The relationship between financial status and risk for medical and mental disorders is complex. Premorbid functioning (level of function prior to the onset of a condition) may influence cognitive performance, motivation and the social interaction skills necessary for gaining employment and career success. Failure to obtain (or maintain) a rewarding job can contribute to increased stress and possible reduced access to treatment for medical or mental health conditions. Two recent studies examined the relationship between financial factors and risk for mental disorders. These studies provide potential strategies for the prevention of some common clinical neuroscience conditions.
Jenkins and colleagues in the United Kingdom studied the relationship between a variety of economic indicators and risk for presence of a mental disorder in over 8000 individuals in England, Scotland and Wales. The previous well-documented association between lower socioeconomic status and increased risk for mental disorders was found in this research study. Risk for any mental disorder (neurotic disorder, psychotic disorder, alcohol or drug use disorder) ranged from 24% of the highest earners to over 40% for lowest income group in men. For women the difference was 18% for the highest income group compared to 33% for the lowest income group.
Examining the relationship between income and risk for mental disorder in more detail in this sample produced an interesting finding. Income was strongly associated with the number of debts and the number of debts strongly correlated with rates of mental disorders. When the presence of personal debt (and other socioeconomic factors) was controlled, the association of income and mental illness vanished or was greater reduced. A small effect for income on rates of neurosis persisted after controlling for number of debts.
The authors of this study note that it was a cross-sectional study and there was no ability to examine the sequence of events. Perhaps the primary association is that those with a mental disorder are more likely to take on debt (whether out of necessity or perhaps because of impaired financial decision making associated with cognitive limitations). But the authors do note an important implication of their research. The role of personal debt and risk of mental disorder is rarely studied. Personal debt levels are increasing in many countries around the world. The role of debt in risk of (and management) of mental disorders is an emerging public health issue.
A second abstract that caught my attention in this topic area is a study by Lang and colleagues in the UK and the U.S. They noted that the prevalence of common mental disorders tends to rise up through midlife when a peak rate is reached. Their study found this effect occurred only in the lowest income group. Those in higher income groups appeared to be protected from this midlife prevalence rate increase. There was no mention of the potential role of debt in this common epidemiological finding.
These findings have influenced how I assess and manage patients. I tend to be more likely to ask about personal debt levels and the influence of debt (and intrusive debt collectors) in mood, anxiety levels and personal distress. Using debt counseling resources and encouraging the limitation of personal debt may become more common important components of clinical neuroscience.
Photo of credit card from Creative Commons file at Wikipedia.
Jenkins R, Bhugra D, Bebbington P, Brugha T, Farrell M, Coid J, Fryers T, Weich S, Singleton N, & Meltzer H (2008). Debt, income and mental disorder in the general population. Psychological medicine, 38 (10), 1485-93 PMID: 18184442
Lang, I., Llewellyn, D., Hubbard, R., Langa, K., & Melzer, D. (2010). Income and the midlife peak in common mental disorder prevalence Psychological Medicine, 41 (07), 1365-1372 DOI: 10.1017/S0033291710002060
No comments:
Post a Comment