The impact of the 2012 student fees increase on the mental health of British graduates: a cohort study Free

A large body of literature shows that financial difficulties are associated with poor mental health. For example, lower socioeconomic status is a risk factor for both physical and mental health problems (Kivimäki et al., 2020), predicting greater depression rates across a number of European countries (Freeman et al., 2016). Recessions also increase depression and anxiety rates (Frasquilho et al., 2015), and depression is linked to greater individual financial stress (Guan et al., 2022) and greater income inequality in a population (Patel et al., 2018).

Students are a population that can be vulnerable to poor mental health, with 37% reporting poor mental health during the COVID-19 pandemic (Jones, 2022). There is also evidence that financial problems negatively impact mental health in students specifically, with student debt and financial stress being associated with poor mental health (Roberts et al., 2000, 1999). Recent research indicates that subjective financial stress is a stronger predictor of student mental health than objective financial difficulties; for example, a recent systematic review in the UK found little evidence that the amount of student debt is linked to mental health, and stronger and more consistent evidence showing that financial stress is associated with poor student mental health, suggesting that the mere amount of debt or level of financial difficulty is not as important as the perceived impact this has (McCloud and Bann, 2019).

In 2012, tuition fees increased for English and Welsh students from ∼£3.5k to ∼£9k a year. Students in Scotland have free fees to study in Scotland or are charged ∼£9k, students in Northern Ireland pay £4.7k to study at home or ∼£9k in other countries of the UK. These loans accrue interest and are taken automatically from payslips with a fixed percentage dependent on salary. At the time, this was predicted to double subsequent student debt (PUSH, 2011). A study in 2015 compared the mental health of British students who started before and after this fees increase and found that those paying higher tuition fees had worse mental health at only one of the four time points across their first two years at university (Richardson et al., 2015). However, additional analyses in this cohort indicated that financial hardship impacted mental health over time (Richardson et al., 2017). The authors suggested that, as this was a short-term study and most students paying greater fees were predicted to never repay these, differences between those paying lower and higher fees may not emerge for several years once repayments on larger loans started (Richardson et al., 2015). Qualitative research has found that those graduating after the increased tuition fees were worried about finances in the future and their current level of debt compared to those paying lower fees (Vigurs et al., 2018); however, the impact on mental health was not examined.

This study therefore sought to follow a new cohort, including students who started university before and after the 2012 fees increase, to examine the impact of student loan debt and financial stress on current mental health. We hypothesised that those starting university later and paying greater fees would report more mental health problems including depression, anxiety, stress, suicidality and general mental health.

We used a cohort design to compare students who started university before and after tuition fees increased in 2012. We recruited participants who started university between 2008 and 2015 with British student tuition fees (or European Union nationals with home fees status), regardless of whether they had a student loan or completed their degree. We recruited through posters, social media, university graduate relations teams and Prolific (an online research platform on which people participate in studies in exchange for financial compensation), between September 2022 and December 2023.

Of 477 participants (251 from Prolific), 68 had insufficient data and 82 were ineligible (not British students or did not start university in the specified period), leaving 327 participants (mean age: 30.6 years). A G*Power analysis indicated that to detect an effect of 0.15 with 3 predictors at p = 0.05, 119 participants are required for 95% power.

Participants completed the following (alphas are reported for the current sample):

Participants reported their age, gender, ethnicity, employment status and income (Table 1).

The 12-item Economic Hardship Questionnaire (Lempers et al., 1989) was used to assess objective financial hardship. For the first 10 items, participants rated, over the past six months, experiences related to financial hardship (such as change in food shopping/eating habits to save money) from 0 (never) to 3 (very often). Internal consistency was good (α = 0.89).

The 14-item Clinical Outcomes Routine Evaluation – General Population (Evans et al., 2002) was used to assess general mental health. Participants rated, over the last week, how often they faced specific experiences (such as happiness, difficulty sleeping, ability to cope when things went wrong) from 0 (not at all) to 4 (most or all of the time). Internal consistency was excellent (α = 0.91).

The seven-item Generalised Anxiety Disorder Scale (Spitzer et al., 2006) was used to assess anxiety levels. Participants rated, over the past two weeks, how frequently they were bothered by anxiety experiences (such as nervousness, worry and restlessness) from 0 (not at all) to 3 (nearly every day). Internal consistency was excellent (α = 0.92).

The 20-item Centre for Epidemiological Studies Depression Scale (Radloff, 1977) was used to assess depression. Participants rated, over the past week, how often they had depressive experiences (e.g. feeling like a failure, feeling lonely, crying) on a scale from 1 (rarely or none of the time – less than one day) to 4 (all of the time – 5–7 days). Internal consistency was excellent (α = 0.95).

The 10-item Perceived Stress Scale (Cohen et al., 1983) was used to assess stress levels. Participants rated, over the last month, the frequency of stress-related experiences from 0 (never) to 4 (very often). Internal consistency was good (α = 0.89).

The six-item Brief Suicide Cognitions Scale (Rudd and Bryan, 2021) was used to assess suicidality. Participants rated the extent to which they agreed with items from 1 (strongly disagree) to 5 (strongly agree). Internal consistency was excellent (α = 0.92).

The project was approved by the university ethics committee. Upon accessing the study link, participants first read the information sheet and provided full informed consent. They then completed the measures in the order listed above and were debriefed online upon completion. Prolific participants were paid £1.50 in exchange for their time.

All variables were within −2–2 skew and kurtosis, indicating normality. We conducted hierarchical regression to examine whether cohort (starting university 2011 or before vs 2012 or after) and tuition fees levels (0–4k vs 8–9k) impacted mental health variables while covarying economic hardship.

Correlations were positive between economic hardship and depression (r = 0.42), anxiety (r = 0.48), stress (r = 0.45), suicidality (r = 0.37) and general mental health (r = 0.43), all at p < 0.001. The cohorts were comparable on gender and ethnicity; those starting university 2011 and before were older (Table 1), but age was not correlated with any mental health outcomes. The mean number of years since participants completed university was 8.74 (n = 315).

The regression results are shown in Table 2. Cohort (≤2011 vs ≥2012), but not tuition fees level (0–4k vs 8–9k) (trend, p = 0.075), predicted increased depression while covarying economic hardship. Cohort and tuition fees levels predicted increased anxiety, stress and suicidality. The effect of cohort reduced but remained significant when covarying economic hardship; the effect of tuition fees remained significant for suicidality with a non-significant trend for anxiety. Neither cohort (trend, p = 0.075) nor tuition fees predicted worsened general mental health.

This cohort study examined whether the 2012 increase in tuition fees impacted British students’ mental health. The results showed that those who started university later with increased tuition fees reported more symptoms of depression, anxiety and stress and greater suicidality, with a non-significant trend for worse general mental health. This contrasts with previous findings showing little cohort differences based on increased fees in students in their first two years of university (Richardson et al., 2015). The findings extend the current literature by demonstrating the longer-term impact of increased tuition fees on mental health. This study shows that, on average, nine years after attending university, differences in mental health emerge between those who started university before and after the tuition fees increase, despite these differences not being evident during their time at university (Richardson et al., 2015).

Greater current economic hardship predicted greater mental health symptoms, including suicidality, and reduced the impact of cohort and tuition fees levels when covaried. This suggests that cohort differences in mental health are because of greater current financial problems in those who paid higher tuition fees. A majority of those paying ∼£9k a year are predicted to never fully repay their student loan (Crawford and Jin, 2014), meaning that the impact of financial problems may persist and cohort differences may increase further with time. The finding that economic hardship was the strongest predictor of mental health aligns with research showing that greater financial difficulties worsen student mental health over time (Richardson et al., 2017).

The sample was predominantly white and female, and those who were more stressed about their graduate debt may have been more likely to participate. Previous research has shown that subjective elements of financial difficulties such as subjective stress about debt, self-esteem, active coping, hopelessness and shame are important mediators (Frankham et al., 2020a, 2020b; Richardson et al., 2015); the role of these in explaining cohort differences is not currently known.

In conclusion, the results suggest that the 2012 tuition fees rise has increased symptoms of depression, anxiety, stress and suicidality in British graduates several years after completing university. This is likely because of additional financial strain in the cohort paying higher tuition fees loans and graduating with larger student loan debt. Previous research has shown that students see student loans as a form of “symbolic violence” to control other social groups (Harris et al., 2021). Our research adds that generational cohort differences in tuition fees may be having a mental health impact at the public health level, and further monitoring and support of the mental health of those with high student debt levels is necessary.

The authors would like to thank the universities and organisations, and Juan Morillo, for helping to advertise the survey.

Funding: This research was funded by a start-up grant from the University of Southampton School of Psychology and for funding for My BILLS study by NIHR ARC Wessex.

Conflict of interest: Thomas Richardson has received payment and receives royalties for the use of “Space from Money Worries” by SilverCloud health and is an advisor for “TellJo” a company around financial vulnerability for which he receives shares and payments. The remaining authors have no conflicts of interest to declare.

Credit author contribution: Thomas Richardson, Conceptualisation, Methodology, Writing – Original draft preparation, Review and Editing. Monica Sood, Data curation, Investigation, Formal analysis, Writing – Original draft preparation, Review and Editing. Jack Large, Conceptualisation, Methodology, Data curation. Tayla McCloud, Conceptualisation, Methodology.

Data availability statement: Data are available from the corresponding author upon reasonable request.