The relationship between personal debt and mental health: a systematic review

Fitch, Chris; Hamilton, Sarah; Bassett, Paul; Davey, Ryan

doi:10.1108/13619321111202313

Cited by 178 publications

(159 citation statements)

References 48 publications

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“…Currently the average UK family owes more than £11k in unsecured debt (AVIVA, 2013). Similarly in the US there is currently $660 billion in outstanding credit card debt (Federal Reserve Bank of New York, 2013) DEBT AND HEALTH There has been a previous review into personal debt and mental health (Fitch, Hamilton, Bassett, & Davey, 2011). However this did not examine relationships with physical health, although the literature shows a strong relationship between physical and mental health (Scott, et al, 2009), and did not examine relationships with substance use.…”

Section: Introductionmentioning

confidence: 99%

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

Richardson

Elliott

Roberts

2013

Clinical Psychology Review

339

278

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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...

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Section: Introductionmentioning

confidence: 99%

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

Richardson

Elliott

Roberts

2013

Clinical Psychology Review

339

278

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“…Equally though, access to microcredit, by nature, involves becoming indebted and there is a wide literature suggesting indebtedness contributes to the development of mental health problems (Fitch et al, 2011). Similarly, while self-employment (a potential outcome of microcredit for enterprise) has long been associated with greater autonomy and control over decision making (Eden, 1975;Lewin-Epstein and Yuchtman-Yaar, 1991;Parslow et al, 2004), studies also show self-employed individuals are considered to be more susceptible to isolation and job stress (Chay, 1993;Dellot, 2014;Jamal, 1997;Lewin-Epstein and Yuchtman-Yaar, 1991) and, for some, this could be a precarious form of employment (Benach et al, 2000;Facey and Eakin, 2010).…”

Section: Microcredit and Its Potential As A Public Health Initiativementioning

confidence: 99%

From wealth to health: Evaluating microfinance as a complex intervention

2017

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Innovative interventions that address the social determinants of health are required to help reduce persistent health inequalities. We argue that microcredit can act in this way and develop a conceptual framework from which to examine this. In seeking to evaluate microcredit this way we then examine how randomized controlled trials, currently considered as the 'gold standard' in impact evaluations of microcredit, compare with developments in thinking about study design in public health. This leads us to challenge the notion of trials as the apparent gold standard for microcredit evaluations and contend that the pursuit of trial-based evidence alone may be hampering the production of relevant evidence on microcredit's public health (and other wider) impacts. In doing so, we introduce new insights into the global debate on microfinance impact evaluation, related to ethical issues in staging randomized controlled trials, and propose innovations on complementary methods for use in the evaluation of complex interventions.

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“…45 Our intervention was based on the assumption that social context plays an important role for mental illness onset and recovery, particularly in the case of debt and depression. 40 Our intervention brought together two existing services: (1) primary care mental health services provided by general practices, supplemented by Improving Access to Psychological Therapies (IAPT) services in England, and in Wales a variety of counselling and psychological therapies services; and (2) debt counselling provided by third-sector providers, such as CAB (see Figure 1). …”

Section: Intervention: Theory and Developmentmentioning

confidence: 99%

“…Fitch et al 40 conducted a systematic narrative analysis of peer-reviewed literature on the relationship between personal debt and mental health. They found that indebtedness may contribute to the development of mental health difficulties and mediate accepted relationships between those difficulties and poverty and low income.…”

Section: Introductionmentioning

confidence: 99%

Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study)

Gabbay

Ring

Byng³

et al. 2017

Health Technol Assess

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Background Depression and debt are common in the UK. Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer) aimed to assess the clinical effectiveness and cost-effectiveness of the addition of a primary care debt counselling advice service to usual care for patients with depression and debt. However, the study was terminated early during the internal pilot trial phase because of recruitment delays. This report describes the rationale, methods and findings of the pilot study, and implications for future research. Objectives The overarching aim of the internal pilot was to identify and resolve problems, thereby assessing the feasibility of the main trial. The specific objectives were to confirm methods for practice recruitment and the ability to recruit patients via the proposed approaches; to determine the acceptability of the study interventions and outcome measures; to assess contamination; to confirm the randomisation method for main trial and the level of participant attrition; and to check the robustness of data collection systems. Design An adaptive, parallel, two-group multicentre randomised controlled pilot trial with a nested mixed-methods process and economic evaluation. Both individual- and cluster (general practice)-level were was used in the pilot phase to assign participants to intervention or control groups. Setting General practices in England and Wales. Participants Individuals were included who were aged ≥ 18 years, scored ≥ 14 on the Beck Depression Inventory II and self-identified as having debt worries. The main exclusion criteria were being actively suicidal or psychotic and/or severely depressed and unresponsive to treatment; having a severe addiction to alcohol/illicit drugs; being unable/unwilling to give written informed consent; currently participating in other research including follow-up phases; having received Citizens Advice Bureau (CAB) debt advice in the past year; and not wanting debt advice via a general practice. Interventions The participants in the intervention group were given debt advice provided by the CAB and shared biopsychosocial assessment, in addition to treatment as usual (TAU) and two debt advice leaflets. The participants in the control group were given advice leaflets provided by the general practitioner and TAU only. Main outcome measures (1) Outcomes of the pilot trial – the proportion of eligible patients who consented, the number of participants recruited compared with target, assessment of contamination, and assessment of patient satisfaction with intervention and outcome measures. (2) Participant outcomes – primary – Beck Depression Inventory II; secondary – psychological well-being, health and social care utilisation, service satisfaction, substance misuse, record of priority/non-priority debts, life events and difficulties, and explanatory measures. Outcomes were assessed at baseline (pre-randomisation) and at 4 months post randomisation. Other data sources – qualitative interviews were conducted with participants, clinicians and CAB advisors. Results Of the 238 expressions of interest screened, 61 participants (26%) were recruited and randomised (32 in the intervention group and 29 in the control group). All participants provided baseline outcomes and 52 provided the primary outcome at 4 months’ follow-up (14.7% dropout). Seventeen participants allocated to the intervention saw a CAB advisor. Descriptive statistics are reported for participants with complete outcomes at baseline and 4 months’ follow-up. Our qualitative findings suggest that the relationship between debt and depression is complex, and the impact of each on the other is compounded by other psychological, social and contextual influences. Conclusions As a result of low recruitment, this trial was terminated at the internal pilot phase and was too small for inferential statistical analysis. We recommend ways to reduce this risk when conducting complex trials among vulnerable populations recruited in community settings. These cover trial design, the design and delivery of interventions, recruitment strategies and support for sites. Trial registration Current Controlled Trials ISRCTN79705874. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 35. See the NIHR Journals Library website for further project information. Mark Gabbay and Adele Ring are part-funded by NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) North West Coast and Richard Byng and Rod S Taylor, Vashti Berry and Elizabeth Shaw part-funded by NIHR CLAHRC South West Peninsula.

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The relationship between personal debt and mental health: a systematic review

Cited by 178 publications

References 48 publications

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

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

From wealth to health: Evaluating microfinance as a complex intervention

Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study)

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