The Psychosocial Context of Financial Stress: Implications for Inflammation and Psychological Health
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sturgeon2016 - p. 1
This study examined 1) the direct relations between financial stress and inflammation, 2) whether the relationships between financial stress and inflammation are mediated in part by negative interpersonal events, psychological distress, and psychological wellbeing, and 3) whether social standing in one’s community moderates the relations between financial stress and psychological distress, psychological well-being, and markers of inflammation (interleukin-6 and C-reactive protein).
sturgeon2016 - p. 2
Financial stress predicts a myriad of psychological difficulties, including greater psychological distress (12) and increased difficulties with family members, friends, and in the workplace (13). Similarly, financial hardships uniquely contribute to poorer physical health in community samples (2). Financial hardship may also limit exposure to resources important for development throughout the lifespan, and may erode protective psychological factors such as self-esteem (13)
sturgeon2016 - p. 3
Little is known, however, about whether similar interpersonal and psychological factors account for the association between financial stress and inflammation. Financial events strain relationships among family members who must make ends meet and who face the prospect of an uncertain future. Thus, negative financial events may spill over and trigger negative interpersonal events which, in turn, influence physical processes such as inflammation.
sturgeon2016 - p. 4
688 middle-aged adults between the ages of 40 and 65 years old were recruited from the Phoenix, Arizona metropolitan area between 2007 and 2012.
sturgeon2016 - p. 5
Major financial stressful events over the previous year were assessed using the financial stress subscale of the Psychiatric Epidemiology Research Interview (PERI) Life Events Scale (25). The internal consistency of the six-item PERI financial stress subscale was acceptable (α = .714).
sturgeon2016 - p. 5
Stressful interpersonal events were measured using items from the PERI detailing stressful events with spouses (6 items), family members (6 items), co-workers (5 items), and social events (3 items). As these items reflect non-overlapping domains of functioning and were compiled as a general measure of interpersonal stress, the internal consistency of this measure was low, as expected (Cronbach’s α = .558).
sturgeon2016 - p. 5
Perceived social status was measured using the MacArthur Scale for Subjective Social Status (20). The test-retest reliability of this measure has been established (26), and it has been used in previous studies assessing subjective social status and health outcomes (20, 26).
sturgeon2016 - p. 5
Vitality subscale scores from the Short Form Health Survey (SF-36) The 4-item Vitality composite score showed good internal consistency (Cronbach’s α = .844).
sturgeon2016 - p. 6
The 5-item World Health Organization Well-Being Index (WHO-5) was used to measure current mental well-being (e.g., “I have felt cheerful and in good spirits”, “I have felt active and vigorous”) (28). WHO-5 scale items were modified to reflect functioning over the past 4 weeks. The internal consistency of this measure was good (Cronbach’s α = .864).
sturgeon2016 - p. 6
Positive and negative affect scores were computed using the Positive Affect-Negative Affect Schedule (PANAS) (29). Both the negative affect scale (Cronbach’s α = .881) and the positive affect scale (α = .874) showed adequate internal consistency.
sturgeon2016 - p. 6
Anxiety was assessed using a composite of 3 items from the 18-item Mental Health Inventory (MHI-18) (30) measuring feelings of anxiety, nervousness, and difficulty with relaxation and one item from the original 38-item MHI (22) assessing feelings of being bothered by nervousness. Both the anxiety composite score (Cronbach’s α = .830) and the depression composite score (Cronbach’s α = .890) showed adequate internal consistency.
sturgeon2016 - p. 6
To quantify levels of IL-6 and CRP, 10ml of blood were collected into EDTA tubes (Becton–Dickinson, Franklin Lakes, NJ), held on ice, and centrifuged within 2 hours of collection for 15 minutes at 1500g. Plasma was then aspirated, aliquoted, and frozen at −80 °C until assay. Plasma levels of IL-6 were quantified using Quantikine High Sensitivity human IL-6 kits (R&D Systems, Inc., Minneapolis, MN), an enzyme-linked immunosorbent assay (33) with an intra-assay coefficient of variation of 4% and inter-assay coefficient of variation of 10%.
sturgeon2016 - p. 6
Medication use was coded using separate binary variables representing use of at least one anti-inflammatory medication or at least one steroid medication versus those who did not use any of these medications.
sturgeon2016 - p. 7
Four binary variables were created that represented whether participants endorsed currently being treated for a cardiovascular illness, arthritis condition, diabetes, and cancer. A count variable was then computed that reflected the total number of current medical conditions for each participant.
sturgeon2016 - p. 9
However, perceived social status significantly moderated the effects of negative financial events on both negative interpersonal events (interaction B = .067, SE = .017, p < .001), and CRP levels (interaction B = .051, SE = .026, p = .050).
sturgeon2016 - p. 9
The model fit indices yielded from the fully-specified model suggested good fit according to the comparative fit index (CFI = .963), Tucker-Lewis Index (TLI = .937), standardized root mean square residual (SRMR = .034), and root mean square error of approximation (RMSEA = .044). The chi-square test of model fit was significant (χ2(89) = 185.80, p < . 001). However, given that this index of model fit is susceptible to inflated values in large sample sizes (37), the fit of the current model was deemed to be acceptable.