Moderating effect of social support on the association between changes in financial stress and depressive and anxiety symptoms during the COVID-19 pandemic in Medicaid recipients: a longitudinal study

The COVID-19 pandemic caused financial disruption for some individuals, especially in lower-income communities. Social support has been shown to protect mental health during stressful times, but little is known about whether social support protects against financial stress. This study assessed if perceived social support moderated the effect of one-year changes in financial stress on changes in depressive and anxiety symptoms during the COVID-19 pandemic in a sample of Medicaid recipients. This was a secondary analysis of 750 adult Medicaid recipients from five community health centers participating in a longitudinal, observational study. Demographics, social support, financial stress, and depressive (PHQ-8) and anxiety (GAD-7) symptoms were self-reported at baseline and one-year follow-up. Multivariable linear regression models assessed the moderating effect of social support on the relationship between one-year changes in financial stress and changes in depressive and anxiety symptoms. Participants had a mean (SD) age of 43.2 (11.2) years; 15.3% were Black and 54.9% were Hispanic. Worsening financial stress was related to increased depressive ( p < 0.01) and anxiety ( p < 0.01) symptoms. Social support was not related to change in depressive ( p = 0.83) or anxiety ( p = 0.28) symptoms. Social support did not moderate the effect of financial stress on depressive (p-interaction = 0.51) or anxiety (p-interaction = 0.07) symptoms. In this sample of low-income adults, perceived social support did not moderate the effect of worsening financial stress on increased depressive and anxiety symptoms during the COVID-19 pandemic. It is important to consider the consequences of financial stress on mental health, even among individuals with strong support networks.