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Debt, income and mental disorder in the general population

Published online by Cambridge University Press:  10 January 2008

R. Jenkins ,
D. Bhugra ,
P. Bebbington ,
T. Brugha ,
M. Farrell ,
J. Coid ,
T. Fryers ,
S. Weich ,
N. Singleton  and
H. Meltzer
R. Jenkins*
Affiliation:
WHO Collaborating Centre, Institute of Psychiatry, De Crespigny Park, London, UK
D. Bhugra
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, UK
P. Bebbington
Affiliation:
UCL Department of Mental Health Sciences, Charles Bell House, London, UK
T. Brugha
Affiliation:
University of Leicester, Department of Health Sciences, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Road, Leicester, UK
M. Farrell
Affiliation:
South London and Maudsley NHS Trust, Addiction Resource Centre, Marina House, London, UK
J. Coid
Affiliation:
Forensic Psychiatry Research Unit, St Bartholomew's Hospital, London, UK
T. Fryers
Affiliation:
University of Leicester, Department of Health Sciences, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Road, Leicester, UK
S. Weich
Affiliation:
Warwick Medical School, Division of Health in the Community, Medical School Building, Gibbet Hill Campus, University of Warwick, Coventry, UK
N. Singleton
Affiliation:
Crime and Drugs Analysis and Research, Home Office, Peel Building, London, UK
H. Meltzer
Affiliation:
University of Leicester, Department of Health Sciences, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Road, Leicester, UK
*
*Address for correspondence: Professor R. Jenkins, WHO Collaborating Centre, Institute of Psychiatry, De Crespigny Park, LondonSE5 8AF, UK. (Email: r.jenkins@iop.kcl.ac.uk)
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Abstract

Background

The association between poor mental health and poverty is well known but its mechanism is not fully understood. This study tests the hypothesis that the association between low income and mental disorder is mediated by debt and its attendant financial hardship.

Method

The study is a cross-sectional nationally representative survey of private households in England, Scotland and Wales, which assessed 8580 participants aged 16–74 years living in general households. Psychosis, neurosis, alcohol abuse and drug abuse were identified by the Clinical Interview Schedule – Revised, the Schedule for Assessment in Neuropsychiatry (SCAN), the Alcohol Use Disorder Identification Test (AUDIT) and other measures. Detailed questions were asked about income, debt and financial hardship.

Results

Those with low income were more likely to have mental disorder [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.68–2.59] but this relationship was attenuated after adjustment for debt (OR 1.58, 95% CI 1.25–1.97) and vanished when other sociodemographic variables were also controlled (OR 1.07, 95% CI 0.77–1.48). Of those with mental disorder, 23% were in debt (compared with 8% of those without disorder), and 10% had had a utility disconnected (compared with 3%). The more debts people had, the more likely they were to have some form of mental disorder, even after adjustment for income and other sociodemographic variables. People with six or more separate debts had a six-fold increase in mental disorder after adjustment for income (OR 6.0, 95% CI 3.5–10.3).

Conclusions

Both low income and debt are associated with mental illness, but the effect of income appears to be mediated largely by debt.

Keywords

Debtincomemental disorder
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 10 , October 2008 , pp. 1485 - 1493
Copyright
Copyright © 2008 Cambridge University Press

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