Pre-existing financial circumstance, job loss, and probable depression among U.S. adults: a prospective population-based cohort study.

Abstract

While job loss is associated with adverse mental health, it is unclear if the relationship between job loss and mental health differs across pre-existing financial circumstances (objective financial status or subjective financial strain). We analyzed data from the nationally representative, longitudinal Cumulative Life Stressors Impact on Mental Health and Well-being study (2023-2024) conducted across the United States. We assessed associations between past-year job loss and probable depression (Patient Health Questionnaire-9, PHQ-9 ≥ 10), balancing on pre-job loss characteristics including objective financial status (USD, household savings ≥$5000) and subjective financial strain (difficulty meeting monthly bills). Propensity score weights were generated using a survey-weighted gradient boosted model. Generalized linear models estimated the odds ratio of probable depression by job loss group, overall and stratified by objective financial status and subjective financial strain. Among 1023 working-age adults, 79 (8.6%) experienced past-year job loss during the study period. Job loss was associated with higher odds of probable depression among adults with pre-existing subjective financial strain [Conditional Odds Ratio, cOR = 1.62 (95% Confidence Interval (CI): 1.01, 2.59)] but not in the group without subjective financial strain, although the formal test comparing estimates between strain groups was not statistically significant [3.72 (95% CI: 0.39, 35.43)]. Estimates were non-significant across objective financial status groups [<$5000 cOR = 1.56 (95% CI: 0.81, 3.02); ≥$5000 cOR = 1.43 (95% CI: 0.88, 2.32)]. Among working-age adults with pre-existing financial strain, job loss was associated with later probable depression. The presence or absence of $5000 or more in objective savings was not associated with differences in the association between job loss and probable depression. These findings suggest that subjective financial strain prior to job loss may be associated with differential mental health following job loss. The CLIMB study was supported in part by the de Beaumont Foundation, JHU Nexus Award, InHealth, Hopkins Business of Health Initiative Pilot Award, and Hopkins Center for Health Disparities Solutions Pilot Project Award.