Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review

Methodological approaches to measuring mental health in a cost-of-living crisis: A rapid review

BACKGROUND

Cost-of-living crises are damaging to population mental health and require a public health response. It is important to assess whether public health interventions are effective. We aimed to identify population-level methods and measures and the appropriateness of the measures for vulnerable populations.

METHODS

A rapid evidence review was undertaken. Nineteen databases, including grey literature, were searched for evidence published between 1970 and April 2023.

RESULTS

Seven reviews, nine primary studies and two reports from grey literature were identified. Methods consisted of analyses of existing data from national or regional cohort studies, household panel surveys, repeated cross-sectional surveys, routine medical data, or data on suicide death rates. Twelve brief validated mental health measurement tools, embedded in population-level surveys, were identified. Two quasi-experimental studies used data from a UK household panel survey to examine the impact of the introduction of specific welfare policies on mental health. Studies identified socio-economic vulnerabilities, but it was not possible to determine whether data were effectively captured from people from minority ethnic groups.

CONCLUSION

Population-level surveys can be used in quasi-experimental studies to measure the effects of a public health initiative with specific roll out dates to tackle cost-of-living impacts. It is unclear as to whether the identified methods and tools are suitable for use with people from minority ethnic groups.

Using self-reported health as a social determinants of health outcome: a scoping review of reviews

Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure.

Inequities in hospitalisation in a South European country: Lessons learned from the last European recession

In Spain, regional health systems (universal access) depend on each Autonomous Communities (ACs). The management of the 2008 economic crisis has been different in the ACs, which may have led to an increase in inequities in the use of health services. The objective of this study was to analyse the impact of individual and regional characteristics on public hospitalisation inequities in Spain for the period 2003-2017. We developed a repeated cross-sectional study through Spanish National Health Surveys (2003, 2006, 2011 and 2017) and the Spanish European Health Survey (2014; n = 118,499 subjects). Multilevel and Oaxaca decomposition analyses were conducted to analyse the effect of individual and regional factors in hospitalisation inequities. The results showed that the prevalence of hospitalisation was higher for women (2003: 11.2%; 2017: 9.0%) than for men (2003: 10.7%; 2017: 8.8%) and it decreased with time. Multilevel analyses showed that, after adjustment for variables related to healthcare demand, there were inequities in the probability of hospitalisation, mainly in women. The decomposition analyses showed a higher effect of the number of hospital beds available on hospitalisation in men than in women. There is a direct relationship between the number of hospital beds and the probability of hospitalisation in both sexes. In conclusion, a progressive decrease in hospitalisation use was observed in Spain in the context of the economic recession. Individual-level and regional-level factors were associated with hospitalisation inequities. It is necessary to guarantee equitable access to health services according to the need even in recession times.

Effects of the economic recession on suicide mortality in Brazil: interrupted time series analysis

OBJECTIVES

to analyze trends in suicide rates in Brazil in the period before and after the start of the economic recession.

METHODS

interrupted time series research using national suicide data recorded in the period between 2012 and 2017 with socioeconomic subgroups analyses. Quasi-Poisson regression model was employed to analyze trends in seasonally adjusted data.

RESULTS

there was an abrupt increase in the risk of suicide after economic recession in the population with less education (12.5%; RR = 1.125; 95%CI: 1.027; 1.232) and in the South Region (17.7%; 1.044; 1.328). After an abrupt reduction, there was a progressive increase in risk for the black and brown population and for those with higher education. In most other population strata, there was a progressive increase in the risk of suicide.

CONCLUSIONS

the Brazilian economic recession caused different effects on suicide rates, considering social strata, which requires health strategies and policies that are sensitive to the most vulnerable populations.

Efeitos da recessão econômica na mortalidade por suicídio no Brasil: análise com séries temporais interrompidas

RESUMO Objetivos: analisar as tendências nas taxas de suicídio no Brasil, no período antes e depois do início da recessão econômica. Métodos: estudo de séries temporais interrompidas utilizando dados nacionais de suicídio registrados no período entre 2012 e 2017 com análises por subgrupos socioeconômicos. Modelo de regressão quasi-Poisson foi empregado para analisar as tendências dos dados ajustados sazonalmente. Resultados: observou-se aumento abrupto no risco de suicídio após recessão econômica na população com menor escolaridade (12,5%; RR = 1,125; IC95%:1,027; 1,232) e na Região Sul (17,7%; 1,044; 1,328). Após redução abrupta, ocorreu aumento progressivo no risco para a população de pretos e pardos e na de maior escolaridade. Na maioria dos demais estratos populacionais, verificou-se aumento progressivo no risco de suicídio. Conclusões: a recessão econômica brasileira produziu efeitos diferentes nas taxas de suicídio, considerando os estratos sociais, o que demanda estratégias de saúde e políticas sensíveis às populações mais vulneráveis.

Methodological limitations in studies assessing the effects of environmental and socioeconomic variables on the spread of COVID-19: a systematic review

BACKGROUND

While numerous studies have assessed the effects of environmental (meteorological variables and air pollutants) and socioeconomic variables on the spread of the COVID-19 pandemic, many of them, however, have significant methodological limitations and errors that could call their results into question. Our main objective in this paper is to assess the methodological limitations in studies that evaluated the effects of environmental and socioeconomic variables on the spread of COVID-19.

MAIN BODY

We carried out a systematic review by conducting searches in the online databases PubMed, Web of Science and Scopus up to December 31, 2020. We first excluded those studies that did not deal with SAR-CoV-2 or COVID-19, preprints, comments, opinion or purely narrative papers, reviews and systematic literature reviews. Among the eligible full-text articles, we then excluded articles that were purely descriptive and those that did not include any type of regression model. We evaluated the risk of bias in six domains: confounding bias, control for population, control of spatial and/or temporal dependence, control of non-linearities, measurement errors and statistical model. Of the 5631 abstracts initially identified, we were left with 132 studies on which to carry out the qualitative synthesis. Of the 132 eligible studies, we evaluated 63.64% of the studies as high risk of bias, 19.70% as moderate risk of bias and 16.67% as low risk of bias.

CONCLUSIONS

All the studies we have reviewed, to a greater or lesser extent, have methodological limitations. These limitations prevent conclusions being drawn concerning the effects environmental (meteorological and air pollutants) and socioeconomic variables have had on COVID-19 outcomes. However, we dare to argue that the effects of these variables, if they exist, would be indirect, based on their relationship with social contact.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12302-021-00550-7.

[Impact of Great Recession on mental health in Spain. SESPAS Report 2020]

The objective of this article is to identify the effects of the Great Recession on the mental health of people residing in Spain. After presenting a conceptual framework on the mechanisms through which economic crises affect mental health, we describe the main results of 45 papers identified in our search. Studies indicate a worsening of mental health in Spain in the years of economic crisis, especially in men. Working conditions (unemployment, low wages, instability, precariousness) emerge as one of the main channels through which mental health is put at risk or deteriorates. This deterioration occurs with intensity in particularly vulnerable groups, such as immigrant population and families with economic burdens. In the case of suicides, the results were inconclusive. Regarding the use of health care services, an increase in the consumption of certain drugs seems to be identified, although the conclusions of all the studies are not coincidental. Social inequalities in mental health do not seem to have remitted. We conclude that Spain needs to improve information systems to a better understanding of the health effects of economic crises. In terms of public policies, together with the reinforcement of health services aimed at addressing mental health problems, an income guarantee network for people in vulnerable situations should be promoted, as well as the development of policies aimed at the labour market.