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)