Levels Of Financial Hardship Research Articles

Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study.

Financial hardship (FH) is a complex issue in cancer care, affecting material conditions, well-being, and coping behaviors. This study aimed to longitudinally examine FH, anxiety, depressive symptoms, and their associations while incorporating social determinants of health and health care cost covariates in a sample of patients diagnosed with cancer. This prospective, longitudinal cohort study analyzed data from 2,305 participants from the Northwestern University Improving the Management of Symptoms during and following Cancer Treatment trial. Outcomes assessed at baseline and at 3, 6, 9, and 12 months postbaseline included depressive symptoms, anxiety, and FH. Analysis involved random intercept cross-lagged panel models to explore between- and within-person effects, incorporating factors such as age, sex, insurance status, neighborhood area deprivation, health care charges, out-of-pocket costs, and health literacy. The cohort had a mean age of 60.7 (standard deviation [SD] = 12.7) years and was mostly female (64.9%) and White (86.2%). Correlations were found between FH and depressive symptoms (r = 0.310) and anxiety (r = 0.289). A predictive relationship was observed between FH and depressive symptoms, with baseline and 6-month depressive symptom levels predicting later FH (baseline β = .079, P = .070; 6-month β = .072, P = .081) and 9-month FH significantly predicting 12-month depressive symptoms (β = .083, P = .025), even after accounting for health care charges and out-of-pocket costs. Baseline and 9-month anxiety showed a predictive relationship with subsequent FH (baseline β = .097, P = .023; 9-month β = .071, P = .068). FH emerged as a prominent issue, with nearly half of participants experiencing some level of FH. Depressive symptoms and anxiety were related to FH. These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact.

Affordability of household water services across the United States

Households that cannot be able to afford their water bills may lose access to drinking water and wastewater services. This study seeks to quantify how many households may struggle to pay for water services across 787 of the largest drinking water providers located within each state of the United States. Household water affordability is the ability for a household to pay for basic water services without undue hardship. Here, we select 6,000 gallons per month (22.7 m3/mo) as sufficient to meet basic needs and define undue hardship as spending more than 4.6% of household income (one day of labor each month) to pay for water services. Monthly bills are combined with census income data based on service area boundaries to determine how many households are spending more than 4.6% of their income on water services. We find that basic water services are unaffordable for 17% of the households (28.3 million persons) in this study. The median, or representative community, has one in seven households spending more than 4.6% of their income paying for water services. We developed a data visualization tool to allow users to explore how affordability challenges change across different volumes of water usage and levels of financial hardship (https://nicholasinstitute.duke.edu/water-affordability/water-affordability-united-states). This research shows that household water unaffordability is not a localized problem but rather is a challenge experienced by households in communities across the nation.

Financial Hardship and the Pain of Social Disconnection During the COVID-19 Pandemic in the United States

Considerable scholarly attention has been directed at increasing social isolation and loneliness during the COVID-19 pandemic, and their adverse impact on later life psychological well-being. Notably absent is the focus on financial hardship in the context of overlapping unprecedented economic and public health crisis. It is unclear whether loneliness continues to differ across different levels of financial hardship even amidst immense uncertainty, social isolation, and anxiety induced by the pandemic. Based on our nationwide web-based survey of adults aged 50 years and older (n=1861), we used ordinal logistic regression to examine the influence of financial hardship on loneliness and assessed the role of socioeconomic status (SES), emotional support, and health status in contributing to such influence. We found significantly higher odds of greater loneliness (β = .28, p < .001) among individuals who reported experiencing greater financial hardship. Among two measures of SES, only household income contributed substantially to the influence of financial hardship on loneliness. We documented significantly lower emotional support and greater health disadvantage among individuals experiencing greater financial hardship. Consideration of emotional support and health status explained the remaining influence of financial hardship, due to their association with both financial hardship and loneliness. Despite a sense of shared vulnerability and social isolation across the general population, our findings suggest that SES inequalities in later life loneliness are maintained even in the midst of the pandemic.

Psychosocial Burden of Childhood Sickle Cell Disease on Caregivers in Kenya.

To characterize the types and magnitude of psychosocial burden present in caregivers who have a child with sickle cell disease (SCD) in Kenya and to identify predictors of caregiver psychosocial burden, including disease severity and financial hardship. Primary caregivers (N = 103) of children aged 1-10 years diagnosed with SCD completed surveys assessing multiple domains of caregiver quality of life (QOL), adjustment to child illness, mental health, and financial hardship. Descriptive statistics characterize psychosocial burden, and linear models assess associations. On indicators of QOL, caregivers report multiple difficulties across most domains, including daily activities and physical, social, cognitive, and emotional well-being. Daily activities emerged as most burdensome. On indicators of parental adjustment to chronic illness, guilt and worry emerged as the greatest concern, followed by long-term uncertainty and unresolved sorrow and anger; relative to these, they reported higher levels of emotional resources. Financial hardship was high, as caregivers reported moderate to major financial losses due to the time spent caring for their child. General linear model analyses revealed that level of financial hardship was a significant predictor of all negative psychosocial outcomes. Results document that Kenyan caregivers of children with SCD experience difficulties across multiple domains of functioning and that financial difficulties are likely associated with psychosocial burden. Results can guide intervention development for caregivers of children with SCD in low-resource, global contexts.

Measuring the financial stresses of childhood cancer and survivorship.

96 G. Dahlman (Children’s Cause for Cancer Advocacy) K. Gallagher (Patient Advocate Foundation) Background: Families battling childhood cancer can face extraordinary financial challenges in access to care. Insurance barriers, coverage limitations and denials, high copays and extraordinary out-of-pocket costs threaten families’ ability to ensure supports necessary for successful treatment. Methods: From April 18, 2017 to May 31, 2017, CCCAA and the Patient Advocate Foundation (PAF) conducted a survey of pediatric cancer patients, caregivers and survivors through an online survey tool. Questions identified demographic and geographic attributes, type of insurance coverage, incidence and reason for insurance denials, degree and source of financial stress, out-of-pocket costs, and survivorship measurements. The survey was sent to unbiased cohort of patients and students from CCCA and PAF. Results: A total of 343 respondents completed the online survey: 143 or 42% were parents or caregivers. Another 143 or 42% were childhood cancer survivors. Among caregivers, 47 or 33% reported insurance denials for treatment, and 63 or 44% reported some level of financial hardship. Among the 44% of respondents reporting financial hardships, 25 or 39% had annual out-of-pocket costs exceeding $5,000. Beyond medical expenses, respondents identified employment and transportation costs, with 87% reporting compromised work schedules and over half reporting trouble getting their child to and from appointments. For survivors, 38 or 27% reported not receiving follow-up care at a late effects clinic, with 34 or 24% reporting that their cancer care impacted their ability to pursue higher education and 43 or 30% reporting that the cost of their medical care impacted their career course or job choice. Conclusions: This joint CCCA/PAF survey identified significant financial challenges, both medical and non-medical, for patients, caregivers and survivors of childhood cancer. This survey along with other data sources suggest that current data and research are insufficient to guide solutions to the care barriers that parents and survivors report.

Financial hardship and drug use among men who have sex with men

BackgroundLittle is known about the role of financial hardship as it relates to drug use, especially among men who have sex with men (MSM). As such, this study aimed to investigate potential associations between financial hardship status and drug use among MSM.MethodsWe conducted a cross-sectional survey of 580 MSM in Paris recruited using a popular geosocial-networking smartphone application (GSN apps). Descriptive analyses and multivariate analyses were performed. A modified Poisson model was used to assess associations between financial hardship status and use of drugs (any drugs, tobacco, alcohol, marijuana, inhalant nitrites, and club drugs).ResultsIn our sample, 45.5% reported that it was somewhat, very, or extremely difficult to meet monthly payments of bills (high financial hardship). In multivariate analyses, a high level of financial hardship was significantly associated with an increased likelihood of reporting use of any substance use (adjusted risk ratio [aRR] = 1.15; 95% CI = 1.05–1.27), as well as use of tobacco (aRR = 1.45; 95% CI = 1.19–1.78), marijuana (aRR = 1.48; 95% CI =1.03–2.13), and inhalant nitrites (aRR = 1.24; 95% CI = 1.03–1.50).ConclusionsFinancial hardship was associated with drug use among MSM, suggesting the need for interventions to reduce the burden of financial hardship in this population.

Work life and mental well-being: single and coupled employed mothers in Southern Europe and Scandinavia

Many European mothers, single and coupled, combine work outside the home and family life. The effects of this on their mental well-being may vary depending on the level of support available from the State's welfare system, since welfare may buffer working mothers from some of the stress that can arise from trying to manage significant responsibilities on the job and at home. Welfare may be especially important for single working mothers, for whom the burden of multiple roles may be even heavier. The present study assessed levels and predictors of well-being of single and coupled employed mothers in Greece, Portugal and Spain, where welfare support is relatively limited. Results were compared to a parallel study with data from Denmark, Norway and Sweden, where welfare support is relatively comprehensive. Coupled mothers in Scandinavia had significantly lower financial hardship, longer education, higher life satisfaction, more enriching jobs, practical support, financial support and social participation than coupled mothers in the Southern European sample. On the other hand, the Scandinavian coupled mothers had higher levels of work family conflict than coupled mothers in Southern Europe. Single mothers in Scandinavia, compared to single mothers in Southern Europe, had significantly longer education, higher life satisfaction and positive affect, more enriching jobs, confidant support, practical support, financial support and social participation. Level of job stress was the same for all mother groups. All groups differed significantly from each other in level of financial hardship, with Scandinavian coupled mothers being best off, followed by Scandinavian single mothers, Southern European coupled mothers, and Southern European single mothers. The regional differences suggest that single motherhood per se need not be a risk factor for poorer well-being, and that welfare policies may have a protective effect for the mental well-being of single mothers.

Equity Financing and Investment in Technological Flexibility

We study the interactions between debt/equity financing and strategic (duopoly) technological flexibility choices of firms facing costly bankruptcy. We show that a firm's level of debt financing or financial hardship is an important determinant of the level and type of investment it chooses, either a less costly inflexible technology or a more expensive flexible technology. The level of financial hardship has a non-monotonic effect: as the level of equity financing increases, the choice of technology may switch and the level of investment may follow a bell-shaped or U-shaped path, depending on the differential investment cost, the bankruptcy cost, and whether or not the less costly technology is the best option for an all equity firm. We also show that the level of external financing (debt) may be used strategically in a non-cooperative tacitly collusive way to increase the expected profits of both firms, a firm may use debt as a commitment device to increase its own expected profit, and higher bankruptcy costs may be beneficial to both firms.