Caught in a downward spiral? The bidirectional relationship between financial insecurity and mental health: a NESDA study
A. N. Nelissen, N. J. de Bles, W. A. van Eeden, S. E. Bauduin, W. J. Maas, B. W. Penninx, E. J. GiltayIntroduction
The relationship between financial insecurity and mental health is complex and likely bidirectional. Most studies on this topic have predominately examined these effects unidirectional and cross-sectionally.
Objectives
Our study aims to investigate the longitudinal bidirectional relationship between depression and/or anxiety and financial insecurity, offering a deeper insight into the temporal relationships.
Methods
Financial insecurity was assessed using two items on food insecurity and financial strain, rated on 3- and 4-point ordinal scales, respectively, measured at up to 4 timepoints during a 13-year follow-up of the NESDA cohort. Clinical diagnoses of depression and anxiety using the CIDI interview and symptom severity through the IDS and BAI scales were also assessed at each wave. Lagged multilevel models examined whether financial insecurity at baseline predicted changes in depression and anxiety and vice versa. All models adjusted for educational level, household contribute, age, and gender, as well as for the prior value of the outcome variable.
Results
The 2,567 individuals with complete data were aged mean 42.4 years (SD 13.2), and 34.6% were female. Both higher food insecurity and financial strain significantly predicted increased odds of onset of depressive disorders (OR = 2.12, 95% CI: 1.43–3.15 and OR = 1.92, 95% CI: 1.51–2.45) (Figure 1), as well as greater depressive symptom severity at 13-year follow-up (p for trend < .001 and p = .001, respectively) (Figure 2). Associations with anxiety disorders and symptom severity at follow-up were also significant (Figure 1 & 2). Conversely, baseline depression and anxiety disorders were associated with increased financial insecurity at subsequent follow-up waves (Figure 3). Depressive symptoms were also a significant predictor of financial insecurity, whereas anxiety symptoms were not (Figure 3).
Image 1: Long description.