In Over Your Head? Ask Your Body.

By January W. Payne
Special to The Washington Post
Tuesday, July 24, 2007

Lynnae Brown knows debt: The 40-year-old market research tracker in New York owes more than $100,000 in student loans, plus $5,000 on her credit cards.

She also knows the toll it can take on her mental health: "Until recently, the debt was the physical manifestation of my worth -- or lack thereof," Brown said in an e-mail interview. "I used it as proof, and psychological punishment, that I made a mistake by going to grad film school and not becoming the next Steven Spielberg [and to] avoid relationships and reach for things I really wanted."

Although there is little quality research linking debt to poor health, experts say there's no question that being in debt can be stressful. And a wide body of research has tied stress to health problems including high blood pressure, cardiovascular disease and stomach disorders such as colitis.

"As with any serious stress," debt does have an "impact on one's physical health," said Elizabeth Carll, a New York-based stress and trauma psychologist. Financial worries may cause a person to be "run-down, have more colds, migraines and headaches, [and] their current medical conditions may get worse."

Brown is one of millions of people across the country for whom financial stress may be protracted enough to affect health and daily life. A 2006 survey conducted by the American Psychological Association found that money is a "top source of stress for adults," the APA reports.

More than three-fourths of American families carry debt, according to the Federal Reserve's 2004 Survey of Consumer Finances; about 9 percent of families with debt fell 60 or more days behind on loan payments during the previous year. And of the three-fourths of families who reported having credit cards in 2004, 58 percent carried an outstanding balance at the time of the survey.

In the past decade, student loan debt carried by graduating college seniors has more than doubled -- from $9,250 per person to $19,200, according to the nonprofit Project on Student Debt; a quarter of college borrowers graduating in 2004 owed more than $25,000 in student loans, not including money their parents may have borrowed on their behalf.

The stress created by this accumulation of debt can become unbearable, experts say. "Maxed Out," a documentary about credit woes released this year, includes the story of Yvonne Pavey, a 59-year-old Indiana wife and mother who police believe drowned herself in 2004 rather than face bill collectors and humiliation before family members.

In Northern California, Ramona Dickerson, a 40-year-old single mother of three boys, said financial stress exacerbates her other worries and spurs unhealthy behavior: "I [will] eat too much [or] won't work out. I'll either go to sleep or I'll eat something I shouldn't eat," said Dickerson, whose debt includes student loans and two mortgages. In an e-mail she added, "I have found that [debt] affected my ability to focus, decreased my discipline and generally distracted me from my plans."

Former financial news reporter Lynnette Khalfani, who wrote a series of books titled "Zero Debt" after paying off $100,000 in credit card debt, says such accounts demonstrate that "debt takes its toll on people in many different ways [including] enormous social, relationship and health implications for people. . . . For millions of people, financial worries and debt in particular are one of their biggest points of stress in their life."

Psychologists and psychiatrists can attest to that.

"I see a lot of people with various kinds of life events that are quite stressful, and invariably intertwined with this is a financial aspect," Carll said. "If you feel you're not paying your bills and you have collection agencies calling all the time, you're going to feel a little bit out of control. It sets up a worry about the future."

Said Michael McKee, a psychologist at the Cleveland Clinic whose clients include those with debt-related issues, "Clearly when you've got a bunch of credit cards and you feel you can't keep your head above water, that's obviously very stressful."

"For most people," he said, the cycle of debt "goes on and on as they borrow from one place to try to pay another . . . or spend more to try to make themselves feel better."

Still, research linking debt to depression and anxiety is scant. One possible reason, according to former University of Pennsylvania researcher Adair Crosley: Few longitudinal studies have good measures of debt.

Another problem, McKee said, is that only in recent years has the relationship between stress and physical health gained respect as a topic of study in medicine and science.

Some studies "strongly implicate the role of psychosocial stress that is associated with indebtedness in promoting poor health outcomes," Crosley said. Other studies investigate behavioral factors and their link to debt: A 2001 study published in the British Journal of Psychology found that drinking, smoking and obesity were associated with debt.

A study published in Social Science & Medicine in 2001 found that debt has a "central place in the association between" financial concerns and depression among mothers. A 2004 study published in the Journal of Further and Higher Education found that students with more financial worries reported feeling more tense, nervous and anxious and had more trouble sleeping than those with fewer financial concerns.

Kelly McGonigal, a psychologist at Stanford University who studies stress, called debt a "toxic version" of stress that "feels uncontrollable and is chronic in time [and] is the most difficult kind of stress." Constant worrying over debt causes a "lingering feeling that something bad is going to happen to you, so you're having this brain-body experience of stress all the time. . . . It can lead to catastrophizing" -- worsening a situation by imagining bad outcomes -- she said.

Symptoms of psychological stress may range from headaches and stomachaches to aggravation of such conditions as hypertension, immune disorders and cardiovascular disease, McKee said. Sleep disruption, eating disorders and anxiety and depression may also develop, along with reduced performance at work or school and relationship problems with family or friends.

"The issue of feeling out of control is probably the single most important universal stressor," said David Baron, chairman of the department of psychiatry at the Temple University School of Medicine. It's that feeling people get when the hot water heater dies, the car needs a new engine and medical bills need to be paid -- all at the same time, he said. "The key to understanding and dealing with stress and finances is sitting down and identifying what are your thoughts and feelings and concerns, and what can [you] do about it?" ยท

January W. Payne is editor of Health Plan Week and a former Health staff writer.

© 2007 The Washington Post Company