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The COVID-19 outbreak, which was followed by home confinement, is expected to have had profound negative impact on the mental health of people. Associated factors, such as losing jobs and income, can be expected to lead to an increased risk of suffering from psychopathological problems. Therefore, this study was aimed at researching the associations of job and income loss with mental health, as well as the possible mediating role of perceived financial stress during the COVID-19 outbreak. The sample included 2381 Spanish workers who were interviewed right after the first COVID-19 lockdown. Measures were taken for generalized anxiety disorder, panic attacks, depression, post-traumatic stress disorder, substance abuse, suicidal thoughts and behaviors, working conditions, sociodemographic variables, and perceived financial stress. Logistic regression models were calculated with psychological variables as outcomes, and with job loss and income loss as predictors. Mediation analyses were performed by adding the financial threat as a mediator. Nineteen point six percent and 33.9% of participants reported having lost their jobs and incomes due to the pandemic, respectively. Only income loss was related to a higher risk of suffering from depression and panic attacks. When adding financial stress as a mediator, the indirect effects of job and income loss on the mental health measures were found to be significant, therefore indicating mediation. These findings pinpoint the vulnerability of this population, and highlight the need for interventional and preventive programs targeting mental health in economic crisis scenarios, such as the current one. They also highlight the importance of implementing social and income policies during the COVID-19 pandemic to prevent mental health problems.

Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.

Mental health concerns are prevalent among university students, with financial stress further compounding these issues. While cognitive behavioral therapy (CBT) is effective for these conditions, its delivery through artificial intelligence (AI) chatbots represents a promising approach, especially in non-Western contexts. This study aims to investigate the efficacy of a culturally adapted, CBT-based AI chatbot for improving the well-being of Chinese university students and to examine whether financial stress moderates its effectiveness. In this randomized controlled trial, 100 university students (mean age 20.8, SD 2.2 years; 62/100, 62% female) were allocated to either an intervention (n=50) or a waitlist control group (n=50). The intervention group interacted with a CBT-based AI chatbot for 7 consecutive days. Depression (Center for Epidemiologic Studies Depression Scale), anxiety (Generalized Anxiety Disorder-7 scale), and loneliness (UCLA Loneliness Scale) were assessed at baseline, day 3, and day 7. Financial stress was measured using the Psychological Inventory of Financial Scarcity. Significant group×time interactions were found for depression (F2,196=8.63; P<.001; η²p=.08) and loneliness (F2,196=5.57; P=.004; η²p=.05), but not for anxiety (F2,196=1.31; P=.27; η²p=.01). Post hoc comparisons showed significant reductions in both depression (t=3.85; P<.001) and loneliness (t=4.28; P<.001) from baseline to postintervention in the intervention group, with corresponding effect sizes of Cohen d=0.71 (95% CI 0.30-1.12) and Cohen d=0.60 (95% CI 0.20-1.00), respectively. No significant changes were observed in the waitlist control group. Exploratory subgroup analyses revealed that participants with high financial stress demonstrated significantly greater improvements in depression (F2,52=11.56; P<.001; η²p=.31) and loneliness (F2,52=11.18; P<.001; η²p=.30) compared to those with low financial stress. The culturally adapted, CBT-based AI chatbot effectively reduced depression and loneliness in Chinese university students, with stronger effects among those experiencing high financial stress. These findings highlight the potential of AI-driven interventions to provide accessible mental health support, particularly for financially stressed students.

Purpose of Review This systematic examination quantifies financial toxicity- the economic burden and related financial distress experienced by patients due to medical costs- in diabetes management globally, analyzing prevalence, mechanisms, and interventions across diverse healthcare systems and geographic contexts. Recent Findings Data indicates 30–60% of diabetes patients experience financial toxicity, with household expenditures ranging from 5 to 40% of income on disease management, and demographic disparities evident. Current intervention strategies demonstrate limited efficacy, particularly in resource-constrained settings, while policy approaches show mixed results across economic contexts. Summary Financial toxicity operates through four identified pathways: direct expenses, indirect costs (productivity/caregiver burden), insurance coverage limitations, and structural access barriers. Research priorities include developing validated measurement instruments for diabetes financial toxicity, implementing contextually appropriate interventions, and establishing causative relationships between financial burden and clinical outcomes through longitudinal studies.

PurposeCancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers’ emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain.MethodsWe conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers’ emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables.ResultsA total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of “1: Much lower” to “5: Much higher”, the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1–5) for financial strain, 3.61 (SD: 0.86; range: 1–5) for physical strain, and 3.88 (SD: 0.89; range: 1–5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19.ConclusionThese findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.

Understanding how youth perceive household economic hardship and how it relates to their behavior is vital given associations between hardship and behavioral development. Yet, most studies ignore youth’s own perceptions of economic hardship, instead relying solely on caregiver reports. Moreover, the literature has tended to treat economic hardship as a stable force over time, rather than a volatile one that varies month-to-month. This study addressed extant limitations by collecting monthly measures of economic hardship, specifically caregiver- and youth-reported material deprivation and youth-reported financial stress, and youth internalizing and externalizing problems from 104 youth–caregiver dyads (youth: 14–16 years, 55% female, 37% Black, 43% White) over nine months. We examined month-to-month variability of these constructs and how youth-reports of material deprivation and financial stress predicted their behavior problems, controlling for caregiver-reports of material deprivation. We found that hardship measures varied month-to-month (ICCs = 0.69–0.73), and youth-reported material deprivation positively predicted internalizing when examining both within- and between-individual variability ( β = .19–.47). Youth-reported financial stress positively predicted within-individual variation in externalizing ( β = .18), while youth reports of material deprivation predicted externalizing when looking between families ( β = .41). Caregiver-reported material deprivation was unrelated to youth behavior when accounting for youth perceptions of economic hardship.

Financial stability is essential for well-being, influencing health, housing, education, and social participation. Individuals with mental illness often face financial hardship, including debt, financial administration problems, and limited access to basic needs. Despite its importance, little research exists on factors supporting financial self-management for this group. This study explores financial hardship experiences, causes, and support mechanisms among clients in supported accommodation in the Netherlands. Twenty-seven clients were recruited via staff of a large supported accommodation setting in the Netherlands, of which 22% received residential support and 48% received floating outreach. Semi-structured interviews were conducted, and thematic analysis was used to interpret participants' lived experiences with financial problems. Participants identified several causes for their financial struggles, including psychological issues, impulsive spending, and a lack of financial literacy. Relationship problems (e.g., divorce) and limited social support also were mentioned to contribute to ongoing financial hardship. Budget coaches, professionals with expertise in debt management, offer personalized guidance and practical assistance with financial management, including creating budgets, managing expenses, and addressing debts. This support was highly valued by clients, helping them to organize their finances, manage expenses, reduce stress, and develop their financial literacy. This study highlights the complex and multifaceted nature of financial difficulties experienced by clients in supported accommodation. Budget coaches, with their specialized knowledge of the target population and financial expertise, can play a crucial role in improving the financial situation of individuals with mental illness. The findings underscore the need for integrated support addressing both financial and mental health challenges to promote long-term independence and well-being for this vulnerable population in the Netherlands.

Background The financial crisis has indirectly affected Lebanese university students, leading to economic distress. Accordingly, this study aimed to assess the substantial negative impact of financial stress on the mental health and well-being of Lebanese college students. Methods A quantitative research approach was applied and took place from June 13th to July 25th, 2023, targeting 1272 university students aged 17 and above from private and public universities across Lebanon through convenience sampling. The InCharge Financial Distress/Financial Well-Being scale (IFDFW), Pittsburgh Sleep Quality Index (PSQI), Beirut Distress Scale (BDS-10), Perceived Stress Scale (PSS-10), and Well-Being Index (WHO-5) were used to assess the students’ well-being. Descriptive analyses of the data was performed using SPSS software version 25. Results 1272 university students participated in this study, mostly females, with a mean age of 21.64 (± 4.43) years. Participants reported a lack of financial independence, unemployment, and no income. Positive associations were obtained between the BDS total scale as well as the PSS total and PSQI scores, while there was a significant negative relationship between IFDFW and PSQI scores. Those with a higher GPA, majoring in science/health and medicine, living in rural areas, and graduate students were linked to lower PSQI and BDS-10 scores. Financial aid and financial independence were associated with lower PSQI and BDS-10 scores. PSS-10 scores were higher among students majoring in science/health and medicine. Higher scores on the IFDFW scale correlated with lower BDS-10 and PSS-10 scores. In contrast, females had higher BDS-10 and PSS-10 scores. Scoring higher on the PSS-10 and PSQI scales, living off campus, or majoring in science/health and medicine, were associated with higher on the WHO-5 scale. Conclusions A significant impact of financial stress on college students in Lebanon was obtained, affecting their well-being and mental health aspects. Marital status, gender, academic major, region of living, and financial independence also influences students’ experiences. Tailored support and further research are needed to address these multifaceted challenges.

Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high‐cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.

Abstract Context The COVID-19 pandemic has impacted healthcare environment. Objective To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI). Design and setting Prospective longitudinal survey study at 2 tertiary centers. Participants Patients with AI. Intervention Patient-centered questionnaire. Main outcome measures Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management. Results Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic. Conclusions A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.