- Research article
- Open Access
Mental health outcomes in times of economic recession: a systematic literature review
BMC Public Health volume 16, Article number: 115 (2015)
Countries in recession experience high unemployment rates and a decline in living conditions, which, it has been suggested, negatively influences their populations’ health. The present review examines the recent evidence of the possible association between economic recessions and mental health outcomes.
Literature review of records identified through Medline, PsycINFO, SciELO, and EBSCO Host. Only original research papers, published between 2004 and 2014, peer-reviewed, non-qualitative research, and reporting on associations between economic factors and proxies of mental health were considered.
One-hundred-one papers met the inclusion criteria. The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours.
On the basis of a thorough analysis of the selected investigations, we conclude that periods of economic recession are possibly associated with a higher prevalence of mental health problems, including common mental disorders, substance disorders, and ultimately suicidal behaviour. Most of the research is based on cross-sectional studies, which seriously limits causality inferences. Conclusions are summarised, taking into account international policy recommendations concerning the cost-effective measures that can possibly reduce the occurrence of negative mental health outcomes in populations during periods of economic recession.
Economic recessions have been estimated to significantly affect the population’s health and wellbeing, which applies, in particular, to vulnerable groups of people [1–5]. In countries that have been hardest hit by the latest recession, which started in 2007, the living and working conditions have substantially worsened . Work became more precarious and unemployment rates increased as a result of the slowdown in global growth and consequent deterioration of the labour markets . For instance, almost half of the citizens of Europe reported knowing someone who had lost his/her job as a direct result of the crisis . Rates of involuntary part-time employment have also been rising since the beginning of the recession . Overall, people are more fearful about losing their employment  since competition for jobs is rising and finding work quickly is perceived as unlikely. It is estimated that labour markets will take time to improve even though there are prospects for economic recovery . Levels of poverty and social exclusion have worsened, mainly in groups that were already at risk . During this recession, more people have been reporting being at risk of being unable to cope with unexpected expenses and even facing difficulties with paying ordinary bills or buying food over the coming year .
It is known that the health of populations is shaped by the socioeconomic context, welfare systems, labour markets, public policies, and demographic characteristics of countries . There are strong reasons to believe that changes in these key determinants may be reflected in the mental wellbeing of populations . Therefore, mental health should be a health area regarded as possibly vulnerable during a recession , especially if mental disorders were already highly prevalent even before the crisis began . Nonethless, some authors have argued that associations between contracting economies and levels of well-being may show mixed patterns of both positive and negative impacts . However, this current recession is likely to aggravate and boost mental health problems through growing socioeconomic risk factors such as unemployment, financial strain, debts, and job-related problems . People facing these major life changes are more prone to mental ill-health [15–18]. It has also been theorised that economic pressure and unemployment have a devastating impact on families, in particular children, since the family is the most important context for their healthy development [19, 20].
This paper intends to cover the main sources and types of recent evidence on populations’ mental health outcomes in times of economic recession. Specifically to summarize the mental health outcomes and the socioeconomic determinants most frequently addressed by the literature on economic recessions, which groups of people seem to be the most vulnerable, and to determine possible research needs.
Search strategy and definition of terms
A systematic search was performed in Medline, PsycINFO, SciELO, and EBSCO Host. The keywords used for reference tracing were derived from Medical Subject Headings (MeSH) in combination with key terms used in other reviews [2, 3, 5, 21, 22].
Two sets of keywords were then used and combined: 1) Recession and socioeconomic terms – “Economic recession” OR “Financial crisis” OR “Recession” OR “Unemployment” OR “Socioeconomic deprivation”; combined with 2) Mental health outcomes – “Mental health” OR “Mental disorders” OR “Suicide” OR “Substance-Related Disorders”.
Regarding the recession and socioeconomic terms, besides the logical use of the words “economic recession” and its synonyms, the word “unemployment” was used as it is a widely recognised countercyclical variable, i.e. a phenomenon that increases in recessions . The term “socioeconomic deprivation” was used, on one hand because it is a broad term that includes the characteristics of both social and economic vulnerability that are expected to increase in periods of recession , and on the other hand, because of its indisputable negative effect on health [5, 11]. Concerning the mental health outcomes, in addition to “mental health”, the term “mental disorders” was used because it is a MeSH term that encompasses “all psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behaviour producing either distress or impairment of function”. Although “mental disorders” is a broad term, it does not include suicide, which is known to be associated with major mental health problems . Therefore a specific keyword for that was entered. The term “substance-related disorders” was also included, because using the broad term “mental disorders” did not retrieve papers with clear specific results and this was a MeSH term used in other reference works .
Eligibility criteria and data extraction
Two reviewers independently screened all the titles and abstracts. The final articles in this review are a consensual reflection of both reviewers. They only considered studies for inclusion that were original research papers, peer-reviewed, published between 2004 and 2014, written in English or Portuguese, and showing associated results between recession or socioeconomic terms and mental health outcomes. Moreover, the authors excluded all duplicates, small sample investigations (<1000 except for case–control studies) for precision reasons and strength of effect sizes , research that did not employ validated instruments or used an inappropriate methodology regarding the associations under consideration (e.g. ambiguous variables under study, poor construct validity, and drawing of conclusions without statistical support), and qualitative research. The data extraction from each study was based on the following variables: the setting and country, the sample (N and age), the years examined, the mental health outcome(s) and the socioeconomic determinant(s), and the key associations or effects found. In general, we found significant disparities in the methods, data collection procedures, analyses, and contexts of existing studies that complicated direct comparison of results among studies. Because of this diversity of metrics and outcome variables, it was impossible to apply statistical criteria to the studies and for that reason it was not appropriate to perform meta-analysis of the results.
Mental health outcomes associated with economic recessions
We organised the main results by mental health outcomes and the socioeconomic determinants most frequently addressed by the literature, based on the quality of study design (cohort, case–control, cross-sectional and ecological). The mental health outcomes were clustered into four main groups: 1) psychological wellbeing (measured by continuous variables of mental health distress, self-rated health, and wellbeing or quality of life variables); 2) common mental disorders (assessed by caseness for depression, anxiety, and somatoform disorders); 3) problems related to substance-related disorders (reports on smoking, patterns of alcohol consumption, drug use, and substance-related harms), and 4) reports on suicidal behaviours (suicide mortality, parasuicidal behaviour, suicidal ideation, and attempts). The socioeconomic determinants retrieved were clustered into three groups by: 1) inter-time variables (pre- and post-economic recession changes); 2) macroeconomic indicators (rates of unemployment, GDP, home foreclosure rates), and 3) individual-level indicators (employment status, psychosocial job quality and security, household income, perceived financial strain or security, perceived economy/recession stress, deprivation, indebtedness, housing payment problems, socioeconomic status).
Study selection results
At the beginning, 20,502 studies were identified and were first filtered on the basis of being original peer-reviewed research papers and published between 2004 and 2014. The remaining 7351 papers were then screened by two independent reviewers through their titles and abstracts, and the subsequent filtering was performed on the basis of the following inclusion criteria: not being duplicates, written in English or Portuguese, were non-qualitative research, and reported associations between recession or socioeconomic terms and mental health outcomes. The full texts of 183 studies were then analysed. The number of papers excluded was a consequence of combinations of search keywords such as “crisis” and “mental health” or “suicide” that resulted in papers not relevant to the study objective. From the analysis of the 183 full texts, the investigators further excluded studies that used an inappropriate methodology regarding the associations between economic recession and mental health outcomes, including non-validated instruments, or used small samples (<1000, with the exception of case–control studies). After the previously described multistep selection method, 101 papers were used for the present review. Figure 1 shows the progress of selection for the study and the number of articles at each selection stage.
Table 1 summarizes the main features of the retrieved studies. Two studies used case–control design, 30 were cohort studies, 40 were cross-sectional studies or repeated cross-sectional studies, one used a mixed cross-sectional and case–control design, and 28 were ecological studies.
Samples and geographical allocation
More than half (66) of the total of 101 studies used national population samples. Out of these 66, 58 were general population samples and the rest were focusing on specific populations. Two used working populations, two used unemployed populations, two used samples of adolescents, one used a sample of patients attending primary care centres, and one used a sample of older adults. Furthermore, 16 studies used cross-national population samples, of which 11 were general population samples and 5 focused only specific populations. Two studies were samples of children and adolescents; one was a sample of working population; one used a sample of patients attending primary care centres, and one used samples of older adults. An additional 19 studies used community or regional samples. Out of these 19, 10 studies used general population, 3 used samples of workers, 1 used a sample of unemployed adults, 2 used samples of adolescents, 1 used a sample of children and parents, 1 used a sample of older adults, and 1 used a sample of hospital patients.
In terms of geographical allocation, 61 studies were conducted in Europe (7 studies were cross-European, 2 studies used samples from both Greece and Poland, and both Denmark and Sweden, 15 used samples from the UK, 8 from Greece, 7 from Sweden, 7 from Spain, 4 from Italy, 3 from Finland, 2 from Iceland, and 1 population sample each from France, Germany, Hungary, Portugal, Slovakia, and Slovenia). Eighteen studies have North American population samples (15 from USA and 3 from Canada); 7 studies were from Australasia countries (five Australian and two from New Zealand). Two studies were South American, one from Argentina and Brazil, and six studies were from Asian countries (three from South Korea, two from Japan, and one study from Hong Kong). In addition, there were seven multicentre studies that used cross continent population samples from various countries.
Pre and post-economic recession changes in psychological wellbeing
Studies comparing the data to pre-recession periods show a consistent aggravation of the mental health status of the populations involved (Table 2).
A longitudinal study from Greece showed that mental health and self-rated health were negatively affected by unemployment during the economic recession (2008–2013), especially among unemployed individuals . A similar result was found in Italy, where the inequalities regarding self-reported health between workers and unemployed individuals were amplified after the onset of the recession .
Repeated cross-sectional studies from Greece also showed that the recession period was associated with a significant deterioration of the population’s self-reported health and increased odds of poor health when compared to control populations [30, 31]. English and Spanish repeated cross-sectional studies indicated that the prevalence of psychological distress significantly increased during the recession period, with a greater impact on men compared to women [32, 33]. However, women also reported increased mental distress during the recession, according to a repeated cross-sectional survey from Sweden . In Japan, comparable surveys before and after the economic recession period showed reports of an increase in poor health across people of all socioeconomic ranks .
Pre and post-economic recession changes in rates of common mental disorders
Regarding morbidity rates for common mental disorders, longitudinal data from Iceland presented aggravated stress levels among the population, though only significant for women and especially if unemployed .
Greek comparable data from before and after the recession exhibited a statistically significant rise in the prevalence of depression [37, 38]. In Spain, evidence displayed a risk of suffering from depression during a recession that was almost three times higher than before . Similar evidence was also found in Canada and Hong Kong [40, 41]. The same Spanish study also showed an increase in the prevalence of anxiety disorders . Nevertheless, no changes in the prevalence of anxiety were found in the Canadian working population sample .
Pre and post-economic recession changes in substance-related disorders
A cohort study from the USA stated that the overall prevalence of any alcohol use significantly declined during the recession but, conversely, binge-drinking became more frequent . Spanish repeated cross-sectional evidence shows that this recession may have triggered alcohol-related disorders, since a noteworthy rise of 4.6 % in the abuse of alcohol and dependence on it was observed . Furthermore, available data from Argentina also revealed that people may tend to increase their intake of lower-quality alcohol, which is known to pose additional threats to health .
Pre and post-economic recession changes in suicidal behaviours
Longitudinal evidence during the Swedish recession reported a post-recessionary increase in suicide rates among unemployed men  suggesting possible delayed effects of the recession on suicidal behaviours. Similarly, Greek cross-sectional data, from before and after the onset of the recession, indicated that the rate of suicidal ideation increased significantly in men . Moreover, in South Korea data from comparable surveys also showed that income gradient-related suicide behaviour was found to have increased in the years after the recession period .
Several ecological studies from Spain have reported a substantial growth of suicidal ideation and suicide attempts [47–49]. In Italy, an ecological study showed an evident increase in suicide rates among Italian men involved in the labour force after 2007 . Similar evidence comes from the UK, where time-trends analysis displayed an increase in the suicide rate, especially among working-age men [51, 52]. In an ecological analysis, Reeves et al. found that most of the European countries experienced a significant rise (6.5 %) in suicide rates after the onset of the recession in 2009 . The same was found in Canada (a rise of 4.5 %) and in the USA (a rise of 4.8 %) .
Macroeconomic indicators associated with mental health outcomes
Data from cohort studies focusing on unemployment rates (Table 3) have shown that high unemployment rates are linked to individuals’ worsened mental well-being and higher mental distress levels [55–57]. Similar evidence was found in a cross-sectional study from the USA [58, 59].
A large cross-national ecological study has shown that rises in unemployment among the population are also associated with lower life satisfaction levels, especially among unemployed individuals . Despite this evidence, however, there is a recent ecological study from Spain that suggests that rises in unemployment rates were associated with a decrease in the demand for mental healthcare .
Recent ecological studies provide evidence of a strong positive association between unemployment rates and suicidal behaviour. A study that covered 30 countries (European, North American, and Australia) demonstrates that increases in the unemployment rate related to the recession period have a negative impact on suicide, especially in those Eastern and Southern European countries with the least developed social protection systems . Similar evidence has been found in studies focusing solely on European countries [62–66] and studies performed in the USA [67–69], as well as in South Korea . In Greece two studies also found strong correlations between unemployment rates and suicide [71, 72], though there is one study reporting no correlation and no increase in suicide behaviours . In England, these correlations were only statistically significant at the regional level , and in Hungary the correlations were only strong 3 to 5 years after the onset of the recession . Using other macroeconomic indicators, Houle et al. found that the state-level foreclosure rate also correlated to suicide rates in the USA  and an Italian study found that the decrease in GDP per person was associated with male suicide .
Individual-level indicators associated with mental health outcomes
Studies demonstrate that people who lose their job during a recession are more vulnerable to the economic recession. For instance, during the Japanese economic crisis unemployed people were twice as likely to report poor health compared to controls . In Hong Kong the prevalence of a major depression episode increased among the unemployed . In addition, research dealing with the European recession shows a significantly higher risk of depression and mental distress among this group of people compared to the general population [28, 29, 33, 39], although Icelandic and Swedish data showed increased stress levels only for unemployed women [34, 36]. When variations in macroeconomic indicators are considered, the unemployed were also more vulnerable to mental health problems and suicidal behaviour [56, 57, 70].
Several individual-level cohort studies (Table 4) found an association between job loss and poor mental health outcomes and low life satisfaction, and suggest that this can be both a risk factor for being unemployed and its consequence [78–86]. In addition, in cross-sectional studies unemployment has also been associated with psychosomatic symptoms and psychological distress [87–90].
Two large cohort studies showed that unemployment was associated with depressive symptoms [91, 92]. The risk of common mental disorders such as depression and anxiety was also found to be significantly greater in unemployed individuals in several cross-sectional studies [93–96].
Furthermore, a case–control study from Finland found that being unemployed was a heavy predictor of risky behaviours such as driving under the influence of drugs . Cross-sectional data from the USA and Germany also discovered that unemployment was significantly related to alcohol and drug use [98–100]. Additionally, alcohol-attributable deaths rate were determined to be higher among the unemployed population during recession, says an ecological study from South Korea .
Suicidal behaviours were also linked to unemployment in several studies. A Canadian case control study found that unemployed individuals have a significantly increased risk of parasuicidal behaviour compared to their matched controls . Likewise, in a large cross-national study, being unemployed was discovered to be a strong risk factor for suicidal ideation and attempts . An Australian study also revealed that, in times of recession, unemployed males commit suicide at 4.62 times the rate of employed men and women 8.44 times more compared with employed females . Also in times of recession a Spanish study states that being unemployed was found to be associated with suicidal ideation .
Precarious and insecure work
Working conditions affect mental health (Table 5). Finnish longitudinal data pinpointed mental distress as being stronger among precarious workers with high job insecurity . Nevertheless, there is a Swedish cohort study that found no significant differences in the effects of job insecurity on health between temporary and permanent workers . Cross-sectional data from during the recession in Italy, determined that job stress was significantly related to workers’ mental health and fear of the crisis . This was supported by British evidence of an increased risk of depression and anxiety among such employees [109, 110].
Debt, deprivation, and financial hardship
Several studies found socioeconomic status and indebtedness to be related to mental health. In the USA, a cohort study, indicated increased incidence of anxiety and mood disorders, and substance use disorders were strongly associated with drops in household incomes . Strong causal conclusions about this matter can also be drawn on the basis of a cohort study from New Zealand that shows a high level of association between inequalities in wealth and psychological distress, stating that people reporting low levels of wealth have three times greater distress than those reporting higher levels of wealth . Longitudinal data also illustrates that housing payment problems and indebtedness have a detrimental effect on mental health  and on the onset of depression and anxiety .
Income inequality at a regional level was also significantly associated with poorer mental health in a cross-sectional study completed in a community sample from Wales, UK . Additionally, low socioeconomic status was related to higher rates of tobacco smoking and the use of cannabis and other illegal drugs compared to people of higher socioeconomic status in a French community-based cohort .
The previously cited studies show that during recession Greek people with serious economic difficulties had 1.33 times higher odds of developing a major depressive episode during the recession , and in South Korea well-off people do better in recessions in terms of the prevalence of depression, suicidal ideation, and suicide attempts .
Families, children, and older people
The literature also stated that families and children affected by socioeconomic factors might face a decline in their mental health (Table 6). Finnish longitudinal research shows that economic stress can lead to deterioration in children’s mental health, mainly through changes in family relationships and parenting quality . A large cross-national study with representative data on adolescents from 31 countries found that the countries most hit by the recession (Ireland and Portugal) faced a rise in psychological health complaints (9–17 %), and this was related to the increase in unemployment rates .
In fact, adolescents who perceived themselves as being socioeconomically worse off have a four-times higher likelihood of rating low life satisfaction and quality of life, claims a study from Slovenia . In addition, children with unemployed parents have a higher prevalence of depression, higher rates of psychosomatic symptoms, and lower perceptions of psychological well-being [121–123].
Trends in a cohort of Canadian adolescents’ total suicide-related behaviour during periods of recession illustrate that the downward trends in suicidal behaviour stopped after the onset of the recession, though no increase has been reported . Moreover, in the USA, repeated cross-sectional analysis before and after the onset of the crisis revealed that state-level unemployment during the year preceding the survey increased girls’ rates of suicidal ideation and suicide plans, but did not affect the suicidal behaviour of boys .
Studies focusing on older adults report that those facing distress related to economic slowdown and rates of home foreclosure also had greater depression and anxiety symptoms in Australian cohort studies [126, 127].
People with mental health problems
A cross-sectional study comparing data from 27 EU countries before and after the crisis found that individuals with mental health problems were more vulnerable to losing their employment than those without these problems. This evidence is particularly important for people already facing mental health problems because it may indicate that during a recession discriminatory attitudes towards people with chronic mental health conditions may harden, both in the job market and in society, further increasing their suffering and isolation .
In general, evidence on the impact of economic crises and recessions on mental health is accruing, but comprehensive studies are lacking. Epidemiological data comparing changes in health status before and after a recession are consistent and report negative associations with mental health and increased mental health problems. However, to measure the extension and duration of these impacts and to isolate the exact causal factors appeared to be challenging. There is a preponderance of cross-sectional and ecological studies compared to cohort or case–control studies. This causes great limitations in terms of determining causality between the recession and mental health problems. Nevertheless, the repeated cross-sectional studies helped to better estimate the changes in the population’s outcomes before and after the recession period.
In terms of geographical allocation, most of the research is being done in Europe and North America during the period of this review (2004–2014). Some of the countries hardest hit by the economic recession (Greece, Spain, and Italy) are monitoring changes in the mental health outcomes of their populations, although they are doing so mainly by using repeated cross-sectional surveys or ecological analysis. We found no specific studies from Ireland or Portugal focusing on the effects of the recession on mental health. We strongly believe that research results from these countries could contribute to a better understanding of the consequences of the recession since its impact on mental health varies greatly, depending on how austerity measures and policy responses were implemented. Additionally, there were a very limited number of studies from low and middle-income countries despite the fact that there are strong reasons to believe that these countries are likely to be heavily affected by the recession, especially because any further reductions in these countries’ already weak health budgets (mental health services in particular) is likely to be very damaging. We argue that research from these countries finds substantial barriers to publication in widely accessible journals due to possibly material and financial constraints, problems of research design and statistics and thinkable difficulty in writing in English. Thus, we argue that this under-representation of research might result in limited conclusions.
Nonetheless, the studies included in this review confirm that recession periods are feasibly associated with the increased prevalence of psychological distress and common mental disorders, substance disorders, and ultimately suicidal behaviour. Despite being limited to the validity of self-reporting, the data on alcohol misuse behaviour indicates that any increase in its prevalence may be countercyclical and related to unemployment rates. We further add that recessions might result in an increased prevalence of smoking and illicit substance use since the literature indicated this may be a coping mechanism used to help deal with unemployment and economic distress . However, the impact may vary according to the profile of substance users. Recreational users may be more susceptible to cuts in income, therefore reducing abuse, while others who are more dependent may actually adopt riskier patterns of substance misuse, such as injecting or binge drinking, in order to maximise the effects of the substances they have managed to purchase . Further analysis of these fields is still required.
Although reports of growing suicidal ideation and attempts in countries in recession are limited to the complexity of the phenomenon, to the cultural background, and to the quality of the data sets and self-reports, which are susceptible to recall bias, it is consistent with the previous idea that suicide is more common in areas of high socioeconomic deprivation, social fragmentation, and unemployment . Futhermore, a great proportion of the evidence from this review shows that unemployment, precarious work, debt, and financial deprivation are significantly associated with mental health problems. Determinants as such are well-known driving forces for widening health inequities, and put some groups of people at higher risk of suffering the impact of the economic recession. The influence of these factors on mental health has been widely recognised in the past [15, 130, 131]. Therefore, special attention should be given to people facing economic pressure and unemployment.
Indirect data supports the view that families and children may be disproportionally affected by recession, which is consistent with the Family Stress Model [19, 20]. Many mental disorders often start in adolescence or young adulthood. Growing up in a challenging environment can put young people in a very vulnerable position [132–134]. Up-to-date evidence shows that 27 % of young Europeans aged below 18 are at risk of poverty or social exclusion and, considering the growing number of people who are unemployed and in deprivation, these are worrying indicators . Failing to protect the mental health of young people and to capitalise on their energy may indicate that we will possibly face a long-lasting loss of future adult productivity [134, 136]. Unexpectedly, there is a substantial research gap on the effects of recession on families and children. A better understanding of these effects could be gained from research focusing on how job losses and economic strain affect family members.
Research and policy implications
Summarising the data from this review gives us a global perspective and allows some hypotheses to emerge that serve as a framework for future research on economic recessions and mental health outcomes:
it is plausible that the actual recession increased the population’s psychological distress;
according to the evidence reviewed, periods of recession correlate with higher prevalence of common mental disorders, substance disorders, and ultimately suicidal behaviour;
it may be possible that in order to cope with psychosocial stress people might turn to substance misuse;
some key factor seem to make people more vulnerable to the effects of the recession: being unemployed, having a precarious work situation, facing debts and economic strain, and having a pre-existing mental illness;
economic recession may also have a severe and long-term impact on mental health in children and young people, especially if they face stress within the family as a result of economic hardship or parental unemployment;
some specific differences between countries and regions were found in this review. The authors hypothesise that this may be explained by the socioeconomic response policy to recession (the presence of unemployment benefits or social programmes) which could influence changes in the mental health outcomes of the populations;
more research is needed concerning mediating factors between the determinants of a recession and mental health outcomes;
more research from countries badly hit by the economic recession and from low and middle income countries is needed;
the links between recession and direct effects on health seem to be very complex, and the lagged effects have not been systematically studied because of a lack of longitudinal studies and therefore a scarcity of long data series persists.
Even though the economy can shape populations’ mental wellbeing, better mental health can in turn be a major contributor to economic growth . Policies and cost-effective measures may affect the extent of the risk factors faced by populations and the occurrence of mental health disorders during and after an economic recession. The World Health Organisation  has argued that the mental health effects of economic crises depend on action in five key areas:
active labour market programmes
family support programmes
regulation of the marketing of alcoholic beverages, restrictions on their availability, and taxation
provision of quality and equitable access to primary care for those people at high risk of mental health problems
debt relief programmes.
Strengths and weaknesses of this study
A language bias might be present since the review was exclusively based on English and Portuguese language research reports. Nonetheless, the potential impact of studies published in other languages in this literature review may be minimal since most of the publications in widely accessible journals are in English.
Another limitation may be the literature search time framed to last 10 years. Although it is an usual procedure , it could have limited the inclusion of other important works. Also, given the heterogeneity of the metrics used by the studies we were unable to use quantitative meta-analytic methods and therefore were not capable of identifying statistical patterns.
As included studies have mainly cross-sectional or ecological design, there is a limited space for establishing causal inferences. This is especially important because this gives only evidence of the rough short-term mental health outcomes related to economic recession and specific socioeconomic indicators, but there is still a lack of evidence on the longer-term consequences, particularly if the number of long-term unemployed people continues to grow and social safety nets experience further cuts.
Moreover, despite the fact that most studies are showing negative associations between the recession and levels of mental health, there may be mixed patterns (positive and negative effects of the recession) that are dependent on countries’ policies and responses adopted to deal with the recession . Thus, the generalisability of the findings is considerably limited by the uniqueness of the welfare and health systems of each country and its response measures to the economic recession itself. The only way to ascertain whether the economic recession has increased the incidence of poor mental health is to intensify the gathering of empirical evidence from long-term cohort studies .
Notwithstanding limitations, the literature review gives a rough approximation of the consequences of the recession, showing an increasing number of people experiencing poor mental health and reporting common mental disorders such as depression and anxiety, substance-related disorders, and suicidal behaviour, which corroborates with what was found in other reference works [1–3].
Quality evidence showing that economic recessions are possibly associated with negative mental health outcomes of populations is growing. This seems especially true for psychological wellbeing, common mental disorders, substance disorders, and suicidal behaviour, despite the fact that the mediation pathways are still undisclosed. There are groups of people that may be especially vulnerable to the effects of recessions: the unemployed, those in debt or facing financial difficulties, people with pre-existing mental health problems, and families with children. It is well known that mental disorders and substance use disorders make major contributions to the global burden of disease in high-income countries and constitute important public health problems. Since economic downturns may possibly exacerbate mental ill-health and suicide risk factors, it is a collective responsibility to take action and reduce these unbearable costs as far as possible. In times of economic constraints countries may want to consider balancing appropriate resources. Structural reforms and the implementation of available cost-effective measures to achieve health and high levels of wellbeing may contribute to a more productive economy and desirable societal assets.
medical subject headings
gross domestic product
Zivin K, Paczkowski M, Galea S. Economic downturns and population mental health: research findings, gaps, challenges and priorities. Psychol Med. 2011;41(7):1343–8. doi:10.1017/S003329171000173X.
Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, et al. Financial crisis, austerity, and health in Europe. Lancet. 2013;381(9874):1323–31. doi:10.1016/S0140-6736(13)60102-6.
Modrek S, Stuckler D, McKee M, Cullen MR, Basu S. A review of health consequences of recessions internationally and a synthesis of the US response during the great recession. Public Health Rev. 2013;35:1.
WHO. Impact of economic crises on mental health. Geneva: The Regional Office for Europe of the World Health Organization; 2011.
Marmot M, Allen J, Bell R, Bloomer E, Goldblatt P. WHO European review of social determinants of health and the health divide. Lancet. 2012;380(9846):1011–29. http://0-dx.doi.org.brum.beds.ac.uk/10.1016/S0140-6736(12)61228-8.
Eurofound. Eurofound year book 2012: living and working in Europe. Dublin, Ireland: Eurofound; 2013.
Eurostat. Unemployment rate, monthly average, by sex and age groups (%). In: une_rt_m, ed.: Eurostat, 2013. Available from: http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=une_rt_m&lang=en
European Comission. Flash Eurobarometer 338 - monitoring the social impact of the crisis: public perceptions in the European Union (WAVE 6), 2013. GESIS Data Archive: Cologne. 2013 Report No.:ZA5773. doi:10.4232/1.11582
ILO. World of work report 2012 ‘better jobs for a better economy’. Geneva: International Labour Office; 2012.
WHO. Poverty, social exclusion and health systems in the WHO European Region. Copenhagen. 2010.
Wilkinson RG, Marmot MG. Social determinants of health: the solid facts. Euro nonserial publication: World Health Organization, Regional Office for Europe. 2003.
Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64(4):284–91. doi:10.1136/jech.2008.082743.
Alonso J, Angermeyer MC, Lépine JP. The European Study of the Epidemiology of Mental Disorders (ESEMeD) project: an epidemiological basis for informing mental health policies in Europe. Acta Psychiatr Scand. 2004;109:5–7. doi:10.1111/j.1600-0047.2004.00325.x.
Catalano R. Health, medical care, and economic crisis. N Engl J Med. 2009;360(8):749–51. doi:10.1056/NEJMp0809122.
Warr PB. Work, unemployment, and mental health. New York: Oxford University Press; 1987.
Jahoda M. Employment and unemployment: a social-psychology analysis. Gambridge: Cambridge University Press; 1982.
Selenko E, Batinic B, Paul K. Does latent deprivation lead to psychological distress? Investigating Jahoda’s model in a four-wave study. J Occup Organ Psychol. 2011;84(4):723–40.
Creed PA, Klisch J. Future outlook and financial strain: testing the personal agency and latent deprivation models of unemployment and well-being. J Occup Health Psychol. 2005;10(3):251–60. doi:10.1037/1076-89126.96.36.199.
Conger K, Rueter M, Conger R. The role of economic pressure in the lives of parents and their adolescents: the family stress model. In: Crockett L, Silbereisen R, editors. Negotiating adolescence in times of social change. New York: Cambridge University Press; 2000. p. 201–23.
Conger RD, Conger KJ. A family process model of economic hardship and adjustment of early adolescent boys. Child Dev. 1992;63(3):526. doi:10.1111/1467-8624.ep9207061028.
Kentikelenis A, Karanikolos M, Papanicolas I, Basu S, McKee M, Stuckler D. Health effects of financial crisis: Omens of a Greek tragedy. Lancet. 2011;378(9801):1457–8. doi:10.1016/s0140-6736(11)61556-0.
Henkel D. Unemployment and substance use: a review of the literature (1990–2010). Curr Drug Abuse Rev. 2011;4(1):4–27.
Claessens S, Kose MA, Terrones ME. What happens during recessions, crunches and busts? Econ Policy. 2009;24(60):653–700.
Lynch J, Kaplan G. Socioeconomic position. Social epidemiology. 2000. p. 1.
Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM. Psychological autopsy studies of suicide: a systematic review. Psychol Med. 2003;33(03):395–405.
Bretteville-Jensen AL. Illegal drug use and the economic recession–what can we learn from the existing research? Int J Drug Policy. 2011;22(5):353–9. doi:10.1016/j.drugpo.2011.03.009.
Carlson MDA, Morrison RS. Study design, precision, and validity in observational studies. J Palliat Med. 2009;12(1):77–82. doi:10.1089/jpm.2008.9690.
Drydakis N. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis. Soc Sci Med. 2014;128c:43–51. doi:10.1016/j.socscimed.2014.12.025.
Minelli L, Pigini C, Chiavarini M, Bartolucci F. Employment status and perceived health condition: longitudinal data from Italy. BMC Public Health. 2014;14(1):946. doi:10.1186/1471-2458-14-946.
Zavras D, Tsiantou V, Pavi E, Mylona K, Kyriopoulos J. Impact of economic crisis and other demographic and socio-economic factors on self-rated health in Greece. Eur J Public Health. 2013;23(2):206–10. doi:10.1093/eurpub/cks143.
Vandoros S, Hessel P, Leone T, Avendano M. Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approach. Eur J Public Health. 2013;23(5):727–31. doi:10.1093/eurpub/ckt020.
Katikireddi SV, Niedzwiedz CL, Popham F. Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991-2010 Health Surveys of England. BMJ Open. 2012;2(5):e001790. doi:10.1136/bmjopen-2012-001790.
Bartoll X, Palencia L, Malmusi D, et al. The evolution of mental health in Spain during the economic crisis. Eur J Public Health. 2014;24(3):415–8. doi:10.1093/eurpub/ckt208.
Blomqvist S, Burstrom B, Backhans MC. Increasing health inequalities between women in and out of work–the impact of recession or policy change? A repeated cross-sectional study in Stockholm county, 2006 and 2010. Int J Equity Health. 2014;13:51. doi:10.1186/1475-9276-13-51.
Kondo N, Subramanian SV, Kawachi I, Takeda Y, Yamagata Z. Economic recession and health inequalities in Japan: analysis with a national sample, 1986-2001. J Epidemiol Community Health. 2008;62(10):869–75. doi:10.1136/jech.2007.070334.
Hauksdottir A, McClure C, Jonsson SH, Olafsson O, Valdimarsdóttir UA. Increased stress among women following an economic collapse: a prospective cohort study. Am J Epidemiol. 2013;177(9):979–88. doi:10.1093/aje/kws347.
Economou M, Madianos M, Peppou LE, Patelakis A, Stefanis CN. Major depression in the era of economic crisis: a replication of a cross-sectional study across Greece. J Affect Disord. 2013;145(3):308–14. doi:10.1016/j.jad.2012.08.008.
Madianos M, Economou M, Alexiou T, Stefanis C. Depression and economic hardship across Greece in 2008 and 2009: two cross-sectional surveys nationwide. Soc Psychiatry Psychiatr Epidemiol. 2011;46(10):943–52. doi:10.1007/s00127-010-0265-4.
Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health. 2013;23(1):103–8. doi:10.1093/eurpub/cks035.
Wang J, Smailes E, Sareen J, Fick GH, Schmitz N, Patten SB. The prevalence of mental disorders in the working population over the period of global economic crisis. Can J Psychiatry. 2010;55(9):598–605.
Lee S, Guo WJ, Tsang A, Mak AD, Wu J, Ng KL, et al. Evidence for the 2008 economic crisis exacerbating depression in Hong Kong. J Affect Disord. 2010;126(1-2):125–33. doi:10.1016/j.jad.2010.03.007.
Bor J, Basu S, Coutts A, McKee M, Stuckler D. Alcohol use during the great recession of 2008–2009. Alcohol Alcohol. 2013;48(3):343–8. doi:10.1093/alcalc/agt002.
Munne MI. Alcohol and the economic crisis in Argentina: recent findings. Addiction. 2005;100(12):1790–9. doi:10.1111/j.1360-0443.2005.01248.x.
Garcy AM, Vagero D. Unemployment and suicide during and after a deep recession: a longitudinal study of 3.4 million Swedish men and women. Am J Public Health. 2013;103(6):1031–8. doi:10.2105/ajph.2013.301210.
Economou M, Madianos M, Peppou LE, Theleritis C, Patelakis A, Stefanis C. Suicidal ideation and reported suicide attempts in Greece during the economic crisis. World Psychiatry. 2013;12(1):53–9. doi:10.1002/wps.20016.
Hong J, Knapp M, McGuire A. Income-related inequalities in the prevalence of depression and suicidal behaviour: a 10-year trend following economic crisis. World Psychiatry. 2011;10(1):40–4.
Lopez Bernal JA, Gasparrini A, Artundo CM, McKee M. The effect of the late 2000s financial crisis on suicides in Spain: an interrupted time-series analysis. Eur J Public Health. 2013;23(5):732–6. doi:10.1093/eurpub/ckt083.
Córdoba-Doña JA, San Sebastián M, Escolar-Pujolar A, Martínez-Faure JE, Gustafsson PE. Economic crisis and suicidal behaviour: the role of unemployment, sex and age in Andalusia, Southern Spain. Int J Equity Health. 2014;13:55. doi:10.1186/1475-9276-13-55.
Alameda-Palacios J, Ruiz-Ramos M, García-Robredo B. Suicidio, prescripción de antidepresivos y desempleo en Andalucía. Gac Sanit. 2014;28:309–12.
Pompili M, Vichi M, Innamorati M, Lester D, Yang B, De Leo D, et al. Suicide in Italy during a time of economic recession: some recent data related to age and gender based on a nationwide register study. Health Soc Care Community. 2014;22(4):361–7. doi:10.1111/hsc.12086.
Barr B, Taylor-Robinson D, Scott-Samuel A, McKee M, Stuckler D. Suicides associated with the 2008-10 economic recession in England: time trend analysis. BMJ. 2012;345, e5142. doi:10.1136/bmj.e5142.
Coope C, Gunnell D, Hollingworth W, Hawton K, Kapur N, Fearn V, et al. Suicide and the 2008 economic recession: who is most at risk? Trends in suicide rates in England and Wales 2001-2011. Soc Sci Med. 2014;117:76–85. doi:10.1016/j.socscimed.2014.07.024.
Reeves A, McKee M, Stuckler D. Economic suicides in the Great Recession in Europe and North America. Br J Psychiatry. 2014;205(3):246–7. doi:10.1192/bjp.bp.114.144766.
Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. Increase in state suicide rates in the USA during economic recession. Lancet. 2012;380(9856):1813–4. doi:10.1016/S0140-6736(12)61910-2.
Davalos ME, French MT. This recession is wearing me out! Health-related quality of life and economic. J Ment Health Policy Econ. 2011;14(2):61–72.
Flint E, Shelton N, Bartley M, Sacker A. Do local unemployment rates modify the effect of individual labour market status on psychological distress? Health Place. 2013;23:1–8. doi:10.1016/j.healthplace.2013.04.004.
Strandh M, Novo M, Hammarström A. Mental health among the unemployed and the unemployment rate in the municipality. Eur J Pub Health. 2011;21(6):799–805.
Eichhorn J. Unemployment needs context: how societal differences between countries moderate the loss in life-satisfaction for the unemployed. J Happiness Stud. 2013;14(6):1657–80. doi:10.1007/s10902-012-9402-y.
Charles KK, Decicca P. Local labor market fluctuations and health: is there a connection and for whom? J Health Econ. 2008;27(6):1532–50. doi:10.1016/j.jhealeco.2008.06.004.
Iglesias García C, Sáiz Martinez P, García-Portilla González MP, Bousoño García M, Jiménez Treviño L, Sánchez Lasheras F, et al. Effects of the economic crisis on demand due to mental disorders in Asturias: data from the Asturias Cumulative Psychiatric Case Register (2000-2010). Actas Esp Psiquiatr. 2014;42(3):108–15.
Norstrom T, Gronqvist H. The Great Recession, unemployment and suicide. J Epidemiol Community Health. 2015;69:110–6. doi:10.1136/jech-2014-204602.
Breuer C. Unemployment and suicide mortality: evidence from regional panel data in Europe. Health Econ. 2014;24(8):936–50. doi:10.1002/hec.3073.
Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet. 2009;374(9686):315–23. doi:10.1016/s0140-6736(09)61124-7.
Toffolutti V, Suhrcke M. Assessing the short term health impact of the Great Recession in the European Union: a cross-country panel analysis. Prev Med. 2014;64:54–62. doi:10.1016/j.ypmed.2014.03.028.
Reeves A, McKee M, Gunnell D, Chang SS, Basu S, Barr B, et al. Economic shocks, resilience, and male suicides in the Great Recession: cross-national analysis of 20 EU countries. Eur J Pub Health. 2015;25(3):404–9. doi:10.1093/eurpub/cku168.
Baumbach A, Gulis G. Impact of financial crisis on selected health outcomes in Europe. Eur J Public Health. 2014;24(3):399–403. doi:10.1093/eurpub/cku042.
Mohseni-Cheraghlou A. Labor markets and mental well-being: labor market conditions and suicides in the United States (1979–2004). J Socio-Econ. 2013;45:175–86. doi:10.1016/j.socec.2013.05.003.
Phillips JA, Nugent CN. Suicide and the Great Recession of 2007–2009: the role of economic factors in the 50 U.S. states. Soc Sci Med. 2014;116:22–31. doi:10.1016/j.socscimed.2014.06.015.
Cylus J, Glymour MM, Avendano M. Do generous unemployment benefit programs reduce suicide rates? A state fixed-effect analysis covering 1968-2008. Am J Epidemiol. 2014;180(1):45–52. doi:10.1093/aje/kwu106.
Chan CH, Caine ED, You S, Fu KW, Chang SS, Yip PS. Suicide rates among working-age adults in South Korea before and after the 2008 economic crisis. J Epidemiol Community Health. 2014;68:246–52. doi:10.1136/jech-2013-202759.
Antonakakis N, Collins A. The impact of fiscal austerity on suicide: on the empirics of a modern Greek tragedy. Soc Sci Med. 2014;112:39–50. doi:10.1016/j.socscimed.2014.04.019.
Madianos MG, Alexiou T, Patelakis A, Economou M. Suicide, unemployment and other socioeconomic factors: evidence from the economic crisis in Greece. Eur J Psychiatr. 2014;28(1):39–49. http://0-dx.doi.org.brum.beds.ac.uk/10.4321/S0213-61632014000100004.
Fountoulakis K, Savopoulos C, Siamouli M, Zaggelidou E, Mageiria S, Iacovides A, et al. Trends in suicidality amid the economic crisis in Greece. Eur Arch Psychiatry Clin Neurosci. 2013;263(5):441–4. doi:10.1007/s00406-012-0385-9.
Saurina C, Bragulat B, Saez M, López-Casasnovas G. A conditional model for estimating the increase in suicides associated with the 2008–2010 economic recession in England. J Epidemiol Community Health. 2013;67(9):779–87. doi:10.1136/jech-2013-202645.
Fountoulakis KN, Gonda X, Dome P, Theodorakis PN, Rihmer Z. Possible delayed effect of unemployment on suicidal rates: the case of Hungary. Ann Gen Psychiatry. 2014;13:12. doi:10.1186/1744-859x-13-12.
Houle JN, Light MT. The home foreclosure crisis and rising suicide rates, 2005 to 2010. Am J Public Health. 2014;104(6):1073–9. doi:10.2105/AJPH.2013.301774.
Mattei G, Ferrari S, Pingani L, Rigatelli M. Short-term effects of the 2008 Great Recession on the health of the Italian population: an ecological study. Soc Psychiatry Psychiatr Epidemiol. 2014;49(6):851–8. doi:10.1007/s00127-014-0818-z.
Berchick ER, Gallo WT, Maralani V, Kasl SV. Inequality and the association between involuntary job loss and depressive symptoms. Soc Sci Med. 2012;75(10):1891–4. doi:10.1016/j.socscimed.2012.07.024.
Olesen SC, Butterworth P, Leach LS, Kelaher M, Pirkis J. Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study. BMC Psychiatry. 2013;13:144. doi:10.1186/1471-244x-13-144.
Thomas C, Benzeval M, Stansfeld S. Psychological distress after employment transitions: the role of subjective financial position as a mediator. J Epidemiol Community Health. 2007;61(1):48–52. doi:10.1136/jech.2005.044206.
McKenzie SK, Imlach Gunasekara F, Richardson K, Carter K. Do changes in socioeconomic factors lead to changes in mental health? Findings from three waves of a population based panel study. J Epidemiol Community Health. 2014;68(3):253–60. doi:10.1136/jech-2013-203013.
Steele F, French R, Bartley M. Adjusting for selection bias in longitudinal analyses using simultaneous equations modeling: the relationship between employment transitions and mental health. Epidemiology. 2013;24(5):703–11. doi:10.1097/EDE.0b013e31829d2479.
Flint E, Bartley M, Shelton N, Sacker A. Do labour market status transitions predict changes in psychological well-being? J Epidemiol Community Health. 2013;67(9):796–802. doi:10.1136/jech-2013-202425.
Kan M. Being out of work and health among younger japanese men: a panel data analysis. Ind Health. 2013;51(5):514–23. doi:10.2486/indhealth.2013-0040.
Butterworth P, Leach L, Pirkis J, Kelaher M. Poor mental health influences risk and duration of unemployment: a prospective study. Soc Psychiatry Psychiatr Epidemiol. 2012;47(6):1013–21. doi:10.1007/s00127-011-0409-1.
Milner A, Spittal MJ, Page A, LaMontagne AD. The effect of leaving employment on mental health: testing ‘adaptation’ versus ‘sensitisation’ in a cohort of working-age Australians. Occup Environ Med England. 2014;167–74. doi: 10.1136/oemed-2013-101759.
Aslund C, Starrin B, Nilsson KW. Psychosomatic symptoms and low psychological well-being in relation to employment status: the influence of social capital in a large cross-sectional study in Sweden. Int J Equity Health. 2014;13:22. doi:10.1186/1475-9276-13-22.
Lindstrom M. Psychosocial work conditions, unemployment and self-reported psychological health: a population-based study. Occup Med (Lond). 2005;55(7):568–71. doi:10.1093/occmed/kqi122.
Bellis MA, Lowey H, Hughes K, Deacon L, Stansfield J, Perkins C. Variations in risk and protective factors for life satisfaction and mental well-being with deprivation: a cross-sectional study. BMC Public Health. 2012;12:492. doi:10.1186/1471-2458-12-492.
Szwarcwald CL, Bastos FI, Esteves MAP. State of animus among Brazilians: influence of socioeconomic context? Cadernos de Saúde Pública. 2005;21:S33–42.
Riumallo-Herl C, Basu S, Stuckler D, Courtin E, Avendano M. Job loss, wealth and depression during the Great Recession in the USA and Europe. Int J Epidemiol. 2014;43(5):1508–17. doi:10.1093/ije/dyu048.
Jefferis BJ, Nazareth I, Marston L, Moreno-Kustner B, Bellón JÁ, Svab I, et al. Associations between unemployment and major depressive disorder: evidence from an international, prospective study (the predict cohort). Soc Sci Med. 2011;73(11):1627–34. doi:10.1016/j.socscimed.2011.09.029.
Ford E, Clark C, McManus S, Harris J, Jenkins R, Bebbington P, et al. Common mental disorders, unemployment and welfare benefits in England. Public Health. 2010;124(12):675–81. doi:10.1016/j.puhe.2010.08.019.
Molarius A, Berglund K, Eriksson C, Eriksson HG, Lindén-Boström M, Nordström E, et al. Mental health symptoms in relation to socio-economic conditions and lifestyle factors: a population-based study in Sweden. BMC Public Health. 2009;9:302. doi:10.1186/1471-2458-9-302.
Pinto-Meza A, Moneta MV, Alonso J, Angermeyer MC, Bruffaerts R, Caldas de Almeida JM, et al. Social inequalities in mental health: results from the EU contribution to the World Mental Health Surveys Initiative. Soc Psychiatry Psychiatr Epidemiol. 2013;48(2):173–81. doi:10.1007/s00127-012-0536-3.
Snorradóttir Á, Vilhjálmsson R, Rafnsdóttir GL, Tómasson K. Financial crisis and collapsed banks: psychological distress and work related factors among surviving employees a nation-wide study. Am J Ind Med. 2013;56(9):1095–106. doi:10.1002/ajim.22210.
Karjalainen K, Lintonen T, Impinen A, Lillsunde P, Mäkelä P, Rahkonen O, et al. Socio-economic determinants of drugged driving: a register-based study. Addiction. 2011;106(8):1448–59. doi:10.1111/j.1360-0443.2011.03422.x.
Compton WM, Gfroerer J, Conway KP, Finger MS. Unemployment and substance outcomes in the United States 2002–2010. Drug Alcohol Depend. 2014;142:350–3. doi:10.1016/j.drugalcdep.2014.06.012.
Murphy RD, Zemore SE, Mulia N. Housing instability and alcohol problems during the 2007–2009 US recession: the moderating role of perceived family support. J Urban Health. 2014;91(1):17–32. doi:10.1007/s11524-013-9813-z.
Freyer-Adam J, Gaertner B, Tobschall S, John U. Health risk factors and self-rated health among job-seekers. BMC Public Health. 2011;11:659. doi:10.1186/1471-2458-11-659.
Shim E, Cho Y. Widening social disparities in alcohol-attributable deaths among Korean men aged 40–59 years during the transitional period of the economic crisis (1995–2005). Int J Public Health. 2013;58(4):521–7. doi:10.1007/s00038-013-0456-3.
Newman SC, Bland RC. Case-control study of unemployment and parasuicide. Compr Psychiatry. 2007;48(6):511–5. doi:10.1016/j.comppsych.2007.06.002.
Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, et al. Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys. J Clin Psychiatry. 2010;71(12):1617–28. doi:10.4088/JCP.08m04967blu.
Milner A, Morrell S, LaMontagne AD. Economically inactive, unemployed and employed suicides in Australia by age and sex over a 10-year period: what was the impact of the 2007 economic recession? Int J Epidemiol. 2014;43(5):1500–7. doi:10.1093/ije/dyu148.
Miret M, Caballero FF, Huerta-Ramírez R, Moneta MV, Olaya B, Chatterji S, et al. Factors associated with suicidal ideation and attempts in Spain for different age groups. Prevalence before and after the onset of the economic crisis. J Affect Disord. 2014;163:1–9. doi:10.1016/j.jad.2014.03.045.
Sirvio A, Ek E, Jokelainen J, Koiranen M, Järvikoski T, Taanila A. Precariousness and discontinuous work history in association with health. Scand J Public Health. 2012;40(4):360–7. doi:10.1177/1403494812450092.
Virtanen P, Janlert U, Hammarström A. Exposure to temporary employment and job insecurity: a longitudinal study of the health effects. Occup Environ Med. 2011;68(8):570–4.
Giorgi G, Arcangeli G, Mucci N, Cupelli V. Economic stress in workplace: the impact of fear the crisis on mental health. Work. 2015;51(1):135-42. doi:10.3233/wor-141844.
Butterworth P, Leach LS, McManus S, Stansfeld SA. Common mental disorders, unemployment and psychosocial job quality: is a poor job better than no job at all? Psychol Med. 2013;43(8):1763–72. doi:10.1017/s0033291712002577.
Meltzer H, Bebbington P, Brugha T, Jenkins R, McManus S, Stansfeld S. Job insecurity, socio-economic circumstances and depression. Psychol Med. 2010;40(8):1401–7. doi:10.1017/s0033291709991802.
Sareen J, Afifi TO, McMillan KA, Asmundson GJ. Relationship between household income and mental disorders: findings from a population-based longitudinal study. Arch Gen Psychiatry. 2011;68(4):419–27. doi:10.1001/archgenpsychiatry.2011.15.
Carter KN, Blakely T, Collings S, Imlach Gunasekara F, Richardson K. What is the association between wealth and mental health? J Epidemiol Community Health. 2009;63(3):221–6. doi:10.1136/jech.2008.079483.
Taylor MP, Pevalin DJ, Todd J. The psychological costs of unsustainable housing commitments. Psychol Med. 2007;37(7):1027–36. doi:10.1017/s0033291706009767.
McLaughlin KA, Nandi A, Keyes KM, Uddin M, Aiello AE, Galea S, et al. Home foreclosure and risk of psychiatric morbidity during the recent financial crisis. Psychol Med. 2012;42(7):1441–8. doi:10.1017/s0033291711002613.
Fone D, Greene G, Farewell D, White J, Kelly M, Dunstan F. Common mental disorders, neighbourhood income inequality and income deprivation: small-area multilevel analysis. Br J Psychiatry. 2013;202(4):286–93. doi:10.1192/bjp.bp.112.116178.
Redonnet B, Chollet A, Fombonne E, Bowes L, Melchior M. Tobacco, alcohol, cannabis and other illegal drug use among young adults: the socioeconomic context. Drug Alcohol Depend. 2012;121(3):231–9. doi:10.1016/j.drugalcdep.2011.09.002.
Meltzer H, Bebbington P, Brugha T, Jenkins R, McManus S, Dennis MS. Personal debt and suicidal ideation. Psychol Med. 2011;41(4):771–8. doi:10.1017/s0033291710001261.
Solantaus T, Leinonen J, Punamaki RL. Children’s mental health in times of economic recession: replication and extension of the family economic stress model in Finland. Dev Psychol. 2004;40(3):412–29. doi:10.1037/0012-16188.8.131.522.
Pfoertner TK, Rathmann K, Elgar FJ, de Looze M, Hofmann F, Ottova-Jordan V, et al. Adolescents’ psychological health complaints and the economic recession in late 2007: a multilevel study in 31 countries. Eur J Public Health. 2014;24(6):961-7. doi:10.1093/eurpub/cku056.
Klanšček HJ, Ziberna J, Korošec A, Zurc J, Albreht T. Mental health inequalities in Slovenian 15-year-old adolescents explained by personal social position and family socioeconomic status. Int J Equity Health. 2014;13:26. doi:10.1186/1475-9276-13-26.
Borges A, Matos M, Diniz J. Estatuto familiar e autoperceção de saúde nos adolescentes. Temas em Psicologia. 2011;19(2):347–60.
Reinhardt Pedersen C, Madsen M, Kohler L. Does financial strain explain the association between children’s morbidity and parental non-employment? J Epidemiol Community Health. 2005;59(4):316–21. doi:10.1136/jech.2003.013839.
Sleskova M, Salonna F, Geckova AM, Nagyova I, Stewart RE, van Dijk JP, et al. Does parental unemployment affect adolescents’ health? J Adolesc Health. 2006;38(5):527–35. doi:10.1016/j.jadohealth.2005.03.021.
Rhodes AE, Lu H, Skinner R. Time trends in medically serious suicide-related behaviours in boys and girls. Can J Psychiatry. 2014;59(10):556–60.
Gassman-Pines A, Ananat EO, Gibson-Davis CM. Effects of statewide job losses on adolescent suicide-related behaviors. Am J Public Health. 2014;104(10):1964–70. doi:10.2105/ajph.2014.302081.
Sargent-Cox K, Butterworth P, Anstey KJ. The global financial crisis and psychological health in a sample of Australian older adults: a longitudinal study. Soc Sci Med. 2011;73(7):1105–12. http://0-dx.doi.org.brum.beds.ac.uk/10.1016/j.socscimed.2011.06.063.
Cagney KA, Browning CR, Iveniuk J, English N. The onset of depression during the great recession: foreclosure and older adult mental health. Am J Public Health. 2014;104(3):498–505. doi:10.2105/AJPH.2013.301566.
Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R. The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS One. 2013;8(7), e69792. doi:10.1371/journal.pone.0069792.
Ben Lakhdar C, Bastianic T. Economic constraint and modes of consumption of addictive goods. Int J Drug Policy. 2011;22(5):360–5. doi:10.1016/j.drugpo.2011.03.004.
Fitch C, Hamilton S, Bassett P, Davey R. The relationship between personal debt and mental health: a systematic review. Ment Health Rev J. 2011;16(4):153–66. http://0-dx.doi.org.brum.beds.ac.uk/10.1108/13619321111202313.
Roelfs DJ, Shor E, Davidson KW, Schwartz JE. Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Soc Sci Med. 2011;72(6):840–54. doi:10.1016/j.socscimed.2011.01.005.
Bradshaw J. Social exclusion, vulnerability & disadvantage task group background paper 3: child poverty in the WHO European Region. Copenhagen. 2012.
Wahlbeck K, McDaid D. Actions to alleviate the mental health impact of the economic crisis. World Psychiatry. 2012;11(3):139–45.
Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. Adolescence and the social determinants of health. Lancet. 2012;379(9826):1641–52. doi:10.1016/S0140-6736(12)60149-4.
Eurostat. Children at risk of poverty or social exclusion–statistics explained. 2013.
WHO. Investing in mental health. Geneva: World Health Organization; 2003.
Cronin P, Ryan F, Coughlan M. Undertaking a literature review: a step-by-step approach. Br J Nurs. 2008;17:38–43.
Goldman-Mellor SJ, Saxton KB, Catalano RC. Economic contraction and mental health: a review of the evidence, 1990–2009. Int J Ment Health. 2010;39(2):6–31.
Frasquilho D. receives a grant from the Portuguese Foundation for Science and Technology (FCT), reference SFRH/BD/80846/2011.
This paper was also supported by the ECOP project “Support for creating excellent research teams and intersectoral mobility at Palacký University in Olomouc” (reg. no. CZ.1.07/2.3.00/30.0004), and by the Czech Ministry of Education, Youth and Sport under contract no. LG 14043 and LG 14042. The authors wish to thank Dr. Sharon Leahy from the University of St. Andrews who assisted in the proof-reading of the manuscript.
None of the authors reported any further financial interests or potential conflicts of interest.
DF, MG and TG conceived the study. DF and CS developed the search strategy, read the papers, extracted data, and drafted the article. DF, MG and TG screened citations against inclusion/exclusion criteria. FS, DG, CS JC provided critical comments. All authors read and approved the final manuscript.
About this article
Cite this article
Frasquilho, D., Matos, M., Salonna, F. et al. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health 16, 115 (2015). https://0-doi-org.brum.beds.ac.uk/10.1186/s12889-016-2720-y
- Economic recession
- Mental disorders
- Mental health
- Substance-related disorders