Background Experiencing a negative wealth shock in late middle age may cause high levels of stress and induce reductions in health-related consumption.
Methods We used data on late middle age individuals (51–64 years) from the longitudinal US-based Health and Retirement Study (N=19 281) to examine the relationship between negative wealth shock and short-term outcomes that serve as markers of the pathways from wealth shock to health: elevated depressive symptoms, as a marker of the stress pathway and cost-related medication non-adherence (CRN), as a marker of the consumption pathway. Negative wealth shock was considered to be a loss of total net worth of 75% or more.
Results Using a nested cross-over approach—a within-person design among exposed individuals only that adjusts by design for all time-invariant individual characteristics—we found that negative wealth shock was significantly associated with increased odds of elevated depressive symptoms (OR=1.50, CI 1.10 to 2.05), but was not significantly associated with higher odds of CRN (OR=1.18, CI 0.76 to 1.82), even after further adjustment for time-varying sociodemographic and health covariates.
Conclusions Negative wealth shock during late middle age confers an increased risk of elevated depressive symptoms, but does not change levels of CRN. Personal and policy factors that may buffer the mental health risks of negative wealth shock, such as social support and social welfare policy, should be considered.
- Epidemiological methods
- PSYCHOSOCIAL FACTORS
- ACCESS TO HLTH CARE
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Contributors All listed authors have contributed substantially to the development of this manuscript and agree to this submission. LRP contributed to the study concept and design, data analysis and interpretation, drafting and revision of the manuscript. BLN, SAB and MRE contributed to data analysis and interpretation and revision of the manuscript. CFMdL contributed to the study concept and design, data analysis and interpretation, revision of the manuscript, and supervision of the study.
Funding This work was supported by the US National Institute on Aging (T32AG027708). The Health and Retirement Study is sponsored by the US National Institute on Aging (U01AG009740) and is conducted by the University of Michigan.
Competing interests None declared.
Ethics approval The Health and Retirement Study is approved by the Institutional Review Board at the University of Michigan.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The Health and Retirement Study data are publicly available on the study website (http://hrsonline.isr.umich.edu/).