The longitudinal relationship between financial hardship and mental health - A systematic review of the evidence

Background: A compelling body of evidence has accumulated in recent years highlighting the association between various socioeconomic factors and a wide range of mental health outcomes. This includes financial hardship - described by Mack and Lansley (1985) as “an enforced lack of socially perceived necessities” - the experience of which has demonstrated a strong negative effect on mental health. To date however, no systematic review of the evidence assessing the longitudinal relationship between financial hardship and mental health has been undertaken. 

Aims: The aim of this review is to better understand the longitudinal relationship between financial hardship and mental health, to critically appraise the quality of existing evidence, and to identify factors that may explain heterogeneity in this association. 

Methods: Scopus, PsycINFO, MEDLINE, Embase, PubMed were searched from inception to July 2023 and yielded a total of 8672 records. Following de-duplication, abstract and full-text screening, 94 studies met inclusion criteria. Included studies were published between 1987 and 2023, and spanned 24 countries. 

Results: The reviewed literature overwhelmingly demonstrated a positive longitudinal association between financial hardship experience and poorer mental health. Despite a diversity of locations, study designs, analytic techniques, modelled confounders, and measures of mental health and financial hardship, 101 of 116 multivariate assessments demonstrated a positive relationship between financial hardship and poorer mental health, particularly depression. 

Conclusion: This body of evidence highlights a clear association between financial hardship and poorer mental health, reinforcing the necessity of intervention that can mitigate the experience of deprivation due to lack of financial resources, and in turn promote mental health.