The proportion of people in the UK experiencing problems repaying debt has increased in recent years. A growing body of evidence suggests that there may be a relationship between debt problems and clinically significant psychological distress. However, the causal direction of this relationship is unclear. Furthermore, it seems likely that psychological factors influence the relationship, such that how people make sense of their financial situation determines, at least in part, the extent to which they experience distress. The present study aims to develop a richer understanding of the relationship between debt and psychological distress from the perspective of those experiencing both difficulties. The study was part of the Debt Counselling for Depression in Primary Care trial (DeCoDer). Semi-structured interviews were conducted with eight adults recruited through GP practices in Liverpool. All identified as having debt problems and significant depressive symptoms. A thematic analysis was undertaken from a social materialist perspective, focusing on how participants’ experience of debt problems impacted on their lives. Two over-arching themes were identified, each consisting of three sub-themes. Living with debt day-to-day described experiences of constant worry, material hardship and feelings of shame. Cumulative psychological impacts described the longer-term consequences of debt problems, highlighting in particular how debt threatened participants’ sense of themselves as valuable and led to a perceived loss of agency in the face of difficulties. Results of the analysis are discussed in light of psychological research and recent arguments from anthropology and political philosophy. The findings suggest that psychological processes of rumination, social comparison and identity threat may be significant factors in causing distress amongst people with debt problems, in part because of a wider social milieu in which not being able to pay one’s debts is seen as a moral failing. Implications for clinical practice and future research are discussed.