Table 4.

Summary of longitudinal associations between financial strain and health-relevant outcomes among U.S. adults

Study, sample & setting	Financial strain measure								Associations between financial strain with health-relevant outcomes	Socioeconomic adjustment	Health adjustment
Study, sample & setting	# of items	Lacking basic needs	Difficulty making ends meet	Coping Strategies	Financial satisfaction	Financial stress/worry	Anticipating strain	Lack of money for wants		Socioeconomic adjustment	Health adjustment
A myocardial infarction registry (n=2693)	1		X						Not associated with angina-specific quality of life (Arnold et al., 2014)	X	X
Adults 21–82 near Deepwater Horizon Oil Spill in Florida & Alabama (n=175)	2 6	X		X					More drug abuse, mood disturbance and depressive symptoms at a two years but not associated with problematic alcohol use (Buckingham-Howes et al., 2019)
Heart disease patients hospitalized at Vanderbilt (n=2042)	1		X						Not associated with incomplete follow-up at 2–3 days, 30 days or 90 days after hospital discharge, or incomplete follow up calls (Leak et al., 2015)		X
Adults with serious mental illness admitted to two outpatient mental health centers (n=271)	3	X							Higher odds of using cocaine or illicit sedatives and more internal stigma, depressive symptoms, interpersonal problems and emotional lability, but not associated with use of alcohol, cannabis or heroin or risk of self-harm, psychosis or other schizophrenia symptoms (Spivak et al., 2019)	X	X
African American female physical activity trial participants 40–65 with diabetes in Chicago (n=288)	9	X							Not associated with study retention (Buchholz et al., 2016)
African-American and Puerto Rican adults who had attended East Harlem schools 21 years earlier (n=674)	8	X	X			X			More mental health services utilization (Brook et al., 2014)	X	X
Adults 75+ in Texas, New Mexico, Colorado, Arizona, and California (n=1964)	4	X	X						Faster 12-year cognitive decline (Sachs-Ericsson et al., 2009)	X	X
Americans Changing Lives Study, 60+	3		X		X				Not associated with physical health by year 8 (n=1653) (Oates, 2016) but increased three-year financial strain predicted worsening depressive symptoms life satisfaction (n=1221) (Brown & Barrett, 2011)	X	X
Black males 16–29 who have sex with men in South Chicago (n=545)	2	X		X					Higher odds of criminal justice involvement over 18 months (Hotton et al., 2020)		X
Black, Hispanic or multi-racial men who have sex with men 16–24 near Los Angeles (n=448)	1	X							Not associated with risk of sexually transmitted infection(s) (Kipke et al., 2020)
Caregivers co-residing with persons with dementia (n=184)	2		X						More caregiving role overload (Liu et al., 2019)	X
Caregivers of a child with cancer at a large Southern medical center (n=163)	2	X	X						Less social support, more child problems, sibling problems, family problems, and parent stress reactions, and a lack of family coping ability over two years (Karlson et al., 2013)
Caregivers of children ≤6 years Philadelphia (n=373)	4	X	X						Not associated with self-rated health or depressive symptoms, accounting for food-, energy-, and housing-insecurity (Weida et al., 2020)	X
Chicago Earned Income Tax Credit Periodic Payment Pilot (n=507)	8		X		X	X	X	X	More depressive symptoms (Andrade et al., 2017)	X
Adults 18–65 interested in smoking cessation in Vermont and Texas (n=102)	8	X	X					X	More motivated to smoke because of affect and likely to expect negative moods after quitting but not associated with barriers to quitting (Robles et al., 2017)	X	X
Coronary Artery Risk Development in Young Adults study, randomly sampled adults 18–30 in Birmingham, Chicago, Minneapolis, & Oakland	1	X							Less verbal memory, slower processing speed and poorer executive function over time (n=3383) (Zeki Al Hazzouri et al., 2017) and higher fasting glucose at the 13-year follow up(n=2591) (Puterman et al., 2012)	X	X
Diabetes patients 30–75 in Northern California (n=7,773)	1	X							Not associated with filling a new prescription or refilling the prescription but associated with delays in refilling (Lyles et al., 2016)	X	X
Employees of a manufacturing company (n=80) and Amazon Mechanical Turk respondents (n=331)	3		X						More musculoskeletal symptom s (Odle-Dusseau et al., 2018)
Family and Community Health Study, African American families with 5th grade child in Iowa or Georgia in 1997–1998	4	X							Not associated with allostatic load scores through 2008 (n=327) (Berg et al., 2017)	X
	12	X		X					Higher hemoglobin A1C levels after 11-years(n=312) (Cutrona et al., 2015)		X
	4	X							Not associated with epigenetic scores for biologic aging over four years (n=386) (Simons et al., 2019)
	4	X							More epigenetic methylation over eight years (n=100) (Simons et al., 2016)	X	X
Fragile Families and Child Wellbeing Study, mothers of children born in 20 large US cities in 1998–2000 with an oversampling of unmarried mothers	1 2	X		X					Higher likelihood of parents breaking up before the child was 5 among Latina mothers (n= 1314) (Cabrera et al., 2019)
	7	X		X					Higher odds of depression within five years (n=3675) (Manuel et al., 2012)	X	X
	8	X		X					More substance use/intimate partner violence/HIV risk at year five (n = 4,898) (Caiola et al., 2021) and, among parents living together at year one, more parental relationship distress at year 5 (n=1492) (Williams & Cheadle, 2016). High and increasing financial strain was associated with more depressive symptoms by year 15 but not anxiety (n=1645) (Daundasekara et al., 2021)	X	X
	9	X		X					More intimate partner violence over 9 years and more physical violence, emotional violence, controlling violence among mothers living with a partner at baseline (n=4234) (O’Connor & Nepomnyaschy, 2020)	X
	7	X		X					Higher odds of prevalent and incident depression and prevalent and incident general anxiety over 3 years (n=2104) (Suglia et al., 2011)	X
	10	X		X					More intimate partner violence among those in a stable relationship for nine years (n=947) (Lucero et al., 2016)	X	X
	5	X		X					More parental relationship distress among those living together in 2006 (Mothers= 1304/Fathers= 1230) (Williams et al., 2015)	X	X
Health and Retirement Study, randomly sampled adults 50+	4	X		X					Higher risk of mortality over 8 years, 1996–2004 (n=8377) (Tucker-Seeley et al., 2009)	X
	2		X		X				Higher C reactive protein but not associated with metabolic dysregulation, 2004–2012 (n=7280) (Boen, 2019)	X
	1		X						Higher risk of diabetes-related kidney disease, 2006–2012 (n=2735) (Corwin et al., 2021)	X	X
	1		X						Poorer glycemic control (hemoglobin A1c levels), 2006–2014 (n= 2662) (Walker et al., 2020)	X	X
	4		X		X	X			Not associated with body mass index BMI 4–8 years later (n= 3956) (Cuevas et al., 2021)	X
	2	X		X					More anxiety symptoms and depressive symptoms, 2006–2014 (n=5,229) (Wilkinson, 2016)
Health, Aging and Body Composition Study, randomly selected healthy adults 70–79 in Memphis & Pittsburgh (n=2457)	1	X	X						Higher risk of 11-year incident dementia (Yaffe et al., 2013)	X	X
Hispanic Established Population for the Epidemiologic Study of the Elderly; randomly sampled adults 75+ years in Texas, New Mexico, Colorado, Arizona, and California	1		X						More frailty by 2008 (n=2438) (Peek et al., 2012) and greater 13-year mortality risk (n=768) (Ottenbacher et al., 2012) but, among those married at baseline, not associated with odds of having a limitation in activities of daily living (n=385) (Monserud, 2019)	X	X
Hispanic/Latinos 18–74 in Chicago, Miami, Bronx, New York, & San Diego (n=4981)	1	X							Larger body mass index (BMI) (Isasi et al., 2016)	X
Indiana 6th-12th graders with 31 year follow up (n=3984)	3		X				X		Less likely to check ingredient labels and less vigorous exercise but also less smoking and no association with seat belt use (Macy et al., 2013)	X
Iowa Youth and Families Project; recruited as cohabitating parents of 7th grade children in rural Iowa in 1989	2 2	X	X	X					Decreasing/increasing or persistently high strain were associated with physical impairment, depressive symptoms and physical illness at year 15 (n=360) (Wickrama et al., 2010)	X
	2 7	X	X	X					Greater depressive symptoms at a 12-years (n=370) (Wickrama, O’Neal, & Lorenz, 2018); poorer marital quality among consistently married for 10 years (n=370) (Wickrama & O’Neal, 2019)
	2 7	X	X	X					More depressive symptoms by 2001 (n=370) (Wickrama et al., 2012) and among husbands, more cardiometabolic disease at 14 years (n=257) (Wickrama, O’Neal, & Neppl, 2018). Ten-year financial strain predicted more psychological distress, poorer physical health and more loneliness among husbands at 26 years, and poorer physical health among wives (n=254) (Wickrama & O’Neal, 2021b). Baseline financial strain and 14-year increased strain predicted more memory impairment at 26 years (n=224) (Wickrama & O’Neal, 2021a).		X
	3 7	X	X	X					More physical impairments by 26 years (n=243) (Neppl et al., 2021)	X
	2 2	X	X	X					Poorer overall health by 2015 (n=370) (Lee et al., 2021)
	7	X							Poorer physical function but not chronic illness cross-sectionally and financial strain trajectories over time did not predict outcomes in 2019 (n=505) (Klopack et al., 2021)	X	X
	4	X							Poorer overall health, larger body mass index, more loneliness, and less life satisfaction among heterosexual married couples over 26 years, but not associated with sense of control (n= 254) (Wickrama et al., 2022). Baseline financial strain, but not 10-year change predicted more pain over 26 years (n= 508) (Wickrama et al., 2021b)		X
	4	X							More physical limitations, subjective memory impairment and loneliness over 16-years (n=244) (Wickrama et al., 2021a)
African American adults 33–84 (n=2256)	5	X	X			X		X	Higher risk of incident heart disease (Moran et al., 2019)	X
Kentucky Substance Abuse Treatment Outcome Study randomly sampled from programs	8	X							Greater drug addiction severity over 1–2 years, but not alcohol addiction severity (n=1,099) (Wahler, 2015)	X
	8	X							Not associated with likelihood of successfully abstaining from alcohol and illicit drugs (n=1123) (Wahler & Otis, 2014)	X	X
Knowledge Networks panel online respondents (n=704)	3	X	X						More post-traumatic stress symptoms and more impaired work/social functioning 2- to 3-years post 9/11 if specific genotypes (Lucas-Thompson & Holman, 2013)	X	X
Mexican/Mexican American, 18+, low-income, uninsured, and/or undocumented mothers of infants (n=205)	2 0	X	X	X			X		More post-partum depressive symptoms at six weeks, but not cortisol levels at 12 weeks (Jewell et al., 2015)
Midlife in the United States; randomly sampled adults 20–74 (n=3257)	4		X		X	X			Less volunteering (Son & Wilson, 2015)	X	X
Mothers of North Carolina newborns 18+who plan to return to work (n=190)	2		X						Lower physical & mental health-related quality of life over time (Tucker et al., 2010)	X
National Health and Aging Trends Study, randomly sampled adults 65 +	4	X							Faster two-year declines in walking speed and reduced ability to walk (n=3234) (Samuel et al., 2019)	X	X
	4	X							Higher odds of six-year incident dementia (n= 5,034) (Samuel, Szanton, Wolff, et al., 2020)
	4	X							Not associated with one-year odds of falls(n=5581) (Okoye et al., 2021)	X
National Longitudinal Study of Adolescent to Adult Health, randomly selected teenagers in the 7th-12th grade in 1995	7	X							Among adolescents with a maternal figure, baseline financial strain predicted higher Framingham Risk Score in 2008–2009 (n=11013) (Doom et al., 2016)		X
	3	X							More alcohol use and heavy drinking cross sectionally, but not longitudinally and more problematic drinking both cross-sectionally and longitudinally, 2001–2009 (n=7159) (Serido et al., 2014)	X
	7	X							Higher Framingham Risk Score among healthy participants in 2016 (n=14493) (Doom et al., 2017)	X
National Longitudinal Survey of Mature Women; women 30–44 in 1967	1		X						More depressive symptoms and less life satisfaction by 2003 (n=3,296) (Shippee et al., 2019)	X
	1		X						Poorer self-rated health by 2003 (n=3181) (Shippee et al., 2012)	X	X
National sample of retired adults 65–100	3		X		X				More depressive symptoms 1992–2005 (n=818) (Krause, 2009)	X
National sample of retired adults 65–100	4	X							Higher odds of ever smoking, but not heavy drinking 1992–2006 (n=2352) (Shaw et al., 2011)	X
National Survey of Fertility Barriers, randomly selected women 25–45 (n=759)	3	X	X						2–6 years change in financial strain not associated with life satisfaction change (Greil et al., 2019)		X
Non-pregnant White, Black or Latina mothers 18–40 in DC, Maryland, California, Illinois, North Carolina (n=1206)	5		X			X			Higher C-reactive protein at 6- and 12-months post-partum (Guardino et al., 2017)	X
Prospective Registry Evaluating Myocardial Infarction Event and Recovery study, 18+ (n=2344)	1		X						Poorer physical health, mental health, and quality of life, more angina symptoms, and a higher likelihood of one-year rehospitalization, but not associated with 4-year mortality risk (Shah et al., 2012)	X	X
Older workers eligible to retire (n=292)	5	X	X					X	Retirement financial strain predicted more alcohol misuse (Belogolovsky et al., 2012)	X
Unpaid caregivers of patients 21+ with brain tumor near Pittsburgh (n=33)	4	X	X	X		X			Greater caregiver burden due to abandonment at diagnosis, but not associated with burden due to schedule, depressive symptoms or anxiety symptoms (Bradley et al., 2009)
Systemic lupus erythematosus patients in San Francisco (n=682)	2		X				X		More depressive symptoms (McCormick et al., 2018)	X	X
Population Assessment of Tobacco and Health study, randomly sampled adults	1		X						Among smokers, more quit attempts but not associated with 1–2 year abstinence (n=7213) (Kalkhoran et al., 2018)	X	X
	1		X						Higher odds of using electronic nicotine delivery systems some days, but not every day among 18–24 year-olds (n=5740) (Han & Seo, 2021)	X
Randomly sampled from Alameda County, California, (n=378)	5	X							More five-year self-reported cognitive impairment among those married (Strawbridge et al., 2011)	X	X
Houston African American church-going adults 18+ (n=1278)	7	X	X					X	More cancer risk factors and higher odds of smoking, insufficient physical activity, being overweight/obese, having <5 servings of fruit and vegetables each day, but not with at-risk alcohol use (Advani et al., 2014)	X
Protecting Strong African American Families program in economically disadvantaged Georgia communities	15	X		X					More depressive symptoms, poorer overall health, more sleep problems, greater impact of and stress due to COVID-19 (n=320) (Adesogan et al., 2022)
	2		X						Poorer two-year overall health (n=348) (Barton et al., 2018)
	4	X							Higher epigenetic aging scores (n=348) (Lei et al., 2021)		X
Puerto Rican Elderly Health Conditions, randomly sampled 60+, 2002–2008	2	X							Not associated with cognitive function (n=1632) (Vigoureux et al., 2021) or four-year cognitive decline (n=3,385) (Barba et al., 2021)	X	X
Random sample of a large national employer (n=1209)	4		X					X	Poorer self-rated physical & mental health and higher likelihood of depression & anxiety diagnoses, but not associated with the heart disease risk count or cardiovascular disease diagnosis (Bialowolski et al., 2021)	X
Randomly sampled adult residents of Atlanta low-income housing communities (n=232)	1		X						Not associated with satisfaction with housing relocation (Oakley et al., 2013)		X
Randomly sampled African American couples within first year of marriage (n=506)	6	X	X						More weight management behaviors at one-year follow up (O’Neal et al., 2015)		X
Resources for Enhancing Alzheimer’s Caregiver Health, family caregivers 1996–2000 (n=659)	1	X							More depressive symptoms (Nam, 2016)	X
Seattle Midlife Women’s Health Study, menopausal women 1990 to 2005	6	X						X	More perceived stress over 9 years (n=418) (Woods, Mitchell, Percival, et al., 2009) but not associated with urine cortisol levels (n=132) (Woods, Mitchell, & Smith-Dijulio, 2009)
Smoking cessation program in Houston (n=320)	7	X	X					X	Lower odds of successful 26 week abstinence (Kendzor et al., 2010)	X
Spanish-speaking Mexican American smoking adults in Houston (n=199)	8	X	X					X	Lower odds of being abstinent from smoking at 26 weeks (Vinci et al., 2017)	X
Study of Women’s Health Across the Nation, non-Hispanic pre-menopausal White women 42–52 years Oakland, Los Angeles, Newark, Pittsburgh, Chicago, Boston and Detroit	1	X							More severe menopausal symptoms over 16 years (n=3289) (Harlow et al., 2017)	X	X
	1	X							Higher perceived stress over 13 years (n=3044) (Hedgeman et al., 2018) and poorer verbal episodic memory but not working memory within 20 years (n =394) (Kolli et al., 2021); among those in Detroit and Chicago, slower mobility over 20 years (n=830) (Lange-Maia et al., 2019)	X
	1	X							Higher odds of having physical function limitations and a higher odds of 12-year declines (n=2497) (Ylitalo et al., 2013), less subjective well-being over 19 years (n=1693) (Avis et al., 2021) and higher 20-year incidence of peripheral neuropathy (n=1718) (Dusendang et al., 2019)		X
	1	X							More depressive symptoms within four years (n=2400) (Li, Liang, et al., 2020), higher five-year odds of depressive symptoms (n=2376) (Li, Zheng, et al., 2020) but not associated with 16-year incident diabetes among those in Detroit (n=424) (Karvonen-Gutierrez et al., 2018)
	1	X							Higher cumulative 15 year depressive symptom burden among participants in Boston, Chicago, Detroit and Pittsburgh (n=1109) (Bromberger et al., 2017)	X	X
Suicide prevention trial for adults 60+ (n=1226)	1		X						Higher odds of suicidal ideation but not associated with depressive symptoms at each study visit (Gilman et al., 2013)	X	X
Motivational interviewing trial for colorectal cancer screening in Kentucky, 50+ (n=134)	1		X						Not associated with use of colorectal cancer screening, perceived colorectal cancer susceptibility, perceived benefits of screening, or barriers to screening (Adegboyega et al., 2022)
Adults 21–30 and 50–70 near San Francisco (n=1159)	1		X						Not associated with reporting a cardiometabolic condition (Child et al., 2022)		X
Southwest wellness trials for women with multiple sclerosis (n=118) and fibromyalgia (n=197)	8	X							Poorer physical functioning, social functioning and role limitations within 1–2 years (Phillips & Stuifbergen, 2009, 2010)	X	X
Mothers in low-income neighborhoods in Boston, Chicago, and San Antonio (n=2014)	1 3	X		X					Both baseline financial strain and two-year increases predicted greater 2-year increase in psychological distress (Hill et al., 2013)	X	X
Working US adults 18+ (n=1,122)	4	X	X						More family-to-work conflict and more psychological distress (Young & Schieman, 2012)	X

Values varied over time

Kuder-Richardson values, not Cronbach α

Values varied across sub-samples

Values varied across sub-domains