Peter Elliott

The relationship between personal unsecured debt and mental and physical health: a systematic review and meta-analysis

This paper systematically reviews the relationship between personal unsecured debt and health. Psychinfo, Embase and Medline were searched and 52 papers were accepted. A hand and cited-by search produced an additional 13 references leading to 65 papers in total. Panel surveys, nationally representative epidemiological surveys and psychological autopsy studies have examined the relationship, as have studies on specific populations such as university students, debt management clients and older adults. Most studies examined relationships with mental health and depression in particular. Studies of physical health have also shown a relationship with self-rated health and outcomes such as obesity. There is also a strong relationship with suicide completion, and relationships with drug and alcohol abuse. The majority of studies found that more severe debt is related to worse health; however causality is hard to establish. A meta-analysis of pooled odds ratios showed a significant relationship between debt and mental disorder (OR=3.24), depression (OR=2.77), suicide completion (OR=7.9), suicide completion or attempt (OR=5.76), problem drinking (OR=2.68), drug dependence (OR=8.57), neurotic disorder (OR=3.21) and psychotic disorders (OR=4.03). There was no significant relationship with smoking (OR=1.35, p>.05). Future longitudinal research is needed to determine causality and establish potential mechanisms and mediators of the relationship.

Somatoform dissociation, psychological dissociation, and specific forms of trauma

Abstract Background: Childhood trauma is clearly associated with psychological dissociation a failure to integrate cognitive, behavioural and emotional aspects of experience. However, there is also evidence that trauma results in somatoform dissociation, where the individual fails to process somatic experiences adequately. Somatoform dissociation is linked to a number of psychiatric disorders that are relatively resistant to treatment. The present study addresses the hypothesis that somatoform dissociation will be associated specifically with childhood trauma that involves physical contact, rather than with non-contact forms of trauma. Methods: An unselected clinical group of 72 psychiatric patients completed standardized measures of childhood trauma, psychological dissociation, and somatoform dissociation. Results: The findings supported the hypothesis, with a specific link between somatoform dissociation and the severity of reported childhood trauma involving physical contact or injury. In contrast, psychological dissociation was associated with a wider range of non-contact trauma. Conclusions: Somatoform dissociation can be understood as a set of adaptive psychophysiologic responses to trauma where there is a threat of inescapable physical injury. Those responses are related to a range of psychiatric disorders, and are likely to interfere with treatment of those disorders. Clinicians may need to assess the nature and severity of childhood trauma and somatoform dissociation when there are high levels of somatic symptoms within psychiatric disorders that cannot be explained medically. Further research is needed to determine methods of treating somatoform dissociation, especially in the context of a history of trauma involving physical contact or injury.

Core beliefs in bulimia nervosa and depression: The discriminant validity of young's schema questionnaire

It has been suggested that depression and bulimia nervosa share common patterns of core beliefs, despite their differences in more superficial levels of cognition (negative automatic thoughts; dysfunctional assumptions). Although recent research appears to support this proposal, its methodological limitations precluded the ability to assess potentially important differences in core beliefs across the groups. The present study addresses those limitations, assessing a broad range of core beliefs among five groups: nonclinical women, nondepressed bulimics, mildly depressed bulimics, severely depressed bulimics, and major depressive disorder patients. Youngs Schema Questionnaire (YSQ) was used as the measure of core beliefs. All of the clinical groups reported less healthy core beliefs than the comparison women, but the major depressive disorder patients and the severely depressed bulimics had more unhealthy core beliefs than the nondepressed bulimics. Multivariate analysis demonstrated differences between all five groups, including the depressed patients and the severely depressed bulimics. These findings support the discriminant validity of the YSQ, suggesting that bulimia and depression are differentiated by core beliefs as well as by more superficial cognitive representations. These preliminary results suggest that the YSQ may be a clinically useful measure of schema-level representations in these disorders, although it will also be necessary to consider the role of schema process in different disorders. If the role of core beliefs in depression and bulimia is confirmed in future research, then there may be a need to adapt cognitive-behavioral treatments for these disorders accordingly.

A Longitudinal Study of Financial Difficulties and Mental Health in a National Sample of British Undergraduate Students

Previous research has shown a relationship between financial difficulties and poor mental health in students, but most research is cross-sectional. To examine longitudinal relationships over time between financial variables and mental health in students. A national sample of 454 first year British undergraduate students completed measures of mental health and financial variables at up to four time points across a year. Cross-sectional relationships were found between poorer mental health and female gender, having a disability and non-white ethnicity. Greater financial difficulties predicted greater depression and stress cross-sectionally, and also predicted poorer anxiety, global mental health and alcohol dependence over time. Depression worsened over time for those who had considered abandoning studies or not coming to university for financial reasons, and there were effects for how students viewed their student loan. Anxiety and alcohol dependence also predicted worsening financial situation suggesting a bi-directional relationship. Financial difficulties appear to lead to poor mental health in students with the possibility of a vicious cycle occurring.

Longitudinal relationships between financial difficulties and eating attitudes in undergraduate students

OBJECTIVE Previous research has shown a relationship between financial difficulties and poor mental health in students, but there has been no research examining such a relationship for eating attitudes. METHOD A group of 444 British undergraduate students completed the Index of Financial Stress and the Eating Attitudes Test (26-item version) at up to four time points across a year at university. RESULTS Higher baseline financial difficulties significantly predicted higher eating attitudes scores at Times 3 and 4 (up to a year), after adjusting for demographic variables and baseline eating attitudes score. Lower family affluence also predicted higher eating attitudes scores at Time 4 (up to a year). A higher eating attitudes score at baseline also significantly predicted greater financial difficulties at Time 2 (3-4 months). When considering these relationships by gender, they were significant for women only. DISCUSSION Greater financial difficulties and lower family affluence predict a worsening in eating attitudes over time in female students. The relationship appears to be partially bi-directional, with financial difficulties driving poorer eating attitudes in the shorter term.