A Systematic Review Examining the Relationship between Debt and the Mental Health Outcomes of Anxiety, Depression and Suicidality within the United States

Background and Purpose: In the United States, debt is a pervasive aspect of household finances, with over 77% of families with debt, including mortgages, credit cards, student loans, or medical debt (Aladangady et al., 2023). While debt is commonly examined in the context of financial and economic wellbeing, a growing body of literature explores its potential impact on mental health. Evidence is mixed: in some instances, debt is associated with increased risk of depression, anxiety, and suicidality, while in other cases, the relationship is less clear. Emerging research also suggests that different types of debt may exert differential effects on specific mental health outcomes. However, there has been no comprehensive review of the relationship between debt, depression, anxiety, and suicidality. This gap is problematic because without a synthesized understanding of how debt influences mental health, particularly across different debt types and mental health outcomes, interventions and policies may fail to address key drivers of psychological distress. This systematic review addresses that gap by examining the associations between debt and depression, anxiety, and suicidality.

Methods: Following PRISMA guidelines, we systematically searched PsycINFO, SCOPUS, and Web of Science using keywords and synonyms for debt, depression, anxiety, and suicidality. Inclusion criteria required adult samples, quantitative results, and statistical association between debt and mental health outcomes. Two team members reviewed studies, with discrepancies resolved by a third.

Results: Our search yielded 3,266 unique results for abstract screening. Of these, 235 studies were reviewed in full, and 40 were included in the final sample. Most were cross-sectional, utilized secondary data, and applied regression-based analysis. Debt types varied; most studies used a summative measure of multiple forms of debt such as credit card, educational, mortgage, medical, and personal loans. Key findings included: 1) a strong positive association between debt and anxiety, depression, and/or suicidality; 2) unsecured debts—such as credit card debt, payday loans, and medical bills—were most consistently associated with adverse outcomes;. 3) secured debts like mortgages may act as protective factors, while educational debt, though often secured, was consistently linked to poorer mental health; and 4) financial stress and perceived strain mediated the relationship between debt and mental health, shaping individual responses to debt burden. Financial stress appears to be a key pathway linking debt to mental health outcomes.

Conclusions/Implications: Multiple forms of unsecured debt had the most significant negative impact on mental health. Additionally, according to our findings, specific populations—young adults, veterans, older adults, and low-income families—experienced disproportionate debt-related distress. Our findings underscore the need for tailored policy responses that address both structural and individual risk factors to reduce the mental health burden of debt—particularly unsecured debt and its disproportionate impact on vulnerable populations. Future research should prioritize longitudinal and mixed-methods studies to explore causal pathways and lived experiences of indebted individuals.