Mortgage affordability and mental healthcare use: Evidence from Finnish population registers

Mortgage repayment may affect mental health through financial strain. We investigate the relationship between mortgage repayment, specifically its affordability, and the use of mental healthcare in Finland. We follow a cohort of adults aged 20-29 in 2002 using linked population registers (2003-2019; unit: person-year) with no ongoing mortgage and compare two outcomes: (i) psychotropic medication purchases (PMP) and (ii) hospital visits and specialised care for mental health reasons (HVM). We estimate two methodologically complementary effects: an event study that captures within-person timing dynamics and a mixed-effects model that captures population-level contrasts. The event study reveals that after the onset of high-burden mortgages, PMP rises by 0.6-0.8 percentage points over the first 3 years, whereas it remains flat or declines for those with low-burden mortgages. For HVM, changes are smaller with convergence thereafter. Adjusted probabilities in logistic models indicate a moderate increase of 1.3 percentage points for tenants compared to owners without a mortgage, once covariates are held constant. We show that affordability at mortgage onset -- rather than homeownership alone -- is a public health lever and a key factor shaping mental health inequalities, with more substantial and more persistent effects for PMP and more modest patterns for HVM; thus showing that maintaining affordable paths to ownership is not only a housing concern but also a determinant of population health.