High levels of credit card debt and the stress of having debt may be bad for your health, a study in Social Science & Medicine suggests. People who reported higher levels of stress about their debt showed higher levels of physical impairment and reported worse health than those with lower levels of debt.

In the study, researchers asked people to rate their own health on a scale of very poor to very good. They rated how much they worried about their total debt. Researchers also asked how difficult it was for survey participants to do everyday activities such as climbing stairs and carrying groceries. Participants also reported how many credit cards they have and whether they carry a balance from month to month.

But it didn’t matter how many credit cards a person had, the big stress factor related to health was the ratio of credit card debt to their total family income—in other words, how much you owe compared with what you earn.

“The stress of owing money, and knowledge that we’re paying high interest rates, may lead to increased stress resulting in worsening health,” said the director of Ohio State’s Center for Survey Research. Credit counseling is one way to reverse debt-stress.