Mental health outcomes in times of economic recession: a systematic literature review

The prevalence of mental distress before the Great East Japan Earthquake and the associated impact of an aged society: An ecological study

Various studies have determined that the Great East Japan Earthquake (GEJE) caused mental distress among residents in affected areas. However, previous studies had not considered the prevalence of mental distress before the GEJE, and ignored the impact of an aged society on mental distress. Therefore, we aimed to describe the prevalence of mental distress before the GEJE in Miyagi Prefecture, Japan and elucidate the effect of an aged society on mental distress. We conducted an ecological study, using municipality in Miyagi Prefecture as the study unit. We used the cross-sectional mail survey data conducted in February 2011. We performed a correlation analysis in each of the 39 municipalities in Miyagi Prefecture. The prevalence of serious mental distress was 9.1%. The proportion of the population aged 65 years or older was related to the prevalence of serious mental distress in municipalities with a low proportion of all workers engaged in primary industry and with a high estimated number of inpatients with mental illness. We found that residents in Miyagi Prefecture suffered from poor mental health before the GEJE. Aged society was related to serious mental distress in the areas with advanced industrial structure and more patients with mental illness. We should approach mental health problems in the context of social structure, particularly in an aged society, based on facts about mental distress before the GEJE.

Impact of oil recession on community mental health service utilization in an oil sands mining region in Canada

OBJECTIVES

This retrospective clinical audit compared changes in community mental health service utilization before and during an economic recession in an oil sands region in Canada which was characterized by a doubling of unemployment rates and poor economic outlook.

METHODS

Sociodemographic descriptors, psychiatric antecedents, clinical characteristics and follow-up care were compared before and during the recession for newly assessed patients in community mental health clinics located across a Northern Alberta oil mining region. Data were collected retrospectively as part of a clinical audit process and then analysed with descriptive statistics, cross-tabular univariate analyses with chi-square tests using SPSS version 20.

RESULTS

A total of 1,465 patients were included. Sociodemographic factors disproportionately elevated during the recession included male sex, Caucasian ethnicity, own home ownership, higher levels of education and unemployment. More patients seeking mental health care were already taking psychotropic medications (e.g. antipsychotics, benzodiazepines and stimulants). At the same time, disproportionately fewer patients engaged in substance abuse or had a prior formal history of mental health problems. The referral reasons during recession were less likely to be associated with substance abuse or mood concerns and more likely for 'other' reasons. The patients seeking psychiatric help during a recession were disproportionately likely to be diagnosed with personality disorders and 'other' less common diagnostic categories and less likely to suffer from mood or trauma-related diagnoses. Referrals for counselling and social services were also disproportionately more common during the recession.

CONCLUSION

This study provides a comprehensive description of longitudinal patterns of mental health service utilization before and during a recession. The findings provide important evidence for policy and planning decisions to encourage resource allocation to help promote accessibility of the most needed community mental health resources.

Trends in gender and socioeconomic inequalities in mental health following the Great Recession and subsequent austerity policies: a repeat cross-sectional analysis of the Health Surveys for England

OBJECTIVE

It is known that mental health deteriorated following the 2008 global financial crisis, and that subsequent UK austerity policies post-2010 disproportionately impacted women and those in deprived areas. We aimed to assess whether gender and socioeconomic inequalities in poor mental health have changed since the onset of austerity policies.

DESIGN

Repeat cross-sectional analysis of survey data.

SETTING

England.

PARTICIPANTS

Nationally and regionally representative samples of the working-age population (25-64 years) from the Health Survey for England (1991-2014).

OUTCOME MEASURES

Population-level poor mental health was measured by General Health Questionnaire-12 (GHQ) caseness, stratified by gender and socioeconomic position (area-level deprivation and highest educational attainment).

RESULTS

The prevalence of age-adjusted male GHQ caseness increased by 5.9% (95% CI 3.2% to 8.5%, p<0.001) from 2008 to 2009 in the immediate postrecession period, but recovered to prerecession levels after 2010. In women, there was little change in 2009 or 2010, but an increase of 3.0% (95% CI 1.0% to 5.1%, p=0.004) in 2012 compared with 2008 following the onset of austerity. Estimates were largely unchanged after further adjustment for socioeconomic position, employment status and household income as potential mediators. Relative socioeconomic inequalities in GHQ caseness narrowed from 2008 to 2010 immediately following the recession, with Relative Index of Inequality falling from 2.28 (95% CI 1.89 to 2.76, p<0.001) to 1.85 (95% CI 1.43 to 2.38, p<0.001), but returned to prerecession levels during austerity.

CONCLUSIONS

Gender inequalities in poor mental health narrowed following the Great Recession but widened during austerity, creating the widest gender gap since 1994. Socioeconomic inequalities in poor mental health narrowed immediately postrecession, but this trend may now be reversing. Austerity policies could contribute to widening mental health inequalities.

Mental health and the jilted generation: Using age-period-cohort analysis to assess differential trends in young people's mental health following the Great Recession and austerity in England

Those born in the United Kingdom post-1979 have been described as a ‘jilted generation’, materially disadvantaged by economic and social policy; however, it is unclear whether this resulted in their experiencing poorer mental health than previous cohorts. Following the 2008 recession, UK austerity reforms associated with worsening mental health also disproportionately impacted those of younger working-age. This study aimed to identify any historic cohort changes in population mental health, and whether austerity widened generational inequalities. Repeat cross-sectional data from the Health Survey for England (1991–2014) were used to calculate prevalence of psychopathology for those of younger and older working-age (16–30 and 31–64 years) and retirement-age (65+ years), measured by General Health Questionnaire-12 (GHQ) score ≥ 4 (caseness). Descriptive age-period-cohort analysis was performed for 15-year birth cohorts, including the jilted generation (born 1976-90). Logistic regression tested differences in outcome between groups.

Age-specific GHQ caseness between successive birth cohorts did not significantly change for men, and significantly improved between 2.8% (95% CI 0.1%–5.5%) and 4.4% (95% CI 2.2%–6.7%) for women. Secondary analysis adjusting for education partially explained this improvement. Following the recession, GHQ caseness worsened in men of younger and older working-age by 3.7% (95% CI 1.2%–6.2%) and 3.5% (95% CI 2.1%–5.0%) respectively before returning to baseline during austerity. All women experienced non-significant increases post-recession, but trends diverged during austerity with caseness worsening by 2.3% (95% CI 1.0%–3.6%) for older working-age women versus 3.7% (95% CI 1.3%–6.2%) for younger working-age women. Those of retirement-age experienced little change throughout. In summary, mental health has historically improved between successive cohorts, including for the jilted generation. However, the 2008 recession and subsequent austerity could be most impacting those of younger working-age, particularly women, to create a new cohort effect. Policymakers should consider the differential impact economic and social policy may have across society by age.

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Mental health in England has consistently improved from generation to generation.

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These generational improvements have been most marked for women.

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Following the onset of austerity young women experienced worsening mental health.

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Mental health of over 65s was relatively protected during recession and austerity.

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Austerity policies have potential to widen generational inequality in mental health.

Changing labour market conditions during the 'great recession' and mental health in Scotland 2007-2011: an example using the Scottish Longitudinal Study and data for local areas in Scotland

This paper reports research exploring how trends in local labour market conditions during the period 2007-2011 (early stages of the 'great recession') relate to reported mental illness for individuals. It contributes to research on spatio-temporal variation in the wider determinants of health, exploring how the lifecourse of places relates to socio-geographical inequalities in health outcomes for individuals. This study also contributes to the renewed research focus on the links between labour market trends and population health, prompted by the recent global economic recession. We report research using the Scottish Longitudinal Study (SLS), a 5.3% representative sample of the Scottish population, derived from census data (https://sls.lscs.ac.uk/). In Scotland, (2011) census data include self-reported mental health. SLS data were combined with non-disclosive information from other sources, including spatio-temporal trends in labour market conditions (calculated using trajectory modelling) in the 32 local authority areas in Scotland. We show that, for groups of local authorities in Scotland over the period 2007-2011, trends in employment varied. These geographically variable trends in employment rates were associated with inequalities in self-reported mental health across the country, after controlling for a number of other individual and neighbourhood risk factors. For residents of regions that had experienced relatively high and stable levels of employment the odds ratio for reporting a mental illness was significantly lower than for the 'reference group', living in areas with persistently low employment rates. In areas where employment declined markedly from higher levels, the odds ratio was similar to the reference group. The findings emphasise how changes in local economic conditions may influence people's health and wellbeing independently of their own employment status. We conclude that, during the recent recession, the economic life course of places across Scotland has been associated with individual mental health outcomes.

Distress and burnout in young medical researchers before and during the Greek austerity measures: forerunner of a greater crisis?

PURPOSE

Distress and burnout are strongly correlated with austerity and financial recessions. Aim of this study was to assess distress and burnout among young medical researchers (YMR) in Greece before and during the financial crisis.

METHODS

In total 2050 YMR affiliated in all the nursing and medical departments of Greece were enrolled (1025 in Period A: 2008 and 1025 in Period B: 2017). Distress and burnout were measured via DASS-21 and Maslach Burnout Inventory (MBI) questionnaires.

RESULTS

Before the crisis, prevalence of distress and burnout among young medical researchers was 24 and 20%, respectively. During the financial crisis distress prevalence increased significantly (56%), while there has also been a tremendous increase in burnout occurrence (60%). Specific sociodemographic characteristics presented significantly increased rate of change (females, singles and divorced/widowers, living with family members, volunteers, smokers and heavy alcohol consumers). Distress and burnout scales were positively correlated (Spearman's r = 0.81; p = 0.01). Depression scores shifted from normal to moderate (rate of change = 13.1%), anxiety levels increased from normal to severe (rate of change = 14.3%) and tension/stress scores elevated from normal to severe (rate of change = 20.2%).

CONCLUSIONS

It is evident that the current financial crisis and working conditions have a strong impact on health status of young medical researchers in Greece. The observed increased trends and the identified predictors could guide targeted and comprehensive interventions towards tackling distress among the medical researchers not only in Greece but also in other countries suffering from financial crisis.

Binge alcohol and substance use across birth cohorts and the global financial crisis in the United States

BACKGROUND

The social and economic consequences of the global financial crisis (GFC) of 2007-9 has had serious impacts on population health, economic prospects, and overall wellbeing in all generations, particularly Millennials, Generation X, and Baby Boomers. The ways in which intergenerational inequality and global economic crises have affected population health, particularly with respect to excessive drinking and substance use in disadvantaged population groups has been understudied. Consequently, in this article, we seek to characterise the effects of the GFC on national trends in binge alcohol and substance use among Millennials, Generation X, and Baby Boomers. By doing so, we aim to contribute to a fuller understanding of the ways in which socioeconomic disadvantage engendered by the GFC has disparately affected the wellbeing of these generational cohorts.

METHODS AND FINDINGS

We present results from National Survey on Drug Use and Health from 2007-16 to characterise binge alcohol and substance use among different generational cohorts in the United States during and after the GFC. Bivariate descriptive analysis and maximum-likelihood logit regressions focused on: (a) individual substances and binge drinking, (b) poly-use and (c) any use to simultaneously model how socioeconomic, demographic, and health characteristics were related to past-month substance use and to report the social, economic, and demographic correlates of substance use. Socioeconomic vulnerability was captured on a five-point scale comprised of: (1) health insurance status, (2) government assistance, (3) income, (4) self rated health, and (5) employment status. Millennials showed generally higher risk of binge alcohol and substance use during 2007-16 than Generation X, while Baby Boomers generally exhibited lower risk. Comparison of individual and poly-use patterns for the birth cohorts before and after reveals: Millennials were at significantly increased risk of use of binge alcohol (AOR = 1.51; 95% CI = 1.46-1.56), cocaine (AOR = 1.19; 95% CI = 1.03-1.37), heroin (AOR = 1.39; 95% CI = 1.01-1.91), and oxycontin (AOR = 2.33; 95% CI = 1.74-3.12) than Gen X while Baby Boomers were at significantly reduced risk of all substances. Nevertheless, Millennials were at significantly reduced risk of crack use (AOR = 0.33; 95% CI = 0.25-0.43) and poly-use (AOR = 0.56; 95% CI = 0.45-0.70) compared to Gen X. These differences may be related to measures of austerity and socioeconomic vulnerability. Millennials exhibited the highest vulnerability related to austerity with an average vulnerability score of 0.97 (95% CI = 0.96-0.98) while Baby Boomers exhibited the lowest average vulnerability score of 0.65 (95% CI = 0.64-0.66) with Generation X in between with 0.72 (95% CI = 0.71-0.73). Increased social and economic vulnerability after the 2007 crisis is strongly associated with higher rates of substance use in all generations.

CONCLUSION

Millennials have been especially affected by socioeconomic changes associated with the GFC as reflected by their heightened vulnerability and increased use of binge alcohol and other substances compared to preceding generations. These findings suggest that attention is needed to address disparities in socioeconomic vulnerability, relationships to substance use and overall mental health of Millennials to mitigate the potential long term negative impacts of the GFC. In the context of a continuing international opioid and heroin crisis, the ways in which Millennials have been differentially affected warrants much greater attention both from policymakers and from researchers.

Stakeholders' views on vocational rehabilitation programs: a call for collaboration with Occupational Health Physicians

BACKGROUND

The triple-dip recession taking place in Italy in 2008-2014 impacted negatively on health, mainly by increasing the rate of unemployment. This increased the prevalence of mental health disorders, while reducing the number of available places on vocational rehabilitation programs (VRPs) delivered by the psychiatric services.

OBJECTIVES

To explore the different points of views of stakeholders (namely, users and professionals) involved in VRPs developed inside an Italian Community Mental Health Center (CMHC).

METHODS

A sample of users, psychiatrists, educators and nurses of an Italian CMHC involved in VRPs took part in a focus group. Content analysis was performed with MAXQDA 12, by developing a hierarchical code system a posteriori (i.e., derived from the data). The respondent validation phase was carried out by means of a multiple-choice questionnaire, administered to all participants.

RESULTS

A total of 86 emerging issues were coded, divided into two macro-areas: Positive and Negative Reinforcements (48 contributions, 56%, and 38 contributions, 44%, respectively), further subdivided into three areas: professional (service) factors, personal (i.e, user-related) factors, and work environment features (including relationships in the workplace). Some contributions raised issues concerning occupational health protection (e.g. need of information about the rights and duties of the users-workers, as well as the risks they are exposed to in the workplace).

CONCLUSIONS

The analysis suggested to address specific issues concerning work and VRPs by means of psycho-education group interventions currently carried out at CMHCs, and pointed to the need to foster collaboration between mental health professionals and the occupational health physician of the company where the VRP is started and where the user might be employed.

Factors Associated With County-Level Differences in U.S. Drug-Related Mortality Rates

INTRODUCTION

Over the past 2 decades, drug-related deaths have grown to be a major U.S. public health problem. County-level differences in drug-related mortality rates are large. The relative contributions of social determinants of health to this variation, including the economic, social, and healthcare environments, are unknown.

METHODS

Using data from the U.S. Centers for Disease Control and Prevention Multiple-Cause of Death Files (2006-2015, analyzed in 2017); U.S. Census Bureau; U.S. Department of Agriculture Economic Research Service; Agency for Healthcare Research and Quality; and Northeast Regional Center for Rural Development, this paper modeled associations between county-level drug-related mortality rates and economic, social, and healthcare environments. Spatial autoregressive models controlled for state fixed effects and county demographic characteristics.

RESULTS

The average county-level age-adjusted drug-related mortality rate was 16.6 deaths per 100,000 population (2006-2015), but there were substantial geographic disparities in rates. Controlling for county demographic characteristics, average mortality rates were significantly higher in counties with greater economic and family distress and in counties economically dependent on mining. Average mortality rates were significantly lower in counties with a larger presence of religious establishments, a greater percentage of recent in-migrants, and counties with economies reliant on public (government) sector employment. Healthcare supply factors did not contribute to between-county disparities in mortality rates.

CONCLUSIONS

Drug-related mortality rates are not randomly distributed across the U.S. Future research should consider the specific pathways through which economic, social, and healthcare environments are associated with drug-related mortality.

When Natural Disaster Follows Economic Downturn: The Incremental Impact of Multiple Stressor Events on Trajectories of Depression and Posttraumatic Stress Disorder

OBJECTIVE

To determine whether there were incremental mental health impacts, specifically on depression trajectories, as a result of the 2008 economic crisis (the Great Recession) and subsequent Hurricane Sandy.

METHOD

Using latent growth mixture modeling and the ORANJ BOWL dataset, we examined prospective trajectories of depression among older adults (mean age, 60.67; SD, 6.86) who were exposed to the 2 events. We also collected community economic and criminal justice data to examine their impact upon depression trajectories. Participants (N=1172) were assessed at 3 times for affect, successful aging, and symptoms of depression. We additionally assessed posttraumatic stress disorder (PTSD) symptomology after Hurricane Sandy.

RESULTS

We identified 3 prospective trajectories of depression. The majority (83.6%) had no significant change in depression from before to after these events (resilience), while 7.2% of the sample increased in depression incrementally after each event (incremental depression). A third group (9.2%) went from high to low depression symptomology following the 2 events (depressive-improving). Only those in the incremental depression group had significant PTSD symptoms following Hurricane Sandy.

CONCLUSION

We identified a small group of individuals for whom the experience of multiple stressful events had an incremental negative effect on mental health outcomes. These results highlight the importance of understanding the perseveration of depression symptomology from one event to another. (Disaster Med Public Health Preparedness. 2019;13:173-182).

Assessment of Behavioral Health Concerns in the Community Affected by the Flint Water Crisis — Michigan (USA) 2016

Objectives

The Flint Community Resilience Group (Flint, Michigan USA) and the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) assessed behavioral health concerns among community members to determine the impact of lead contamination of the Flint, Michigan water supply.

Methods

A Community Assessment for Public Health Emergency Response (CASPER) was conducted from May 17 through May 19, 2016 using a multi-stage cluster sampling design to select households and individuals to interview.

Results

One-half of households felt overlooked by decision makers. The majority of households self-reported that at least one member experienced more behavioral health concerns than usual. The prevalence of negative quality of life indicators and financial concerns in Flint was higher than previously reported in the Michigan 2012 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey.

Conclusions

The following can be considered to guide recovery efforts in Flint: identifying additional resources for behavioral health interventions and conducting follow-up behavioral health assessments to evaluate changes in behavioral health concerns over time; considering the impact of household economic factors when implementing behavioral health interventions; and ensuring community involvement and engagement in recovery efforts to ease community stress and anxiety.

FortenberryGZ, ReynoldsP, BurrerSL, Johnson-LawrenceV, WangA, SchnallA, PullinsP, KieszakS, BayleyegnT, WolkinA. Assessment of behavioral health concerns in the community affected by the Flint water crisis — Michigan (USA) 2016. Prehosp Disaster Med. 2018;33(3):256–265.

Cause-specific sickness absence trends by occupational class and industrial sector in the context of recent labour market changes: a Finnish panel data study

OBJECTIVES

We aimed to provide previously unestablished information on population-based differences in cause-specific sickness absence trends between occupational classes and further between four large industrial sectors within the different occupational classes while controlling for other socioeconomic factors and employment patterns. We focused on the period 2005-2013, during which the labour market underwent large economic and structural changes in many countries.

DESIGN

Register-based panel data study.

SETTING

Large representative datasets on Finnish wage earners aged 25-59 years.

OUTCOME MEASURE

Annual risk of sickness absence (>10 working days) based on repeated logistic regression.

RESULTS

Between 2005 and 2013, the proportion of employees with sickness absence decreased. Occupational class differences in sickness absence trends varied by disease group. Overall, the decrease in absences was smallest among lower non-manual employees. Sickness absence levels were highest in the health and social work sector and in the manufacturing sector within the non-manual and manual classes, respectively. Absences due to musculoskeletal diseases decreased temporarily during the peak of the economic recession in 2009, particularly in the manufacturing sector within the manual class. The decrease in absences due to musculoskeletal diseases was smallest in the trade sector within the lower occupational classes. Overall, education, income and employment patterns partly explained the differences in the absence levels, but not in the trends.

CONCLUSIONS

We found a complex interplay between the associations of occupational class and industrial sector with sickness absence trends. During the economic recession, absences due to musculoskeletal diseases decreased temporarily in a segment of wage earners who were known to have been hit hard by the recession. However, the trend differences were not explained by the measured structural changes in the characteristics of the study population. Both occupational class and industrial sector should be taken into account when tackling problems of work disability.

Decision-Making in Suicidal Behavior: The Protective Role of Loss Aversion

BACKGROUND

Loss aversion is a central and well operationalized trait behavior that describes the tendency for humans to strongly prefer avoiding losses to making equivalent gains. Human decision-making is thus biased toward safer choices.

AIM

The aim of this study was to explore the relationship between loss aversion and suicidal behavior in a large cohort of adolescents recruited in 30 schools of seven European countries for a longitudinal study (Current Controlled Trials ISRCTN65120704). We hypothesized that individuals with higher loss aversion would be less likely to attempt suicide.

METHODS

A mixed monetary gamble task was used to generate loss aversion scores for each participant. Logistic regression was used to estimate the cross-sectional association between loss aversion and life-time suicide attempts in the baseline sample (N = 2,158; 156 attempters), and incident attempts were predicted in a 4-month prospective model (N = 1,763; 75 attempters). Multiple regression was used to estimate the association between loss aversion and suicidal ideation.

RESULTS

Loss aversion was a significant predictor of attempted suicide in both the cross-sectional (OR = 0.79; P = 0.005) and prospective analysis (OR = 0.81; P = 0.040), adjusting for depression, anxiety, stress, and sex. The correlation between pre and post measures of loss aversion was r = 0.52 (P < 0.001). Interestingly, although depression, anxiety, and stress were associated with suicidal ideation, loss aversion was not (cross-sectional model: P = 0.092; Prospective model: P = 0.390). This suggests that the concept of loss aversion may be useful in understanding the transition from suicidal thoughts to attempts.

CONCLUSION

This and previous studies suggest that altered decision-making is involved in suicide attempts. In our study, we show the involvement of loss aversion in particular, and propose that individuals high in loss aversion are discouraged from carrying out the suicide attempt because of a greater focus on the negative consequences of the decision.

Work-Related Stress in the Banking Sector: A Review of Incidence, Correlated Factors, and Major Consequences

For a number of years now, banks have been going through enormous changes in organization and structure. New technology and new ways of structuring the operation have left their mark on the working conditions and daily lives of employees. Deregulation of labor markets, emerging technologies and new types of jobs have significantly reshaping working lives by continuous changes on employment and working conditions. Such a scenario has a relevant impact not only on companies' organization but also on working population's health. The banking sector is particularly well-deserved of a specific and thorough analysis, in view of the recent increase in psycho-social disorders of employees. This may be related to the major organizational changes affecting this sector and, in particular, to the restructuring processes resulting from the global economic crisis. Our aim is to assess the scale of the phenomenon and how far it relates specifically to the processes of bank organization. With this in mind, through a review of the literature, we selected the main studies dealing with work-related stress in banking, so that we could reach a better understanding of the phenomenon as it relates specifically to this set of workers. The search took place on the MEDLINE® database; in total 20 articles were chosen. There was uniform agreement among the studies that stress in the banking workplace is now at critical levels, and that it can have deleterious psychological effects on workers, and on their physical health, and that organizations, too, are affected. Most studies showed that mental health problems had increased in the banking sector, and that they were stress-related. Examples began with anxiety and depression, carried on through maladaptive behaviors, and ended in job burnout. The reviewed studies' limitations were then discussed, and possible ways forward considered.

Impact of the economic crisis on health-related behaviors in Italy

BACKGROUND

Evidence exists supporting the impact of the Great Recession on health-related behaviors internationally, though few studies are available concerning the Italian population.

AIM

To assess the impact of the late 2000s economic crisis on health-related behaviors linked to population mental health in Italy.

METHODS

Descriptive study. Health indicators came from the Italian Institute of Statistics database (years 2000-2015). Statistics performed by means of linear regression models.

RESULTS

Increased smokers (β = 1.68, p = .03), heavy smokers, that is, people smoking 11-20 cigarettes per day (β = 2.18, p = .04) or more than 20 cigarettes per day (β = 1.04, p < .01) and mean number of smoked cigarettes per day (β = 0.56, p = .02) were noticeable. Also, prevalence of overweight increased (β = 0.91, p = .04), while the Italian families' expenditure for alcoholic beverages decreased (β = -812.80, p = .01). Alcohol consumption decreased (β = -0.60, p < .01), especially in men (β = -0.95, p < .01); binge drinking increased in years 2009-2010. No change was noticeable in the diet indicators collected.

CONCLUSION

The economic crisis may have increased smoking, overweight and binge drinking in Italy (though data on the latter phenomenon are not conclusive), and reduced overall alcohol consumption.

Perceived effects of the economic recession on population mental health, well-being and provision of care by primary care users and professionals: a qualitative study protocol in Portugal

INTRODUCTION

Economic recession periods can pose accentuated risks to population's mental health and well-being as well as additional threats to health systems. Users and health professionals are key stakeholders in care delivery; however, little attention has been given to their experiences of the crisis. This paper presents a qualitative study protocol to assess users' and health professionals' perceptions about the effects of the post-2008 economic recession on mental health and care delivery in the Lisbon Metropolitan Area, Portugal.

METHODS AND ANALYSIS

The methodology to assess perceived effects of the economic recession by primary care users and professionals on population mental health, well-being and provision of care is presented. Focus groups with users and semistructured interviews with health professionals will be carried out in three primary healthcare units in Lisbon areas especially affected by the crisis. Thematic analysis of full-transcribed interviews will be conducted using an iterative and reflexive approach.

ETHICS AND DISSEMINATION

The study protocol was approved by the Ethics Committee of NOVA Medical School, NOVA University of Lisbon. The findings will be useful for other researchers and policy-makers to develop and implement the assessment of prevailing experiences of users and health professionals on the effects of the economic recession on mental health and quality of care in primary health context, promoting their involvement and contribution to services responsiveness.

Parents with mental health problems and their children in a German population based sample: Results of the BELLA study

BACKGROUND

Mental health problems (MHP) of parents are associated with an increased risk of psychological and developmental difficulties in their children. This study aims at analyzing population-based data of parents with MHP and their children and the effects of associated risk factors in order to further targeted preventive and therapeutic interventions.

METHODS

The BELLA study is the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents. MHP in parents and in their children as well as associated risk factors were examined in a sample of N = 1158 parents with children aged 11 to 17 years.

RESULTS

Parental MHP were identified in 18.6% of the sample. Risk factors associated with parental MHP were low SES, parental unemployment, stressful life events, parental daily strain, parental chronic disease, and child MHP. A rate of 19.1% of the children of parents with MHP reported MHP themselves, the corresponding rate among children of parents without MHP was 7.7%. In multiple regression analyses the risk for children of parents with MHP to report MHP themselves was almost two times higher than the risk of children of parents without MHP. Other significant associations with child MHP included gender, the parents' age, and stressful life events.

CONCLUSIONS

Parental MHP constitute a significant risk for the mental health of their children. Targeted screening methods and preventive interventions are needed.

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system, but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambiguously detected. The impact of the recession on the general population in terms of diseases associated with mental health is well documented; however, the high levels of unemployment are identified as direct causes. Therefore, social policies rather than measures affecting the healthcare system would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap.

Long-term effects of youth unemployment on mental health: does an economic crisis make a difference?

BACKGROUND

Ill health is a risk factor and a consequence of unemployment, which might vary depending on the national rate of unemployment. We investigated the long-term effect of youth unemployment on mental health and explored the possible interaction during periods of high (economic crisis) and low (non-crisis) unemployment rates.

METHODS

A register-linked population-based cohort study was conducted including individuals aged 17-24 years. The crisis cohort (n=6410) took part in the Labour Force Survey during the economic crisis (1991-1994) in Sweden and the non-crisis cohort (n=8162) took part in the same survey before the crisis (1983-1986). Follow-up was 19 years. Adjusted HRs and 95% CIs for an inpatient care discharge mental diagnosis with employed people as the reference group were calculated by Cox regressions models.

RESULTS

In fully adjusted models, <3 months (HR: 1.69; 95% CI 1.14 to 2.49), 3-6 months (2.19; 1.43 to 3.37) and >6 months (2.70; 1.71 to 4.28) of unemployment were associated with increased risks of getting a mental diagnosis in the crisis cohort. In the non-crisis cohort the risks were: 1.92; 1.40 to 2.63, 2.60; 1.72 to 3.94 and 3.33; 2.00 to 5.57, respectively. No interactions between labour force status and level of unemployment were found.

CONCLUSIONS

Youth unemployment is related to mental health problems, independent of the overall national rate of unemployment, which is important as the youth unemployment rates are currently at stable high level.

Unemployment as a source of mental distress to individuals and their family: Unemployed parents' perceptions during the economic recession

BACKGROUND

Due to the economic recession, several people in Europe became unemployed. This situation may risk their mental health.

AIM

This study explored parents' perceptions about their unemployment's effects in daily life during the recession.

METHODS

A total of 59 unemployed parents (40.7% fathers and 59.3% mothers), ageing 44.4 years (±6.2), answer a question on how the unemployment affected their family lives. Thematic analysis was used to analyse data.

RESULTS

The findings suggest that unemployment is a source of adult and youth mental distress and of economic hardship and changes in family relations.

CONCLUSION

Support to unemployed individuals and their families could benefit from these insights when granting the needed financial and socioemotional assistance.

Dream Teens: Adolescents-Led Participatory Project in Portugal in the Context of the Economic Recession

This article describes the implementation process of a nationwide project to enhance young people's participation and active citizenship in the context of Portugal's economic recession. This project used an innovative Positive Youth Development approach that engaged Portuguese youth (aged 11-18 years) through social media tools to facilitate their civic engagement and development. Participants from all over the country were empowered (1) to design and conduct research activities on topics of their choice and about their life contexts and (2) to create ways to improve youth civic participation in their communities, while developing supportive interactions with adults and peers. Overall, youth were engaged in their activities, felt their voices were heard, and felt that they were viewed as experts of their own well-being and living contexts. Youth research actions and preliminary findings were then compiled in a set of recommendations that was formally received by a high commissioner of the Ministry of Health. The article concludes with a discussion of the next steps for the project and its limitations so far.

Number of Dependents, Community Support, and Mental Health in Later Life: Does Gender Make a Difference?

This study examined associations of number of dependents and community support with mental health and whether the nature of these associations differs for males and females. Data were obtained from 209 elderly Nigerians using self-report measures. Hierarchical multiple regression (stepwise method) and Hayes regression-based PROCESS approach for tests of moderation were employed in analyzing the data. Results of a hierarchical multiple regression showed that number of dependents predicted mental health for the total sample and for men, but not for women. For the subgroups of men and women, there were significant predictions of mental health by community integration, community participation, and use of community organization, even after controlling for the roles of sociodemographic variables. The hypothesis on the moderation effect of community support on the associations of number of dependents and mental health was also supported. Findings highlighted the importance of addressing gender differences in the role of social capital in mental health.