Individuals with disabilities are at higher risk of experiencing material hardship, defined as difficulty accessing essential needs such as housing, food, and healthcare. The social model of disability emphasizes that structural factors, including discrimination and inadequate social services, create obstacles to meeting basic needs.1 For example, common stereotypes—such as perceiving individuals with disabilities as dependent or less capable—can trigger emotions like fear or pity, which can in turn hinder their social participation and discourage them from seeking support when they need help.2 Also, employers may fail to recognize or accommodate their social inclusion needs in the workplace.3

Building on such notions, some types of hardship can manifest for persons with disabilities. For example, individuals with disabilities often face higher healthcare costs due to increased medical needs and the use of services that are not fully covered by the public health system.4 These expenses often force individuals to reduce spending on essentials like housing and food. Healthy food remains expensive, and specialized diets further increase financial strain.5 Also, accessible and affordable housing is scarce, with individuals often facing additional costs for modifications and accommodations.6 In some cases, they may face stigmatizing attitudes by house providers and agents, or denial for reasonable accommodations.7

A set of such hardships can pose a risk to one's psychological health. An important underlying mechanism in this link is the disruption of ontological security—the sense of stability, continuity, and predictability in one's life. For example, people often feel helpless and anxious about the future when they are unable to pay for basic requirements.8, 9, 10 In addition, interpersonal conflict—particularly within families—is often exacerbated by financial strain. For example, tension among family members is often increased by disagreements over financial priorities brought on by a lack of resources.11 Over time, financial strain can erode emotional support networks, making it more difficult for individuals to manage stress effectively.

Beyond these broader psychological impacts, specific types of material hardship can have a direct and distinct impact on psychological health.12 Prior research suggests that food hardship frequently leads to dietary shortages in important vitamins and minerals (e.g., iron, B vitamins, and omega-3 fatty acids), all of which play an important role in mood regulation.13 when physical and psychological health issues go untreated, they tend to worsen over time, ultimately creating a cycle of poor health and psychological stress.14 Last, housing issues —such as overcrowded conditions and frequent relocations—can disrupt social networks, making it harder for individuals to maintain emotional support.

More importantly, an individual's psychological state plays a crucial role in resilience against immediate and acute stressors. For instance, individuals with better psychological health at the onset of hardship are more likely to interpret and assess stressors constructively, viewing challenges as manageable rather than overwhelming. This is because psychological resilience allows them to draw on coping strategies and a positive mindset,15 helping them reframe difficulties in a way that minimizes stress and promotes adaptive responses. Also, they are better positioned to seek social support when in need, gather relevant information, and develop problem-solving strategies to cope with difficulties.16 In other words, psychological resources, such as emotional stability and cognitive coping skills, act as protective factors that buffer against distress.17 Relatedly, existing studies documented that when people are faced with stressors, such as job loss18,19 and housing problems,17,20 their better psychological health at baseline helps mitigate the negative effects on health.

People with disabilities in Korea face significant material hardship for various reasons. Approximately 40 % of households that include persons with disabilities live below the poverty line—nearly double the national poverty rate for all households.21 Despite efforts to promote inclusion, they continue to face socioeconomic challenges, including discrimination in a daily life and a lack of tailored services.22 In Korea, studies documented that socioeconomic status, such as lower income and employment status are related to physical and psychological health of persons with disability,23 thereby causing persistent social isolation and exclusion.24 While such conditions provide a foundation for identifying the socioeconomic factors affecting psychological health, the ways in which different types of material hardship pose a threat to health remain understudied.

Using large-scale, nationally representative datasets of people with disabilities in Korea, this study seeks to examine whether and how material hardship threatens psychological health in this population. A key focus is whether the association between material hardship and psychological health varies across the distribution of psychological health, with baseline psychological health potentially serving as an indicator of individual resilience. Additionally, considering that housing, food, and healthcare have distinct characteristics as essential goods and services, the study explores whether the effects of material hardship differ by the type of goods and services.