Economically speaking, poor mental health seems to relate more to a
person's debt load than how poor he or she may be.
Millions of Americans have watched in dismay as their investments have
plummeted in value during the country's economic downturn. Unemployment is
growing. Countless people are struggling to pay their mortgage while those who
can't have lost their homes. And what has now become a global financial crisis
is taking its toll on people's mental health, not just on their
A study reported in the October 2008 Psychological Medicine,
published by Cambridge University Press in England, found a strong link
between debt and mental illness. Almost a quarter of all people with mental
illness are in debt, compared with only 8 percent of people with no mental
illness, the study found.FIG1
The study, headed by Rachel Jenkins, M.D., a professor at the Institute of
Psychiatry in London, was based on a nationally representative sample of
people living in the United Kingdom—some 8,600 individuals. All were
assessed for anxiety and depressive disorders, psychosis, alcohol abuse, and
drug abuse. They were also asked detailed questions about their income and
debt. Jenkins and her colleagues then looked to see whether there were any
links between mental disorders and income or debt.
The researchers found that those subjects with a low income were twice as
likely to have a mental disorder as were those with a higher income. Also, the
more debts they had, the more likely they were to have some form of mental
The researchers then compared the relationship between income and mental
disorders with the relationship between debt and mental disorders. The
relationship between having a low income and having a mental disorder was
weakened when debt was considered. In contrast, the relationship between
having debt and having a mental disorder remained robust even when a low
income was considered, and it was only slightly weakened when other
sociodemographic variables were considered.
In fact, even after adjusting for income and other variables, the more
debts people had, the more likely they were to have a mental disorder overall,
an anxiety or a depressive disorder, psychosis, alcohol dependence, or drug
dependence. Also, people with six or more separate debts had a sixfold
increase in mental disorder after adjusting for income.
Thus, there may be a strong association not only between low income and
mental illness, but also between debt and mental illness, Jenkins and her team
concluded. But of the two associations, the latter seems to be more
The study was not designed to determine whether debt leads to mental
illness or whether mental illness leads to debt. However, “Both are
probably true,” Jenkins told Psychiatric News.
Truly, some of the study data could be used to argue either case. For
instance, that debt was found to be four times as prevalent among people with
psychosis as among people in good mental health suggests that serious mental
illness keeps people from holding down good jobs and thus puts them at risk of
going into debt. In contrast, that debt was found to be three times as
prevalent among people with an anxiety or a depressive disorder as among
people in good mental health implies that the stress of being in debt can
erode people's mental health.
In any event, the implications for psychiatrists are the same in either
case, Jenkins advised. They should assess the financial situations of their
patients, she said, and if their patients are in considerable debt, they
should refer them to a debt-management expert.
The study was funded by England's Department of Health, the Scottish
Executive Health Department, and the Welsh Assembly Government.
An abstract of “Debt, Income, and Mental Disorder in the
General Population” is posted at<http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=2178012>.▪