Measures of financial strain have been incorporated into several large-scale population health studies, including the Americans’ Changing Lives Study, Coronary Artery Risk Development in Young Adults (CARDIA), Study of Women Across the Nation (SWAN), and the Whitehall II study, among many others. Overall, greater reports of financial strain are associated with poorer health, including increased mortality risk, poor mental health, and alterations in physiological processes implicated in the development of chronic diseases, such as cardiovascular disease and diabetes, as well as premature mortality (Georgiades et al., 2009; Matthews et al., 2002; Puterman et al., 2012; Szanton et al., 2008).

 

Several measures have been developed to assess financial strain. Recently the National Academy of Medicine convened a panel of experts to identify which social and behavioral measures should be captured as part of electronic health records (NAM, 2014). A measure of financial resource strain was recommended. Derived from (Kahn and Pearlin, 2006), the specific measure is as follows:

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• In the past month, how hard has it been for you to pay for the very basics like food, housing, medical care, and heating? Would you say… (1 = very hard, 2 = hard, 3 = somewhat hard, or 4 = not very hard)

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Benefits of this measure are that it is a single item, face valid, and covers multiple life domains. However, this item may not be appropriate for researchers interested in the differential effects of financial strain from specific sources. It is notable that versions of this measure have been used to assess financial strain at different stages of the life course. For instance, if interested in childhood financial strain, Kahn & Pearlin asked: “Thinking back to your years up to age 18, how difficult was it for your family to meet expenses for basic needs like food, clothing, and housing?”

Additional measures of financial strain include:

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Economic Strain Model (Pearlin et al., 1981)

At the present time:

1. Are you able to afford a home suitable for (yourself/your family)?

2. Are you able to afford furniture or household equipment that needs to be replaced?

3. Are you able to afford the kind of car you need?

4. Do you have enough money for the kind of food (you/your family) should have?

5. Do you have enough money for the kind of medical care (you/your family) should have?

6. Do you have enough money for the kind of clothing (you/your family) should have?

7. Do you have enough money for the leisure activities (you/your family) want(s)?

8. Do you have a great deal, some, a little, or no difficulty in paying your bills?

9. At the end of the month do you end up with some money left over, just enough to make ends meet, or not enough money to make ends meet?

These sets of questions were originally administered by interview. While scoring is not provided in the article, several large-scale studies have used item 9 as a stand-alone item. A cumulative score could also be created.

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Financial strain (McLoyd et al., 1994)

1. How often in the past 2 years, in order to make ends meet, you had to borrow money from friends or family to help pay bills? (1 = not at all, 4 = a lot).

2. How often you decided not to buy something you really needed for yourself or your children because you couldn't afford it (1 = not at all, 4 = a lot).

3. How difficult it has it been to pay the family bills lately? (1 = not difficult at all, 4 = very difficult).

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Financial strain (Okechukwu et al., 2012)

This single item is derived from Pearlin et al., 1981 and included in The Work, Family, and Health Network Study.

• How would you describe the money situation in your household right now?’

Response options: ‘‘comfortable with extra,’’ ‘‘enough but no extra,’’ ‘‘have to cut back,’’ and ‘‘cannot make ends meet’’

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Financial Chronic Stress Scale (Lantz et al., 2005)

1. How satisfied are you with your/your family’s present financial situation? (5-point response scale with 1 = completely satisfied and 5 = not satisfied at all)

2. How difficult is it for you/your family to meet monthly payments on your bills? (5-point response scale with 1 = extremely difficult and 5 = not difficult at all)

3. In general, how do your (family’s) finances usually work out at the end of the month? (1 = some money left over, 2 = just enough money, and 3 = not enough money)

Responses to each item are standardized (with a mean of zero and standard deviation of one) and then averaged to create a scale with all items given equal weight.

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Author(s) and Reviewer(s):

Prepared Aric A. Prather, PhD. Reviewed by Nancy E. Adler, PhD. If you have any comments on these measures, email Aric.Prather@ucsf.edu. Version date: January 2018

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References:

Georgiades, A., Janszky, I., Blom, M., Laszlo, K.D., Ahnve, S., 2009. Financial strain predicts recurrent events among women with coronary artery disease. International journal of cardiology 135, 175-183.

Kahn, J.R., Pearlin, L.I., 2006. Financial strain over the life course and health among older adults. J Health Soc Behav 47, 17-31.

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Lantz, P.M., House, J.S., Mero, R.P., Williams, D.R., 2005. Stress, life events, and socioeconomic disparities in health: results from the Americans' Changing Lives Study. J Health Soc Behav 46, 274-288.

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Matthews, K.A., Kiefe, C.I., Lewis, C.E., Liu, K., Sidney, S., Yunis, C., Coronary Artery Risk Development in Young Adults, S., 2002. Socioeconomic trajectories and incident hypertension in a biracial cohort of young adults. Hypertension 39, 772-776.

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McLoyd, V.C., Jayaratne, T.E., Ceballo, R., Borquez, J., 1994. Unemployment and work interruption among African American single mothers: effects on parenting and adolescent socioemotional functioning. Child Dev 65, 562-589.

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Medicine, I.o., 2014. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. National Academies Press, Washington, D.C.

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Okechukwu, C.A., El Ayadi, A.M., Tamers, S.L., Sabbath, E.L., Berkman, L., 2012. Household food insufficiency, financial strain, work-family spillover, and depressive symptoms in the working class: the Work, Family, and Health Network study. American journal of public health 102, 126-133.

Pearlin, L.I., Lieberman, M.A., Menaghan, E.G., Mullan, J.T., 1981. The stress process. J Health Soc Behav 22, 337-356.

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Puterman, E., Adler, N., Matthews, K.A., Epel, E., 2012. Financial strain and impaired fasting glucose: the moderating role of physical activity in the Coronary Artery Risk Development in Young Adults study. Psychosomatic medicine 74, 187-192.

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Szanton, S.L., Allen, J.K., Thorpe, R.J., Jr., Seeman, T., Bandeen-Roche, K., Fried, L.P., 2008. Effect of financial strain on mortality in community-dwelling older women. The journals of gerontology. Series B, Psychological sciences and social sciences 63, S369-374.

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