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Introduction
What is the relationship between personal debt and mental health, in particular suicidal ideation? Three methodological approaches have been used to investigate this association: an examination of coroners' reports of suicides (Graham & Burvill, 1992; Yip et al. 2007); the collation of information from the case-notes of psychiatric in-patients who were admitted because of a suicide attempt (Hatcher, 1994); and an analysis of debt and suicidal ideation from national surveys of psychiatric morbidity (Hintikka et al. 1998). All three types of study indicate that indebtedness is a risk factor for suicidal ideation, and for both successful and unsuccessful suicide attempts.
Various factors have been put forward as increasing the risk of suicidal behaviour among those in debt: problem gambling (Yip et al. 2007), unemployment (Haider & Haider, 1992; Hintikka et al. 1998; Yip et al. 2007), family or relationship problems (Graham & Burvill, 1992) and amount of debt (Haider & Haider, 2002). Cox et al. (2004) argue that psychological individual differences such as level of self-criticism and hopelessness are just as valuable as sociodemographic characteristics and psychiatric diagnoses in understanding suicidality in the general population. In a study of suicidal ideation among income support participants in Australia, Butterworth et al. (2006) reported that those in receipt of such support showed higher levels of demoralization (hopelessness, worthlessness and dissatisfaction) compared with non-recipients, in addition to higher rates of suicidal ideation.
The aim of this paper was to establish the significance of any debt and particular sources of debt among the many correlates of suicidal thoughts, to quantify the effect of the multiple factors that interact with debt to increase the likelihood of suicidal ideation, and to examine the role of hopelessness in the relationship between debt and suicidal ideation.
Method
Sampling procedures
This analysis is based on a stratified multi-stage random probability sample, selected for the third national survey of psychiatric morbidity among adults in England carried out in 2007 (McManus et al. 2009).
In the first phase of sampling, postcode sectors (on average 2550 households) were stratified on the basis of a measure of socio-economic status within a regional breakdown. These postcode sectors, representing the primary sampling units, were divided into regions based on the Strategic Health Authorities...