Financial Hardship and Social Assistance as Determinants of Mental Health and Food and Housing Insecurity During the COVID-19 Pandemic in the United States

Abstract

BackgroundWhile social assistance through the United States (U.S.) federal Coronavirus Aid, Relief, and Economic Security (CARES) Act provided expanded unemployment insurance benefits during the coronavirus disease 2019 (COVID-19) pandemic until the summer of 2020, it is unclear whether subsequent social assistance has been or will be sufficient to meet everyday spending needs and to curb the adverse health-related sequelae of financial hardship.MethodsThis study estimated recent trends in financial hardship among working-aged Americans with job-related income loss during the pandemic. It also used multivariable logistic regression and repeated cross-sectional individual-level U.S. Household Pulse Survey data on 91,222 working-aged adults between September and December 2020 to explore the associations of financial hardship with mental health outcomes and food and housing insecurity after accounting for receipt of social assistance.ResultsExperiencing somewhat of a financial hardship (vs no hardship) was linked to 3-7 times higher odds of anxiety and depressive symptoms and a likely eviction, and 11 times higher odds of food insufficiency. Experiencing considerable financial hardship (vs no hardship) predicted 5-7 fold higher odds of anxiety and depressive symptoms, 34-fold higher odds of a likely housing eviction, and 37-fold higher odds of food insufficiency (all P values <.001). Across outcomes, these relationships were stronger at each successively higher level of financial hardship (all P values for linear trend <.001), and more than offset any corresponding benefits from social assistance.ConclusionsEven after accounting for receipt of social assistance, working-aged adults experiencing financial hardship had markedly greater odds of anxiety and depressive symptoms, food insufficiency, and an anticipated housing eviction. These findings point to the urgent need for direct and sustained cash relief well in excess of current levels of social assistance, and provide a critical baseline assessment for evaluating the impacts of federal public policy responses to economic hardships during the pandemic. It is essential that the U.S. Congress and the new Biden administration provide adequate and needs-based social policy relief measures in order to mitigate the pandemic’s adverse impacts on the physical, mental, and social well-being of millions of Americans.