A systematic review examining the relationship between debt and the mental health outcomes of anxiety, depression and suicidality within the United States

Background: Personal debt in the United States has reached historic highs, raising growing concern about its impact on mental health. While prior reviews have examined debt and mental health, less is known about how specific debt types relate to distinct psychological outcomes within the U.S. Methods: Following PRISMA 2020 guidelines, we systematically searched PsycINFO, Scopus, and Web of Science for English-language, peer-reviewed articles published between 1980 and 2024. Eligible studies used quantitative methods, included adult U.S. populations, and reported statistical associations between personal debt and anxiety, depression, or suicidality. This review is registered with PROSPERO (CRD42024594465). Results: Thirty nine studies met inclusion criteria, covering debt types such as student loans, unsecured debt, mortgage debt, and bankruptcy. Debt was consistently linked to higher symptoms of anxiety, depression, and suicidality. Mechanisms included financial strain, debt collection pressure, and diminished sense of control. Under certain conditions, some secured debt (e.g., mortgages) appeared protective. Conclusions: Debt operates as a psychosocial stressor with significant mental health consequences. Findings highlight the importance of standardized measurement, longitudinal research, and integrated financial-mental health interventions. Structural reforms and targeted supports are needed to reduce the psychological burden of personal debt.