Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2022 Nov 22;12(11):e061797. doi: 10.1136/bmjopen-2022-061797.
The credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment.
This is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women.
Over-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men.
Over-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.
信贷市场迅速扩张，增加了那些缺乏稳定就业或收入的人过度负债的风险，这是新冠疫情后令人担忧的一个问题。我们研究了过度负债对心理健康不良的影响，以及这种影响是否会因年龄、性别、教育程度或不稳定就业而改变。
这是一项使用瑞典斯科讷公共卫生队列数据的队列研究，该队列基于从瑞典斯科讷南部一般成年人群中随机选择的个体，于 1999/2000 年启动（回应率为 58%），并在 2005 年和 2010 年进行了随访。通过结合现金余额和支付家庭账单困难的信息来评估过度负债。心理健康状况通过一般健康问卷-12 进行评估。那些在基线时心理健康状况较差的人被排除在外，并且进一步将分析限制在有完整主要变量数据的职业活跃人群中，最终纳入 1256 名男性和 1539 名女性。
过度负债在女性、教育程度较低、出生在国外和在基线时从事不稳定职业的人群中更为常见。在 1999/2000 年或 2005 年暴露于过度负债的个体中，2010 年心理健康不良的年龄调整发病率比（IRR）为 2.2（95%CI 1.7 至 2.8）。调整 1999/2000 年或 2005 年的教育程度、原籍国和不稳定职业后，IRR 为 2.0（95%CI 1.6 至 2.6）。交互分析表明，高教育程度可能与过度负债一起协同作用，导致男性心理健康不良。
过度负债与社会阶级、性别和外国出生等不利的社会权力关系有关。不稳定就业与心理健康不良独立相关，也可能通过过度负债来介导这种影响。新冠疫情可能导致过度负债增加，在旨在缓解疫情社会影响的政策中应予以承认。
