Socio economic deprivation is an important risk factor for poor physical and mental health. A study of 65 countries by WHO showed that rates of depression varies by levels of income equality. Unemployment and financial hardship are shown by evidence to be the likely mediators between class and illness. Another measure linking these two is debt.Debt levels have recently increased in many communities across the globe.In US there is 660 billion dollars of outstanding debt. In UK, this is 156 billions ( unsecured debt).
Is there evidence to support the link between debt and health? Thomas Richardson , Peter Elliott and Ronald Roberts ( from Universities of Southampton and Kingston, UK) systematically reviewed the published literature to answer this question.
All research studies that examined the relationship between personal unsecured debt ( not secured loans or mortgages) and physical health, mental health, drug or alcohol problems or suicide were included. 65 papers met the inclusion criteria.
Nearly 80% of studies reported that being in debt was related to worse health. 42% of those with debt had a mental disorder compared with 18% who had no debt. Among those with mental disorder, 25% were in debt, while only 9% of those without mental disorder were in debt. There was a statistically significant relationship between debt and presence of a mental disorder, depression, suicide completion, suicide completion or attempt, problem drinking, drug dependence, neurotic disorders and psychotic disorders.
The OR for having a mental disorder while in debt is 3.24. For completed suicide this is 8.
Limitations: Most studies are cross-sectional and hence casuality cannot be established. Longitudinal studies lacked standardised measures of health. There are no prospective cohort studies in this area. Bias is possible with self rated health measures.
Comments– RCpsych has previously suggested professionals to specifically ask about debt during assessments. Given the recession and austerity environment, services need to bolster debt relief programmes for better community and individual health outcomes.
Summary of the article:
Richardson T, Elliott P, Roberts R. Clin Psychol Rev. 2013 Sep 10;33(8):1148-1162