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

Assets, 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. We address this gap using longitudinal cohort data collected from 2021 to 2023 across four timepoints. The sample comprised 831 women (M = 35.9 years old) living in Nawalpur, a rural district in the Gandaki province of Nepal; the majority of which were married (88%) and of Janajati caste/ethnicity (61%). Financial position was determined using household assets, depressive symptoms with the Patient Health Questionnaire-9, and financial stress with a single bespoke item. Direct and indirect effects were estimated using a cross-lagged panel mediation model (CLPM); we also conduct cross-sectional mediation models – of the sort typically employed in mediation analyses – for comparison and bias estimation. In the CLPM, financial stress significantly mediated the financial position-depressive symptom relationship between timepoints one and three, but not between timepoints two and four. 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 generally comparable. Our findings suggest that interventions components that address financial stress may help improve depressive symptoms. Methodologically, we argue that more researchers should employ longitudinal designs when investigating mediation processes.