Debt, income and mental disorder in the general population

Abstract

BackgroundThe association between poor mental health and poverty is well known but its mechanism is not fully understood. This study tests the hypothesis that the association between low income and mental disorder is mediated by debt and its attendant financial hardship.MethodThe study is a cross-sectional nationally representative survey of private households in England, Scotland and Wales, which assessed 8580 participants aged 16–74 years living in general households. Psychosis, neurosis, alcohol abuse and drug abuse were identified by the Clinical Interview Schedule – Revised, the Schedule for Assessment in Neuropsychiatry (SCAN), the Alcohol Use Disorder Identification Test (AUDIT) and other measures. Detailed questions were asked about income, debt and financial hardship.ResultsThose with low income were more likely to have mental disorder [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.68–2.59] but this relationship was attenuated after adjustment for debt (OR 1.58, 95% CI 1.25–1.97) and vanished when other sociodemographic variables were also controlled (OR 1.07, 95% CI 0.77–1.48). Of those with mental disorder, 23% were in debt (compared with 8% of those without disorder), and 10% had had a utility disconnected (compared with 3%). The more debts people had, the more likely they were to have some form of mental disorder, even after adjustment for income and other sociodemographic variables. People with six or more separate debts had a six-fold increase in mental disorder after adjustment for income (OR 6.0, 95% CI 3.5–10.3).ConclusionsBoth low income and debt are associated with mental illness, but the effect of income appears to be mediated largely by debt.

The relationship between personal unsecured debt and mental and physical health: A systematic review and meta-analysis

“…Debt also appears to be more common in suicide completers , (Chan et al, 2009;Chen et al, 2006;Wong et al, 2008;, and increases the risk of suicidal ideation and attempts after controlling for possible confounds such as mental illness (Hintikka et al, 1998;Meltzer et al, 2011). Individual studies have shown a relationship with drug use, problem drinking and drug dependence as well as tobacco smoking (Berg et al, 2010;Jenkins et al, 2008;Meltzer et al, 2013;Nelson et al, 2008;Roberts et al, 1999;2000;Stuhldreher et al, 2007;Webley & Nyhus, 2001). In terms of mental health, many studies have shown a relationship with common mental disorders (Clark et al, 2012;Cooper et al, 2008;Meltzer et al, 2013;Patel et al, 1998;Pothen et al, 2003), and global mental health as measured by the General Health Questionnaire (Goldberg, 1991Brown et al, 2005Finlay-Jones & Eckhardt, 1984;Gathergood, 2012;Hatcher, 1994;Hintikka et al, 1998;Roberts et al, 1999;2000).…”

“…Similarly debt is defined differently. For example for the analysis on problem drinking, Jenkins, et al (2008) defined debt as being currently behind on a tax or bill, whereas Stuhldreher, et al (2007) look at those who have been in debt due to gambling.…”

“…Jenkins, Fitch, et al (2009) reported descriptive statistics only, as did Hintikka, Kontula, Saarinen, Tanskanen, Koskela, and Viinamäki (1998) who reported a greater likelihood of scoring above cut-off on the GHQ in those with debt. Effects were found for neurotic disorders, psychotic disorders, alcohol and drug dependence specifically (Jenkins, Bebbington, et al, 2009;Jenkins, et al, 2008;Meltzer, et al, 2013) as well as depression (Meltzer, et al, 2010;Zimmerman & Katon, 2005). Dose-response effects were also found for number of debts and risk of mental disorder Meltzer, et al, 2013).…”

Family contexts and adolescents' emotional status

“…Poor (mental) health is often associated with less engaged parenting and a reduced ability to emotionally attend and respond to children's needs; these, in turn, can affect the psychological and emotional well-being of children. In addition, it should be underlined that the economic resources and mental health of parents are not independent of each other: economically disadvantaged individuals are more likely than advantaged ones to experience psychological problems (for example, see Readings and Reynolds, 2001); but, in turn, socio-economic deprivation and financial difficulties frequently coincide with mental health difficulties (Hudson, 2005;Jenkins et al, 2008). On the other hand, the literature documents that both the material resources and the parents' health vary considerably across living arrangements.…”

Inpatient Profile of Patients with Major Depression in Portuguese National Health System Hospitals, in 2008 and 2013: Variation in a Time of Economic Crisis

“…Factors like household indebtedness, unemployment and impoverishment are potentiated in times of economic crisis and play a crucial role in the development of mental illnesses (Jenkins et al 2008;Reading and Reynolds 2001;Skapinakis et al 2006;Taylor et al 2007; WHO 2011) predisposing people to a higher risk of mental health problems such as major depression, alcohol consumption and suicide (Dee 2001;Dooley et al 1994;Dorling 2009;Lewis and Sloggett 1998;Mathers and Schofield 1998;McKee-Ryan et al 2005;Murphy and Athanasou 1999).…”