2018 Peer Reviewed Articles on Stress and Health
Financial stress and mental health among higher education students in the UK up to 2018: rapid review of evidence
Abstract
Introduction In the United kingdom of great britain and northern ireland and many other countries, debt accrued during college education has increased substantially in recent decades. The prevalence of mutual mental health issues has also increased alongside these changes. However, it is as nevertheless unclear whether at that place is an association between financial stress and mental health among higher education students.
Methods We conducted a rapid review of the peer-reviewed scientific literature. Eligible studies were English-language publications testing the clan between whatever indicator of financial stress and mental health amid higher education students in the UK. Papers were located through a systematic search of PsychINFO, PubMed and Embase up to November 2018.
Results The search strategy yielded 1272 studies—9 met the inclusion criteria. A further two were identified through paw-searching. The median sample size was 408. Only iii of seven studies establish an association between higher debt and worse mental health. In that location was a consistent cross-sectional relationship betwixt worse mental health and both experience of financial difficulties (seven of 7 studies) and debt worry/financial business organization (4 of five studies), though longitudinal evidence was mixed and limited to six studies.
Conclusion Among college education students in the Uk, there is fiddling evidence that the amount of debt is associated with mental wellness. Withal, more subjective measures of increased financial stress were more consistently associated with worse mental wellness outcomes. However, the identified bear witness was judged to be weak; further research is required to examine whether links between financial stress and mental health outcomes are robust and causal in nature.
- Debt
- financial stress
- mental health
- college pedagogy
This is an open access article distributed in accordance with the Creative Eatables Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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- Debt
- financial stress
- mental health
- higher education
Introduction
The widening participation of young people in higher education in contempo decades has focused attending on student mental health and well-being, and raised concerns regarding the impact of financial stress. For case, in England, tuition fees have increased and grants accept been replaced past loans, leaving the boilerplate undergraduate with debts of effectually £50 000.i In addition to hereafter debt concerns, a sizeable fraction of higher didactics students in the UK (21% in 2004) as well feel personal financial crises each yr.2
At that place is growing business organization among students, the wider public, and policy-makers in the United kingdom of great britain and northern ireland that increasing financial pressures may explicate co-occuring trends in worsening educatee mental health.3 A recent study comparison 2015/2016 with 2006/2007 found that the number of UK higher teaching students disclosing mental health issues increased fivefold, and university deaths past suicide increased past 79%.4 Seemingly every bit a consequence, student mental wellness services are under pressure, with demand in the U.k. increasing3 but not being met.5 Consequences of poor mental wellness tin can include academic underperformance and dropping out of university,6 7 and thus these trends have implications for individuals, their families, the higher teaching sector and the public health community.viii
A number of studies suggest that pupil debt may be related to students' mental wellness issues,9 10 just other studies have reported null findings.7 11 Such links may be anticipated, given the substantial literature on the relationship between debt and mental health in the general population. A 2013 systematic review10 found that more severe debt was associated with depression, suicide, drug and alcohol dependence and psychotic disorders. In addition to corporeality of debt, a 2018 survey of over 3000 United kingdom students12 indicated that 3 in 5 students worried well-nigh paying back their loan, 84% worried well-nigh having plenty coin to live on and 50% believed that their mental health suffered as a result of fiscal difficulties.
Given existing bear witness, it is difficult to conclude with whatsoever certainty whether financial stress is associated with students' mental health, nor which domain of financial stress is nigh important—the corporeality of debt, experience of financial difficulties or worry well-nigh debt. Additionally, it remains to exist seen whether associations are bidirectional, or robust to aligning for potential confounders such every bit socioeconomic background13 and preceding mental wellness problems.14 As such, the present review sought to speedily summarise the existing literature in this area, focusing on UK students.
Methods
We conducted a rapid review of peer-reviewed scientific literature examining the links between financial stress and mental wellness among higher didactics students in the UK. Rapid reviews are a form of bear witness synthesis which are typically systematic in nature but omit particular steps taken in a full systematic review (eg, only 1 author screens the identified papers). They tin can exist considered a streamlined approach to traditional systematic review methods and yield valid inferences on the research topic addressed, although with less certainty than a total systematic review.xv
Three databases (PsychINFO, PubMed and Embase) were searched for any papers up to 29 November 2018. The search term 'pupil' was combined with keywords related to mental health and finances. Attributable to the scarcity of literature in the field, whatsoever studies which reported any measure of financial situation, stress or difficulties or debt, however defined, were considered to be measuring fiscal stress. Owing to the fourth dimension constraints and the big number of studies examining 'debt stress' and 'financial stress' but not mental health outcomes, the word 'stress' was not included amid the mental wellness terms. We therefore executed the post-obit search:
(Mental or Depress* or Anxi*) AND (Debt* or Loan* or Financ*) AND Pupil
English language-language studies were included if they measured associations between mental wellness and fiscal stress in higher didactics students inside the UK (at whatsoever time). The authors preidentified four key studies in the field eligible for inclusion and ensured that this search strategy captured all of them. Titles and abstracts were screened by one author (TM) for eligibility, followed by the total texts of whatever seemingly eligible papers. Additionally, we hand-searched papers from the most recent relevant systematic review10 and recent work by atomic number 82 authors on included studies to ensure that no key papers had been missed.
Information were and then extracted by one writer (TM) into a table devised by the authors; run across table 1. Data extracted included year(s) of data collection, sampling method, number of participants and response rate, whatever relevant consequence measures, analytical strategy (including confounding adjustment) and principal findings (regardless of summary measure out used). Nosotros narratively summarised our findings, stratified by the indicator of financial stress since meta-analysis was not judged to be possible.
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Table 1
Characteristics of included studies
Results
Study characteristics
The search strategy yielded 1272 results once duplicates were excluded, and simply ix studies were accounted to meet the inclusion criteria (effigy 1). A further two studies were identified through manus-searching. Thus, the terminal number of included studies was eleven.
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The earliest study took identify between 1997 and 1998, and the most recent betwixt 2012 and 2014. Seven of the studies simply recruited undergraduates, iii had a mixed sample of undergraduates and postgraduates with over 80% undergraduates and graduate status was unclear for one study.16 Four of the included papers reported contacting all UK educatee unions, ii recruited participants from ii London universities and the 5 remaining studies were all based at ane institution only. Reported response rates ranged from 38% to 95% and were unreported for five studies. Sample sizes ranged from 89 to 2146 with a hateful of 536.vii (SD 558.5).
All of the included studies were survey based. Five of the included papers reported on cantankerous-sectional surveys, and the remaining six on information from longitudinal prospective studies. The longest written report spanned 3 years (i time point per yr), while the remaining five were conducted over the start ii years of students' degrees.
In terms of financial measures, 7 studies used the amount of debt students anticipated leaving university with or their tuition fee corporeality. 5 papers reported asking students if they had ever considered abandoning their studies due to fiscal issues, while four asked virtually other financial difficulties the students had experienced. 3 papers also reported using the Alphabetize of Fiscal Stress17 (IFS), a mensurate of fiscal difficulties experienced in the past 6 months. For the purposes of synthesis, these three measures (financial difficulties experienced, considering dropping out due to fiscal problems, and the IFS) were all considered to be measures of fiscal difficulties. Iii studies asked about debt worry (also called debt stress), and ii studies asked about financial concern; these were as well grouped.
The majority of studies (viii of 11) used questionnaires ordinarily used for measuring general mental health in the general population, such as the General Wellness Questionnaire (GHQ)18 (four studies) and the General Population version of the Clinical Outcomes in Routine Evaluation Questionnaire19 (Core-GP) (iii studies). Two of these studies too used specific anxiety and low measures. The remaining three studies used just measures of anxiety and low (Hospital Feet and Depression Scale (HADS), psychosis Prodromal Questionnaire-Cursory (PQB) (Version) and disordered eating behaviours Eating Attitudes Exam-26 (EAT-26), respectively). Additionally, ii studies measured examination results and one asked about aid seeking via full general practitioner and satisfaction around assist seeking. The characteristics and cardinal findings of each study can be found in table ane.
Debt and mental health
Seven studies investigated the relationship between corporeality of debt and mental health. Of these, three establish an association betwixt more than debt and poorer mental health, and one found an clan betwixt less debt and poorer mental health. The remaining three studies reported no association.
Cooke et al eleven found no clan between anticipated debt and mental wellness among final year students from 1 UK university (north=2146). Similarly, Richardson et al 8 found no divergence longitudinally in general mental health, depression or anxiety between groups with dissimilar tuition fee debt amounts (northward=390). The only report that looked at psychosis also institute no show that debt was cross-sectionally associated with psychosis chance when gender, age and ethnicity were controlled for.twenty
Ane minor study16 (northward=89) found that college debt was associated with poorer mental wellness and more than financial business organisation. Two other cross-sectional studies21 22 (due north=103 and n=360) used structural equation modelling to judge that larger debt was associated with worse mental health through longer hours worked or a higher likelihood of because abandoning studies.
On the other manus, Ross et al 7 institute in one university (due north=334) that students with worse mental health had less debt, though students who reported that worrying about money affects their academic performance had significantly higher debt than those who did non. This study also found that in that location was no association between debt amount and bookish operation (examination results).
Financial difficulties and mental health
All vii studies investigating the relationship between experiencing fiscal difficulties and poorer mental wellness found some association between the two, though longitudinal and bidirectional findings were mixed.
All three studies by Roberts et al vi 21 22 used cross-sectional information from two U.k. universities (due north=103, n=360, and n=408) and reported that difficulty paying bills was associated with poorer mental wellness. All three also reported that participants who had considered abandoning their studies due to financial reasons had poorer mental wellness than those who had not.
Andrews and Wilding2 used longitudinal data collected beyond two time points (n=351), and found that experiencing financial difficulties during university (such as being unable to beget essentials) was associated with the development of depression midcourse, but not anxiety. This written report also reported a relationship between more fiscal difficulties and worse examination functioning at the end of 2d year, a relationship that was mediated by the midcourse low scores. Another longitudinal study14 institute that those who reported experiencing financial difficulties at baseline (according to the IFS) were likewise more likely to written report anxiety, low and stress cross-sectionally, and anxiety ii months later. Those who indicated at baseline that they had considered abandoning their studies for financial reasons had higher depression scores 6 and 8 months afterward. None of the mental wellness measures at baseline were associated with IFS scores ii months later, though worse general mental health at baseline was associated with more financial difficulties iv months later.
The only report that looked at psychosis outcomes observed no relationship between because abandoning studies for financial reasons and psychosis symptoms.20 Still, this written report plant that higher IFS scores at baseline were associated with both increased mental distress and psychosis symptoms afterward 4 months, and distress after half dozen months. Conversely, higher psychosis symptom scores at baseline were not associated with college IFS scores at either follow-up points. Lastly, i written report ended that experiencing financial difficulties (higher IFS score) at baseline was associated with more than severe eating attitudes long term (at 8 and 12 months), merely only in women.23 Severe eating attitudes at baseline were associated with higher IFS scores at the 4 month time point just (not at 8 or 12 months).
Debt worry/financial business organization and mental wellness
Four out of five studies found an clan betwixt an indicator of financial concern or debt worry and poorer mental health (table 1). The fifth study (n=408) found that students' reported stress about debt was non associated with their psychosis risk.20
Cooke et al 11 collected data from undergraduates at ane university (n=1391) every yr for three years, and observed an clan between more financial concern (measured by i question) and worse mental health at every time point. This study also found that, amongst third year students, debt worry was associated with worse full general mental health. When students were separate into groups according to 'no debt worry', 'low debt worry' and 'loftier debt worry', there was some evidence for differences betwixt the 'low' and 'high' groups in outcomes such equally feeling more unhappy and irritable and less able to cope, but fewer differences between the 'no' and 'loftier' groups.
A second longitudinal study14 demonstrated that greater subjective stress about debt at baseline was associated with depression cross-sectionally, and with greater anxiety, stress and poorer general mental wellness cantankerous-sectionally and at the longest follow-up indicate (effectually viii months).
One particularly small study16 (north=89) found that those with more financial concern (more agreement with statements such as 'I worry about my financial situation') had worse general mental wellness, but were not more probable to indicate that their mental health affects their everyday performance.
Finally, Ross et al vii (n=334) identified that students with poorer mental health were more probable to report that worrying about money affects their bookish operation. Additionally, students who indicated that they thought that worrying about money affected their performance on average ranked lower in bookish functioning than students who did not indicate this.
Discussion
Summary of bear witness
In summary, this review identified 11 papers (seemingly from 6 separate studies) examining the associations betwixt indicators of financial stress and mental health among college education students in the U.k.. Findings differed by financial stress indicator. There was piddling evidence that debt was associated with mental health—the simply studies that reported an association were either very minor or suggested that debt impacted on mental health through the experience of financial difficulties. Financial difficulties were cantankerous-sectionally associated with worse general mental health, and increased symptoms of feet and low. Notwithstanding, longitudinal findings were mixed and generally differed by follow-upwardly time indicate and measure out. There was some very limited evidence for bidirectional relationships betwixt fiscal difficulties and both general mental health and astringent eating attitudes, but not anxiety, depression and psychosis symptoms. Bear witness was more than consequent for a relationship betwixt mental wellness and the subjective measures of debt worry/financial concern. 4 studies reported a cantankerous-exclusive relationship between these indicators and mental health outcomes including full general mental wellness, anxiety and low. However, only ii studies nerveless longitudinal data for this indicator.
Taken together, nosotros believe that the strength of the identified evidence is weak, such that it is unclear how robust the associations are between financial stress and mental wellness amidst Britain college education students. While evidence indicates that more than subjective measures of financial stress may be associated with worse mental wellness, information technology is unclear whether the reported associations reflect causal relationships, whether these act in either or both directions and whether they take long-term implications.
Limitations of the available bear witness
The studies included were typically very modest in size, ranging from 89 to 2146 (median=408), and many were conducted at just one Britain university. This field may exist particularly vulnerable to publication bias as a result, with small studies reporting null findings less probable to get published. It is too unclear whether these findings generalise to the Uk higher teaching educatee population equally a whole, especially every bit primal factors such equally bachelor support differ considerably by university.
In many papers, key information such as survey dates and analytical strategies was non provided, which fabricated appraisal challenging. Response rates were frequently not reported,vi 14 20 23 which ways that the possibility of selection bias could not exist appraised—those experiencing financial difficulties and mental health problems may be less likely to respond to surveys, potentially leading to an underestimation of the clan between these variables. Additionally, where multiple papers with the same lead author are included, they appear to be reporting on findings from the same study, but without additional details nosotros cannot be completely sure.
Finally, studies were by blueprint limited in the extent to which they could brand causal claims regarding the human relationship between financial stress and mental health. Cross-sectional studies are unable to demonstrate the management of causality, and this is frequently still not possible in the longitudinal analyses where follow-upwards length was limited.
The associations reported may also exist confounded past other variables such as socioeconomic factors, and many studies did not account for these in their analyses.six xi 23 Even where adjustment is made, residual confounding or misreckoning due to omitted variables remains a potential explanation for the reported associations. Equally such, empirical strategies that rely on alternative assumptions for causal inference are likely to be useful in future. Changes across time and place in exposure to debt (eg, the 2012 tuition fee rises from £3000 to £9000 in England; even so in that location are no fees in Scotland) could provide potentially exogenous (unconfounded) sources of variation with which to examine the causal effects of debt on mental health outcomes. Such a design would require comparable data across time and/or place, and would likely crave large sample sizes to exist sufficiently powered (eg, to test interaction terms in a divergence-in-divergence design).24
Limitations of this review
There are several limitations of this review. Rapid reviews are increasingly used in prove synthesis,25 and may be a more efficient alternative to total systematic reviews which typically take substantially longer (eg, 24 months vs 2) and may yield similar findings,15 particularly if multiple databases are searched.26 However, in that location remains more than dubiousness in the conclusions drawn in a rapid versus full systematic review, and the extent of this uncertainty is specific to the research question and which aspect of the review process was expedited. In this review, while multiple search engines were used, and we additionally manually searched for relevant papers, it is possible that some relevant evidence was missed, since only 1 author screened papers. A full systematic review could therefore be warranted. This review was likewise limited to studies conducted in the UK. Understanding how this association differs beyond countries would exist useful in order to better understand the relative importance of fiscal stress with regards to student mental health, and place back up systems and policies that may alleviate links betwixt them. As such, futurity piece of work could consider a broad range of countries, while examining potential reasons for cantankerous-national similarities and differences in the association betwixt financial stress and mental health.
Conclusions
In summary, while evidence in this field is still very limited, information technology appears that fiscal stress, as indicated by students' fiscal business concern, may be associated with mental health outcomes—potentially more so than the corporeality of debt accrued. Given ongoing concerns regarding student mental health, further research should use robust methods and a range of financial stress measures to establish whether there are long-term causal relationships betwixt financial stress and mental health.
What is already known on this discipline
-
Increases in student debt in contempo decades have coincided with increased rates of mental health bug and deaths by suicide among higher educational activity students. Yet, information technology is unclear whether fiscal stress is associated with mental health outcomes amid this population, nor which aspects of increased financial stress may exist of import.
What this written report adds
-
In a rapid review of links between student financial stress and mental wellness, we found that some indicators of financial stress (such as financial business organization and experience of financial difficulties) were associated with worse mental health, but amount of debt was not. However, the forcefulness of show was judged to exist weak. Given ongoing concerns regarding loftier rates of student mental health problems, further research is needed to establish whether there are long-term causal relationships between financial stress and mental health, with a focus on the various types of financial stress students face. Additionally, understanding how the association betwixt financial stress and mental health differs between countries would too be useful in guild to identify beneficial support systems and policies.
Acknowledgments
The authors give thanks Praveetha Patalay for her helpful comments on an earlier version of this manuscript, and Alex Bryson and Gill Wyness for helpful discussions.
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