Purpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a “health self-management program” [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. Measures: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. Analyses: Multinomial logistic regression and post-hoc marginal effects models. Results: Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. Conclusion: Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.
Depressive symptoms and marital satisfaction in the context of chronic disease: A longitudinal dyadic analysis.
