Abstract
Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.
Highlights
The financial crisis that hit the global economy in 2008 led to the deepest recession since the 1930s (European Commission, 2009), possibly longer, wider and deeper than the Great Depression (Bambra et al, 2016)
Literature on how the use of mental health care varies in times of economic crisis is scarce, and recent reviews found mixed evidence (Zivin et al, 2011; Cheung and Marriott, 2015; Martin-Carrasco et al, 2016)
Our results suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders, as had been found in previous reviews (Zivin et al, 2011; Cheung and Marriott, 2015)
Summary
The financial crisis that hit the global economy in 2008 led to the deepest recession since the 1930s (European Commission, 2009), possibly longer, wider and deeper than the Great Depression (Bambra et al, 2016). Recent reviews assessing the health consequences of economic crises have revealed a significant relationship between these periods and psychopathology including suicide, onset or exacerbation of mood and anxiety disorders, heavy drinking, and psychological distress (Frasquilho et al, 2016; Martin-Carrasco et al, 2016). These results would make expectable an increased search for mental health treatment.
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