A literature review published in BMC Public Health by researchers from Portugal and the Czech Republic summarizes results from 101 studies investigating the effect of recent economic recessions on populations’ mental health. Most of the studies were conducted in countries in Europe and North America. The results indicate that, despite the lack of longitudinal data, there is growing evidence cross-nationally that periods of recession lead to an increase in the diagnosis of ‘mental illness,’ substance use and abuse, and suicide rates.
“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.”
A significant implication of this finding is that the impact of the recession becomes a family problem, and therefore a community mental health problem. Studies that collected data on adolescents and children found that those whose parents were unemployed had higher rates of mental health concerns or lower perceptions of well-being. In one study, youth unemployment rates were also linked to a greater incidence of psychological complaints.
The researchers covered studies published between 2004-2014, which enabled them to consider the effects of the most recent economic recession on mental health. Socioeconomic determinants across studies were clustered into 1) pre- and post- recession changes; 2) macroeconomic indicators, e.g., national rates of unemployment; and 3) individual variables, e.g., employment status and indebtedness. Several studies found increased rates of episodes of depression and anxiety among people who lost their jobs during periods of financial strain, were financially indebted or belonged to a lower socioeconomic status. Alcohol and substance use did not increase across the board and was found, instead, to be related to pre-recession use.
“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 maximize the effects of the substances they have managed to purchase,” the review authors write.
The finding that economic variables are linked to mental illness and substance use may be reflected in the increasing numbers of people being diagnosed with depression in particular (the WHO describes depression as a “global public health concern”), and mental health concerns in general. From this perspective, Kristian Wahlbeck and David McDaid suggest that solutions should focus on actions like mental health reform, job market support for the unemployed, family programs, alcohol price regulation, programs for debt relief, strengthening social networks, and sensitive coverage of suicides by the media. Often, though, the discourse on the cause of individual ‘mental illness,’ eschews social and political efforts, focusing instead on biological determinants and medical and pharmacological solutions.
The authors admit that the studies covered in this review have some significant limitations – several of the studies involve cross-sectional data where information from the population under consideration was only collected at one point in time. Also, there was a paucity of data from low and middle-income countries.
More longitudinal research is needed, according to the authors, to more accurately parse out the factors that can influence the effects of recessions on mental health. For instance, studies have shown that there is a lack of quality mental health care for racial and ethnic minority groups, which requires changes to service provision for these communities. It may be that during times of economic recession such structural deficits impact vulnerable groups even more negatively.
As the authors conclude:
“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.”
Frasquilho, D., Matos, G. M., Salonna, F., Guerreiro, D., Storti, C. C., Gaspar, T., & Caldas-de-Almeida, J. M. (2016). Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health, 16(1), 1-40. (Abstract)