When money runs short, friends and family are often seen as a buffer against the strain. A new study of adults on low incomes in the US suggests that, during the COVID-19 pandemic, feeling well supported did not protect people from the mental health toll of worsening financial stress.
The research, published in BMC Public Health on 3 October 2026, was a secondary analysis of 750 adult Medicaid recipients who received care at five community health centres in Massachusetts. Participants, aged 21 to 62 at enrolment, completed online questionnaires when they joined, between December 2019 and December 2020, and again about a year later.
The participants were on average 43.2 years old (SD 11.2). Just over half (54.9%) identified as Hispanic, and 15.3% identified as non-Hispanic Black.
Financial stress in this study meant how stressful people found it, over the past week, not to have enough money for basics, bills, pocket money or leisure. Depressive symptoms were measured with the PHQ-8 questionnaire and anxiety symptoms with the GAD-7. Perceived social support was measured once, at the start, and people were grouped into low, medium and high support.
Over the year, 60% of participants stayed in the same financial stress category, while financial stress improved for 20.3% and worsened for 19.7%.
After accounting for baseline symptoms and factors such as ethnicity, education, dependants, food insecurity and housing insecurity, worsening financial stress was linked to increases in both depressive and anxiety symptoms (p < 0.01 for each). The level of social support was not linked to changes in depressive symptoms (p = 0.83) or anxiety symptoms (p = 0.28). It also did not change the strength of the link between financial stress and symptoms (p = 0.51 for depression and p = 0.07 for anxiety).
The authors note that the results echo other studies from the pandemic. They suggest that financial strain during pandemics or recessions may outweigh the protective role that social support has shown in earlier studies carried out in more prosperous times. They argue that healthcare systems and policymakers should recognise the effect of financial stress on mental health, particularly among people on low incomes, and that interventions aimed directly at reducing financial stress may help.
The study has important limits. It was observational, so it cannot show that financial stress caused the changes in symptoms. The changes were not large enough to be clinically significant, although the authors say they may matter at population level. Support was measured only once and was based on perception, and the surveys did not ask directly how the pandemic had affected participants. The sample was made up of insured adults on low incomes attending an urban health system, with a higher share of Hispanic participants than the wider health system population, so the findings may not apply to people with higher incomes, uninsured or rural groups, or other countries.
The findings add to evidence that money worries weigh heavily on mental health, a theme Psychreg explores in its guide to how financial stress affects mental health. Research in the Philippines has also found money to be a leading source of stress, as Psychreg reported when it covered how money and faith shape the way Filipinos manage stress. For people already stretched, the study suggests that support from loved ones may not be enough on its own when finances get worse.
