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Primary Submission Category: Socioeconomic status
Alternative financial services and self-rated mental health in U.S. adults: A propensity score analysis
Authors: Sicong “Summer” Sun, Yuanyuan Yang, Nishi Khodaria, Sebastian Polackal, Naomi Zewde,
Presenting Author: Sicong “Summer” Sun*
Background: Debt is a social determinant of health, but less is known about how use of alternative financial services (AFS), including payday loans, auto title loans, and pawnshops, relates to mental health. We examined whether AFS use is associated with poorer self-rated mental health among U.S. adults.
Methods: We analyzed data from the 2025 Financial Health Pulse Survey (N=10,844). AFS use was defined as any use of payday, auto title, or pawnshop lending in the past 12 months. The outcome was self-rated mental health. To reduce confounding, we used propensity score matching to balance sociodemographic and financial characteristics between AFS users and non-users. We then estimated adjusted associations using ordered logistic regression in the matched sample.
Results: Nearest neighbor matching improved covariate balance (N AFS users = 493; N non-users = 493). In the matched sample, AFS use was associated with poorer self-rated mental health (OR = 1.60, p < .001), with lower predicted probabilities of excellent (-0.043) and very good (-0.059) mental health and higher predicted probabilities of good (0.018), fair (0.005), and poor (0.029) mental health. Findings were consistent across sociodemographic subgroups.
Conclusions: AFS is strongly associated with poorer self-rated mental health, even after balancing observed confounders. AFS reliance may act as a population-level mental health risk factor. Integrating financial capability screening, referrals, and assistance into clinical and community settings, including medical-financial partnerships, may help reduce mental health risks linked to high-cost debt.