Suzan Abdel-Rahman
- Department of Demography and Biostatistics, Faculty of Graduate Studies for Statistical Research, Cairo University, Giza, 12613, Egypt
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Nykiforuk CIJ, Belon AP, Scott LKA. Untangling Concepts of Financial Circumstances for Public Health Professionals and Scholars: A Glossary and Concept Map. Am J Public Health 2024; 114:79-89. [PMID: 38033280 PMCID: PMC10726926 DOI: 10.2105/ajph.2023.307449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 12/02/2023]
Abstract
Public health discipline and practice have prioritized work on poverty and populations at high risk for material deprivation, with less consideration for the full spectrum of financial circumstances relative to well-being. Public health can make a much-needed contribution to this area, which is currently dominated by the financial industry, focused on individual behaviors, and lacking the definitional consensus needed for research and evaluation. A population-level lens can reveal the social determinants and health consequences of real or perceived poor financial circumstances. This article aims to improve conceptual understanding of financial circumstances among public health scholars and professionals. We identified concepts through a critical literature review of peer-reviewed and practice-based resources on financial well-being and financial strain. We developed a glossary of concepts related to financial circumstances and categorized concepts according to their level of influence using an approach informed by socioecological models. We provide a concept map that illustrates the relationships between concepts in the context of their levels of influence. This article will help to advance an agenda on financial well-being promotion in public health research and practice. (Am J Public Health. 2024;114(1):79-89. https://doi.org/10.2105/AJPH.2023.307449).
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Affiliation(s)
- Candace I J Nykiforuk
- Candace I. J. Nykiforuk and Ana Paula Belon are with the Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Lisa K. Allen Scott is with Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Ana Paula Belon
- Candace I. J. Nykiforuk and Ana Paula Belon are with the Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Lisa K. Allen Scott is with Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Lisa K Allen Scott
- Candace I. J. Nykiforuk and Ana Paula Belon are with the Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Lisa K. Allen Scott is with Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
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Salsi S, Ariano E, Casey J, Loewen M, Engel L. Financial Capability Interventions Used for Specific Diagnoses Related to Functional Impairment: A Scoping Review. Am J Occup Ther 2024; 78:7801205060. [PMID: 38305720 DOI: 10.5014/ajot.2024.050254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
IMPORTANCE Occupational therapists often address financial occupations of clients with acquired functional impairments who experience challenges with financial capability (FC). OBJECTIVE To explore the intervention literature aimed at improving FC in five diagnostic adult populations. DATA SOURCES MEDLINE, CINAHL, PsycInfo, EconLit, and EMBASE; researchers also completed backward and forward citation searching and contacted expert authors. STUDY SELECTION AND DATA COLLECTION Two independent reviewers completed article screening, selection, and extraction using a scoping review approach; a priori inclusion criteria were peer-reviewed articles, written in English, involving adults with one of five diagnostic conditions, describing any intervention to improve FC. FINDINGS Twenty-four articles met the inclusion criteria. Most articles were aimed at substance use or mental health populations (n = 20); fewer focused on brain injury (n = 2), multiple sclerosis (n = 1), or mixed-diagnosis (n = 1) populations. Only 4 were randomized controlled trials (RCTs). Interventions were heterogeneous and complex, including components of skills training (n = 21), individualized budgeting (n = 18), representative payeeship (n = 11), education (n = 10), structured goal setting (n = 7), savings building (n = 5), metacognitive strategies (n = 2), and assistive technology (n = 1). CONCLUSIONS AND RELEVANCE Despite growth in the area, the literature regarding FC intervention is limited, with few RCTs and many populations unrepresented. The literature for a systematic review of FC intervention efficacy for these populations is insufficient, particularly because included studies used varied components, limiting comparison. Further research is imperative to guide evidence-based practice. Plain-Language Summary: This study is an overview of literature about interventions to address the financial occupations of clients with acquired functional impairments. The findings give occupational therapy researchers and clinicians the information they need to begin analyzing, using, and building the evidence to support the use of interventions to improve clients' financial capability and well-being.
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Affiliation(s)
- Sofia Salsi
- Sofia Salsi, MScA OT, OT Reg (MB), is PhD Graduate Student, Applied Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emily Ariano
- Emily Ariano, MOT, OT Reg (MB), is Occupational Therapist, Victoria General Hospital, Winnipeg, Manitoba, Canada. At the time of this review, Ariano was Master of Occupational Therapy Student, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer Casey
- Jennifer Casey, MOT, OT Reg (Ont.), is Occupational Therapist, Children's Therapy Collective and Children's First Initiative, Winnipeg, Manitoba, and Fort Frances, Ontario, Canada. At the time of this review, Casey was Master of Occupational Therapy Student, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Morgan Loewen
- Morgan Loewen, MOT, OT Reg (MB), is Occupational Therapist, Deer Lodge Centre, Winnipeg, Manitoba, Canada. At the time of this review, Loewen was Master of Occupational Therapy Student, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Engel
- Lisa Engel, MSc (OT), PhD, OT Reg (MB), is Assistant Professor, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, and Institute for Work and Health, Toronto, Ontario, Canada;
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Titus AR, Li Y, Mills CK, Spoer B, Lampe T, Kim B, Gourevitch MN, Thorpe LE. Associations between a Novel Measure of Census Tract-Level Credit Insecurity and Frequent Mental Distress in US Urban Areas, 2020. J Urban Health 2023; 100:1140-1148. [PMID: 38012504 PMCID: PMC10728417 DOI: 10.1007/s11524-023-00792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/29/2023]
Abstract
Access to and utilization of consumer credit remains an understudied social determinant of health. We examined associations between a novel, small-area, multidimensional credit insecurity index (CII), and the prevalence of self-reported frequent mental distress across US cities in 2020. The census tract-level CII was developed by the Federal Reserve Bank of New York using Census population information and a nationally representative sample of anonymized Equifax credit report data. The CII was calculated for tracts in 766 cities displayed on the City Health Dashboard at the time of analysis, predominantly representing cities with over 50,000 residents. The CII combined data on tract-level participation in the formal credit economy with information on the percent of individuals without revolving credit, percent with high credit utilization, and percent with deep subprime credit scores. Tracts were classified as credit-assured, credit-likely, mid-tier, at-risk, or credit-insecure. We used linear regression to examine associations between the CII and a modeled tract-level measure of frequent mental distress, obtained from the CDC PLACES project. Regression models were adjusted for neighborhood economic and demographic characteristics. We examined effect modification by US region by including two-way interaction terms in regression models. In adjusted models, credit-insecure tracts had a modestly higher prevalence of frequent mental distress (prevalence difference = 0.38 percentage points; 95% CI = 0.32, 0.44), compared to credit-assured tracts. Associations were most pronounced in the Midwest. Local factors impacting credit access and utilization are often modifiable. The CII, a novel indicator of community financial well-being, may be an independent predictor of neighborhood health in US cities and could illuminate policy targets to improve access to desirable credit products and downstream health outcomes.
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Affiliation(s)
- Andrea R Titus
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Yuruo Li
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Benjamin Spoer
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Taylor Lampe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Byoungjun Kim
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Marc N Gourevitch
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Stickley A, Shirama A, Sumiyoshi T. Financial debt, worry about debt and mental health in Japan. BMC Psychiatry 2023; 23:761. [PMID: 37848860 PMCID: PMC10580597 DOI: 10.1186/s12888-023-05235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Financial debt has been linked to poorer mental health. However, most research has been undertaken in western countries. This study examined the association between financial debt, worry about debt, and mental health in Japan, where there has been little specific focus on debt and its effects on mental health. METHODS Data were analyzed from 3717 respondents collected in an online survey in 2023. Information on financial debt and worry about debt was collected with single-item questions. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale were used to respectively collect information on depression and anxiety symptoms, while a single-item measure was used to obtain information on a recent history of suicidal ideation. Logistic regression was used to assess associations. RESULTS Both financial debt (17.7%) and worry about debt (14.8%) were prevalent in the study sample. In fully adjusted analyses, compared to those with no debt and worry about debt, individuals who were worried about debt but had no debt, or who had debts and were worried about debt had significantly higher odds for suicidal ideation and depressive symptoms. In contrast, having debt but not being worried about debt was not associated with any of the mental health outcomes. CONCLUSION The results of this study suggest that worrying about debt is strongly associated with poorer mental health among Japanese adults. Interventions to address debt and its associated worries may be important for improving public mental health in Japan.
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Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553, Japan.
| | - Aya Shirama
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo, 187-8553, Japan
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Levinsson H, Probert-Lindström S, Holmgren R, Nilsson Sundström E, Ahlström R. Suicidal behaviour in over-indebted individuals: a cross-sectional study in Sweden. Nord J Psychiatry 2023; 77:669-675. [PMID: 37261778 DOI: 10.1080/08039488.2023.2218349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/15/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Associations between debt and suicidal behaviour have been identified, but the research is sparse. Thus, more research is needed to understand the association between economic vulnerability and suicide. The study aimed to generate further knowledge about over-indebted individuals who have attempted suicide at least once. METHOD Participants were a Swedish sample comprising 641 over-indebted individuals. The inclusion criteria were that the participants should be indebted and have been subjected to debt collection measures and/or seizure orders by the Swedish Enforcement Authority. Participants answered questionnaires regarding socio-demographic variables, debt size, history of suicide attempt, critical life events, and social contacts, and filled the Hospital Anxiety and Depression Scale (HADS). In the statistical analyses, Chi2 test for independence and t-test was used, and binary logistic regression to adjust for the confounding effects of the variables on each other. RESULTS The analysis revealed that nearly one in five (19.3%, N = 123) had attempted suicide at least once. A larger part of the respondents who had a history of suicide attempts reported that they were living alone (OR 2.30 (95% CI 1.34-3.89, p = .002). Many of those living alone were women (χ2 (1, n = 121) = 4.88, p = 0.03, ɸ = 0.22). CONCLUSIONS The results of the current study point to the fact that economic vulnerability is an important psychosocial aspect to take into serious consideration concerning mental health and suicide prevention. Longitudinal research is needed to explain, predict and prevent suicide due to over-indebtedness.
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Affiliation(s)
| | - Sara Probert-Lindström
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Region Skåne, Clinical Psychiatric Research Center, Lund, Sweden
| | - Rebecka Holmgren
- Stress Research Institute, Department of Psychology, Stockholm University, Sweden
| | | | - Richard Ahlström
- Department of Health Sciences, Mid Sweden University, Oestersund, Sweden
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13
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Lin CC, Semelsberger S, Saeed AA, Weiss J, Navarro RA, Gianakos AL. Perception of Debt During Resident Education-A Systematic Review. Perm J 2023; 27:99-109. [PMID: 37350090 PMCID: PMC10502380 DOI: 10.7812/tpp/23.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Debt is a common issue among medical residents in the United States. This review attempts 1) to evaluate the level of debt among residents, 2) to assess perceptions toward debt among residents, 3) to determine debt-management options pursued, and 4) to gauge whether levels of debt affect resident career choices. A systematic literature search of articles published between January 2012 and January 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed. The combination of search terms of (financial literacy OR debt) AND (residency OR graduate medical education) were utilized. Primary outcome measures assessed were the levels of debt and perceptions toward the debt. Secondary outcome measures were debt-management options pursued and whether debt affected career choices for residents. Twenty-one studies evaluating a total of 15,585 residents were included in this systematic review. Levels of debt greater than $200,000 were not uncommon across residents and debt burdens are increasing. Greater levels of debt are associated with increased stress and anxiety. Residents reported multiple debt-management options pursued, including loan forbearance, moonlighting, income-based repayment models, military financial support, and loan forgiveness programs. Those with increased levels of debt were less likely to pursue subspecialty training and academic employment positions. The findings conclude that residents carry a substantial amount of debt, and it is a common source of stress and anxiety. Although there are many different avenues that are pursued for debt repayment, levels of debt appear to affect decisions to pursue subspecialty training and to pursue academic positions. Strategies or programs aimed at reducing the debt burden felt by residents could be of great value.
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Affiliation(s)
- Charles C Lin
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | | | - Ali Al Saeed
- Lake Erie College of Osteopathic Medicine, Lake Erie, PA, USA
| | - Jennifer Weiss
- Department of Orthopaedic Surgery, Kaiser Permanente, Los Angeles, CA, USA
| | - Ronald A Navarro
- Department of Orthopaedic Surgery, Kaiser Permanente, Los Angeles, CA, USA
| | - Arianna L Gianakos
- Department of Orthopaedic Surgery, Yale Medicine, Orthopaedics, and Rehabilitation, New Haven, CT, USA
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14
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Komzia N, Bäckström M, Håkansson A. Gender and maladaptive personality correlates in problem gambling and over-indebtedness: Novel findings from a cross-sectional study in Sweden. Heliyon 2023; 9:e18844. [PMID: 37701411 PMCID: PMC10493418 DOI: 10.1016/j.heliyon.2023.e18844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 09/14/2023] Open
Abstract
Although most individuals consider gambling to be an innocent and fun activity, when it develops into problem gambling, it can have detrimental outcomes to one's life, such as over-indebtedness. This cross-sectional study explores the role of maladaptive personality traits and gender in both problem gambling and over-indebtedness, in an online sample of 1479 adult gamblers (65% males) in Sweden. Participants were administered the Problem Gambling Severity Index (PGSI), the Personality Inventory for DSM-5-Brief Form (PID-5-BF), and questions addressing subjective over-indebtedness and other risk factors. Quasi-Poisson loglinear models and logistic regression analyses demonstrated that Disinhibition (OR = 1.38, 95% CI [1.24, 1.53]), and Antagonism (OR = 1.23, 95% CI [1.14, 1.34]) showed the strongest associations to problem gambling, and that only Disinhibition (OR = 1.72, 95% CI [1.22, 1.43]) and Antagonism (OR = 2.00, 95% CI [1.52, 2.66]) were significantly related to over-indebtedness. The prevalence of problem gambling and over-indebtedness was more common among women, and gender moderated the univariate relationships of Negative Affectivity, Disinhibition and Psychoticism to problem gambling. These findings call for future research addressing maladaptive personality traits, problem gambling and over-indebtedness, and highlight the need for tailored interventions and prevention strategies, particularly for women who may be at higher risk.
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Affiliation(s)
- Nikoleta Komzia
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | - Martin Bäckström
- Department of Psychology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
- Gambling Disorder Unit, Malmö Addiction Center, Malmö, Sweden
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15
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Mudrazija S, Butrica BA. How does debt shape health outcomes for older Americans? Soc Sci Med 2023; 329:116010. [PMID: 37331283 DOI: 10.1016/j.socscimed.2023.116010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
The deleterious effects that debt can have on health outcomes are well documented, yet comprehensive studies of the debt-health link for older adults remain limited even as their indebtedness has increased dramatically in recent decades. Additionally, the literature cannot explain the causal pathway linking poor health with debt. Using data from the Health and Retirement Study (1998-2016), we examine a range of physical and mental health measures and assess how they may be shaped by the amount and type of debt held by older adults. To address the likely endogeneity of debt and health, we employ marginal structural models, developed specifically as an identification strategy in the presence of possible endogeneity, alongside population-averaged models that allow us to compare outcomes for populations with and without debt without relying on unverifiable assumptions regarding the underlying population distribution as is the case with random- and fixed-effects models. Findings indicate that carrying any debt has a negative effect on a range of health outcomes for older adults, including objective and subjective physical and mental health. In addition, the more debt older adults carry, the more detrimental it is for their health. Finally, the type of debt matters: while secured debt has a limited, if any, negative impact on health outcomes, unsecured debt has a substantial negative impact on health. Policymakers should design policies that promote the prudent use of debt and discourage carrying large debt burdens, especially unsecured debt, into retirement as this would promote better health outcomes for older Americans.
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Affiliation(s)
- Stipica Mudrazija
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA.
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16
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May T, Aughterson H, Fancourt D, Burton A. Financial adversity and subsequent health and wellbeing during the COVID-19 pandemic in the UK: A qualitative interview study. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100224. [PMID: 36742992 PMCID: PMC9883074 DOI: 10.1016/j.ssmqr.2023.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/22/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
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.
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17
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Hamil-Luker J, O’Rand AM. Black/white differences in the relationship between debt and risk of heart attack across cohorts. SSM Popul Health 2023; 22:101373. [PMID: 36915601 PMCID: PMC10005910 DOI: 10.1016/j.ssmph.2023.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Background Numerous studies show that increasing levels of education, income, assets, and occupational status are linked to greater improvements in White adults' health than Black adults'. Research has yet to determine, however, whether there are racial differences in the relationship between health and debt and whether this relationship varies across cohorts. Methods Using data from the 1992-2018 Health and Retirement Study, we use survival analyses to examine the link between debt and heart attack risk among the Prewar Cohort, born 1931-1941, and Baby Boomers, born 1948-1959. Results Higher unsecured debt is associated with increased heart attack risk for Black adults, especially among Baby Boomers and during economic recessions. Higher mortgage debt is associated with lower risk of heart attack for White but not Black Baby Boomers. The relationship between debt and heart attack risk remains after controlling for health behaviors, depressive symptoms, and other economic resources that are concentrated among respondents with high levels of debt. Conclusion Debt is predictive of heart attack risk, but the direction and strength of the relationship varies by type of debt, debtors' racial identity, and economic context.
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18
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Giovanis E, Ozdamar O. Coping Strategies, well-being and inequalities during the COVID-19 pandemic period. CURRENT PSYCHOLOGY 2023:1-23. [PMID: 37359668 PMCID: PMC10162901 DOI: 10.1007/s12144-023-04710-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
As a response to the outbreak of the COVID-19 pandemic, governments around the globe have carried on strict lockdown measures affecting millions of jobs, public life, and the well-being of people. This study examines people's subjective well-being, such as the perception of the economic situation and mental well-being, who made adjustments to cope with the earning losses. We estimate the well-being cost, which is the money required to compensate people because of the reduction in earnings or employment loss and the coping strategy followed to bring their well-being to the levels of those who have not adopted any coping strategy. We examine two outcomes; the perception of the economic situation and a mental well-being index. We employ data from the ERF COVID-19 MENA Monitor Surveys for Egypt, Jordan, Morocco and Tunisia. The results show that coping strategies with earning losses impact well-being and are associated with high costs. In most cases, the coping strategies of borrowing from banks and selling assets present the highest well-being costs. Furthermore, the estimates highlight significant discrepancies across gender and types of workers, such as those employed in the informal sector and temporary contracts. Supplementary information The online version contains supplementary material available at 10.1007/s12144-023-04710-1.
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Affiliation(s)
- Eleftherios Giovanis
- Faculty of Economics and Administrative Sciences Department of International Trade and Business, Izmir Bakircay University, Menemen, İzmir Turkey
| | - Oznur Ozdamar
- Faculty of Economics and Administrative Sciences Department of International Trade and Business, Izmir Bakircay University, Menemen, İzmir Turkey
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19
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Nigatu YT, Elton-Marshall T, Hamilton HA. Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario, Canada. Int J Soc Psychiatry 2023; 69:774-783. [PMID: 36373945 PMCID: PMC9666416 DOI: 10.1177/00207640221136795] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown. AIM The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures. METHODS Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05-4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59-2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31-2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47-2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41-5.70) after adjusting for potential confounders including education, income and employment. CONCLUSIONS Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.
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Affiliation(s)
- Yeshambel T Nigatu
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- School of Epidemiology and Public
Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research
Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Epidemiology and
Biostatistics, Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada
| | - Hayley A Hamilton
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research
Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
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20
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van der Velden PG, Contino C, Muffels R, Verheijen MS, Das M. The impact of pre- and post-trauma financial problems on posttraumatic stress symptoms, anxiety and depression symptoms, and emotional support: A prospective population-based comparative study. J Anxiety Disord 2023; 96:102714. [PMID: 37120960 DOI: 10.1016/j.janxdis.2023.102714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/07/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
Potentially traumatic events (PTEs) are associated with a higher risk of mental health problems and a lack of emotional support. The extent to which pre- and/or post-trauma financial problems further increase this risk, while controlling for pre-trauma mental health problems and lack of support and compared to nonvictims, is largely unknown. To better understand this risk, data was extracted from four surveys of VICTIMS study using the Dutch population-based longitudinal LISS-panel. Multivariate logistic regression analyses (MLRA) showed that nonvictims (nnonvictims total=5003) with persistent financial problems (present at T1 and present at T2 one year later) more often suffered from severe anxiety and depression symptoms (ADS; Adjusted OR (aOR)= 1.72) and lack of emotional support (aOR=1.96) than nonvictims without these problems, and that victims of PTEs (nvictims total=872) with persistent financial problems more often suffered moderate ADS (aOR=2.10) than nonvictims with persistent financial problems. MLRA showed that victims with pre- and/or post-trauma financial problems were more at risk of probable PTSD than victims without financial problems (aORs ≥ 2.02). Victim services and (mental) health care professionals should screen for pre- and post-trauma financial problems and, when found, refer the victims to relevant professionals since these problems can significantly hinder recovery.
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Affiliation(s)
- Peter G van der Velden
- Centerdata, Tilburg, the Netherlands; TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.
| | | | - Ruud Muffels
- TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | | | - Marcel Das
- Centerdata, Tilburg, the Netherlands; Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands
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21
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Ginapp C, Aminawung JA, Harper A, Puglisi LB. Exploring the Relationship between Debt and Health after Incarceration: a Survey Study. J Urban Health 2023; 100:181-189. [PMID: 36650355 PMCID: PMC9918653 DOI: 10.1007/s11524-022-00707-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
Financial debt and incarceration are both independently associated with poor health, but there is limited research on the association between debt and health for those leaving incarceration. This exploratory study surveyed 75 people with a chronic health condition and recent incarceration to examine debt burden, financial well-being, and possible associations with self-reported health. Eighty-four percent of participants owed at least one debt, with non-legal debt being more common than legal debt. High financial stress was associated with poor self-reported health and the number of debts owed. Owing specific forms of debt was associated with poor health or high financial stress. Non-legal financial debt is common after incarceration, and related stress is associated with poor self-reported health. Future research is needed in larger populations in different geographical areas to further investigate the relationship and the impact debt may have on post-release poor health outcomes. Policy initiatives to address debt in the post-release population may improve health.
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Affiliation(s)
- Callie Ginapp
- Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520-8056, USA.
| | - Jenerius A Aminawung
- Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520-8056, USA
- SEICHE Center for Health and Justice, 300 George Street G05, New Haven, CT, 06520, USA
| | - Annie Harper
- Department of Psychiatry, Yale University School of Medicine, 319 Peck St., Erector Sq. Building #1, New Haven, CT, 06511, USA
| | - Lisa B Puglisi
- Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520-8056, USA.
- SEICHE Center for Health and Justice, 300 George Street G05, New Haven, CT, 06520, USA.
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Östergren PO, Bodin T, Canivet C, Moghaddassi M, Vilhelmsson A. Selling one's future: over-indebtedness and the risk of poor mental health and the role of precarious employment - results from the Scania Public Health Cohort, Sweden. BMJ Open 2022; 12:e061797. [PMID: 36414307 PMCID: PMC9685259 DOI: 10.1136/bmjopen-2022-061797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment. METHODS This is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women. RESULTS Over-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men. CONCLUSIONS Over-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.
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Affiliation(s)
| | - Theo Bodin
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Region Stockholm, Center for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Catarina Canivet
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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23
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Rojas Y. Financial indebtedness and suicide: A 1-year follow-up study of a population registered at the Swedish Enforcement Authority. Int J Soc Psychiatry 2022; 68:1445-1453. [PMID: 34340574 PMCID: PMC9548947 DOI: 10.1177/00207640211036166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Economic hardship is an established suicidogenic factor. However, very little is known about whether financial difficulties in terms of debt problems, specifically, is related to suicide. This would seem to be an important research gap, not least at a time when the repercussions of the global financial crisis are still being felt by many people. AIMS This study sets out to examine whether experiencing financial indebtedness is related to suicide. METHODS For this purpose, people aged between 18 and 64 with a registration date for a debt in the Swedish Enforcement Authority register between 2015 and 2017 (n = 180,842) are followed up for a 1-year period for death by suicide and compared with a sample from the general Swedish population (n = 928,265). The analysis is based on penalized maximum likelihood logistic regressions. RESULTS Those who had experienced financial indebtedness were two and a half times more likely to commit suicide than those who had not lived through this experience (OR = 2.50), controlling for several demographic, socio-economic, and mental health conditions prior to the date of the registration at the Enforcement Authority. CONCLUSION Debt repayment problems have a significant and detrimental impact on individuals' risk of committing suicide, even when several other socioeconomic risk factors are controlled for. The results reinforce the importance of ongoing attempts to remove the issue of debt problem from its status as a rather hidden suicidogenic risk factor.
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Affiliation(s)
- Yerko Rojas
- School of Social Sciences, Södertörn University,
Huddinge, Sweden
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24
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Hämmig O, Herzig J. Over-indebtedness and health in Switzerland: A cross-sectional study comparing over-indebted individuals and the general population. PLoS One 2022; 17:e0275441. [PMID: 36219609 PMCID: PMC9553041 DOI: 10.1371/journal.pone.0275441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/17/2022] [Indexed: 11/06/2022] Open
Abstract
Background Previous international studies have shown that over-indebtedness is associated with poor health. However, in Switzerland research addressing over-indebtedness is widely lacking, strongly needed and particularly important because it is evidently a rising but still commonly tabooed, socially “undesired” and highly stigmatized phenomenon that is rarely discussed and largely ignored and unexplored. Methods A cross-sectional survey was conducted among over-indebted adults seeking advice from one of the four official debt advisory centers in the Canton of Zurich. The survey finally included 219 respondents participating voluntarily and anonymously. This sample was then linked with a comparable subsample of the nationally representative Swiss Health Survey of 2017, namely 1,997 respondents of the same age from the Canton of Zurich. For reasons of comparability identical health questions and measures were taken from the Swiss Health Survey and used in the over-indebtedness survey. The pooled or combined dataset covered a total of 2,216 adult individuals. Results Remarkably high prevalence rates and relative risks of poor self-rated health, severe musculoskeletal and sleep disorders and moderate to severe depression were observed among over-indebted individuals compared to the general population. More than 50% of the over-indebted individuals had poor general health or moderate to severe depression compared to the general population with 14% and 7%, respectively. And far above one third of the over-indebted but ‘only’ between 6% and 8% of the general population showed severe musculoskeletal disorders and sleep disorders. Even after adjustment for various control variables and covariates, over-indebtedness increased the odds ratios for poor health outcomes consistently and dramatically, i.e. by a factor of 8 and more (aOR = 8.5–11.6). Conclusions Over-indebtedness in Switzerland has particularly negative effects on various aspects of the health of the persons concerned, irrespective of their demographic characteristics and their social and employment status.
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Affiliation(s)
- Oliver Hämmig
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- * E-mail:
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25
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Mansor M, Sabri MF, Mansur M, Ithnin M, Magli AS, Husniyah AR, Mahdzan NS, Othman MA, Zakaria RH, Mohd Satar N, Janor H. Analysing the Predictors of Financial Stress and Financial Well-Being among the Bottom 40 Percent (B40) Households in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12490. [PMID: 36231802 PMCID: PMC9566332 DOI: 10.3390/ijerph191912490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
This paper aims to analyse factors affecting financial stress among the Bottom 40 Percent (B40) group of Malaysian households, reflecting overall financial well-being. Data were collected through questionnaires from 1008 respondents across five major regions in Malaysia. The data were analysed using Exploratory Factor Analysis (EFA) and Partial Least Squares-Structural Equation Modelling (PLS-SEM). This study provides evidence that financial behaviour, financial vulnerability (debt and income), and locus of control (luck and self-confidence) significantly affect financial stress among B40 households. The results show a significantly positive relationship between financial stress with financial vulnerability (debt and income) and locus of control (self-confidence). On the contrary, financial behaviour and locus of control (luck) show a significant negative relationship with financial stress. The result also indicates that financial stress affects financial well-being. Overall, the findings indicate that policy-makers should invent more effective and substantial stimulus packages or other measures to reduce the financial burden on B40 households. The findings could eventually provide insights for future research to delve into the social impact of financial stress. This study also has established a valid and reliable instrument to measure financial stress involving B40 households in Malaysia that eventually reflects the financial well-being of this group of people.
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Affiliation(s)
- Maslina Mansor
- Faculty of Economics & Management, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
| | - Mohamad Fazli Sabri
- Department of Resource Management & Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Mustazar Mansur
- Center for Sustainable & Inclusive Development Studies, Faculty of Economics & Management, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
| | - Muslimah Ithnin
- Corporate Communication Unit, Ministry of Health Malaysia, Putrajaya 62000, Malaysia
| | - Amirah Shazana Magli
- Department of Resource Management & Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Abd Rahim Husniyah
- Department of Resource Management & Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Nurul Shahnaz Mahdzan
- Department of Finance, Faculty of Business & Economics, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Amim Othman
- Department of Resource Management & Consumer Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Roza Hazli Zakaria
- Department of Economics & Applied Statistics, Faculty of Business & Economics, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Nurulhuda Mohd Satar
- Department of Finance, Faculty of Business & Economics, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Hawati Janor
- Faculty of Economics & Management, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia
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Rojas Y. Unmet financial obligations and alcohol-related mortality: A nationwide register-based follow-up study. SSM Popul Health 2022; 19:101139. [PMID: 35769970 PMCID: PMC9234466 DOI: 10.1016/j.ssmph.2022.101139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/02/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022] Open
Abstract
This study sets out to explore whether experiencing financial indebtedness is related to alcohol-related mortality. For this purpose, people aged between 20 and 64 having a registration date for a debt in the Swedish Enforcement Authority's register during 2015 (n = 48,541) were followed up for a five-year period for alcohol-related mortality and were compared with a sample from the general Swedish population (n = 261,148). On the basis of logistic regression analysis, it is shown that people who had experienced financial indebtedness were almost two and a half times more likely to suffer from alcohol-related death than those who had not lived through this experience (OR = 2.43), controlling for several demographic, socio-economic, and health conditions prior to the date of the registration at the Enforcement Authority. The results provide support for the notion that debt repayment problems may, in itself, be an important indicator to consider in the study of alcohol-related harm. Consequently, debt counselling and other programs directed toward mitigating debt-related stress may play an important role in alleviating the adverse effects of indebtedness.
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Wu B, Cui Y, Jiang Y. The Role of Microfinance in China's Rural Public Health: Evidence from the Anti-Poverty Microcredit Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10872. [PMID: 36078586 PMCID: PMC9518356 DOI: 10.3390/ijerph191710872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
This study presents nonlinear evidence of the effects of a microcredit program implemented in poverty-stricken villages in China on rural public health using multivariate-ordered Probit and IV-ordered Probit models. The results, which were based on a unique set of data gathered from two rounds of official tracking statistics obtained through investigation (2015 and 2018) at a household level, suggest that rural residents' health levels and health insurance demands are related to the formal credit amount that they receive from the microcredit program. Further, the amount of debt that remains to be paid is a negative mediator and the poverty reduction degree is a positive mediator for the health impact of credit. After dividing the sample into subgroups according to income, credit rating and social network, the results show heterogeneity: the health outcomes of groups with a low income, a high credit rating and a strong social network are more significantly improved by loans. The estimations are still robust after using network and village clan numbers as instrumental variables to address endogeneity. Although most of the existing literature demonstrates that credit and indebtedness have negative impacts on health, our results supplement previous findings of the positive causality between access to formal credit and rural public health by showing that the former can exert positive effects by relaxing individuals' external constraints and increasing health spending.
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Affiliation(s)
- Benjian Wu
- School of Economics, Minzu University of China, Beijing 100081, China
| | - Yi Cui
- School of Economics, Beijing Technology and Business University, Beijing 100048, China
| | - Yushuo Jiang
- School of Economics, Minzu University of China, Beijing 100081, China
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Mathieu S, Treloar A, Hawgood J, Ross V, Kõlves K. The Role of Unemployment, Financial Hardship, and Economic Recession on Suicidal Behaviors and Interventions to Mitigate Their Impact: A Review. Front Public Health 2022; 10:907052. [PMID: 35875017 PMCID: PMC9298506 DOI: 10.3389/fpubh.2022.907052] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 12/02/2022] Open
Abstract
Understanding the social determinants and risk factors for suicidal behaviors underlies the development of effective suicide prevention interventions. This review focused on recently published literature (2010 onwards), with the aim to determine the role of economic factors (at the individual and population level) on suicidal behaviors and ideation as well as the effectiveness of interventions addressing these factors in reducing suicidal behaviors and ideation. Where available, literature examining the economic impact of COVID-19 was highlighted. Economic recession and unemployment are associated with increased risk of suicidal behavior at the population and individual level. Additionally, personal financial problems such as debt and financial strain are associated with increased risk of suicidal behavior and ideation at the individual level. Regarding interventions, unemployment benefits, employment protection legislation, higher minimum wage and active labor market programs may reduce suicide at the population level. However, it is not clear what impact they have at the individual level, nor in relation to suicide attempts, self-harm, or suicidal ideation. There was a lack of evidence as to the effectiveness of financially focused suicide prevention interventions at either level. Current findings were contextualized within, and advance, prominent social theoretical models. Recommendations focused on future areas of research, including the unfolding economic impact of COVID-19, as well as the co-design and evaluation of tailored interventions and/or gatekeeper training for those in the financial and welfare sector, and enhanced early education aimed at increasing financial literacy in young people before onset or exacerbation of financial hardship.
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Affiliation(s)
| | | | | | | | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention and WHO Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
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Guan N, Guariglia A, Moore P, Xu F, Al-Janabi H. Financial stress and depression in adults: A systematic review. PLoS One 2022; 17:e0264041. [PMID: 35192652 PMCID: PMC8863240 DOI: 10.1371/journal.pone.0264041] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/31/2022] [Indexed: 12/27/2022] Open
Abstract
Financial stress has been proposed as an economic determinant of depression. However, there is little systematic analysis of different dimensions of financial stress and their association with depression. This paper reports a systematic review of 40 observational studies quantifying the relationship between various measures of financial stress and depression outcomes in adults. Most of the reviewed studies show that financial stress is positively associated with depression. A positive association between financial stress and depression is found in both high-income and low-and middle-income countries, but is generally stronger among populations with low income or wealth. In addition to the "social causation" pathway, other pathways such as "psychological stress" and "social selection" can also explain the effects of financial stress on depression. More longitudinal research would be useful to investigate the causal relationship and mechanisms linking different dimensions of financial stress and depression. Furthermore, exploration of effects in subgroups could help target interventions to break the cycle of financial stress and depression.
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Affiliation(s)
- Naijie Guan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- * E-mail:
| | - Alessandra Guariglia
- Department of Economics, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Patrick Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Fangzhou Xu
- Department of Economics, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Hareth Al-Janabi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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Mohd Hassan NZA, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Aminuddin F, Ab Rahim FI, Jawahir S, Abdul Karim Z. The inequalities and determinants of Households' Distress Financing on Out-off-Pocket Health expenditure in Malaysia. BMC Public Health 2022; 22:449. [PMID: 35255884 PMCID: PMC8900333 DOI: 10.1186/s12889-022-12834-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/22/2022] [Indexed: 01/02/2023] Open
Abstract
Background Out-of-pocket (OOP) payments for healthcare services potentially have severe consequences on households, especially among the poor. Under certain circumstances, healthcare payments are financed through selling household assets, or borrowings. This certainly could influence households’ decision, which likely resorts to forgoing healthcare services. Thus, the focal point of this study is aimed to identify the inequalities and determinants of distress financing among households in Malaysia. Methods This study used secondary data from the National Health and Morbidity Survey (NHMS) 2019, a national cross-sectional household survey that used a two-stage stratified random sampling design involving 5,146 households. The concentration curve and concentration index were used to determine the economic inequalities in distress financing. Whereas, the determinants of distress financing were identified using the modified Poisson regression model. Results The prevalence of borrowing without interest was the highest (13.86%), followed by borrowing with interest (1.03%) while selling off assets was the lowest (0.87%). Borrowing without interest was highest among rural (16.21%) and poor economic status (23.34%). The distribution of distress financing was higher among the poor, with a concentration index of -0.245. The modified Poisson regression analysis revealed that the poor, middle, rich, and richest had 0.57, 0.58, 0.40 and 0.36 times the risk to develop distress financing than the poorest socio-economic group. Whereas, the presence of one and two or more elderly were associated with a 1.94 and 1.59 times risk of experiencing distress financing than households with no elderly members. The risk of developing distress financing was also 1.28 and 1.58 times higher among households with one and two members receiving inpatient care in the past 12 months compared to none. Conclusions The findings implied that the improvement of health coverage should be emphasized to curtail the prevalence of distress financing, especially among those caring for the elderly, requiring admission to hospitals, and poor socio-economic groups. This study could be of interest to policymakers to help achieve and sustain health coverage for all.
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Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Nur Amalina Zaimi
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Farhana Aminuddin
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Fathullah Iqbal Ab Rahim
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Suhana Jawahir
- Centre of Health Economics Research (CHEeR), Institute for Health Systems Research (IHSR), Ministry of Health Malaysia, Kompleks Institut Kesihatan Negara (NIH), Blok B2, No.1, Jalan Setia Murni U13/52, Seksyen 13 Setia Alam, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Zulkefly Abdul Karim
- Faculty of Economics and Management, Center for Sustainable and Inclusive Development (SID), Universiti Kebangsaan Malaysia (UKM), Bangi, Malaysia
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Rojas Y. Status of Debtor Registration at an Enforcement Authority and Risk of Nonfatal Suicide Attempt. CRISIS 2022. [PMID: 35138185 DOI: 10.1027/0227-5910/a000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Not much is known about whether paying unpaid debt is related to a reduced risk of suicidal behavior. Aims: To examine whether nonfatal suicide attempt varied by status of nonpayment of debt as registered at the Swedish Enforcement Authority (SEA). Method: People aged between 20 and 64 years with a registration date for an unpaid debt at the SEA during 2016 (n = 57,039) and registered as either active or inactive for a debt and/or a decision of debt reconstruction in the register in 2018 were followed up for a 2-year period for suicide attempt and compared with a sample from the general Swedish population (n = 301,714). Results: Those who were still active for a debt and/or a decision of debt reconstruction were about twice (Odds Ratio = 2.21) as likely to attempt suicide than those who no longer had an active debt in the SEA register. Limitations: The study was limited to suicide attempts that were registered as such in the National Patient Register. Conclusion: The results, based on unique nationwide register data, reinforce the importance of making tackling debt and financial distress part of current suicide prevention strategies. Professionals and others who interact with indebted people may be important gatekeepers in preventing suicide attempts.
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Affiliation(s)
- Yerko Rojas
- School of Social Sciences, Södertörn University, Huddinge, Sweden
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32
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Rojas Y. Debt Problem of One Partner and Depressive Morbidity in the Other: A 2-Year Follow-up Register Study of Different-Sex Couples in Sweden. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2022; 44:1-15. [PMID: 35153462 PMCID: PMC8821787 DOI: 10.1007/s10834-022-09817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
This study sets out to examine whether depressive morbidity varies by status of financial indebtedness of a spouse or cohabiting partner. For this purpose, individuals aged between 20 and 60 with a different-sex spouse/cohabiting partner with a registration date for a debt at the Swedish Enforcement Authority (SEA) during 2017 (n = 6979) are followed-up for a 2-year period for prescriptions of antidepressants and compared with a sample from the general Swedish population (n = 29,708). The analysis is based on penalized maximum likelihood logistic regressions. Both women and men were more likely to suffer from depressive morbidity if the spouse/cohabiting partner had been registered at the SEA in 2017 and was still active for a debt in the SEA's register in 2018 (OR 1.31 and OR 1.57, respectively), irrespective of their own health, employment, socioeconomic status, and other background variables. This also held true for men if a wife/cohabiting partner had been registered at the SEA in 2017 but was no longer active for a debt in the SEA's register in 2018 (OR 1.29). For women, on the other hand, only those with no history (11-year period) of prescription of psychotropic medications were also at an enhanced risk of depressive morbidity if a husband/cohabiting partner had gone from being registered for a debt at the SEA in 2017, to not being registered as active for a debt in the SEA's register in 2018 (OR 1.24). The results reinforce the importance of acknowledging that negative effects of financial indebtedness extend beyond the individual debtor.
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Affiliation(s)
- Yerko Rojas
- School of Social Sciences, Södertörn University, 141 89 Huddinge, Sweden
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Cawyer CR, Blanchard C, Kim KH. Financial Literacy and Physician Wellness: Can a Financial Curriculum Improve an Obstetrician/Gynecologist Resident and Fellow's Well-Being? AJP Rep 2022; 12:e64-e68. [PMID: 35141038 PMCID: PMC8816634 DOI: 10.1055/s-0041-1742268] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to evaluate the effects of a financial literacy curriculum on resident and fellow's sense of well-being and financial stress. Study Design This single institution pilot study prospectively enrolled obstetrician/gynecologist (OB/GYN) medical trainees (residents and fellows) to take part in a five-part personal financial literacy curriculum during the 2019 to 2020 academic year. Topics covered included the following: financial education and its relationship to personal well-being, overview of financial terms and principles, budgeting, debt planning, and investing and giving. Primary outcomes were the improvement in well-being as measured by the Expanded Well-Being Index (E-WBI) and financial stress as measured by the Financial Stress Scale-College Version (FSS-CV) survey. Results Of the 35 residents and fellows who participated in the study, 21 (60%) completed the postintervention survey. After course completion, there was significant improvement in the individual's E-WBI ( p < 0.05) and no significant improvement in their FSS-CV ( p = 0.06). After completing the course, trainees agreed that financial literacy improved their sense of well-being ( p = 0.018). Conclusion Cultivating financial literacy is associated with an improvement in the sense of well-being in residents and fellows and should be considered for inclusion in other graduate medical education (GME) programs.
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Affiliation(s)
- Chase R Cawyer
- Division of Maternal Fetal Medicine, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Christina Blanchard
- Statistician I, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth H Kim
- Division of Gynecology Oncology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Link D. The Face of Debt Is Female. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Australians’ Financial Wellbeing and Household Debt: A Panel Analysis. JOURNAL OF RISK AND FINANCIAL MANAGEMENT 2021. [DOI: 10.3390/jrfm14110513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
“An excess of everything is bad”. This famous old proverb fits well with the current condition of Australian household debt that is continuously rising. Research in Australia’s household indebtedness is scarce and strategies to control the rising household debt remain contentious. The government of Australia has introduced financial literacy and financial capability measures to help control the rising household debt. Given that the literature highlights the importance of improving financial wellbeing, we analyse if financial wellbeing is a factor, which could be relevant to the reduced household debt. We use the Household, Income and Labour Dynamics in Australia panel survey in our analysis and find that improved financial wellbeing is associated with the reduced debt-taking behaviour of Australians. Our robust analysis confirms our findings. Finally, our empirical results suggest that improving households’ perception of their personal financial situation can bring improvement in their financial decisions, including the decision to take on debt.
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O'Rand AM, Hamil-Luker J. Landfall After the Perfect Storm: Cohort Differences in the Relationship Between Debt and Risk of Heart Attack. Demography 2021; 57:2199-2220. [PMID: 33051832 DOI: 10.1007/s13524-020-00930-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Analyses of the Health and Retirement Study (HRS) between 1992 and 2014 compare the relationship between different levels and forms of debt and heart attack risk trajectories across four cohorts. Although all cohorts experienced growing household debt, including the increase of both secured and unsecured debt, they nevertheless encountered different economic opportunity structures and crises at sensitive times in their life courses, with implications for heart attack risk trajectories. Results from frailty hazards models reveal that unsecured debt is associated with increased risk of heart attack across all cohorts. Higher levels of housing debt, however, predict higher rates of heart attack among only the earlier cohorts. Heart attack risk trajectories for Baby Boomers with high levels of housing debt are lower than those of same-aged peers with no housing debt. Thus, the relationship between debt and heart attack varies by level and form of debt across cohorts but distinguishes Baby Boomer cohorts based on their diverse exposures to volatile housing market conditions over the sensitive household formation period of the life course.
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Affiliation(s)
- Angela M O'Rand
- Department of Sociology, Duke University, 417 Chapel Drive, Durham, NC, 27708-0088, USA.
| | - Jenifer Hamil-Luker
- Department of Sociology, Duke University, 417 Chapel Drive, Durham, NC, 27708-0088, USA
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Ten Have M, Tuithof M, Van Dorsselaer S, De Beurs D, Jeronimus B, De Jonge P, De Graaf R. The Bidirectional Relationship Between Debts and Common Mental Disorders: Results of a longitudinal Population-Based Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:810-820. [PMID: 33851286 PMCID: PMC8043431 DOI: 10.1007/s10488-021-01131-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/23/2022]
Abstract
Researchers and politicians have regularly expressed their worries about a widening of socioeconomic inequalities in physical and mental health. Debts have been relatively understudied as a specific aspect of socioeconomic disadvantage contributing to poor mental health. This study examines the bidirectional association between debts and common mental disorders (CMDs) in the adult population of the Netherlands. Data were obtained from the second ('baseline') and third (3-year follow-up) wave of the Netherlands Mental Health Survey and Incidence Study-2, a representative cohort of adults. Questions were asked about debts and difficulty in repaying debts in the past 12 months. The answers were combined into one variable: no debts, easy, difficult, and very difficult to pay back debts. Twelve-month CMDs were assessed with the Composite International Diagnostic Interview version 3.0. Increasing levels of difficulty in repaying debts predicted onset of CMD at follow-up in those without 12-month CMD at baseline, and persistence of CMD at follow-up in those with 12-month CMD at baseline. Conversely, CMD was not linked to onset of debts at follow-up in those without 12-month debts at baseline, but was associated with persistence of difficulty to pay back debts at follow-up in those with 12-month debts at baseline. These associations remained significant after adjustment for baseline sociodemographic variables, negative life events and physical health. Health professionals and debt counsellors should pay more attention to patients' debts and clients' mental health respectively in order to refer those with financial or mental health problems to the appropriate services.
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Affiliation(s)
- Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands.
| | - Marlous Tuithof
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
| | - Saskia Van Dorsselaer
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
| | - Derek De Beurs
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bertus Jeronimus
- Department of Developmental Psychology, Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Peter De Jonge
- Department of Developmental Psychology, Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Ron De Graaf
- Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS, Utrecht, The Netherlands
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Gouzoulis G, Galanis G. The impact of financialisation on public health in times of COVID-19 and beyond. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1328-1334. [PMID: 34117649 PMCID: PMC8441777 DOI: 10.1111/1467-9566.13305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
The substantial literature in political economy and sociology has shown that the increasing importance of financial activities (financialisation) exhibits significant effects on many socioeconomic conditions. While these conditions are relevant to public health, the dominant focus of the literature has been centred on the impact of financial markets on health services and health-care systems. This paper analyses how the financialisation of non-financial corporations, real estate and pensions can worsen public health through the transformation of workplace and living conditions as well as financially dependent social groups' perception of health risk. Our analysis raises several questions which aim to provide the basis of a future research agenda on the effects of financialisation on public and global health.
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Affiliation(s)
- Giorgos Gouzoulis
- Institute for Innovation and Public PurposeUniversity College LondonLondonUK
| | - Giorgos Galanis
- Institute of Management StudiesGoldsmiths, University of LondonLondonUK
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Bialowolski P, Weziak-Bialowolska D, Lee MT, Chen Y, VanderWeele TJ, McNeely E. The role of financial conditions for physical and mental health. Evidence from a longitudinal survey and insurance claims data. Soc Sci Med 2021; 281:114041. [PMID: 34087548 DOI: 10.1016/j.socscimed.2021.114041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Both theory and empirical evidence suggest that financial conditions are influential for mental health and might contribute to physical health outcomes. METHODS Using longitudinal survey data and health insurance claims data from 1209 employees in a large U.S. health insurance company, we examined temporal associations between measures of financial safety, financial capability, financial distress, their summary index (financial security) and six subsequently measured mental and physical health outcomes. RESULTS We found that financial safety and financial capability were positively associated, while financial distress was negatively associated, with subsequent self-reported measures of physical and mental health, even after controlling for these health measures at baseline and other confounders. Additionally, financial conditions were associated with reduced risk of depression based on health insurance claims data. Financial safety was also associated with anxiety. CONCLUSIONS Policy-makers might consider the introduction of more effective measures for ensuring favorable financial conditions as an important contributor to better population health. Furthermore, policy could encourage teaching adequate financial management techniques and the importance of understanding of long-term consequences of financial decisions, as those might be pivotal for health outcomes.
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Affiliation(s)
- Piotr Bialowolski
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA.
| | - Dorota Weziak-Bialowolska
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA
| | - Matthew T Lee
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA
| | - Ying Chen
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
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Ferreira MB, de Almeida F, Soro JC, Herter MM, Pinto DC, Silva CS. On the Relation Between Over-Indebtedness and Well-Being: An Analysis of the Mechanisms Influencing Health, Sleep, Life Satisfaction, and Emotional Well-Being. Front Psychol 2021; 12:591875. [PMID: 33995172 PMCID: PMC8116657 DOI: 10.3389/fpsyg.2021.591875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/18/2021] [Indexed: 01/15/2023] Open
Abstract
This paper aims to explore the association between over-indebtedness and two facets of well-being - life satisfaction and emotional well-being. Although prior research has associated over-indebtedness with lower life satisfaction, this study contributes to the extant literature by revealing its effects on emotional well-being, which is a crucial component of well-being that has received less attention. Besides subjective well-being (SWB), reported health, and sleep quality were also assessed. The findings suggest that over-indebted (compared to non-over-indebted) consumers have lower life satisfaction and emotional well-being, as well as poorer (reported) health and sleep quality. Furthermore, over-indebtedness impacts life satisfaction and emotional well-being through different mechanisms. Consumers decreased perceived control accounts for the impact of over-indebtedness on both facets of well-being (as well as on reported health and sleep). Financial well-being (a specific component of life satisfaction), partly mediates the impact of indebtedness status on overall life satisfaction. The current study contributes to research focusing on the relationship between indebtedness, well-being, health, and sleep quality, and provides relevant theoretical and practical implications.
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Affiliation(s)
- Mário B Ferreira
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa de Almeida
- Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal.,Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Jerônimo C Soro
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | | | - Diego Costa Pinto
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carla Sofia Silva
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
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41
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Guariglia A, Monahan M, Pickering K, Roberts T. Financial health and obesity. Soc Sci Med 2021; 276:113665. [PMID: 33810889 DOI: 10.1016/j.socscimed.2020.113665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
We use individual-level panel data from the English Longitudinal Survey of Ageing over the period 2004-2013 to investigate the links between financial health and obesity. We find that having no debt (high savings) is associated with a 3.6 (1.6) percentage point lower probability of having a Body Mass Index in excess of 30. Our results are robust to using different estimation methods, to measuring financial health with a subjective indicator, and adiposity with waist circumference. A lower rate of time preference and lower stress levels may be mechanisms which help to explain the association between good financial health and obesity.
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Affiliation(s)
- Alessandra Guariglia
- Department of Economics, University of Birmingham, University House, Edgbaston, Birmingham, B15 2TY, UK.
| | - Mark Monahan
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, UK.
| | - Karen Pickering
- Mtech Access, Suite 2, 30 Murdoch Rd, Bicester, OX26 4PP, UK.
| | - Tracy Roberts
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, B15 2TT, UK.
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Håkansson A, Fernández-Aranda F, Jiménez-Murcia S. Gambling-Like Day Trading During the COVID-19 Pandemic - Need for Research on a Pandemic-Related Risk of Indebtedness and Mental Health Impact. Front Psychiatry 2021; 12:715946. [PMID: 34381392 PMCID: PMC8350024 DOI: 10.3389/fpsyt.2021.715946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Stock exchange trading increasingly has been highlighted as a possible cause of gambling disorder, typically in rapid and excessive "day trading" which may cause over-indebtedness and mental health problems. The COVID-19 pandemic has been suspected to increase online gambling and gambling problems. In a number of recent media reports, day trading has been reported to increase during COVID-19, possibly in relation to changes in everyday life, financial problems and job insecurity during the pandemic. Increasing day trading has thereby been suspected to cause addictive behavior, financial difficulties, and poor mental health. However, there is hitherto a lack of research in the area. The present paper addresses the potential for day trading to cause problem gambling, debts and mental health problems, and calls for research and clinical guidelines in problem gambling related to stock market behavior as a problematic gambling behavior. Screening tools, awareness among clinicians, and longitudinal research studies may be warranted, both during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Malmö Addiction Center, Clinical Sports and Mental Health Unit, Malmö, Sweden
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-L'Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-L'Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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43
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Bialowolski P, Weziak-Bialowolska D, McNeely E. The Role of Financial Fragility and Financial Control for Well-Being. SOCIAL INDICATORS RESEARCH 2021; 155:1137-1157. [PMID: 33612917 PMCID: PMC7883334 DOI: 10.1007/s11205-021-02627-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 05/21/2023]
Abstract
Financial fragility is recognized as a substantial issue for individual well-being. Various estimates show that between 46 and 59% of American adults are financially fragile and thus vulnerable in terms of their well-being. We argue that the role of financial control in shaping well-being outcomes-despite being less recognized in the literature than the role of financial fragility-is equally or even more important. Our study is a longitudinal cohort study that made use of observational data. Two waves of the Well-Being Survey data from 1448 U.S. adults were used in the analysis. Impacts of financial fragility and financial control on 17 well-being outcomes were examined, including emotional well-being (nine outcomes), physical well-being (four outcomes), social well-being (two outcomes), in addition to an unhealthy days summary measure and the flourishing index. Financial fragility was shown to be on average less influential for the well-being outcomes than financial control. Our results suggest that financial control plays a protective role for complete well-being. Less evidence in support of a harmful role of financial fragility for well-being is provided. Tests for moderation effects revealed no interaction between financial control and financial fragility within our sample, indicating that financial control did not modify the relationship between financial fragility and well-being.
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Affiliation(s)
- Piotr Bialowolski
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Suite G28, Boston, MA 02115 USA
| | - Dorota Weziak-Bialowolska
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Suite G28, Boston, MA 02115 USA
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Suite G28, Boston, MA 02115 USA
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44
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Hiilamo A. Debt matters? Mental wellbeing of older adults with household debt in England. SSM Popul Health 2020; 12:100658. [PMID: 33313374 PMCID: PMC7719960 DOI: 10.1016/j.ssmph.2020.100658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 12/04/2022] Open
Abstract
Background A record number of older individuals have household debt, but little is known about possible links between debts and their mental wellbeing. This study examines the extent to which different aspects of household indebtedness predict mental wellbeing among this population. Methods A sample of 17,091 individuals (72,700 observations) aged 50 and over in England was derived from waves 1–8 of the English Longitudinal Study of Ageing. Mental wellbeing was assessed by two outcome measures: number of depressive symptoms (CES-D 8) and quality of life (CASP-19 score). The predictors of mental wellbeing were examined using quartiles of non-zero overall debt amount, debt-to-income and debt-to-non-housing wealth ratios as alternative measures of debt burden. Linear regression models estimated the associations of mortgage and non-mortgage debt measures with mental wellbeing while adjusting for observable socioeconomic confounding factors. Individual fixed effect models were used to control for all time-constant factors among a longitudinal subsample. Results Individuals in the highest debt-to-wealth quartile were particularly at risk of lower mental wellbeing, that is, a higher number of depressive symptoms and lower quality of life. After covariate adjustment, non-mortgage debt predicted lower mental wellbeing on both measures but mortgage debt was only linked to lower quality of life. Among the subsample who experienced changes in high non-mortgage debt levels, a small association of these changes with mental wellbeing outcomes were observed. Asymmetric within-individual estimation showed that both getting rid of and acquiring new debts during the study period predicted symmetrically (small) increases and decreases, respectively, in mental wellbeing. Conclusion These findings indicate that among older individuals in England, non-mortgage debt status is linked to poor mental wellbeing. High, non-mortgage, debt-to-wealth ratios may help identify risk of mental wellbeing issues in older people with debts. Little is known on debt and mental wellbeing among older individuals in England. Debt type and debt measures matter for mental wellbeing. Non-mortgage debt was linked to lower mental wellbeing between observations. However, smaller effects of non-mortgage debts were observed within-individuals.
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Affiliation(s)
- Aapo Hiilamo
- Centre for Analysis of Social Exclusion (CASE) & Department of Social Policy, London School of Economics and Political Science (LSE), Houghton Street, London, WC2A 2AE, United Kingdom
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45
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Mihalopoulos C, Chatterton ML, Engel L, Le LKD, Lee YY. Whither economic evaluation in the case of COVID-19: What can the field of mental health economics contribute within the Australian context? Aust N Z J Psychiatry 2020; 54:1157-1161. [PMID: 33008268 DOI: 10.1177/0004867420963724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
COVID-19 has resulted in broad impacts on the economy and aspects of daily life including our collective mental health and well-being. The Australian health care system already faces limitations in its ability to treat people with mental health diagnoses. Australia has responded to the COVID-19 outbreak by, among other initiatives, providing reimbursement for telehealth services. However, it is unclear if these measures will be enough to manage the psychological distress, depression, anxiety and post-traumatic distress shown to accompany infectious disease outbreaks and economic shocks. Decision making has focused on the physical health ramifications of COVID-19, the avoidance of over-burdening the health care system and saving lives. We propose an alternative framework for decision making that combines life years saved with impacts on quality of life. A framework that simultaneously includes mental health and broader economic impacts into a single decision-making process would facilitate transparent and accountable decision making that can improve the overall welfare of Australian society as we continue to address the considerable challenges that the COVID-19 pandemic is creating.
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Affiliation(s)
- Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Lidia Engel
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Yong Yi Lee
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
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46
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Swanton TB, Gainsbury SM. Debt stress partly explains the relationship between problem gambling and comorbid mental health problems. Soc Sci Med 2020; 265:113476. [PMID: 33143953 DOI: 10.1016/j.socscimed.2020.113476] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/16/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
RATIONALE Easy access to consumer credit products, such as credit cards, overdrafts, and personal loans, may facilitate gambling beyond affordable levels, which can result in debt problems. Debt and mental health problems are both potential motivators and core consequences of problem gambling. Debt stress (i.e., worry regarding ability to repay debts) is one potential psychological mechanism underlying the relationship between debt and mental health problems. Few previous studies have investigated debt stress among gamblers. OBJECTIVE This cross-sectional study aimed to investigate the mediating effect of debt stress between gambling frequency and mental health and wellbeing. METHODS & RESULTS A sample of 309 Australian past-month gamblers (83.8% male; mean age 41.5 years) completed an online survey. There was no evidence for the preregistered association between gambling frequency and debt stress, ruling out a predicted mediating effect for debt stress between gambling frequency and mental health and wellbeing. However, exploratory path analysis showed debt stress has statistically significant mediating effects between problem gambling and psychological distress, depression, wellbeing, and gambling-related family impacts, after controlling for sociodemographic factors and psychiatric history. CONCLUSIONS & IMPLICATIONS Debt stress is a robust indicator of financial problems and may indicate underlying problem gambling and mental health issues, making debt stress a useful risk indicator. Clinical services should conduct screening for debt stress and address subjective worry about debts as a standard part of treatment plans as this may help to mitigate some of the impact of gambling and/or financial problems on poor mental health. Health practitioners should develop strong referral networks with gambling and financial counselling services. Government investment in making gambling and financial counselling services freely available and easily accessible is recommended to ensure appropriate support is received via effective care pathways.
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Affiliation(s)
- Thomas B Swanton
- The University of Sydney, Faculty of Science, School of Psychology, Brain & Mind Centre, Gambling Treatment & Research Clinic, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Sally M Gainsbury
- The University of Sydney, Faculty of Science, School of Psychology, Brain & Mind Centre, Gambling Treatment & Research Clinic, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
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47
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Sato Y, Watt RG, Saijo Y, Yoshioka E, Osaka K. Student Loans and Psychological Distress: A Cross-sectional Study of Young Adults in Japan. J Epidemiol 2020; 30:436-441. [PMID: 31474676 PMCID: PMC7492703 DOI: 10.2188/jea.je20190057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Levels of student loan debt have been increasing, but very little research has assessed if this is associated with poor health. The aim was to examine the association between student loans and psychological distress in Japan. Methods We conducted a cross-sectional web-based self-administered questionnaire survey in 2017. The sample comprised of 4,149 respondents aged 20–34, with 3,170 graduates and 979 current university students. The independent variables were whether or not current students had student loans, and for graduates, the total amount of their student loan debt. The dependent variable was severe psychological distress assessed using the Kessler Psychological Distress Scale (K6; the cut-off point was 12/13). Covariates were demographic and parents’ socioeconomic variables. A Poisson regression analysis with a robust error variance was conducted to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Because there was a significant interaction between current student status and the status of borrowing student loans, stratified analyses were conducted. Results The percentage of those with student loans was 33.8% among graduates and 35.2% among current university students. Among graduates, student loan debt was significantly associated with a high possibility of having severe psychological distress after adjusting for covariates (PR of ≥4 million yen, 1.44; 95% CI, 1.02–2.03). Among current university students, there was no significant association (PR of borrowing student loans, 0.91; 95% CI, 0.60–1.37). Conclusions There was a significant association between student loan debt and psychological distress among graduates but not current university students.
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Affiliation(s)
- Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry
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48
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López-Casasnovas G, Saez M. Saved by Wealth? Income, Wealth, and Self-Perceived Health in Spain during the Financial Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197018. [PMID: 32992933 PMCID: PMC7579060 DOI: 10.3390/ijerph17197018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/04/2022]
Abstract
We evaluate the association between the variations in income and wealth, (both aggregate and split between real estate and financial wealth), and self-perceived health in Spain using a longitudinal sample of individuals before and after the financial crisis. We estimated generalized linear mixed models, with a binomial response and a logistic link, for four waves of the Spanish Survey of Household Finances (two before and two after the crisis), adjusting for variables at the family and individual levels. We also controlled for familial and individual heterogeneity and for temporal trends. While an increase in wealth greatly increases the probability of younger individuals reporting better health, this is not the case for older individuals. Decreases in gross wealth are associated with decreases in the probability of declaring good/very good health only in families whose reference person is over 44 years old. We conclude that: (i) not just income but net wealth effects impact on the consequences of income fluctuations on consumption and health assessed, (ii) the composition of individuals’ net wealth may also matter, since they are differently affected by the shocks in the economic crisis, (iii) age plays a significant role and, finally, (iv) individual reactions in terms of consumption and savings, given any level of income and wealth, according to the risk aversions for precautionary idiosyncratic motives, may also need to be considered in order to complete the picture.
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Affiliation(s)
- Guillem López-Casasnovas
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, 08005 Barcelona, Spain;
- Department of Economics and Business, Universitat Pompeu Fabra, 08005 Barcelona, Spain
- Barcelona Graduate School (BGSE), Universitat Pompeu Fabra, 08005 Barcelona, Spain
| | - Marc Saez
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, 08005 Barcelona, Spain;
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-972-418338; Fax: +34-972-418032
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Eriksson M, Carlberg B, Pennlert J, Söderberg S, Eliasson M. Time trends and socioeconomic differences in blood pressure levels: The Northern Sweden MONICA study 1994–2014. Eur J Prev Cardiol 2020; 24:1473-1481. [DOI: 10.1177/2047487317722263] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
People with low socioeconomic status have higher blood pressure (BP), increasing their risk of myocardial infarction and stroke. We hypothesized that the gap in systolic (SBP) and diastolic (DBP) BP, according to educational level, has decreased over time but, that economical vulnerability would confer higher BP.
Methods
A total of 4564 women and 4363 men aged 25–74 years participated in five population-based surveys in the Northern Sweden MONICA study between 1994 and 2014 (participation rate 76.8–62.5%).
Results
SBP decreased by 10 mmHg in women and 4 mmHg in men, while DBP was unchanged. Treatment with antihypertensives increased in all but the youngest men. The prevalence of BP control in the population (<140/90 mmHg) increased and in 2014 reached 75% among women and 70% among men. The decrease in SBP was more pronounced in people without university education than in people with university education and DBP showed the same pattern, regardless of education.
After adjustment for confounding factors, age, male sex, higher body mass index, and being born in a Nordic country were related to higher SBP and DBP. University education was related to lower SBP, while variables mirroring economic vulnerability were not associated with BP levels.
Conclusions
BP levels as well as the socioeconomic gap in BP has decreased in Sweden but people with a lower level of education still have higher SBP. Lacking economic resources is not associated with high BP.
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Affiliation(s)
| | - Bo Carlberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Sweden
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Richards J, Scheckel CJ, Anderson A, Newman JR, Poole KG. Life vs Loans: Does Debt Affect Career Satisfaction in Osteopathic Graduates? J Osteopath Med 2020; 120:497-503. [DOI: 10.7556/jaoa.2020.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Background
The cost of undergraduate osteopathic medical education continues to grow. It is important to understand how the rising cost of matriculation negatively affects training and career satisfaction of entering students.
Objective
To better understand any association between level of educational debt and satisfaction with osteopathic medical education, career choice, and financial services.
Methods
Responses were analyzed from the American Association of Colleges of Osteopathic Medicine survey of pending medical school graduates from 2007 through 2016 regarding indebtedness and specialty selection.
Results
From 2007 to 2016, the mean educational debt level at graduation rose consistently among osteopathic graduates (from $155,698 to $240,331, respectively). In all years, there was no significant effect of debt quartile on satisfaction with choice of osteopathic medicine as a career. Quartile variable with debt did not show a significant effect on satisfaction with education experience in 2010, 2013, and 2016. Top quartile debt was associated with higher satisfaction with financial service departments in all years.
Conclusion
Although debt has consistently increased for osteopathic medical graduates, it does not affect their satisfaction with either their educational experience or their choice of osteopathic medicine as a career.
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