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Association of negative financial shocks during the Great Recession with depressive symptoms and substance use in the USA: the CARDIA study
  1. Samuel Longworth Swift1,
  2. Tali Elfassy2,
  3. Zinzi Bailey3,
  4. Hermes Florez2,
  5. Daniel J Feaster2,
  6. Sebastian Calonico4,
  7. Steve Sidney5,
  8. Catarina I Kiefe6,
  9. Adina Zeki Al Hazzouri5
  1. 1 Center for Healthcare Equity in Kidney Disease, University of New Mexico, New Mexico, Albuquerque, USA
  2. 2 Public Health Sciences, University of Miami, Miami, Florida, USA
  3. 3 Sylvester Cancer Center, University of Miami, Miami, Florida, USA
  4. 4 Columbia University, New York, New York, USA
  5. 5 Kaiser Permanente Norther California Division of Research, Oakland, California, USA
  6. 6 Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, USA
  1. Correspondence to Samuel Longworth Swift, Center for Healthcare Equity in Kidney Disease, University of New Mexico, 901 University Blvd SE, Albuquerque, NM 87131-1466, USA; samswift{at}


Background The Great Recession of 2008 was marked by large increases in unemployment and decreases in the household wealth of many Americans. In the 21st century, there have also been increases in depressive symptoms, alcohol use and drug use among some groups in the USA. The objective of this analysis is to evaluate the influence of negative financial shocks incurred during the Great Recession on depressive symptoms, alcohol and drug use.

Methods We employed a quasi-experimental fixed-effects design, using data from adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Our financial shock predictors were within-person change in employment status, income and debt to asset ratio between 2005 and 2010. Our outcomes were within-person change in depressive symptoms score, alcohol use and past 30-day drug use.

Results In adjusted models, we found that becoming unemployed and experiencing a drop in income and were associated with an increase in depressive symptoms. Incurring more debts than assets was also associated with an increase in depressive symptoms and a slight decrease in daily alcohol consumption (mL).

Conclusion Our findings suggest that multiple types of financial shocks incurred during an economic recession negatively influence depressive symptoms among black and white adults in the USA, and highlight the need for future research on how economic recessions are associated with health.

  • Economics
  • depression
  • social and life-course epidemiology
  • substance abuse

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  • Contributors SLS did the analysis and drafted the manuscript, and DJF and AZAH reviewed the code and assisted with the analysis. TE, ZB, HF, SC, SS and CIK all provided a critical review of the manuscript.

  • Funding The Coronary Artery Risk Development in Young Adults (CARDIA) study is supported by contracts HHSN268201300025C, HHSN268201300026C, HHSN268201300027C, HHSN268201300028C, HHSN268201300029C and HHSN268200900041C from the National Heart, Lung, and Blood Institute and the Intramural Research Program of the National Institute on Aging.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.