10-00 Avoiding the Hazards of Financial Stress

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Kim Burnham, PhD
Editor, The Burnham Review

    Financial stress can cause a number of dysfunctions. Stress can negatively affect us on a cellular level, an overall health level as well as affect our relationships with our family and friends. Stress can affect our work performance and more.
    Disease and dysfunct6ion can also contribute to stress and concerns over money.

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References for Financial Stress Effects

Pustaver, M. R. (1994). "Mechanical low back pain: etiology and conservative management." J Manipulative Physiol Ther 17(6): 376-84.

    OBJECTIVE: To review literature pertaining to low back pain (including lumbar disk herniation) and its treatment by manipulative therapy and rehabilitative exercises. DATA SOURCES: A Medline literature search was performed. English and foreign language materials were reviewed. Key words included the following: manipulation, manipulative therapy, lumbar intervertebral disk herniation, lower back pain. STUDY SELECTION: The studies detailed the neurologic and biomechanical aspects of manipulative therapy, as well as the efficacy of manipulative and rehabilitative management of mechanical low back pain. Also included were studies detailing the etiology of mechanical low back pain. DATA SYNTHESIS: Recent studies have indicated there are certain activities that commonly precipitate lower back injuries. Several methods of treatment for these injuries are discussed. The review indicated the most effective form of treatment is manipulative therapy. The neurologic and biomechanical aspects of manipulation are discussed. CONCLUSION: Low back pain is a common cause of physical, emotional and financial distress. This paper concluded that manipulative therapy is an efficacious as well as cost-effective method of treatment in cases of mechanical low back pain.

Morra, D. J., G. Regehr, et al. (2008). "Anticipated debt and financial stress in medical students." Med Teach 30(3): 313-5.

    BACKGROUND: While medical student debt is increasing, the effect of debt on student well-being and performance remains unclear. AIM: As a part of a larger study examining medical student views of their future profession, data were collected to examine the role that current and anticipated debt has in predicting stress among medical students. METHOD: A survey was administered to medical students in all four years at the University of Toronto. Of the 804 potential respondents across the four years of training, 549 surveys had sufficient data for inclusion in this analysis, for a response rate of 68%. Through multiple regression analysis, we evaluated the correlation between current and anticipated debt and financial stress. RESULTS: Although perceived financial stress correlates with both current and anticipated debt levels, anticipated debt was able to account for an additional 11.5% of variance in reported stress when compared to current debt levels alone. CONCLUSIONS: This study demonstrates a relationship between perceived financial stress and debt levels, and suggests that anticipated debt levels might be a more robust metric to capture financial burden, as it standardizes for year of training and captures future financial liabilities (future tuition and other future expenses).

Hanratty, B., P. Holland, et al. (2007). "Financial stress and strain associated with terminal cancer--a review of the evidence." Palliat Med 21(7): 595-607.

    Financial circumstances are a significant influence on the quality of life for older people and may be important to health and wellbeing at the end of life. The aim of this study is to review the evidence for the existence and consequences of financial stress and strain at the end of life for people dying with cancer. We conducted a systematic search of four electronic databases for studies, providing data on illness-related financial burden (stress), or perception of financial hardship (strain), from patients with terminal cancer or their caregivers. Twenty-four papers were identified from 21 studies published in English between 1980 and 2006, the majority (14) of cross-sectional design. Financial stress was reported in all 13 studies from the USA (median 33%, range 10-66%), but only four sought measures of financial strain. In the USA, specific social consequences, such as moving house or change in employment to cope with caregiving, were reported in four of these studies; one of these also noted changes in treatment choices and avoidance of care for other family members. In studies from outside the USA, there is a dearth of data on financial stresses and the consequences of this for the household, despite widespread reporting of financial strain. To fill a gap in our understanding and improve holistic palliative care, researchers need to ask the questions about the consequences of financial stresses and strain for the health and wellbeing of the household.

Siahpush, M. and J. B. Carlin (2006). "Financial stress, smoking cessation and relapse: results from a prospective study of an Australian national sample." Addiction 101(1): 121-7.

    AIMS: Our aim was to examine the association between financial stress and subsequent smoking cessation among smokers, and relapse among ex-smokers. DESIGN AND PARTICIPANTS: Data came from the first two waves of the Household Income and Labour Dynamics in Australia (HILDA) survey. The size of the subsample of smokers was 2076, and that of ex-smokers was 2717. Data collection was based on face-to-face interviews. MEASUREMENT: Eight questionnaire items (e.g. difficulty paying electricity, gas or telephone bills and going without meals due to shortage of money) were used to construct a nine-point financial stress index. FINDINGS: Smokers with more financial stress were less likely to quit, with the odds of quitting reducing by 13% (95% CI: 4-21%; P = 0.008) per unit of the financial stress index. Ex-smokers with more financial stress were more likely to relapse (P < 0.001). CONCLUSIONS: Special programmes may have to be implemented to counter the potentially adverse effects of tobacco price increases on smokers who have financial stress and fail to quit smoking.

Guicciardi, M. E. and G. J. Gores (2008). "Cell stress gives a red light to the mitochondrial cell death pathway." Sci Signal 1(7): pe9.

    Although the ultimate outcome of prolonged exposure of cells to stress is often death, the early response appears to be the activation of survival pathways that are likely to give the cell an opportunity to repair low-level damage. How these stress-initiated survival pathways influence B cell lymphoma/leukemia 2 (Bcl-2) proteins, the core cell death machinery, has remained unclear; however, two papers now provide insight into stress-mediated survival mechanisms. The liver is unusually resistant to p53-mediated apoptosis. It appears that p53-mediated induction of the gene that encodes insulin-like growth factor-binding protein-1 (IGFBP1) attenuates the cell death response in hepatocytes by preventing the formation of a complex between p53 and the proapoptotic protein BAK. This is especially interesting as IGFBP1 is not a member of the Bcl-2 family, yet it inhibited BAK. In three unrelated cell lines, another regulatory interaction that influences cell survival occurs at the mitochondria. In this case, protein phosphatase 1gamma (PP1gamma) regulated the phosphorylation status of the Bcl-2/Bcl-X(L)-associated death promoter (BAD). The prefoldin family member URI is normally phosphorylated by S6 kinase 1, which liberates PP1gamma from a URI-PP1gamma complex. However, the withdrawal of growth factors or nutrients stabilizes this complex, which renders PP1gamma inactive. The net response of this stress stimulus is an increased abundance of phosphorylated BAD, which raises the threshold required to trigger cell death. These two studies have identified new players and mechanisms that integrate stress responses and cell death.

Fry, M. J., D. W. Cartwright, et al. (2003). "Preterm birth a long distance from home and its significant social and financial stress." Aust N Z J Obstet Gynaecol 43(4): 317-21.

    The present paper reports a retrospective cohort of preterm infants admitted to our hospital who delivered outside the normal geographical catchment area of the mother's local level three neonatal nursery. Nineteen mothers had 21 preterm infants (23.1-34.9 weeks, 500-2330 g born) where 14 infants required ventilation (median 57 h, range 3-428). Eighteen survivors had a median length of stay of 41 days (range 3-91). Twelve of 19 mothers were interviewed: all described isolation, loneliness, poor social support and significant financial hardship related to getting their infants back to a local hospital or home. To avoid these problems, we recommend confining travel to within a short distance from home or local maternity unit after 22 weeks.

Gyamfi, P., J. Brooks-Gunn, et al. (2001). "Associations between employment and financial and parental stress in low-income single black mothers." Women Health 32(1-2): 119-35.

    Using a sample of 188 low-income single black mothers (93 employed and 95 nonemployed), this study investigated financial strain, maternal depressive affect, and parenting stress among former welfare recipients who are now working, and current welfare recipients who are not employed. The findings suggested that being employed did not reduce financial strain, as the two groups reported similar levels of strain. However, regression analyses indicated that not being employed was associated with reporting higher levels of stress. Parenting stress was also associated with attaining less education, having boys, reporting more financial strain and depressive affect. Correlates of maternal depressive affect were mother's education and financial strain. Interaction effects were found for employment by financial strain, indicating that higher levels of depressive affect were related to more financial strain among nonemployed mothers. The findings suggest that although employment is associated with better mental health for poor mothers, entry into the workforce is associated with stronger links between financial strain, parenting stress and depressive affect for mothers leaving welfare.

Wrosch, C., J. Heckhausen, et al. (2000). "Primary and secondary control strategies for managing health and financial stress across adulthood." Psychol Aging 15(3): 387-99.

    The study examined the relation among three types of control strategies (persistence, positive reappraisals, lowering aspirations) and subjective well-being across adulthood (N = 3,490). Specifically, the authors investigated whether age-adapted endorsement of control strategies is conducive to subjective well-being if individuals experience health or financial stress. The results reveal an overall enhanced reliance on control strategies in older as compared with younger adults. In addition, persistence showed a stronger positive relation to subjective well-being in young adulthood as compared with old age. In midlife and old age, positive reappraisals had a stronger positive relation to subjective well-being than persistence. Lowering aspirations was negatively related to subjective well-being, independent of age. Age differences in the relation of control strategies to subjective well-being were particularly salient in individuals who faced either health or financial stress.

Saunders, P. (1998). "Poverty and health: exploring the links between financial stress and emotional stress in Australia." Aust N Z J Public Health 22(1): 11-6.

The links between poverty and health have been investigated in a number of independent studies, as well as by the Poverty Commission in the 1970s and, more recently, the National Health Strategy. However, much of the poverty research suffers from the lack of detailed information on health status, while the work conducted in the public health sphere has used rather rudimentary poverty measures. The research reported here attempts to overcome these limitations by using unit record data from two national household surveys conducted by the Australian Bureau of Statistics in 1990. Together, these two data sets contain an enormous amount of detailed information on household incomes and the health status of individuals. Data from the two surveys are combined in a way which allows the links between poverty and health to be explored in greater detail than has hitherto been possible in Australia. Analysis of the integrated data set focuses on the links between poverty and several measures of stress-related poor health. The results from a variety of different methods point to the existence of significant differences between the reported incidence of stress of those whose incomes place them either side of a poverty threshold. The size of the statistical association between poverty and stress is of both numerical and statistical significance, although further work, preferably using longitudinal data, is needed on the important issues of causation.

Peirce, R. S., M. R. Frone, et al. (1996). "Financial stress, social support, and alcohol involvement: a longitudinal test of the buffering hypothesis in a general population survey." Health Psychol 15(1): 38-47.

    This study examined whether specific facets of social support (tangible assistance, appraisal, and belonging) moderate the relationship between a specific type of stress (financial stress) and alcohol involvement (drinking to cope, heavy drinking, and alcohol problems). Data were derived from a community sample stratified by education and race. Respondents (N = 1,040) were interviewed in 1986 and 1989 and had drunk alcohol during the year preceding both interviews. Results supported the buffering influence of tangible support on the financial stress-alcohol involvement relationship. In contrast, neither appraisal nor belonging support consistently revealed a buffering pattern. These findings indicate the importance of taking into account specific components of social support when examining the relationship between specific sources of life stress and alcohol involvement.

Krueger, P. M. and V. W. Chang (2008). "Being poor and coping with stress: health behaviors and the risk of death." Am J Public Health 98(5): 889-96.

    OBJECTIVES: Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. METHODS: Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n = 40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. RESULTS: High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. CONCLUSIONS: The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.

Logue, B. J. (1991). "Women at risk: predictors of financial stress for retired women workers." Gerontologist 31(5): 657-65.

Research on women workers tends to neglect older workers, and much of the literature on retirement has focused on male experiences. This analysis uses data from the 1982 New Beneficiary Survey to examine financial stress in retirement for a sample of highly committed women workers. Separate regressions are done for married and unmarried women, and particular attention is paid to the impact of gender-segregated jobs. Results suggest the relative importance of work history and sociodemographic variables as predictors of financial stress in early retirement.

Dupont, A., A. H. Bernsen, et al. (1978). "[Temporal, financial and mental stress involved when a severely mentally retarded child between 6 and 14 years of age lives at home]." Ugeskr Laeger 140(45): 2815-20.