As one can imagine, taking on a massive amount of debt can affect one’s mental and physical health negatively. In a 2013 study published in Anxiety, Coping, and Stress found that “those with greater financial strain perceived more stress, had more symptoms of depression, anxiety, and ill-health.” With many student loan borrowers fitting into the category of “greater financial strain,” it is no wonder that they are experiencing depression, anxiety, lack of sleep, and headaches over their debt.

Currently, Americans owe over 1.45 trillion in student loan debt according to Student Loan Hero. The average student loan payment for borrowers aged 20 to 30 years is $351 a month. Tim DeMello, founder and CEO of Gradifi, a start-up based in Boston that provides a student loan benefit program for its employers stated that “you have some students with $400, $600, $800 or even $1,200 a month in student loan payments.” This is delaying, and in most cases, preventing these individuals from getting married, starting families, and buying a home. In other cases, it is smaller things like the inability to go on vacation, pay rent, buy a car, or even get food and clothes.

The previously mentioned student, which came from the University of South Carolina, looked at certain factors which include the type of college, degree earned, and how wealthy the borrowers’ family were to determine the toll of climbing student debt totals as well as what certain factors can mitigate these negative effects. The result of this study was “cumulative student loans were significantly and inversely associated with better psychological functioning.” Basically, as The Atlantic put it, “student-loan debt was not great for the mental health of study participants.”

Interestingly, the study found that borrowers from poorer backgrounds performed better when it came to their mental health. The study suggests this could be because the debt can serve as a catalyst for an individual to receive higher socioeconomic status, which can help rather than hurt and individual. The researchers state, “Those who are able to enroll in college despite their early-life disadvantages may be in better mental health or possess personality characteristics that increase their odds of attending college, such as being future-oriented or highly motivated.”

After analyzing the data from a survey conducted by the National Longitudinal Survey of Youth, which surveyed 4, 643 Americans, the researchers determined that “the higher the student debt, the more likely they suffered from depression.” Moreover, they have determined that certain type loans, particularly ones that can’t be deferred, also add to the stress of borrowers since the debt sticks with them for the rest of their lives until the debt is paid off.

Those that appear to suffer the most are the middle class according to report. This is due to their inability to qualify for governmental assistance, while at the same time their parents don’t earn enough to take on the bulk of the costs. They are essentially caught in-between, which weighs heavy on their mental and physical health in comparison to other groups of borrowers.