This paper systematically reviews the relationship between personal unsecured debt and health. Psychinfo, Embase and Medline were searched and 52 papers were accepted. A hand and citedby search produced an additional 13 references leading to 65 papers in total. Panel surveys, nationally representative epidemiological surveys and psychological autopsy studies have examined the relationship, as have studies on specific populations such as university students, debt management clients and older adults. Most studies examined relationships with mental health and depression in particular. Studies of physical health have also shown a relationship with self-rated health and outcomes such as obesity. There is also a strong relationship with suicide completion, and relationships with drug and alcohol abuse. The majority of studies found that more severe debt is related to worse health; however causality is hard to establish. A meta-analysis of pooled odds ratios showed a significant relationship between debt and mental disorder (OR=3.24), depression (OR=2.77), suicide completion (OR=7.9), suicide completion or attempt (OR=5.76), problem drinking (OR=2.68), drug dependence (OR=8.57), neurotic disorder (OR=3.21) and psychotic disorders (OR=4.03). There was no significant relationship with smoking (OR=1.35, p>.05). Future longitudinal research is needed to determine causality and establish potential mechanisms and mediators of the relationship.Dr Bellack, Please find attached a response to the reviewer's comments and an amended manuscript. We hope that these changes address the concerns raised, and the paper can now be accepted for -This relationship is especially strong for mental health in particular depression.-There are also relationships with substance use and suicide.-Research suffers from inconsistent use of standardised measures.-A lack of longitudinal studies makes it difficult to demonstrate causality. *Highlights (for review)We would like to thank the reviewer for their detailed comments. In relation to these we have made the following changes, which have all been marked in the main manuscript via track changes:-We have now clarified in the title, abstract, introduction, discussion and highlights that this examines personal unsecured debt specifically.-In the Method, Search Procedure we have changed "Classes" into "Classed" -In Appendix B (Characteristics of Panel Surveys) we have added "years" to 4-6. The formatting of the tables meant that some words were cut off: this has now been corrected for all the tables.-Page 17, fifth line of first paragraph, "self-related" has been changed to "self-rated." -Page 19, second paragraph, a new paragraph has been started after the line beginning "The advantage." -Page 20, first line of second paragraph, "somewhat unclear" has been changed to "unclear".-Page 21, second paragraph, the first line has been amended to specify about "personal, unsecured debt".-Page 5: more detail has been added to justify why studies on secured loans and mortgage debt were excluded.-Resul...

Previous research has shown a relationship between financial difficulties and poor mental health in students, but most research is cross-sectional. To examine longitudinal relationships over time between financial variables and mental health in students. A national sample of 454 first year British undergraduate students completed measures of mental health and financial variables at up to four time points across a year. Cross-sectional relationships were found between poorer mental health and female gender, having a disability and non-white ethnicity. Greater financial difficulties predicted greater depression and stress cross-sectionally, and also predicted poorer anxiety, global mental health and alcohol dependence over time. Depression worsened over time for those who had considered abandoning studies or not coming to university for financial reasons, and there were effects for how students viewed their student loan. Anxiety and alcohol dependence also predicted worsening financial situation suggesting a bi-directional relationship. Financial difficulties appear to lead to poor mental health in students with the possibility of a vicious cycle occurring.

Purpose Previous cross-sectional research has examined the effect of loneliness on mental health. The purpose of this paper is to examine longitudinal relationships in students. Design/methodology/approach A total of 454 British undergraduate students completed measures of loneliness and mental health at four time points. Findings After controlling for demographics and baseline mental health, greater loneliness predicted greater anxiety, stress, depression and general mental health over time. There was no evidence that mental health problems increased loneliness over time. There was no relationship with alcohol problems. Baseline loneliness predicted greater eating disorder risk at follow-up and vice versa. Research limitations/implications This study is limited by a relatively small and heavily female sample. Practical implications Social and psychological interventions to reduce loneliness in university settings may improve mental health. Social implications Universities should consider organising social activities to mitigate feelings of loneliness in students. Originality/value This study adds to the literature as a longitudinal analysis showing that loneliness exacerbates poor mental health over time. This also adds to the literature for students specifically, and suggests a possible bi-directional relationship between eating disorders and loneliness for the first time.

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Three-hundred sixty British university students completed a questionnaire providing information on demographic characteristics, financial circumstances, smoking, and drug and alcohol use. A 14-item inventory of physical symptoms, the short form 36 health survey (SF-36), and the General Health Questionnaire (GHQ-12) were used to assess their physical and psychological well-being. Except for physical functioning, all subscales of the SF-36 and the GHQ indicated levels of health significantly below population norms matched for age and sex. Poorer mental health was related to longer working hours outside the university and difficulty in paying bills. Students who had considered abandoning study for financial reasons had poorer mental health, lower levels of social functioning and vitality, and poorer physical health as indicated by variables on the SF-36. They were also heavier smokers. Students' personal debt was significantly associated with their knowing people involved in prostitution, crime, or drug dealing to help support themselves financially.