Changes in household debt due to COVID-19 and mental health concerns among adults in Ontario,Canada

Abstract

Background:

Canadian households experienced unexpected changes in their economic well-being during the COVID-19 pandemic. The extent of the impact of the pandemic on household debt and its effect on health and mental health remains unknown.

Aim:

The aim of the study was to examine the associations of change in household debt due to COVID-19 with serious psychological distress (SPD) and general health measures.

Methods:

Data were from the 2020 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The 2020 cycle employed a web-based panel survey of 3,033 adults. The survey included measures of change in household debt due to the COVID-19 pandemic, mental and general health. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors.

Results:

Overall, 17.5% of respondents reported that their household debt increased due to the COVID-19 pandemic. Such an increase in household debt was significantly associated with SPD (OR = 2.92, 95% CI, 2.05–4.16), fair/poor mental health (OR = 2.02, 95% CI, 1.59–2.56), frequent mental distress days (OR = 1.80, 95% CI, 1.31–2.48), fair/poor general health (OR = 1.93, 95% CI, 1.47–2.52), and suicidal ideation (OR = 3.71, 95% CI, 2.41–5.70) after adjusting for potential confounders including education, income and employment.

Conclusions:

Household debt during the COVID-19 pandemic is an important determinant of health. Individuals who reported an increase in household debt due to COVID-19 were more likely to report serious mental health concerns including suicidal ideation. This suggests that debt-related interventions may be needed to alleviate the adverse effects of indebtedness on health.

Keywords

COVID-19 debt distress suicide pandemic indebtedness

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References

Adler

N. E.

Boyce

Chesney

M. A.

Cohen

Folkman

Kahn

R. L.

Syme

S. L.

(1994). Socioeconomic status and health. The challenge of the gradient. American Psychologist, 49(1), 15–24. https://doi.org/10.1037//0003-066x.49.1.15

Akerstedt

Knutsson

Westerholm

Theorell

Alfredsson

Kecklund

(2004). Mental fatigue, work and sleep. Journal of Psychosomatic Research, 57(5), 427–433. https://doi.org/10.1016/j.jpsychores.2003.12.001

Banerjee

Kosagisharaf

J. R.

Sathyanarayana Rao

T. S.

(2021). “The dual pandemic” of suicide and COVID-19: A biopsychosocial narrative of risks and prevention. Psychiatry Research, 295, 113577. https://doi.org/10.1016/j.psychres.2020.113577

Bank of Canada. (2021). Debt relief programs and money left on the table: Evidence from Canada’s response to COVID-19. Retrieved August 25, 2022, from https://publications.gc.ca/collections/collection_2021/banque-bank-canada/FB3-5-2021-13-eng.pdf

BDO Canada LLP. (2021). BDO affordability index 2021: COVID-19 eroding standard of living for Canadians. Retrieved November 4, 2021, from https://debtsolutions.bdo.ca/bdo-affordability-index-2021/

Braveman

P. A.

Cubbin

Egerter

Williams

D. R.

Pamuk

(2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100 Suppl 1 (Suppl 1), S186–S196. https://doi.org/10.2105/AJPH.2009.166082

Bridges

Disney

(2010). Debt and depression. Journal of Health Economics, 29(3), 388–403. https://doi.org/10.1016/j.jhealeco.2010.02.003

Brown

Taylor

Wheatley Price

(2005). Debt and distress: Evaluating the psychological cost of credit. Journal of Economic Psychology, 26(5), 642–663. https://doi.org/10.1016/j.joep.2005.01.002

Bushman

Mehdipanah

(2022). Housing and health inequities during COVID-19: Findings from the national Household Pulse Survey. Journal of Epidemiology and Community Health, 76, 121–127. https://doi.org/10.1136/jech-2021-216764

10.

Chang

S.-S.

Stuckler

Yip

Gunnell

(2013). Impact of 2008 global economic crisis on suicide: Time trend study in 54 countries. British Medical Journal, 347, f5239. https://doi.org/10.1136/bmj.f5239

11.

Dawel

Shou

Smithson

Cherbuin

Banfield

Calear

A. L.

Farrer

L. M.

Gray

Gulliver

Housen

McCallum

S. M.

Morse

A. R.

Murray

Newman

Rodney Harris

R. M.

Batterham

P. J.

(2020). The effect of COVID-19 on Mental Health and Wellbeing in a representative sample of Australian adults. Frontiers in Psychiatry, 11, 579985. https://doi.org/10.3389/fpsyt.2020.579985

12.

Dijkstra-Kersten

S. M.

Biesheuvel-Leliefeld

K. E.

van der Wouden

J. C.

Penninx

B. W.

van Marwijk

H. W.

(2015). Associations of financial strain and income with depressive and anxiety disorders. Journal of Epidemiology and Community Health, 69(7), 660–665. https://doi.org/10.1136/jech-2014-205088

13.

Drentea

Lavrakas

P. J.

(2000). Over the limit: The association among health, race and debt. Social Science & Medicine, 50(4), 517–529. https://doi.org/10.1016/s0277-9536(99)00298-1.

14.

Drentea

Reynolds

J. R.

(2015). Where does debt fit in the stress process model? Mental Health and Society, 5(1), 16–32. https://doi.org/10.1177/2156869314554486

15.

Dubey

Biswas

Ghosh

Chatterjee

Dubey

M. J.

Chatterjee

Lahiri

Lavie

C. J.

(2020). Psychosocial impact of COVID-19. Diabetes & Metabolic Syndrome, 14(5), 779–788. https://doi.org/10.1016/j.dsx.2020.05.035

16.

Ettman

C. K.

Gradus

J. L.

Galea

(2020). Invited commentary: Reckoning with the relationship between stressors and suicide attempts in a time of COVID-19. American Journal of Epidemiology, 189(11), 1275–1277. https://doi.org/10.1093/aje/kwaa147

17.

Frasquilho

Matos

M. G.

Salonna

Guerreiro

Storti

C. C.

Gaspar

Caldas-de-Almeida

J. M.

(2016). Mental health outcomes in times of economic recession: A systematic literature review. BMC Public Health, 16, 115. https://doi.org/10.1186/s12889-016-2720-y

18.

Goldstein

S. J.

Gaston

S. A.

McGrath

J. A.

Jackson

C. L.

(2020). Sleep Health and serious psychological distress: A nationally representative study of the United States among white, black, and Hispanic/Latinx adults. Nature and Science of Sleep, 12, 1091–1104. https://doi.org/10.2147/NSS.S268087

19.

Government of Ontario. (2022). About ontario. Retrieved June 16, 2022, from https://www.ontario.ca/page/about-ontario

20.

Hall

Buysse

D. J.

Nofzinger

E. A.

Reynolds

3rd Thompson

Mazumdar

Monk

TH.

(2008). Financial strain is a significant correlate of sleep continuity disturbances in late-life. Biological Psychology, 77(2), 217–222. https://doi.org/10.1016/j.biopsycho.2007.10.012

21.

Hamilton

H. A.

Wickens

C. M.

Ialomiteanu

A. R.

Mann

R. E.

(2019). Debt stress, psychological distress and overall health among adults in Ontario. Journal of Psychiatric Research, 111, 89–95. https://doi.org/10.1016/j.jpsychires.2019.01.008

22.

Hawryluck

Gold

W. L.

Robinson

Pogorski

Galea

Styra

(2004). SARS control and psychological effects of quarantine, Toronto, Canada. Emerging Infectious Diseases, 10(7), 1206–1212. https://doi.org/10.3201/eid1007.030703

23.

Heintz-Martin

Recksiedler

Langmeyer

A. N.

(2022). Household debt, maternal Well-Being, and child adjustment in Germany: Examining the family stress model by family structure. Journal of Family and Economic Issues, 43, 338–353. https://doi.org/10.1007/s10834-021-09777-1

24.

Hojman

D. A.

Miranda

Á.

Ruiz-Tagle

(2016). Debt trajectories and mental health. Social Science & Medicine, 167, 54–62. https://doi.org/10.1016/j.socscimed.2016.08.027

25.

Hughes

R. A.

Heron

Sterne

J. A. C.

Tilling

(2019). Accounting for missing data in statistical analyses: Multiple imputation is not always the answer. International Journal of Epidemiology, 48(4), 1294–1304. https://doi.org/10.1093/ije/dyz032

26.

International Monetary Fund. (2022). Canada: Staff concluding statement of the 2022 article IV mission.Retrieved October 12, 2022, from https://www.imf.org/en/News/Articles/2022/10/10/cs10102022-canada-staff-concluding-statement-of-the-2022-article-iv-mission

27.

Jenkins

E. K.

McAuliffe

Hirani

Richardson

Thomson

K. C.

McGuinness

Morris

Kousoulis

Gadermann

(2021). A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: Findings from the first wave of a nationally representative cross-sectional survey. Preventive Medicine, 145, 106333. https://doi.org/10.1016/j.ypmed.2020.106333

28.

Jenkins

Bhugra

Bebbington

Brugha

Farrell

Coid

Fryers

Weich

Singleton

Meltzer

(2008). Debt, income and mental disorder in the general population. Psychological Medicine, 38(10), 1485–1493. https://doi.org/10.1017/S0033291707002516

29.

Jenkins

Fitch

Hurlston

Walker

(2009). Recession, debt and mental health: Challenges and solutions. Mental Health in Family Medicine, 6(2), 85–90.

30.

Kessler

R. C.

Barker

P. R.

Colpe

L. J.

Epstein

J. F.

Gfroerer

J. C.

Hiripi

Howes

M. J.

Normand

S. L.

Manderscheid

R. W.

Walters

E. E.

Zaslavsky

A. M.

(2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60(2), 184–189. https://doi.org/10.1001/archpsyc.60.2.184

31.

Kessler

R. C.

Green

J. G.

Gruber

M. J.

Sampson

N. A.

Bromet

Cuitan

Furukawa

T. A.

Gureje

Hinkov

C.-Y.

Lara

Lee

Mneimneh

Myer

Oakley-Browne

Posada-Villa

Sagar

Viana

M. C.

Zaslavsky

A. M.

(2010). Screening for serious mental illness in the general population with the K6 screening scale: Results from the WHO World Mental Health (WMH) survey initiative. International Journal of Methods in Psychiatric Research, 19 Suppl 1(Suppl 1), 4–22. https://doi.org/10.1002/mpr.310

32.

McIntyre

R. S.

Lee

(2020). Projected increases in suicide in Canada as a consequence of COVID-19. Psychiatry Research, 290, 113104. https://doi.org/10.1016/j.psychres.2020.113104

33.

Mental Health Research Canada. (2020). National poll on impact of COVID-19. Retrieved October 4, 2022, from https://www.mhrc.ca/national-poll-covid/findings-of-poll-2

34.

Moriarty

D. G.

Zack

M. M.

Kobau

(2003). The Centers for Disease Control and Prevention’s healthy days measures - population tracking of perceived physical and mental health over time. Health and Quality of Life Outcomes, 1, 37. https://doi.org/10.1186/1477-7525-1-37

35.

OECD. (2020). The territorial impact of COVID-19: Managing the crisis across levels of government. Retrieved October 30, 2022, from https://www.oecd.org/coronavirus/policy-responses/the-territorial-impact-of-covid-19-managing-the-crisis-across-levels-of-government-d3e314e1/

36.

OECD. (2021). Tackling the mental health impact of the COVID-19 crisis: An integrated, whole-of-society response. Retrieved October 24, 2022, from https://www.oecd.org/coronavirus/policy-responses/tackling-the-mental-health-impact-of-the-covid-19-crisis-an-integrated-whole-of-society-response-0ccafa0b/#boxsection-d1e30

37.

Okoro

C. A.

Strine

T. W.

McKnight-Eily

Verlenden

Hollis

N. D.

(2021). Indicators of poor mental health and stressors during the COVID-19 pandemic, by disability status: A cross-sectional analysis. Disability and Health Journal, 14, 101110. https://doi.org/10.1016/j.dhjo.2021.101110

38.

Olfson

Wang

Wall

Marcus

S. C.

Blanco

(2019). Trends in serious psychological distress and outpatient mental health care of US Adults. JAMA Psychiatry, 76(2), 152–161. https://doi.org/10.1001/jamapsychiatry.2018.3550

39.

Orpana

H. M.

Lemyre

(2004). Explaining the social gradient in health in Canada: Using the National Population Health Survey to examine the role of stressors. International Journal of Behavioral Medicine, 11(3), 143–151. https://doi.org/10.1207/s15327558ijbm1103_3

40.

Orpana

H. M.

Lemyre

Gravel

(2009). Income and psychological distress: The role of the social environment. Health Reports/Statistics Canada, Canadian Centre for Health Information, 20(1), 21–28.

41.

Orpana

H. M.

Lemyre

Kelly

(2007). Do stressors explain the association between income and declines in self-rated health? A longitudinal analysis of the National Population Health Survey. International Journal of Behavioral Medicine, 14(1), 40–47. https://doi.org/10.1007/bf02999226

42.

Ôunpuu

Krueger

Vermeulen

Chambers

(2000). Using the U.S. Behavior Risk Factor Surveillance System’s health related quality of life survey tool in a Canadian city. Canadian Journal of Public Health, 91(1), 67–72. https://doi.org/10.1007/BF03404258

43.

Reeves

Stuckler

McKee

Gunnell

Chang

S.-S.

Basu

(2012). Increase in state suicide rates in the USA during economic recession. Lancet, 380(9856), 1813–1814. https://doi.org/10.1016/S0140-6736(12)61910-2

44.

Richardson

Elliott

Roberts

(2013). The relationship between personal unsecured debt and mental and physical health: A systematic review and meta-analysis. Clinical Psychology Review, 33(8), 1148–1162. https://doi.org/10.1016/j.cpr.2013.08.009

45.

Rojas

(2022). Financial indebtedness and suicide: A 1-year follow-up study of a population registered at the Swedish Enforcement Authority. International Journal of Social Psychiatry, 68, 1445–1453. https://doi.org/10.1177/00207640211036166

46.

Shillington

K. J.

Vanderloo

L. M.

Burke

S. M.

Tucker

Irwin

J. D.

(2021). Ontario adults’ health behaviors, mental health, and overall well-being during the COVID-19 pandemic. BMC Public Health, 21(1), 1679. https://doi.org/10.1186/s12889-021-11732-6

47.

StataCorp LLC. (2019). Stata (Version 16). https://www.stata.com/stata16/

48.

Statistics Canada. (2015). Household debt in Canada. Retrieved August 30, 2022, from https://www150.statcan.gc.ca/n1/pub/75-001-x/2012002/article/11636-eng.htm

49.

Statistics Canada. (2021a). Household economic well-being during the COVID-19 pandemic, experimental estimates, first quarter to third quarter of 2020. Retrieved October 5, 2021, from https://www150.statcan.gc.ca/n1/daily-quotidien/210301/dq210301b-eng.htm

50.

Statistics Canada. (2021b). Canadian Internet Use Survey, 2020. Retrieved November 4, 2021, from https://www150.statcan.gc.ca/n1/daily-quotidien/210622/dq210622b-eng.htm

51.

Statistics Canada. (2022a). Consumer price index. Retrieved October 6, 2022, from https://www150.statcan.gc.ca/n1/daily-quotidien/220920/dq220920a-eng.htm

52.

Statistics Canada. (2022b). The contribution of pandemic relief benefits to the incomes of Canadians in 2020. Retrieved October 7, 2022, from https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021005/98-200-X2021005-eng.cfm

53.

Strine

T. W.

Chapman

D. P.

(2005). Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Medicine, 6(1), 23–27. https://doi.org/10.1016/j.sleep.2004.06.003

54.

Stuckler

Basu

Suhrcke

Coutts

McKee

(2009). The public health effect of economic crises and alternative policy responses in Europe: An empirical analysis. Lancet, 374(9686), 315–323. https://doi.org/10.1016/S0140-6736(09)61124-7

55.

Sweet

(2021). Debt-related financial hardship and Health. Health Education & Behavior, 48, 885–891. https://doi.org/10.1177/1090198120976352

56.

Sweet

Nandi

Adam

E. K.

McDade

T. W.

(2013). The high price of debt: Household financial debt and its impact on mental and physical health. Social Science & Medicine, 91(1982), 94–100. https://doi.org/10.1016/j.socscimed.2013.05.009

57.

The World Bank. (2022). World development report 2022: Finance for an equitable recovery. Retrieved August 24, 2022, from https://www.worldbank.org/en/publication/wdr2022#downloads

58.

Turunen

Hiilamo

(2014). Health effects of indebtedness: A systematic review. BMC Public Health, 14, 489. https://doi.org/10.1186/1471-2458-14-489

59.

Vallée

(2020). Bank of Canada: Monitoring payment deferrals during the COVID-19 pandemic. Bank of Canada. Retrieved October 5, 2022, from https://www.bankofcanada.ca/2020/11/monitoring-payment-deferrals-during-the-covid-19-pandemic/#chart5a

60.

Warth

Puth

M.-T.

Tillmann

Porz

Zier

Weckbecker

Münster

(2019). Over-indebtedness and its association with sleep and sleep medication use. BMC Public Health, 19(1), 957. https://doi.org/10.1186/s12889-019-7231-1

61.

Weida

E. B.

Phojanakong

Patel

Chilton

(2020). Financial health as a measurable social determinant of health. PLoS One, 15(5), e0233359. https://doi.org/10.1371/journal.pone.0233359

62.

WHO. (2020). Impact of COVID-19 on people’s livelihoods, their health and our food systems. Retrieved October 4, 2022, from https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people’s-livelihoods-their-health-and-our-food-systems#:~:text=The%20economic%20and%20social%20disruption,the%20end%20of%20the%20year

63.

WHO. (2022). Suicide prevention. Retrieved October 4, 2022, from https://www.who.int/health-topics/suicide#tab=tab_1

64.

Wolfe

J. D.

Baker

E. H.

Uddin

Kirkland

(2022). Varieties of financial stressors and midlife health problems, 1996–2016. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 77, 149–159. https://doi.org/10.1093/geronb/gbab108