The impact of the Great Recession on mental health and its inequalities: the case of a Southern European region, 1997–2013

International Journal for Equity in Health, Jan 2016

Background Numerous studies have shown that macroeconomic changes have a great influence on health, prompting different concerns in recent literature about the effects of the current recession. The objetive of the study was to assess the changes in the mental health of the working-age population in the Basque Country (Spain) and its social inequalities following the onset of the 2008 recession, with special focus on the role of unemployment. Methods Repeated cross-sectional study on the population aged 16–64, using four Basque Health Surveys (1997–2013). Age-adjusted prevalences of poor mental health and incremental prevalence ratios (working status and social class adjusted) between years were calculated. Absolute/relative measures of social inequalities were also calculated. Results From 2008, there was a clear deterioration in the mental health, especially among men. Neither changes in employment status nor social class accounted for these changes. In men, the deterioration affected all working status categories, except the retired but significant changes occurred only among the employed. In women, poor mental health significantly increased among the unemployed. Students were also especially affected. Relative inequalities increased only in men. Conclusions The Great Recession is being accompanied by adverse effects on mental health, which cannot be fully explained by the increase of unemployment. Public health professionals should closely monitor the medium and long-term effects of the crisis as these may emerge only many years after the onset of recessions.

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The impact of the Great Recession on mental health and its inequalities: the case of a Southern European region, 1997–2013

Bacigalupe et al. International Journal for Equity in Health The impact of the Great Recession on mental health and its inequalities: the case of a Southern European region, 1997-2013 Amaia Bacigalupe 0 Santiago Esnaola 1 Unai Martín 0 0 Department of Sociology 2, University of the Basque Country (UPV/EHU) , Barrio Sarriena s/n. 48940, Leioa , Spain 1 Department of Health, Basque Government , Donostia-San Sebastian 1. 01010, Vitoria-Gasteiz , Spain Background: Numerous studies have shown that macroeconomic changes have a great influence on health, prompting different concerns in recent literature about the effects of the current recession. The objetive of the study was to assess the changes in the mental health of the working-age population in the Basque Country (Spain) and its social inequalities following the onset of the 2008 recession, with special focus on the role of unemployment. Methods: Repeated cross-sectional study on the population aged 16-64, using four Basque Health Surveys (1997-2013). Age-adjusted prevalences of poor mental health and incremental prevalence ratios (working status and social class adjusted) between years were calculated. Absolute/relative measures of social inequalities were also calculated. Results: From 2008, there was a clear deterioration in the mental health, especially among men. Neither changes in employment status nor social class accounted for these changes. In men, the deterioration affected all working status categories, except the retired but significant changes occurred only among the employed. In women, poor mental health significantly increased among the unemployed. Students were also especially affected. Relative inequalities increased only in men. Conclusions: The Great Recession is being accompanied by adverse effects on mental health, which cannot be fully explained by the increase of unemployment. Public health professionals should closely monitor the medium and long-term effects of the crisis as these may emerge only many years after the onset of recessions. Economic recession; Spain; Socioeconomic factors; Mental health; Unemployment Background Since the onset of the financial crisis in 2007, Western countries have been going through a deep recession with huge impacts not only in the economic sphere, but also in the social, cultural and political arenas. Many structural and intermediary determinants of health have undergone a profound transformation, as can be seen in the escalating mass unemployment, increasing flexibility and nonstandardized forms of employment, cuts in wages and other benefits, and growing poverty or social inequalities [ 1 ]. All these effects have been especially serious in southern European countries, where the International Monetary Fund and the European institutions have imposed strict austerity measures, implementing large-scale cuts and a generalized dismantling of the public sector [ 2 ]. Numerous studies have shown that macroeconomic changes have a great influence on the health of populations, prompting different concerns in recent literature about the effects of the current recession [ 3, 4 ], which reflect different views about the relationship between crises and health. Some analyses, primarily based on mortality data, show an improvement in population health during economic downturns [5]. Others, however, insist that the aggregated relationships cannot be directly translated to the individual level, where there is conclusive evidence that socioeconomically disadvantaged populations suffer higher ill health and mortality [ 6 ]. In line with this view, some other studies have demonstrated that when economic conditions worsen during crises, poor physical and mental health, and mortality tend to rise [ 3 ] and health inequalities can increase [ 7 ]. It is striking, then, that the impact of this economic crisis on social inequalities in health has received so little attention among researchers [ 4, 8 ]. Since the onset of the current crisis, the countryspecific analyses carried out on mental health have focused on changes in prevalence of depression and anxiety symptoms, suicide related mortality rates, incidence of suicidal ideation and prevalence of perceived mental health, showing either a generalised deterioration across the population as a whole or in specific groups [ 9 ], especially in Spain [ 10–14 ], Italy [ 15, 16 ], Greece [ 17–20 ] and the UK [ 21 ]. A recent comparative study in Europe has shown that the increase in depression was noticeable in countries that have been strongly hit by the economic crisis, such as Cyprus and Spain [ 22 ]. In Spain, an increase in the frequency of diagnosed mental disorders in primary care has been reported [ 12 ], as well as short-term mental health risks [ 13 ], anxious and depressive symptoms in men [ 14 ] and suicidal ideation [ 10 ] while mixed results have been described for suicide related mortality [ 11, 23 ]. An important limitat (...truncated)


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Amaia Bacigalupe, Santiago Esnaola, Unai Martín. The impact of the Great Recession on mental health and its inequalities: the case of a Southern European region, 1997–2013, International Journal for Equity in Health, 2016, pp. 17, 15, DOI: 10.1186/s12939-015-0283-7