Student mental health: a prospective cohort study of the impact of increased tuition fees

Abstract

Research has demonstrated that debt is associated with poor mental health in students. In 2012 annual tuition fees in England and Wales increased from £3.5k a year to up to £9k a year. This thesis aimed to assess the impact of this increase on student mental health. A systematic review of the literature on the relationship between debt and physical and mental health found a total of 65 papers. These included panel surveys, nationally representative epidemiological surveys and psychological autopsy studies as well as research with specific populations such as university students and debt management clients. Most research has examined relationships with mental health in particular depression, with studies of physical health often relying on self-rated health. There are also relationships with suicide completion and drug and alcohol abuse, though cross-sectional designs make causality hard to establish. A meta-analysis of pooled odds ratios showed a significant relationship between debt and mental disorder, depression, suicide completion or attempt, problem drinking, drug dependence, neurotic disorder and psychotic disorders. A prospective cohort design compared the mental health of 681 first year undergraduate students who started university before fees increased to those who started after it. Participants completed measures of global mental health, depression, anxiety, stress, alcohol dependence, eating disorder symptoms and psychotic symptoms. At time 1, those paying £3-5k had higher scores on depression and global mental health than those paying £8-9k. However at time 2, there was a significant time*fees interaction for depression, global mental health, anxiety and stress; specifically, those paying £0-2.9k or £3-5k improved over time, whilst those paying £8-9k stayed the same. Multiple regression analyses demonstrated a number of other financial variables predicted symptoms of poor mental health. This suggests the fees increase may lead to poorer recovery from mental health problems in students.

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