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

Alia Alhomsi; Paula D Strassle; Stephanie Ponce; Izzy Mendez; Stephanie M Quintero; Miciah Wilkerson; Anita L Stewart; Anna M Napoles

doi:10.1089/heq.2022.0197

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

Health Equity. 2023 Jul 20;7(1):395-405. doi: 10.1089/heq.2022.0197. eCollection 2023.

Authors

Alia Alhomsi¹, Paula D Strassle¹, Stephanie Ponce¹, Izzy Mendez¹, Stephanie M Quintero¹, Miciah Wilkerson¹, Anita L Stewart², Anna M Napoles¹

Affiliations

¹ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, Maryland, USA.
² Center for Aging in Diverse Communities, Institute for Health and Aging, University of California San Francisco, San Francisco, California, USA.

Abstract

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

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

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

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

Keywords: anxiety; depression; financial hardship; loneliness; lost income; psychological distress.