Understanding the association between material hardship and posttraumatic stress disorder: a test of the social selection and social causation hypotheses and an exploration of gender differences

• Published in: Social Psychiatry and Psychiatric Epidemiology 2022-01, Vol.57 (1), p.57-66
• Main Authors: Holmes, Samantha C., Austin, Anna E., Smith, Megan V.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Economic policy; Epidemiology; Gender aspects; Gender differences; Hardship; Humans; Logistic Models; Longitudinal Studies; Mediation; Medicine; Medicine & Public Health; Multivariate statistical analysis; Original Paper; Post traumatic stress disorder; Poverty; Psychiatry; Psychological stress; Sex Factors; Stress Disorders, Post-Traumatic - epidemiology
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-021-02162-1

Purpose There is a well-established association between poverty and posttraumatic stress disorder (PTSD); however, little research has tested the temporality of the association. Methods Using data from Waves IV (2008; N  = 14,800) and V (2016–2018; N  = 10,685) of the National Longitudinal Study of Adolescent to Adult Health, we examined temporal associations between material hardship (a specific operationalization of poverty) and PTSD, as well as assessed for potential gender differences in associations. We conducted logistic regression and generalized structural equation modeling to examine associations between material hardship and PTSD and assess for mediation and moderation by gender. Results Prior PTSD diagnoses were associated with an increased likelihood of material hardship (OR = 1.64; 95% CI 1.21, 2.21). The indirect effect of gender on material hardship through PTSD diagnoses was significant. Prior material hardship was associated with an increased likelihood of PTSD diagnoses (OR = 1.81; 95% CI 1.35, 2.42). The indirect effect of gender on PTSD diagnoses through material hardship was significant. There was no evidence of moderation by gender for either association. Conclusion Results suggest reciprocal associations between material hardship and PTSD. Economic policies, as well as improved access to evidence-based PTSD treatments, may reduce the burden of both material hardships and PTSD.