Race, Depression, and Financial Distress in a Nationally Representative Sample of American Adults
Thoughts
Connects with: @kahn2006
Annotations
assari2019 - p. 1
Theoretical work [1] and empirical data [2–4] have shown a close link between objective (e.g., wealth and income) and subjective (e.g., subjective social position) indicators of socioeconomic position (SEP) and health.
assari2019 - p. 1
Financial distress is a unique indicator of SEP. Although correlated with other SEP indicators [7], it is different enough from other conventional objective SEP indicators, such as education and income, in that it captures financial trouble that is a stronger antecedent to poor mental health than other
assari2019 - p. 2
objective SEP indicators that may not fully capture individuals’ material circumstances [8].
assari2019 - p. 2
The policy implication of research on financial distress is that standard SEP indicators should not be the only criteria for eligibility to the economic social programs and interventions
assari2019 - p. 2
Link and Phelan’s Fundamental Cause Theory (FCT) conceptualized SEP as an upstream determinant of population health [1]. Mirowsky and Ross argued that the health effects of SEP are “enduring, consistent, and growing” [25]. While the health effects of objective measure of SEP (e.g., income, education, employment) are well documented [26–30], less is known about the association between subjective indicators of SEP, particularly financial distress, and health, after adjustment for SEP indicators.
assari2019 - p. 2
The current study used data from the NSAL 2003-2004, which a component of the Collaborative Psychiatric Epidemiology Surveys (CPES) [43–45]. Although detailed description of the CPES and NSAL methodology is published elsewhere [43–45], here we provide some aspects of the NSAL methods.
assari2019 - p. 3
The current study collected data on race/ethnicity, age, gender, objective SEP (educational attainment, household income, employment status, and marital status), subjective SEP (i.e., financial distress), and 12-month MD
assari2019 - p. 3
Financial Distress. Financial distress was measured using the following two items: (1) “How difficult is it for (you/your family) to meet the monthly payments on your (family’s) bills?”, and (2) “How much do you worry that your total (family) income will not be enough to meet your (family’s) expenses and bills?” Response items for the first item ranged from 0 (not at all difficult) to 4 (extremely difficult).
assari2019 - p. 3
Major Depressive Episode (MDE). 12-month MDE was measured using the modified version of the World Mental Health (WHO) Composite International Diagnostic Interview (CIDI). CIDI is a fully structured diagnostic interview schedule [46]. The CIDI measures a wide range of psychiatric disorders based on the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria. Originally developed for the WHO study started in 2000, the CIDI is an interview schedule that is being used by lay interviewers who were trained.
assari2019 - p. 3
Confounders. Socio-demographic factors included age (years), gender (male = 0, female = 1), educational attainment, household income, employment status, marital status.
assari2019 - p. 7
When we had financial distress as the outcome, in addition to depression, objective SEP indicators (education, employment, and income) were correlated with financial distress. This suggests that (education, employment, and income impact financial distress, which is in line with the literature of the link between subjective and objective SEP indicators. However, when in our model, MDE was the outcome, in the presence of financial distress, objective SEP indicators (education, income, marital status, and unemployment) did not have residual effects on MDE. This finding of our sensitivity analysis suggests that financial distress, an indicator of subjective SEP, may have stronger association with MDE than objective indicators of SEP.