Perceived financial hardship linked to depression, especially in the wealthy

New research published in Epidemiology and Psychiatric Sciences demonstrates that how people feel about their financial situation significantly affects their risk of developing or worsening depression. Surprisingly, this effect is stronger among high-income households.

It is well-established that depression is influenced by social factors such as income, education, and relationships. Previous studies have found that financial hardship is a strong predictor of depression, sometimes even stronger than unemployment or education. However, most research focused on actual income or used simple measures of depression, leaving out the role of how people subjectively perceive their financial struggles. The COVID-19 pandemic heightened both economic difficulties and mental health challenges globally, providing a critical opportunity to study this relationship more closely.

Led by Gustave Maffre Maviel, the French EpiCov study tracked a nationally representative sample of 14,236 individuals aged 15 and older from 2020 to 2022 through four survey waves. Participants reported their depressive symptoms using the widely accepted PHQ-9 scale, which classifies symptoms into “no or mild,” “moderate,” and “major” categories. The study also asked participants about their perceived financial hardship, grouped into no hardship, moderate hardship, and severe hardship categories.

Using advanced statistical models, the researchers tracked how depression levels changed over time for each participant. This approach is more nuanced than traditional binary measures (depressed vs. not depressed) because it follows symptom progression or improvement in distinct stages.

The results revealed that individuals who felt moderate financial hardship were about 1.4 times more likely to move from having no or mild symptoms to moderate or major symptoms. Those who reported severe hardship were more than twice as likely to develop or worsen their depressive symptoms.

Importantly, these associations were strongest among high-income groups, challenging the typical view that financial strain mainly impacts the mental health of low-income people. For wealthier individuals, sudden or unexpected financial difficulties, such as job loss or debt, may trigger a sharper mental health decline compared to those accustomed to ongoing financial challenges.

Perceived financial hardship was also not linked to an improvement in depressive symptoms, suggesting that feeling financially strained may have a lasting negative impact.

Maviel and colleagues suggested a possible explanation for the findings: “financial hardship in high-income households is linked to short-term economic negative events, such as job loss or debt, which could be associated with depressive symptoms. On the other hand, financial hardship is more structural in low-income households; thus, its link with changes in mental health could be less likely.”

“Secondly, it may be that depression levels among people who experience high levels of financial hardship are so high that they are unlikely to increase further,” the authors added.

The study accounted for many confounding factors, including age, sex, education, health history, and employment status. However, the study has limitations. For instance, notable participant dropout over time may have underestimated the true strength of the association, as individuals with depression are often more likely to leave a study.

The study, “Experience of financial hardship and depression: a longitudinal population-based multi-state analysis,” was authored by Gustave Maffre Maviel, Alexandra Rouquette, Camille Davisse-Paturet, Arthur Descarpentry, Arnaud Sapin, Nathalie Bajos, Jean-Baptiste Hazo, Anne Pastorello, Josiane Warszawski, M. Melchior, Cecile Vuillermoz, and the EpiCov Study Group.