In this large repeat cross-sectional study of representative samples of the English population, we have found evidence to suggest population mental health has deteriorated in men following the start of the 2008 recession. Notably, this change does not appear to arise only as a result of an increase in unemployment, but mental health appears to have declined among those in employment. Household income also does not account for the observed trend in mental health. While some commentators have recently suggested that the current recession may affect both genders in a similar manner, we find that the deterioration in mental health appears only among men. Furthermore, this differential association cannot be adequately accounted for by changes in employment status (such as greater unemployment) among men. We also find evidence to suggest that socio-economic inequalities (assessed by both highest education level and area-level deprivation) have increased over the course of the last decade, but the recession had not been associated with a widening of socio-economic inequalities in mental health by the year 2010.
Our study has a number of strengths. We used a large nationally representative dataset which used a validated screening test for anxiety and depression. Importantly, we assessed trends over a long length of time with annual measures available for most of the period and an outcome likely to be sensitive to changes in the macroeconomic environment. This allows greater certainty in attribution compared to studies limited to comparisons of single before and after surveys.
As our study makes use of available data, a number of important limitations exist. First, data were not available for every year, with the omission of GHQ in 2007 potentially problematic as this represents the last full pre-recessionary year. Second, we have been limited to repeat cross-sectional analysis. Longitudinal analysis of individuals would allow greater scope for relating changes in individual employment status to health. Third, while we have chosen a validated outcome measure, it is possible that framing effects could account for some of the observed changes. In particular, GHQ items were asked first in the self-completion questionnaire in 1999, 2002 and 2009, all years with a high prevalence. However, the higher prevalence following 2008 among men remains in 2010. Fourth, defining recessionary periods and exploring their effects are notoriously difficult. We have studied changes over time but did not directly incorporate macroeconomic measures into our analysis. In addition, we have only been able to investigate a few of the potential pathways between recession and mental health. Further work is needed to explore other pathways such as temporary employment and increased job insecurity. Lastly, although our study has investigated changes in population mental health associated with the recession, we cannot establish whether this is a causal relationship, as other temporal changes could account for the observed trends. However, many factors that could potentially account for our findings, such as changes in health or social care provision, could also be considered mediating factors rather than confounders.
Much previous research has focused on mortality, and in particular suicide, associated with recession. In an analysis of cause-specific mortality and its association with recession in European countries, Stuckler et al22
found that the most consistently observed relationship was an increase in suicide among young men. Recently, they found that increases in suicide rates have been observed across European countries following the onset of the current recession.23
Consistent increases in male suicide rates have been noted in many other studies.24
The relationships between morbidity in mental health, health inequalities and recessions are less well understood and findings differ between studies.7
A recent before and after comparison of patients attending primary care services in Spain found a marked increase in the prevalence of mental health disorders following the onset of the current global recession.26
Household unemployment and mortgage difficulties were particularly associated with these attendances. However, not all studies have found a negative association between economic recession and mental health. For example, Vinamaki et al27
found no statistically significant increase in poor mental health (assessed using GHQ) following the economic recession in Finland between 1993 and 1995 in repeated general population samples.
While our study finds men's mental health has declined while women's has not, it should be noted that important indirect effects of the recession, including changes in the public sector workforce and changes in government assistance for children, had yet to be implemented during the time of this study. Our analysis does not yet show any indication of worsening mental health inequalities associated with the current recession. However, there is a general trend towards a greater level of inequality more recently and there is no evidence to suggest narrowing. Further research will be required to assess ongoing impacts of the recession by gender and socio-economic position. As our analysis was restricted to a working-age population, research focusing on retired individuals is also needed to investigate the potential impact in older age groups. The existing evidence suggests that the relationship between mental health and recessions differs, at least in part, by social welfare system.10
There is therefore a need for cross-national comparisons of trends in population health and health inequalities to better identify social policy responses that protect from any adverse health impacts of recession.
The finding that mental health across the general population has deteriorated following the recession's onset, and this association does not appear to be limited to those out of employment nor those whose household income has declined, has important implications. Previous research has highlighted the importance of job insecurity, rather than solely employment status, as potentially resulting in adverse effects on mental health.32
One potential explanation for our results would be that job insecurity during the current recession is responsible for the deterioration in mental health with men's psychological health remaining more affected by economic fluctuations despite greater female labour market participation. This paper highlights the continuing importance of addressing mental health issues using population-wide approaches by both policymakers and health professionals and not limiting such efforts to those directly affected by unemployment.