1. Over-indebtedness and effects on health – What are the costs to society? -A macro health-economical analysis Richard Ahlström Faculty of Health and Society University of Malmö Sweden

2. The situation in Sweden Today, about 400.000 Swedes plus their family members are considered being over-indebted. In all 1,2 million (13 % of the population). Forty percent of the over-indebted individuals quit the job- market, after about four years after the onset of the struggle with debts.

3. Men

5. Health scores (SF-36) among 725 over-indebted men and women in comparison to an age and gender matched population sample

6. Prevalence of depression among over-indebted individuals and expected scores in the normal population (Instrument: HADD-Hospital admission anxiety and depression scale) Over-indebted % Population % Limit value ≥ 8 19,5 9 Limit value ≥ 1128,7 6

7. Prevalence of anxiety among over- indebted individuals and expected scores in the normal population. (Instrument: HADA – Hospital admission anxiety and depression scale) Anxiety (HADA) Over-indebted %Population % Limit value > 8 18,5 12 Limit value > 11 37,5 8

8. The proportion of over-indebted individuals that are scoring high for PTSD-post-traumatic stress syndrome (Instrument: PCL-17). Category % Have PTSD (>44)47,9 Do not have PTSD52,1

9. Prevalence of suicidal thoughts and suicide attempts (Instrument: Paykel, 1973) Over-indebted % Population % Suicidal thoughts Total 38,5 20,3 Women 39,4 22,7 Men 37,8 17,9 Suicide attempts Total 17,3 3,6 Women 19,4 4,6 Men 14,9 2,5

10. What is the annual deficit (loss) to the Swedish society i.e. (tax-payers) when summing up the costs of over- indebtedness? http://www.riksrevisionen.se/PageFiles/22431/RiR_2015_14- Overskuldsersattning_Anpassad.pdf http://www.riksrevisionen.se/PageFiles/22431/Bilaga1.pdf Riksrevisionen – The Swedish National Audit Office

11. Costs to society loss of production healthcare costs sickness benefits social welfare benefits unemployment benefits counselling administrative costs Enforcement bank losses

12. Costs according to Ahlström (2015) Loss of production 14 billions € /year Health care 5 billions € /year Sickness benefits Early retirement social welfare benefits Unemployment benefits 2,5 billions € /year

13. Grand total = 21,5 billions € /year