Abstract
BackgroundOver-indebtedness is currently rising in high-income countries. Millions of citizens are confronted with the persistent situation when household income and assets are insufficient to cover payment obligations and living expenses. Previous research shows that over-indebtedness increases the risk of various adverse health effects. However, its association with sleep problems has not yet been examined. The objective of this study was to investigate the association between over-indebtedness and sleep problems and sleep medication use.MethodsA cross-sectional study on over-indebtedness (OID survey) was conducted in 70 debt advisory centres in Germany in 2017 that included 699 over-indebted respondents. The survey data were combined with the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). We limited analyses to participants with complete data on all sleep variables (OID: n = 538, DEGS1: n = 7447). Descriptive analyses and logistic regression analyses were used to examine the association between over-indebtedness and difficulty initiating and maintaining sleep, and sleep medication use.ResultsA higher prevalence of sleep problems and sleep medication use was observed among over-indebted individuals compared to the general population. After adjustment for socio-economic and health factors (age, sex, education, marital status, employment status, subjective health status and mental illness), over-indebtedness significantly increased the risk of difficulties with sleep onset (adjusted odds ratio (aOR) 1.79, 95%-confidence interval (CI) 1.45–2.21), sleep maintenance (aOR 1.45, 95%-CI 1.17–1.80) and sleep medication use (aOR 3.94, 95%-CI 2.96–5.24).ConclusionsEvidence suggests a strong association between over-indebtedness and poor sleep and sleep medication use independent of conventional socioeconomic measures. Considering over-indebtedness in both research and health care practice will help to advance the understanding of sleep disparities, and facilitate interventions for those at risk.Trial registrationGerman Clinical Trials Register: DRKS00013100 (OID survey, ArSemü); Date of registration: 23.10.2017; Date of enrolment of the first participant: 18.07.2017, retrospectively registered.
Highlights
Over-indebtedness is currently rising in high-income countries
The present study reveals a strong association between over-indebtedness and sleep problems in terms of sleep onset and maintenance as well as sleep medication use
The results contribute to the increasing evidence on the vital role of socioeconomic factors with regards to sleep problems and sleep medication use
Summary
Over-indebtedness is currently rising in high-income countries. Millions of citizens are confronted with the persistent situation when household income and assets are insufficient to cover payment obligations and living expenses. In Germany alone, currently 6.9 million individuals are estimated to be over-indebted, defined as the situation when household income and assets are insufficient to both meet all payment obligations and cover living expenses over a longer period of time [3]. Those affected are facing severe financial stress and are prone to experience social exclusion and stigmatization [4]. Over-indebtedness has been shown to increase the risk of serious adverse health effects, but its association with sleep problems and associated sleep medication use has not yet been examined
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