Middle-income Americans pulled back on spending this past holiday season, according to the Consumer Reports Index, an overall measure of Americans' personal financial health.

The monthly Index comprises five measures: Employment, Retail, Sentiment, Stress, and the Trouble Tracker.

The Trouble Tracker, a measure of the financial difficulties faced by Americans, was little changed overall, though for those earning $100,000 or more it dropped to 19.6 from 33.2 a month earlier. Troubles were on the rise for Americans earning less than $50,000, climbing to 65.8 from 59.6.

The most prevalent consumer troubles overall:

• Inability to afford medical bills or medications (12.7 percent).
  
• Lost or reduced health care coverage (8.2 percent).
  
• Missed payments on a major bill, not including mortgage: (6.6 percent).

Job losses are outpacing job starts. The Index's employment measure declined for the second straight month, falling to 48.8 from 49.7, and is now at its lowest level since March 2010. Job starts in the past 30 days fell to 3.4 percent from 5.4 percent, while job losses remained elevated and unchanged, at 5.8 percent.

"These indicators make a poor case for anyone claiming a majority of Americans are ready to reengage in the economy," says Ed Farrell, director of consumer insight at the Consumer Reports National Research Center. "This month, middle-income families will be confronted by a paycheck that is lower than last month, and for some lower than last year, due to expiration of the payroll tax cut. If they're already not interested in spending, having less money to spend isn't going to help."

Despite the personal financial headwinds, consumer sentiment edged up, to 51.2 from 49.9, with modest gains across all income groups.

The Consumer Reports Index, a monthly telephone poll of a nationally representative sample of American adults, is conducted by the Consumer Reports National Research Center. A total of 1,002 interviews were completed January 3-6, 2013. The margin of error is +/- 3.2 percentage points at a 95 percent confidence level.

Previously: Consumer Reports Index: Sentiment among wealthier Americans drops sharply