Debt and mental health: new insights about the relationship and the importance of the measure of mental health

Overindebtedness, unemployment, and poor mental health - and the role of sense of control: a population-based Swiss study

Background

Both overindebtedness and unemployment are critical life events that can result in or lead to poor mental health. What is less known is that the two partly interrelated events frequently go along with a feeling of loss or lack of control in life, which could be the main reason why they are associated with poor mental health. This has not been examined in previous research, particularly not in this combination.

Methods

This study used and merged two cross-sectional data sets. Data collected in 2019 on 219 overindebted clients of the four official debt advisory centers in the Canton of Zurich were linked with a comparable subsample of 1,997 respondents from the Swiss Health Survey of 2017. The entire study population covered 2,216 adult individuals living in the Canton of Zurich.

Results

The prevalence of no or low sense of control, medium to high psychological distress, and moderate to major depression was much higher among the 44 solely unemployed (36/30/12%), the 189 solely overindebted (73/83/53%), and particularly among the 30 unemployed and overindebted (93/97/60%) than among all 1,953 other survey participants (21/13/7%). Unemployment, overindebtedness, and a (resulting) lack or loss of control were all found to be strong risk factors for the two mental health outcomes under study. Associations, or rather negative health effects, were partly but not fully mediated by the sense of control. Overindebtedness much more strongly predicted psychological distress (ß = -0.37) and depression (ß = 0.17) than unemployment (ß = -0.05/0.01). The sense of control turned out to be an independent explanatory factor for poor mental health and even the strongest of all (ß = 0.49/-0.59).

Conclusion

Improving a person's control beliefs could be a promising measure for preventing mental health disorders in general and in people who are unemployed and/or overindebted in particular.

The Impact Mechanism of Household Financial Debt on Physical Health in China

In recent years, Chinese household financial debt has been growing rapidly due to the expansion of mortgage lending. This study aims to examine the impact mechanism of Chinese household financial debt on physical health. Using the 2010-2018 China Household Tracking Survey (CFPS) panel data, we developed fixed effects models to explore the effect of household financial debt on individuals' psychical health, and we also used an instrumental variable to address endogeneity. The findings suggest that there is a negative effect of household financial debt on physical health and these findings still hold after a series of robustness tests. In addition, household financial debt can affect individuals' physical health through mediating variables, such as healthcare behaviors and mental health, and the effects are more significant for those who are middle-aged, married, and with low-income levels. The findings of this paper are important for developing countries to clarify the relationship between household financial debt and population health, and to develop appropriate health intervention policies for highly indebted households.

The impact of natural disasters on household debt: evidence from 2014 China family panel studies

Based on data from the 2014 China Family Panel Studies, we investigate the causal relationship between natural disasters and household debt using ordinary least squares and propensity score matching. This paper found that natural disasters can not only increase the probability of households owning debt but also have a significant positive impact on the number of household debt. The results of heterogeneity analysis show that natural disasters have a greater impact on families with large sizes and high-consumption levels. Mechanism checks suggest that household income and individual's health are shown to be the potential mechanism through which the impact of natural disasters on household debt.

Over-indebtedness and health in Switzerland: A cross-sectional study comparing over-indebted individuals and the general population

Background

Previous international studies have shown that over-indebtedness is associated with poor health. However, in Switzerland research addressing over-indebtedness is widely lacking, strongly needed and particularly important because it is evidently a rising but still commonly tabooed, socially “undesired” and highly stigmatized phenomenon that is rarely discussed and largely ignored and unexplored.

Methods

A cross-sectional survey was conducted among over-indebted adults seeking advice from one of the four official debt advisory centers in the Canton of Zurich. The survey finally included 219 respondents participating voluntarily and anonymously. This sample was then linked with a comparable subsample of the nationally representative Swiss Health Survey of 2017, namely 1,997 respondents of the same age from the Canton of Zurich. For reasons of comparability identical health questions and measures were taken from the Swiss Health Survey and used in the over-indebtedness survey. The pooled or combined dataset covered a total of 2,216 adult individuals.

Results

Remarkably high prevalence rates and relative risks of poor self-rated health, severe musculoskeletal and sleep disorders and moderate to severe depression were observed among over-indebted individuals compared to the general population. More than 50% of the over-indebted individuals had poor general health or moderate to severe depression compared to the general population with 14% and 7%, respectively. And far above one third of the over-indebted but ‘only’ between 6% and 8% of the general population showed severe musculoskeletal disorders and sleep disorders. Even after adjustment for various control variables and covariates, over-indebtedness increased the odds ratios for poor health outcomes consistently and dramatically, i.e. by a factor of 8 and more (aOR = 8.5–11.6).

Conclusions

Over-indebtedness in Switzerland has particularly negative effects on various aspects of the health of the persons concerned, irrespective of their demographic characteristics and their social and employment status.

Perceived manageability of debt and mental health during the COVID-19 pandemic: A UK population analysis

OBJECTIVES

This study examined the association between perceived manageability of debt and risk of depression, anxiety, and mental health help-seeking among a nationally representative sample of adults living in the United Kingdom (UK).

METHODS

Data was derived from the COVID-19 Psychological Research Consortium (C19PRC) Study Wave 6 (August/September 2021) which examined the psychological, social, and economic effects of the COVID-19 pandemic on the UK adult population. Bivariate and logistic regression analyses were conducted to determine the association between different levels of perceived debt manageability (i.e., "easily manageable", "some problems", "quite serious problems", "very serious problems", "cannot manage at all") and mental health related outcomes.

RESULTS

Almost a quarter of the sample (24%, n = 494) reported debt management problems, and debt manageability associated with higher levels of anxiety, depression, and mental health help-seeking. After adjusting for demographic variables (e.g. income, receipt of benefits), logistic regression analysis demonstrated a dose-response association between increasing levels of debt manageability problems and mental health outcomes. Specifically, adjusted odds ratios for anxiety ranged from 2.28 ('some problems') to 11.18 ('very serious problems'), for depression ranged from 2.80 ('some problems') to 16.21 ('cannot manage at all'), and for mental health help-seeking ranged from 1.69 ('some problems') to 3.18 ('quite serious problems', 'very serious problems').

CONCLUSION

This study highlights that debt manageability problems represent a robust predictor of depression, anxiety, and mental-health help seeking.

Debt Problem of One Partner and Depressive Morbidity in the Other: A 2-Year Follow-up Register Study of Different-Sex Couples in Sweden

This study sets out to examine whether depressive morbidity varies by status of financial indebtedness of a spouse or cohabiting partner. For this purpose, individuals aged between 20 and 60 with a different-sex spouse/cohabiting partner with a registration date for a debt at the Swedish Enforcement Authority (SEA) during 2017 (n = 6979) are followed-up for a 2-year period for prescriptions of antidepressants and compared with a sample from the general Swedish population (n = 29,708). The analysis is based on penalized maximum likelihood logistic regressions. Both women and men were more likely to suffer from depressive morbidity if the spouse/cohabiting partner had been registered at the SEA in 2017 and was still active for a debt in the SEA's register in 2018 (OR 1.31 and OR 1.57, respectively), irrespective of their own health, employment, socioeconomic status, and other background variables. This also held true for men if a wife/cohabiting partner had been registered at the SEA in 2017 but was no longer active for a debt in the SEA's register in 2018 (OR 1.29). For women, on the other hand, only those with no history (11-year period) of prescription of psychotropic medications were also at an enhanced risk of depressive morbidity if a husband/cohabiting partner had gone from being registered for a debt at the SEA in 2017, to not being registered as active for a debt in the SEA's register in 2018 (OR 1.24). The results reinforce the importance of acknowledging that negative effects of financial indebtedness extend beyond the individual debtor.

The Relationship Between Financial Worries and Psychological Distress Among U.S. Adults

This study examines the association between financial worries and psychological distress among US adults and tests its moderating effects by gender, marital status, employment status, education, and income levels. Data were derived from the cross-sectional 2018 National Health Interview Survey (NHIS) of the adult population. The hierarchical regression analysis revealed that higher financial worries were significantly associated with higher psychological distress. Additionally, the association between financial worries and psychological distress was more pronounced among the unmarried, the unemployed, lower-income households, and renters than their counterparts. The findings suggest that accessible financial counseling programs and public health intervention programs are needed to mitigate financial worries and its negative influences on overall psychological health, with greater attention devoted to vulnerable populations.

Long-Term Impact of Economic Downturn and Loneliness on Psychological Distress: Triple Crises of COVID-19 Pandemic

Background: The COVID-19 crisis poses global mental health and global economy challenges. However, there is a lack of longitudinal research investigating whether financial instability and social disruption may increase the risk of developing mental health problems over time that may potentially outlast the pandemic. Methods: We conducted an online survey for members of the general population (n = 2703) in Germany during the twelve months spanning from April 2020 to March 2021. We investigated the development of COVID-19 related psychological distress, the number of unemployed people, federal government debt, income distribution, and loneliness over the time period. Results: Over a period of twelve months, 53.6% of respondents in Germany reported experiencing psychological distress, varying from mild levels, 34.2%, to severe levels, 19.4%, of distress. High federal government debt, high incident COVID-19 cases, low incomes, and the prevalence of loneliness were found to be associated with increased long-term mental health problems. Psychological distress scores were most strongly increased in female and young respondents as well as those who reported fewer years of education, low income, and higher loneliness. Conclusions: Our study highlights factors that have a long-term impact on mental health amid the COVID-19 pandemic. We suggest that specific mental-health services could be offered to support high-risk groups experiencing financial fragility and loneliness. For purposes of safeguarding their mental health there is a need to monitor and track such risk factors in real time.

The Bidirectional Relationship Between Debts and Common Mental Disorders: Results of a longitudinal Population-Based Study

Researchers and politicians have regularly expressed their worries about a widening of socioeconomic inequalities in physical and mental health. Debts have been relatively understudied as a specific aspect of socioeconomic disadvantage contributing to poor mental health. This study examines the bidirectional association between debts and common mental disorders (CMDs) in the adult population of the Netherlands. Data were obtained from the second ('baseline') and third (3-year follow-up) wave of the Netherlands Mental Health Survey and Incidence Study-2, a representative cohort of adults. Questions were asked about debts and difficulty in repaying debts in the past 12 months. The answers were combined into one variable: no debts, easy, difficult, and very difficult to pay back debts. Twelve-month CMDs were assessed with the Composite International Diagnostic Interview version 3.0. Increasing levels of difficulty in repaying debts predicted onset of CMD at follow-up in those without 12-month CMD at baseline, and persistence of CMD at follow-up in those with 12-month CMD at baseline. Conversely, CMD was not linked to onset of debts at follow-up in those without 12-month debts at baseline, but was associated with persistence of difficulty to pay back debts at follow-up in those with 12-month debts at baseline. These associations remained significant after adjustment for baseline sociodemographic variables, negative life events and physical health. Health professionals and debt counsellors should pay more attention to patients' debts and clients' mental health respectively in order to refer those with financial or mental health problems to the appropriate services.

Association between household debt and depressive mood among Chinese residents

OBJECTIVES

The aim of this study was to examine the association of household debt and depressive mood among Chinese adults and to evaluate whether the association varies across types of debt.

STUDY DESIGN

This is a secondary data analysis of a nationally representative survey.

METHODS

A prospective cohort study of participants was drawn from the China Family Panel Studies (CFPS). In total, 5135 participants had their depressive mood measured in the CFPS starting from 2014 to 2016 and had participated in the biennial survey. We used logistic regression models to identify predictors of depressive mood with debts, sociodemographic factors, health status factors and health behaviors factors. Adjusted for all measured covariates, we conducted an independent analysis for the experience of housing loans from formal institutions (HLFI), other loans from formal institutions (OLFI), housing loans from relatives and friends (HLRF) and other loans from relatives and friends (OLRF).

RESULTS

Multiple logistic regression analyses revealed that household debt was a significant risk factor for depressive mood (1.35; 95% confidence interval [CI], 1.19-1.54), after controlling for potential confounders. Independent analysis revealed that HLFI was not a significant predictor, while HLRF (1.26; 95% CI, 1.08-1.48), OLFI (1.45; 95% CI, 1.13-1.87) and OLRF (1.23; 95% CI, 1.02-1.47) remained significant risk factors.

CONCLUSION

OLFI, HLRF and OLRF were associated with depressive mood, while HLFI was not. To address the problem of individual depressive mood, its apparent association with household debt should be paid more attention.

Relationship Between Debt and Depression, Anxiety, Stress, or Suicide Ideation in Asia: A Systematic Review

Background: This article aims to review research manuscripts in the past 5 years that focus on the effects of debt on depression, anxiety, stress, or suicide ideation in Asian countries. Methods: A search for literature based on the PRISMA guidelines was conducted on Medline, PubMed, Web of Science, Scopus, and ScienceDirect, resulting in nine manuscripts meeting inclusion criteria. The studies were conducted in Thailand, Korea, Singapore, Pakistan, India, Cambodia, and China. Results: The findings of the studies show that there is evidence to support that being in debt is related to Asian participants experiencing depression, anxiety, stress, or suicide ideation. However, the studies are limited to quantitative studies only. The definition of debt is also unclear in most manuscripts. Few manuscripts also examined how other factors influence the relationship between debt and mental illness. Conclusion: There are limited studies on the psychological effects of debt on the Asian population. Future studies should focus on the relationship between debt and psychological well-being among this population.

Financial Fraud, Mental Health, and Quality of Life: A Study on the Population of the City of Madrid, Spain

Over the past few decades, the financial system has engaged in abusive practices that meet the definition of fraud. Our objective is to compare the prevalence of psychological distress and levels of health-related quality of life according to having been exposed to financial fraud and its economic impact on family finances. The City of Madrid Health Survey 2017 included specific questions on exposure to financial fraud-this section was administered to half of the participants (n = 4425). Mental health need or caseness was defined by a score greater than two on the 12-item version of the Goldberg health questionnaire. Health-related quality of life was assessed by the Darmouth Coop Functional Health Assessment Charts/WONCA (COOP/WONCA). The prevalence of financial fraud was 10.8%. The prevalence rate ratio for caseness of those who experienced severe economic impact due to fraud was 1.62 (95%, CI 1.17-2.25; reference: no fraud), after adjustment by age, sex, social class, and immigrant status. Women experienced a decreased quality of life, even with a moderate impact of fraud, while men experienced a decreased quality of life related to fraud with severe economic impact. The current study contributes to a growing body of literature showing the effects of economic shocks on health as a result of financial fraud.