Health Disparities
Credit deserts and depression in the U.S.: neighborhood credit scores, rurality, and mental health in a large national sample Catherine Ettman* Catherine Ettman Ettman Ettman Ettman Ettman Ettman Johns Hopkins Bloomberg School of Public Health
Given close links between economic context and mental health, we sought to understand how area-level credit scores are related to depression in the U.S. and whether the relationship varies across urban and rural areas. Using data from the Facebook COVID-19 Trends and Impact Surveys (CTIS; N=12,378,999 responses from November 2020-June 2022), we estimated the association of median area-level credit scores from TransUnion (sub-prime: 660; prime or above >660) with cross-sectional daily individual level frequent feelings of depression. We used multilevel logistic regression models with ZIP code random effects to estimate the association between area-level credit scores and depression. Fully adjusted models included individual-level demographics (race and ethnicity, sex, education, employment and age) and area-level covariates (median household income in the ZIP code, rurality), and a 6-month calendar-time indicator. We then ran a fully adjusted model with an interaction between credit score and urban versus rural areas. First, we found that living in a sub-prime ZIP-code was associated with higher odds of depressive feelings in the U.S. Overall, the predicted probability of frequent feelings of depression was 12.03% (95% CI 11.98%, 12.07%) compared with 14.57% (95% CI 14.49%, 14.65%) among those living in prime versus sub-prime ZIP codes. When we examined predicted probabilities from a model including an interaction between rurality and prime vs. sub-prime area, we found that the association between credit scores and depression varied across rurality, with sub-prime being more strongly related to depression in rural vs. urban areas. The highest predicted probability of depression was observed among adults living in sub-prime ZIP codes in rural areas (14.82%, 95% CI 14.68%, 14.95%). Living in a sub-prime ZIP code was associated with worse mental health in both rural and urban areas, with the greatest risk for depression in rural areas with sub-prime credit.
