The Financial Well-Being Scale: Reliability,Validity,and Clinical Correlates Among Childhood Trauma Survivors

Abstract

Purpose

This study examined the reliability, validity, and clinical correlates of the financial well-being as measured using the CFPB Financial Well-Being Scale (FWBS) among Chinese childhood trauma survivors.

Methods

The sample consisted of childhood trauma survivors in a survey project (n = 151), with a subsample at follow-up approximately 5 months after baseline (n = 71). Participants first completed validated screening measures of financial well-being and mental health symptoms at baseline (T1), and then reported their symptoms again at follow-up (T2).

Results

Financial well-being is reliably and validly measured using the FWBS in this sample. T1 financial well-being significantly predicted disturbances in self-organization (β = −.238, p = .01) and depressive symptoms (β = −.239, p < .01) at T2.

Discussion

Financial well-being is a reliable and valid construct in this sample. Financial well-being predicted psychological symptoms among childhood trauma survivors. Trauma care services should take financial well-being into consideration.

Keywords

Financial well-being childhood trauma depression posttraumatic stress disorder (PTSD)complex PTSD

Childhood Trauma Survivors Are at an Increased Risk of Developing Physical and Mental Health Problems

Childhood trauma has been gaining significance in the fields of public health and social work as there is increasing empirical evidence linking it to various physical and psychological health outcomes. Childhood trauma encompasses maltreatment such as physical and psychological abuse, neglect, as well as exposure to domestic violence and caregivers with mental illnesses (Choi et al., 2020; Cronholm et al., 2015; Fang et al., 2015). The meta-analysis conducted by Hughes et al. (2017) indicated that 33% to 88% of the global population have been exposed to childhood trauma and adversities, such as physical abuse and family violence.

There is robust evidence that supports the positive association between childhood trauma and physical, mental, and behavioral problems, including but not limited to stroke, diabetes, depression, anxiety, as well as risk-taking and violent behaviors (Byansi et al., 2023; Hughes et al., 2017; McKay et al., 2021; Merrick et al., 2017; Poole et al., 2017; Tomlinson et al., 2024; Watt et al., 2020; Zhang et al., 2020; Zhang et al., 2024). Zhang et al. (2024) studied 18,723 university students and reported that students exposed to four or more types of childhood adversities had nearly doubled the risk of cardiometabolic diseases and tripled the risks of severe anxiety symptoms and bipolar disorder or schizophrenia compared to students without exposure to childhood trauma or adversities.

Financial Conditions Play a Crucial Role in the Recovery of Childhood Trauma

Aside from health problems, a link between childhood adversities and financial well-being and financial insecurity about everyday life expenses in adulthood has also been found across income levels (Harter & Harter, 2022). A study which employed a prospective cohort design demonstrated that abused and neglected children were more likely to experience longer-term economic consequences as they tend to have a lower level of employment, earnings, and education (Currie & Widom, 2010).

While individuals with childhood trauma are more likely to experience physical and mental health issues and financial problems, financial well-being, defined as having financial security and freedom of choice in the present and future (Consumer Financial Protection Bureau, 2015), constitutes a key factor in recovery. Trauma survivors typically experience “resource loss,” be it psychosocial or material, or both, hindering their potential to escape from abusive environments and embark on the path to recovery (Cloitre et al., 2020). As a result, financial resources are pivotal in their recovery journey, as they may increase their ability to move away from their abusers, such as moving to a new, stable housing and making a living (Herman, 1992). A prospective study by van der Velden et al. (2023) investigated the associations between traumatic events, financial well-being, and anxiety and depressive symptoms, and reported the bidirectional relationships. The results show that trauma survivors who have pre- and/or post-trauma financial problems have a higher risk of anxiety and depressive symptoms than those without financial problems. They are also three times more likely to develop posttraumatic stress disorder (PTSD) compared to non-victims with persistent financial problems (van der Velden et al., 2023). Another systematic review by Guan et al. (2022) examined the relationship between financial stress and depression in adults, where the studies demonstrated a positive correlation between debt and common mental disorders, including depression. Their results also showed that low income was significantly associated with depression across low, middle, and high-income countries, while both cross-sectional and longitudinal studies reported a positive relationship between subjective financial strain and depression.

The social causation theory has been applied to explain the association between financial well-being and mental health (Guan et al., 2022). The social causation theory states that one's economic condition is a determinant of his/her mental health (Jin et al., 2020; Lund & Cois, 2018). People with a higher socioeconomic status enjoy better mental health as they have better living conditions, easier access to healthy and nutritious food, and more social and medical resources. In contrast, individuals who have lower wealth are more susceptible to mental health problems due to financial stress, worse living environment, malnutrition, limited access to healthcare services, and less social capital (Jin et al., 2020; Kim et al., 2016; Lund & Cois, 2018).

The Present Study

Although financial insecurity has been identified as a significant risk factor for mental health problems, less is known about the validity of financial well-being measures among childhood trauma survivors (de Oliveira Cardoso et al., 2023). More studies are also needed to understand the potential effects of financial well-being on clinical outcomes among childhood trauma survivors, as most previous studies used a cross-sectional design (Guan et al., 2022). Therefore, this study aimed to fill these gaps by examining: 1) the reliability and validity of the CFPB Financial Well-Being Scale among childhood trauma survivors in the Chinese context, 2) the prevalence of financial difficulties in our sample, and 3) the cross-sectional and longitudinal clinical correlates of financial well-being. Informed by the aforementioned literature, we hypothesized that baseline financial well-being would predict subsequent levels of psychological symptoms (including PTSD, disturbances of self-organization [DSO], and depressive symptoms) among childhood trauma survivors.

Method

Participants

We analyzed data from a survey project which aimed to examine the psychological and social correlates of mental health issues among Chinese-speaking adults. The project obtained ethical approval at Hong Kong Baptist University. In 2023, potential participants were recruited through online advertising on social media platforms. The inclusion criteria were as follows: 1) aged 18 or above, 2) being able to read and write Chinese, and 3) agreeing to provide online informed consent to participate. Participants were excluded if they reported having a diagnosed reading disorder, dementia, or intellectual disabilities. For the purpose of this study, only participants who reported at least one childhood traumatic experience on the Brief Betrayal Trauma Survey and passed validity checks on their responses were included for analysis. Therefore, a total of 151 participants exposed to childhood trauma were included in this study. After an average of 162.8 days (SD = 12.85), a subsample (n = 71) further completed a follow-up survey (retention rate = 47.0%).

Measures

Demographic Variables

At baseline, participants were asked to report their age, gender, education level, and whether they attended any psychiatric appointments in the past 12 months.

Brief Betrayal Trauma Survey (BBTS)

The BBTS is a self-reported measure with 24 items, assessing 12 different traumatic experiences. It specifically quantifies childhood betrayal trauma, childhood non-betrayal trauma, adulthood betrayal trauma, and adulthood non-betrayal trauma. The 3-year test-retest reliability of the BBTS was reported to be good, with agreement percentages of 83% and 75% for childhood trauma and adulthood trauma, respectively, in an adult community sample (Goldberg & Freyd, 2006). In addition, the Chinese version of the BBTS has been used in previous studies (Chiu et al., 2010) and was found to be reliable among Hong Kong samples. For each item, “never,” “one or two times,” and “more than that” were all possible responses, whereas those apart from “never” were regarded as positive. All four types of traumatic experiences were calculated. Cronbach's alpha for the BBTS in the present sample was .808.

Financial Well-Being

The Consumer Financial Protection Bureau's (CFPB) Financial Well-Being Scale (FWBS) is a self-reported measure of financial well-being with 10 items. Financial well-being is a state where an individual can fully meet current and ongoing financial obligations, feel secure in their financial future, and make choices that allow them to enjoy life (Consumer Financial Protection Bureau, 2015). The CFPB FWBS has demonstrated high marginal reliability from .89 to .90 for adults aged 18 to 61 (Consumer Financial Protection Bureau, 2017). In this study, a collaborative approach (Chan et al., 2017) was used to translate the FWBS into Chinese. First, two translators (one linguistics scholar and one clinical psychologist) independently translated the FWBS into Chinese. Second, the two Chinese versions were reviewed and compared in a work group, which included the two translators and two additional social work and psychology researchers. Finally, the work group reached a consensus and came up with a final Chinese version of the FWBS. Cronbach's alpha for the Scale in the present sample was .828.

Financial Distress Scale

Two items related to emotional distress due to financial challenges from the APR Financial Stress Scale by (Heo et al., 2020) were included in this study. The two items included the following: “I feel sad because of my financial situation” and “I feel anxious because of my financial situation” (1 = Strongly Disagree, 5 = Strongly Agree). In a sample of 789 Chinese young adults, the two items had excellent reliability (α = .920) and were strongly correlated with interpersonal problems due to financial challenges (r = .499, p < .001) (unpublished data of Fung & Cheung, 2024). The Cronbach's alpha for this measure was .930 in the present study.

International Trauma Questionnaire (ITQ)

The ITQ is an 18-item self-reported measure that examines both the symptom clusters of PTSD (i.e., re-experiencing, avoidance, sense of current threat) and DSO (i.e., affective dysregulation, negative self-concept, and disturbances in relationships) recognized in the ICD-11 (Cloitre et al., 2018). DSO symptoms are one of the core features of complex PTSD and they differentiate between classical and complex PTSD. The ITQ has high internal consistency (α = .89 to .94) and concurrent validity (r = .89) with another PTSD measure (Cloitre et al., 2021). The Chinese version of the ITQ has also been validated in a previous study (Ho et al., 2019). Cronbach's alpha for the ITQ in the present sample was .933.

Patient Health Questionnaire (PHQ-9)

The PHQ-9 is a self-reported measure for DSM-5 depressive symptoms with 9 items and a possible range from 0 to 27. It is internally consistent (α = .86), with good test-retest reliability (r = .84) and concurrent validity (r = .77) with the Beck Depression Inventory (BDI-II) (Kroenke et al., 2001; Kung et al., 2013). Additionally, the Chinese version of the PHQ-9 has demonstrated decent diagnostic validity, where a cutoff score of 15 was found to have a sensitivity of 81% and a specificity of 98% (Yeung et al., 2008). Cronbach's alpha for the PHQ-9 in the present sample was .901.

Data Analysis

Statistical analysis was conducted using IBM SPSS Statistics 22.0. Descriptive statistics were used to interpret the sample characteristics. Pearson's correlation analysis was conducted to examine the relationship between financial well-being and financial distress, as well as the correlates of financial well-being. Further analysis was also conducted using hierarchical multiple regression to investigate whether financial well-being could predict PTSD, DSO, and depressive symptoms in the follow-up sample, after controlling for demographic variables and the severity of the dependent variable at baseline.

Results

Descriptive Statistics and Cross-Sectional Correlates of Financial Well-Being

The sample characteristics and cross-sectional correlational analyses among variables at both T1 (n = 151) and T2 (n = 71) are reported in Table 1.

Table 1.

Descriptive Statistics and Correlations Among Variables at T1 (n = 151) and T2 (n = 71)

			Correlation (Pearson)
Variables (T1)	Mean (SD)	Frequency (%)	T1 Depressive	T1 PTSD	T1 DSO	T2 Depressive	T2 PTSD	T2 DSO
Age	30.42 (12.68)		−.29***	−.18*	−.34***	−.24*	−.32**	−.26*
Gender (Female)		121 (80.13)	.10	.10	.14	.06	−.02	.01
Education level (Undergraduate or above)		102 (67.55)	.03	.01	.05	−.10	−.23	−.21
Psychiatric appointment (Past 12 months)		51 (33.77)	.28***	.40***	.27***	.12	.30*	.08
Financial well-being	17.12 (8.16)		−.38***	−.29***	−.32***	−.34**	−.11	−.35**
Financial distress	6.44 (2.71)		.37***	.28***	.34***	.31**	.10	.19
Depressive symptoms	13.78 (7.24)		/	/	/	.46***	.46***	.44***
PTSD symptoms	12.36 (6.51)		.53***	/	/	.37**	.56***	.33**
DSO symptoms	14.42 (6.38)		.78***	.54***	/	.48***	.58***	.65***
Childhood trauma	3.26 (2.21)		.18*	.27***	.12	.14	.13	−.05

Notes. *p < .05 **p < .01 ***p < .001

At baseline, the FWBS was reliable (α = .828) and was highly, negatively correlated with financial distress (r = −.70, p < .001), indicating its internal consistency and concurrent validity. In addition, the FWBS was correlated with depressive symptoms (r = −.38, p < .001), PTSD symptoms (r = −.29, p < .001), and DSO symptoms (r = −.32, p < .001). Conversely, financial distress was positively correlated with depressive symptoms (r = .37, p < .001), PTSD symptoms (r = .28, p < .001), and DSO symptoms (r = .34, p < .001). These findings indicated that, among the current sample of childhood trauma survivors, the higher the FWBS scores, the lower the level of financial distress, and the fewer the clinical symptoms participants reported having.

Frequency of Financial Difficulties in the Current Sample

Adopting questions from the CFPB Financial Well-Being Scale, the financial difficulties reported by participants at T1 (n = 151) are shown in Table 2. Noteworthily, only 35.1% reported that they could secure their financial future (item 2), and only 44.4% reported that they had no money left at the end of the month (item 8).

Table 2.

Participants who Reported Financial Difficulties (Always or Often) at T1 (N = 151)

CFPB Financial Well-Being Scale	Frequency (%)
1. I could handle a major unexpected expense.	21 (13.9)
2. I am securing my financial future.	53 (35.1)
3. Because of my money situation, I feel like I will never have the things I want in life.	55 (36.4)
4. I can enjoy life because of the way I’m managing my money.	16 (10.6)
5. I am just getting by financially.	77 (51.0)
6. I am concerned that the money I have or will save won’t last.	101 (66.9)
7. Giving a gift for a wedding, birthday or other occasion would put a strain on my finances for the month.	41 (27.2)
8. I have money left over at the end of the month	67 (44.4)
9. I am behind my finances.	76 (50.3)
10. My finances control my life.	67 (44.4)

Could Financial Well-Being at T1 Predict Depressive, PTSD, and DSO Symptoms at T2?

From our Pearson's correlation analyses (see Table 1), baseline FWBS scores were negatively correlated with depressive symptoms (r = −.34, p < .01) and DSO symptoms (r = −.35, p < .01) at T2, but not PTSD symptoms (r = −.11, p = n.s.). In our further investigation using hierarchical multiple regression models, the results demonstrated baseline FWBS scores significantly predicted subsequent levels of depressive symptoms (β = −.239, p < .01) and DSO symptoms (β = −.238, p = .01), but not PTSD symptoms (β = −.002, p = .986), among the follow-up sample, after controlling for the demographic variables (i.e., age, gender, education level), psychiatric appointments in the past 12 months, exposure to childhood trauma, and baseline score on respective scales. The regression results are reported in Table 3. These longitudinal analyses provide preliminary evidence on the significant predictive power of baseline financial well-being on subsequent depressive and DSO symptoms at follow-up.

Table 3.

Hierarchical Multiple Regression Predicting T2 Depressive, PTSD, and DSO Symptoms (N = 71)

	T2 depressive symptoms		T2 PTSD symptoms		T2 DSO symptoms
	Step 1	Step 2	Step 1	Step 2	Step 1	Step 2
Variables	β	β	β	β	β	β
Age	−.222*	−.161	−.321**	−.321**	−.157	−.097
Gender	−.014	−.030	−.092	−.093	−.025	−.042
Education level	−.112	−.085	−.181	−.181	−.233*	−.207*
Psychiatric appointment	−.080	−.052	.060	.060	−.055	−.034
Childhood trauma	.135	.159	<.001	<.001	−.024	−.001
T1 Score (DV)	.453***	.412***	.493***	.492***	.623***	.607***
T1 Financial well-being	/	−.239*	/	−.002	/	−.238*
F	4.172**	4.455***	8.458***	7.136***	10.338***	10.696***
Adjusted R²	.214	.257	.390	.380	.445	.492
ΔR²	.281	.050	.442	<.001	.492	.051
ΔF	4.172**	4.703*	8.458***	<.001	10.338***	7.015*

Notes. *p < .05 **p < .01 ***p < .001.

Discussion and Applications to Practice

This study aimed to increase our understanding of the frequency, reliability, and validity of financial well-being (as measured using the FWBS) in our sample of childhood trauma survivors, as well as the cross-sectional and longitudinal correlates of financial well-being. We found that a majority (66.9%) of our participants reported concerns in saving money at baseline. While our sample is not representative of all childhood trauma survivors, it implies that Chinese survivors may commonly encounter financial difficulties. As childhood trauma could negatively affect one's social-interpersonal skills, including leadership (Lam, Fung & Lee, 2024), future studies need to examine whether financial difficulties could, at least indirectly, result from childhood trauma. In fact, saving is commonly emphasized and valued in Chinese cultures, future studies should also consider the potential influences of cultural factors on the prevalence and effects of financial difficulties in trauma survivors as well as in the general population.

Apart from being one of the first few studies examining the potential mental health effects of financial well-being among childhood trauma survivors (de Oliveira Cardoso et al., 2023), there are several significant findings in this study. First of all, the FWBS was shown to be a reliable and valid instrument in our sample of Chinese childhood trauma survivors. On top of that, we used it to measure and demonstrate the prevalence of financial difficulties in our current sample. Moreover, our adoption of longitudinal analyses on top of cross-sectional data has allowed us to unravel not only the mental health issues associated with financial well-being, but also the direction of their relationship. Most importantly, we have identified financial well-being to be a predictor for subsequent DSO and depressive symptoms.

The predictive power of financial well-being on subsequent depressive symptoms in our sample was in line with a previous finding, where financial strain was significantly associated with depression (Guan et al., 2022). On the other hand, contrary to a prior study by van der Velden et al. (2023), financial well-being was unable to predict subsequent PTSD in our sample, although it was shown to be a significant predictor for subsequent DSO symptoms. Of note, our findings were nevertheless in congruence with the Social Causation Theory, where the economic condition is regarded as a social determinant of mental health (Jin et al., 2020; Lund & Cois, 2018). Under lower levels of financial well-being, existing DSO and depressive symptoms in childhood trauma survivors were aggravated, as a result of the interactions between environmental factors and their mental health challenges (Jin et al., 2020; Kim et al., 2016; Lund & Cois, 2018). For instance, they might face chronic stress due to insufficient income to support their daily life, unable to be independent and move away from abusive environments, nor having the ability to utilize financial resources that may alleviate their psychological burden (e.g., seeking mental healthcare).

Our findings demonstrated that childhood abuse survivors may commonly encounter financial adversities in their adulthoods (see Table 2), and that financial well-being plays a significant role in predicting their subsequent levels of DSO and depressive symptoms. These shed light on the importance of evaluating one's financial security and stability as part of clinicians’ comprehensive assessment, as financial distress can exacerbate one's mental health symptoms in the long run, particularly among trauma survivors. It is crucial for frontline health and social care service providers, including social workers, to promote and incorporate early interventions (e.g., financial education workshops) in their practices, and to advocate for programs that support childhood trauma survivors’ financial well-being through timely and effective case management and referrals (e.g., public assistance benefits). While studies examining the effectiveness of the above-mentioned preventive measures and empowerment-based interventions are limited in the context of childhood trauma survivors, existing works on survivors of intimate partner violence, whose biggest barrier to leaving the abusive relationships is often the lack of financial resources, have found the potential benefits and importance of incorporating financial literacy intervention that aims to increase their financial empowerment and sense of financial well-being (Johnson, 2021; Stylianou et al., 2019).

Despite its strengths of using validated measures for financial well-being and employing a longitudinal design, this study has a few limitations. Firstly, our sample size at follow-up was relatively small, due to a relatively high attrition rate (53.0%). Secondly, although we included both cross-sectional and longitudinal analyses, causal conclusions could not be made necessarily regarding our sample. Thirdly, a majority of our sample were females and had received post-secondary education. Last but not least, the PTSD, DSO and depressive symptoms of our participants were measured by self-reported instruments, instead of structured diagnostic interviews. Therefore, future studies should use larger and more representative samples with a larger variability and a higher retention rate. Future studies can also use clinical interviews and/or medical records to determine the severity of symptoms among the participants. Some existing studies also found the mediating role of financial well-being on the relationship between financial literacy (i.e., one's financial knowledge, behaviors, and attitudes) and socioeconomic status among low-income households in general (Munisamy et al., 2022). It might be worth exploring the roles financial literacy and objective/subjective socioeconomic status play on the financial well-being of childhood trauma survivors coming from different socioeconomic backgrounds. In spite of the above limitations, we hope that this study can raise awareness of how financial well-being might affect childhood trauma survivors in health and social service settings.

Footnotes

Acknowledgements

None.

Author Contributorship

HWF contributed to the conceptualization and study design. HWF collected the data. CHOH, RHLL and HWF conducted data analysis. CHOH, RHLL and KYS prepared the first draft. HWF and JYHW provided supervision and overall guidance regarding the interpretation of the findings. All authors provided critical comments regarding the first draft and contributed to the revision of the manuscript. All authors read and approved the final manuscript.

Availability of Data and Material

The dataset generated and analyzed during the current study is available from the corresponding author (HWF) on reasonable request.

Code Availability

Not applicable.

Consent to Participate

Online written informed consent was obtained from all participants before study participation.

Consent for Publication

Not applicable.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics Approval

The paper analyzed data from a survey project, which obtained ethical approval from the institutional review board at the Hong Kong Baptist University. All participants provided online written informed consent before they completed the survey.

Financial Disclosures

None to declare.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Ka Yan Sit

Hong Wang Fung

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