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

 描述（由申请人提供）：在理解不同类型的财务压力（资产损失，收入损失，信用卡和医疗债务）与身心健康结果之间的关系方面仍然存在根本性的差距。这种差距的持续存在是一个重要的问题，因为累积的财务压力和压力性生活事件的经历（例如，失业、丧失抵押品赎回权、破产）显著增加了 发展不利的精神和身体健康疾病，这种情况在晚年尤其严重。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，他们面临着巨大的财务压力，包括巨额医疗费用和社会困难，如支持网络磨损。长期目标是确定财务紧张、以及精神和身体健康结果，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。该应用程序的目的是确定健康状况随时间推移的趋势的关键变化，并提供新的和潜在的重要见解，了解一个重要的影响因素，美国的健康，即财政紧张。我的核心假设是 经济压力的程度是老年妇女、非裔美国人和拉丁美洲人不利的心理健康和身体健康状况的一个强有力的独立预测因素。该假设是在申请人手稿中产生的初步数据的基础上提出的，并受到压力过程和累积（不利）优势理论的指导。这一假设将通过追求四个具体目标进行检验：1）确定财务紧张影响的程度 身心健康;（2）确定社会资源（支持和社会联系）功能，以修改之间的关系，财政紧张和不利的精神和身体健康; 3）确定广义经济条件对事件性财务压力与身心健康之间关系的潜在影响，特别是在宏观经济背景下，（大衰退与非衰退期）影响美国老年人随后的健康;以及4）确定心理和身体健康的长期轨迹在多大程度上（12年以上）与金融压力的变化有关，特别是在健康轨迹如何受到"大衰退"影响的概念框架内。2008年的净个人财务压力和其他突出的压力生活事件。这种方法是创新的，因为它利用了经济史的一个自然实验，这个实验表明，2008年至2010年发生了深刻的经济变化，失业、破产和丧失抵押品赎回权。拟议的研究是重要的，因为它预计将确定与不利的心理和身体健康相关的财务压力的关键因素，以及它们对种族和性别的差异影响，从而更好地了解基于压力的健康差异的影响。最终，这些知识有可能为美国老年人未来的财务安全提供洞察力，这将有助于减少健康方面的差距。拟议的研究与公共卫生有关，因为它旨在提高我们对财务压力，压力生活事件和社交网络对精神和身体健康结果之间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，拟议的研究是相关的NIH的使命的一部分，涉及到发展的基础知识，将有助于减少人类残疾的负担。

 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.