Abstract
Job loss, debt and financial difficulties are associated with increased risk of mental illness and suicide in the general population. Interventions targeting people in debt or unemployed might help reduce these effects. We searched MEDLINE, Embase, The Cochrane Library, Web of Science, and PsycINFO (January 2016) for randomized controlled trials (RCTs) of interventions to reduce the effects of unemployment and debt on mental health in general population samples. We assessed papers for inclusion, extracted data and assessed risk of bias. Eleven RCTs (n = 5303 participants) met the inclusion criteria. All recruited participants were unemployed. Five RCTs assessed 'job-club' interventions, two cognitive behaviour therapy (CBT) and a single RCT assessed each of emotional competency training, expressive writing, guided imagery and debt advice. All studies were at high risk of bias. 'Job club' interventions led to improvements in levels of depression up to 2 years post-intervention; effects were strongest among those at increased risk of depression (improvements of up to 0.2-0.3 s.d. in depression scores). There was mixed evidence for effectiveness of group CBT on symptoms of depression. An RCT of debt advice found no effect but had poor uptake. Single trials of three other interventions showed no evidence of benefit. 'Job-club' interventions may be effective in reducing depressive symptoms in unemployed people, particularly those at high risk of depression. Evidence for CBT-type interventions is mixed; further trials are needed. However the studies are old and at high risk of bias. Future intervention studies should follow CONSORT guidelines and address issues of poor uptake.
Highlights
Job loss, debt and financial difficulties are associated with an increased risk of mental illness, self-harm and suicide (Fitch et al 2011; Haw et al 2015)
Examples of types of intervention include: group support or workshops to provide people with job search skills and resilience to the impact of rejected applications; advice type interventions (e.g. Citizens Advice Bureau) to help people navigate their way through benefits systems and/or access relevant support or to provide debt advice; interventions aimed at training frontline staff in job centres or benefits agencies or debt collection agencies to identify individuals who have mental health problems and help them respond appropriately
We excluded studies focused on people with serious mental illness, as this is a distinct subgroup of the population requiring specific intervention types; people not of working age; rehabilitation interventions for people with somatic or mental health problems that either aimed to help them get back into work, or to prevent them from losing their job if they were currently employed; and interventions aimed at selected specific groups of the working population
Summary
Debt and financial difficulties are associated with an increased risk of mental illness, self-harm and suicide (Fitch et al 2011; Haw et al 2015). Interventions to help mitigate the effect of job loss and debt on mental health are an important element of policy response to periods of recession. A number of policy documents (WHO, 2011; van Stolk et al 2014) have summarized some of the limited randomized controlled trial (RCT) evidence of the effects on mental health of interventions for people who have lost their jobs, most notably studies of the JOBS programmes in the USA (Caplan et al 1989; Vinokur et al 1995b) and the Työhön job search programme in Finland (Vuori et al 2002). Debt and financial difficulties are associated with increased risk of mental illness and suicide in the general population. Interventions targeting people in debt or unemployed might help reduce these effects
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