Financial Strain Research Articles

#254 PaCE CKD: examining health status and financial burden in patients with chronic kidney disease: assessing the non-clinical burden of disease

Abstract Background and Aims There is a detrimental effect of chronic kidney disease (CKD) on health states, with many patients worldwide experiencing considerable symptom burden and development of comorbidities, leading to frequent medical appointments and hospitalisations. Patients experience disease-associated financial strain as their ability to work is impaired. The aim of this multinational study was to characterise the non-clinical burden of CKD by quantifying the effect of CKD on health states and productivity in patients versus general population in several regions. Method Patients with early (stages 1-3) to advanced (stages 4-5) of CKD, including those receiving dialysis treatment, in Germany, Mexico, Taiwan, the UK, and the US were enrolled to a cross-sectional non-interventional survey measuring: Scores were compared with a general population cohort, matched 1:1 in sample size against patient cohorts and for demographic characteristics (e.g. age and area of residence). Results Across five countries, an average of 201 (range: 190–212) patients were enrolled, of whom 42% were receiving dialysis in Germany, 57% in Mexico, and 55% in the UK with smaller proportions of patients on dialysis cohorts in the US (32%) and Taiwan (15%). Haemodialysis was the most prevalent mode of dialysis in all countries, with most patients receiving dialysis in a clinic or hospital. Enrolled patients who had received a kidney transplant accounted for 11.5% on average across all countries. Compared with general population, people with CKD experienced a 24% reduction in mean [SD] EQ-5D utility scores, with patients in the US experiencing the greatest disparity in health states (0.64 [0.27] versus 0.95 [0.08]). Patients with CKD reported significantly more problems across all EQ-5D domains in Germany, Mexico, the US, and UK than general population cohorts. The highest percentage of patients reporting problems was in Mexico, with 81.4% reporting problems in usual activities compared with 4.4% in the general population. Patients receiving dialysis reported a mean EQ-VAS value of 70.3 compared with 91.8 in non-dialysis dependent patients, indicating that treatment burden negatively contributes towards patients perception of their health. In addition to impaired health states, patients reported elevated impairment across work and non-work activities in all countries. Patients reported increased rates of absenteeism, presenteeism, work impairment and non-work activity impairment, with the greatest impairment observed in the UK of 46.4% in non-work activity impairment compared with the general population. Conclusion These results indicate that people with CKD experience substantial burden of disease that extends beyond its clinical aspects. Decision makers should consider broader disease effects when addressing the burden of CKD.

Performance of the Modified Caregiver Strain Index in a Sample of Black and White Persons Living With Dementia and Their Caregivers.

This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia. Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups. Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = -0.54, Black: r = -0.55), with a p < .001 for all validity analysis. The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.

Food Insecurity and Hypoglycemia among Older Patients with Type 2 Diabetes Treated with Insulin or Sulfonylureas: The Diabetes & Aging Study.

Severe hypoglycemia is a serious adverse drug event associated with hypoglycemia-prone medications; older patients with diabetes are particularly at high risk. Economic food insecurity (food insecurity due to financial limitations) is a known risk factor for hypoglycemia; however, less is known about physical food insecurity (due to difficulty cooking or shopping for food), which may increase with age, and its association with hypoglycemia. Study associations between food insecurity and severe hypoglycemia. Survey based cross-sectional study. Survey responses were collected in 2019 from 1,164 older (≥ 65years) patients with type 2 diabetes treated with insulin or sulfonylureas. Risk ratios (RR) for economic and physical food insecurity associated with self-reported severe hypoglycemia (low blood glucose requiring assistance) adjusted for age, financial strain, HbA1c, Charlson comorbidity score and frailty. Self-reported reasons for hypoglycemia endorsed by respondents. Food insecurity was reported by 12.3% of the respondents; of whom 38.4% reported economic food insecurity only, 21.1% physical food insecurity only and 40.5% both. Economic food insecurity and physical food insecurity were strongly associated with severe hypoglycemia (RR = 4.3; p = 0.02 and RR = 4.4; p = 0.002, respectively). Missed meals ("skipped meals, not eating enough or waiting too long to eat") was the dominant reason (77.5%) given for hypoglycemia. Hypoglycemia prevention efforts among older patients with diabetes using hypoglycemia-prone medications should address food insecurity. Standard food insecurity questions, which are used to identify economic food insecurity, will fail to identify patients who have physical food insecurity only.

Navigating the complexities of care: exploring quality of life among parents-caregivers of children with neurological impairments in Bulgaria

ABSTRACT This study delves into the quality of life (QoL) experiences of parents caring for children with neurological impairments in Bulgaria. Employing the World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument, a cross-sectional analysis was conducted on parents of neurologically impaired children (n = 52) and parents of healthy children (n = 43). The study uncovers the intricate interplay of physical, psychological, social, and environmental dimensions that contribute to caregivers’ well-being. Despite the challenges parents of neurologically impaired children face, including the delicate balance between caregiving and employment, financial strains, and the need for culturally sensitive support services, they demonstrate remarkable adaptive capacities. The findings advocate for a multifaceted approach in addressing the challenges to improve the overall QoL for parents nurturing children with disabilities in Bulgaria.

Can Stem Cell Therapy be an Effective Therapeutic Option for Complex and Neurological Conditions?

This article explores the feasibility and potential benefits of stem cell therapy as a promising therapeutic intervention for individuals facing severe behavioral and cognitive impairments, targeting underlying neurological mechanisms to offer potential symptom improvement and function restoration, thereby enhancing the quality of life for patients and potentially alleviating stress and burnout among caregivers. The aims of the study include investigating the efficacy of stem cell therapy in addressing these impairments and evaluating its potential to alleviate caregiver burden. Through a comprehensive review of existing literature, clinical trials, and studies, this research synthesizes the mechanisms of stem cell therapy, potential applications, clinical trial outcomes, caregiver experiences, and economic implications. The methods employed involve analyzing diverse data sources to provide a holistic understanding of the possibilities and challenges associated with stem cell therapy. Key outcomes of the study include highlighting promising results from clinical trials targeting conditions such as autism spectrum disorder, Parkinson's disease, and Crohn's disease, which underscore the transformative potential of stem cell therapy in patient care. Additionally, economic implications suggest potential reductions in healthcare costs and alleviation of financial strain on individuals, families, and healthcare providers. Stem cell therapy represents a paradigm shift in healthcare, promising to redefine treatment approaches and alleviate broader societal burdens associated with complex neurological conditions. The relevance of the study lies in emphasizing the need for continued research, ethical considerations, and multidisciplinary collaboration to ensure the safe and effective integration of stem cell therapy into clinical practice, ultimately offering new hope and improved care for patients, caregivers, and healthcare systems worldwide.

The role of psychological distress in the relationship of financial strain with oral health and dental attendance in Dutch adults: A mediation analysis based on cross-sectional data.

The study aimed to assess whether psychological distress mediates the association between financial strain and oral health and dental attendance in the Dutch adult population. The study followed a cross-sectional design based on 2812 participants from the 2014 wave of the Dutch population-based GLOBE study. Financial strain was considered the exposure, while psychological distress measured with the Mental Health Inventory-5 (MHI-5) was the mediator. The outcomes included self-reported number of teeth, self-rated oral health, and self-reported dental attendance. Generalized regression analyses were used for the mediation analysis adjusted for several covariables. Greater financial strain was significantly associated with poorer self-rated oral health (total effect: 0.09, 95%CI: 0.05; 0.14) and restorative or no dental attendance (i.e. participants never visiting a dentist or only visiting a dentist for regular treatments or when they have complaints with their mouth, teeth, or prosthesis) (total effect: 0.05, 95%CI: 0.02; 0.09). Greater financial strain was not significantly associated with self-reported number of teeth (total effect: -0.14, 95%CI: -0.91; 0.64). Psychological distress significantly mediated the association of financial strain with self-rated oral health (average causal mediation effect [ACME]: 0.02, 95%CI: 0.01; 0.03) and self-reported dental attendance (ACME: 0.01, 95%CI: 0.00; 0.02), respectively. However, it did not significantly mediate the association of financial strain with self-reported number of teeth (ACME: -0.11, 95%CI: -0.25; 0.02). The estimated proportion of the total effect of financial strain on self-rated oral health and self-reported dental attendance that could be explained by psychological distress was respectively 24% (95%CI: 14%; 48%) and 19% (95%CI: 6%; 62%). Psychological distress partly explains the association of financial strain with self-rated oral health and dental attendance, but not with self-reported number of teeth. Future studies using longitudinal data are necessary to confirm the results.

Family caregivers of children transitioning hospital to home receiving nasogastric feeding: descriptive qualitative study.

Nasogastric tube (NGT) feeding is used for children unable to tolerate adequate nutrition orally to sustain growth and development. This vulnerable population is at risk of gaps in care because they often lack a medical home due to the transitional nature of the technology. This study explores perspectives and challenges of family caregivers (FCs) of children requiring NGTs transitioning from hospital to home. Semi-structured qualitative interviews were conducted with FCs at the Hospital for Sick Children and Children's Hospital of Eastern Ontario. Research ethics approval was obtained (SK REB# 1000064641, CHEO REB# 19/133X). Written informed consent was obtained. Thirteen interviews revealed FCs feeling overwhelmed and uncomfortable with first communication of the NGT but learned to manage NGTs with training and virtual care support over time. Initial transition home was described as challenging due to physical, emotional, and financial strain associated with constant management of NGTs. Our study describes the importance of emotional support and additional time for decision making during initial communication to FCs of their child's NGT need, and access to specialized healthcare professionals after transitioning home. Future programs should focus on personalized education and psychosocial support for FCs of children with NGTs at home. This study delves into the challenges faced by family caregivers (FCs) of children requiring nasogastric tube (NGT) feeding when returning home from the hospital. There is a pressing need for more time for FC decision-making and emotional support during the initial communication of the need for an NGT for their child. In addition, FCs require ongoing 24/7 support including access to healthcare professionals specialized in NGT care after the initial transition home. The study highlights the need for personalized education and psychosocial supports for FCs of children with NGTs to improve their experiences at home.

Cumulative costs of severe traffic injuries in Finland: a 2-year retrospective observational study of 252 patients

Road traffic injuries cause considerable financial strain on health care systems worldwide. We retrospectively analyzed injury-related costs of 252 severely injured (New Injury Severity Score, NISS ≥ 16) patients treated at Tampere University Hospital (TAUH) between 2013 and 2017, with 2-year follow-up. The costs were divided into direct treatment, indirect costs, and other costs. We analyzed various injury- and patient-related factors with costs. The total costs during the 2-year study period were 20 million euros. Median cost was 41,202 euros (Q1 23,409 euros, Q3 97,726 euros), ranging from 2,753 euros to 549,787 euros. The majority of costs (69.1%) were direct treatment costs, followed by indirect costs (28.4%). Other costs were small (5.4%). Treatment costs increased with the severity of the injury or when the injury affected the lower extremities or the face. Indirect costs were higher in working age patients and in patients with a higher level of education. The relative proportions of direct and indirect costs were constant regardless of the amount of the total costs. The largest share of costs was caused by a relatively small proportion of high-cost patients during the 1st year after injury. Combined, this makes planning of resource use challenging and calls for further studies to further identify factors for highest costs.

An evaluation of the impact of social and structural determinants of health on forgone care during the COVID-19 pandemic in Baltimore, Maryland.

Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021-2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35-49 (compared to 18-34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic.

Out Of Pocket Expenditure Of End Stage Renal Disease Patients For Maintenance Haemodialysis.

Background: End stage renal disease (ESRD) is a major and growing public health problem in Bangladesh. It is linked to higher hospitalization rates, lost productivity, illness, and early death, and it is a major cost on people, health care systems, and societies. Haemodialysis as a life saving measure can save patients but out-of-pocket expenditure of Haemodialysis in Bangladesh is high in comparison to their monthly family income. Therefore, it places a significant financial strain on the families of the disease victims. The aim of this study was to find out the out-of-pocket expenditure of ESRD patients for maintenance haemodialysis. Methods: This descriptive cross sectional study was carried out among 160 ESRD patients getting haemodialysis at Dialysis centre of a selected tertiary government hospital in Dhaka during the period of January to December 2022. Simple random sampling technique was followed. Data were collected by face to face interview with a semi-structured questionnaire and by check list reviewing medical documents. Results: The mean (±SD) age of the respondents was 49.28 ±12.706 years. Majority (60.6%) were male and 39.4% were female. Majority (29.4%) had secondary followed by 21.9% who had higher secondary level of education. About three fourths (71.9%) were from urban, 18.8% from rural, 8.1% from semi-urban areas and 1.3% were slum dwellers. The median of monthly family income was Tk. 20000 (interquartile range 15750). The median (IQR) total direct cost was Tk. 15983 (7203). The mean (±SD) total indirect cost was Tk. 5431.25±1128.17. The mean (±SD) total haemodialysis cost was Tk. 24205.59 ±17164.580. Conclusion: Out-of-pocket expenditure of Haemodialysis in Bangladesh is high in comparison to monthly family income and it poses huge financial burden to the families of the victims of end stage renal disease. The study recommended cost effective measures like subsidized or free of cost treatment of ESRD and free of cost haemodialysis of patients to reduce the financial burden of the families. Bangladesh Armed Forces Med J Vol 56 No (1) June 2023, pp 28-34

Financial strain, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic

ObjectivesThis study aims to examine the change in financial strain, health behaviors, and psychological well-being of family caregivers of older adults during the COVID-19 pandemic and explore the differences in mental health outcomes by gender, race, and relationship status. MethodsUsing the 2020 National Health and Aging Trends Study COVID-19 supplement, our sample included 2026 family caregivers of older adults. Structural equation modeling was conducted. ResultsCaregivers with financial strain showed worse mental health than those with no financial strain. Female or adult children caregivers reported significantly less time walking, more financial strain, and a higher level of negative mental health outcomes compared to male or spouse caregivers; non-White caregivers reported greater positive mental health outcomes compared to White caregivers during the pandemic. DiscussionHealth professionals should consider the financial and mental health impact of COVID-19 among family caregivers when designing and delivering caregiver support programs. InnovationThis study provides nationally representative estimates of several important health behaviors and health outcomes for caregivers of older adults during and after the COVID-19 pandemic, helping to fill the knowledge gap about the characteristics of caregivers whose health and well-being were most affected by the pandemic.

Prevalence and correlates of anxiety and depressive symptoms after Spontaneous Coronary Artery Dissection (SCAD): a cross-sectional study.

Spontaneous coronary artery dissection (SCAD) is recognised as a particularly stressful cause of heart attack. However few studies have documented the prevalence of post-SCAD anxiety and depressive symptoms, or identified patients most at risk. This study documents the prevalence and correlates of post-SCAD anxiety and depressive symptoms. 310 (95% women) SCAD survivors were recruited by the Victor Chang Cardiac Research Institute from a database of 433 SCAD survivors. Participants completed an online questionnaire to gather demographic, medical and psychosocial information, including the Generalised Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Bivariate and multivariate analyses were undertaken to identify the significant demographic, psychosocial and medical correlates of post-SCAD anxiety and depressive symptoms. Time between SCAD and questionnaire completion varied from 2 months to 18 years (mean = 5.5 years; SD = 3.5 years). Rates of anxiety and depressive symptoms were 20.7% (GAD-7 ≥ 10) and 20.9% (PHQ-9 ≥ 10) respectively, and did not vary by time since event. In bivariate analyses, correlates (p < .05) of anxiety and depressive symptoms were absence of a close confidante, financial strain, mental health diagnosis pre-SCAD, comorbid obesity, not being in paid employment (anxiety only), younger age (depression only), and not knowing another SCAD survivor (depression only). Variables retained in multivariate models were absence of a close confidante, financial strain, not being in paid employment, mental health diagnosis pre-SCAD (depression only), and younger age (depression only). This study demonstrated that over one in four SCAD survivors experience either anxiety or depressive symptoms after SCAD, and identified those who may need additional support in their psychological recovery.

Double jeopardy for families of prisoners in Kashmir: A focus on prison visiting experiences

This analysis delves into the challenges faced by women prisoners’ families in Kashmir during the prison visitation process. Drawing on 51 interviews with incarcerated women and their families, this article elucidates the difficulties in establishing and maintaining communication with the prisoners. Despite the pivotal role families play in the visitation process and rehabilitation of prisoners, there is a notable absence of consideration of the challenges from the familial perspective in extant discourse. In the context of Kashmir, the visitation process is intricately complicated, as logistical and political challenges intertwine to add layers of complexity to the procedure. Further, there exists negligible research that considers the perspective of families visiting their loved ones in prison. The article explores the double jeopardy families face due to financial strain, long travel distances, strict prison procedures, lockdowns due to the pandemic and political instability. The analysis illustrates the gendered complexities involved in sustaining connections with women prisoners amid practical and emotional constraints.

Perceived Mental and Physical Health During the Pandemic: The Role of Financial Stress

This study uses the double ABC-X model to explore the link between COVID-19-induced stressors and health outcomes. Analyzing a unique online survey of 2,290 respondents in 2021, our results suggest that the process behind the relationship between financial strain and health is nuanced where financial stress plays an important role. Specifically, the results reveal that changes in income, employment status, and expectations regarding future income significantly affect perceived mental and physical health, with financial stress acting as a significant mediator. Our findings imply that financial counseling could be more effective if the client’s idiosyncratic coping mechanisms such as their financial stress are incorporated in the practice beyond quantitative analyses. Our findings provide directions for future research, as well as implications for financial counselors, healthcare providers, and policymakers.

Abstract SS03-06: Screening for Health Related Social Needs, and now what?

Abstract Screening cancer patients for health related social needs (HRSN) presents benefits and challenges for the patients as well as for the health care facilities. Who gets screened? How often? What are the results used for? What services can be provided? These are some of the issues that institutions face. At the same time patients can feel singled out, afraid to be honest thinking they would receive sub-optimal treatment, and have wrong expectations, among others. In this session we will address the importance of screening for HRSN such as transportation, housing, food security, and financial strain. Strategies to approach the patient and possible ways to address the needs will also be discussed. Citation Format: B. Segarra-Vazquez. Screening for Health Related Social Needs, and now what? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr SS03-06.

The Long-Term Impact of Student Debt on Career Choices and Social Mobility of Low-Income Students

This paper explores the long-term impact of student debt on the career choices and social mobility of low-income students in the United States. Utilizing a mixed-methods research design, the study combines quantitative data from national surveys and secondary sources with qualitative insights from in-depth interviews. The findings reveal that low-income students graduate with significantly higher levels of student debt compared to their higher-income peers, which constrains their career options and compels them to prioritize financial stability over personal interests. This debt burden also impedes their ability to achieve upward social mobility, as it limits their capacity to save, invest, and make significant life purchases such as buying a home. Moreover, the psychological stress associated with substantial debt further exacerbates these challenges, leading to chronic stress and mental health issues that impede career progression and overall quality of life. The intergenerational effects of student debt are also profound, as financial strain on parents and subsequent economic instability experienced by their children perpetuate cycles of poverty. This study underscores the need for comprehensive policy interventions to alleviate the burden of student debt and promote greater economic equity.

Care for the caregiver: an exploration of caregiver burden of children with chronic medical conditions at a tertiary care hospital in Karachi, Pakistan – a mixed-methods study

ObjectivesCaregiver burden often goes unrecognised and can substantially affect caregivers’ physical, psychological and financial well-being, thereby impacting quality of care. This study investigates burden among caregivers of children with chronic...

A Research Review of Financial Distress Prediction

This study claims that two key points must be addressed in order to increase the success rate and robustness of financial distress prediction: firstly, a simplified financial prediction indicator system must be established based on a correct understanding and clearly distinguish about the concept of financial distress. Secondly, we establish a reasonable and plausible financial distress prediction model. It has been established that machine learning models can enhance financial distress prediction models' predictive power to some degree, bu the outcomes of these models vary. This is mostly due to a lack of knowledge about financial distress and a poor choice of indicators for predicting financial distress. This paper makes the case that there are three distinct, dynamic phases of financial distress. The financial strain stage is the initial phase. The financial distress at this stage is reflected in the financial indicators, as there are now some challenges with loan repayment due to the slowdown in the main business's revenue growth rate, the slowdown in operating cash flow, and the drop in the current ratio. The second stage can be called the financial crisis stage. The enterprise's ability to generate income is still declining, along with the quality of revenue and turnover rate. It’s worth noting that gearing ratio, which will be approaching 50% or above at this stage. The third stage of financial distress is distress situation. In this stage, the firm’s balance sheet structure keeps getting worse, and the gearing ratio keeps rising at an unprecedented rate. In the meantime, with growing revenue-cost-expense ratios and negative profits, profitability is still declining. At this stage, at least two of the three cash flows from financing, investing, and operating operations were negative in terms of cash flow.

Expanding Access to Patient Care in Community Pharmacies for Minor Illnesses in Washington State.

As the shortage of primary care providers widens nationwide, access to care utilizing non-physician providers is one strategy to ensure equitable access to care. This study aimed to compare community pharmacist-provided care for minor ailments to care provided at three traditional sites of care: primary care, urgent care, and emergency department, to determine if care provided by pharmacists improved access with comparable quality and reduced financial strain on the healthcare system. Pharmacy data was provided from 46 pharmacies and 175 pharmacists who participated across five pharmacy corporations over a 3-year period (2016-2019). Data for non-pharmacy sites of care was provided by a large health plan, matching episodes of care for conditions seen in the community pharmacy. Cost-of-care analysis was conducted using superiority study design and revisit data analysis was conducted using noninferiority study design. Median cost-of-care across traditional sites of care was $277.78 higher than care provided at the pharmacies, showing superiority. Noninferiority was demonstrated for revisit care when the initial visit was conducted by a pharmacist compared to traditional sites. The authors conclude community pharmacist-provided care for minor ailments improved cost-effective access for patients with comparable quality and reduced financial strains on the healthcare system.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BackgroundCovid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)—a multifaceted construct that measures a person’s socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.MethodsFollowing PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into ‘actual versus perceived’ and ‘static versus fluid’ classes to explore their differential effects on emotional health.ResultsOut of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed ‘expected’ results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.ConclusionsThis review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.