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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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References

Acheson, D (1998). Independent Inquiry into Inequalities in Health. H.M. Stationery Office: London.Google Scholar
Bebbington, PE, Nayani, T (1995). The psychosis screening questionnaire. International Journal of Methods in Psychiatric Research 5, 11–20.Google Scholar
Benzeval, M, Judge, K, Whitehead, M (1995). Tackling Inequalities in Health: An Agenda for Action. Kings Fund: London.Google Scholar
Berthoud, R, Kempson, E (1992). Credit and Debt. The PSI Report. Policy Studies Institute: London.Google Scholar
Dohrenwend, BP, Levav, I, Shrout, PE, Schwartz, S, Naveh, G, Link, BG, Skodol, AE, Stueve, A (1992). Socioeconomic status and psychiatric disorders: the causation-selection issue. Science 255, 946–952.CrossRefGoogle ScholarPubMed
Eaton, W, Muntaner, C, Bovasso, G, Smith, C (2001). Socioeconomic status and depression. Journal of Health and Social Behaviour 42, 277–294.CrossRefGoogle Scholar
Fryers, T, Melzer, D, McWilliams, B, Jenkins, R (2004). A systematic literature review. In Social Inequalities and the Distribution of Common Mental Disorders. Maudsley Monograph 44 (ed. Melzer, D., Fryers, T. and Jenkins, R.), pp. 1–125. Psychological Press: Hove, UK.Google Scholar
Kempson, E, Whiley, C, Caskey, J, Collard, S (2000). In or Out? Financial Exclusion: a Literature and Research Review. Financial Services Authority: London.Google Scholar
Kish, L (1965). Survey Sampling. Wiley and Sons: London.Google Scholar
Koppel, S, McGuffin, P (1999). Socioeconomic factors that predict psychiatric admission at local level. Psychological Medicine 29, 1235–1241.Google Scholar
Lewis, G, Bebbington, P, Brugha, TS, Farrell, M, Gill, B, Jenkins, R, Meltzer, H (1998). Socioeconomic status, standard of living and neurotic disorder. Lancet 352, 605–609.Google Scholar
Lewis, G, Pelosi, A, Araya, RC, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine 22, 465–486.Google Scholar
Marmot, M (2001). Inequalities in health. New England Journal of Medicine 345, 134–136.CrossRefGoogle ScholarPubMed
Meltzer, H, Gill, B, Petticrew, M, Hinds, K (1995). OPCS Surveys of Psychiatric Morbidity in Great Britain. Report 1: the prevalence of psychiatric morbidity among adults living in private households. H.M. Stationery Office: London.Google Scholar
Muntaner, C, Eaton, W, Miech, R, O'Campo, P (2004). Socioeconomic position and major mental disorders. Epidemiological Reviews 26, 53–62.CrossRefGoogle ScholarPubMed
National Association of Citizens' Advice Bureaux (1992). The Cost of Living: CAB Evidence on Debt and Poverty. NACAB: London.Google Scholar
National Association of Citizens' Advice Bureaux (2001). Debt: A Growing Problem. Advice week briefing September 2001. NACAB: London.Google Scholar
Patel, V, Kleinman, A (2003). Poverty and common mental disorders in developing countries. WHO Bulletin 81, 609–615.Google ScholarPubMed
Patel, V, Periera, J, Couthino, R, Fernandes, J, Mann, A (1998). Poverty, psychological disorder and disability in primary care attenders in Goa, India. British Journal of Psychiatry 172, 533–536.Google Scholar
Pothen, M, Kuruvilla, A, Philip, K, Joseph, A, Jacob, KS (2003). Common mental disorders among primary care attenders in Vellore, South India: nature, prevalence and risk factors. International Journal of Social Psychiatry 49, 119–125.CrossRefGoogle ScholarPubMed
Ramsay, M, Partridge, S (1999). Drug Misuse Declared in 1998: Results from the British Crime Survey. Home Office: London.Google Scholar
Reading, R, Reynolds, S (2001). Debt, social disadvantage and maternal depression. Social Science and Medicine 53, 441–453.Google Scholar
Robins, LN, Regier, DA (1991). Psychiatric Disorders in America: the Epidemiological Catchment Area Study. The Free Press, Macmillan, Inc.: New York.Google Scholar
Rowntree, B (1901). Poverty: a Study of Town Life. MacMillan & Co.: London.Google Scholar
Saunders, JB, Aasland, OG, Babor, TF, de la Fuente, JR, Grant, M (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addiction 88, 791–804.Google Scholar
Sharpe, J, Bostock, J (2002). Supporting People with Debt and Mental Health Problems. Research with Psychological Therapists in Northumberland. Northumberland Health Action Zone: Northumberland, UK.Google Scholar
Singleton, N, Meltzer, H, Gatward, R, Coid, J, Deasy, D (1998). Psychiatric Morbidity among Prisoners in England and Wales. The Stationery Office: London.Google Scholar
Social Exclusion Unit (2004). Mental Health and Social Exclusion. Office of the Deputy Prime Minister: London (http://archive.cabinetoffice.gov.uk/sen/papcJ717.html?id=257). Accessed 28 December 2007.Google Scholar
Stockwell, T, Sitharthan, T, McGrath, D, Lang, E (1994). The measurement of alcohol dependence and impaired control in community samples. Addiction 89, 167–174.CrossRefGoogle ScholarPubMed
Stouffer, SA, Suchman, E, Dewiney, L, Stor, S, Williams, R (1949). The American Soldier, vol. 1. Princeton University Press: Princetown, NJ.Google Scholar
Townsend, P (1979). Poverty in the United Kingdom. Allen Lane: London.Google Scholar
Weich, S, Lewis, G (1998 a). Material standard of living, social class and the prevalence of the common mental disorders in Great Britain. Journal of Epidemiology and Community Health 52, 8–14.Google Scholar
Weich, S, Lewis, G (1998 b). Poverty, unemployment and common mental disorders. British Medical Journal 317, 115–119.CrossRefGoogle ScholarPubMed
Weich, S, Lewis, G, Jenkins, SP (2001). Income inequality and the prevalence of common mental disorders in Britain. British Journal of Psychiatry 178, 222–227.Google Scholar
Wilkinson, RG (1997). Health inequalities: relative or absolute material standards. British Medical Journal 314, 591–595.Google Scholar
WHO (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.Google Scholar
WHO (1999). SCAN Schedules for Clinical Assessment in Neuropsychiatry, version 2.1. World Health Organization: Geneva.Google Scholar