We will use the Michigan Recession and Recovery Study (MRRS), a new population-based longitudinal survey sample of Southeastern Michigan residents fielded in 2009-10 and 2011, to examine the association between various dimension of debt and indicators of health and health behavior that could plausibly be influenced by short-run changes in indebtedness. The widespread economic and employment shocks associated with the Great Recession may have altered asset and debt profiles for many Americans, but there are as yet few sources of data that have captured change in financial well-being in the wake of the global recession of the late 2000s that also include detailed information on health and heath behaviors of working-aged adults. 

Using two waves of data from the MRRS, we will explore associations between baseline levels and changes in the amount and composition of debt and levels and changes in depressive symptoms, anxiety, harmful or hazardous alcohol use, foregone medical or dental visits, and skipping or taking lower than recommended doses of prescribed medications to save money. We explore multiple measures of debt, including: (1) the volume of total debt and of distinct types of debt (i.e., amount of medical debt versus mortgage debt), (2) the magnitude of debt relative to assets or income (i.e., a debt-to-assets ratio measure, a debt-to-income measure), (3) the immediacy of the need to respond to debt (i.e., a measure of the number of unpaid bills), and/or (4) perceived or actual financial strain (i.e., perceived difficulty making ends meet, a measure of behaviors that suggest cash flow problems).

We have conducted analyses using data from wave 1, and data are just become available to conduct longitudinal analyses, but all will be complete prior to the APPAM meeting in November 2012. At baseline in 2009-2010, debt was associated with many of our measures of well-being, but different forms of debt had varying associations with health outcomes. For example, several specifications of respondents’ debt-to-asset ratios (DTA) (e.g., logged continuous, dichotomized at 0.5 or higher) were linked with foregoing needed medical or dental visits, while these measures were not associated with skipping or splitting medications among those who were prescribed medications. However, further exploration revealed that debt-to-asset ratios were associated with skipping or splitting pills, but only among those who had income-to-needs ratios of two or above (i.e., not poor or near poor). Such differences by income were not as apparent when considering foregone medical or dental visits, and we will explore possible reasons for this difference (e.g., type of health insurance coverage). Moreover, while unpaid bills and medical debt were associated with skipping or splitting pills, credit card debt, medical debt, and having other loans were associated with foregone medical or dental visits. Higher debt-to-asset ratios are also associated with a greater likelihood of reporting symptoms suggesting depression and of an anxiety attack in the past four weeks. Harmful alcohol use is not associated with DTA, but more work remains to be done to consider types of debt and the possibility for heterogeneous associations across groups.