Perceiving financial hardship: mental health outcomes and lifestyles choices

Joan Llobera Canaves, Ruth Martí Lluch, Oana Bulilete, Maria Jesus Serrano Ripoll, David Medina Bombardo, José Ignacio Ramírez Manent, Christian Jean-Mairet I Soler, Catalina Vicens Caldentey

Keywords: Primary care, mental health, healthy lifestyles, financial stress

Background:

Primary care screening for unmet social needs can yield crucial data for patient-centered care. There are several hypotheses (such as behavioral, psychosocial, social support) used to analyze the association between non-communicable chronic diseases and experiencing financial strains (FS).

Research questions:

Objectives:
to analyze and compare the characteristics of a general adult population sample declaring having FS versus those who did not (no-FS);
to examine the relationship between FS and lifestyles, mental health outcomes and social support.

Method:

Cross sectional study from DESVELA cohort. Setting: primary health care (4 centers) . Population: general population between 35 to 65 years with health coverage in the Balearic Islands. Measurements: sociodemographic, educational level, monthly income (€), FS, material deprivation, lifestyles [tobacco, adherence to Mediterranean diet (PREDIMED), physical activity (IPAQ)], self-rated perceived health (SRPH), BMI, at least 1 comorbidity, social support (Duke-11), anxiety (GAD-7), depression (PHQ-9) and quality of sleep (PSQI). Statistical analysis: descriptive, chi-square, T-test.

Results:

364 participants; mean age 48.5±8.1; men 50.4%. Declaring FS: 25.1% (91/362) vs no-FS 74.9% (271/362); secondary educational level: 26.3% FS vs 73.7% no-FS, p0.00; income 1.001-2000€: 50.6% FS vs 49.4% no-FS, p0.00; material deprivation: FS 89.2% vs 10.8%, p0.00; regular SRPH 44.6% FS vs 55.4% no-FS, p0.00; active smokers, 35.2% vs 64.8% no-FS, p0.03; high adherence to Mediterranean diet 16.0% FS vs 84.0% no-FS, p0.01; high level physical activity FS 23.6% vs 76.4%, p0.80; BMI: mean difference 1.6±0.7, p0.02; having 1 comorbidity 28.7% vs 71.3%, p0.02; perceived social support: mean difference 4.9±1.0, p0.00; severe anxiety levels FS 50.0% vs 50.0%, p0.00; moderately-severe depression 66.7% FS vs 33.3%, p0.00; good quality of sleep 11.4FS vs 88.6% no-FS, p0.00.

Conclusions:

There is a clear association between perceiving FS and psychological well-being, as well as certain lifestyle choices, such as smoking or following the Mediterranean diet.

Points for discussion:

Social determinants of health

Mental health outcomes

Health promotion