Financial Strain and Child Health: Measures and Evidence From a Systematic Literature Review.

Introduction: Despite the focus on pediatric social needs, there is a dearth of research on financial strain, which is characterized by challenges in meeting basic needs. This study systematically reviewed the literature on different measures of self-reported financial strain and health outcomes.

Methods: A systematic literature search in PubMed, PsychINFO, and Web of Science identified papers that examined relationships between self-reported financial strain and health outcomes among U.S. children or adolescents. Two blinded reviewers screened each paper (65 papers, 39 studies) and extracted data. Financial strain measures were coded for content. Findings were synthesized based on age and type of measure.

Results: Financial strain measures asked about the lack of money for basic needs (32 studies), difficulty making ends meet (23 studies), relying on coping strategies (13 studies), experiencing stress or worry about finances (4 studies) anticipating future strain (4 studies), and the lack of money for leisure (4 studies). Financial strain was associated with poorer health and well-being and more behavior challenges among children of all ages, poorer academic performance among school-age children, and more depressive symptoms among adolescents. Associations were consistent across diverse samples when accounting for other socioeconomic factors and across financial strain measures, including a single item about difficulty making ends meet. Fourteen studies tested hypothesized mechanistic factors that explain associations, including material, psychosocial, and behavioral pathways.

Discussion: The consistency of associations between financial strain and pediatric health and well-being highlights an urgent need to address financial strain to advance health equity. Results show predictive validity for a simple financial strain question, similar to one recommended by the National Academy of Medicine.