Financial Functioning Before Mental Health Disclosure to a Retail Bank.

Abstract

Importance: Financial functioning is an important dimension of mental health, affecting independence and overall functioning. However, there is uncertainty about how financial functioning evolves over time and across mental health conditions, with current evidence largely relying on survey or experimental data.

Objective: To evaluate whether financial functioning differs in the period preceding mental health disclosure to a bank and whether differences are shared or condition specific.

Design, setting, and participants: In this case-control study, deidentified banking records from a major UK bank were used to compare financial indicators between individuals with a bank-disclosed mental health condition between January 2019 and August 2025 and controls, matched 1:3. Analyses were conducted between July 2025 and March 2026.

Exposures: Bank-recorded mental health disclosures mapped to diagnostic groupings of mental, behavioral, and neurodevelopmental conditions.

Main outcomes and measures: A total of 331 monthly financial indicators were used to capture financial functioning. A 2-stage bayesian hierarchical model examined how variation in case-control differences was distributed across financial indicators, conditions, and their interaction.

Results: The case group comprised 18 428 individuals with mental health disclosures (mean [SD] age, 41.5 [13.9] years; 10 357 women [56%]) and the control group included 64 229 individuals (mean [SD] age, 40.9 [14.5] years; 36 052 women [56%]). Differences in financial functioning were evident up to 36 months before disclosure. Compared with controls, posterior mean estimates for cases showed higher welfare-related income (disability benefits: 0.80; 95% credible interval [CrI], 0.78-0.83), greater financial distress (credit scores: -0.52 [95% CrI, -0.55 to -0.49]; overdraft use: 0.49 [95% CrI, 0.47-0.52]), and more frequent bank interaction (eg, telephone banking use: 0.56 [95% CrI, 0.53-0.58]). Additional differences included higher cash use and reduced spending on self-care and recreational activities among cases (standardized differences ≤0.4 SD units). Variance decomposition indicated that most variation was attributable to differences across financial indicators (SD, 0.11; 88% of total variance), with negligible variation explained by condition (SD, 0.01; <1%) and a small contribution from interaction effects (SD, 0.04; 12%), indicating broadly consistent patterns across conditions.

Conclusions and relevance: In this case-control study of bank customers, those who disclosed a mental health condition differed from controls across a range of financial indicators preceding the disclosure, with similar patterns across conditions. The findings suggest that banking data may provide objective measures of financial functioning to inform support strategies in banking and clinical contexts.