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Table 6 Characteristics of studies included in review focusing children and adolescents, older adults and people with mental health problems, 2004–2014

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

Study

Setting

Study design

N

Year

Age

Socioeconomic determinants

Mental health outcomes

Associations/Effects

Strengths

Limitations

[118]

Regional sample of parents and children, Southern Finland

Cohort

1149

12 y

843 mothers

30–59y

573 fathers

28–66 y

Individual-level indicators

Family perceived financial strain

Psychological Well-being

Parental Mental health distress caseness (GHQ-12)

Child mental health

Family economic hardship creates a risk for child mental health through economic pressures and problems in parental mental health, marital interaction, and parenting even in a welfare state.

Gives information on transgenerational effect of family economic pressure on child mental health.

Child mental health was reported by both parents and children, which adds to the reliability.

Temporal order of exposures, confounders, and the outcome under consideration affected all participants at the same time producing stronger causal conclusions

Reporter bias is expected since mothers and fathers reported on their own mental health and parenting.

Other contexts determinants such as reductions in funding in day care and schools can act as confounders.

Generalizing findings is limited to the uniqueness of the Finish welfare system with extensive governmental support to families.

[119]

Cross-national samples of adolescents, 31 countries worldwide

Repeated cross-sectional

164,623

(2005–2006)

168,284

(2009–2010)

11–15y

Inter-time Variables

Macroeconomic indicators

Unemployment Rates

Psychological Well-being

Psychological health complaints (HBSC symptom checklist)

Ireland and Portugal were the only countries facing a rise In psychological health complaints (9–17 %) with increasing unemployment (21–148 %).

Youth unemployment rates in 2010 increased the likelihood of psychological health complaints.

Uses nationally representative data on adolescents from 31 countries, surveyed over two time points, before and after recession

Data derives from 2006–2010 and the crisis started in 2008 so the long term effects of the recession could not be investigated. The sample is composed only by adolescents aging 11 to 15 years old.

[120]

National population sample of adolescent,

Slovenia

Cross-sectional

1815

(2010)

15y

Individual-level indicators

Family Affluence Scale, perceived material welfare, family type, occupational status of parents

Psychological Well-being

Mental health (KIDSCREEN-10, SDQ), Life satisfaction Feelings of depression

The adolescents who perceived to be socioeconomically worse off had 4-times higher odds (p < 0.001) of a low life satisfaction, a greater chance of a low quality of life, and a higher SDQ score than those who perceived to be better off (p < 0.001).

Uses a national representative sample and several variables to measure socioeconomic status.

Includes only 15-year-olds who are enrolled in school and does not include dropouts, who might be among the most socioeconomically underprivileged.

Its cross-sectional design removes the possibility of causal inference.

[121]

National population sample of adolescents,

Portugal

Cross-sectional

4877

(2010)

10–18 y

Individual-level indicators

Parental employment status

Psychological Well-being

Health Related Quality of Life

Having at least one parent unemployed has a statistical significant negative impact on perceptions of adolescent health.

Gives important information about the transgenerational effect of employment status.

Its cross-sectional design removes the possibility of causal inference.

The study was not designed specifically to address causal links between the variables and parental employment.

[122]

Cross-national samples of children and adolescents, Denmark and Sweden

Cross-sectional

4299

2–17 y

(1996)

Individual-level indicators

Parental employment status

Psychological Well-being

Psychosomatic symptoms

Children in families with one or both parents without paid work had an increased prevalence of recurrent psychosomatic symptoms (OR = 1.52 to 3.20)

Gives important information about the transgenerational effect of employment status.

Underreporting bias is expected as children differ in their tendency to report symptoms to their parents. Also the parents’ reports on their children can depend on their own health. Its cross-sectional design removes the possibility of causal inference.

[123]

Regional sample of adolescents, Kosice, Slovakia

Cross-sectional

2836

14–22

Individual-level indicators

Parental employment status

Psychological Well-being

Self-rated health

Long-term well-being

Health complaints

Parental long-term unemployment (especially of fathers) is negatively associated with adolescents’ subjective health. Father’s long-term unemployment was a significant predictor of moderate self-rated health and low long-term well-being among girls and boys. Mother’s long-term unemployment was negatively associated with self-rated health of girlss and long-standing illness among boys.

Gives important information about the transgenerational effect of employment status.

Lack of specific detailed information

about parental unemployment (maternity leave of mothers, retirement, or

invalidity of parents were considered unemployment)

[124]

Regional sample of adolescents, emergency room, Ontario, Canada

Cohort

15,739

(2002–2011)

12–17 y

Inter-time Variables

Pre and Post- recession period

Suicidal behaviours

Hospital records of suicide-related behaviours

The suicide-related behaviours incidence rates decreased by 30 % in boys and girls from FYs 2002/03 to 2006/07, but stopped afterwards and subsequent admissions increased.

Large sample of adolescents and examines trends in the total suicide related behaviour during recession periods.

The hospital records do not identify suicidal intent. Data is not representative of the general population. Suicide-related behaviours are complex and other variables may act as confounders.

[125]

National population sample of adolescent,

USA

Repeated cross-sectional

403,457

(1997–2009)

mean age 16 y

Macroeconomic indicators

State level job loss

Suicidal Behaviours

Suicide ideation, attempts and plans

State level unemployment during the year preceding the survey increased girls’ probability of suicidal ideation and suicide plans, but did not affect the suicide-related behaviors of boys

Uses a national representative sample and

Gives important information about economic circumstances effects on adolescents risk behaviours.

It is unable to identify the pathways through which unemployment rates affect adolescents’ suicide-related behaviors.

[126]

Regional sample of older adults, Canberra/Queanbeyan, Australia

Cohort

1973 (2005–2010)

mean age 66.58 y

(SD = 1.5)

Inter-time Variables Individual-level indicators

Pre and Post- recession period

Financial security

Financial hardship

Common Mental Disorders

Depression

Anxiety (Goldberg Scales) Self-reported health

Economic slowdown related distress is linked to greater depression symptoms at both waves 2 (t(655) = −3.44,p = .001) and 3 (t(662) = −4.96, p < .001), and greater anxiety symptoms at both waves (wave 2 - t(655) = −3.62, p < .001; wave 3 - t(662) = −5.15, p < .001).

Temporal order of exposures, confounders, and the outcome under consideration affected all participants at the same time producing stronger causal conclusions.

The analysis was restricted to older adults at baseline. Consequently, the results and recommendations should not be applied to younger cohorts.

Limited period of time, the long term effects of the recession could not be investigated.

[127]

National population sample of older adults, USA

Cohort

2261

(2005–2006) (2010–2011)

>57 y

Individual-level indicators

Home foreclosure

Common Mental Disorders

Depressive symptoms

(CES-D)

Increases in neighborhood-level foreclosure was associated with an increased rate in depression in older adults. Notices of default (OR = 1.75; 95 % CI = 1.14, 2.67) and properties returning to ownership by the bank (OR = 1.62; 95 % CI = 1.06, 2.47) were associated with depressive symptoms.

Establishes longitudinal associations between home foreclosure and depressive symptoms producing stronger causal conclusions.

The mechanisms linking increases in foreclosure to depressive symptoms are not explored.

The sample is limited to a longitudinal cohort of older American adults.

[128]

Cross-national working population sample, European Union countries

Cross-sectional

20,368 (2006) 20,124 (2010)

18–64 y

Inter-time Variables Macroeconomic indicators ndividual-level indicators

Pre and Post- recession period

Employment Status

Sate level unemployment

Psychological Well-being

Mental health distress (MHI-5) Mental health disorders

Following the onset of the recession, individuals with mental health problems were more vulnerable to losing their jobs [OR = 1.12, 95 % CI: 1.03–1.34] (OR: 1.12, 95 % CI: 1.03, 1.34).

Uses nationally representative data on people with and without mental health problems from 27 countries in Europe surveyed over two time points, before and after recession.

The data was collected through brief, self-reported questionnaires.

Limited period of time, the long term effects of the recession could not be investigated.

Its cross-sectional design removes the possibility of causal inference.