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

Abstract

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.

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

“…In recent years, many and mostly Scandinavian or Central European studies have investigated either the association between unemployment and mental health ( 2 , 4 , 9 , 11 , 18 , 23 , 29 ) or between overindebtedness and mental health ( 3 , 5 , 12 , 21 , 25–28 ). Only very few studies in the research literature have examined both relationships ( 3 ) or perceived sense of control as a potential mediator in one of these relationships ( 17 , 25 ).…”

“…In recent years, many and mostly Scandinavian or Central European studies have investigated either the association between unemployment and mental health ( 2 , 4 , 9 , 11 , 18 , 23 , 29 ) or between overindebtedness and mental health ( 3 , 5 , 12 , 21 , 25–28 ). Only very few studies in the research literature have examined both relationships ( 3 ) or perceived sense of control as a potential mediator in one of these relationships ( 17 , 25 ). And up to now, no other study has been published, particularly not for Switzerland, that has investigated both of these potential risk factors for mental health and additionally considered perceived sense of control as a potential mediator.…”

“…The present cross-sectional study is based on a combined set of survey data of 219 overindebted individuals at the age of 18 years or older and 1,997 representatives of the general resident population in the Canton of Zurich of the same age. Data were collected in the year 2019 in a full sample survey among overindebted adults seeking advice from one of the four official debt advisory centers in the Canton of Zurich and then linked with a comparable subsample of respondents of the nationally representative Swiss Health Survey of 2017 of the same age and canton of residence ( 25 ). The study population covered a total of 2,216 adult individuals, and the pooled dataset was restricted to responses to a limited number of identical health-related and other questions asked in both surveys.…”

“…Overindebtedness was measured simply by being a client of one of the four debt advisory centers of Canton Zurich and by having agreed to participate in the overindebtedness survey. In the experience of the debt advisors, already seeking advice from an official debt advisory center by definition means being overindebted or, more precisely, being hardly or no longer able to repay and/or service all debts and outstanding accounts fully and on time ( 1 , 25 ). As respondents of the Swiss Health Survey were not asked if they were overindebted or had sought debt advice and visited a debt advisory center, they were considered not being overindebted, even though a small proportion of them might meet the criteria and have insufficient household income to meet all payment obligations.…”

“…No descriptive statistics for the study population are shown here, as those details have already been provided in a previously published article using the same pooled data set ( 25 ). Frequency distributions of the mediator and the two outcome variables were first calculated and stratified by different subgroups of the study population (see Table 1 ) to gain a first impression of the emotional state and mental health condition of these mutually exclusive subgroups, which are characterized by different combinations of the presence or absence of unemployment and/or overindebtedness.…”