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Table 2 Overview of intervention effects and pathways

From: National or population level interventions addressing the social determinants of mental health – an umbrella review

Domain Intervention Mechanistic pathway (as stated in review) Overall evidence on MH outcomes (positive effect, negative effect, no effect, inconclusive, mixed effect, suggestive but inconclusive, insufficient evidence) Strength of Evidence: AMSTAR 2 grading (number of reviews)
Demographic Paid maternity leave Reduced stress associated with transition and adapting to multiple roles, new identities, financial strain. positive critically low (3)
Gender equity policies e.g. reproductive rights/ family planning, policies related to violence against women, family supportive employment Reduction in stress, discrimination, violence, financial difficulties, poverty, double burden of work and caring/household tasks, or time pressure positive critically low (2)
Economic Generous welfare benefits Welfare state interventions alleviate financial pressures on women particularly, reducing gender inequalities in mental health outcomes positive critically low (1)
Austerity Reduced social spending limits potential to alleviate psychosocial stress related to health and social care, employment, housing and family needs for those seeking to access state social support negative critically low (1)
Benefits for families in poverty Parental psychosocial stress as the link between low income and child mental health outcomes no evidence of effect high (1)
Welfare to work Increase in relative income position reduces psychological stress. Also combined consumption and status effects, where income effects on health are mediated by material conditions and in turn social exclusion, and thereby through both physical and psychological mechanisms. Parental stress in turn impacts on child mental health. no evidence of effect high (2)
Unemployment insurance Generous UI increases financial security which increases psychological wellbeing. Effects on employed are through reducing job insecurity as a chronic psychosocial stressor. Potential negative mechanisms through disincentive to work, stigma. positive critically low (2)
Privatisation Increases stress through increased job insecurity negative critically low (1)
Neighbourhood Mixed income housing in low income neighbourhoods Positive impacts on MH through improvement in neighbourhood physical and social conditions; negative impacts through disruptions of social ties and social deterioration in receiving neighbourhoods. insufficient evidence critically low (1)
Tenant based rental assistance As above inconclusive but suggestive positive critically low (1)
Warmth related housing improvements Inhibiting a key intermediary between poverty and poor health. Qualitative data revealed links via increased thermal comfort, increased space, reduced noise and increased housing satisfaction. positive moderate (1)
Physical housing improvements – rehousing/retrofitting, rehousing from slums, housing led neighbourhood renewal As above mixed moderate (1)
Environment Entry and integration policies for migrants to high income countries Exclusionist contexts were worse for mental health than assimilationist (where migrants are afforded citizenship but encouraged to conform with host society norms) and the best levels of mental health were associated with integrationist contexts (where migrants are accepted in and afforded rights within the new community.) negative low (1)
Social/Cultural Family interventions (inc parenting programmes) Behavioural problems are likely to lead to secondary mental health problems, such as depression positive critically low (1)
Restriction of access to lethal means Restriction of access prevents successful completion of suicide but not mental distress positive critically low (3)
School based MH education Education and awareness among patients and/or physicians, leading to increasing appropriate anti-depressant prescribing, lower rates of untreated major depression and lower suicide positive critically low (1)
Gatekeeper education As above positive critically low (1)
Screening Increased identification and treatment of MH problems insufficient evidence critically low (1)
Mass media campaigns To change behaviour by affecting decision-making processes at the individual level through message promotion, potentially before crisis occurs. no effect critically low (1)