Financial stress as a mediator of financial position and depressive symptoms among rural Nepali women

BackgroundAssets, income, socioeconomic status, and other measures of financial position are consistent predictors of depression. Although financial stress has been proposed as a mediator of this relationship, no study has explored this hypothesis using a rigorous longitudinal design or outside of high-income countries.AimsWe address this gap using longitudinal cohort data across four timepoints.MethodThe sample comprised 831 women (<i>M</i> = 35.9 years old) living in Nawalpur, a rural district in the Gandaki province of Nepal; the majority were married (88%) and of Janajati caste/ethnicity (61%). The direct effect of financial position on depressive symptoms and its indirect effect through financial stress were estimated using a cross-lagged panel mediation model (CLPM); we also conducted cross-sectional mediation models - of the sort typically employed in mediation analyses - for comparison and bias estimation.ResultsIn the CLPM, financial stress significantly mediated the financial position-depressive symptom relationship between timepoints one and three, but not between timepoints two and four (likely due to loss of power). After accounting for financial stress as a mediator, the direct effects of financial position on depressive symptoms were not statistically significant. The cross-sectional models overestimated the relationship between financial stress and depressive symptoms; otherwise, results between the CLPM and cross-sectional models were comparable.ConclusionsOur findings suggest that interventions addressing financial stress may improve depressive symptoms. Methodologically, we argue that more researchers should employ longitudinal designs when investigating mediation processes.