Health and health inequality during the great recession: Evidence from the PSID

Self-Reported Mental Health and the Demand for Mental Health Care After a Labor Market Shock: Evidence from the Spanish Great Recession

This research examines the mental health inequalities between employed and unemployed individuals among the fluctuations over the business cycle. To analyze whether a recession affects self-evaluated mental health and consequently increases the demand for mental health care, I exploit the sudden increase of the unemployment rate in Spain during the period 2007-2009. First, I analyze the impairment of self-evaluated mental health as a consequence of the Great Recession and if it prevails during the economic recovery. In addition, I estimate if the effect on self-reported mental health is reflected in demand for mental health care. The results from an event study design show that the economic downturn increases the differences between employed and unemployed individuals in self-evaluated mental health. However, and despite the continuous improvement in unemployment, the mental health gap remained unchanged between 2014 and 2017, which could imply the persistence of some lasting impacts of the Great Recession on mental health. Nonetheless, I find a reduction in the differences of using drugs related to mental health during the period 2011-2012, when I estimate the largest inequalities in self-evaluated mental health.

Direct and Indirect Management Models in Public Health in the Framework of Mental Health

This article analyzes the relationship between per capita expenditure and financial and macroeconomic variables in the framework of mental health, in regions where the prevailing system is public healthcare governed by the state and in regions where the prevailing system is that of public ownership. The period 2006-2017 was analyzed. A simple linear regression analysis was carried out to determine the relationship between the expenditure per inhabitant and a series of relevant variables such as asset turnover, cash flow, and expenditure as a percentage of gross domestic product (GDP), applying statistical tests to validate the study. In regions where public-private co-financing prevails in the health system, two crucial variables to measure per capita expenditure on mental health were GDP per capita and cash flow of mental health providers. In the regions where management is direct, the crucial variables were asset turnover of mental health providers and expenditure on mental health as a percentage of GDP per capita. These elements are key to determining how to develop public investment policies in hospital systems in the different regions of Europe and the world.

County-Level Economic Changes and Drug Mortality in the United States: Evidence from the Great Recession

We aimed at examining whether county-level economic changes were associated with changes in county-level drug mortality rates since the Great Recession and whether the association is equally distributed across major sociodemographic subgroups. Using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (2004-2019), combined with census data, we conducted fixed effects analyses by including county-level economic changes as primary exposures and county-level drug-related mortality rates (per 100,000 people) from 2004-2007 (i.e., prior to the recession) to 2008-2011, 2012-2015, and 2016-2019 as an outcome variable based on 1833 counties. Our findings showed that drug mortality rates increased from 13.9 (2004-2007) to 16.0 (2008-2011), 18.0 (2012-2015), and 23.0 (2016-2019). Counties experiencing smaller median household income growth during and/or after the recession were associated with greater increase in drug mortality than counties experiencing larger median household income growth among the total population and all sociodemographic subgroups. Counties experiencing larger increases in unemployment rates and percentage of vacant housing units were associated with greater increase in drug mortality than counties experiencing smaller or no increase in unemployment rates and percentage of vacant housing units among certain sociodemographic subgroups. Findings suggest the importance of local economic contexts in understanding drug mortality risk since the recession. Drug overdose prevention polices need to be formulated by taking local economic changes following a major recession into consideration.

Effects of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health: systematic review

BACKGROUND

A rise in mental illness is expected to follow the COVID-19 pandemic, which has also been projected to lead to a deep global economic recession, further adding to risk factors.

AIMS

The aim of this review was to assess the impact of the COVID-19 pandemic and previous pandemics, epidemics and economic crises on mental health.

METHOD

Searches were conducted in PubMed, Web of Science, PsycINFO and Sociological Abstracts. We included studies of all populations exposed to the COVID-19 pandemic, and other similar pandemics/epidemics and economic crises, compared with non-exposed time periods or regions. The outcome was mental health.

RESULTS

The 174 included studies assessed mental health impacts of the COVID-19 pandemic (87 studies), 2008 economic crisis (84 studies) and severe acute respiratory syndrome (SARS) epidemic (three studies). Outcomes were divided into affective disorders, suicides, mental healthcare utilisation and other mental health. COVID-19 pandemic studies were of lesser quality than those for the economic crisis or SARS epidemic. Most studies for all exposures showed increases in affective disorders and other mental health problems. For economic crisis exposure, increases in mental healthcare utilisation and suicides were also found, but these findings were mixed for COVID-19 pandemic exposure. This is probably because of quarantine measures affecting help-seeking and shorter follow-ups of studies of COVID-19 pandemic exposure.

CONCLUSIONS

Our findings highlight the importance of available, accessible and sustainable mental health services. Also, socioeconomically disadvantaged populations should be particular targets of policy interventions during the COVID-19 pandemic.

Health status and the Great Recession. Evidence from electronic health records

We investigate the impact of the Great Recession in Italy on the incidence of chronic diseases using new individual longitudinal data from Electronic Health Records. We exploit the exogenous shock in the economic conditions occurred in 2008 to estimate heterogeneous effects of an unprecedented rise in local unemployment rates in an individual fixed-effects model. Our results document that harsh economic downturns have a negative long-lasting effect on cardiovascular disease and a temporary effect on depression. This effect is heterogeneous across gender, increases with age and is stronger right before the retirement age. An important policy recommendation emerging from this study is that prolonged economic downturns constitute an additional external risk for individual health and not a temporary benefit.

The Intergenerational Transmission of Mental and Physical Health in Australia: Evidence Using Data From the Household Income and Labor Dynamics of Australia Survey

Promoting good health across the life course is high on countries agenda. There is a growing evidence base that health is correlated across generations. We examine the persistence of physical and mental health status across generations and explore how different early life factors and adult outcomes impact on this association. In particular, we focus on childhood disadvantage and childhood health, educational attainment, and social mobility measured by household income compared to one's parents. We use data from 19 waves of the Household, Income and Labor Dynamics in Australia (HILDA) Survey. The analysis is restricted to young adults (aged 25-35 years old in 2019) and their parents. We find an intergenerational correlation in health which ranges from 0.19 for physical health to 0.20 for the QALY and 0.21 for mental health. After we include covariates related to childhood disadvantage, childhood health, educational attainment, and social mobility, the intergenerational correlations are reduced to 0.13 for physical health, 0.18 for mental health, and 0.14 for QALYs. We find that early life disadvantage is the only factor influencing the intergenerational correlation for all health measures. Policy focusing on reducing the negative impact of early life disadvantage is likely to have a larger impact on improving health across the life course and reducing intergenerational health inequalities.

Macroeconomic conditions and health-related outcomes in the United States: A metropolitan and micropolitan statistical area-level analysis between 2004 and 2017

We study the relationship between macroeconomic conditions and health in the United States using data from the Behavioral Risk Factor Surveillance System between 2004 and 2017. Unlike many existing studies that use state or county as the level of aggregation, our analysis uses a sample of metropolitan and micropolitan statistical areas. Our results suggest strong associations between worsening macroeconomic conditions and reduced access to care and health insurance coverage. While we do not detect any robust relationships between business cycles and health outcomes in the general population, we do find consistent evidence of worse self-reported health during economic downturns among minorities and less-educated individuals. In addition, there is some suggestive evidence of countercyclicality of healthier lifestyle choices. However, the findings for health behavior outcomes are not robust to adjusting for multiple hypothesis testing.

The business cycle, health behavior, and chronic disease: A study over Three decades

The effect of macroeconomic fluctuations on individual health remains highly debated. We estimate the effect of the business cycle on health and health behavior in the U.S. using the NLSY79 panel data for 11,406 respondents between 1979 and 2014. Most of our survey respondents have no chronic illness in 1979, and develop these conditions during the sample period. This allows us to estimate the true effect of economic fluctuation on the likelihood of developing chronic conditions. The results indicate a considerable difference in the cyclic variation of chronic diseases. After controlling for innate individual characteristics such as family health history, and unobserved regional characteristics, we find that obesity decreases during economic downturns, while diabetes, hypertension, and congestive heart failure increase. Sub-sample analyses show that Blacks are more likely to develop diabetes and hypertension and are less likely to develop obesity during economic downturns than other racial groups. The incidence of obesity declines during recessions for women, while males are more likely to develop diabetes. Income loss, particularly among Blacks, and lack of change in physical activity mediate these differential effects.

Drinking during downturn: New evidence from the housing market fluctuations in the United States during the Great Recession

We investigate how the decline in home prices over the Great Recession in the U.S. impacted drinking behavior. We match data on actual and shadow home prices (from Zillow Research) to individuals' drinking behavior from the Behavioral Risk Factor Surveillance System (BRFSS) by county of residence and year/month of the interview. We improve upon the existing literature by using new measures of exogenous macroeconomic shocks captured by fluctuations in home prices and finding heterogeneous impacts of the downturn based on homeownership. We find that decline in home prices is commonly associated with increases in alcohol consumption, both on extensive and intensive margins. Additionally, we find that the effects are more consistent among homeowners compared to renters. Given that alcohol consumption is one of the leading causes of death in the U.S. and that the COVID-19 pandemic has triggered an economic crisis in many societies, the results have important public health implications.

Impacts of the 2008 Great Recession on dietary intake: a systematic review and meta-analysis

Background

The 2008 Great Recession significantly impacted economies and individuals globally, with potential impacts on food systems and dietary intake. We systematically reviewed evidence on the impact of the Great Recession on individuals’ dietary intake globally and whether disadvantaged individuals were disproportionately affected.

Methods

We searched seven databases and relevant grey literature through June 2020. Longitudinal quantitative studies with the 2008 recession as the exposure and any measure of dietary intake (energy intake, dietary quality, and food/macronutrient consumption) as the outcome were eligible for inclusion. Eligibility was independently assessed by two reviewers. The Newcastle Ottawa Scale was used for quality and risk of bias assessment. We undertook a random effects meta-analysis for changes in energy intake. Harvest plots were used to display and summarise study results for other outcomes. The study was registered with PROSPERO (CRD42019135864).

Results

Forty-one studies including 2.6 million people met our inclusion criteria and were heterogenous in both methods and results. Ten studies reported energy intake, 11 dietary quality, 34 food intake, and 13 macronutrient consumption. The Great Recession was associated with a mean reduction of 103.0 cal per adult equivalent per day (95% Confidence Interval: − 132.1, − 73.9) in high-income countries (5 studies) and an increase of 105.5 cal per adult per day (95% Confidence Interval: 72.8, 138.2) in middle-income countries (2 studies) following random effects meta-analysis. We found reductions in fruit and vegetable intake. We also found reductions in intake of fast food, sugary products, and soft drinks. Impacts on macronutrients and dietary quality were inconclusive, though suggestive of a decrease in dietary quality. The Great Recession had greater impacts on dietary intake for disadvantaged individuals.

Conclusions

The 2008 recession was associated with diverse impacts on diets. Calorie intake decreased in high income countries but increased in middle income countries. Fruit and vegetable consumption reduced, especially for more disadvantaged individuals, which may negatively affect health. Fast food, sugary products, and soft drink consumption also decreased which may confer health benefits. Implementing effective policies to mitigate adverse nutritional changes and encourage positive changes during the COVID-19 pandemic and other major economic shocks should be prioritised.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01125-8.

Effects of macroeconomic fluctuations on mental health and psychotropic medicine consumption

Our aim in this paper is to understand the impact of macroeconomic fluctuations on mental health and psychotropic medicine consumption. In order to do that we exploit differences in the fluctuations of business cycle conditions across regional units in Catalonia. Our findings suggest that, in general, economic fluctuations at the local level had no significant effect on the consumption of psychotropic medicines. However, we show that a deterioration in local labour market conditions is associated with a reduction in the consumption of anxiolytics medicines. We also report an increase in the consumption of anxiolytics in regions with a softer deterioration in the economic situation. Although we report mild improvements in both mental and physical health for some sub-groups of the population, we also find significant reductions on the probability of sleeping 6 h or more. Thus, these elements point towards potential negative effects of local labour market conditions on health in the medium/long term.

Association of negative financial shocks during the Great Recession with depressive symptoms and substance use in the USA: the CARDIA study

BACKGROUND

The Great Recession of 2008 was marked by large increases in unemployment and decreases in the household wealth of many Americans. In the 21st century, there have also been increases in depressive symptoms, alcohol use and drug use among some groups in the USA. The objective of this analysis is to evaluate the influence of negative financial shocks incurred during the Great Recession on depressive symptoms, alcohol and drug use.

METHODS

We employed a quasi-experimental fixed-effects design, using data from adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Our financial shock predictors were within-person change in employment status, income and debt to asset ratio between 2005 and 2010. Our outcomes were within-person change in depressive symptoms score, alcohol use and past 30-day drug use.

RESULTS

In adjusted models, we found that becoming unemployed and experiencing a drop in income and were associated with an increase in depressive symptoms. Incurring more debts than assets was also associated with an increase in depressive symptoms and a slight decrease in daily alcohol consumption (mL).

CONCLUSION

Our findings suggest that multiple types of financial shocks incurred during an economic recession negatively influence depressive symptoms among black and white adults in the USA, and highlight the need for future research on how economic recessions are associated with health.

Midlife in the 2020s: Opportunities and challenges

Development is a cumulative, lifelong process, but strikingly little is known about development in midlife. As a consequence, many misconceptions exist about the nature of midlife and the developmental milestones and challenges faced by middle-aged adults. We first review dominant views and empirical research that has debunked false narratives. Next, we discuss major opportunities and challenges of midlife. This includes the unique constellation of roles and life transitions that are distinct from earlier and later life phases as well as shifting trends in mental and physical health and in family composition. We additionally highlight the importance of (historical shifts in) intergenerational dynamics of middle-aged adults with their aging parents, adult children, and grandchildren; financial vulnerabilities that emerge and often accrue from economic failures and labor market volatility; the shrinking social and health care safety net; and the rising costs of raising children. In doing so, we discuss issues of diversity and note similarities and differences in midlife experiences across race or ethnicity, sexual orientation, and socioeconomic status. We consider midlife as a pivotal period that includes a focus on balancing gains and losses, linking earlier and later life periods, and bridging generations. Finally, we propose possibilities for promoting reversibility and resilience with interventions and policy changes. The suggested agenda for future research promises to reconceptualize midlife as a key period of life, with a concerted effort to focus on the diversity of midlife experiences in order to meet the unprecedented challenges and opportunities in the 2020s and beyond. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Ideal Cardiovascular Health Among American Adults After the Economic Recession of 2008-2009: Insights from NHANES

BACKGROUND

The economic recession of 2008-2009 resulted in unprecedented employment and economic losses leading to deterioration of cardiovascular health. We examined the trends in ideal cardiovascular health as measured by the American Heart Association's (AHA's) Life's Simple 7 metric during the periods of economic recession and subsequent economic recovery.

METHODS

Data on adults ages ≥20 years from the NHANES from economic-recession (2007-2010) and post-recession (2011-2016) periods was analyzed. The AHA's Life's Simple 7 score of 10-14 was used to classify ideal cardiovascular health status. Socioeconomic status was divided into 3 categories: high, middle, and low based on education and income status. Multivariable linear and logistic regression models including demographics, insurance status, health care access, and adjustment for multiple testing were used to analyze the trends in prevalence of ideal cardiovascular health across socioeconomic strata.

RESULTS

We observed a decline in the multivariable-adjusted mean cardiovascular health score from 8.18 in 2007-2010 to 7.94 in 2015-2016 (P_linear = 0.02). This was primarily driven by the increasing prevalence of obesity (34% in 2007-2010 vs 41% in 2015-2016, P_linear = 0.005) and poor fasting glucose (8% in 2007-2010 vs 12% in 2015-2016, P_linear = 0.003). In multivariable-adjusted models, we observed the decreasing prevalence of ideal cardiovascular health with a nonlinear trend in the participants in the highest (51% in 2007-2010 vs 42% in 2015-2016, P_quadratic = 0.01) and lowest socioeconomic strata (16% in 2007-2010 vs 13% in 2015-2016, P_quadratic = 0.02). The prevalence of ideal cardiovascular health was higher in participants with high-socioeconomic status compared with other socioeconomic status participants.

CONCLUSIONS

Despite economic recovery, ideal cardiovascular health metrics have not yet recovered. Cardiovascular health appears to be further deteriorating for US adults, particularly those in high- and lower-socioeconomic strata.

How did the 2008-11 financial crisis affect work-related common mental distress? Evidence from 393 workplaces in Great Britain

This paper analyses how the 2008-11 financial crisis relates to work-related common mental distress of those with continuous employment during the crisis. The literature connecting the 2008-11 financial crisis to common mental distress (anti-depressant drug use, suicide, etc.) generally estimates a negative effect. We used a sample of 393 workplaces from the 2011 Work and Employment Relations Study (WERS) for which employers and worker representatives agreed on that the crisis affected the workplace. WERS then provides detailed questions about how the financial crisis affected the workplace. We use these questions to show which crisis-induced work-changes are important for work-related common mental distress. In the British-context, increased workload and changes in nonfinancial benefits of work are most relevant worsening work-related common mental distress by 1.8 and 0.9 on a scale from 0-30 respectively.

The unobserved pattern of material hardship and health among older Americans

This paper investigates the relationship between self-reported health and material hardship among older Americans. Differently from income-based measures, material hardship provides a more specific description of the concrete adversities faced by the elderly. We have used the last six waves of the Health and Retirement Study to explore the relative contributions of state dependence, unobserved heterogeneity and time-specific shocks on reporting poor health, experiencing food insecurity and medication cutbacks. We have used a Latent Markov model to estimate a multivariate non-linear system of equations for panel data allowing time-varying unobserved heterogeneity. Our results reveal a high state dependence of both health and material hardship conditions. Estimated trajectories reveal that pathways of material hardship are associated differently with health. Material hardship is also spread across its dimensions.

The PSID in Research and Policy

The PSID has remained a valuable vehicle for evidence-based policy research for decades and should remain so for many more. In this short review, I cover major policy-related strengths from PSID research in the areas of event history analysis; mobility and volatility; cross national comparisons; health and health insurance; mobility into and out of poverty; the effects of parental income on children; and the use of the child development sample to broaden the PSID policy focus in new and interesting ways. I also include the emerging study of longer term intergenerational patterns of mobility and transfer, including across three generations. Finally, I take up the question of how PSID data and methods could be further improved to make the survey more valuable to public policy, focusing on administrative data linkages.

Education-related disparities in reported physical activity during leisure-time, active transportation, and work among US adults: repeated cross-sectional analysis from the National Health and Nutrition Examination Surveys, 2007 to 2016

BACKGROUND

Understanding socioeconomic disparities in physical activity is important, given its contribution to overall population-wide health and to health disparities. Existing studies examining trends in these disparities have focused exclusively on physical activity during leisure-time and have not investigated the potential moderators of socioeconomic disparities in physical activity. Using self-reported data from the US National Health and Nutrition Examination Survey (NHANES) 2007 to 2016 for 29,039 adults aged 20 years and over we examined education-related disparities in overall (total) moderate-to-vigorous intensity physical activity, and in its sub-components, recreational (leisure-time) and non-recreational (active transportation and work) activity. We also examined if education-related disparities in physical activity were moderated by age, gender, and race/ethnicity.

METHODS

Logistic regression models were used to evaluate disparities in physical activity according to education group and their moderation across age, gender, race/ethnicity, and time-period.

RESULTS

Overall activity levels (% ≥150 min/week) were highest amongst highly educated adults, yet contrasting education-related disparities were found for recreational and non-recreational activities (active transportation and work), favoring the highest- and lowest-educated groups respectively. Within each domain of activity, associations were moderated by age and race/ethnicity, and by gender for work-based activity. The net result was that education-related disparities in total activity were substantially larger in older adults (P < 0.001) and amongst women (P < 0.001). For example, the estimated difference in the probability of being active in the highest versus the lowest educational groups was 23.1% (95% CI: 19.1, 27.2) amongst those aged ≥60 years, yet 10.8% (95% CI: 7.1, 14.6) amongst those aged 20-39.

CONCLUSIONS

Education-related disparities in physical activity persisted from 2007 to 2016. Our results suggest that understanding and addressing these disparities requires assessment of their multiple domains, and identification of the demographic sub-groups for which the disparities are more or less pronounced.

The contribution of differences in adiposity to educational disparities in mortality in the United States

BACKGROUND

There are large differences in life expectancy by educational attainment in the United States. Previous research has found obesity’s contribution to these differences to be small. Those findings may be sensitive to how obesity is estimated.

METHODS

This analysis uses discrete-time logistic regressions with data from the National Health and Nutrition Examination Survey (NHANES), pooled from 1988 to 1994 and 1999 to 2010, to estimate the contribution of differences in adiposity, or body fat, to educational differences in mortality. I show that results depend upon the measure of adiposity used: body mass index (BMI) at the time of survey or lifetime maximum BMI.

RESULTS

College graduates were less likely than high school graduates to be obese at the time of survey (25% vs. 34.6%, respectively) and were also less likely to have ever been obese (35.7% vs. 49.4%, respectively). Lifetime maximum BMI performed better than BMI at the time of survey in predicting mortality using criteria for model selection. Differences in maximum BMI were associated with between 10.3% and 12% of mortality differences between college graduates and all others, compared to between 3.3% and 4.6% for BMI at the time of survey. Among nonsmokers, between 18.4% and 27.6% of mortality differences between college graduates and all others were associated with differences in maximum BMI.

CONTRIBUTION

Adiposity is an overlooked contributor to educational differences in mortality. Previous findings that obesity does not contribute to educational disparities were based on BMI at the time of survey, which is less informative than maximum BMI. The contribution of adiposity to educational mortality differences will likely grow as smoking prevalence declines. Health surveys should collect information on weight history.