The effects of the global stock market crash of 2008 have not just been economic. The health and social consequences of the financial crisis are becoming clearer over time and were anticipated by public health academics early on.

Based on a 30 year review of EU data on how economic changes affect mortality, in 2009 Stuckler et al warned that the recession could result in an increase in premature deaths from ‘intentional violence’, particularly suicide (Stuckler et al, 2009).

More recently and closer to home the Joseph Rowntree Foundation looked at mental health, resilience and unemployment in the context of the current economic recession. The findings showed that 73 unemployed people living in Bradford felt their mental health was worse because of the many aspects associated with losing a job and coping with unemployment (Giuntoli et al, 2011).

The authors of a recent PLoS ONE study (Evans-Lacko et al, 2013) are interested in how the economic recession has affected people with mental health problems in terms of job losses and unemployment. The study looks at several aspects of unemployment for people with mental health problems during this current recession:

• The impact of economic hardship on unemployment rates of people with mental health problems in the EU in 2006 and 2010
• The role of public stigma towards people with mental health problems and their employment rates in 2006 and 2010
• The subgroups of people with mental health problems who are most affected

Overall the authors say the aim of this research is to assess:

unemployment rates among individuals with mental health problems before and during the current economic recession

Methods

Data source

This study uses data from the Eurobarometer Mental Wellbeing surveys from 2006 and 2010. The survey is part of the EU Public Opinion Analysis activity and uses face to face interviews of citizens from 27 EU countries who are over 15 years old. The Mental Wellbeing surveys include assessments of attitudes toward mental illness and treatment-seeking. The samples of people interviewed in 2006 were not the same as those interviewed in 2010.

Assessments

Mental health problems were assessed using the Mental Health Inventory (MHI-5), a well-validated measure (Rumpf et al, 2001). Stigmatising attitudes were assessed by asking participants if they agreed or disagreed with the following four questions about ‘people with psychological or emotional problems’:

1. They ‘constitute a danger to others’
2. They ‘are unpredictable’
3. They ‘have themselves to blame’
4. They ‘never recover’

Socio-demographic information included gender, education, age and urbanicity (the size of the locality where people lived). National unemployment rates were taken from the Eurostat yearbooks for 2006 and 2010.

Statistical analysis

Four separate multivariate logistic regression models were used to define statistical data for predictors of unemployment for people with mental health problems in 2006 and 2010. Independent variables included age, gender, urbanicity, country-level attitudes regarding dangerousness, recovery, blameworthiness and unpredictability of people with mental health problems.

Results

Socio-demographic characteristics

• Compared to people without mental health problems, people with mental health problems were disproportionately women
• Most people with mental health problems had completed education up to least 16 years of age but a higher proportion had no formal education or had finished before they were 16 years old
• People with mental health problems were less likely to be in paid employment, a student or a homemaker and more likely to be unemployed or disabled/retired

Unemployment among people with mental health problems

• Unemployment rates were higher for people with mental health problems in both 2006 and 2010
• The gap in unemployment rates between people with and without mental health problems had widened by 2010, which was statistically significant and confirmed by numerous sensitivity tests

Relationship between unemployment and mental health status

• In 2010, men with mental health problems and people with mental health problems who had lower levels of education were more likely to be unemployed than they were in 2006
• People with mental health problems living in countries with higher levels of stigmatizing attitudes about dangerousness were more likely to be unemployed in 2010 than they were in 2006

Conclusion

The authors conclude that the study findings suggest that:

times of economic hardship may intensify social exclusion of people with mental health problems, especially males and individuals with lower education

They argue that the findings should prompt policymakers and practitioners to act so the negative effects of the economic crisis on people with mental health problems can be addressed:

Interventions to combat economic exclusion and promote social participation of individuals with mental health problems are even more important during times of economic crisis and these efforts should target support to the most vulnerable groups

Strengths and limitations

There are a few limitations to bear in mind about the type of data this study is based on. The data is only a ‘snapshot’ from two separate years with different samples of people and was not collected with the investigation in mind. Mental health status is self-reported, not clinically verified and of unknown severity. Because of the limitations of the Eurobarometer survey, important data about ethnicity and immigration status was not available. As it is a household survey, people not living in a conventional home setting were excluded. So there may be other factors that the authors were not able to explore.

Nonetheless, the research showed that during the present economic recession the unemployment rates of people with mental health problems have risen across Europe. The data analysed revealed that a possible factor in this increase was social stigma, particularly the belief that people with mental health problems are dangerous. So the role of stigma and the tendency for attitudes towards people with mental health problems to harden during times of financial crisis need to be recognised by policy makers. This is a potentially complex area, as the authors note:

and intervention would need to carefully consider the complexity of cultural factors and beliefs underlying public attitudes

As well as investing in supportive, targeted employment, health and debt management programmes, governments should also consider the importance of programmes to combat stigma and discrimination against people with mental health problems.

Findings suggest that programmes to combat exclusion and to promote mental health may be more important during times of economic crisis.

Link

Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R (2013) The Mental Health Consequences of the Recession: Economic Hardship and Employment of People with Mental Health Problems in 27 European Countries. PLoS ONE 8(7): e69792. doi:10.1371/journal.pone.0069792

Stuckler D et al. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. The Lancet, 25 July 2009, Vol. 374, Issue 9686, Pages 315-323. DOI: 10.1016/S0140-6736(09)61124-7. [Abstract]

Giuntoli G et al. Mental health, resilience and the recession in Bradford (PDF). Joseph Rowntree Foundation, Jul 2011.

Rumpf HJ, Meyer C, Hapke U, John U. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res. 2001 Dec 31;105(3):243-53. [Abstract]