A heavy burden of family financial stress from COVID on mental health of adolescents

In a recent study published in The Lancet Regional Health – Americas, journal researchers examined the impact of the financial stress associated with the coronavirus disease 2019 (COVID-19) pandemic on the mental health of adolescents in the United States (U.S.).

Study: COVID-19-related financial strain and adolescent mental health. Image Credit: Astafjeva / Shutterstock

Background

Apart from the unprecedented increase in mortalities, the drastic social distancing and lockdown measures enforced by governments worldwide also resulted in a global economic crisis. Recent studies have shown distinct associations between financial stress due to income loss during the pandemic and depression and other mental health issues in adults.

Children and youths from families facing financial stress and socioeconomic constraints experience significant mental health problems, including behavioral and developmental impairments. As they age, they are also more likely to develop social dysfunction and health problems. Additionally, other drastic pandemic-related changes such as isolation, closure of schools and other areas where youths interact socially, and uncertainty about the future have also been associated with deteriorating mental health in youths.

However, the specific impacts of pandemic-related financial stress, changes in familial interactions, and factors such as the mental health of the parents, conflict within the family, and quality of parenting on adolescents’ mental health have not been comprehensively investigated.

About the study

In the present study, the researchers used data from the longitudinal Adolescent Brain Cognitive Development (ABCD) study, which had been collecting information from adolescent participants aged nine and ten across 21 sites in the U.S. through online surveys before the onset of the COVID-19 pandemic. The ABCD study also administered targeted surveys between May 2020 and 2021 to understand the impact of the COVID-19 pandemic on adolescents.

Two exposure measures were used to analyze the impact of the pandemic-associated financial stress — one was the objective strain characterized by parent-reported pandemic-related wage loss in the household, and the other was the subjective strain based on the financial stress reported by the adolescents. The objective strain was measured based on a binary (yes or no) answer to whether a household member had suffered wage loss since the onset of the pandemic. The subjective strain was measured based on how often the adolescent had worried about the family not having enough money for necessities in the past week. The answers were on a scale of zero to four, with zero being “never” and four being “very frequently.”

The outcome measures were assessed on an eight-item sadness scale which analyzed feelings of loneliness, sadness, inability to have fun, and despair on a scale of one to five, with one being “never” to five denoting “always.” The ABCD study surveys also contained questions that assessed substance use, such as alcohol, marijuana, and other drug use among the participants.

Statistical analyses included univariate comparisons between participants from families that suffered wage loss and those that retained their wages during the pandemic. Furthermore, longitudinal mediation analyses were conducted to understand the mechanisms behind financial stress’s impact on adolescents’ mental health.

Results

The results reported a high prevalence (greater than 70%) of financial stress due to wage loss during the COVID-19 pandemic, especially in low-income families. Furthermore, wage loss and resultant financial stress were associated with depressive symptoms among the participants.

The association between financial stress and depression remained robust despite accounting for other environmental confounders. Additionally, the factors that mediated the association between wage loss and depression in youths were found at family and individual levels, such as family conflict and financial stress. These results indicated that socioeconomic disadvantages could affect adolescents’ mental health through changes in parenting and the home environment and the stress experienced by adolescents about their socioeconomic status.

The findings of the study have two significant clinical implications. The first one highlighted the impact of social determinants on mental health. While the COVID-19 pandemic might have made this association more salient, it also indicates the broader association between financial status and mental health in youths. The second clinical implication suggested two intervention targets for mitigating the mental health burden due to the pandemic — the subjective financial stress and family conflict experienced by the youth.

Conclusions

Overall, the results suggested that the economic crisis that resulted from the worldwide response to the COVID-19 pandemic had a significant impact on adolescents’ mental health. In families that suffered wage loss, familial conflicts and financial stress in youths were associated with depressive symptoms. The study discussed intervention strategies to mitigate the mental health burden in youths during periods of economic stress.