Financial Strain on Mental and Physical Health - Does Race/Ethnicity Matter

 描述(由申请人提供)：在理解不同类型的经济压力(资产损失、收入损失、信用卡和医疗债务)与心理和身体健康结果之间的关系方面仍然存在根本差距。这种差距的持续存在是一个重要的问题，因为累积的经济压力和紧张的生活事件(例如，失业、丧失抵押品赎回权、破产)的经历显著增加了 患上不利的精神和身体健康疾病，这种情况在晚年尤为严重。此外，2008年的经济危机改变了数百万美国老年人的财务状况，他们面临着巨大的经济压力，包括大规模的医疗诈骗和社会困难，如支援网受损。长期目标是确定财务压力与心理和身体健康结果之间的关联程度，并更好地了解美国老年人的财务状况和健康轨迹的完整组合。这项应用的目标是识别随着时间的推移健康状况趋势的关键变化，并对美国健康的一个重要因素--即财务压力--提供新的、潜在的重要见解。我的中心假设是 经济压力程度是老年女性、非裔美国人和拉丁裔女性心理健康和身体健康状况不利的独立预测因子。这一假设是基于申请者在手稿中产生的初步数据，并以压力过程和累积优势理论为指导提出的。这一假设将通过追求四个具体目标来检验：1)确定金融压力影响的程度 心理和身体健康；2)确定社会资源(支持和社会联系)在多大程度上改变经济压力和不利的心理和身体健康之间的关系；3)确定广泛的经济状况对突发财务压力和心理和身体健康之间关系的潜在影响，特别是在宏观经济背景(大衰退与非衰退时期)如何影响美国老年人随后的健康的框架内；4)确定心理和身体健康的长期轨迹(在12年期间)与财务压力的变化有关的程度，特别是在2008年“大衰退”如何影响健康轨迹的概念框架内--扣除个人财务压力和其他突出的应激生活事件。这种方法是创新的，因为它利用了一项自然的经济史实验，该实验表明，从2008年到2010年，在失业、破产和丧失抵押品赎回权方面发生了深刻的经济变化。这项拟议的研究具有重要意义，因为它预计将确定与不利的心理和身体健康相关的经济压力的关键因素，以及它们按种族和性别的不同影响，从而更好地了解基于压力对健康差距的影响。归根结底，这些知识有可能为美国老年人未来的经济保障提供洞察，这将有助于缩小健康差距。这项拟议的研究与公共健康相关，因为它旨在提高我们对经济压力、应激生活事件和社会网络对心理和身体健康结果的复杂和未探索的关系的理解。这些发现有可能让政策制定者了解2008年经济衰退的后果。因此，这项研究与美国国立卫生研究院的任务有关，即发展有助于减轻人类残疾负担的基础知识。

 DESCRIPTION (provided by applicant): A fundamental gap remains in understanding the relationship between different types of financial strain (asset loss, income loss, credit card and medical debt) and mental and physical health outcomes. Continued existence of this gap represents an important problem because the experience of cumulative financial strain and stressful life events (e.g., job loss, foreclosure, bankruptcy) significantly increases the risk of developing adverse mental and physical health illnesses, a situation that is particularly exacerbated in late-life. Additionally, the economic crisis of 2008 altered the financial well-bein of millions of older Americans who faced significant financial strains, including large medical bils and social hardships such as frayed support networks. The long-term goal is to determine the extent of the association between financial strain, and mental and physical health outcomes and to better understand the complete portfolio of the financial status and health trajectories of olde persons in the U.S. The objective of this application is to identify critical changes in trends in health status over time and to provide new and potentially important insights into an important contributing factor in America's health, namely financial strain. My central hypothesis is that the extent of financial strain is a strong independent predictor of adverse mental health and physical health conditions for older women, African Americans and Latino's. This hypothesis has been formulated on the basis of preliminary data produced in manuscript by the applicant and also guided by the stress process and cumulative (dis)advantage theories. This hypothesis will be tested by pursuing four specific aims: 1) determine the extent to which financial strain influences mental and physical health; 2) determine the extent to which social resources (support and social connectedness)function to modify the relationship between financial strain and adverse mental and physical health; 3) determine the potential influence of broad economic conditions on the relationship between incident financial strain and mental and physical health, particularly within the framework of how macroeconomic context (Great Recession vs. non-recessionary periods) affects subsequent health for older Americans; and 4) determine the extent to which long-term trajectories of mental and physical health (over 12 year period) are associated with changes in financial strain particularly within the conceptual framework of how health trajectories have been affected by the "Great Recession" of 2008 net of individual financial strain and other salient stressful life events. The approach is innovative because it capitalizes upon a natural experiment of economic history which showed that profound economic changes took place from 2008 to 2010 in terms of job losses, bankruptcies and foreclosures. The proposed research is significant because it is expected to identify key elements of financial strain associated with adverse mental and physical health, and their differential effects by race and gender, leading to a better understanding of stress-based influences on health disparities. Ultimately, such knowledge has the potential to provide insight into the future financial security of older Americans that will help reduce the disparities in health. The proposed research is relevant to public health because it aims to improve our understanding of the complex and unexplored relationship between financial strain, stressful life events and social networks on mental and physical health outcomes. The findings have the potential to inform policy makers of the consequences of the 2008 recession. Thus, the prosed research is relevant to the part of NIH's mission that pertains to developing fundamental knowledge that will help to reduce the burden of human disability.